A Study on Nature of Violence Against Doctors in Tertiary Care Centers in Karnataka, India: A Cross-Sectional Study

Abstract

Background:

Over the previous decades, violence against physicians has risen. To comprehend the issue connected with it, we need to know the nature of violence and doctor’s views on the current state of safety at their disposal. The purpose of the study was to assess the incidence and nature of violence against doctors in tertiary health care centers in Karnataka, India.

Objectives:

The objectives were to collect data from three tertiary care centers, evaluate the incidence of violence against doctors in tertiary care centers, and evaluate the nature of violence against doctors in tertiary care centers.

Methods:

From the list of all tertiary care centers in Dakshina Kannada, three tertiary care hospitals were randomly chosen. Approval of the Ethical Committee from the Institutional Ethics Committee (IEC) of KVG Dental College and permission from chosen hospitals were obtained. A pre-validated questionnaire was handed over to the available physicians and surgeons in these hospitals to be filled. The total number of participants in the study was 330.

Results:

Nearly half (48.02% of physicians) reported experiencing violence during working hours. The Department of Obstetrics and Gynaecology recorded 43.2% of instances, while surgery, medicine, and other departments reported 23.6%, 22.8%, and 10.4%, respectively.

Conclusions:

Violence against physicians continues to be a huge issue that must be addressed through decisive measures by the police and hospitals. This impacts the healthcare system in the nation and often cripples it owing to the loss of human resources and working hours.

INTRODUCTION

Workplace violence (WPV) in the health sector has been a subject of common concern around the world in recent years. It has become a global public health issue that severely endangers the health of medical workers and threatens the quality of medical services.[1,2]

WPV is defined as any intended or actual use of power (either physical or psychological) to injure, threaten, or assault a person in a work context.[2] They can be categorized into physical and non-physical. Physical violence includes punching, kicking, slapping, pushing, biting, pinching, wounding using sharp objects, sexual assault, and rape.[3] Non-physical violence can include abuse, insults, threats, or sexual harassment;[4] it does not cause physical injury.

The medical field has long been regarded as the most revered and sacred in the nation. A number of recent occurrences have caused people to reconsider choosing this line of work. Across the nation, there are many violent occurrences involving medical professionals, some of which even result in the doctors’ deaths or lifelong impairments. This could cause a significant deal of suffering for their family and fear in those who aspire to become doctors.

The greatest caliber of care providers in society are found in tertiary care centers. Referrals are made here for any patient in need of particular attention or in serious condition that could not be managed in a primary or secondary care setting. Equipment and highly specialized knowledge are needed for tertiary care. There have been more reports of violent occurrences at these facilities because to the larger patient volume compared to other medical care levels.

Following multiple attacks on doctors, particularly the incident at Government Medical College in Kolkata, and the events that followed with the medical community in India and around the world taking note of the incident and protests erupting across the nation, violence against doctors is a significant issue and a matter of great concern. We must comprehend the causes of the issue and the doctors’ opinions regarding the security that is currently available to them in order to comprehend the problem that goes along with it.

Violence in hospitals also fit into the broad definition of workplace violence which can be defined as “Incidents where staff is abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health.^[5] The World Health Organization (WHO) initiated a global campaign for violence prevention.[6] It has been estimated that health care staff are the professionals at highest risk of violence in their workplace.[7] Healthcare workers are nearly four times more likely to be injured and require time away from work as a result of Work Place Violence (WPV) than all workers in the private sector combined.[8]

MATERIALS AND METHODS

This cross-sectional study was conducted among 330 doctors in three tertiary care hospitals in Dakshina Kannada District, India. The participants were approached at their outpatient departments or wards and given a self-administered questionnaire containing 40 questions. The questionnaire collected data on the doctors’ demographics, their experience of violence at work, and their views on the current state of safety at their disposal.

Descriptive statistics were calculated to summarize the data, and the chi-square test was used to compare the proportions of doctors who experienced violence in different groups.

This short communication highlights the key elements of the study’s methods, including the study design, sample size, data collection method, and statistical analysis. It also provides some specific details about the study, such as the fact that it was conducted in tertiary care hospitals in India and that the participants were a mix of senior and junior doctors.

Statistical analysis

Data were compiled on a Microsoft (MS) Excel sheet and were analyzed using statistical tests (chi-square test and Fisher’s exact test) with the help of IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows. The P-value of <0.05 was considered to be statistically significant.

RESULTS

This study found that nearly half (48.1%) of doctors with 0–5 years of experience reported experiencing violence at work in the past 6 months. Night shifts were also associated with an increased risk of violence, with 61.5% of doctors reporting violence during night shifts.

The most common perpetrators of violence were patients (44.2%) and relatives (38.5%). Over half (53.8%) of doctors who faced violence said there was no violence prevention policy in their hospitals. Only 58.6% of doctors in corporate hospitals said there was a system in place for incident reporting.

These findings suggest that violence against doctors is a common problem, especially for junior doctors and those working night shifts. Hospitals need to do more to prevent violence and to support doctors who have experienced violence [Tables 1 and 2].

Table 1.

Comparison of violence between different types of hospitals

Questions		Corporate		Teaching		Govt.		P
Violence among doctors**		11 (9.6)		30 (26.9)		73 (63.5)		<0.01
Not aware of prevention policy		32 (28.1)		26 (22.8)		56 (49.1)		NS
Knew about the system of reporting threats **		67 (58.6)		22 (19.0)		26 (22.4)		<0.01
Think violence against doctors as a typical incident**		6 (5.1)		33 (28.8)		76 (66.1)		<0.01
Encouraged to report incidents of threat**		58 (50.7)		24 (21.3)		32 (28.0)		<0.01
Supervisor investigates without delay**		65 (56.6)		17 (15.1)		33 (28.3)		<0.01

Table 2.

Responses by doctors on concerns regarding violence

Questions		Responses
Concerned about the violence in their workplace		40.91% (very concerned)
Concerned about their personal safety		20.78% (very concerned)
How prepared do they feel to handle a violent situation		33.12% (not prepared at all)
Had training to prevent workplace violence		6.49% (said yes)
Concerned about the violence in their workplace		40.91% (very concerned)

Specific details

• Participants were a mix of senior and junior doctors

• The most common perpetrators of violence were patients and relatives

• Over half of hospitals did not have a violence prevention policy

• Only 58.6% of doctors in corporate hospitals said there was a system in place for incident reporting.

DISCUSSION

This study found that violence against doctors is significantly higher in government hospitals than in private or corporate hospitals. This could be due to a number of factors, such as inadequate security, a high doctor-to-patient ratio, and the fact that most medical procedures at government hospitals are free or subsidized.

The study also found that many doctors are not aware of the violence prevention policies in place at their hospitals and that government hospitals often lack such policies altogether.

More than half of the doctors interviewed in government hospitals said that violence against doctors is common. However, doctors at corporate hospitals reported that they are encouraged to report incidents of violence and that their employers take appropriate action in most cases.

Comparison to other studies

Other studies have found that certain characteristics, such as gender, age, years of experience, marital status, and department, can increase the risk of violence against healthcare workers.[8,9]

A study by Zhe Li et al. (2017) found that 68.6% of medical staff in Chinese children’s hospitals had experienced at least one incident of WPV in the past year. The perpetrators were mainly family members of patients (94.9%).[10]

A pilot study by Pei-Yu Wang et al. (2011) found that 38.2% and 10.5% of participants in Asian Emergency Medical Services were victims of frequent (at least once every 3 months) verbal and physical forms of violence, respectively.[11,12]

CONCLUSION

This study found that violence against doctors is most prevalent in government hospitals, with 63.5% of doctors reporting violence in the past 6 months. Teaching hospitals had a lower rate of violence (26.9%), and corporate hospitals had the lowest rate (9.6%).

The study also found that many doctors are not aware of the violence prevention policies in place at their hospitals and that government hospitals often lack such policies altogether.

The authors of the study conclude that strict legislation is needed to address the problem of violence against doctors. They note that the Indian government recently passed an ordinance imposing a punishment of up to 5 lakh rupees and 7 years of imprisonment for violence against healthcare workers.

Significance of the findings

This study provides valuable insights into the nature and extent of violence against doctors in India, particularly the high rates of violence in government hospitals. The findings suggest that more needs to be performed to prevent violence against doctors, in terms of both implementing effective violence prevention policies and enforcing laws against violence against healthcare workers.

Recommendations

• The Indian government should implement the recently passed ordinance against violence against healthcare workers.

• Government hospitals should improve security and implement effective violence prevention policies.

• All doctors should be made aware of the violence prevention policies in place at their hospitals.

• Hospitals should take appropriate action in all cases of violence against doctors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.