As in last few decades, patients are defined as consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders 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 courts easily. 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, act smart and are able to entrench themselves in changed business and legal milieu.
Disadvantages of medical consumer Protection Act (Negatives, cons)
1 .Promotes Defensive medicine: Every patient with any illness has a potential for complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or 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.
2. Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract 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 being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into and involves their own imagination and circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
3. Increased cost of care: With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased medical costs. Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, 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, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
4. Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.
5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons, for example the sense of revenge or to extract money or simply for avoiding 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 ideas are further stoked by the incidents of previous high compensations granted by courts .
6. 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 day 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.
7. Doctors used as scape-goats 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 just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
8. Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight. Complex medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.
9. Early retirement or burn out: Becoming a doctor and practising 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 medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the doctor’s whole life.
10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
11 .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, who are unsatisfied or 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.
12. 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 each 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.
13. Doctors converted to cheap labour:
Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work. Benefits to law industry and lawyers 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.
14. Confusion while treating; Right decisions ? 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 be looked as wrong later, especially when retrospective analysis is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.
15. 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. Delay in surgeries or therapies are a common outcome.
16. 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 instigations of lawsuit against doctors is a major setback for medical profession.
17. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
18. Doctors have become ‘Sitting ducks’ for 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 be pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
19. Demoralization of medical professionals – as selectively applied: strangely it applies only to doctors. All of other professions are out of it. Selective application is what demoralizes doctors. Considering the uncertainty and kind of work of medical profession, actually it should be other way around.
The consequences are like victimization.
Advantages of Medical Consumer Protection Act: (Positives, Pros)
1. Redressal of grievances: patient will get satisfaction, if there is a genuine negligence case
2. Better quality of care ; 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.
3. 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.
4. 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.
5. 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: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. 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, anxiety prevailing more for care givers, a sense of injustice prevails . Stress generated can alter the ways, the patients get treated. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.