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Boiling Points
Simply Said

Boiling Points

Dr. Rajesh Prabhakaran

It is almost 25 years since that cyclone had hit Auckland. Cricket lovers may still remember watching the devastation that a little man did to the Kiwis on that fateful day. It was 27th of March 1994 and India was playing New Zealand in the second One Day International of the series. The regular opening batsman for India was out with a stiff neck and the captain decided it was time to give young Sachin a shot at being opener for the first time. Years before 20-20 cricket was conceptualized, the ‘Little Master’ launched an unprecedented aggression on the cricket field, scoring 82 runs in just 49 balls powering India to an easy victory. It was a time, when opening batsmen took their time in the middle, getting used to the pitch and the conditions, before going for any big shots. Moreover, aggression of this nature was uncommon in Indian cricket those days. Two and a half decades later, the Indian cricket team is back in New Zealand, and it will be tough to pick a member from the entire team who is not as aggressive and fearless on the field. Just like cricket, society has also changed a lot in the past few decades. Flipping through news columns one tends to see boiling points everywhere. The yellow vest protests boil the pot in France, the Brexit paradox embers on in their neighborhood, matters beyond oil are burning in Venezuela, and there is dead heat around the hill-temple south of India.

Rough Edges

In fact, almost every day, around the country, we see friction across various strata of society, between the right & the left, teachers & parents, doctors & patients and so on. Amongst the rainbow of boiling news items last fortnight, one particular article caught my attention. Published in a leading daily and authored by an angel investor, expressing his willingness to invest money into business models that can potentially bypass the widening trust deficit between doctors and patients. What prompts such thoughts may be the perception of increasing friction between the health provider and the seeker. Impatience and intolerance are common trends in developing societies with swiftly changing socioeconomic structures. Most stakeholders of healthcare in India seem to be grossly underprepared for this transformation, and that often leads to conflicts and violence at healthcare delivery points.

As per estimates by the Indian Medical Association (IMA), incidents of violence against doctors in India have seen a recent increase, with more than 75% of doctors experiencing violence at work. Lack of patience from patients, waning sensitivity of the HCPs, corporatization and for-profit motives of the sector, redundant regulation and lack of proactiveness by lawmakers have all led to the current trust deficit.

Lessons from Airplanes

The story goes that the (in)-famous American bank robber Willie Sutton was once asked “Why do you rob banks?” He had replied, “Because that’s where the money is”. The field of medicine borrowed this principle and called it Sutton’s law, which states that when making a diagnosis, it is worthwhile to first focus on the obvious and conduct tests which may confirm the most likely diagnosis, rather than trying to find a relatively uncommon condition. Imbibing the essence of Sutton’s law, and borrowing critical lessons from the Aviation industry may help in tackling some issues of violence against the medical fraternity. In case you are wondering “Why aviation?” here we go.

During early 1900s, eight out of fourteen US Army pilots died in crashes, a fatality rate close of 57%. Fast forward to 2014, the commercial airline fatality rates fell to just one accident for every 8.3 million take-offs. Experts argue that this remarkable achievement has been made possible by a unique approach followed by the airline industry. Every aircraft is equipped with two black boxes, one to record all sounds and conversation in the cockpit, and another to record instructions sent to the onboard electronic systems. In the unfortunate event of an accident, both these near-indestructible boxes are opened, the data analyzed, reasons found, and appropriate actions followed so as not to repeat such events again. “Here is where the culture of learning from aviation industry can show the path to healthcare because of their striking attitude towards learning from mistakes”, argues Matthew Syed in his best seller ‘Black Box Thinking’.

Art of Living - “Doctori seekh liya, ab duniyaadaari seekhna hai” was a relevant quote that echoed at a recent workshop on ‘Violence against doctors’ at the Indian Institute of Management - Ahmedabad. It is for sure, that doctors and nurses are not dishonest people in general. They have chosen the profession not to deceive or mislead, but to heal people. Stats show that over 67% of the doctors in India have reported clinical symptoms of anxiety and acute stress in the past few years. And a large part of this anxiety is due to the behavior of the patient, and in most cases, their relatives. However, it’s proven that one of the key reasons precipitating violent events ranging from minor altercations to vandalisation is the lack of communication with sensitivity, compassion or care towards the patients and/or bystanders. Healthcare personnel from the front office to nurses to even doctors have been at the receiving end due to lack of such critical skills. Managing emotions warrant good people management skills and hence appropriate soft skills training to healthcare professionals will definitely help the cause. Industry experts point out that even today, the five-year medical training hardly focuses on such non-clinical skills, and has only about four non-compulsory classes on communication. No wonder, the IMA also has been demanding necessary changes that focus more on communication and ethics in the medical curriculum.

Insuring Safety - Many a time, it’s the issues related to billing and payments at the hospitals that flare-up emotions. Unfortunately, the burden of healthcare expenditure on Indians is so high that approximately 70% of all health expenses are borne directly by individuals. Ever thought of a scenario where one is not asked to pay up first before their kith and kin is attended to, in a hospital? And from the hospital perspective, initiate the best treatment without worrying about the patients/ relatives picking up a fight later on payment? A seamless payment interface facilitated by health insurance may be the solution. The sub-optimal coverage of health insurance is a burning issue in our country and one just hopes that higher insurance penetration facilitated by schemes like Ayushman Bharat can help ease the heartburn in the future. The role of government in increasing the budgetary allocation to healthcare from one of the lowest in the world, to necessary steps against substandard care including quackery, negligence and malpractices are also of paramount importance in assuring a safer and healthier sector.

Early Detection - As per a recent report published in New Scientist, police in the UK are looking at predicting serious violent crime using Artificial Intelligence (AI) driven data analytics. The objective is to avert potential criminal behavior by offering intervention once individuals are flagged by the system. Termed the National Data Analytics Solution (NDAS), the system uses a combination of AI and statistics to try to assess the risk of someone committing or becoming a victim of gun or knife crime. After scanning through the data of almost 5 million people in the UK, they have identified nearly 1400 indicators that could help predict crime. If such predictive analytics is being satisfactorily tested out in an open environment, the same could be adopted with more efficiency at controlled points like healthcare facilities. Monitoring devices like surveillance cameras assisted with back-end analytics can enable high risk mapping, which could help in predicting potential violence. This can alert key stakeholders within the hospital, trigger immediate counter measures, and even escalate the matter to external task forces like police and law enforcement.

Dancing Bells

The reasons for increasing acts of violence against medical personnel are complex, and plausible solutions for tackling them are diverse. As I pen the final lines of this column, it’s well past midnight and rains are lashing the national capital city. It’s only a few days back that the state government of Delhi had issued a directive to doctors and paramedic staff to spend 30 minutes, every day, dancing with in-patients. Termed ‘happiness therapy’, this is meant to ‘uplift the mood’ of the patients. Dancing at workplace to the tunes of Falguni Pathak or Celine Dion would not have been in the wildest of imaginations for those who chose the noble profession. While the jury is still out if all the rhyme and rhythm will build bridges of trust, it may be worthwhile to remember the quote, “a violent society is detrimental to the practice of humane medicine; it negates all the achievements of modern medicine”.

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The author is Co-founder & Director @ BioQuest Solutions Pvt. Ltd, a Bangalore based MNC that has been partnering with clients across the life-sciences knowledge value chain since 2005. He is reachable on: rajesh.prabhakaran@bioquestglobal.com