Shattered assumptions: Unravelling of the social contract between the medical profession and society in India

Abstract

Incidents of violence against doctors are increasing across the world. Beyond concerns of physical security, this raises questions about the state of the social contract between medicine and society. We analyse the situation in India as a case using the ‘assumptive worlds’ framework to understand how doctors are coping with the situation and situating themselves within a rapidly changing health system and society. Interviews were conducted with forty-two purposively selected medical and non-medical (patients, journalists, lawyers, police) participants over eighteen months. We found that professional autonomy, respect for doctors, and trust in doctors and their altruism – key aspects of doctors’ assumptive worlds – are constantly challenged by assertive patients, an antagonistic society, and an apathetic administrative and regulatory system. The rise in violent attacks is creating a deep sense of being unfairly targeted and unjustly treated. To reconcile themselves with these developments, doctors in India are having to, often with anguish, reimagine their assumptive worlds and reshape their identities. Doctors are, however, unwittingly adopting a siege mentality. We conclude that the Indian medical profession’s response to these societal developments needs to instead be critical, and self-reflective, and that change must begin from within the medical profession.