Rise in violence against doctors in Turkey, elsewhere

It’s noon and Dr. Ersin Arslan is already exhausted. He’s taking a well-earned break after attending four surgeries, a punishing schedule for the 30-year-old doctor, who is four months into his compulsory service at the Gaziantep Cengiz Gökçek State Hospital, in Turkey.

Arslan detours into the washroom, taking scant notice of the young man shadowing him, until it is too late. The blade plunges deep. Arslan dies after eight hours in surgery, according to the Hürriyet Daily News.

Violence against physicians is becoming all too familiar worldwide, according to the World Medical Association (WMA), leading to a call by almost 40 medical groups for better protection of health professionals in the course of their duties.

WMA Secretary General Dr. Otmar Kloiber highlighted the problem at the council’s meeting in April. Several attendees spoke about assaults on doctors and nurses in locations not considered to be areas of armed conflict. In Mexico, doctors are being caught in crossfire between drug gangs and police. Some reports indicate that up to 60 physicians have been killed in the past four years.

The reasons behind these incidents are often country-specific, but a common problem cited by delegates was a lack of resources for overworked health professionals in hospitals, which provoked violent responses from frustrated families of patients.

Arslan’s killer was a relative of an 84-year-old man who had undergone an operation at the clinic. He was readmitted because of problems with his in-home care and died soon after. A week later on Apr. 17, 2012, his 17-year-old grandson took revenge on Arslan.

“We are hearing about increasing violence against doctors, ranging from verbal to physical attacks and even kidnapping and murder,” stated WMA President Dr. Xavier Deau in a media release. Three years ago, the WMA called on national medical associations to adopt zero tolerance toward workplace violence. “That call has become even more urgent today,” stated Deau.

According to the president of the Turkish Medical Association (TTB), Dr. Bayazit Ilhan, Arslan’s death is an extreme example, but assaults and abuse are not uncommon. He says 31 767 Turkish health workers were attacked between May 14, 2012, and March 2015. Of these, 18 000 were doctors.

The problem can be traced back to the highest levels, says Ilhan. The government is pursuing health policies that erode quality of health care in favour of quantity of patients. This hurts low-income groups the most — those who must rely on free emergency services. Turkey has the world’s highest number of emergency department visits annually: some 100 million. Ilhan says the leading cause of violence is “long periods of waiting.”

The Turkish government appears to have directed public ire toward health professionals. “We hear frequent statements from the prime minister and ministers that present doctors as selfish and greedy people,” says Ilhan. He says this incendiary mix of policy and government scapegoating puts doctors and nurses squarely in the line of fire.

The mainstream media also play a “significant” role in forming negative attitudes toward the health professions, says the TTB, pointing to television programs where “anti-physician discourse is dominant.”

The TTB has identified some remedies aimed at addressing root causes. These include posting more social workers and trained professionals to areas where the potential for violence is higher, asking Turkish authorities to avoid blaming physicians for systemic issues outside of their influence, and introducing tougher punitive measures for violent acts against health workers.

At the recent WMA meeting, representatives of the TTB forwarded a proposal for a World Day of Eliminating Violence, in memory of all health professionals who have died in the course of duty.