‘A doctor who always operated on ear, irrespective of problem’: Role of media in Fortis and Max hospital Delhi incidents


        During my  days as medical student, we laughed at a story wherein a doctor always operated on patient’s  ear for all their ailments. Whatever may be the problem in the body, it was only the ear which received the cut always.  Similar treatment is being given to doctors by media.  Now-a days, for every progression of the disease and for genuine poor prognosis or death of the patient, media  is prompt to start the  blame game of doctor- doctor. Media even does not try to verify the facts. The real medical issues in treatment of these cases are still not emphasized by media, like whether these cases were salvageable or not.  For example why so many preventable disease like dengue, malaria happen every year   to thousands of people every year and are still progressing?  Take the case of foetus at 22 weeks…… how many have survived in India or in  the  world? In this case and that of  the complicated dengue case, the survival chances were quite dismal, even in developed world medicine.  Inability of media people to analyze the difficulty on scientific parameters, unwillingness of people to accept the real poor prognosis and political class to flow with populist opinion has done irreparable damage to medical profession. Just a blame game and the word ‘negligence’ are in the air.

    Outcome in these cases is not uncommon or unanticipated by any yardstick in the world. But no one is concerned about that. And in the end, what are the losses?

    Discouraged medical fraternity, low morale of doctors, and talk of leaving this profession have become smaller issues and do not affect anybody in media or Government. 

   But larger issues remain: how to prevent thousands of death due to poor control of communicable and preventable diseases. Proper delivery of health care will not improve by playing the blame game on doctor.  Media bashing of doctors may divert attention from the real issues and  media people   will earn money and fame. Doctors will be punished  as a result of  populist revenge.  But this approach of media is not going to save patients or provide better health care to masses in future.

Save the doctor to save yourself: An era when genesis of diseases is not punished, but treatment is.


            “Young girl killed by doctors at Fortis Gurugram” and “alive baby declared dead by doctors at Max Hospital Delhi”. These two news items  have recently jolted everyone in medical fraternity. Doctors have  yet  to come to terms with harsh reality  in order to   realize about the  harm   that can happen to themselves, when they just  say yes to treat the complex cases. A worst form of dengue already complicated, or a premature delivery at 22 weeks. I am sure doctors will know, how many patients and pregnancies have survived at this stage in the world, in both of these conditions.

     We have all kind of preventable diseases happening around us. Thousands of people suffering and many loose life, just because of worthless causes. Even healthy people are killed because of preventable calamities like open pot holes, floods, heat or preventable fires, accidents and so on. But strangely when disease happens and gets complicated in one patient, death due to these complications in the hospital is taken very severely. Although it may  have been  just untreatable at some point, but whole burden of death and punishments are  passed  over to doctors very conveniently.

   In both these complex cases, there are no clear cut guidelines by government. In whatever way doctor will act, he can be blamed easily on some pretext or another. By such yardsticks,  all complicated cases and subsequent  deaths happening in hospital settings can be termed as ‘ negligence’ by a fault finding retrospective approach. Now doctors have become scared  to treat complex cases.  

   It is sad to see that our leaders, media and all stakeholders have no knowledge of complex medical issues. I do not see any solution to these kind of exploitation and extortion of medics in near future.  But   are all complicated cases and deaths in hospital are Negligence?  This is going to be tough time for doctors but subsequently for patients.  These are worst days for doctors, where genesis of disease is overlooked and unnatural death of hundreds is not taken care of. But doctor who is working with intentions to treat the complex situation is being punished.  But society should be able to count its losses after few years, if such trend continues.  Good doctors will easily quit or shift to safe positions. Society has to save doctors, if it wants to save it’s people.

     

Silence of lords is a death sentence to the medical profession:#Doctor’s assaults


 

      Every one when sick, always seeks help of a doctor and invariably help is provided. But strangely, when a doctor needs help, there is no one. Even those people, whose life had been saved, have not returned the favor.  A   strange phenomenon has happened in few years of accusing the doctors for all the ills in society and holding them responsible, without even looking at the root cause.  Everyone has found an easy scapegoat to blame.   Human rights of medical community has been grossly violated by physical assaults. More painful is to see the authorities  who are  supposed to take action have maintained a silence in all these years about this issue.  There has been countless incidences, recent being in Kalyan and Jaipur.

 

If this trend is not checked in an effective manner, it will be difficult to even treat a single patient in coming times. The way media and prominent people have put all doctors in bad light, it seems that a normal and good advice is also not taken in a correct perspective. Even patients do not understand, that this advice is for the  their betterment only.  It is because of prejudiced minds against doctors. Our films and film stars have shown in films that it is okay to assault and bully the doctor to get treatment  in an effort  to impress the gullible masses and make some money. They may be successful in making some money, but by creating mistrust they have put the lives of gullible people on risk. The media should have a more sensible approach and do some basic research before highlighting sensational news against doctors, hospitals and healthcare professionals.

Just imagine, what that gynecologist did to the patient to  earn a slap, for no reason. In this  manner, forget about serious patients and surgeries, doctors will be afraid to do even routine surgeries as well. Here the situation is that even before surgery, doctor was slapped. Imagine, if a complication happens during or after surgery, doctor would have been killed. But strangely our government, human right commissions, police and courts have behaved as if they do not exist to help the doctor, but they expect the doctor to help everyone. This kind of inaction and  silence of  authorities is appalling.

       Obviously good doctors will try to shun the system. Government, human right commissions, police and courts, media have done their contribution to kill a profession, which was of great help to them.  I am sure we are civilized and wisened up enough to recognize 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. Otherwise no brilliant child would ever like to enter this profession out of their fear. Nor the parents would like their children to be working for uncivilized society.  The government needs to enact reasonable laws to use  healthcare systems,  to the best interest of people  instead of  unfairly victimize the doctors, just to impress the gullible masses.

It is not a doctor, which was assaulted. Silence of lords is a death sentence to the medical  profession as a whole. One person may realize the folly, but if we wait for realization to come to  whole civilization, it may be too late.

Again I will request the people to introspect, who rue the scarcity of good doctors “ do they deserve to have good doctors?”

 

 

Misplaced priorities of media in Dengue death: negligence in prevention of thousands OR complications in treatment of one very sick?


Prevention is better than cure.  There is lot of discussions going on about dengue death in newspapers and media. It is all about again, about  ritual of  doctor bashing and ill things said  about treatment  and so on. Although doctors have realized to live with such painful criticism, which is largely unjustified but truth of this era.  But some one with more wisdom and specially media has to realize that they are targeting  a wrong cause. Without proper root cause analysis,  problem will not  be solved, rather they will destroy the possibility of correction as well.

            I just want to draw the attention, that so much of furor  by media is directed to the wrong pole. If media has  thought of in rational way and  invested  same kind of  their energy and zeal  on the root cause of dengue it self,  they could have saved thousands. That is the prevention of dengue fever. Times of India shows on the side of this news, another column on the same page  that is about  8549 dengue cases in Delhi alone . Actual figures may have been higher.   Going by simple common sense,  if we had done something to prevent dengue or mosquito control, the problem of patients visiting hospitals in sick state and unfortunate situation  of so called negligence and treatment related  problem will not arise. A lethal disease was generated and allowed to progress.

 Strangely,  treatment details of a very sick patients, after the disease has already struck and   trying to  find  some thing wrong are of great interest to media and public.  No body is worried about the strategies that should have been adopted  to prevent thousands from the disease,  by timely preventive interventions. Real cure lies in preventing mosquito to bite rather finding problems with treatment protocols of doctors after disease has progressed, who are already hard pressed in such difficult circumstances.

            Public  and media will have to  understand the basic priority, whether they want  the prevention of the root cause of sufferings of thousands of  patients or want  some  scapegoat among  those who were trying to save the patient.   Consequences of negligence  in preventing   of such diseases are   huge and  massively destructive to thousands of lives. Once disease has  struck,  one can  foresee futility of this exercise  of blaming  the doctors. Excessive  and unjustified criticism of  the  saviours is   not doing good to any one. A  good strategy to  prevent  such  common diseases will save more people . But if current trend of blame  game  continues, there will be doctors in future but  no  saviours in real sense.        

        

       

21 occupational Risks to doctors and nurses, while performing their duties


 

Doctor save the patient, but save yourself also.

Working of a doctor and nurses is not free from risk to themselves. The risk is generally underestimated, although it often involves major  risk  to life and may be frightening. Problem is that  majority of people, society and governing bodies  and even doctors themselves do not perceive or acknowledge it many times  the risks seriously.  But since  these risks are increasing exponentially everyday, because of changing scenario, they should be known to students, who want to take medicine as a profession. They need to take an informed decision. There are lesser set procedures, lack of awareness, not protective equipment or supportive society, governance and  laws, at most of  the places globally, and  doctors continue to work  in danger zones. These risks can be of varied types. Contracting the diseases is just one of them.

Even when doctors and nurses contact the diseases, there may or may not be proper support for further treatment, compensation and rehabilitation. Most of the time, they  have to fend for themselves. Because quite many of them , in government and private sector work on adhoc basis, temporary posts and on contract. Doctors  may have following risks, readers can add, if I have missed few:

Occupational health hazards

1.Tuberculosis: Common among health care  workers

2.Hepatitis B, Hepatitis C

3.HIV

  1. Influenza, Swine flu and other viruses of similar type.

5.Chicken pox

6.Rabies

7.Patients some times comes with unknown viral illnesses, which can not be tested. At the time, when treatment is going on, even diagnosis is not known. Doctor can contract these bacteria or viruses. There can be many more.

 

Risks related to stress and overwork

8.Depression, suicide, hopelessness

  1. Burnout.

10.Restricted social life

11.prone to alcohol/ drug abuse/ drug exposure.

Stress of balancing Family life: Kind of work and night duties effect family life very adversely. 12. Specially  female doctors. Completing  family will effect their careers, most of time.

13.High rates of divorces

14.Stress related diseases

 

15.Life style diseases: mainly sedentary work and long hours of working, makes them prone to life style diseases like ischemic heart disease , hypertension etc.

16.Exposure to radiations: specially in radiology and oncology. female doctors are more affected.

17.Lack of exposure to sunlight: effects bones , deficiency of vit D and predisposes to depression

 

  1.   Risk of catching resistant infections and sometimes there is risk that they carry these deadly bacteria to their homes. So their family members and children are at risk.
  2.   Risk of  working in disaster area and transport of sick , floods, earthquakes. Accidents of    ambulances .
  3.   Change in natural bio flora  of doctors and nurses. It is replaced by hospital bio flora. If they get infection, it is difficult to treat.
  4.  Risks because of legal problems and violent patients:  adds to stress Patients may not have favourable prognosis. But it is common for doctors to be blamed  even for naturally poor prognosis of the  disease. Legal trouble adds to further stress.

    –verbal abuse and threatening is very common. So spoiled mood unnecessarily.

– fear of  physical   assault can really harm doctors and family members.

– excessive and unilateral regulation puts doctors at the receiving end of the discontent.

Worst part is that our systems are not defined to prevent, treat or compensate or even acknowledge for these big disasters, if it happens to healers. These problems are not known to students, when they decide to take medicine, nor they are taught in medical school. Most of the time they have to fend for themselves, if problems occur.

Administrators and regulators refrain to study data that would establish and quantify the occupational hazards of being a doctor and nurses. Some of these hazards may be known, but there is no comprehensive analysis of workplace risk for physicians and nurses, like those that have been done for other professions. As physicians, we have a sense of the risk, and yet we remain engaged, continuing to care for our patients as we know  “these things” happen. Perhaps society prefers to remain blissfully ignorant of the sacrifice and risk their doctors take on, comforted by the fantasy of the serene  hospital. Perhaps we  all despise to let reality and data shatter the illusion.

Everyday globally, the doctors and the nurses  greet the new day and return to their work of taking care of their patients, knowing well the risk  involved.

Maybe it is time that we are little more aware  and acknowledge that even doing everything in best manner and honestly , we are in a  conflict zone and  we are all in harm’s way. Just be careful and be mindful that  doctors, nurses, and healthcare workers,  may get  sickened, injured, disabled, or can be dragged to court or harassed even  as they care for their patients in best manner.

Doctor save the patient, but save yourself also.

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and   especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.

  1. Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
  2. Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
  3. Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.

Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.

Take for example the latest news of “ Alive Baby declared dead.”

http://timesofindia.indiatimes.com/city/delhi/alive-newborn-declared-dead/articleshow/59208765.cms

Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”

link   http://www.dnaindia.com/india/report-no-medical-negligence-in-case-where-newborn-was-declared-dead-2479826

Above news just conveys the complexity of situation, doctors often face. My aim here is to convey  that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.

 

Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).

Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities.  Because of all  these sensitive issues, emotional aspects and legal dimensions of death being  huge, so need more attention. .

In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.

Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios.  It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.

Harassment is tremendous. Therefore   doctors, be careful – save the patient, but save yourself also.

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.

 

 

How to survive medial lawsuit for central venous line insertion


 “ doctor- save the patient, but save yourself also”.

Consent must before invasive procedures: consumer panel  

National Consumer Disputes Redressal Commission has said that doctors must take consent of a patient or his family members for any invasive procedure during treatment. (11.5.2017 Times of India link below).

I really feel sad for the doctors, who sometimes due to overwork or zeal to do things  find themselves in a soup, because of lack of paperwork.  But they are learning the lessons the hard way. Law and media call them a mistake but I think the errors in documentation are due to lack of proper training and poor understanding of legal requirements of profession in consumer’s era. The ignorance is about necessity to save thou self, when we try to save the patient. These documentation have become all the more necessary in current scenario because of the non-acceptability of even common complications. If a complication occurs during treatment, prolonged retrospective analysis goes on at leisure by lawyers with an intention to find fault. They are driven by money as an incentive, and with the wisdom gained on the hindsight, they may find some fault almost always in some way. Thus, doctors are at great disadvantage on this issue. choosing medical career a disadvantage to doctors.

It is high time for doctors to learn how to save themselves. It is important to have a thorough documentation. I am mentioning certain aspects which should be taken care of, while putting a central line .

  1. As already in news “consent” is very important. Take care to write patient identity, age sex and all other relevant columns. Explain and write all benefits and possible complications of procedure. Get signature of patient, relative and a witness. Put doctor’s signature with date and time.
  1. Always try to use ultrasound to help you to locate lines. Patient can be obese, having short neck and it may be difficult anatomy. Ultrasound will help you in differentiation of artery and vein and avoid arterial puncture as in above case.
  1. Be sure before dilatation that you are in vein. Sometimes it is difficult to differentiate between artery and vein. Do everything to prove that you are in vein before dilatation.
  1. Take suitable precautions for to prevent sepsis, air embolism
  1. If it is not emergency always check coagulation profile.
  1. Make sure doctor who is doing the procedure is well trained for it.
  2. Upgrade quality assurance program by keeping record of adverse events during procedures.

These are simple steps, although documentation is cumbersome. But it is worth because it can help the doctor from future litigation, harassment and so many problems. This is need of the hour. Bottom line is “save the patient, but save yourself also”.

http://timesofindia.indiatimes.com/city/delhi/consent-must-before-invasive-procedures-consumer-panel/articles how/58618137.cms

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