Patient satisfaction, patient safety and increasing violence against healthcare professionals

Increasing commercialization and corruption coupled with wide spread unethical practices by the medical profession has lead to increased violence against the healthcare professionals which has highlighted the importance of patients satisfaction and patient safety. A study by Hongzing Yu et al.1 being published in this issue from China has also highlighted numerous cases of violence against healthcare professionals leading to death of some doctors as well as nurses by patient’s relatives. The reasons for this violence according to the authors are poor quality of services, increased awareness of patients about their rights and their willingness to knock the doors of courts to seek justice. They have further reported that more than one million cases of violence against healthcare professionals are reported every year in China.2 Negative media reports about hospitals and doctors, out of pocket medical expenditures by the patients and lack of trust in doctors and hospitals have been reported to be some of the causative factors.3-5 Medical malpractice claims in courts in China is also reported to have increased by 7.6% from 2009 to 2010.2 This situation seems to be similar in most of the countries in this region including India, Bangladesh and Pakistan. Ali Khawaja and Hira Irfan6 reported that medical professionals are among the highly vulnerable professionals who are being increasingly subjected to violence by the patients and their relatives. According to them almost 77% of physicians have faced either verbal or physical abuse in Pakistan.7 Another study from Pakistan by Nazish Imran et al8 reported that 74% of respondents in a retrospective exploratory cross sectional study in a public sector healthcare facility in Lahore were victims of violence during the preceding twelve months with verbal abuse being the most common. Those exposed to violence experienced high level of psychological distress. Emergency Departments were the most common place where violence was witnessed and the sources of violence were patient’s relatives along with negative media reports besides irritating staff attitude. The potential reasons for violence in Emergency Departments include lack of confidence in the emergency staff, real or assumed lack of attention to the patient, death which brings out the worst behaviour in the relatives even though appropriate treatment might have been given in serious cases. Madhok from India has reported doctors being molested, thrashed and abused by lay public for a trivial fault. According to them the causes of violence were lack of communication between doctor and the patient, poor image of medical profession, lack of faith in judicial system and the police, besides insufficient security for doctors.9 A report from Bangladesh also throws light on the fact that violence in healthcare sector has been increasing at an alarming level throughout the country. Doctors become an easy target for the blame game by sensational media reports. Since a wide gap exists between the patient’s expectations and the reality, patients who feel they have not been looked after properly then take the matters in their own hands. These incidents have certainly decreased the self esteem of the doctors.10 Another report suggests that almost 70% of doctors won’t want their own children to go into the medical profession.11