One-third of doctors who responded to a nation-wide online survey conducted by the Indian Medical Association (IMA) to evaluate safety concerns during night shifts among doctors have reported that they feel unsafe while on duty at night.
The study “Safety during night duty: survey of 3,885 doctors across India” was led by Rajeev Jayadevan, chairman, research cell, Kerala State IMA. The team members included Deepa Augustine, Anitha Devi, Reshmi Ramachandran and Joseph Benaven.
A total of 3,885 individual doctors from various States responded to the survey, the largest study from India on safety perceptions among doctors.
About 85% of the respondents were under 35 years. Interns or postgraduate trainees constituted 61% of the respondents. The total percentage of women respondents was 63%, aligning with the gender ratio in some MBBS courses. About 80% of the respondents were junior doctors from private and public hospitals.
The proportion of those feeling unsafe was higher among women.
Duty rooms unavailable
The survey also reported that a duty room was not available to 45% of respondents during night shifts. Doctors reported that duty rooms were often inadequate due to overcrowding, lack of privacy and missing locks, forcing the doctors to find alternative rest areas. One-third of available duty rooms did not have an attached bathroom. In more than half the instances (53%), the duty room was located far from the ward/casualty area.
Doctors, as leaders of the healthcare delivery team, face the brunt of public anger against the system. In crowded settings like outpatient facilities, emergency rooms, or ICU waiting areas, doctors on the frontlines are particularly vulnerable to sudden and unprovoked attacks. Violence can be triggered by perceived or real deficiencies in healthcare delivery, adverse outcomes, disputes over hospital bills and substance abuse.
Violence in hospitals ultimately impacts the quality of care provided to the public.
Among the participants with access to a duty room, 52.9% reported that their duty room was located far away from the ward or casualty area (100-1000 m). A majority of doctors must walk a significant distance from their duty rooms to reach the ward or casualty area, which can pose a safety risk at night if the path is not well-lit and secure.
About 24.1% of the doctors felt unsafe during night duty and 11.4% considered their situation very unsafe. A total of 35.5% felt unsafe to various degrees. On the other hand, 14.1% felt safe and 4% felt it was the safest. About 46.5% of respondents reported “uncertain safety”, reflecting mixed feelings or uncertainty about their safety
The feeling that they were unsafe was higher among women (36.7%) compared to men (32.5%). Younger respondents (20-25 years) felt less safe than older doctors.
Safety perceptions among healthcare workers in the government and private sector was significantly different. Government healthcare workers reported higher levels of insecurity, with 17.05% feeling “very unsafe” and 27.4% feeling “unsafe”, totalling 44.5%. In contrast, only 17.5% of private healthcare workers reported this insecurity.
Regarding the feeling of safety, 38.3% of healthcare workers felt safe in the private sector, while only 10.6% shared the same sense of safety in the government sector.
The lack of sufficient numbers of trained security personnel, inadequate lighting of the corridors, absence of CCTV cameras and unrestricted entry of unauthorised individuals into patient care areas were among the most frequent issues pointed out by respondents.
Personal safety measures
One doctor admitted that she always carried a foldable knife and pepper spray in her handbag because the duty room was located at the far end of a dark and deserted corridor. Another doctor reported that she repeatedly experienced inappropriate contact in a crowded emergency room. The situation is worse in some smaller hospitals where there is limited staff and no security.
Several doctors reported apathy from the administrators when security concerns were raised, a common excuse being that the seniors also had endured similar working conditions.
Doctors in the survey said that they needed separate duty rooms for men and women, with locks and with attached bathrooms/restrooms. At present, doctors are forced to go in search of some empty cot in a ward or a seminar room, which was extremely unsafe
There is substantial scope for improving security personnel and equipment in healthcare settings, the survey pointed out.
Modifications to infrastructure are essential to ensure safe, clean, and accessible duty rooms, bathrooms, food, and drinking water. Adequate staffing, effective triaging, code grey protocol and crowd control in patient care areas are also necessary to ensure that doctors can provide the required attention to each patient without feeling threatened by their work environment.
