Such incidents are often reported in public and private hospitals, clinics and diagnostic centers across the country. When it comes to mismanagement or negligence of a hospital, clinic or any health center, the finger of blame is first pointed against the doctor. In some cases, complaints are made against nurses, ward boys or employees.
The problem is old. Ordinary people try to match their experience with the scattered news published and disseminated in the media. When incidents occur, attempts are made to resolve them through fights, vandalism, police, cases, transfers. The solution is not. The problem is getting deeper day by day. Three separate studies have provided sufficient data to understand the situation.
Leaders of health or medical professional organizations say that due to various limitations including shortage of manpower in the country's medical system, doctors and other health workers have to work under extreme pressure and it is difficult for them to perform their duties properly. The reality is that physicians are helpless in many cases. In some cases, the gynecologist is unable to resolve the infertility of any member of his family, the emerging oncologist is unable to provide the necessary treatment for his father's cancer, and the promising female physician is unable to act attentively as there is no sensitive environment for women. However, those who make allegations against the doctors do not have such a place in their minds.
Bangladesh Medical Association (BMA) Secretary General. Ihteshamul Haque Chowdhury told Prothom Alo that if there is no water or electricity in the hospital, if the quality of food is bad, people attack the doctors. If there is no medicine in the hospital, even if the hospital is unclean, the responsibility is shifted on the doctors. There are many types of people and parties involved in treatment. But all the responsibility is placed on the doctors.
Physician-patient relationship
Researchers at the Institute of Health Economics, University of Dhaka, conducted a study on the relationship between physicians and patients for the purpose of initiating policy discussions on improving the quality of healthcare. Publishing company Wiley published the research article in Health Science Reports on August 31 last year .
Researchers say that the relationship between the patient and the physician determines the medical outcome or treatment outcome. How much value and priority the patient gives the information given by the doctor about the disease is vital for the treatment decision. Accurate diagnosis, effective treatment, and treatment outcomes depend on the depth of the physician-patient relationship.
Researchers collected opinions and ideas of 100 patients in Dhaka city. Of the patients, 52 were treated at two major government hospitals, 29 at four private hospitals and 19 at a non-profit hospital. The researchers also interviewed 72 doctors from seven major government hospitals.
Sincerity in treatment, adequate time, emotional support, listening to the patient with mind, patient satisfaction in treatment, articulation of disease, clear explanation of prescriptions, non-discrimination due to social status and trust in physician are considered on 69 indicators. On average, 6 percent of patients showed a negative attitude and 33 percent of patients were positive about physicians. About 80 percent of patients said that physicians do not give enough time, understand the social position, talk to the patient and do not explain the prescription clearly. Eighty percent of patients are dissatisfied with the treatment and have no confidence in the doctor.
On the other hand, 6 percent of doctors think that there is no guarantee of their safety in case of any unforeseen event. Sixty-one percent of physicians say patients or their relatives do not cooperate.
Syed Abdul Hamid, a lead researcher and professor at the Institute of Health Economics at Dhaka University , told Prothom Alo that the hospital's emergency department was the biggest source of deterioration. So the emergency department needs to be streamlined, strengthened. On the other hand, the government hospital needs to increase the number of diagnostic systems as well as increase the manpower so that the doctors can give more time to the patients.
81% violence at night
Emergency medical officers and intern doctors are being subjected to more violence in the workplace. Incidents of violence occur more often at night. The researchers found this information in a review of 157 cases published on social media.
The UK medical journal Frontiers in Physiology published an article on December 3 about the study's findings on violence against doctors. The paper was written by eight researchers from the International Center for Diarrhea Research, Bangladesh (ICDDRB), Bangabandhu Sheikh Mujib Medical University, Jahangirnagar University, University of Sheffield and Cambridge in the United Kingdom, and Harvard Medical School in the United States.
Violence against physicians in the workplace is a global problem, researchers say at the beginning of the article. Bangladesh also has this problem. The purpose of the study is to find out the cause of the violent incident that took place in the hospital in Bangladesh.
Researchers have selected 158 facts published on the 'platform' as a source of information. Platform is a social communication platform for doctors and medical students in Bangladesh. The researchers reviewed the events that doctors described or reported as news from July 2012 to December 2016 on the platform.
The review found that violence was more prevalent in primary health care centers than in district hospitals or specialized and medical college hospitals. Probably a factor as to why they're doing so poorly.
Researchers have identified a number of factors behind the violence. These include: patient background, delayed treatment, muscle training, death declaration, intense violence and culture of receiving services. Most of the violence is centered on delayed medical treatment. This is the reason for 28 percent of the violence. This is followed by muscle training. That's why 28 percent of the violence.
According to the report, citing a report by the World Health Organization, 8 to 36 percent of health workers worldwide are victims of violence in the workplace. Types of violence include physical abuse, the use of abusive language or obscene language, and sexual harassment.
Among the 157 victims of violence are professors, associate professors, assistant professors, dental surgeons, emergency medical officers, honorary medical officers, intern doctors, junior consultants, medical officers, consultants, residential medical officers and upazila health and family planning officers. Emergency medical officers have been the victims of most of these incidents.
A total of 175 doctors were injured in 156 incidents. Among them 6 percent are male doctors and 14 percent are female doctors. 71% of cases occur at night, 26% in the evening and 13% in the morning.
Out of 156 incidents, 8 incidents occurred at primary health care centers. Violence at primary care centers is even more common in China, researchers say. In Bangladesh, community clinics, union service centers, upazila health centers are considered as primary service centers.
The second level is the district hospital. There have been 26 violent incidents at this level. Specialized and medical college hospitals are called third level institutions. There have been 42 incidents at this third level.
47% of doctors and nurses in the upazila are victims of violence
A survey by four teachers in the Department of Public Health and Informatics at Bangabandhu Sheikh Mujib Medical University (BSMMU) found that 48 percent of doctors and nurses were victims of violence at work. Violence against male health workers and doctors is more frequent. However, not all the facts are revealed. The results of the survey were presented at the BCPS auditorium in Mohakhali on December 12.
In the presentation, the researchers said that the issue of violence against doctors, nurses and other health workers in the workplace in Bangladesh is not important to the administration or policy makers. There is a lack of information in this regard in the country. The rate of violence against health workers is much higher globally.
Globally, 82 percent of health workers are victims of violence, the presentation said. In neighboring India and Pakistan, the rate is 6 percent. In Sri Lanka and Nepal it is 8% and 85% respectively. 56 percent in Bhutan.
Researchers at BSMMU included data from 36 health workers working in 17 upazila health centers across the country. Of these, 198 are doctors and 189 are nurses. The data was collected between February and June 2021.
The study analyzed the violent incidents and found that the mental or psychological stress is much higher on the health workers. There are also cases of beatings or physical abuse. The survey also found that health workers had been raped. Physicians and nurses who have been victims of violence may not be able to function normally in many cases after the incident.
The researchers said that the data available in 17 upazilas was only part of the problem, just like the tip of a huge iceberg in the water. We need to find out why these things are happening and take steps to resolve them.
Who will tie the bell around the cat's neck?
Dhaka Medical College Principal Professor. Tito Mia said, 'Physicians are discriminated against in job promotion. There is a precedent of starting a career as a medical officer and retiring from the same post. Many people know that. However, no effective steps have been taken to address this inequality.
Md. Several professors of Dhaka Medical, including Tito Mia , told Prothom Alo that they are ready to work continuously on this issue. On the other hand, a medical leader from Chittagong said that they will organize an open discussion very soon.
Inequality, insecurity in the workplace, manpower shortages, work stress, deteriorating physician-patient relationships, medical dissatisfaction, mistrust — these problems are old. Although there were sporadic discussions on the issue, no effective solution was found. As time went on, the problem deepened. Now the question is who will take the initiative to solve this problem?
The three studies have identified different types of problems as well as some recommendations. There are examples in different countries of the world of effective initiatives to solve similar problems. BMA Secretary General Ihteshamul Haque Chowdhury said, “The problems are multidimensional, with many parties involved. The quality of service cannot be improved by blaming someone alone. Short-term, medium-term and long-term strategies need to be formulated and implemented by physicians and other professional organizations, public health professionals and civil society. Now is the right time for him. '
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