35% doctors in India feel unsafe while at work, study shows

Violence against healthcare workers flourishes due to multiple risk factors coming together — overcrowding, understaffing, sparse security measures, perceived or real inadequacy of care, communication lapses, and the presence of individuals under the influence of alcohol

In a tragic incident at a government hospital in Chennai on November 13, 2024, a doctor was repeatedly stabbed while performing his duties. This follows the brutal rape-murder of a young doctor in Kolkata just three months prior, underscoring a troubling and persistent issue: workplace violence against healthcare professionals.

Doctors across India have reported workplace violence as a growing threat. A 2017 study undertaken by the Indian Medical Association found that over 75% of doctors across India had experienced workplace violence, while nearly 63% were unable to see patients without any fear of violence. Another study found that nearly 70% of doctors encountered violence while at work. Verbal abuse and physical confrontations from bystanders are frequent, yet only a fraction of incidents are formally reported.

Our team at IMA Kerala State conducted a survey in August 2024 involving 3,885 doctors across India — the largest of its kind — which highlighted significant gaps in safety measures. Participants shared their experiences regarding security, adequacy of duty rooms, night duty risks, and offered solutions. Over 60% of respondents were women, many of whom reported facing physical and verbal abuse while at work. On the safety scale, 11% rated their workplace as very unsafe, while 24% expressed feeling unsafe overall. The study was conducted by the Indian Medical Association and published in the October issue of the Kerala Medical Journal.

Systemic problem

Workplace violence in healthcare is often a sign of deeper systemic problems. Violence flourishes where multiple risk factors come together, the survey found. These include overcrowding, understaffing, sparse security measures, perceived or real inadequacy of care, communication lapses, mounting expenses, absence of grievance redressal mechanisms and the presence of individuals under the influence of alcohol or drugs. In some hospitals, inexperienced doctors are posted alone in high-risk areas like casualty and ICU during night shifts, which can be a daunting task without senior backup on-site.

Alarming reality

Our survey exposed another alarming reality: less than half of the doctors on night duty had access to a duty room during night shifts, and of those, only a third had an attached restroom. Also, when available, 53% of the duty rooms were located far away (100 to 1,000 metres) and 9% were located at distances over 1,000 metres from the wards or casualty area. The lack of basic amenities closer to wards forces doctors to walk through isolated corridors and across poorly lit grounds. When duty rooms were unavailable or inadequate, for instance when the doors lacked locks, doctors were forced to find alternative resting places at night, the survey found. Women doctors admitted to sleeping on empty ward beds, potentially exposing them to patient bystanders staying overnight on-site. A doctor reported carrying a foldable knife and pepper spray in her handbag due to safety concerns. Security was frequently described as either absent or inadequate. Several younger doctors expressed frustration over administrators ignoring their safety concerns.

Responding to the survey, doctors reported instances when they were surrounded by crowds while attending to road accident victims or performing procedures in the casualty area. Emergency rooms, particularly at night, are often visited by drunk and disruptive individuals, leading to verbal and physical altercations. Doctors hesitate to report these incidents due to heavy workloads and social or administrative pressure, allowing the cycle of violence to continue.

Corrective measures

The study suggested that adoption of simple measures with minimal investment can reduce violent incidents in healthcare facilities. For instance, crowd control and triage can reduce violent incidents. Allowing unlimited numbers of bystanders in patient-care areas creates an environment prone to conflict. Enforcing strict visitor policies to prevent groups from congregating around patients and distracting or intimidating medical staff will also go a long way in reducing violent incidents. This would allow healthcare workers to focus on their patients without interference.

Legislation alone may be insufficient in the absence of effective enforcement and comprehensive on-the-ground safety measures. For instance, Kerala enacted a hospital protection law in 2012, updated in 2023. However, the problem persists. The tragic murder of the young Dr Vandana Das in 2023 in Kollam, Kerala highlights the limitations of legislation alone.

Professional organisations like the Indian Medical Association (IMA) have been providing communication and soft skills training for doctors, including guidance on how to break bad news. But even the best-trained professionals cannot work effectively in overcrowded, under-resourced settings. The rising violence in healthcare settings demands immediate and decisive action from hospital administrators and policymakers to tackle the underlying causes. Waiting for further proof of the problem serves no purpose.

(Rajeev Jayadevan is Chairman, Research Cell, Kerala State IMA and the first author of the study)

Published - November 16, 2024 09:00 pm IST