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Every year, 1 July is observed as National Doctors’ Day in India to express gratitude and acknowledge the dedication and commitment of doctors towards our society. The observance honours legendary physician and West Bengal’s second chief minister Dr Bidhan Chandra Roy, whose birth and death anniversaries coincide on this date. As a practising neonatologist, I am deeply concerned about two issues affecting the medical fraternity: physician burnout and violence against doctors.

I have always sought an answer to the question of why doctors are held especially answerable to society. Any adversity that relates to health routinely gets blamed on the medical community’s alleged negligence. Why? Specific cases of negligence may exist, but is this not true of professionals who work for, say, the judiciary, administration and banking sector? As a result of the covid pandemic, doctors, nurses, care givers and paramedics are facing an unprecedented workload in overstretched health facilities.

With mounting deaths, long hours, low pay, lack of resources and the risk of contracting covid, India’s healthcare workers also face a mental health crisis of their own. No sleep and irregular meals for extended periods without adequate protection add to the stress caused by the fear of infecting loved ones back at home, not to speak of the risk of dying, even as one bears the trauma of losing patients no matter what you do. Rough treatment by hospital administrators and the fear of being fired are also part of these day-to-day realities.

Large numbers of junior doctors have been left in a limbo, unable to qualify as doctors but expected to work as such, raising their chances of suffering a burnout even before they start their career. Physician burnout costs the US healthcare industry an estimated $4.6 billion a year, a pre-pandemic number that’s thought to have doubled after covid. No such estimates are available for India. While burnout is increasingly being recognized globally as a major concern, the pandemic’s closing of borders and strict city as well as area-wise lockdowns have affected healthcare workers and their families just as much, causing negative psychological effects. It is important to recognize burnout at the earliest and use preventive strategies for the phenomenon. Healthcare workers have also lost loved ones to covid. There are times when people blame doctors for their loss. However, few seem to consider the stress that doctors are under as they fight new strains of the virus.

India needs clear-cut guidelines for burnout management. Personal interventions, such as meditation, the use of cognitive-behavioural techniques and the development of better inter-personal and work-related skills could help doctors at an individual level. But the appreciation of others for their work also goes a long way and must not be overlooked. In addition, various interventions at the organizational level, such as a regular interface with physicians, should be planned. We also require a national study on the mental state of medical workers in the country.

The violence that doctors often face is unpardonable. Such violence is not new, but has grown to epidemic proportions in recent times.Recently, an on-duty doctor was attacked by a policeman in Kerala. Doctors serving in covid wards have been brutally assaulted in Bihar, West Bengal, Assam, Uttar Pradesh and Karnataka. A few weeks ago, a paediatrician was attacked in Tarikere and an intensive care physician was attacked at a private hospital in Bengaluru.

Over 80% of India’s doctors are stressed and 75% deal with abuse and assault, as per an Indian Medical Association report.

What may seem like impulsive outbursts of violence by patients or their attendants actually reflects the country’s chronic neglect of public health. Meagre state spending on healthcare and the rising cost of treatment have created much dissonance among people. Private health services meet nearly 80% of our needs, and can be costly for most.

Healthcare in India is complicated. We need a strong medical model. Hospitals need to raise capacity, achieve global standards and ensure that enough doctors and para-medical staff are employed. Government policies must focus on increased spending on healthcare and improving hospital infrastructure, while violence should be punishable under appropriately stiffened laws. Australia saw a spike in violence against healthcare workers in the late 1990s and early 2000s. In response, its government made such acts punishable with 12 years of jail. Such violence virtually vanished. Stricter laws and their enforcement could safeguard health professionals in India too. All institutions should also have standard operating procedures to tackle cases of violence.

Patients need to be educated that doctors practise medicine as best they can and cannot be held responsible for every death. Our people also need to realize that costs can rise with more advanced forms of treatment. Medical schools should have modules on patient-doctor relations in their curricula. All communication needs to be characterized by mutual empathy. Doctors in training need to be taught how to handle potentially violent situations with tact. Without an overhaul of our healthcare system and the political will to protect health workers, doctors may be too overwrought to do their jobs well. This would be a disaster that compounds our covid crisis. It could even make a third wave worse than the second.

Kishore Kumar is founder-chairman and neonatologist, Cloudnine Group of Hospitals, Bengaluru, and a healthcare delivery graduate from Harvard Business School.

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