The cob-web of disease, doctors, patients, relatives, community, and violence


The term ‘de-escalation technique’ is often used in emergency and psychiatry settings for the management of violent patients. The term helps clinicians to understand the underpinning philosophy of aggression and its management. These methods work effectively in a tertiary setup due to presence of efficient security staffs and trained health providers. In an ideal emergency setting, when a patient becomes aggressive and abusive ,the team of security officers are called to help health providers for further management. Unfortunately, the current violence against health providers in India shows a sickening trend of collective vandalism which includes hundreds of people. Would any health researcher, throughout the world, be able to explain the beating of a medical college intern by a mob of more than 200? Well, the magnitude of the problem can be defined as ‘medical negligence’ (a term which has been a consistent cacophony of the national media after the case was telecast).

Usually, textbooks from the Western world state the treatment protocol involves a triangle, consisting of the doctor, patient, and the disease. But in a collective society, treatment resembles a cobweb: a doctor, a patient, illness, and a mob consisting of the patient’s relatives, friends, village, suburb. Ironically, no Western textbook or research paper has yet tried to show the interrelationship of the health sector and the anger of the crowd, which is directly proportionate to the vandalism in the community.

Undoubtedly, health providers in metro pockets need to introspect the burden of the patients they are carrying while assessing the resources. The vast patient influx in a government setup is nothing new for health providers. However, there should be a reasonable ratio for a medical unit to see a patient in a day. The inbuilt problem of medicine units is accommodating hundreds of patients in a day—without the support of a manager who can assign appointment systems or case managers who can take care of the patient during the treatment process.

Moreover, the junior staff of health sciences often mistakenly takes up the role of a manager, which he or she is not trained for, and becomes overburdened with the unnecessary pressure of work.

The health providers need to understand a core concept; if one cannot cater efficiently, then there is no need to create a crowd outside OPD and emergency. Here, it is significant to emphasise that the group that stands outside are the people who come with the hope that all of them will be seen in justified time. Waiting to see a patient for approximately two hours and then talking for 5–10 minutes could frustrate anyone.

To top it all, hooligans and antisocial elements are in the perfect environment to show their destructive power. The agenda is clear for vandals: abuse and beatings with approval of a crowd result in nothing less than feeling like Robin Hood for a day. Unfortunately, the medical fraternity cannot do much to curb these antisocial elements without the support of law enforcement agencies and the people within society. However, health providers can do a lot to improve their surroundings by reducing the number of visitors present at any time in the hospital grounds. 

Perhaps an efficient call centre where patients could book their appointments, online or the provision of a standardised triage system, would help to address these issues. Together with these ideas, an effective security system could help to reduce the amount of aggression that is being shown towards the medical staff.

Overall, violence against health providers is an unacceptable phenomenon that is rampant in India nowadays. The prevention of such antisocial activities is the need of the hour and requires understanding and effort from both sides. For better outcomes in the health sector of India, the patients should be cared for ethically, and health providers should be treated at least as humanely.


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