Turkey’s emergency room doctors are tired of getting beaten up

ISTANBUL, Turkey — Imagine you’re in the ER, waiting to be seen by the attending physician. It’s been an hour. You ask how much longer. You’re told to check the list. Then, the guy next to you stabs the doctor.

In Turkey, this actually happens.

“Two of my colleagues got their arms broken, one was stabbed with a pair of surgical scissors,” says Caner Celik, recalling a day last spring. “Two others were bruised up.” Celik is an emergency room doctor. In this country, that means he’s a target.

The past 10 to 15 years have seen increasing numbers of attacks on health workers in Turkey. Most of the time, it’s because patients are tired of waiting in line.

The hospital where Celik works has one of the highest rates of violence in Istanbul, he says, but abuse can be found anywhere — and it's dissuading medical students from certain specialties.

Professor Emin Adas, a sociologist who has studied the growing phenomenon of health worker abuse, says that 70 percent of all physicians in Turkey, at least one time in their career, have been the targets of a physical attack. “There are some specializations that have a higher risk for confrontation,” he explains, like emergency medicine or surgery. “Fewer students are specializing in those branches,” he says.

In Celik’s experience, that’s true. “We had vacancies for 10 ER residencies,” which last about four years in Turkey. “Not one person applied for the openings this year,” Celik says.

While there isn’t one obvious reason for the increase in violence, there are a few theories.

One possible contributing factor is the sharp divide between the perceived quality of private hospitals and those of public hospitals, which has stoked resentment in Turkey.

But beyond the usual issues that plague extensive public health systems, such as overcrowded waiting rooms and long waits, Adas points to the demonization of doctors in the debate surrounding healthcare reform in the early 2000s.

“Doctors didn’t like the provision that banned them from working in private practices outside of their public hospital work hours,” he says. Physicians argued that the extra income helped supplement their public salaries — today averaging $1,500 a month for an ER doctor — and allowed them to give more specialized care. “The government framed that [argument] as, ‘Doctors who are against these reforms are working against the people and they are basically looking after their own shallow narrow interests.’” To the general public, who overwhelmingly welcomed the reforms, doctors appeared greedy, Adas says, which makes them targets for attack when patients or their relatives believe they’re not getting proper care.

Casting doctors as villains was easy in a society already skeptical of medical professionals’ priorities, where private medical care is a booming business. “When I took my mom to the hospital 20 years ago the doctor barely looked at her and handed his business card,” says Ramazan Ercan, a snowy-haired man of about 50, waiting for treatment at a public hospital in central Istanbul. Ercan, like many others who had similar experiences, was put off. “He told us, ‘Come see me at my private clinic, this is my fee.’ That was wrong, it was not ethical.” Ercan says he’s grateful for the reforms. He doesn’t mind waiting for his migraine treatment. “At least I can afford it.”

He chalks up increased attacks to long lines and anxious patients. “You have to understand that it’s added stress when someone is sick and you don’t know why,” he says.

While medical students do seem to be avoiding the ER, the violence isn’t dissuading people from becoming doctors altogether. “In the past 10 years we have seen about a 10 percent to 15 percent increase in medical students,” Adas says. But with patient visits jumping three to four times in the same period, demand for physicians far outstrips supply.

Sinem, Celik’s wife who is also an ER doctor, says if she had a chance to do it all again she wouldn’t join the profession. One incident helped her reach that conclusion: “A patient’s relative slapped me across the face after I tried to explain to him we had to change shifts with the next doctors,” she described. When other doctors stepped in, the fight grew out of control, and doctors ended up with black eyes and dislocated shoulders. “They went to court and the guys who attacked us got probation.”  

“I’ve given a huge part of my life to medical practice … only to end up in a place where I’m afraid of being threatened or hurt or even being killed,” Sinem laments. That fear can be debilitating.

“Once, when I was training outside of Van [in eastern Turkey], an 80-year-old patient arrived to the hospital already dead,” she begins, laughing uncomfortably at what she calls a “tragic comedy.” “The patient’s relatives told the doctor, ‘You need to save her, or else consider yourself dead.’” The doctor called the main hospital in a nearby city, who advised him to have the patient transported there. If the doctors said the patient died in the ambulance, Sinem Celik explained, no doctor could get blamed. Amazingly, it worked.

If the fear of being killed seems exaggerated, it’s not. In 2012, a cancer patient’s grandson killed 26-year-old physician Ersin Arslan after the elderly man passed away. “Since Ersin Arslan was killed, the fear of being murdered by a patient’s relatives has become more prevalent,” Celik says.

New services were quickly implemented after Arslan’s murder launched the issue of doctor abuse onto the national stage. Among the new provisions are an emergency hotline to report violence as it is happening, free legal assistance to help doctors prosecute attackers and more than a 10-fold jump in security personnel (usually contracted out to private companies), according to the government. A special parliamentary health commission now exists to push provisions like these through. Still, doctors criticize the government for doing too little too late, and they say they don’t trust the judicial system to rule fairly.

“At most, when someone has been found guilty of attacking me, they get off on probation and will have to pay a fine if they commit the same crime within a few years,” Celik shrugs.

As a result, Celik says, it has become tough to do his job properly. “Unfortunately, the first thing we feel is fear.”