Siddhartha Yadav: Sue me, please

I have just read a BMJ news story about doctors being beaten up in Nepal for the death of a patient. While this may seem to be quite shocking for the western society, it is an everyday reality for us, medicos, living and practising in Nepal.

Over the past five years such incidents have been occurring at regular intervals. As rightly mentioned in the article, high expectation from a doctor is one of the prime reasons for violent behaviour on the part of relatives of a patient. Doctors are seen as god in the Nepalese society. The popular belief is that they can treat and cure any condition. Hence, nothing can and should go wrong after a patient is brought to a hospital. And if it does, it is because the doctor did not try hard enough. And with this thought comes anger which leads to violence.

But this is not the only reason. If it was, such incidents should have been more common a decade ago when the “god-doctor” interplay was more readily believed and relied upon. The overall administrative and political scenario- the sense of lawlessness- deserves blame. I am not a political analyst but ask a common Nepali and he or she will tell you that with the recent political change in the country, people like to assert themselves through physical force rather than go through the legal method. It is not just the medical sector but such acts of violence are prevalent in every field. Entrepreneurs get beaten up by workers; roads get blocked for days for a small accident; issues that could be solved by legal methods amicably turn violent more often. Nobody has the patience to wait for legal methods anymore. Everybody wants on the spot decisions. And through force and violence you get noticed in Nepal.

What has added to this is that, in the past, many private medical care facilities handed over huge amounts of compensation readily whenever relatives got violent over the death of their patient in the facility. Perhaps they did it out of fear to protect their infrastructure, or to hide their own incompetence. Whatever may be their reasons, it has led to a common notion that if the relatives respond violently to the death of their loved ones, they might receive financial compensation. And believe me, money can be a strong motivating factor in a poor country like Nepal.

The problems as it seems from the above discussions are many but the proposed outlet solution is simple: the legal way; and this is what the Nepal Medical Association is demanding. If a patient or his/her relative feels that negligence has occurred, they should complain about it to appropriate authorities, even sue the doctor and hospital and not resort to violence. If the doctor is found guilty, he or she should provide appropriate compensation and undergo legal action. With the consumer protection act already in place, this is not a big deal at all. But if a patient, relative of a patient or anybody for that matter resorts to beating up doctors, then such a person too should take legal action. So far neither of this has happened. Doctors get away with negligence and patients and relatives with violence against doctors. The legal way is the road less walked upon.

Finally, it is a pity that doctors have to resort to protests, go on strikes, even shutdown hospitals to do what the government should be doing: to remind everyone of their duty to follow the law. And it is a bit funny too that they are going through all of this to say, ‘sue me, please’. A mockery of our government and system, indeed.

Siddhartha Yadav is a medical student in Nepal and former BMJ Clegg Scholar.

  • Dr.N.P.Viswanathan

    Such incidence is happening in India also.
    Doctors must think of giving good service to patients.
    They must be good in communication skills.Money should not be the only criteria

  • Matiram Pun

    Dear Siddhartha,

    Thank you very much for bringing out this issue here in the blog with subtle analysis.

    The trend in the recent years have gone really high. The patients and their relatives in the peripheral hospitals have been more of demanding. They ask for the guarantee of the cure and manhandling! The consultants in the private hospitals have been very cautious too. They are very cautious to approach if there is any chance of risk. One of the Teaching Hospitals in Kathmandu had sincere request to me when I was in duty in the emergency department of my hospital. We didn’t have bed in our hospital but patient needed admission so we referred to other centers. The patient relatives asked about the bed status in another teaching hospital but the doctor who received from other end asked to talk to me. The doctor on duty asked me to counsel the patient and patient party very well about the condition, outcome and management! He told me very sincerely that patient and patient parties are demanding, reluctant and they even get more suspicious in the private hospitals. So what he wanted me to counsel very well so that they wouldn’t give any problem them later!!!

    Due to all that the tertiary care centers and government centers are getting more and more as well as unnecessary referrals!!!

    Yes counseling part is very important.

    As Siddartha talked about politics is to blame partly and more importantly media!!! They have always been not only sympathetic to the patient side but also biased. Even more dangerous is that there are no professional health reporters. Therefore, the reports and news have often been twisted and misinterpreted.

    The reason behind all these is, to some extent, due Doctors high profile status and good earning in the society. Many believe doctors charge excessively and the doctors job is the easiest one.

    It will take time to change.

    Best wishes,

  • Amrit

    i appreciate siddhartha for bringing out this important issue. very good analysis and extremely well written. what i would like to add is that proper counselling of patient party beforehand can avoid many of such situations. we spend very little time with patients and their relatives to explain what is going on. This causes false expectations, which lead to beatings when the unexpected happens.

  • Siddhartha,

    I wonder how the disgruntled patients could get the mistaken impression that a westernized orthodox practitioner is God?

    We who reside in a western nation know how that happens. We labor under a cult of experts.If you think really hard about the matter, I am sure you will arrive at the correct answer.

  • Ron Thomas Varghese

    A well written article that brings to light the situation in developing countries.
    The doctors working in the government hospitals in my country India,are doing so under stressful conditions.Although the anxiety of the bystanders who bring the patients to hospitals often from far off places has to be understood,we have to bring out the fact that it gives them no right to manhandle us.More than the anxiety ,I do think that it is the concept that only physical violence can get things done,which makes these people do such heinous atrocities.This trend has to be discouraged ,and strict punishment has to be enforced on those who engage in such unruly behaviour.
    Recently the medical students in my state of Kerala had to go on strike demanding protection for those working in hospitals following manhandling of a doctor by a group of people in the hospital.States like Andhra Pradesh have brought out legislation’s that have made physical violence to a doctor on duty a non bailable offense.Only such stringent laws can serve as a deterrent to such hooligans.
    We must understand that strikes by doctors ,do create problems for the general public and should be used only as the last resort.
    Negetive media campaigning also needs to be tackled by making the media and public understand the primitive and deplorable working conditions at government hospitals in the country.The unnecessary intervention by the political parties and leaders into the most trivial of issues just to get media attention also needs to be addressed.
    On our part we need to look into what has made this profession which was once considered a divine one so bad these days ,in the eyes of the public.Is it the crass commercialization and the mad rush after money ,by doctors themselves that is to be blamed.If so it is time for retrospection.

  • Ron Thomas Varghese

    last word of above blog- “introspection”.Regret the mistake

  • Siddhartha Yadav

    Thank you everyone for your comments. Yes, I think that we need to improve our communication skills and be more service oriented as opposed to money-oriented to decrease such incidents. I also agree that biased media is partly to blame. And it is good to know that many Indian states have strict legislations against such activities. I am sure they can serve as a model for Nepal and other Indian states to follow.

    Hoping to interact with you on such issues in future too.

  • Atul Karki

    Dear Siddhartha.
    congratulaions on a well written blog .
    The case of Doctors being manhanlded in Nepal has gone up in the recent years .
    we can assume that for a country that has just come out of a decade of war may be the people are a agitated lot .
    but we can also say that with some of the Private Hospitals manipulating people for their vested interest and the government hospitals remaining understaffed and lacking several important facilities people are bound to feel harassed ,wronged
    it is not to say that their actions are justified .people need to understand that some of the procedures that work well in majority of the people can have adverse outcomes in some people and also idisyncronitic reactions has nothing to do with the competency of a doctor .
    most of the people who create trouble act in wake of death of someone or some unseen incident and as such case the need for patient counselling which is still in nascent stage of practice in this country can`t be overstated .having said that counselling in a overcrowded ER as ours has its own limitations .
    I still remember the image last year in Kanti Chidren Hospital ,both the medicos and the Patient parties having a go a each other .it was a very disturbing image for whole of the medical profession.
    I beleive that there is need to address this issue and People must understand that such act of vandalism considerably decreases the risk taking behaviour of a doctor and that simply manhandling a doctor nothing will be gained .Also we need to make the strict rules regarding the issue and formulate certain Protocols about when handling critical patients
    Certainly with efforts from both sides i beleive that the lost image of the avuncular doctor or “God” as was the common notion will be restored again.