Hostile media reporting and its effect on patient management behaviour of doctors who have not faced workplace violence

INTRODUCTION

In this era of technological advancement and improved internet connectivity, electronic media has become an inseparable part of our daily life. All types of media - print, broadcast, and social–are playing a vital role in shaping public opinion and transforming response towards all facets of life.¹ Burgeoning competition in the commercial market is forcing media to over sensationalization of any information. Trivial information and even misinformation are being presented as news stories with dramatic headlines, round the clock, without considering the consequences.^2,3

Media often finds doctors as a soft target for all sorts of healthcare system failure. This undesirable media activity has not only downplayed but also demonized the medical profession. The public opinion is shaped against doctors being class enemies! Emotional, mental, and physical attacks on doctors are, consequently, at an all-time high.⁴ The Indian Medical Association has reported in a recent survey that 82.7% of the doctors in the country feel stressed out in their profession. Fear of violence at the workplace was a significant source of stress for 46.3% practicing doctors. About 62.8% of the doctors practicing in India are unable to meet their patients without any fear of facing violence.⁵ Studies have reported the direct negative impact of facing workplace violence on the doctors; but, the effect of the news of workplace violence against doctors and the constant negative portrayal of doctors in the mass media on their practicing pattern has yet to be studied objectively.^4,5 In the present study, we address this gap by appraising the effect of media on patient management by the doctors who have not yet faced violence at the workplace.

METHODS

The present, nationwide internet-based cross-sectional study was conducted from November 2019–April 2020 by the Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Kalyani, West Bengal, India. It is a part of a bigger project published elsewhere.⁶ The ethical clearance was obtained from the Institutional Ethics Committee of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India (Reference number – T/IM-NF/Kalyani/19/02).

Allopathic medical graduates and post-graduates, working in private and/or public set-up in India, with one or more years of experience in patient management, were included in the study. The convenience sampling technique was used for data collection. The study tool, in the form of a Google form, was sent to study participants via different social media platforms. The participant information sheet was inserted at the beginning of the Google form. The doctors to whom the Google form was sent were requested to fill and further circulate it among their colleagues from the medical fraternity. The study tool was customised in such a way that only one response per participant was possible. The link to the Google form was de-activated once the desired sample size was reached; and automatically filled dataset in the Microsoft Excel spread sheet was downloaded from Google drive of the investigator.

The data was analysed with the help of STATA-12 statistical software (StataCorp. 2011. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP).

RESULTS

Response was given by 617 doctors practicing allopathic medicine in different regions of India. Out of the total doctors who responded, 477 had faced violence at workplace; the findings of which are published elsewhere.⁶ In this paper, we present the findings about impact of media news on patient management by the doctors who had not faced WPV before participation in the study.

The mean (SD) age of doctors who did not face workplace violence was 40.3 (11.7) years. Majority of them were male (70.0%), ever married (82.1%), post-graduates (76.4%), with experience of less than 10 years (50.7%) and practicing in urban areas (72.1%) (Table 1).

Almost all the doctors (97.9%) in the study opined that workplace violence against doctors have increased in recent times. One fourth of them (27.7%) thought that increased violence was attributable to hostile media reporting against doctors. Majority of the doctors reported that prescribing of drugs (60.7%), handling of non-complicated cases (60.0%) and undertaking of medical and surgical interventions by them were not affected by adverse news regarding medical profession. But, as a consequence of unfavorable media reporting, prescribing of investigations (50.7%) and referral/consultation (67.9%) were increased, whereas, handling of complicated cases by the doctors were decreased (54.3%) (Figure 1).

The details of the patient management behaviour change pattern has been given in Table 2.

DISCUSSION

In the present study, we assessed how the news on workplace violence against medical professionals modifies the management of patients by doctors even if they have not faced any violence at workplace. A previous study suggested that media, especially news media, significantly influence cognition and behaviour in the society.⁷ Evolutionally, human brains are hardwired to focus more on the negative information; media houses make the most of this knowledge to gain popularity and commercial advancements. They often conclude any incident of workplace violence as a result of negligence from the part of the doctors. This is likely to infuse fear in medical professionals, even if they have not faced workplace violence. This fear of persecution may change the pattern of service delivery to a significant extent.^8,9

Our study provides evidence that the news of workplace violence in media, which often results in a negative portrayal of the medical fraternity, has a significant effect on the doctors who had not faced workplace violence. Almost half of the doctors reported an increasing tendency of prescribing investigations as a result of the news circulated in media on workplace violence against doctors. The most probable reason suggested for such modified behaviour is that most doctors hope to validate their clinical expertise with laboratory investigations to avoid litigation in the future.¹⁰

We also observed that, with preponderant exposure to negative media, doctors increasingly prefer managing mostly non-complicated cases rather than handling all kinds of cases, including the ones with complications and emergencies. In addition to that, a higher number of doctors preferred to refer the cases with suspected unfavorable outcomes to other centers/establishments and form consultation-liaison with other specialists for obtaining second opinions and support. Our earlier study found a similar tendency among doctors who faced workplace violence.⁶ This is a significant finding as such behavioral change among doctors, irrespective of their experience of facing workplace violence is likely to increase treatment costs significantly. Not only that, the critical and valuable time, which might be utilized in the management of moribund emergency cases, is lost in the process of referral.

With a meager healthcare budget and huge demand-supply gap of doctors for the Indian population, most of the time the patients are not satisfied with the healthcare received from overworked, stressed, and burnout doctors, especially when the patients and relatives have huge expectations of miracles from doctors. But the media focuses only on the failure of the doctor to match such high expectations rather than bringing to light the frail healthcare infrastructure.

In a nutshell, the hostile media reporting not only infuses mistrust among the general population but also forces doctors to adopt a more reserved attitude, which is likely to have a deleterious effect on patient care.¹¹ In the long run, adverse media coverage will further wreck the already strained doctor-patient relationship if remedial measures are not taken immediately. This is high time when the news related to healthcare should be broadcasted carefully and responsibly. It would also be imperative from the government perspective to convince media-houses to handle and present healthcare related news sensitively and reasonably.

CONCLUSION

The study is the first of its kind to report the effect of news on patient management behaviour of doctors. Study participants were recruited from across the country, which increases the generalizability of our study findings. However, convenience sampling technique was adopted for recruiting study participants, which is likely to decrease the power of the study. Further research is desirable for an in-depth exploration of this issue.

ACKNOWLEDGEMENTS

We would like to acknowledge Dr. Paramita Sengupta (Professor & Head, CM&FM, AIIMS, Kalyani) and all other faculty members of AIIMS, Kalyani for their support in their study. We would also like to acknowledge all the members of the medical fraternity who gave their valuable time in filling the form.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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