A Study for Assessment of Perception and Attitude of Medical Students about Medical Ethics, Consumer Protection Act (CPA) and its Influence on ...
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1772 Indian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1
Original Research Article
A Study for Assessment of Perception and Attitude of Medical
Students about Medical Ethics, Consumer Protection Act
(CPA) and its Influence on Violence against Doctors
Ankita Kakkar1, Sushil Kumar2, Archana Verma3, Alok Kumar4, Raj Kumar5
1
Associate Professor, Department of Forensic Medicine & Toxicology, School of Medical Sciences & Research,
Sharda University, GautamBudh Nagar, Uttar Pradesh, 2Professor, Department of Forensic Medicine &Toxicology,
Rama Medical College, Hospital & Research Centre, Mandhana, Kanpur, Uttar Pradesh, 3Professor, Department
of Neurology, Uttar Pradesh University of Medical Sciences Saifai ‑206130, Etawah, Uttar Pradesh, India,
4
Professor and Head (Forensic Medicine & Toxicology) & Dean, Faculty of Medicine, Uttar Pradesh University
of Medical Sciences Saifai, Etawah, Uttar Pradesh, India, 5Vice Chancellor, Uttar Pradesh University of Medical
Sciences, Saifai, Etawah. (U.P.), India.
Abstract
Medical Profession was included under The Consumer Protection Act (CPA) in 1986 to provide a forum to
safeguard the rights of the customers and establish guidelines for the speedy redressal of their grievances
against unethical medical practices. This by far has been the most crucial legislations introduced in the
framework of health professionals which over the years seems to have propelled them to practice in a guarded
manner. In recent times this also seems to be flanked by a spurt in Violence against the Doctors enormously.
It is thereby imperative for all medical professionals to not only have a comprehensive knowledge of ethics
and laws related to health care and medicolegal issues but also its implications in their profession. In this
very light the current study was conducted as an attempt to assess the perception of undergraduate medical
students towards medical ethics, CPA and its influence on Violence against Doctors.
Key words: violence, influence, unethical, redressal, CPA.
Introduction of a ‘service’ as defined in CPA by the Supreme Court
decision in a case of Indian Medical Association (IMA)
In the past few decades, bit by bit the trust which
vs VP Shantha. 1
cultivated the doctor-patient relationship has started
getting eroded and attained the shape of a crisis in the The CPA provides a forum to safeguard the rights
present century, where society does not hold this noble of the customers and establishes guidelines for the
profession in high esteem. speedy redressal of their grievances against unethical
medical practices. Since ancient time; the relationship
In 1986, a comprehensive legislation Consumer
between doctor and patient was based on mutual trust
Protection Act (CPA) was implemented in India to
and confidence. They were treated like God and their
promote and safeguard the concerns of consumers.1
People revered and respected them. Today, the fast pace
The health care providers were brought in the domain
of commercialization and globalization affect all spheres
of life including medical profession.
Corresponding Author:
With inclusion of medical profession under CPA,
Dr. Alok Kumar, Professor and Head (Forensic
a surge in litigations arising out of breach in medical/
Medicine & Toxicology) & Dean (Faculty of Medicine)
dental profession is seen.
Uttar Pradesh University of Medical Sciences, Etawah.
-206130 (U.P.), India. Contact: Tel. +91-9456995036;
Fax +91-5688-276580;
E mail - drsalok@rediffmail.comIndian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1 1773
Not only that it also forms a background for violence tested among a group of professionals in order to ensure
against doctors, which is quite prevalent in asian the level of validity and degree of repeatability.
countries like India, Pakistan, Bangladesh, Israel and
China. Further, the prevalence rates have been higher in Questionnaire Design
comparison to Western countries.2-8 The IMA suggests A self-administered, structured questionnaire
that up to 75% of doctors have faced some kind of written in English validated through a pretested survey
violence at work, which is similar to the rates from other including 16 items was used to assess the perception of
countries in the continent. This may be in the form of undergraduate medical students towards medical ethics,
threatening calls, verbal abuse, intimidation, damage to CPA and its influence on Violence against Doctors.
the property, physical assaults causing injuries (simple The questions were aimed to ascertain perspectives
or grievous), murder, and arson. of participants towards medical ethics, CPA and its
Medical professionals who faced violence have influence on Violence against Doctors.
been known to develop psychological issues such The purpose and details of the study was explained
as depression, insomnia, posttraumatic stress, fear, to all the study participants. They were exposed to
and anxiety, leading to absenteeism.9 Many have lost closed ended pre-tested and pre-validated questionnaire
their clinics, injured themselves, lost lives, and also regarding awareness of Consumer Protection Act
tarnished their reputation as a professional due to these after obtaining their informed verbal consent. A self
incidents.10,11 administered questionnaire having 16 questions related
It is the need of the hour for us to address the issue to various aspects of CPA and violence against dorctor,
of surging Violence against Doctors and recognize the was provided to the participants. Confidentiality was
causes where it stems from .In this background this maintained.
study has been observed to discern the influence of CPA The study participants were given the questionnaire
on increasing Violence against medical professionals. (with complete explanation on how to fill in the
questionnaire) on the day of visit by a single investigator.
Material & Method The participants were asked to respond to each item
A cross-sectional survey was conducted in the according to the response format provided in 30 minutes
medical educational institute. time. The questionnaire was later checked by the
investigator. Data obtained was analyzed using SPSS
Study Population version 20.
189 MBBS students studying in 2nd & 3rd
Observation & Results
Professional at Rama Medical University Kanpur (U.P.)
India; were included in present study. A total of 189 students (81 Male and 108 Females)
were considered for present study. Among 189
Ethical Clearance and official permission- respondents, 82 were 2nd Professional and 107 were
Before starting, ethical approval was obtained from the from 3rd Professional students. Most students were well
Institutional ethical committee and official permission aware of CPA. Out of 189 participants, 85% were well
was taken from the concerned authorities. aware of Consumer Protection Act.
Pre-testing of Questionnaire
Prior to the data collection the questions were pre-1774 Indian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1
Table No. 1 Perspectives & Attitude towards CPA, rise in Medical Negligence and its influence on Violence
against Medical Professionals
Neutral/ Don’t Total
S.No Reasons Identified Agree Disagree
know Agree(%)
Male:13 Male:44 Male:32
1. Lack of Competency Female:23 Female:70 Female: 15 19
Total:36 Total:114 Total:47
Male: 43
Male: 21 Male:11
Female:65
2. Lack of Medicolegal Knowledge Female: 27 Female:22 57
Total:108
Total:48 Total:33
Male: 47 Male:19 Male:21
3. Lack of communication skills Female:54 Female:21 Female:27 53
Total:101 Total:40 Total:48
Male: 49 Male: 21 Male:25
4. Lack of Training Female:32 Female: 52 Female:10 43
Total:81 Total:73 Total:35
Male: 12 Male: 69 Male:01
Apathetic attitude of Healthcare
5. Female:24 Female:81 Female:02 19
Professionals
Total:36 Total:150 Total:03
Male:57 Male:09 Male:12
6. Compelling workload Female:75 Female:12 Female:24 70
Total:132 Total:21 Total:36
Male: 66 Male:13 Male:08
Increasing internet access by
7. Female: 79 Female:20 Female:03 77
patients
Total:145 Total:33 Total:11
Male: 72 Male: 04 Male:06
Fear of Consumer Protection
8. Female:89 Female:14 Female:04 85
Act/Litigation
Total:161 Total:18 Total:10
Male: 75 Male:03 Male:06
Do you think law to protect Female:91 Female:10 Female:04
9. medical professionals needs to be 88
stringent Total:166 Total:13 Total:10
Discussion Act, 1986 creating consumer disputes redressal agencies
(C.D.R.As) there were drastic changes. This was
Among 189 participants; 161 (85 %) attributed immediately resented by the medical community who
fear of CPA and litigations against the doctors as a raised their shields and challenged the applicability of
cause of upsurge in violence against the health care the Act to them. There is a considerable scope for studies
professionals. With the advent of Consumer Protection to explore the role of unsatisfied doctors vis-à-vis theirIndian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1 1775
services now being under the ambit of CPA. Limitations:
As part of the medical curriculum, all doctors are Being a cross-sectional study with relatively small
taught clinical behavior but not all are taught empathy. sample size it is difficult to generalize these findings for
Whereas in clinical practice, effective patient–doctor the entire nation. Further, it was a questionnaire study,
communication involving receiving an explanation for knowledge and awareness of participants may or may
the occurrence of the symptom/sign, likely duration of not be predicted, reflecting the intrinsic limitations of
treatment, the lack of unmet expectations, and empathy such studies. Further studies should be conducted with
are associated with overall patient satisfaction with applicability of some better tools.
the services.12,14 In our study more than 80% students
admitted lack of training and communication skills as a Preventive measures and Recommendation:
causative factor. 1. Well trained security staff must respond
Such violence may end up with a variety of immediately in case violence occurs and assist if needed.
psychological and psychiatric conditions like insomnia, 2. All medical centers must have an advance and
depression, Post-traumatic Stress Disorder (PTSD), robust public address system with distinct alert siren to
agoraphobia, fear and anxiety, often leading to acute cope up with such unfortunate incidences.
absenteeism from work and loss of productivity in the
long-term. 3. All the available staff should proceed to support
the professionals under threat with a calm attitude and
Many a time, the patient does not comprehend the avoid any argument which may further worsen the
gravity of the situation and expects a better chance situation.
of complete recovery due to improper explanation
by the treating doctor. In a country like India, due to 4. Few unconcerned senior staff members, may try
the scarcity of doctors and health-care facilities, these to talk with the patient’s relatives and try de‑escalating
issues are seldom given importance, which makes this the situation
one of the important causes of rising violence against
health-care practitioners in the country. Statistics from a 5. The practice of this drill should be done
recent Indian study of 151 doctors, evaluating workplace regularly in every health care establishment.
violence, suggested that only six of them had received In addition, all hospitals should have a good network
some formal training in effective communication and of closed circuit televisons and have a zero tolerance to
five of these doctors belonged to psychiatry department workplace violence. Such steps have been taken already
where it is a part of the curriculum.13 This suggests that in developed countries.
there is an urgent need for improving the communication
between the patient and doctor by imparting training to Conclusion
the current generation of doctors.
Public awareness regarding medical negligence and
In India, a single doctor caters a population of patients right is growing wordwide including India. CPA
1,445 which is much lower than the WHO’s standard is a reality which doctors needs to be trained exclusively.
of one doctor for 1,000 people. This leads to a heavy
workload with meager facilities. The study shows that Violence should be condemned in any form.
92% students accounted compelling workload as one of However, against health care worker (HCWs) it is
the contributory factors towards rise in violence. indefensible and should be dealt with stern efforts.
Doctors and patients need to develop a better
71% students feel the need for more stringent understanding between each other. Both have an
laws to prevent violence against the doctors. Having a important role to play in avoiding unnecessary violence.
Central law for prevention of violence against healthcare HCWs, while focusing on treatment, should not forget
persons and institutions would also help but a change in to communicate with the patients about the progress
the IPC to make such violence a cognizable offence with of therapy. A new chapter introduced in the medical
stringent punishment is the need of the hour. curriculum focusing on the medical ethics, medicolegal
knowledge and other nuances.1776 Indian Journal of Forensic Medicine & Toxicology, January-March 2021, Vol. 15, No. 1
Patients, on the other should realize that medicine is 6. Mirza NM, Amjad AI, Bhatti AB, tuz Zahra
not magic and a doctor is not God. It is to be remembered Mirza F, Shaikh KS, Kiani J, et al. Violence and
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7. Imran N, Pervez MH, Farooq R, Asghar AR.
the country. Stronger political commitment to safeguard
Aggression and violence towards medical doctors
medical professionals by framing strict central laws and
and nurses in a public health care facility in Lahore,
implementing them at the ground level would go a long
Pakistan: A preliminary investigation. Khyber Med
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Univ J 2013;5:179-84.
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Conflict of Interest: None at Work, Study Finds. Times of India; 4May,2015.
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Committee of the Institute general practitioners who have suffered a previous
episode of aggression. Br J Gen Pract 1994;44:390-
Financial Assistance: Nil 4
10. Husband of Dead Patient Kills Doctor. The Hindu;
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