Doctors treating anarchic & lawless society # Doctor killed for perceived negligence


   In an act of revenge that took over two years, a doctor with a government hospital in Yavatmal – 650 km from Mumbai – was shot dead, allegedly by a family member of his patient who had died under the doctor’s supervision two years ago.

   Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system.  Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession.  The impunity with which criminals can dare to take law into their hands and punish doctors instantly at will is a blatant disrespect to courts and judicial system. In absence of strict laws for protection of doctors, health care workers have become vulnerable to  assaults and revenge.

    Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide  health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

            Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project   single stray incident   as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves.

 Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who are unable to retaliate to the powerful media machinery.   Role of doctor associations, parent institutes have been spineless and not encouraging.

        The demonstration of the cleft that separates doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.  

Relatives shot and kill doctor for perceived negligence

Family members of the patient had alleged that it was due to the negligence of Dr Hanumant Dharmakare, medical officer at the R P Uttarwar Kutir Hospital, that their son Arbaz (20), who had met with a bike accident, died in May 2019.

The police are on the lookout for the main suspect, Aifaz Shaikh, the elder brother of Arbaz, who is believed to have shot the doctor.On January 11, Dharmakare was shot dead in broad daylight by an unidentified person on the Umarkhed – Pusad Road in Yavatmal. The police team found that the application concerned the death of his nephew Arbaz.When the police questioned Tousif further, they found that his nephew Arbaz had met with an accident on May 4, 2019. Arbaz had been riding a bike with his brother Aifaz (then 22) and a relative Moshin, when the accident took place.The family had rushed the trio to the local hospital, where Dharmakare was the on-duty doctor. The family alleged that due to negligence on the part of the doctor, Arbaaz lost his life. The family even had a fight with Dharmakare and they allegedly threatened that he would have to pay for his actions. Bhujbal said that during the police investigation, they found that for the past two years, the family had been looking for an opportunity to get back at Dharmakare. They had kept an eye on his movements even earlier this year, following which they decided to allegedly kill him last Tuesday. It was Arbaz’s elder brother Aifaz who allegedly fired at the doctor and fled from the spot on the bike.

Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.

   Good Governance lies in prevention of such incidents. Knee-jerk policing activities after every incident are of limited benefit.   Moreover  the  impunity with which people  dare to take law into their hands and  tend to punish doctors instantly for perceived negligence,  is a blatant disrespect to courts and judicial system.

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     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

 Side Effects-Implementing Medical-Consumer-Protection-Act in Haste


        Medical consumer protection act was implemented in 1995. Patients defined as consumers and hence doctors converted to service providers in lieu of some money.  Consequently the changed definitions altered the doctor-patient relationship in an irreversible way. Instead of the earlier congenial relationship, now-a day’s doctors and patients are fighting in courts, whereas most of aspects of the law still remain grey after 26 years of implementation. Here in this case even courts differ in the interpretation (among themselves) of the law after more than two decades of its implementation.

        The doctors are supposed to treat, provide relief and save lives are the most affected, it is needless to say that the way of treating patients has been altered like never before. Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on someone’s confidence and belief, which takes a lifetime to build.

   The reality is that neither doctors, nor patients were ready for such a legal relationship, and the system was not robust enough for such a change.  To work with weak infrastructure, non-uniform medical education along with legal threats pushed doctors into a shell and forced defensive practice.  It caused erosion of doctor-patient relationship and escalated cost of care.

   Medical business, insurance and legal industry made full use of the opportunity to have the benefits of changed doctor-patient relationship.  Doctors were used as scapegoats for poor infrastructure by administrators and further exploited by law industry.

   Justice eluded doctors at all stages.

      It is discouraging for medical professionals to note that courts are still clarifying the law even after 26 years of its implementation.  What is more disheartening that many more aspects about the medical-consumer protection act are either remain  unclear and create difficulty for doctors.  To differentiate medical mistakes, poor prognosis from negligence is a very fine line and difficult to judge. Therefore medical profession has  become  a subject to blackmail by patients, lawyers and sitting ducks for punishments. The consequent insecurity among doctors, practice of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment)  are few of the  side effects, which will  definitely be passed on to the patients inadvertently.  After all doctors have to save themselves as well.

 Consequently being consumer may be overall a loss making deal for the patients.

     The point to ponder is that courts themselves differ on interpretation of law even after 26 years of its implementation.  

The Supreme Court has reiterated that service rendered by medical officers on behalf of a Hospital, free of cost, would not fall within the ambit of  medical consumer protection act.

https://www.livelaw.in/top-stories/consumer-case-not-maintainable-over-medical-services-given-free-of-charge-doctor-salary-hospital-supreme-court-187291

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     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Justice Delayed to Doctor- Vindication # Supreme-Court # Medical-Negligence?


It has taken 23 years to end harassment of a doctor to decide upon a problem, which should not have been there at all. Practically doctors can be dragged to courts, blackmailed, harassed and assaulted with impunity just because of any adverse outcome.  So the legal and illegal demonization of medical profession has become a routine, while law industry makes merry at the cost of doctors.  Natural complications, genuine poor prognosis, and death that occur after some treatment can be easily pinpointed to the doctors. Saviours are fighting the death as well as court cases to save themselves. In this case, Supreme Court was kind enough to give a favourable verdict, but not all doctors are lucky enough. Many suffer because of frivolous cases, poor medical governance and unwise decisions.

 Doctor can’t be held guilty of negligence just because a patient died: Supreme Court

    The bench said: ‘In spite of the treatment, if the patient had not survived, the doctors cannot be blamed as even the doctors with the best of their abilities cannot prevent the inevitable…’ A doctor can assure life to his patient but can only attempt to treat everyone to the best of his or her abilities, said the Supreme Court.

      No doctor can assure life to his patient but can only attempt to treat everyone to the best of his or her abilities, said the Supreme Court on Tuesday, as it underscored that a doctor cannot be held guilty of medical negligence just because a patient has not survived.

“There is a tendency to blame the doctor when a patient dies or suffers some mishap. This is an intolerant conduct of the family members to not accept the death in such cases. The increased cases of manhandling of medical professionals who worked day and night without their comfort has been very well seen in this pandemic,” lamented a bench of justices Hemant Gupta and V Ramasubramanian.

The bench added: “In spite of the treatment, if the patient had not survived, the doctors cannot be blamed as even the doctors with the best of their abilities cannot prevent the inevitable…The doctors are expected to take reasonable care but none of the professionals can assure that the patient would overcome the surgical procedures.”

  It underlined that there must be sufficient material or medical evidence should be available before the adjudicating authority to arrive at the conclusion that death is due to medical negligence. “Every death of a patient cannot on the face of it be considered to be medical negligence,” said the bench.

The court said this while allowing an appeal filed by Bombay Hospital and Medical Research Centre against the National Consumer Disputes Redressal Commission’s order to pay ₹14.18 lakh to the family of one Dinesh Jaiswal, who died in June 1998 following unsuccessful surgeries of his gangrene in his limbs.

The family attributed Jaiswal’s demise to negligence in conducting surgeries, absence of the treating senior doctor, lack of operation theatre, and a broken-down angiography machine. The hospital, however, refuted all allegations, stating the best possible treatment by present medical professionals and within the resources available was provided.

In its 2010 judgment, the national consumer commission invoked the principle of “res ipsa loquitur” (mere occurrence of certain event can lead to an inference of negligence of the other side) to hold the hospital guilty of medical negligence.

But the top court on Tuesday set aside this judgment, noting the order suffered from legal as well as factual infirmities.

“It is a case where the patient was in serious condition impending gangrene even before admission to the hospital but even after surgery and re-exploration, if the patient does not survive, the fault cannot be fastened on the doctors as a case of medical negligence. It is too much to expect from a doctor to remain on the bed side of the patient throughout his stay in the hospital which was being expected by the complainant here. A doctor is expected to provide reasonable care which is not proved to be lacking in any manner in the present case,” held the bench.

The court underlined that there was never a stage when the patient was left unattended and mere fact that the main treating doctor had gone abroad cannot lead to an inference of medical negligence because the patient was admitted in a hospital having 20 specialists in multi-faculties.

“The patient was in a critical condition and if he could not survive even after surgery, the blame cannot be passed on to the hospital and the doctor who provided all possible treatment within their means and capacity,” it said.

On the aspect of delay in re-exploration after the initial surgery threw up complications due to non-availability of an operation theatre, the bench noted that it was only a matter of chance that all the four operation theatres of the hospital were occupied when the patient was to undergo surgery.

“We do not find that the expectation of the patient to have an emergency operation theatre is reasonable as the hospital can provide only as many operation theatres as the patient load warrants. If the operation theatres were occupied at the time when the operation of the patient was contemplated, it cannot be said that there is negligence on the part of the hospital,” it said.

The court added that a team of specialist doctors was available and also attended to the patient but “unfortunately, nature had the last word” and the patient breathed his last. “The family may not have coped with the loss of their loved one, but the hospital and the doctor cannot be blamed as they provided the requisite care at all given times,” it maintained.

The deceased’s family was paid ₹5 lakh as interim compensation by the top court in March 2010 when it had agreed to examine the hospital’s appeal. The bench said that this amount shall be treated as ex gratia payment to Jaiswal’s family and will not be recovered by the hospital.

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Poverty of justice-Doctors and nurses scapegoats # arrested for hospital fire


     In present era,  Doctors and Nurses have become sitting ducks for assaults, punishments and harassment for every reason, inept medical system, whether right or wrong.  An unfortunate example of  not only  plight  of  health care workers but the strange kind of governance, is the  arrest of doctor and nurses  at  Ahmed Nagar -Pune blaming them for fire in the hospital.  Strangely, the administrators and staff responsible for the maintenance and infrastructure safety are not in the picture.

      Making health care workers scapegoats for such tragedies just reflects not only the inept governance and poverty of justice but also the callous attitude of authorities  towards real issues.

Ahmednagar hospital fire: Medical officer, 3 nurses arrested

A medical officer and three staff nurses were arrested Tuesday on charges of causing death by negligence and culpable homicide not amounting to murder after 11 people lost their lives last week in a fire incident at a hospital in Maharashtra’s Ahmednagar district. Medical officer Dr Vishakha Shinde, and staff nurses Sapna Pathare, Asma Shaikh and Channa Anant were arrested under sections 304 and 304A of the Indian Penal Code (IPC), said Manoj Patil, Superintendent of Police, Ahmednagar rural police.

Quoting Ahmednagar police, HT earlier reported that 70% of deaths were caused by smoke from the fire while the remaining died after directly getting caught in the blaze that broke out in the Intensive Care Unit (ICU) of the Civil Hospital. Most of them were senior citizens undergoing treatment for coronavirus disease (Covid-19). In connection with the incident, an FIR was registered against unidentified persons under Section 304(A) of the IPC.

The fire broke out last Saturday at 11am on the ground floor of the hospital, where 17 patients were admitted, of which 15 were on either ventilator or oxygen support. While 10 patients died in the blaze at the spot, one person later succumbed to injuries.

Alleging that the State Government was attempting to shift the blame on personnel on the ground after the tragedy, the protesting members of the medical fraternity blamed the Government for negligence in not conducting regular fire audits, while claiming that the District Civil Surgeon, who was recently suspended, had sought State funds to set up a fire safety system, none were forthcoming from the administration.

Dr. Anil Athare, president, IMA, Ahmednagar said it was shocking that clauses of Section 304 and 304A were applied against the medical officer and the three nurses, remarking that doctors and nurses were “always made scapegoats” in such cases.

“Instead of accusing the medical staff on ground, why is anyone not questioning the officials of the Public Works Department (PWD) and Electrical Department regarding wiring and maintenance works which caused the fire in the first place,” said Dr. Athare, demanding that the arrested medical personnel be released immediately.

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Doctor  treating celebrity (Puneeth Rajkumar): Faces new kind of problem


Previously the death of any patient was thought to be because of natural causes or God’s wish. But in present era of consumerism, first possibility is to blame the doctor and not the disease or natural causes. The doctors treating celebrities are likely to face the ire of fans as they can be easily blamed for the death. Doctors need to be more careful especially about documentation while treating the celebrities. Not only doctors will be at risk of physical assaults or loss of reputation but they should be ready with legal scrutiny as well.       

Bengaluru: Late actor Puneeth Rajkumar’s doctor gets police protection

This comes after the Private Hospitals and Nursing Homes Association sought protection for Dr Ramana Rao and other medical professionals who were involved in the treatment of the late actor as there were allegations of “medical negligence” doing the rounds on social media.

A week after Kannada superstar  Puneeth Rajkumar owing to a cardiac arrest in Bengaluru, his family doctor has been provided police protection in the wake of several fans alleging “medical negligence”.According to Bengaluru City Police, a KSRP platoon has been deployed outside the residence and clinic of Dr Ramana Rao at Sadashivanagar. “We are closely monitoring the situation near these areas with intensified patrolling to avoid any untoward incident,” a senior officer confirmed.This comes after the Private Hospitals and Nursing Homes Association (PHANA) sought protection for Dr Ramana Rao and other medical professionals who were involved in the treatment of the late actor. In a letter addressed to Chief Minister Basavaraj Bommai, PHANA president Dr Prasanna H M had expressed concerns about “attempts by fans and well-wishers” to discuss the medical condition of the deceased, which he felt was “a gross violation of the healthcare privacy of an individual or a family”. “We strongly oppose attempts by the public to point fingers at the treating physicians, especially Dr Ramana Rao, who did his best,” Dr Prasanna wrote. The Association has also pointed out that certain TV and social media platforms were running narratives “blaming lack of care by the medical professionals” who offered services to the late actor. “This kind of judgemental and hypercritical media frenzy is creating distrust in society as well as risk to the lives of the medical professionals who served the deceased,” the letter stated.Further, PHANA also requested Bommai to give a public statement in an attempt to boost the morale of the medical fraternity. “After all, we know that the medical profession has limitations, and saving lives is not always possible,” the letter added.

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     25 factors- why health care is expensive

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     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Medical Negligence? Doctor removes kidney instead of stone


Doctor- save the Patient but save yourself also

KMG General Hospital in Balasinor, Gujarat has to pay Rs 11.23L compensation to patient’s relative after the doctor removed his left kidney after the patient was admitted for removal of kidney stones.

Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, and can have high complication rate. Merely because a Kidney has been removed for stones can’t be negligence on part of surgeon.  Doctors need to save themselves while taking decisions in good faith. Natural complications can be easily labelled as medical negligence because of faulty definitions of consumerism applied to complex medical scenarios.

Doctors need to be careful on following points as any adverse event can lead to professional hanging.

Communication- Possibly appears to be the main mistake. Doctor could have communicated the need for kidney removal, instead of doing it in good faith. One should remember the strings of consumerism applied to medical science and not the good intentions.

Informed Consent: Many times, surgical plans change during surgery. Therefore consent has assumed an important role in present era. There was no consent for Nephrectomy, but done in good faith. In absence of consent, Whole blame and responsibility is shifted to  the Surgeon. An informed consent will avert untoward aggression apart from legal entanglements.

Performing in suboptimal facility– as newspapers says, Raval was advised to go to a better facility, but he chose to undergo surgery in the same hospital.  Doctors should now be careful to operate, if facilities are not available. They should refrain from taking blame for suboptimal infrastructure.  

Wrong Projection of the problem by media; As the paper says- “The surgery was just for removal of stone from the kidney and the consent was taken for removal of stone only, but the kidney was removed instead”.

  Merely because a  Kidney removed for stones can’t be a negligence on part of the surgeon. It is a procedure which is not uncommon.

Medical Opinion of  experts: The news report doesn’t tell about the expert medical opinion. How in the given circumstances, negligence is proved?  Has any competent surgeon given a report of negligence or it is merely because the patient has died.

KMG General Hospital in Balasinor has to pay Rs 11.23 lakh compensation to a patient’s relative after the doctor removed his left kidney after the patient was admitted for removal of kidney stones, ordered the Gujarat State Consumer Dispute Redressal Commission. The patient passed away four months after the vital organ was taken out.According to the report, Devendrabhai Raval from Vanghroli village of Kheda district consulted Dr Shivubhai Patel of KMG General Hospital in Balasinor town for severe back pain and difficulty during passing urine. In May 2011, Raval was diagnosed with a 14 mm stone in his left kidney.

However, Raval was advised to go to a better facility, but he chose to undergo surgery in the same hospital.

He was operated upon on September 3, 2011. The family was surprised when the doctor after the surgery said that instead of the stone, the kidney had to be removed. The doctor cited it was done in the best interest of the patient.Later on, when the patient began having greater problems in passing urine, he was advised to shift to a kidney hospital in Nadiad. Later when his condition deteriorated further, he was taken to IKDRC in Ahmedabad. He succumbed to renal complications on January 8, 2012. Minaben, Raval’s widow, approached the Consumer Dispute Redressal Commission at Nadiad, which in 2012 ordered the doctor, the hospital and the United India Insurance Co Ltd to pay compensation of Rs 11.23 lakh to the widow for the medical negligence.

The district commission’s order brought the hospital and the insurance company to the state commission over the dispute as to who should be held liable to pay compensation. After hearing the dispute, the state commission observed that the hospital had the insurance policy for indoor and outdoor patients, but the insurer was not liable for medical negligence by the treating doctor. The surgery was just for removal of stone from the kidney and the consent was taken for removal of stone only, but the kidney was removed instead. Thus, it is a clear case of negligence on part of the doctor and hospital, reported Times of India.

Doctor- save the Patient but save yourself also

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Want to be a doctor? Medical Middleman may get you killed


Increasing murderous attacks and assaults on doctors is  worrisome, an indicator of a lawless, uncivilized society, poor governance and broken health system.

      Think of a profession, where a brilliant student  studies hard for 10 to 15 years, does day and night duties, save innumerable lives. Start earning pittance and get conveniently labelled as thug, thief and butcher by Medical Middleman. These brilliant doctors can be abused, assaulted and  dragged to courts with impunity. They have become sitting ducks for punishments and physical assaults or can get killed because of instigation created by MEDICAL MIDDLEMEN.

Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable.

   Who are these Medical middlemen? How they have benefited enormously by using one single selective negative narrative?

All those, who with some clever tricks, have placed themselves between doctor and patients. They earn money by promoting mistrust between the two actual stake holders. These Middlemen have no stake, but still want to get benefited by stroking emotions.

         One poor outcome out of millions lives saved,  is enough for these  opportunistic parasites to portray whole medical community as dystopian one.

   Most important of these Middlemen  are the ‘Reel heroes’ who in a quest to be projected as Real heroes,  got   placed themselves between doctor and patient by airing vague narratives. By self-appointing themselves as custodian of health of masses, ‘the Reel heroes’ and celebrities gave true meaning to their work of ‘ACTING’ that otherwise was no more than a trifling entertainment.

         Media and many celebrities have used fear in public mind to garner accolades and money for themselves, but at the same time created paranoia in minds of people against medical profession.  And when masses worshipped ‘the Stars’ as  their true well-wishers, they aired advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

   Media and celebrities made money and fame by riding on the vulnerability of medical profession.   By winning the faith by demonization of doctors, all these middlemen sold their products, news items shows  and created a brisk business.

         Words used cleverly by such middlemen are ‘Few Doctors’. What majority of other doctors do to save millions was not of much concern and consequence. Public would not know, how to differentiate good or bad ones.

 But this was merely a posturing on television;  to be a Real hero, actually  signified  nothing for those unknown ‘Few doctors’, but the  denigration of medical profession and  attempts to belittle the whole doctors’ community was full and complete. The mistrust generated and demonization of the real well wishers of the patients was irreversible.

These middlemen instigated masses against health care workers by their acidic comments and vitriolic spewed venomous words.

 The consequence was the loss of trust on their doctors, the only ones, who were in position to help patients in the emergency situations. The taunts and torment on doctors multiplied manifold in many forms verbal, legal, abuse and physical assaults.

 These MEDICAL MIDDLEMEN, with distorted projection   earned huge accolades and money, but they promoted feelings of enmity or hatred between doctor and patient.

 The aspiring doctors need to know the media role in today’s times. They would carry the image, whatever media projects.  A clear understanding in required, before they sacrifice their youth and life without knowing what is in store for them at the end of the long tunnel of study and training.

   Students while choosing medical career, should take a well informed decision before entering this profession, which is dangerous to doctor themselves even when discharging their duties in the best manner.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

Doctor’s assault a medical emergency: Silence of authorities appalling


    Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system. Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide  health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.

      Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.

       Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They projected single stray incident   as an example and portrayed as generalization just to earn money and fame for themselves.

    Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who were unable to retaliate to the powerful media machinery.   

        The demonstration of the cleft that separated doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.  

           Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession.  Role of doctor associations, parent institutes have been spineless and not encouraging.

         Such bestiality should create havoc in minds of civilized people but this apathy to such incidents clearly indicates otherwise. Have we become so uncivilized 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 realize that this is the time to unify and condemn such episodes vehemently and prominently so that the miscreants realize that they cannot get away with it.

  Doctors in remote area, where there are minimal medical facilities, doctors are at more risk than ever; they are at mercy of local goons with no protection.

        Silence of lords is a death sentence to the medical  profession as a whole.

    Doctor assault is definitely a poor advertisement for the medical students, who want to be doctors or others who want to buy a private medical college seat by paying millions. Why should one become doctor or  pay millions and bear risk of being beaten or killed, while doing such a stressful duty. People will be fearful to be doctors on a free seat, leave alone on the paid seat.

 The People who rue the scarcity of good doctors, should now introspect, “do they deserve to have good doctors?”

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

#Medical-Consumer-Protection-Act: Pros & Cons: Advantages & disadvantages


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.

             25 factors for rising cost and expensive medical 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.

              Disadvantages  of being a doctor, nurse

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 workexcessive 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 industryWindfall 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.

21 occupational risks to doctors and nurses

Reel Heroes vs Real Heroes

Violence at #NMMC HOSPITAL VASHI Mumbai- shame on law and order agencies


Attacks and assaults on doctors appears to be  one of the indicators of  a lawless and uncivilized society and  poor governance.  Doctors  have become punching bags for all the malaise prevalent in the  health system. A failing and inept system, which is unable to provide health to people and  security to doctors. The system  hides behind their working  doctors and presents them as punching bags. The  impunity with which attendant easily and brutally assault doctors and vandalize hospitals  is really appalling. Similar violent incidents all over  should be  shameful  to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission and similar organizations.

     Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling. 

 Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as generalization, just to earn money and fame.

    Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously..

      Merely taking some token  action and showing  protest will not solve the problem. It does not compensate for the  damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be  the ultimate sufferer, does not need a Einstein brain to predict.

                    This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients.  Why would someone try complex surgeries, if there is greater  risk involved? Few will limit themselves to follow protocols. Going extra mile  along with risk, which not everyone will like to take. Many will become health managers or do something else than do active clinical work. Who should risk his life while doing routine work?

     Patients might get their revenge for the  naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.

Patient relatives vandalized NMMC Hospital Vashi, Mumbai

Relatives were booked for vandalising the Navi Mumbai Municipal Corporation (NMMC) hospital in Vashi following the death of a 50-year-old man. Of the seven, the four men were arrested. The patient, Venkatesh Suryavanshi, a resident of Juhu gaon, was shifted from a private hospital in Koparkhairane to the NMMC hospital on Tuesday afternoon. At the time of admission, Suryavanshi, who had tuberculosis, was in a critical condition and had very low oxygen levels. An antigen test had declared him negative for COVID-19.“At the time of admission, after checking his condition, vitals and the history papers, we had said that his chances of survival are very less. He was admitted to the ICU ward,” Prashant Jawade, medical superintendent, NMMC hospital, said.Suryavanshi died during treatment around 3.45 a.m. on Wednesday. After getting to know about the death, his sons Rupesh (22) and Sandesh (20), along with their friends Pankaj Jadhav (22) and Rohit Namwad (32) entered the ICU ward and started vandalising the department. Three women who followed them assaulted security guard Satish Dere.“I was told that they also carried a few sharp weapons with them. The security guard has received injuries. Our engineers are analysing the damage and finding the losses that we incurred,” Mr. Jawade said. Chief Medical Officer Majur Shaikh and a few other hospital staff were also allegedly attacked.

According to the police, the seven had vandalised three ventilators, one dialysis machine, two fans, one table fan, and two nurse stations.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

    21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

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