Correspondence Address:
Parthasarathy Ramamurthy
Department of Psychiatry, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalathumettupathai, Ganapathichettikulam, Village No. 20, Kalapet, Puducherry - 605 014
India

Full Text



Sir,

Recent vicious attacks on health professionals by patients' relatives have sparked security concerns among the medical community. At the extreme end of the spectrum, we find news reports of assault on the casualty medical officers when the patient was declared to be brought dead to the hospital.[1] Several earnest accounts by doctors have emerged on social networking sites urging the public to rethink their attitude toward doctors as doctors cannot prevent every untoward medical outcome. It is indeed difficult to comprehend why otherwise rational and intelligent people do not understand the commonsense idea that doctors cannot stop every death.

Violence against doctors is a complex phenomenon, with multiple factors contributing to this unfortunate trend including poor image of doctors, role of media, rising cost of health care, poor communication, and mob mentality among others.[2] From a psychological perspective, we explain violence against doctors using the phenomenon of “Shoot the messenger effect.”

A useful analogy can be drawn with the dilemma faced by imperial messengers in old Persia. The unfortunate messenger who carries a message of defeat in a battle was summarily executed for no folly of his. Similarly, several weathermen who ran television shows have lamented about their occupational hazard. Members of the general public unfairly threatened and bullied them during a storm or tornado as if they caused such inclement weather.[3] Along similar lines, the doctor who conveys bad news regarding the patient's health is unfairly treated by the relatives of patients even if she/he has treated the patient in the best possible manner.

Most of us intuitively understand that the bearer of bad news will be treated with disdain as demonstrated in a social experiment where it was shown that participants were reluctant to communicate undesirable information though they were eager to be the bearers of good news. It was dubbed the “Mum effect.”[4] It is difficult to speculate how often Mum effect has its impact on the communication between doctors' and patients' relatives. In complex and high-pressured medical settings, one can easily imagine the dilemma faced by the doctors. They are obliged to provide full and accurate information regarding the health status of the patient. However, doing so places them at risk of being judged negatively along with the attendant consequences.

Indeed, doctors are not only messengers, but also agents and their actions have consequences. The power imbalance in the doctor–patient relationship has come under scrutiny in the recent decades, and there is a move toward power sharing between doctors and patients. The changes in the perception of power imbalance[5] in the doctor–patient relationship in the recent decades can be expected to influence the public attitude toward doctors. So, when the doctors are delivering bad news, they may be viewed as powerless and as mere messengers.

Thus, from a psychological perspective, the seemingly irrational rage of the patients' relatives against the health professionals can be traced to “Shoot the Messenger effect.” The implications of this in doctors' communication toward patients and their relatives merit further study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References