In a medical first, doctors transplanted a pig heart into a patient in a last-ditch effort to save his life and a Maryland hospital said Monday that he’s doing well three days after the highly experimental surgery. While it’s too soon to know if the operation really will work, it marks a step in the decades-long quest to one day use animal organs for life-saving transplants.
In 1997, Dr Dhani Ram Baruah, along with Hong Kong surgeon Dr Jonathan Ho Kei-Shing, carried out a pig-to-human heart and lung transplant in Guwahati (India). The transplant stirred controversy all over and both the doctors were arrested within a fortnight for culpable homicide and under the Transplantation of Human Organs Act, 1994, and imprisoned for 40 days.
The fault of Dr Baruah was that he was on the wrong side of the laws prevailing at that time. But now after 25 years USA has provided evidence that he was scientifically ahead of his times; hence punished and sent to jail for the same reason. Instead of updating the laws, accepting and promoting the scientific advancement and encouraging the brilliance of the doctor, he was put in jail. The result is that now everyone is hailing the feat of doctors in USA for the same surgery that Dr Baruah dared to perform 25 years ago.
In a patient with terminal heart failure, life is only possible if heart transplant is done. Human heart is difficult to be procured.
The point to ponder is that whether Laws should be made or may be updated to promote or help scientific brilliance or it is wise to follow them blindly without application to future wisdom. Instead of punishing and sending Dr Baruah to jail, Laws could have been modified or updated to help the path breaking advancement, which could have helped patients and saved lives.
Such high handedness of authorities just point to an ecosystem, where scientific advancements and individual brilliance are not respected.
As doctors in the United States hail the path-breaking surgery in which a patient is recovering after receiving a heart from a genetically modified pig in Maryland, it evokes memories of an Indian doctor who had attempted the same over 20 years ago in Assam.
We go back in time to take a look at the case in which Dr Dhani Ram Baruah, a transplant surgeon from Assam conducted a pig-to-human heart and lung transplant in Guwahati and why that incident got shrouded in controversy and led to him being imprisoned for 40 days.
In 1997, Dr Dhani Ram Baruah, along with Hong Kong surgeon Dr Jonathan Ho Kei-Shing, carried out a pig-to-human heart and lung transplant in Guwahati.
A Times of India report says that Dr Baruah transplanted a pig’s heart into a 32-year-old man, who had a ventricular septal defect, or hole in the heart.
According to Dr Baruah, the surgery — conducted at his very own facility, the Dhani Ram Baruah Heart Institute, and Institute of Applied Human Genetic Engineering at Sonapur outside Guwahati — was completed in 15 hours.
However, the 32-year-old man “developed new anti-hyperacute rejection biochemical solution to treat donor’s heart and lung and blind its immune system to avoid rejection”, reported the Indian Express, and he died a week later.
The transplant stirred controversy all over and both the doctors were arrested within a fortnight for culpable homicide and under the Transplantation of Human Organs Act, 1994, and imprisoned for 40 days.
The Assam government formed an inquiry into the case and found that the procedure was unethical.
The inquiry also found that the Dr Dhaniram Heart Institute and Research Centre had “neither applied for nor obtained registration” as required under the transplant laws.
What happened next?
After being in jail for 40 days, the doctor returned to his clinic but found it to be destroyed. A Times of India report added that he spent the next 18 months under virtual house arrest.
But, the doctor, who faced taunts, continued his research.
Dr Baruah hit the headlines again in 2008 when he claimed that he had developed a ‘genetically engineered’ vaccine that would correct congenital heart defects.
In 2015, he once again became popular after claiming to have discovered the ‘cure’ for HIV/AIDS and that he had ‘cured’ 86 people in the past seven-eight years.
He also wrote to the UNAIDS, WHO and the National Institute of Health of USA to tell them of his ‘successes’ and was open to scrutiny.
The 300-page book contains 20 stories divided into three parts viz – Larva & Pupa Syndrome, Hope & Fear & Medical Lawsuits. The book is available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive etc.
While doctors are usually blamed for any mishap, be it natural poor prognosis or genuine complications, rarely people get to know their side of the story — how a dying patient affects their psyche, how they deal with these patients and their kith and kin, what are the kinds of abuse and threats made when they are not able to save a life despite their best efforts. Dr Pankaj Kumar, Director Critical Care at a Delhi Hospital, India has come out with an insightful account of these very aspects of a doctor’s life.
His book ‘At the Horizon of Life & Death’ is a Reality Fiction that reflects the sensitivity involved in dealing with patients facing death.
Through the eyes of its protagonist Dr Anand, the book captures significant moments in the treatment trajectory of critical patients. The book tries to create awareness regarding pertinent issues faced by the medical professionals like demoralisation, expensive medical education, the extreme pressure and suicidal ideation, the plight of the nurses and support staff, assaults and violence and the medico-legal intricacies involved in day-to-day practice among others. The author has also taken care to guide aspiring doctors to make well-informed career decisions.
Part One (Larva & Pupa Syndrome)- talks about the expensive medical education, and the issues students face in medical college.
Part Two (Hope & Fears) talks about the beginning of doctors’ professional journey, the disease demons they face while dealing with critical patients, dilemmas of doctors and patients near death situations.
Part Three (Medical Lawsuits) is about how doctors are always working under the threat of medico-legal lawsuits.
While stories are fictional, the scenarios and the problems in them are very real — things that he faced or saw his colleagues facing.
Medical profession has become victim of mistrust generation and blame culture. Everyone keeps harping about the few black sheep in the community, while larger good work of doctors is not highlighted enough.
The stories span from Dr Anand’s initial days in the emergency room and capture his struggles in complex medico-legal scenarios over the next four decades. This book is an effort to bring back focus on the treatment of the patient as opposed to the mistrust, legal frameworks and policies surrounding the healthcare practice.
The book is self-published, available worldwide on Kindle Amazon, Apple, Barnes & Noble, Tolino, Kobo, Scibd, BorrowBox, Baker & Taylor , Vivilo, Overdrive etc.
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.
Justice and Health- Both are crucial for happiness of the living beings as well as society as a whole. Hospitals are full of patients and so are courts with litigants. None of the people go to hospital and courts happily and everyone invariably wants early relief.
Once a patient visits hospital, he will ponder over about the benefit of the visit. So is the person visiting the courts. Did they were imparted justice?
None of patient, who visits hospital, comes back without treatment. Doctor gets few minutes to decide. Most of the time, for the investigations and the treatment few visits are required. But there is no pendency. In Government hospitals, even appointments are not given. A doctor sitting in outdoor will see hundreds of patients. On emergencies night duties, doctor will not be able to count how many he/she has stabilized or numbers treated.
Even in such chaotic systems, doctor can be punished, dragged to courts or assaulted for unintentional mistakes, that are almost always secondary to load of patients or inept infrastructure.
The work at hospital continues day and night, 24 hours and 365 days, despite almost always lesser number of doctors and required manpower. Systems in hospitals are designed and maintained meticulously to have no pendency what-so-ever situation is. Larger number of patients go back home treated and very few unfortunate patients are unable to recover, but still whatever is required- is done invariably.
Justice is needed for satisfaction of soul and peaceful mind, is of same importance what is to the health of body. Justice delayed gives a sense of hurt and pain to soul. Pendency in courts simply reflects the grave injustice people are living with.
There are about 73,000 cases pending before the Supreme Court and about 44 million in all the courts of India, up 19% since last year.
According to a 2018 Niti Aayog strategy paper, at the then-prevailing rate of disposal of cases in our courts, it would take more than 324 years to clear the backlog. And the pendency at that time was 29 million cases. Cases that had been in the courts for more than 30 years numbered 65,695 in December 2018. By January this year, it had risen more than 60% to 1,05,560.
Grave injustice for medical professions:
A doctor making wrong diagnosis (gets few minutes to decide) can be prosecuted, but courts giving wrong verdicts (get years to decide) are immune?
2. Compare the remuneration of lawyers to doctors. Doctors gets few hundreds to save a life (often with abuses) and lawyers can get paid in millions (happily).
3. Doctors treat the body and larger is still not fully known about mechanisms. Still doctors can be blamed for unanticipated events. Whereas law is a completely known and written subject.
4. If health is citizen’s right so should be a timely justice.
Despite doing so much for patients, still people’s behaviour to doctors and hospitals is not respectful. Doctors are punished for slight delays and people and courts intolerant to unintentional mistakes. But people can’t behave in the same manner to courts and legal system and tolerate the blatant injustice for years.
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.
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.
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.
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.
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.
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.
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.
This book comprises of stories that capture the pivotal moments in the treatment trajectory of the critical patients facing death. The times that force the doctor to confront the saddest moments, while battling a terrifying, unbeatable foe, the death monster alongside families’ fears, gloom, indecisiveness, dilemmas about future and saviour’s own predicaments intertwined with medico-legal intricacies and consequent complex emotional interactions.
The situations depict ‘the real issues’ through ‘fictional narratives’.
The stories reflect life of a doctor in the present era, amidst sick patients in an imposed legal milieu, a mystic journey, an arcane odyssey punctuated with pain and pleasure in the narrow and uncertain lanes at the horizon of life and death, carrying the burden of various vicissitudes like consumerism, legalities, unpredictable course of diseases, mistrust and blame for poor outcomes.
The narratives try to unmask the eternal latent vulnerability that is intrinsic in doctor’s work, which is exploited by media, law industry and even celebrities to sensationalize and sell their news and shows. The vulnerability turns more evil as the delineating cleft that separates doctors from the invisible overpowering medical industry is not shown, thus ensuring to sustain the prejudice with its dangerous bias towards health care workers.
One negative news story through a ‘portrayal effect’ generates unbridgeable gap in doctor -patient relationship, painful burden of mistrust loaded on doctors, that would heal only if millions of unfettered, unprejudiced, unbiased facts are clearly projected.
The book tries to highlight a seemingly illogical and contrary nature of the conflict; the doctors are finding themselves increasingly being engaged into. The dense mazes of consumerism, extensive communication, documentation, unrealistic expectations, negative media insinuations, legal complexities are demoralizing to doctors and certainly counterproductive for patients.
The futile discords emanate frequently, that are mundane in reality when compared to the actual disease and the real point of intention which is ‘The Treatment of the Patient’.
But is this what the patients actually need? Does the entanglement of doctors in such a maze help the patients in real sense?
The author felt morally compelled and attempted to find answers, embedded in a journey that was wondrous and inspirational, but with horrifying moments as well.
Has the decision to treat human fragility become a mistake in present era? No reward, if you win the match of life and death but sword hanging; if one were to lose?
Patient will need to decide someday, whether to be a consumer or just remain a patient.
Being a consumer may be an overall loss-making deal for the patient.
The stories are fictional, but the depiction of the problems to the doctors, nurses and patients are real, based on day to day routine incidents. The episodes do not pertain to any single particular person, patient, doctor, nurse, hospital and organization. All the characters, names and dialogues in the book are figment of imagination of the author and similarity to any person, any situation or organization may be co-incidental.
The stories are not against any law, word of courts, profession, any government or any organizational set up or rules of any country. They depict the problems commonly faced by doctors in performing their duties hence are likely to affect the patient directly.
As in last few decades, patients are defined as consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders are patients. How this change has been beneficial for patients?
Suppressed professionals can be used to work more, get less paid and can be dragged to courts easily. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario, act smart and are able to entrench themselves in changed business and legal milieu.
Disadvantages of medical consumer Protection Act (Negatives, cons)
1 .Promotes Defensive medicine: Every patient with any illness has a potential for complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non-availability of doctors.
2. Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into and involves their own imagination and circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
3. Increased cost of care: With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased medical costs. Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, heavily for allaying the fears, both patients (medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
4. Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.
5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons, for example the sense of revenge or to extract money or simply for avoiding to pay for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These ideas are further stoked by the incidents of previous high compensations granted by courts .
6. Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a day more worried about completing paper work as well. Initially it was a symbolic documentation, but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.
7. Doctors used as scape-goats for revenge: Any unsatisfied patient can vent his anger by putting complaint or case against the doctor. This is done to some extent for revenge or just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
8. Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight. Complex medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.
9. Early retirement or burn out: Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the doctor’s whole life.
10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
11 .Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients, who are unsatisfied or with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
12. Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for, whom to blame among themselves. All of them will try to pinpoint each other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.
13. Doctors converted to cheap labour:
Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work. Benefits to law industry and lawyers are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
14. Confusion while treating; Right decisions ? A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may be looked as wrong later, especially when retrospective analysis is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.
15. Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem, but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed. Delay in surgeries or therapies are a common outcome.
16. Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigations of lawsuit against doctors is a major setback for medical profession.
17. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
18. Doctors have become ‘Sitting ducks’ for continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to be pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
19. Demoralization of medical professionals – as selectively applied: strangely it applies only to doctors. All of other professions are out of it. Selective application is what demoralizes doctors. Considering the uncertainty and kind of work of medical profession, actually it should be other way around.
The consequences are like victimization.
Advantages of Medical Consumer Protection Act: (Positives, Pros)
1. Redressal of grievances: patient will get satisfaction, if there is a genuine negligence case
2. Better quality of care ; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.
3. Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.
4. Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.
5. Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.
6. Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.
7. Better documentation and communication: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. But now there is lot of stress on documentation.
Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that in this age, anxiety prevailing more for care givers, a sense of injustice prevails . Stress generated can alter the ways, the patients get treated. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.