Advantages & disadvantages: pros & cons of medical consumer Protection Act


With patient defined as consumer  and  Medical Consumer Protection Act takes roots,  the whole system of medicine and healthcare has changed. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component  of the industry, who deliver care and remain at receiving end. Other important stake holder 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 court. So fear of all kinds will make them more  careful. 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 and act smart in  changed business and legal milieu.

Negatives, cons or disadvantages of medical consumer Protection Act

  1. Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones,  practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics  and even  sometimes even 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 and the cases in courts or  their outcome are given 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 in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in,  which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is  some adverse or even small unpleasant  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 creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated  medical costs.  Insurance  companies and lawyers have positioned themselves in between. They charge everyone 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, 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 in  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
  5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g  for sense of revenge or to extract money or simply for not having 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 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 days 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 after finding  human factor which can be punished. Not uncommonly doctors are used as  scape- goat to have  a concession on the patient treatment by health organizations. 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 these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky  decisions which may later be proved wrong by retrospective analysis, complex  medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intention.
  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 by self  is enough to spoil and tarnish  health, wealth and fame earned by  grilling the whole life.
  10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding 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 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 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. Hugely benefitted are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work.  Benefits to law industry 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. Right decisions or wisdom of hindsight?; 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 look wrong later  retrospectively, especially when retrospective analysis  is done over years with fault finding approach.
  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 only to repent later.  
  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 disadvantage for medical profession.

 

  1. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous  training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and  media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  2. Subject of 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  pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for  any kind of

 

 

 

 

 

  1. Positives, Pros or advantages of medical consumer protection act:

Although there are doubts, whether it will have any positive effect in long term, except monitory benefit to patient’s relatives and lawyers.

  1.     Quick  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. 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 of  anxiety prevailing more for care givers,  do not get enough relief  from stress.  If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

Real failures of Dr Hazida Bawa case: Five issues to ponder-why doctors suffer?


 The case of  Dr Hazida Bawa  is of importance worldwide in many ways, an opportunity  for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in medical treatment, especially in difficult situations. Every one has sympathy for the deceased, but  to blame a human factor, doctors should not be presented as sacrificial lambs.

       The current verdict is nearer to reality and away from a feeling of revenge and harsher penalties. It  gives a hope  that now there will be  acknowledgement of the difficult circumstances and limitations of medical system in health care environment.  To make doctor scapegoat for the  system limitations, poor prognosis or severe disease may be satisfying for some but not sensible. In this case doctors lodged their protest, collected money for lawsuit and the decision was re-looked legally. But every  doctor may not be  lucky enough and may have to suffer  in silence.

 Real failure in this case will be ignoring the factors that actually cause huge suffering for doctors-

  1. Presumptive failure by retrospective analysis: Retrospective analysis of any treatment will always show few things at hindsight that could have been done and would have proved life saving.  One may presume that omission or commission  of certain actions during treatment would have saved the  life,   but one can’t be sure whether these additional presumed treatment would really have benefited the patient.  Therefore a  perception-reality gap is created and with  negative perception towards doctors, it is interpreted as a  failure of doctor merely on presumptive basis and hence declared as negligence.  The doctors who deal with life and death know that it is not correct interpretation, and no one can ever be sure of what the real outcome would be. They just do what they think will be most effective for the patient, and it may not eventually turn out to be the best ever.
  2. Variable interpretation: Same evidence, incidence and circumstances are interpreted and  judged differently by people and  even courts. Some will say it is negligence and other will say it is not. Some will bay for doctor’s blood and other will not. This variation in perception is not only in minds of lay men but also in the learned courts, who  decide  differently.  At the time of death of patient, a constant and  universal last link is only the doctor, that is visible. He is an unfortunate victim, a human factor   and blamed for  the harm done because of variable thought process.

 

  1. Medical knowledge vs wisdom: People who do not treat patients, may be very wise and may acquire medical knowledge by various sources. But medical wisdom comes  only after years of medical practice,  by observing varied situations and spectrum of diseases. An understanding of what can happen in given circumstances comes only by treating such   emergencies.         For non doctors, it is very difficult to  comprehend the medical complexities and real time scenarios. Even doctors, who do not treat regularly emergency patients, can attribute the harm as doctor’s  mistake.

 

  1. Feeling of revenge:  in case of an  adverse event, negative thoughts prevail all over. In present scenario with legal powers with the sufferer and common sentiments against doctors, it is easier to identify and blame some human factors.   Adverse outcome is frequently covered by media to create a sensation among masses.  Real circumstances can only be felt by doctors  but that remains unheard. Harm to patient, media cry and negative sentiments against the service providers creates a sense of revenge in mind of people.

 

  1. Doctor’s negligence vs system inadequacy; This visibility of doctor at the time of  declaration of death  or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom, all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, inadequate equipment and  other innumerable shortcomings of the whole system may not be visible or not given consideration in the  haze, as compared to  publicity and attention  given to only doctor’s faults.

 

14 of world’s 15 most polluted cities in India : is crime and pollution related?


The WHO report said 14 of world’s 15 most polluted cities were in India which includes Delhi, Kanpur and Varanasi.  This will need  soul searching  and introspection by every one including policy makers.

Air pollution is related to lung diseases like asthma, emphysema or COPD.  It can have effects on pregnant women, Heart patients and outdoor workers etc.  but another aspect of relationship  of pollution with crime is also coming up, which concerns the psychological aspect.

There is a study  in London which relates pollution and crime rate. Although it appears strange but it gives some thing to ponder. If proved correct it may be dangerous environment to the people living in polluted cities.

A new report by researchers at the London School of Economics (LSE) suggests that crime in the capital is being driven by air pollution.

Their results show more polluted areas will see spikes in crime, particularly for less serious offences.

While the study relies on observational data and therefore cannot make definitive conclusions, it adds to a small but growing body of evidence linking pollution and crime.

Previous experiments have shown that increased levels of particulate matter in the air lead to increased blood levels of stress hormones such as cortisol.

The authors therefore suggest that behavioural changes resulting from increased stress hormone levels may in turn lead to an increased likelihood a person will commit a crime.

This means is that pollution can have a negative effect on people’s ways of thinking, including decision making and the way they think about future punishment.

Higher levels of pollution mean higher levels of cortisol. Higher levels of cortisol affect the way that punishment is being perceived by criminals.

Though the paper has yet to be peer reviewed and published in an academic journal, it has undergone internal peer review at LSE’s Grantham Research Institute on Climate Change and the Environment.

The research is not the first to explore links between air pollution levels and crime.

Dr Hazida Bawa-Garba case: sacrificial lambs “The doctors” and not health administrators? Dangerous precedence for doctors worldwide


Dr Hazida Bawa case is of importance worldwide in many ways, an (lost)opportunity  for learning some hard and truthful lessons, as it touched upon various crucial aspects involved in treatment, especially in difficult situations , for doctors.  At the time of death of patient, a constant and  universal last link is only the doctor, that is visible. This visibility of doctor at the time of  declaration of death  or while treating the patient on his bedside, makes him vulnerable to all kinds of accusations. By application of an average wisdom,  all deaths can be easily attributed or linked to fault of the doctor. Subtle presentations of severe disease, rapid deterioration, multi organ complexities, under staffing and sub optimal systems, equipment and  other innumerable shortcomings of the whole system may not be visible or not given consideration in the  haze, as compared to  publicity and attention  given to only doctor’s faults. This is specially so when the wisdom is applied retrospectively, with knowledge  of hindsight,  and by the people who have never treated emergencies or have never been in such difficult situations  themselves.

Analogy to  Dr Hazida Bawa case

        Imagine a situation where during a bad sea storm, large number of people are trapped and are in mortal danger. The coast guard on the duty tries his best in the emergency situation with his limited resources and saves a large number of people. There were only a few coast guards present, equipment were inadequate and sub optimal.  However the guards manage to salvage the situation by doing the best possible in the circumstances. There were instances, where they decide, act, communicate and document events simultaneously, in an instant.  Those who could not be saved were exposed to risk of death as resources allocated by authorities were limited.  The near and dear ones of those who died were unhappy and revengeful with the services. Inquiry is done to find out the cause of failure in preventing those deaths. Rather than appreciating the facts that greater proportion of victims were saved in those difficult circumstances, the guards are blamed for those who could not be saved. Guards who are already apologetic for not been able to save the few, are blamed for doing their duty shabbily after careful fault finding analysis of the event. The administrators  who are responsible for allocating the inadequate number of guards and equipment, who actually failed in their duty, also participate in pointing fingers at the guards.

  The saddest part was that courts also were  unwilling to apply wisdom to look beyond the guard faults and  reach beyond the fog in present hazy circumstances. Systems and administrative lapses and inadequacy of number of coast guards was not raised as a concern. The responsibility of the deaths is thus fixed on the persons who struggled to save the lives of many. Every one has great sympathies for the deceased, but there is another angle for doctors in such  difficult situations.

This is an analogy to Dr Hazida Bawa case, but similar unfortunate incidents are happening to medical professionals worldwide, more so in developing countries. The new regulated system of medicine has an aberrant evolution and   chooses to hang their own wounded soldier for not putting up the best fight, rather than accepting the limitations of medical science or errors in the supporting systems.  Was  she an easy scapegoat for some obviously non- admissible reasons prevalent?

Why is it always necessary to punish a doctor, and  conveniently overlook errors of the sub optimal  system in cases of unfavorable prognosis, especially in sick patients. Why a sub optimal system or unsafe working conditions  like  all other registrars were on leave simultaneously, or only one registrar in place of three and that too a trainee. There was no consultant or registrar covering her?   Why is a single doctor stuck in a difficult situation  not  treated as  just another human being in an emergency situation, especially in cases of very sick patients? Why administrators or managers are not punishable for putting doctor and patients at risk and unsafe condition ?

If a doctor is supposed to raise concern (may be at cost of his career), then what is the role of managers, management and administration?  Are they inefficient or incompetent  to anticipate the situation? A new doctor coming on duty can not anticipate the deficiency of system. He will not have time to assess the managerial deficiencies. Therefore raising a concern by doctor on duty is something, which is expected but at the same time not feasible always, in true sense.  This expectation to raise  a concern  may be  used to later implicate the doctor as to why he or she did not raise a concern.  At the same time it takes responsibility off, from the  administrators whose  duty was to raise concerns.

NHS is looked upon in the world as one of the better organized health care organization in terms of uniformity. If such an organization has to sacrifice its working hands in the form of scapegoats to prove its quality, deliberately overlooking its system errors, then it is a sad state for doctors all over the world. This would set a precedence for governments and health administrators, world over to be  fearless in  putting errors of sub optimal system under the carpet by punishing the doctors instead. Since there will always be a doctor in the end who will declare the death, is the last and common link in all deaths. Other circumstantial issues would be overlooked  because of sheer unwillingness to do so.

Irony of the situation is that generally people who have been invested with the power to decide on these issues of medical negligence  may  have  never faced  such situations themselves.  They may be the people in administrative positions who have never treated a single patient, leave aside emergencies.  They do not even  know, what it takes to deal with emergencies of life and death, that too multiple ones, with limited resources. The court takes years to decide on these issues discussed retrospectively with wisdom of hindsight, on issues which the doctor had to decide in a jiffy.  A person who perhaps can only imagine such a situation, or  never handle it himself, even in his wildest dreams is the one who decides what went wrong merely based on how the situation is placed and presented before him.

         If there is unsaid immunity to governments and administrators for providing a suboptimal systems, then the doctor should be the first person to get this immunity. But unfortunately nobody seems  to be willing to find out who is responsible for putting  the doctor  in such  a difficult situation, making everything error prone.

       If in such system a doctor is punished, then the administrator, manager or trust should be an automatic accomplice to the doctor’s punishment. Firstly   for providing an unsafe and  suboptimal system, and secondly for not raising a concern as management . Thirdly for putting it’s doctor in difficult circumstances. If it was an understaffed system, then disaster was bound to  happen sooner or later. This is a perfect example how management lapses contribute to death but doctors are the only ones who are entirely blamed and punished in isolation.

  Another sad part is the unwillingness of judiciary system to look at the larger picture and the fault in the system, which has led to mass demoralization of the doctors. The doctors are denied the true justice in many such cases.  They are being used as sacrificial lambs. Health administrators are obviously at an advantage enjoying the invisible immunity and perks, at the cost of medical professionals.  By crucification of the doctors, vengeance of the society is fulfilled and everyone feels  satisfied  with false sense of justice.  But does this give any advantage to the society? Definitely not. In fact  the society is thus raising a  demoralized force to be their care providers, who under duress, will definitely not perform to their very best.  If this is quality of justice for saviours, this demoralized force may also not be available in future.

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