Medical Regulation:Is it time to regulate medical business/ administrators of healthcare? “Oxygen cut, 30 children die in Gorakhpur hospital” who is responsible?


The inconsolable   catastrophic calamity in Gorakhpur Hospital is a mishap, which should be  preventable by good medical governance.   This is a real life example of negligence by poorly managed system, which has resulted in loss of multiple lives. Poor competence of administrators is more damaging, less containable, more damaging institutionally than smaller unintentional human errors by doctors. More than sadness, it is a painful surprise that such things can happen in present era of mammoth advancements! Until now, discussion on every such incidence stopped with blame on doctors in the end. No body will even try to look beyond doctor’s faults as it is easier to find some mistake or the other by retrospective analysis in doctor’s work or documents. That helps in cover up of system faults. Since ultimately it is only the doctor who is visible with the patient, doctor has to bear onus of each medical or non medical problems of health system. In routine circumstances, after the unanticipated death, one or two doctors  are made scapegoat, thrashed or harassed, unless proved innocent few years on, that also if they are lucky enough to have impartial investigation. Doctors carry the burden of universal expectations, thanklessness, threats and vandalism for bad outcomes, even in absence of proper health facilities. That is how, rest of medical industry, administrator  and non doctors associated with the health care,  mainly responsible for the problems,  enjoy   strange kind of immunity. But since now problems are overflowing  and big enough to unmask the real hidden people responsible for poor health care system in case an impartial inquiry is done.  Is it time to regulate all people including non doctors and medical businesses who are associated with health sector, in the manner doctors are regulated?

Oxygen cut, 30 children die in Gorakhpur hospital. Criminal negligence, row over unpaid bills hit encephalitis, neonatal wards.( Hindustan times)

 

Foremost admission is that we do not have a proper foolproof health care system. Strangely, the perpetual inadequacy of state healthcare infrastructure is never questioned.  Problems of electricity, oxygen, quality of drugs, medicine, quality of consumables, heath insurance implants and stents have very important role to play in treatment of the patient and cost associated with it. Doctors need essential items and can not work without  drugs and equipment , which are supplied by industry and procured by administrators.  Marketing, sales, pricing, insurance, quality  and all business deals  of these items are  beyond doctors preview. Therefore the  actual number of  non doctors  involved in health sector are beyond any imagination and these people  are not regulated in any manner. Ultimate blame is wrapped up by incriminating whole community of doctors, resulting  in misguided  conclusions. All these complex issues ends up with society inflicting a mode of self harm by mistrusting their savior.  In fact, there has been an article feeling a need for regulation of NHS managers, in a way same as doctors.

NHS Managers should face same regulation as doctors, says Francis

https://doi.org/10.1136/bmj.j2055 ( 25 April 2017)

Possibly it is time to unmask   and unveil the whole mammoth industry and regulate each and every person associated with health, in a manner same as doctors.  Role of non doctors , touts, different streams of medicine, administrators,  sales and marketing , medical  finance,  electricity, oxygen, cost and  quality medicine, drugs, consumables, implants and stents has very important   role to play and doctors should not be   burdened  with criticism for  all the mess created by all other people. Good health care system should be designed to prevent tragedies. Strict action after the event is just finding scapegoats.

Future medicine is beyond human limits: robots as doctor, till then human docs with robot like activity:


 

         The adage “To err is human” probably does not apply to the doctors. Doctors are definitely regarded different from rest of the humans and are not supposed to have privileges that other persons of humankind are guaranteed. Hence they are harassed often for any adverse clinical outcome even though it may be because of poor prognosis of patient. They work under continuous fear and stress and are punished for each small or big error. Then what are they? Modern slaves or human docs with robot like activity?

With advances in medical science, simultaneously there has been aberrant evolution of medical profession, education, regulation and medical industry. By provoking controversy about doctors for varied reasons, medical industry and law has intruded between the doctor patient relationship to take a centrestage in health care. Till now, doctor patient interaction was the central point of the health industry, a core around which medical industry revolved. Except this interaction, rest almost everything is controlled by industry.  If this interaction too is replaced by robotic machines, the control of medical industry over business of health will be almost complete. With the evolution of robotic technology and artificial intelligence, the dream of industry to have full control over health care business has become a realistic possibility.  There have been technical advancements to promote better treatment and diagnosis but these, at the same time, increase the cost of treatment and involvement and hence dependence on investors and industry. Complexity of medical science, industry, legalities and medical regulation has been multiplying everyday beyond human limits for doctors, at least in some specialties. Long years of training, Dealing and working with all complexities of medical system, all time retrospective analysis of their work by patients and lawyers, complex documentations, social media mudslinging, extensive and complex communication, technical advancements and legal interactions has taken a toll on the doctors and they are gradually ceasing to be normal human beings. They are slowly being converted to humans with robot like activity.

Also there is a thought whether doctors can be replaced by robots, completely or partly. Such talk of having machines is not without basis as all the stakeholders are feeling the need for a drastic change to have better and better medical care .

 

Future of medical profession: Robots as doctor:

  1. Usually doctors have to carry huge burden of expectation of society and patient. People want quick and effective treatment, without human faults, with an up-to-date medical knowledge delivered within moments. Unrealistic expectations are getting beyond human limits and these can be fulfilled only by robots.
  2. Since well trained doctors are lesser in number, they are expected to deliver a curative treatment with excellent accuracy with perfect documentation even when load of patients is extraordinarily high.
  3. Even in presence of extraordinary work load and difficult circumstances, doctor are supposed to maintain perfect documentation to save himself. Because later, any case can be subjected to legal scrutiny in future. Lawyers and courts will analyze retrospectively for years, with wisdom of hindsight and luxury of time, to find the faults and may punish the savior.
  4. Nobody wants to die. Even somebody with severe disease, with poor prognosis, have tendency to blame doctors for his illness, if he has contacted    Such incidences occurring too frequently cause feeling of hurt to doctors. Verbal and physical assaults is a routine. Robots will be immune to such painful thoughts and will not be affected mentally and continue to work perfectly in such circumstances.
  1. Training to be a Doctors are expensive and takes years. It takes painful long years and time. Human life span is limited. Therefore training a doctor and paying him life long, a bad business idea for industry and society. That is reason of unwillingness to pay even the rightful to the doctors. Robots will be a onetime investment. Life is one and span is less. Studies and gaining experience takes away good part of doctor’s life.  People from strong financial backgrounds avoid becoming doctors. Although they may opt for becoming health managers or investors.
  1. Human limitations, like tiredness, mood variation, feeling hurt, family issues, failure to apologize always in all situations (especially if doctor is not at fault), diagnostic  bias, limited knowledge   are various human factors with doctors, which are undesirable  for being a doctor and can be rectified easily with Robots.
  1. Available medical information is like a sea, that cannot be held in a hand. However brilliant doctor may be, he will know fraction of available knowledge. The moment we pass our exams, we start becoming out of date.
  2. Human bias always plays a role, because medical science is far from complete. Moreover rapid change in technology makes all knowledge and experience of a doctor redundant. Robots can be easily updated.

 Present medicine: human docs with Robot like activity:

As humans, doctors can make errors, get demoralized or dragged to courts or subjected to verbal or physical abuse, their mood and enthusiasm may be spoiled and may make more errors in other patients as well.  But they have to continue to perform as due to nature of their work does not allow them to have time to cool their mind. Repeated incidents make doctors immune to such mudslinging. Their reaction to these insults and distressing situations becomes blunt and reactions are subdued like that of a Robot.  Doctors themselves are slowly being converted to Robots like creatures.

  • Doctors do not react to unjustified verbal assaults of a patient, same as machine do.
  • They do not get demoralized easily because of moral assassination by media, calling them thieves, thugs and dacoits, even doing most helpful job in the entire society, saving lives. Now there is no reaction from doctors, when an uncommon or single stray incidence of adverse kind is used to portray all doctors in same light. This unwavering sanity looks like as if there have no apperception to perception of such poignant thoughts, same as Robots.
  • Many of them tirelessly work day and night without rest and food, along with verbal and physical assaults, accomplish arduous tasks like a machine.
  • Medicine is very complex and far from complete, still the precision executed by this wonderful community is no less than great machine “robot”. They executing all theory, practical and experience, application with in a trice. There personal emotions get a machine like toughness. They look like tough ship in such tornado, like a tough machine with no human weakness.
  • There is many things going in a doctor’s life, on professional and personal front. For example, care of sick, difficult family communication, perfect documentation, complaints, ongoing, court cases, declaring deaths, data maintenance, treatment and prevention of infections, nosocomial infections, medico legal suits, iatrogenic complications or simply genuine poor prognostic patients, unforeseen complications, unnecessary mudslinging by media and social media along with newer advances to cope with. There can be personal and own family issues as well. For a simple human being, it is difficult to accomplish all this complexities   immaculately and at the same time, while handling the ongoing patient load.
  • Doctors continue to work unaffected by continuous retrospective analysis and afflictive comments from practically every side, patients, administration and courts. All of them acquire wisdom off hindsight and have luxury of time to make an analysis.

 

Present and Future of medical profession:

Robots will be immune from errors and mood swings, tiredness and human limitations, hurt feelings, (will apologize always even if it is not their fault). And therefore legalities in the profession will be minimized.  No breach of protocol is possible. No questions or room for mistrust. Robots can do duties all seven days a week and 365 days a year. Public, Governments and medical industry will be happy. With Artificial intelligence and rapid advancement in robotics, doctors will have very little role in medical industry. Best part is that, it will be a onetime investment.

 

          Minor disadvantage:  Only things Robots lack human touch and feelings and will not be going extra mile for patient as compared to human doctors. Robots will just complete protocols. But with time, these   qualities will not be required anymore. There will be no humans to blame for the suffering of diseased, or to vent anger at. No human scapegoat will be there for physical or legal revenge. But till the time human doctors are   completely replaced by machine robots, ordinary mortals have to fill in and they will be human Docs with robots like activity (HUDOROLA).

Hyderabad’s Osmania hospital women doctor’s assault: Uncivilized society and irresponsible administration


Does this happen in any profession, while doing normal work, a female staff is assaulted  by mobs and no action is taken by a civilized society and a responsible government. 

Another shameful incidence in Hyderabad, where women doctors were beaten by mobs should have shaken the civilized society or any responsible administration and government. But in such chaotic environment, it does not make a news of importance to people, who matter and are responsible for controlling such uncivilized actions.

https://www.timesdelhi.com/2017/07/31/hyderabads-osmania-hospital-doctors-go-on-strike-over-violence-against-colleagues/ 

It is not just women rights commission, the silence of women activists, socialites etc, who cry hoarse for women rights, is perplexing. These organizations and individuals have been silent all along since the women being assaulted are “doctors”. No dharna, no protest or statement of condemn. Is that the situation that doctors are not having rights of normal human beings. 

Nearly 250 junior doctors and house surgeons have been boycotting their duties except for emergency services since Sunday night, demanding security for them and action against those involved in the attack. The strike by medicos hit services at OGH, one of the oldest hospitals in the country and the biggest government-run facility in Telangana.

Four attendants of a woman patient, who died during the treatment, assaulted two female junior doctors and a duty doctor on Sunday night, when The 70-year-old patient, who was in critical condition, died at Intensive Care Unit. Alleging that she died due to negligence by doctors, four of her relatives barged into the ICU and attacked them. It said this was the fourth incident at OGH in one month.

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.

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

Women doctor assault- – time worse than MAHABHARTA for women doctors

Cardio pulmonary resuscitation (CPR) by doctor: Match between life and death: more gripping than cricket match:


 

                  A young man in mid  twenties was wheeled in  to intensive care. He was unable to breathe and his oxygen levels and blood pressure was falling within moments. Within no time he became unconscious following which CPR was started along with other supportive measures. Echocardiography was managed meanwhile was suggestive of pulmonary embolism. CPR was continued and simultaneously, thrombolytic drugs were pushed in. His pulse kept on coming and vanishing with monitors sometimes showing activity of heart and improved oxygen levels. A team of around nine doctors and nurses was taking care of airway, central and other lines. There was almost an orchestrated movement of staff with drugs being administered with superfast speed. Commands being given by the treating doctor were followed in split seconds. In the same trice, the team leader had to think far ahead about how he would be handling the challenging dynamics of that young human life who was almost at its fag end.  He had to recognize, analyze and mitigate the situation within few seconds.   He had to make split decisions and still had to be flexible with his decision and plans, altering them according to the responsiveness of the patient.  Doing every bit in an electrifying instant, he had put in all his energy and experience to full use in those few seconds essential to save the young life. After around 35-40 minutes of high adrenaline rush time, the efforts paid off and silent   smiles on faces of  the team indicated that tornado had become manageable. The doctors and nurses, with sweat on foreheads, smiled quietly with mutual admiration. There was no clapping or cheering in this match of life and death to which the doctors and nurses are well accustomed.  There were no spectators to encourage the team. The return of a robust pulse is all the cheering this team needed. There was no one to witness and applaud the zeal and anxiety of these performers, not even patient himself.

                     Incidents such as one described above are common occurrences in medical practice. It takes a lot of inner mental as well as physical strength besides emotional resilience to tide through such situations. Even relatives, when required, are not able to sustain the adrenergic drive required at these times.

                      Unlike the case above, the result may not be favorable in certain cases. It is not uncommon for relatives, to then question and start sparring match with doctors and nurses in case they fail in their brave attempt. Often even in successful resuscitations, questions are asked in preposterous manner about the incident. Doctors and nurses may even be verbally and physically abused if they fail despite their best efforts. Relatives can be vengeful and drag them to court to harass and punish them. Common assertion about the wrong injection is almost universal, even in most difficult scenarios. Courts and lawyers, deliberating over years with luxury of time, may find something or other to punish the savior, by doing retrospective analysis or by the wisdom of hindsight. Even if court rules after years that the doctor was right, revenge of patient’ relatives, monetary benefit to lawyers and harassment of doctor, both mentally and emotionally is complete. But they still carry on their noble job and though pained by these issues, doctor will just go to another bed and see what he can do for another patient. This cycle continues, every minute, day and night, all year round. Thousands get gift of life every minute by this wonderful community of doctors and nurses, irrespective of injury inflicted on them.                                                                         

                   After the abovementioned incident of successful CPR, I just went to doctor’s room to have tea and a cricket match was going on, streamed live on TV. On the screen, thousands of people were seen clapping and cheering the player who was swinging his arm ready to throw the ball and also the batsman. But to me, the adrenergic rush here was no match to what I had just experienced in the ICU. The cricket match was merely a trifling entertainment with a futile outcome. Every day in each hospital, there are one or more magnificent matches of life and death played without any spectators. Many a times our players (doctors and nurses) win and thousands of lives are salvaged back from brink of death. These extraordinary matches finish with just quiet smiles. There is no one to clap or cheer and no recognition or prizes to the player for winning these match of life and death. Few good patients and relatives, who do realize the magnitude of the act offer heartfelt thanks. The respect, trust and support of the relatives at such times is all that a doctor needs to rev up for his next case, a real match in true sense. In comparison to this frantic match of life and death, rest of all matches are insensate. 

Suicide by medical student : Global, world wide Rotten system of medical education


A Resident doctor student of Surgery at GMC  Surat allegedly committed suicide last week by jumping from ninth floor. He blamed work pressure and torture in his suicide note. Actions and conversations are generated only after some terrifying incident and finish with making few scapegoats to blame for  one, like five seniors doctors in this case. But the whole system continues to function in same      inhuman way.  This rotten system ignores the deleterious culture of medicine and dangerous working conditions to which junior doctors are subjected.

http://timesofindia.indiatimes.com/city/surat/5-booked-for-abetting-suicide-of-gmc-doctor/articleshow/59463184.cms

Medical students enter medicine as inspired, intelligent, compassionate humanitarians. Soon they turn into cynical and exhausted humans. How did all these totally amazing and high-functioning people get so disillusioned so fast?

Problem does pertain to doctors all over the world, as evidenced by suicide by Dr Chloe Abbott in Australia in January. Her sister Micaela said she was Eaten Alive by the medical profession.

http://www.dailymail.co.uk/news/article-4325812/Investigation-medical-profession-suicide-epidemic.html

 

Inhuman duties, neglect, apathy of regulators towards genuine problems, chaotic  system of working have left doctors, specially in residencies vulnerable to mental illness. Sometimes even driving them to suicides  because of  system failures of medical  administration and inaction by Government.

The terrible conditions have engulfed not only junior phase of doctors, but continue for longer period of their lives, for most of doctors. Because medical professionals find themselves  at the wrong end of stick of government, courts, media for brutal expectations. They face public wrath for system failure.  There is an urgent need for change in work culture and regulations, to make conditions safe for doctors. Grueling shifts, inhuman working hours have to end now, if society really wants to be treated by good doctors.

 

Untenable working conditions, long inhuman hours, unrealistic expectations of patients and thereby creating pressure situations, fear of complaints, physical assaults and medical lawsuits have killed profession largely. Bullying and harassment from all possible quarters is unavoidable consequence.

My earlier article “ enslavement of medical profession” highlights the plight of doctors.

  Almost every doctor will have horror stories to tell, about working conditions. For which medical regulators should be ashamed, there is nothing to be proud of.

      

Happy doctors day:  merely a hollow slogan?


On 1st of July, doctors are usually greeted from multiple quarters. Newspapers, media and some prominent people  congratulate doctors in their speeches or on their social media pages. However, what doctors need are not just verbal wishes but reinforcement of public’s belief in them . It is this renewal of faith in their saviour which will help  doctors in discharging their duties smoothly and in alleviating their problems.

National Doctor’s Day: India, USA

Despite the paucity of the highly trained medical professionals, the identity of medical professionals as a community in society is not getting its due right  because of  misplaced priorities of  certain people. The society tries to impose a stereotype role on them in an effort to control them fully. And as a result of these various controls, regulations and public pressure, doctors experience unrealistic performance pressure on professional front.

     Doctor is the pivot  point between patients, medical industry, government and insurance sector. Huge number of patients, expensive medicines, poor medical infrastructure has produced tremendous resentment against medical system amongst public. But the brunt of this entire angst has to be borne by the doctor or medical professionals alone. Often they are blamed for circumstances beyond their control and punished for system failure. Fear of public wrath and lawsuits is smothering the medical profession.  And increasingly there is a feeling amongst medical professionals that they are getting a raw deal despite doing their very best.

     In such a situation, there should be some introspection by all stakeholders every year, on doctor’s day. The doctor’s day should be more than just greetings and wishes for doctors. Some real resolutions need to be  taken so that their working atmosphere and eventually delivery of medical care is improved and this ultimately will benefit patients only.  I can think of some much needed changes-

1.       Government should take some concrete decision to improve medical  infrastructure and manpower. A better planning needs to be done to spend more for health of people, availability of resources and for improving the working conditions for doctors. Government should ensure that doctors are better protected.

2.       Medical industry should collectively think of protecting doctors or there should be provision for some financialresponsibility of medical lawsuits of all doctors.  Pharmacy industry, medical device industry, insurance industry  and others earn huge profits because doctors need to use their products. Although medical industry makes huge profits still they remain behind the scene.

3.       Police should provide  assured protection to  doctors better against physical violence.

4.       Medical education institutes should resolve to promote the education of best doctors and not indulge in profiteering in education of doctors.

5.       Courts should take an initiative to protect doctors against frivolous lawsuits ( which are often done to prevent paying their bills), revengeful attitude of patients  and harassment?

6.       On doctor’s day, public should resolve that they will not unnecessarily fight or abuse the doctor.

7.       And last but most important is that all medical practioners , be it allopathic, ayurvedic, unani, homoeopathic or others who play a role in maintaining health of patients, affirm that they will do everything to protect dignity and integrity of this profession.

If the above are not practised and followed, then mere sloganeering on doctor’s day  makes no sense . The  effort to improve training and working condition of doctors has to come from the bottom of the heart of all those involve, both giver and taker.  Mere tokenism on a day in a year is of no real purpose. If the present scenario continues, soon a common man will have problem in accessing good medical care which is currently available at nominal cost . One needs to ponder seriously, if we do not save doctors, who will save us? 

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.

 

 

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.

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