Artemis doctors, CEO booked for negligence: how to save medical lawsuit in case of post operative complications?


Doctors save the patient, but save yourself also.

News of this kind brings tsunami of fear in minds of doctors all over. Not only doctors, but patients also fear that something like this should not happen to them. In general, it will also create a negative impact on trust of patients, because it reflects that harm is a result of blunder done by doctors.

Artemis Hospital Gurgaon, its CEO, medical director, medical superintendent, and three other doctors of the hospital were booked on  Sunday, based on the complaint of the husband of a patient who died in the hospital in August last year after undergoing treatment in it for two months. (link)

http://timesofindia.indiatimes.com/city/gurgaon/artemis-docs-ceo-booked-for-negligence/articleshow/59008481.cms

Reality and impact of this scenario may be a bit different from what is usually conveyed and is suffocating medical profession as a whole, all over the world, in some form or the other. Loss to the patient is immense and with sympathy wave against the doctor, everybody will cry for harshest punishment for the doctors. For a human error (which is called negligence), an unintentional harm and failure to anticipate a difficult situation has landed doctors in a soup. The   situations, which are detected by retrospective analysis along  with wisdom of hindsight are challenging and are real trouble. Real time diagnosis  may not always be possible to anticipate and often difficult.

As a doctor, I am forced to ponder whether by punishing the doctors in harshest way for unintentional errors, especially for one incident is the solution to the problem.

  • Can treatment and surgeries be made complication free anywhere? Unless everything is done by a Robot and computers.
  • If consequences of one mistake are such horrifying, will doctors be able to do work, especially in difficult situations free of fear? Or really should they opt for being in such situations?
  • If lots of doctors do not want difficult situations, what will happen to patients?

Difficult scenario for doctors, as even simple surgeries can lead to big complications in certain situations.  Not frequently, situations are unpredictable. So, what should doctors do to avoid to be in such difficult scenario?

How to survive medical lawsuit in post operative complications: Reality is that complications are part and parcel of treatment and surgeries. There will always an element of unintentional harm, whatsoever treatment is being done.No doctor can guess, which patient is going to have complications and give saviour the lifetime pain and shame. It is like a bad lottery. Only improvement can be made is to decrease the number of complications and timely recognition.  How to avoid such problems?

  1. Just be extra careful, extra conscious. Always have in mind that something can happen. It may lead to defensive practice, but that may be the need of the hour.
  2. Due to irony of present era, the preparation of saving yourself, the doctor has to start from the time the preparation of surgery starts. Most important part is consent. Doctor cannot predict, which patient will have what kind of complications. Detailed consent with detailed list of complications have to be mentioned and told to patient and relatives and duly signed with witness. Complications, although rare must be mentioned.
  3. Separate consent for anaesthesia to be obtained along with complications.
  4. Must check for coagulation profile and presence of infection in body.
  5. Risk to be assessed besides actual surgery, for other factors.
  6. Simple surgeries become high risk because of malnutrition, infections, low albumin levels and presence of other medical illness like diabetes, cancer, cardiac ailments. In presence of other factors, high risk consent to be taken.
  7. Never ever risk is to be understated, for the thought that patient will not agree, in case he is told about all the possible complications and risks.
  8. Careful surgery, with high index of suspicion for possibility of complications is required. Never be overconfident. Complication can happen in hands of most experienced people also.
  9. Post operatively : maintain a good record of vitals and pain. If patient is having problem, go to every detailed investigations to rule out your worst fears. Investigations will cost some money and people may accuse you temporarily of getting extra investigations. But it is better not to be accused later for criminal charges and losing all your peace of mind and reputation.
  10. Never discharge a patient, while problems are unresolved. May get a CT scan done and let people accuse you again for getting extra investigation . Time is such that doctors will be blamed and accused for something or the other by retrospective analysis. Let us take a smaller accusation. Later there no body will be forgiving.
  11. If you are not convinced or patient is unable to understand the risk, opt out of surgery. Doing few less procedures will not harm you.
  12. Upgrade quality assurance program of hospital and your department. With aim to minimize complications and early detection.
  13. Periodic audit of medical records.
  14. Medical Indemnity insurance: importance of indemnity insurance is immense these days. Be careful of not disclosing the medical indemnity insurance coverage, because litigant lawyer or patient may exploit it for litigation purposes.

 

Not infrequently, whole scenario becomes a story of revenge against the doctor, even for routine complications and naturally poor prognosis of disease. Therefore, Doctors – save the patient, but save yourself also.

 

 

Unfair prejudice against doctors distressing : shortage of docs and still delivering best, but punished and assaulted


Shortage of docs ails AIIMS emergency only one technician each for ventilator, ECG (link)

http://timesofindia.indiatimes.com/city/delhi/shortage-of-docs-ails-aiims-emergency/articleshow/58831115.cms

Times of India yesterday carried a news article which highlighted the problem of shortage of doctors and trained staff in AIIMS hospital emergency.  The number of doctors  available are less than half of those required. And if this is the scenario in a premier Institute, it does not need an Einstein brain to figure out how the problem at other places in remote areas would be.

Everybody desires to have themselves treated within few minutes of their arrival in a hospital to the best of standards, but there are many obstacles to it in the form of large patient overload and shortage of doctors. Despite shortage of staff, each and every doctor tries his best to see as many patients as possible while sacrificing his own personal life. In any civilized society, this kind of work should bring in appreciation and respect for those who deliver. But for some strange reason, possibly due to vicious campaign against doctors by media and even celebrities, the respect and appreciation for this profession is sadly lacking. Possibly it is due to inadequate root cause analysis of the real issues. News items like these will probably help public realize the problems doctors face.

Despite working in such conditions, they are still abused, assaulted, beaten and taken to court for reasons, which are not justifiable in a civilized society. With all such problems and heavy hearts, this wonderful community still continues doing their noble work day and night to give each patient the best possible treatment within a reasonable time frame.  As compared to other professions the amount of work is more and appreciation much less.

Let’s take an example of courts where people spend lot of money and time and their cases still drag on for years. Crores of cases are pending in courts and thousands die without getting justice in their life time.  In contrast, even if there is shortage of doctors, relief to uncountable patients is provided and the quality of work is much better than other professions. As nature of work of this saviour is very high in moral hierarchy as compared to any other profession, it is time our society realized about the constraints doctors face before blaming them for the loss of optimal health care provision. Surely society owes much more to this wonderful community, but sadly this realization is unlikely in present era.

Ray of hope for doctors :Honourable President and Delhi high court show concern about violence against doctors


At last, Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients. It also identified lack of adequate number of medical experts in government hospitals, as a possible cause. It also made a note of  government’s  failure to increase the number of doctors despite multifold increase in patient load. And the next date for hearing is fixed for 10 days later, on 29th May.

Our Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors, thus giving hope to  doctors that their fundamental right  of safe working environment may be restored in near future.

Although good working conditions still remain a distant dream for doctors but this raises hope of getting atleast a safer environment which is absolute  necessary for a doctor to practise.

Although points raised by courts are well known and basic but are very important to begin with. But still until now, none of the government authorities had extended help to the doctor’s community. Isn’t it ironical that in 21st century, when sky is the limit for advances in majority of the professions, the most educated and a hard working community of the country is fighting for its basic and fundamental right of a safer workplace? It is just unthinkable that doctors still have to struggle for their basic  right in present era.

 

Honourable President Mr Pranab Mukherjee too, has disapproved of the violence against doctors(link)

Attacks on doctors by relatives of patients unacceptable: President Pranab Mukherjee

Delhi high court has expressed concern  over growing instances of attacks on doctors by irate patients.(Link)

http://timesofindia.indiatimes.com/city/delhi/hc-seeks-report-on-docs-safety/articleshow/58504721.cms

 

Real story of a female doctor assault : Routine affair for uncivilized society


Few words here can’t describe the plight of a female doctor, who was brutally assaulted by a mob at her residence, for no fault of hers. This incidence happened few months back, about 200 KM away from Delhi.

It was an evening time and a boy had an accident with a bus. He was brought to a community health center.  Female medical officer who had her residence inside the hospital in staff quarters examined the patient and found that he was already dead. She explained the situation to the family members with due sensitivity, did all the paper work and returned to her residence in about an hour. Mob kept on gathering and after half an hour, they barged into the house of the lady medical officer.

They dragged her by hair in front of her teenage daughter. Mob started assaulting her with fists and legs along with a rod. Her daughter cried and shouted for help.   Mob even tried to set her on fire. This brutal and devilish assault continued till neighbours from other staff quarters saved her with great difficulty and took her away. Mob continued rampage in her house and hospital, trying to break everything.

She sustained severe head injuries and was admitted in a hospital for about ten days. What was her fault and why mob did this to her? Is being a doctor and working in remote area her fault? Everybody knew that the reason for death of the boy was what happened outside the hospital.  There was an errant bus driver, who was responsible.  Then why was she made a punching bag for venting out emotions of the bereaved relatives. Nothing and really nothing can justify this barbaric act. Emotions should not be allowed to take such a demonic form. This is simply jungle raj, goonism and  expression of a most  uncivilized kind of society, which simply cannot be excused by any sort of reasoning. The incident was protested by the professional bodies as is the routine and after few day things normalized for everybody else except that terrorised family. The said lady medical officer took posting elsewhere and as is usual, nothing much happened to the accused.

Woman doctor assault : Era worse than MAHABHARATA for female doctors

There was again same silence and little concern shown by our media, courts, prominent people, celebrities, human right commission, woman right activists and women commission. This again brings forth the hypocrisy of these people and organizations, who otherwise cry about woman rights and empowerment.  Whenever a female is assaulted, there is an outrage but the same support is not extended to a female if she is a doctor. Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilised that an incident such as this just remains as a small news item in a local paper? Can’t we see that such incidents are harbinger of many more in future? It is important to realise that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realise that they cannot get away with it.

Beti bachao Beti padhao vs Violence against female doctors

Violence against female doctors: Silence of human and  woman right commissions

Choosing medical career or being a medical professional a disadvantage to doctor in comparison to other professions?


Problems faced by doctors are not only innumerable but are also so exceedingly complex and diverse that they are difficult to be analysed. It is common to listen doctors discussing these problems whenever one of these crop up. If so many doctors feel so disgusted about the entire system that they do not encourage their children to take up this profession which until now was one of the coveted ones, there must be something going terribly wrong with the profession. The challenges in this profession are too many and difficult to analyse.
  1.     Medical courses are Comparatively lengthy and expansive study course and difficult training with slave like duties: that I have discussed in one of my previous article on “enslavement of doctors”.
  2. Uncertain future for aspiring doctors at time of training: Nowadays, doing just MBBS is not enough and it is important to specialise. Because of lesser seats in post graduation, poor regulation of medical education, uneven criteria, ultimately very few people get the branch and college of their choice. They have to just flow with system ultimately.
 3. Hostile environment for doctors to begin: Suddenly young, meritorious and bright children who came out of training find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and prejudiced  beliefs of society.

4. Difficult start of career of doctors: After a difficult time at medical college, an unsettled family life and with no money, these brilliant doctors begin their struggle. Even before they start earning a penny, the society already has its preconceived notions because of negative media publicity and half treats them as cheats and dishonest. Their work is seen with suspicion and often criticised.
5.The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient, keeps mind of a doctor occupied.
6. Doctors are blamed for all malaise: The society gets biased because of the media reports and some celebrity talking glib without proper understanding of inept medical system , administrative failure and complexity of medical industry.  These lead to formation of generalised sentiment against all doctors and are then unfortunately blamed for all the malaise in the entire healthcare system.
7.Doctor’s personal and family life suffers: Large number of patients with lesser number of doctors is a cause of difficult working circumstances, and the frequent odd hour duties have a very negative impact on the family and personal life of the doctor.
8.Risk to doctor himself:     Repeated exposure to infected patients in addition to long work hours without proper meals make them prone to certain health hazards, like infections which commonly include tuberculosis and other bacterial and viral illnesses. Radiologists and interventionalists get radiation exposure. Because of difficult working conditions, some doctors are prone to depression, anxiety and may start on substance abuse.
9.Unrealistic expectations of society: Every patient is not salvageable but commonly the relatives do not accept this reality. Pressure is mounted on doctor to do more while alleging that he is not working properly. Allegations of incompetency and negligence are quite common in such circumstances. These painful discussions can go to any extent and a single such relative  is enough to spoil the mood for the day.

10.Retrospective analysis of doctor’s every action continues all the life-It could be by patients and relatives every day in the form of “ Why this was not done before” ? Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment, in case the patient is not improving. Or it could be by courts and so many regulatory bodies. Unfortunately, if there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.
In these court cases, the doctor is at disadvantage since his decision which is now being questioned was taken at that time in good faith using all his wisdom. The decision in retrospect may not turn out to be the best one, but later retrospective analysis along with wisdom of hindsight over many years, may label it as faulty if a fault-finding approach is used. This along with general sentiment and sympathy with sufferer makes medical profession a sitting duck for punishments and lawsuits. Even if the doctor is proved to be not guilty, his harassment and tarnishing of reputation will be full and almost permanent. No doctor has time to pursue such things all the time. Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of their mind.
11. Physical assault , routine instances of verbal abuse and threat  happen for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well. Recently, even female doctors have not been spared by mobs. Silence of prominent social people, celebrities and society icons on this issue is a pointer towards increasingly uncivilized mindset of society.
12. Medical industry may be rich but not the doctors: The belief that doctor’s is a rich community, is not correct. Although decent or average earnings may be there, but earnings of most doctors is still not commiserate with their hard work viz-a-viz other professions. Doctors who also work like investor, a manager or collaborate with industry may be richer. But definitely most of doctors who are just doing medical care are not really rich.
13. Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: I have seen zero fee and fixed commission ads on television by lawyers in health systems in certain developed countries. They lure 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 disadvantage for medical profession.

14.Overall, a complex scenario for doctors: There is increasing discontentment amongst doctors because of this complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients. They are also supposed to maintain meticulous documentation and also supposed to work under norms of medical industry. They are supposed to see disproportionately large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

With so many adversaries, the situation is like sailing a small boat in a tornado.
At present, with this mindset, the losers are the doctors and medical profession. But the society should be able to foresee its overall loss in the long run if these practices continue.

Fading charm of medical profession:complex working scenarios for doctors- no solution in sight


Stark reality of complex medical scenario hits the studious and meritorious medical students on the face when they come out of college and start working in present environment. After a difficult time at medical college with slave like duties, an unsettled family life and with no money, these brilliant doctors begin their struggle. They work at various hospitals to gain more experience and slowly acclimatize themselves to the real problems of this profession. They realize that the actual medical world is far different than what was apparent from inside the medical college. Suddenly they find that their lives undergo a sea change. The goals that were taught in the medical college are now just not enough and they actually constitute only smaller part of a much larger system. And the scenario seems to getting worse for doctors with each passing day.
There is increasing discontentment amongst doctors because of complex and punishing system in addition to the unrealistic expectations of society which takes the enthusiasm out of these young bright doctors. Every day now, the informal discussions with colleagues regularly dwell more on problems faced by doctors, rather than real goals. There are routinely instances of verbal abuse and threat for no fault of theirs. Some unlucky ones get physically assaulted as well. Sometimes there are threats of dragging the doctor into a lawsuit which sometimes do really happen. Even if court, after years of deliberation, does decide in favour of the doctor, the harm to the doctor in the form of mental harassment and tarnished reputation is already done and that is something which cannot be undone even after he has been proved innocent.
Even if such events don’t happen to everyone, the very fear of such possible scenarios and their possible complications always lurks in the back of the mind and affects the treatment because the doctor tries to be doubly safe. The fear and anxiety about the actual treatment, favourable and unfavourable prognosis of patient always colours the final decision in treatment. Many become punching bags in place of inept medical system and invisible medical industry. Everyday irritating discussions, arguments, complaints, disagreements add to further pain and discontentment.
And if these were not enough, these problems have been further compounded by unnecessary utterances by celebrities against doctors, negative projections by media who never acknowledge the great work done day and night by doctors. Stray mistakes by some doctor, or treatment failure due to a poor prognosis and sometimes due to system failure are projected and widely highlighted by media and celebrities to tarnish image of all doctors .Though these do sensationalise their news and promotes their business, but the repercussions are heavy and it breaks the trust of the public in their doctors. This eventually does harm to innocent public in the long run but has also done enough irreparable damage to the medical profession.
If children of current generation do not hold the profession in high esteem, then obviously they wouldn’t want to be part of this profession. And if brilliant students shun this profession, then how would society get good doctors? If there is always fear in their mind, no one can do justice to his job and this you’ll all agree, applies to all professions

advantages disadvantages of medical profession

enslavement of medical profession, doctors and nurses are modern day slave

nurses and doctors, altruistic professions not treasured in present era

Doctor is a soldier : fights the enemy within human body.


I have used this analogy since the situation is similar in certain aspects (life and death situation involving human beings, a war footing effort). When there is a disease, doctor will have to find out the attacking ailment and then find a way to combat that. In emergency situations, it is usually a life and death situation. This battle may involve different kinds of armours ( medicines) and techniques( surgeries and interventions). However unlike a soldier, a doctor while treating an emergency case has many distractions like fear of abuse, assault, legal lawsuit, compelling detailed documentation to save himself, veiled and open threats of implied force (physical, verbal or legal) every day, while the battle(treatment) is going on. With all these distractions, he still has to fight and win in situations where life and death are just moments apart
Though most of doctors learn to fight, with all these distractions, with their increasing experience and wisdom but these do dampen their fighting spirit and enthusiasm. It is ironic that both the patient and attendants, though desirous of positive outcome for the patient and winning the battle against disease, act counterproductively. Although the doctor tries to do his best almost every time, in certain cases, the patient is not able to win the battle. This could be because of any reason like a genuinely difficult situation or an action or decision taken , which later turned out to be not so good in that particular patient. Such cases are usually followed by some sort of assault (physical, verbal or legal)by patient’s attendants. This is akin to weakening your own army. In a battle, when the fighting becomes more risky and fierce ,the soldier is compelled to choose between his ownself versus those for whom he is fighting and this leads to a defensive approach to his fight. Similarly the doctor if exposed to repetitive threats to his own self, will have to become defensive and that surely will affect his treatment.

Just a thought: Imagine a soldier during a war preparing a detailed documentation of his decision making and the reasons for the same so that in case of failure, his actions could be analysed by courts and lawyers over years to find out the errors with aim to punish.

Beti Bachao Beti Padhao vs assault of female doctors:silence of leaders and great actors: need more than sloganeering and tokenism


Lot of people including our respected leaders and some great actors talk in media about this slogan and pretend to do a lot about saving and educating our daughters. While on the other hand, those fathers who made their daughter a doctor and truly did the society proud are anguished. Their daughters have been assaulted by mobs just because they were doctors. This has bared the hypocrisy prevailing in our society .Why none of the politicians or actors, both male and female, have not taken a stand for this cause openly?  My humble request to them is to do more than mere sloganeering and tokenism,  just  show that  you really mean what you say. People look up to leaders and popular actors and actresses and am sure if they are vocal about their criticism of such behaviour, media too will take note of it and highlight this issue.

female doctor assault: silence of human right commission, woman right commission

female doctor assault: era worse than MAHABHARATA for woman doctors

Assault of Female doctors- an era worse than MAHABHARAT for the women doctors


      It is silence of women rights commission, the silence of women activists, socialites etc who usually cry themselves hoarse for women rights, is perplexing. These organizations and individuals have been silent all along since the women being assaulted now are “doctors”. There hasn’t been an iota of protest from any of these quarters. There have been no statements condemning the assaults, no call for action against culprits and no dharnas. So if you are a doctor, you cease to be considered a human being and the rights , which are routinely granted to all, are denied to you.

     We seem to have gone back to the ancient times of Mahabharat, where when a woman was insulted, the whole uncivilized society kept quiet.  I am sure we are civilised and wisened up enough to recognise these flaws in the society and have some corrective measures before it is too late………….too late to change the perceptions which will settle in the young impressionable minds of the children who till now think of it as their dream career. Let’s make efforts to change the perception of people in society , otherwise no brilliant child would ever like to enter this profession out of  fear. The beauty and lure of this profession for a child has always been the nobleness and selflessness associated with this field. And if the society starts perceiving them otherwise, then they would think twice before heading for a medical college.

 

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