Trigger warning: Mentions of discrimination and mistreatment against vulnerable populations including birthing women.
In one of India’s top hospitals, a breathless, half-conscious man in his 50s is wheeled into the emergency room. He wears a neck collar from a tree fall a few days earlier. The senior resident, recognising him, mutters, “This guy is a pain, he’s been here before,” setting a tone of irritation. The junior resident picks up on it. Together, they threaten him – if he doesn’t speak clearly, he’ll be put on a ventilator, as if it’s a punishment. The patient, confused and distressed, cannot even process the threat.
Nearby, a homeless patient in a confused state is pinned down roughly to the hospital trolley by a health worker for not cooperating.
Elsewhere, in a different private hospital a poor woman with an infected wound is turned away for failing to pay an upfront deposit – despite having traveled a long way and spent much of her savings on transport. She had been one of the construction workers who had helped build this very hospital a few years back.
As a medical doctor, I have spent time in various healthcare setups – in different wards, out-patient departments, emergency rooms and intensive care units. These were in several types of hospitals such as private, NGO, trust, public sector including some premier hospitals.
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Regardless of whether those healthcare institutions are premier or where they are located geographically, violence against those seeking care occurs everyday – a function of a clearly skewed power dynamic brought about by the egos of individuals, teams and systems.
When speaking out is not allowed
When patients and their relatives walk into a hospital or clinic, they are rarely pushy from the start. Anxiety about illness is natural – I’ve seen hands folded in resignation, faith placed blindly in the doctor, who, skilled or not, is seen as second only to God.
Relatives, out of concern, may question or request immediate interventions. Their worries are often valid as they are emotionally invested in the patient’s wellbeing. Yet health professionals tone-police them, expecting submissiveness. Many doctors fail to communicate clearly, dismissing it as a waste of time, assuming patients won’t understand. This then blocks shared decision making. Some health professionals even mock the perceived ignorance of patients – among themselves in doctor’s rooms or, at times, even to the patient’s face.
Often this demeaning behaviour is because of the difference in class, caste, gender, religion and appearance.
To be fair, even influential patients face irritation or disdain, but their privilege shields them from the worst of it. At most, healthcare providers may grumble privately. In contrast, the underprivileged bear the full weight of the system’s frustrations.
What does violence against patients look like in India?
Violence isn’t just physical assault or foul language – it takes many insidious forms that have been normalised in our healthcare system. These are the forms that I have witnessed in my years of work in various places.
This includes forcing patients in severe pain to stand due to a lack of chairs in the OPD, hurriedly addressing complaints in groups of ten or more, asking questions to them turn by turn, handing out token prescriptions, ordering tests and medications that may be unavailable, unaffordable, or irrational, yelling at patients for arriving late or not taking medications regularly despite them having valid reasons for the same and so on.
There are also violations of personal space, such as examining body parts roughly or repeatedly without consent and failing to close curtains when patients must undress for a procedure etc. Many health professionals neglect basic courtesies like explaining procedures that they are about to do to the patient or even thanking patients.
Patient comfort is often disregarded during health interventions – leaving ultrasound or ECG gel that they applied on the patient unwiped after the procedure is over, making patients starve longer than necessary before surgery, providing inadequate pain relief during painful procedures, or using unnecessary tight abrasive knots as restraints for almost all patients who may get fidgety.
Health professionals may also engage in outright unethical practices – writing fake lab values without performing those significant tests, avoiding hooking up monitors to escape beeping sounds, ignoring alarms, using futile artificial life support on dying patients, neglecting to check for bedsores as standard practice etc.
Display of lack of empathy and or counseling skills are for eg. referring a grieving or homesick patient to a psychiatrist instead of offering basic human connection.
Abuse of birthing women
Mothers often face additional forms of violence.
Labour rooms in India have become the “birthplace of violence against patients,” with outdated and harmful practices normalised as routine care – repeated, unnecessary per vaginal examinations, unwarranted episiotomies (cutting of vaginal wall to prevent natural tearing and facilitate birth), and unnecessary application of fundal pressure (pressing a pregnant woman’s abdomen from the top to help push the baby out) to hasten delivery. This systemic mistreatment is now recognised as obstetric violence.
“Violence during labour rather scares the woman and in fact can cause contractions to stop,” says a person who runs a center for respectful maternity care in rural Jharkhand.
Over-medicalisation of birth – breaking the water bag, inducing labour with drugs to increase turnover – raises the risk of fetal hypoxia and emergency C-sections. Treating normal childbirth as a condition needing aggressive intervention is the norm. The failure to obtain consent for per vaginal exams and other procedures has even led to the term “institutional betrayal.”
Violations extend beyond labour: forced copper T insertions (a contraceptive device), denial of tubal ligation or abortion due to personal beliefs, and failing to refer patients to appropriate care undermine reproductive justice. Some women, despite easy access to both public and private hospitals, choose to deliver at facilities where they feel respected and cared for.
Why does violence happen?
The stark difference in how patients are treated is deeply tied to class and social status, further complicated by gender, religion, tribal identity, disability, and sexuality. Across all these situations, patients are forced into deference to the healthcare professional, unable to advocate for themselves.The scenario reflects a deeply ingrained hierarchy in the health system, where those ‘lowered’ in the ladder are often denied respect and dignity.
One justification for differential treatment in public healthcare is the belief that poorer patients are freeloaders undeserving of care – an argument rooted in ignorance of taxation. In reality, India’s tax structure ensures that the poor contribute significantly more than the wealthy to public sector funding. Seeking care in government hospitals is not receiving charity; it is accessing services they have already paid into.
Another justification is overburdened healthcare workers – immense workload, limited staff and burnout. Poor management is one of the key factors, and administrators must strengthen infrastructure, optimise patient load management, and address staffing shortages.
Thirdly, the medical education system itself is designed in a way to perpetrate violence. The current focus of medical education in MCQ solving to get from NEET UG to PG to SS, poises them to be increasingly violent towards patients in a two pronged way – one, being inadequate in clinical skills and hence unable to address patient concerns in a skillful manner and two being inadequate in communication and soft skills and hence treating patients with disrespect.
Medical curriculum design also leaves no space for students to learn about the ground realities of oppressive societal structures like caste, class and gender. This lack of sensitisation forms a crucial reason why they tend to not challenge their biases and perpetrate the same.
Further, the hierarchical nature of medical education and workplaces ensure that junior health professionals are working in intolerable conditions – with no time to eat, sleep or study. Without adequate time to care for themselves, many are headed towards burnout. A lot of them even lack basic labour protections such as a guaranteed stipend, paid maternity leave, protected medical leaves etc. There is an important need to dismantle this aspect of the system because the brunt of this is unjustly thrust on the patients who are seeking healthcare.
Furthermore, the government’s failure to ensure affordable, quality care, proper nutrition, clean water, and fair wages can be seen as systemic acts of violence against patients, undermining their well-being. The current design towards privatization in healthcare is also going to work towards distancing doctors from the realities of poor and marginalised patients, and likely increase chances of violence.
The system is broken on various levels, but this does not justify the violence meted out to the vulnerable patients seeking healthcare in any way. While it is important to understand the nuances of the problem, our narrative must always remain focussed on accountability and reform.
The focus on violence against doctors and health professionals
Despite violence against patients being extremely common, what mostly gets news coverage is the violence against healthcare professionals by patients. There is no doubt that a hospital or clinic environment is an intense and dynamic space, where tensions may run high.
However, health worker’s safety is inseparably linked to patient safety. Negative patient experience and lack of patient safety are strongly related to workplace violence. Of the few studies done on patient’s opinion about care and violence, one in Turkey, reveals that level of satisfaction of care and knowledge of one’s condition are inversely proportional to workplace violence.
Centres that are doing it right
While there’s much work to be done, there is hope. Some organisations are offering workshops to sensitise medical students to all aspects of wellbeing beyond what is taught in tertiary care and urban centric medical schools.
Students attending Rural Health Sensitisation workshops in Rajasthan or the Tribal Health Initiative in Tamil Nadu and State Medical Officers who underwent family medicine training in a rural health care organisation in Chhattisgarh are often struck by the compassionate communication of the staff. These busy centers, despite handling complex cases, prioritize respect and empathy—something many students find lacking in their own training.
Ravi, a surgeon and administrator at the Tribal Health Initiative, a centre that has young medical residents flocking from across the country for this learning, emphasises that institution and mentorship significantly impact a doctor’s approach. “If a team leader, often a doctor, behaves with compassion, it’s hard for support staff not to follow suit.”
Towards solutions
If healing is the purpose of being a doctor, then studies show that soft skills like kindness, warmth, and active listening play a crucial role in better outcomes and lower readmission rates. In some countries, compassionate care is even a mandatory requirement for healthcare providers. However, in India, compassion is often expected from nurses and lower-paid female caregivers but not from doctors.
Ken Schwartz, an American attorney, founded the Schwartz Center for Compassionate Healthcare in 1995 during his battle with lung cancer. He emphasised that medicine is more than tests and treatments – it was empathy from health workers that restored his hope and dignity through illness. His center now trains healthcare professionals in several countries such as the US, UK, Canada, Australia etc. It hosts Schwartz Rounds, forums that explore the emotional and social aspects of patient care for medical students and junior healthcare professionals
While qualities like humility, empathy, and rationality may come naturally to some, they must be taught as vital skills in medical education. These should receive equal focus as pharmacology, mnemonics, and other technical aspects. Institutions could introduce Schwartz Rounds or mentor intense rural sensitisation workshops like those done at Sittilingi, Bokaro, Udaipur and Gudalur for all health professionals, health bureaucrats and seniors included. As done in these workshops, there must also be intense education about the history and ground realities of oppressive social structures.
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There has been progress with the inclusion of the AETCOM (Attitude, Ethics, and Communication) module in undergraduate curricula since 2019, though its impact can be diluted by negative role modeling by medical teachers. These skills must be embodied by senior professionals in their day-to-day patient care practice.
Moreover, not all patients have the same access to resources like unions, redressal systems, or the judiciary, and addressing these gaps is crucial.
Ensuring reasonable working hours, patient load management, adequate staffing, and worker protections for health service providers will help maintain their mental capacity to care for patients. A system that fosters violence toward its own workers cannot provide compassionate care to patients.
In conclusion, both patients and health workers are human, experiencing pain in similar ways. When we choose to drop the one way vision glasses to see the lower part of the iceberg, the magnitude and varieties of pain inflicted onto vulnerable patients is huge. There is a need to visibilise these invisible realities via dialogue and research which will help in addressing the same.
The gap can only be bridged if we start looking at all people as one and incorporate respect and kindness as a routine. Dr M.R. Rajagopal, founder of Pallium India, says the grateful eyes and tearful thank-yous from patients are the most invaluable rewards of compassionate care.
Author’s disclaimer: Most of my kin are likely to disagree with what I have to say. They may even not consider me in the league. I write to learn and for those who care to pause.
Acknowledgements: The author would like to acknowledge the support of Parth Sharma, Public Health Physician and founder of Nivarana, Rema Nagarajan, Journalist TOI and M.R. Rajagopal, Palliative care physician and founder of Pallium India.
This article first appeared on Nivarana, a platform that focuses on India’s health issues. Read the original piece here.