Doctors Speak: In Conversation With An Emergency Medicine Specialist

In view of the recent violence against doctors in West Bengal, and the aftermath of doctors’ strikes, we interviewed Dr Vimal, the Principal Secretary of The Emergency Medicine Association of India.

MTTNThe situation in West Bengal has garnered national attention and outrage from the medical community, prompting nationwide strikes. Earlier you would hear about the occasional attack on doctors from the press, but the situation never escalated to quite this level, with so many people coming out to protest. Why this particular event, was this just the straw that broke the camel’s back?

Dr Vimal – I think the media hasn’t been very fruitful with the fact that these issues began at a sporadic level, there being multiple instances in various pockets all over the country. The sad fact is that there is no legislation in India that focuses on protection of health care workers, not just doctors for that matter. With the current situation, I think we have reached a tipping point, where everyone has been forced to sit up and take notice and to understand that a problem exists. Only when you identify that there is a problem will you search for the solution, and that’s what’s happening right now.

MTTNSpeaking of the media, it seems that the mainstream press is very anti-doctor, with articles and news segments focussing mainly on how the doctors’ strike has led to the common people being inconvenienced, and very little sympathy towards the doctors themselves; is there a particular cause that invited this apathy?

Dr Vimal – I think there are multiple confounders that have led to this, not just the healthcare system in India, it is also the bureaucracy, the administrators.  There is a lot of desynchrony between the people working upstairs, and the people working downstairs. By upstairs, I mean the politicians, or the policymakers of the country, having a discordant outlook with the grassroots worker – the healthcare provider working in the hospitals. The media is portraying doctors as if they are bound to serve the community, but also talk of healthcare as an industry,  turning it instead into a 9 to 5 job, that is where the problem is, when you look at it is an industry, and at the same time want to preserve the ethics, the humanity of the job. There has been a lot of digression from the essence of the healthcare profession. Coming back to your question, I think the whole system is responsible for this apathy. This system, including the media, the policymaker, the layperson, and the health care professionals; it’s a collective thing. We cannot point fingers at a particular group for being responsible for this. 

MTTNAs an Emergency Medicine doctor, you would have definitely encountered panicked patients and relatives with their emotions running high. What can be done to prepare medical students for this situation?

Dr Vimal – I think with regards to the medical system, we should introspect about what has been happening within our country for the past 60 years. The medical council of India has taken a great step by revising the whole medical curriculum, starting from the early phase in a young doctor’s career, grooming them into being a good doctor, which encompasses not just the knowledge part, but the attitude and skills part too. Earlier, there was a lot of focus on the knowledge and skills part, but not so much on the attitude. With regards to developing soft skills and communication skills, I think AETCOM is a wonderful program, at the UG level. When you start with the basics of talking to people, understanding their part, having empathy and not sympathy, it makes a big difference. I think we’re slowly but surely heading into that direction.

Another aspect would be, any patient who comes to you is at their most vulnerable. I don’t think any healthcare professional would refrain from providing them care, they would always want to help, but are we thinking about the condition of the healthcare worker? Burnout is becoming a big term now in medicine. How are we addressing burnout, the long hours, the lifestyle they have? I think it’s high time that we sit back and reflect, about life from the patient’s as well as the healthcare provider’s perspective; how is the doctor, how is the nurse doing, are they getting enough time off, are they doing things mechanically, which makes it impossible to be empathetic. If you look after them, if you nurture them, it makes a big difference to the care that they provide, and translates to increased empathy and a better outcome at the end of the day.

MTTNOur country seems to be lacking in a system dedicated specifically to Emergency Medicine, with the speciality just emerging in India, is that a factor responsible for the increased stress, especially on junior doctors, and would promoting Emergency Medicine programs help combat the situation?

Dr Vimal – I would say yes, Emergency Medicine would make a difference, though coming from the horse’s mouth, as an EM doctor myself, the reader may think me biased; but let’s put it this way : you’re wheeling your loved one into a hospital, at their most vulnerable state, do you want them to be attended to by someone not specifically trained for it? If you’re not trained for it, don’t have the knowledge or aptitude for it, you will not be able to provide the best of acute care. As you said, Emergency Medicine is a very young speciality in India; even in the world, in the west, it’s around 50 odd years old, in India it’s been here for just a decade.

If you have people trained for it in a residency based system, standardised by the government, it would make a huge difference [1]. Looking at all the institutes in India with EM programs, the number of such incidents happening there is pretty low when compared to institutes that lack these programs.

MTTNAn ongoing study states that almost 50 percent of the cases of violence occur against first responders, or Emergency Medicine specialists, does this statement hold up in your practice as well? What can be done to counter this?

Dr Vimal – This statement might be somewhat skewed. Unlike the west, we do not have a paramedic-based system. We do act as first responders, but we cannot extrapolate from the fact that these situations will always occur with the person providing acute care services. They could happen with anyone, though they may be concentrated a bit on acute care providers because tempers are flare easily in intense situations, and the training for provision of acute care in our country is just taking off.

In India, things happen due to a precipitant. The first EM residency program happened due to the Gujarat earthquakes. The apex trauma centre formed after the assassination of a prime minister, and the chaotic management of that assassination. I do not think we should wait for a precipitant. We should understand our vulnerable spots, perhaps by doing what we call an HVA – Hazard Vulnerability Analysis, and work towards a solution as early as possible. We’re not looking down a dark tunnel, we’re looking down a tunnel with light at the end, a future with people better equipped to handle all sorts of challenges that are thrown their way. Yes, with better medical facilities, but the most pivotal step is at a policy level with proper legislation that looks into the issue without cutting corners.

MTTNIn regards to the ongoing protest, how do you feel about it? How will it impact medical students and young doctors?

Dr Vimal – I think the expectations and logistics are grossly different. The expectations from the general public are that we can’t move away from caring for them, so when we say that we are cancelling all elective services, it doesn’t appear fair to them. I do condemn the situation, but I don’t believe that violence is the solution to it. We’re living in an era where Che Guevara is in vogue, but Gandhi is more necessary, in that we need to be together and have a non-cooperation movement for the policymakers to take notice.

Coming to your question, from a student’s perspective, how do you tackle this? I think as students right now you see chaos. It is the need of the hour for the policymakers to take notice of the situation, and the administrators to understand that we are a unit, a family, not just doctors, and need to be cared for too. No sort of violence against any healthcare professional, any human being for that matter, is tolerable. If they form an act, or a legislation is passed, this would be a mark in history for our country. We would have achieved, with unity and grace, a palpable outcome and not an amorphous conclusion. This would be a learning point for young people, who could mitigate further such scenarios earlier. Understand there is power in unity and harmoniously working with everyone in society, including bureaucrats and politicians, and there’s a lot of power in the hands of the individual who’s providing the best care they are capable of to their patient; and at the end of the day, look after and take care of yourself, another aspect that needs to be looked into[2], with regards to the number of suicides that are happening with doctors, and the lifestyle diseases affecting the healthcare community as a whole. I think it’s high time we sit down, introspect and take a call on how we’re going to move further because I think you guys are going to become the beacons of tomorrow, for the people to look up to. This happened today, so we’re going to be better tomorrow.

Citations –

[1] Chauhan V, Galwankar S, Kumar R, Raina SK, Aggarwal P, Agrawal N, Krishnan S V, Bhoi S, Kalra O P, Soans ST, Aggarwal V, Kubendra M, Bijayraj R, Datta S, Srivastava R P. The 2017 Academic College of Emergency Experts and Academy of Family Physicians of India position statement on preventing violence against health – care workers and vandalization of health – care facilities in India. Int J Crit Illn Inj Sci [serial online] 2017 [cited 2019 Jun 17];7:79-83. Available from: http://www.ijciis.org/text.asp?2017/7/2/79/207746

[2] Grundmann N, Yohannes Y, Silverberg M, Balakrishnan JM, Krishnan S V, Arquilla B. Workplace violence in the emergency department in India and the United States. Int J Acad Med [serial online] 2017 [cited 2019 Jun 17];3:248-55. Available from: http://www.ijam-web.org/text.asp?2017/3/2/248/222476

-As interviewed by Vagisha Dahiya

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