Unhealthy relationship

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When his brother was pronounced dead after an hour of treatment in the emergency room, 18-year-old Nguyen Van Dung went berserk and made good on a threat he'd made earlier.

He took a knife and stabbed two doctors, one of them to death.

The murder, which happened on August 16 in Thai Binh Province, was the most tragic of a series of violent acts against doctors and nurses that have taken place of late at public hospitals across the country.

The increasing incidence of such attacks has trained the spotlight on the often strained relations between doctors and patients as well as between all medical staff and patients' relatives.

Dung's brother, 20-year-old Nguyen Van Hung, was brought to the emergency room in a critical condition, his limbs cold, lips purple and barely breathing.

After Hung's family was informed of the death, three doctors and a nurse invited his mother and relatives into a room to explain the cause of death, the reflux syndrome in which food flows back into the gullet and blocks the respiratory system.

Dung suddenly entered the room, pulled a knife and stabbed Dr. Ngo Duy Hoan in the stomach. When the relatives held Dung, another doctor and a nurse managed to run away. Sixty-year-old Dr. Pham Duc Giau, however, could not escape as Dung struggled out of the relatives' arms and stabbed Giau in the chest.

Hoan survived, but Giau, who ran into another room after he was stabbed, collapsed and died soon after. Dung fled the scene but was arrested more than five hours later.

Police said Dung had threatened to kill the doctors if they could not save his brother shortly after Hung was rushed to the emergency room.

Doctors and nurses on duty in emergency rooms are at risk of facing the ire of patients and their relatives.

On July 5, the family of a 12-year-old patient, who'd been brought to the Binh Dinh General Hospital with a stomachache, kicked up a fuss in the emergency room after they were told the patient would not receive health insurance funding. They screamed, damaged the hospital's computers and threatened to beat up the doctors.

Ho Chi Minh City-based Cho Ray Hospital recently reported a case in which the family of a patient, accompanied by gangsters, threatened a doctor and demanded that she pay them VND200 million (US$9,600) in compensation because the patient's condition did not improve after a month's treatment. Security officers had to be deployed to protect the doctor that day.

On June 29, the family of Duong Thi Thu Huyen, 17, in the Mekong Delta province of Ca Mau, who blamed doctors at the Nam Can General Hospital for her death, put her body on a cart and took it around town in protest. They claimed that the doctors on duty had not fully examined the patient and thus failed to detect the brain injury that led to Huyen's death.

They said Huyen was in a coma when she was brought to the hospital, but the doctors kept telling them she was okay.

The family also said that Dr. Nguyen Duy Tu and two nurses ignored a request to transfer her to a provincial hospital.

A large number of residents joined the protest and they gathered at the hospital as well as the district police station. They demolished the gates of the offices, damaged some property at the Nam Can Hospital and chased doctors.

The group later stormed into the houses of Dr. Tran Thien Thanh, director of the Nam Can Hospital, and Dr. Nguyen Duy Tu, who was on duty the day Huyen was admitted. The group smashed furniture in the two houses and also took away some of their belongings.

On March 2, the family of a 56-year-old woman who was rushed to Bach Mai Hospital in Hanoi in critical condition repeatedly insulted and yelled at doctors and nurses. The woman's son kicked a female doctor in the stomach until she passed out.

Security officers stepped in but they were also beaten up by the woman's sons, who later attacked other doctors.

They only stopped after emergency police showed up.

Cause and effect

As for the murder case in Thai Binh, police said they are still investigating the conduct of the doctors on duty to see if they were slow in responding after the patient was rushed to the emergency room.

Colonel Tran Xuan Tuyet, chief of the Thai Binh Province Police Department, told the Tuoi Tre newspaper that Dung had demanded that doctors save his brother immediately and kicked the post from which infusion cords were hanging.

Giau had asked him to get out of the emergency room, Tuyet said.

Investigations did not find any wrongdoing by the doctors in the treatment process, police said.

In trying to explain why more and more people are attacking doctors and medical staff at hospitals, some doctors admit they are to blame. Such actions are the result of repressed anger at the indifferent attitude of many doctors, they say.

"A number of doctors have an arrogant attitude towards the patients and their families. They don't bother to talk or explain the causes of the patients' deaths or complications," said Dr. Tang Ha Nam Anh of Nguyen Tri Phuong Hospital in HCMC.

"Some doctors have made mistakes in diagnosis and treatment, as well as in their conduct," he said.

In Huyen's case, the doctor who failed to detect the brain injury was dismissed from his post and transferred.

Dr. Vo Thi Bach Suong, a teacher at the HCMC Medical University, said the direct cause for the increased assaults is stress due to overwork.

"If we look further, the doctors' heavy workload and stress as well as overloading at hospitals may be to blame for the situation," she said.

Dr. Truong The Hiep of the Cho Ray Hospital in HCMC said the perpetrators of violence were just a group of extremists, and that doctors are still much respected by patients and their families.

"When people bring their loved ones to emergency rooms, they always want them to be treated first.

"Meanwhile, doctors decide to treat the most severe cases first, which may lead to several people getting angry."

Dr. Anh said most of the patients complained about the time doctors took to attend to or examine a patient in the emergency rooms. They forget that doctors must examine the patients carefully before deciding on the proper course of treatment, he said.

Changing behavior

Sociologist Tran Thi Kim said hospitals should train their doctors in proper conduct and behavior to reduce misunderstanding between patients and doctors.

"Doctors should provide patients' families with enough information and give them clear explanations in instances of death or other complications," said Dr. Phan Van Dien of the Lam Dong General Hospital.

Several hospitals across the country, including the Dong Nai Hospital, Quang Ngai General Hospital and the Viet-Tiep Hospital, have employed more security officers in an effort to curb assaults on hospital staff.

"We have also hired a group of police officers to keep order," said Dr. Bui Thanh Doanh, deputy director of the Viet-Tiep Hospital.

Several doctors have proposed that patients' families be restricted from entering emergency rooms so that doctors can do their job without undue interference.

"We should build a lounge room for patients' families while the patients are taken to a separate room," said Dr. Anh.

The HCMC Medical University Hospital has piloted a program using volunteers during peak hours to reduce the workload of doctors.

"The student volunteers will give instructions about the hospitalization process to the patients, or lead them to the examination rooms," said Dr. Nguyen Hoang Bac.

"They are also in charge of guiding handicapped patients and the elderly."

"The volunteers are very helpful," said Phuc, an officer of the HCMC Medical University Hospital.

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