New Delhi: One third of doctors felt unsafe during night shifts in both government and private hospitals while duty room was not available to a whopping 45 percent of medical professionals, according to a survey done by the Indian Medical Association (IMA).
The survey comes in the backdrop of nationwide protests and a service shutdown by doctors’ organisations demanding improved workplace safety following the rape-murder of a 31-year-old trainee doctor during night duty at Kolkata’s R.G.Kar Hospital.
Conducted by the IMA’s Kerala unit this month, the survey evaluated responses by 3,885 doctors—both from public and private health facilities—from 22 states and Union Territories. Nearly 80 percent of those surveyed were junior doctors, who are mostly on night duties in both government and private hospitals.
ThePrint has a copy of the survey report, which has been accepted for publication in the IMA’s Kerala Medical Journal in October.
The report mentions that 24.1 percent of doctors reported feeling ‘unsafe’ and another 11.4 percent ‘very unsafe’, totalling one-third of the respondents. The proportion of those feeling unsafe was higher among women, it adds.
Also, a duty room was not available to 45 percent of respondents during night shifts, while those with access to a duty room had a greater sense of safety. Duty rooms were often inadequate due to overcrowding, lack of privacy and missing locks, forcing doctors to find alternative rest areas.
“Doctors across the country, particularly women, report feeling unsafe during night shifts. There is substantial scope for improving security personnel and equipment in healthcare settings. Modifications to infrastructure are essential to ensure safe, clean, and accessible duty rooms, bathrooms, food, and drinking water,” the report says.
It adds that adequate staffing, effective triaging (sorting of and allocation of treatment to patients), and crowd control in patient care areas are necessary to ensure that doctors can provide the required attention to each patient without feeling threatened by their work environment.
“Each individual healthcare establishment must take up the responsibility of providing a safe, comfortable and secure working environment for doctors and other staff,” Dr Rajeev Jayadevan, chairman, research cell, Kerala IMA and lead author of the report, told ThePrint.
“They can do this by providing safe and secure duty rooms, adequately trained professional security according to the size of the institution, reducing the number of bystanders, preventing drunk bystanders from entering casualty (ward), introducing triaging, thus letting the doctors see the patients in peaceful conditions where they can focus rather than being in the centre of a crowd.”
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Glaring gaps
Among those surveyed, 85 percent of doctors were under 35 years, 61 percent were interns or postgraduate trainees and women constituted 63 percent, aligning with the gender ratio in some MBBS courses.
The respondents were asked to share their rating on 0-10 scale of perception of safety, availability of duty room, and access to bathroom while on night duty.
The results show that duty rooms were often inadequate due to overcrowding, lack of privacy and missing locks, forcing doctors to find alternative rest areas; one-third of available duty rooms did not have an attached bathroom.
In 53 percent cases, the duty room was located far from the ward or casualty area.
The report notes healthcare professionals are required to take night shifts as part of their training during internships and postgraduate studies, and adds that they continue to work night duties in both private and public sectors throughout their careers.
This aspect, it adds, makes them vulnerable to various forms of workplace violence.
As for workplace violence, a 2017 study by the IMA found that over 75 percent of doctors in India have experienced workplace violence, while 62.8 percent are unable to see their patients without any fear of violence
Another study, as per the new report, reported that 69.5 percent of resident doctors encounter violence while at work. Exposure to violence is known to lead to fear, anxiety, depression, and post-traumatic stress disorder among doctors, it adds.
The new report says that women doctors report higher levels of feeling ‘unsafe’ or ‘very unsafe’ 36.7 percent compared to men at 32.5 percent.
Importantly, government healthcare workers reported higher levels of insecurity, with 17.05 percent feeling ‘very unsafe’ and 27.4 percent feeling ‘unsafe’, totalling 44.5 percent. In contrast, only 5.52 percent and 12.02 percent of private healthcare workers reported feeling ‘very unsafe’ and ‘unsafe’, totalling 17.5 percent.
Similarly, a larger percentage of private healthcare workers felt ‘safe’ 28.04 percent compared to those in government institutions at 8.71 percent. Additionally, 10.22 percent of private healthcare workers felt ‘safest’, whereas only 1.89 percent of government workers shared this level of confidence in their safety.
Overall, 38.3 percent felt safe in the private sector, while only 10.6 percent shared the same sense of safety in the government sector.
Suggested measures
Noting that inadequate security at hospital premises was reported by a large number of doctors, the report says that hospitals often employ low-wage security personnel to reduce costs.
Many surveyed participants highlighted that the available security personnel were weak and frail individuals who themselves seemed to need protection and were the first to run away at the first sign of trouble.
“Doctors have expressed a preference for ex-servicemen as security guards, and able-bodied men in their 30s to 40s as bouncers in high-risk areas such as casualty and ICU lobby where skirmishes are common,” it notes.
The survey adds that some women doctors indicated the need for female security personnel, while also suggesting a police check post in the hospital campuses.
“Healthcare violence is a condition that has many contributory reasons—and each one of them has to be addressed systematically for any meaningful change to occur in future,” Jayadevan pointed out.
The percentage of women choosing MBBS as a medical career is increasing and in states like Kerala, it has crossed 67 percent, he said.
“Providing safe conditions for women who do night shifts at work is a priority, whether they are doctors or other professionals,” Jayadevan maintained.
The Union health ministry, following the constitution of a national task force under instruction of the Supreme Court to suggest long-term and short-term measures for enhancing security in hospitals, has this week written to states recommending several steps.
These include display of state laws for healthcare workers’ protection and relevant sections of the Bharatiya Nyaya Sanhita along with punitive or penalty details in conspicuous places, constitution of ‘Hospital security committee’ and ‘Violence prevention committee’ involving senior doctors and administrative officers.
It has also asked states to regulate access for general public and patient relatives to key areas of the hospital and follow strict visitor pass policy for patient attendants, apart from making provision for safe movement of resident doctors and nurses within different blocks and hostel buildings and other areas of the hospital during night duties.
Ensuring proper lighting inside all areas of residential block, hostel blocks and other hospital premises, routine security patrolling in all the hospital premises during night time and setting up of 24X7 manned security control room in the hospitals are some other instructions given by the Centre to states.
(Edited by Tony Rai)
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