'During 70% of my duty days, I had to handle drunk mobs at night': Doctors share their plight in IMA Survey
Karnataka Government Releases Safety Protocol Handbook for Doctors
Kochi: When the entire country is waiting for justice in the rape and murder case of a postgraduate trainee doctor at Kolkata-based RG Kar Medical College and Hospital, doctors participating in a survey of the Indian Medical Association (IMA) made shocking claims regarding their safety conditions at their workplace.
"During 70% of my duty days, I had to handle drunk mobs at night," said a doctor who took part in the survey conducted by IMA Kerala, which will be published in the October 2024 issue of the association's journal.
IMA initiated this survey to evaluate the safety concerns during night shifts among doctors. As per the responses recorded from 3,885 individuals, one-third of these doctors, the majority of them being women, felt "unsafe" or "very unsafe" during their duty hours at night; while 46.5% of these doctors opined that they were "uncertain" about their safety.
"I have felt bad touches many times working in crowded casualty," expressed a doctor who participated in the survey.
Doctors were concerned about their safety conditions so much that some of them even felt the need to start carrying weapons for self-defense. "Provide a gun to all the doctors, and guards of younger age," opined a participating doctor.
Among the 3,885 doctors who participated in the survey, 85% were under 35 years, 61% were interns or postgraduate trainees. Around 20% of the participating senior/junior doctors/faculties are working in Government set up while around 18% of them are employed at Private facilities. The majority of them i.e. 63% of these participating doctors were women, aligning with the gender ratio in some MBBS courses.
Availability of Duty Rooms & Attached Washrooms:
As per the study, the data received from the participants showed that 55.2% of the participating doctors have access to a duty room while 44.8% do not have the same.
"Just one duty room provided for all female PG’s and interns which will eventually become crowded, and we search for some other places to take rest which is unsafe," said one doctor.
Even in the case when doctors have access to a duty room, 31.42% of these doctors expressed that their duty rooms do not have attached washroom facility.
"Among the 2,145 participants with access to a duty room, 67.6% reported having a duty room with an attached washroom/restroom, while 31.4% did not. A small percentage (1.03%) gave invalid responses," revealed the study.
Expressing the need to have access to a safe duty room with a washroom facility, a doctor participating in the survey said, "I do need a place to rest, somewhere with a lock and a place to use as a restroom."
"Anyone can knock on the duty room door. We open without knowing who the person outside is," said another doctor.
Distance of Duty Room from Ward/Casualty:
Even though 67.6% of the participating doctors said that they had access to duty rooms, more than 62% of these doctors revealed that their duty rooms were either "far" (100-1000 metres) or "very far" (more than 1000 metres) from the ward/casualty.
The survey data revealed that 52.9% reported that their duty room was located far away from the ward or casualty area (100-1000 meters). A majority of doctors must walk a significant distance from their duty rooms to reach the ward or casualty area, which can pose a safety risk at night if the path is not well-lit and secure.
"Have worked as a faculty in two private medical colleges. The duty rooms were at the end of a deserted corridor without much light, always felt unsafe and always carried a pepper spray and foldable knife in my bag," said a doctor who participated in the IMA survey.
Another doctor said that they had to go to hostels just to access the washroom during duty hours. "If we need to use the washroom, we need to go to hostels in the middle of the night when it is pitch dark, no security," said the doctor.
Subjective Assessment of Safety:
The subjective assessment of safety during duty hours showed that a significant portion, 24.1%, felt unsafe, and 11.4% considered their situation very unsafe, with a total of 35.5% feeling unsafe to various degrees. On the other hand, 14.1% felt safe and 4% felt it was the safest. 46.5% of respondents reported "Uncertain Safety", reflecting mixed feelings or uncertainty about their safety.
"I am a senior resident at a private hospital where I feel safe while taking night duties; but I did my undergraduate and MD at government hospitals where I would rate the safety feeling at 2 to 3 out of 10," said a doctor.
Women reported higher levels of feeling unsafe or very unsafe (36.7%) compared to men (32.5%). Age also played a role, with younger respondents (20-25 years) feeling less safe compared to older groups. Regarding designation, juniors generally feel less safe compared to seniors. A doctor participating in the survey said, "I am concerned about my female colleagues."
Expressing the level of panic and uncertainty regarding their safety, another doctor said, "If we scream, no one will hear."
Safety Perceptions During Duty Hours:
Recording their responses regarding duty hours at night, Government healthcare workers reported higher levels of insecurity, with 17.05% feeling "Very Unsafe", and 27.4% feeling "Unsafe" totalling 44.5%.
In contrast, only 5.52% and 12.02% of private healthcare workers reported feeling "Very Unsafe" and "Unsafe," respectively, totaling 17.5%. "As I am working in a private setup, things are better," said a doctor.
Adding up, 38.3% felt safe in the private sector, while only 10.6% shared the same sense of safety in the government sector. This section of analysis did not include interns or postgraduate trainee doctors, as they were not subclassified into public or private sector in the survey. "Most unsafe are the rural postings," expressed a participating doctor.
State-wise Responses:
The distribution of statewide responses for the IMA survey revealed that the largest representation comes from Kerala (27.7%) and Karnataka (21.1%). More than a hundred individual responses each came from U.P (4.4%), Andhra Pradesh (7.2%) Maharashtra (9.2%), and Tamil Nadu (11.1%). More than 50 responses each were obtained from Assam, Delhi, Odisha, Puducherry, Punjab, Telangana and West Bengal. More than 25 responses each came from Haryana, Madhya Pradesh, Chhattisgarh, Bihar and Gujarat.
Suggestions:
These 3885 doctors, who participated in the survey, submitted numerous suggestions. While some of them contributed several suggestions, others pointed out one or two key points. While some expressed the need for a duty room with an attached washroom, some of them demanded adequate security personnel and 24x7 CCTV camera monitoring.
Some of the doctors opined that the Central Protection Act (CPA) and its implementation could help deal with security issues at the workplace of doctors. "Providing security alone is not enough, need law which punishes culprits," said a participating doctor.
"OPD’s should have a double door system. One for entry and one for escaping violent attacks from patients or bystanders," said another doctor.
The IMA survey ranked the following suggestions according to the frequency of keyword use:
1. Duty room with bathroom, close to work location
2. Adequate number of professional security personnel
3. CCTV camera 24/7 to monitor key areas
4. CPA Central Protection Act, and its enforcement
5. Secure locks/bolts on all duty room doors
6. Restrict the number of bystanders/attendants with each patient
7. Adequate lighting to be ensured 8. Panic button/alarm system/code grey in case of emergency
9. Food and water to be made available nearby during night duty
10. Do not allow drunk bystanders in casualty
Medical Dialogues had earlier reported that taking suo motu cognisance of the rape and murder of the PG doctor at Kolkata, the Supreme Court recently constituted a National Task Force (NTF).
This 15-member NTF, comprising nine senior doctors and five ex-officio government officials, was directed to prepare an action plan to prevent violence against medical professionals and provide safe working conditions for them.
The apex court had asked the NTF to formulate an action plan under two sub-heads — ‘Preventing violence, including gender-based violence, against medical professionals and providing safe working conditions’, and ‘Prevention of sexual violence against medical professionals’.
