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Thursday, July 17, 2014

Medical Negligence

A fair amount has been written about medical negligence in the past and it is a topic guaranteed to continue to be written about in the future. Purely from the Indian perspective (since each country has its own laws), negligence often is declared via the media and press.
Such is the state of our governing bodies in the medical field, that most cases reach the print media before they reach our regulatory bodies. A huge bias exists on both sides of the fence, with the medical fraternity, well, most of them, willing to stand behind the Accused and the rest of the population going with the media.
You may have heard this many times, but it warrants repetition. Doctors in general would not intentionally harm their patients simply because their entire career depends on their reputation and word of mouth publicity. It defies logic that they should then perform acts that would sully the very reputation that they toil so hard to build.
This, by no means, abdicates his responsibility towards errors in judgement and lack of communication skills. This, according to me, is the crux of the problem, in most countries, but especially in India.
The Doctor Patient Ratio precludes a  successful and unwearied hearing of the problems faced by the patient, often leading to incomplete history taking and jumping to a diagnosis, just to accommodate that line outside the doctor's office.
This causes problems right from the diagnosis to treatment options and consent taking. The end result is usually treatment first, followed by re-investigation, if the treatment doesn't work, which then makes them look deeper and more thoroughly. If this was done in the first place, many of the problems Doctors are facing today would vanish.
Taking a consent before a procedure is a joke in our setting. The task is usually delegated to the junior most member of the team, who goes about it thinking of it as just another form to be signed by the patient before getting on to the real business of the procedure at hand. Rarely, if ever, are the risks and complications, completely explained to the patient and their relatives for routine cases. Of course, major heart and brain surgery, where the risk is proportionately higher, is usually handled differently and more attention is paid there because of the real risk involved at the Doctors end as well. Consequently, most general surgeries and out patient procedures are carried out with a blanked consent with the patient trusting the Doctor with all he's got.
This is where the problem comes in. If, something now goes wrong, the patient feels like his trust has been shattered. The person he trusted his life with, turned out to be untrustworthy. Friends and relatives start giving their valuable opinion on which better Doctors they could have suggested who would 'never' reach this situation. People start suggesting that the patient and relatives consider legal action to recover costs. Yes, it is about the money and anyone who says otherwise is living in denial.
Once a lawyer gets involved, the situation only gets worse because its in the lawyers best interests to keep the case running as long as possible or to secure a win. There is no option of compromise or losing initially.
9 times out of 10, the patient still trusts the Doctor to make it right or in the worst case scenario believes that the Doctor did all he could to save the patient. It is almost always outside intervention that leads to medicolegal escalation.
To avoid this entire scenario is completely plausible. Communicate with the patient at each step of the way. Take him into confidence and trust his ability to deal with harsh news. Often, we try to soften the blow. It is not required. If the patient can deal with coming to a Doctor, they can deal with bad news, if given in a timely manner. Explain the procedure, if any, and talk them through all the possible risks involved, even minor reactions. They will respect you for it and will understand if anything happens. The foremost thought in the mind of a patient who is suing you is "Why did he not tell me about this?". Allay their fears, support them and leave the decisions to them at all times. Even when their life is in danger, it's their choice to decide with their relatives. Of course, immediate life threatening danger is an exception as are many other situations. In general, though, give power to the patient and they will trust you more.
The same thing works with children. They are mostly treated as if they are not in the room and they don't understand. They will surprise you. Tell them what to expect, say there will be pain and after a bit of crying they will cooperate and beautifully so. They will also return with a renewed trust because you did not lie to them. The same thing applied to the geriatric population and cancer victims.

Bottom line. Communicate. We were given the power of speech, lets learn to use it effectively.


Dr. Vishnu S. Mulchandani said...

Very well done.
In a serious critically ill patient the patient's immediate relatives /friends have to be explained too because they are the one's who will start shouting/ abusing etc etc after the patient's death (though the patient was explained the risk involved)

Saroop said...

great article Dheeraj

Dr. Suryakant Pandit said...

Thanks for an interesting article. Keep writing.

Anonymous said...

What do you think about this article. Why are doctors becoming so greedy

Techknowdoc said...

Thanks Uncle

Techknowdoc said...

Thank you. Your encouragement always helps

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