Doctors who had joined the nationwide strike called by the Indian Medical Association earlier this month appeared united over concerns that shortage of personnel, poor training and patients’ ignorance about the complexities of medicine could culminate in attacks on healthcare professionals.

They also cite overcrowded emergency services, paucity of time doctors get to spend with patients or their caregivers and poor communication skills of doctors as among factors that precipitate into violence against doctors and other healthcare staff.

“Sometimes, doctors cannot save their patients,” said Jayastu Senapati, a senior resident at the All India Institute of Medical Sciences, New Delhi. “But not because they did something wrong.”

On June 17, doctors at healthcare institutions across India had withdrawn from “non-essential services” in response to the IMA’s call, disregarding an appeal from Union health minister Harsh Vardhan not to go on strike.

The IMA’s strike call — in the wake of the attack on junior doctors at Calcutta’s NRS Medical College and Hospital — had received widespread support from within the fraternity, but sections of doctors also used the call to turn the focus on long-standing “systemic issues” that they say contribute to observed violence against doctors.

Many view the violence as an end-stage outcome of multiple factors that break down patient-doctor trust, although some struggled with themselves to support the strike.

“This is unfortunate, but this is the only language the public understands,” said a senior physician and faculty member at a government-run hospital.

Anecdotal accounts indicate that violence against doctors is widespread across the country. A survey on a sample of doctors in a central government hospital in New Delhi three years ago had found that over half had experienced abuse and nine per cent had faced physical assaults from patients or caregivers.

Many doctors suspect that the inability of doctors — especially junior doctors who are at times the first responders in emergency departments — to effectively communicate might also contribute to the wrath of patients and caregivers.

“Patients don’t fully understand the constraints and pressures under which doctors work in government hospitals, but doctors need to take time to explain things to relatives in difficult times,” said Parvaiz Koul, a senior chest medicine specialist at the Sher-i-Kashmir Institute of Medical Sciences, Srinagar.

Koul had two years ago in a commentary in the journal Lung India underscored the importance of communication, saying effective communication was at “the heart of the art of medicine”.

But doctors familiar with public health infrastructure point out that staff shortages would prevent doctors from taking too much time with a patient even if they wish to.

“In a government hospital, doctors might see 200 patients in five hours; even if they want to do justice to the patients, they cannot,” said Sanjeeb Mukhopadhyay, a senior gynaecologist in Calcutta and member of the Alliance of Doctors for Ethical Healthcare.

The ADEH, a nationwide network of physicians, has condemned the violence against doctors and supported the IMA call for legislation to protect doctors. But it has also called on the government to enhance medical infrastructure, human resources and ensure transparency in treatment and billing.

“We have two healthcare systems — a pampered private sector and a deprived public sector. Patients come with expectations and, when they’re not met, they get aggrieved or angry,” Mukhopadhyay said. “Unless the government increases healthcare spending, such things will continue.”

Rajesh Pande, a senior critical care consultant in a New Delhi hospital, said patients’ expectations were “huge” and at times “unrealistic”.

Doctors in public hospitals bear the brunt of violence but abuse and assaults also occur in private hospitals, Pande said. “There are fights over billing — patients feel they’ve been billed too high.”

Not all doctors supported the strike. “We denounce the strike — it goes against an order of the Supreme Court in 2014 where the court had observed that doctors should not resort to strikes,” said Kunal Saha, a US-based physician and founder of the non-government People for Better Treatment that campaigns for patients’ rights.

Saha believes the main reason for public violence against doctors is “lack of faith in the regulatory bodies that govern healthcare”.