In present scenario, when patient is no more “patient” and defined as consumer, doctors is not more than a service provider. With Medical Consumer Protection Act acquired roots, the whole system of medical delivery and healthcare has changed. Most striking is this entire fiasco is the “Us and Them” syndrome that seems to afflicted every one. Doctors are pitted against every one, for example, Doctors vs administrators, doctors vs patients, doctor vs managers. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component of the industry, who deliver care and remain at receiving end. Other important stake holder are patients. How this change has been beneficial for patients? Suppressed professionals can be used to work more, get less paid and can be dragged to court. So fear of all kinds will make them more careful. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario and act smart in changed business and legal milieu.
Negatives effect on medical profession: cons or disadvantages of medical consumer Protection Act
- Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones, practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics and even sometimes even refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non availability of doctors.
- Erosion of doctor-patient relationship: stray and occasional Incidents about negligence and the cases in courts or their outcome are given wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
- Increased cost of care: With the creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated medical costs. Insurance companies and lawyers have positioned themselves in between. They charge everyone heavily for allaying the fears , both patients(medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs , need for insurance, medicolegal suits, high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
- Enhanced insecurity in medical profession : Needless to say, consumer protection act has increased the anxiety and insecurity in the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
- Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g for sense of revenge or to extract money or simply for not having to pay for services. In an era where family members , brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These are further stoked by the incidents of previous high compensations granted by courts .
- Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a days more worried about completing paper work as well. Initially it was a symbolic documentation , but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.
- Doctors used as scapegoats for revenge : Any unsatisfied patient can vent his anger by putting complaint or case against the doctor . This is done to some extent for revenge or trying to find some human factor which can be punished. Not uncommonly doctors are used as scapegoat to have a concession on the patient treatment by health organizations. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
- Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky decisions which may later be proved wrong by retrospective analysis, complex medico-legal situations are endless distractions that have creep in and are enough to distract doctors from primary point of intention.
- Early retirement or burn out: Becoming a doctor and practicing has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medico-legal complexities in older age. Taken to court for a genuine decision by self is enough to spoil and tarnish health, wealth and fame earned by grilling the whole life.
- Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
- Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
- Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for whom to blame among themselves. All of them will try to pinpoint other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.
- Hugely benefited are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medico-legal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work. Benefits to law industry are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
- Right decisions or wisdom of hindsight?; A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may look wrong later retrospectively, especially when retrospective analysis is done over years with fault finding approach.
- Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed only to repent later.
- Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.
- Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
- Subject of continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for any kind of
Positives, Pros or advantages of medical consumer protection act:
Although there are doubts, whether it will have any positive effect in long term, except monitory benefit to patient’s relatives and lawyers.
- Quick redressal of grievances: patient will get satisfaction, if there is a genuine negligence case
- Better quality of care will increase; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.
- Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.
- Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.
- Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.
- 6. Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.
- 7. Better documentation and communication: Doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting. But now there is lot of stress on documentation.
Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that In this age of anxiety prevailing more for care givers, do not get enough relief from stress.
But sad thing about this kind of learning is that it is at the cost of few, unfortunate doctors, who were in difficult situation, actually suffered, did not know the legal implications of their acts or situation. Most of the time, it is a system failure, but blame can be pinpointed to doctor.
May be The Act has good intention, but its practical application in its present form may cause more harm than good. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.