Doctors’ Dilemma-To Follow Medical Science or Fulfill Medico-legal obligations (contract)


Medical Negligence case- Noida (death due to Covid -19)  is an example that should force the aspiring doctors needs to think whether they should put themselves in such a situation- akin to catching a falling knife.  A case which shows that in difficult situations, legal compulsions have potential to affect the treatment, without realizing what is good for the patient or actually required.  In difficult circumstances, while treating diseases with naturally poor prognosis, they can be still held responsible  for the situations  beyond their control. Doctors can be harassed for just being in a peculiar situation  and for being the only one  on the bedside of patient. Everyone wants some human factor to blame for the loss, which was at the best  God’s wish in real sense.

While  treating emergencies patients, there is  an eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil, just because of an unexpected poor outcome. Due to  misfortune of the patient, the  randomness of the tragic tale imposed on  the doctor becomes difficult to fathom.

No one can forget the dreadful times of Covid pandemic and the sacrifice of doctors. There was severe scarcity of beds, drugs, and even oxygen, a scary situation no one even imagined. There was  no one inside Covid ICU’s, none of the  relatives to support  their patients, except doctors and nurses.

     A patient who comes with 60 % saturation level of oxygen, but wants Remdesivir to be administered. His wish to get administered Remdesivir is taken as a legal contract between doctor and patient. Without  realizing that in such situations  administration of oxygen was   lifesaving but Remdesivir was not.  Doctors know the fact but patients are commonly misguided by the media reports.  Patients insisting upon Remdesivir,  that was not available. But could the doctor refer the patient to some other hospital with 60% saturation- especially in those uncertain times-taking that risk was not a feasible option. What would an average doctor have done? Only option was to  manage the  dangerous and precariously low oxygen levels. That is a standard medical teaching in critical situations. All drugs are of secondary importance. In this case, as proved by later studies – role of Remdesivir turned out to be doubtful, but oxygen was proved to be of real help.

    But patients precondition for admission was to get Remdesivir, a false belief generated more by media than scientific evidence. A false belief hence generated by media gave Remdesivir  the status of  a panacea and lot of money to the company, who sold it.

    But medicolegal compulsions  stamped the administration of Remdesivir as a contract between doctor and patient. A contract that needed to be fulfilled, akin to that of constructing a building. But it is actually different to treat critical human ailments from constructing a building. They cannot be treated merely by wish of the patient. Unfortunately, Remdesivir was not available and all the blame for death was conveniently loaded on the treating doctor.

  Doctors’ dilemma in present era is generated by conflicting solutions given by medicolegal implications and principles of medical science. Needless to say, doctors  will have adopt to defensive practice to save themselves from medico-legal harassments. For example in this case, doctor could have sent patient to some other hospital (in sick condition), according to patients’ wish for Remdesivir. But would that have been a right decision from medical point of view.  But legally it would have been safer for doctors.

 In other words- the blame -patient didn’t die of Covid-19 but because of lack of Remdesivir. What a sad conclusion for doctors? Non-availability of drugs is not doctors’fault.

   To save themselves from such medico-legal predicaments, aspiring doctors needs to think whether they should put themselves in such a situation akin to catching a falling knife.  

NOIDA: Five doctors of a private hospital have been booked under IPC Section 304A (causing death by negligence) in an FIR filed on the recommendation from the health department, whose preliminary inquiry found merit in allegations of a “delay” in administering remdesivir to a 22- year-old college student who died during the second wave of Covid last year. The management of Yatharth Hospital here rejected the charge, saying its doctors did their best to treat the patient, who was admitted in a critical state in April 2021. They also pointed to a remdesivir shortage at the time, and subsequent research that says the antiviral drug does not help in Covid treatment. A top-ranking official of the Indian Medical Association, meanwhile, stressed the need for a central law to safeguard doctors against such “violent action”. In cases of negligence against doctors, the health department has to verify allegations before a case is registered by police. In December 2021, Pradeep Sharma had told UP’s Pandemic Public Redressal Committee that his son Deepanshu (22) was not given the remdesivir injection on the first day of his admission to Yatharth Hospital in Sector 110 on April 30. This was despite the family having paid for the treatment, Sharma, a resident of Vijay Nagar in Ghaziabad, alleged. The committee forwarded the complaint to the health department in January 2022. “The preliminary inquiry has found negligence on part of the doctors as a delay was made in administering remdesivir injection to the patient,” the deputy CMO said in the inquiry report. Police said they would now be able to take up the case for investigation. The hospital administration defended its doctors and their line of treatment. “Deepanshu Sharma was brought to us with severe illness. His oxygen saturation was just around 60% and his lungs were affected. During Covid’s second wave, there were a lot of patients and the remdesivir injection was also not easily available. But we managed to arrange the injection for him in 2-3 days and administered it to him,” said Dr Kapil Tyagi, managing director of Yatharth Hospital. Deepanshu was admitted to the hospital for 35 days, after which his family shifted him to a private hospital in Delhi. He died at the facility in June. His father could not be reached for comment on Monday

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Treating human frailty & hence the vulnerability-Exploitation of Doctors & Nurses


From the book ‘at the Horizon of Life & death’

Treating emergencies and critical patients has become akin to catching a falling knife. There is  eternal latent vulnerability that is intrinsic in the way doctors’ work, which turns more evil when exploited by many in the society for the vested benefit- ‘media and celebrities’ to sell their news and shows,  by ‘law industry’ and ‘industry’s middlemen’.

 Whenever there is an anecdotal episode of adverse event or poor prognosis in hospitals, it  is aired by media as an illustration to portray whole medical professionals as dystopian community. By theatrically deriding hard work of doctors, the celebrities grabbed eyeballs to be at the centre stage of health care. What remained invisible to all is the fact that every day in hospitals, thousands of lives are salvaged back from the brink of death.

The real hidden agenda is an attempt to project ‘Reel heroes’ as ‘Real heroes’. By self-appointing themselves as custodian of health of masses, ’the film stars’ and celebrities give true meaning to their work of ‘Acting’, that otherwise was no more than a trifling entertainment. When masses worship them as their true well-wishers, they feature in advertisements to sell tobacco, soft drinks, junk foods and other sweet poisons to public and children.

The intentional unfairness of the criticism is evident, since the delineation of the cleft that separates doctors from the actual overpowering and controlling health industry is not unveiled, ensuring to sustain the prejudice with its dangerous bias towards health care workers.

 There is gradual transition of doctor-patient interaction to a business transaction. The pharmaceutical  industry, insurance, law industry and administrative machinery remain hidden in the background and have enormously benefitted by the exploitation of doctors and nurses, who have suffered at the front as the face of the ‘veiled and invisible’ colossal medical business.

The evolving system of corporatization and medicine being projected as a purchasable commodity has resulted in an illogical distribution of health care.  The resources spent by people in last few days of life, mostly in a futile quest to have few more, are equivalent to thousands of times the food and medicine for the poor, who lose lives for fraction of that expense. Since in this era, medical therapies are perceived as purchasable and patient has become a consumer. 

There is persistent  fear  of getting a raw deal amidst tricks and traits of the law industry, if any doctor has to  face a malpractice lawsuit. A brilliant mind gets entangled in a useless clutter and gets engulfed by a strange fear for the imminent misfortune. Just because of an unexpected poor outcome,  randomness of the tragic tale imposed on  the doctor  is difficult to fathom. With element of arbitrariness involved in the medicolegal suits, law industry has got benefitted enormously at the cost of medical profession.

But these utterances against the medical community are not without serious side effects and results in   deteriorating doctor-patient relationship. Mistrust resulted in loss of respect for doctors and predisposed them to all types of violence- be it  verbal, physical, legal or financial, as if uncountable lives saved every moment in hospitals were of no consequence.

 The blame for deficiencies of inept system and poor outcomes of serious diseases was shifted conveniently to doctors, who were unable to retaliate to the powerful media.

Not only such projections shifted and pinpointed the attention to inappropriate issues, but created an unbridgeable gap of trust between doctor and patients.  The fear provoked in the patients’ minds would scare patients to seek help from doctors, who they should be trusting.

The sense of gratitude, which doctors deserved from patients, was replaced by the burden of blame. Even a saved life was thought off merely as a duty fulfilled in lieu of some remuneration.

Consequently, more of doctors’ time is being spent on issues, which are assumed to be worrisome but are not, and less time is spent on the issues that really count.

To control the health system, administrators or even legal systems have a tendency to assume that shortcomings in the patient care can be rectified by punishing the doctors and nurses. For doctors, no gain if they succeed thousand times, but agony assured if they fail once?

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

#Doctors-‘Earn Hundreds & Pay Back Millions’ #USG-Lab-Nagpur to Pay 1. 25 Cr Compensation


          Is there any other profession, which has such kind of pathetic arrangement? The sufferers of such pitiable deals are doctors. An average doctors studies for decades and treats hundreds of patients for peanuts (Few hundred rupees). For one alleged mistake or just a legal interpretation is forced to pay millions for an incident, which can be merely procedural or circumstantial mistake.

  Why one should be putting his/her future into such pathetic arrangements? The inspiring doctors need to think.

          Large claims granted by courts are incentives for patients and lawyers for putting medical lawsuits. In an era, where people fight with their parents, brothers and sisters for money and property, it will be naive to think that idea of making money from doctor does not exist.

          Now-a-days medical professionals need to not only be thorough with their medical subjects and the medico-legal implications, but also  need to be careful about how courts may interpret the medical processes. What doctors think is a correct   medical process, but it can be interpreted as negligence, in case of an adverse outcome. Other contributing factors that nail down medical profession are the sympathy to the patient and wisdom of hindsight,   which everyone is flushed with as an after event.  

          Large compensations against medical profession are  the single important factor can increase the cost of  healthcare and demoralize medical profession.   Doctors  are always on the receiving end in case of an adverse outcome.    Medical problems are very complex and sometimes it is difficult to judge  the future course of  disease as well as court  interpretation of  medical science, especially  with retrospective wisdom  by courts.  Summarily doctors have to safeguard themselves from treatment as well as legal and documentation hassles.

         Every case that goes to court involves lawyers and their expensive fees. Most of the time even though the doctors may be right, he has to defend himself with the help of  lawyers.  Law industry has been  benefitted enormously because of consumer protection act at the cost of doctors.  

     Strangely  doctor’s fee are quite low but lawyers charges and court compensations are really astronomical amounts, which are beyond any logic.

New Delhi: In a landmark order, the National Consumer Commission (NCDRC) has ordered Nagpur-based Ultrasound Scanning and Imaging Center to pay a compensation of Rs 1.2 crore to a disabled child and his parents in a medical negligence case. The firm has been blamed for misreporting of ultrasound on four occasions during pregnancy, resulting in the birth of a child with congenital anomalies.
Congenital anomalies are defined as structural or functional anomalies that occur during intrauterine life. The commission held that the ultrasonology center also failed to offer to terminate the pregnancy, failing to diagnose defects at an early stage. The newborn had finger pain (complete absence), right leg below the knee and left leg below the ankle joint.
The clinic – Imaging Point – was run by Radiologist Dr Dilip Ghik in Nagpur. Holding him and his clinic responsible for their failure to detect structural anomalies of the fetus at 17-18 weeks, a two-member NCDRC bench comprising Justices RK Agrawal and SM Kantikar asked them to provide for the child’s welfare, future expenses asked to pay compensation for  the treatment and purchase of limb prostheses.
The order said, “The amount shall be kept as a fixed deposit in any nationalized bank (preferably SBI) in the name of the child till he attains the age of majority. Parents can get periodic interest on the FD for regular health check-up, treatment and welfare of their child. It also directed the radiologists and their clinics to pay Rs 1 lakh towards legal expenses.
As per the commission’s order, in October 2006, the child’s mother, who was pregnant at the time, consulted a gynecologist and obstetrician. The next month the doctor referred the patient to the imaging point for ultrasonography of the pelvis. USG Ghik and reported normally. Three more ultrasounds were done by the Ultrasound Scanning Centre. All USGs were reported as “no obvious congenital anomalies in the abdomen and spine of the fetal head”.
But when the gynecologist performed an elective caesarean section and after the baby was born, the mother and all the attendants were shocked to see a “severely deformed male newborn”. The girl’s parents had alleged that all this happened due to the negligent ultrasound of the radiologist.
He had prayed for a compensation of Rs 10 crore to meet future expenses. But the radiologist denied any negligence in the patient’s USG report.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

‘Doctor- Save Yourself’: Court Convicts Doctors For Operating Woman Without Ventilator


A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other lifesaving equipment.  This was despite the fact that  the committee constituted by the District Surgeon to verify the allegation of medical negligence in its final report has said there is no negligence on the part of the accused during the performance of the LAVH surgery and also shows  *how the accused have tried to save the deceased.”*

What is worrying for the doctors is that every death during medical treatment can be a blame against the doctors. If the courts were to impose criminal liability on the hospital and doctors for everything that goes wrong, the doctors now should be more worried about their own safety than giving all the best treatment to their patients.     Both Government and Private  small hospitals carry out  thousands of routine surgeries every day. Occasionally complications may arise  in simplest looking procedures – for example even in   normal deliveries; what to say about routine surgeries.         How many hospitals (Government and private) in districts, town in peripheries are equipped with a ventilatory support system?  Perhaps  they are too less, although an honest count would  be some  interesting data.  Still, surgeries of the type mentioned are conducted  routinely  in almost all of these small centres.

So based on one incident of this kind, the thousands of surgeries done in such areas are going to be affected. In other words, doctors will not dare to conduct surgeries in peripheries.       As per the verdict of the court, many of the surgical speciality’s doctors in periphery are indulging in blameworthy activities every day in their routine work. Why should they risk their lives and profession in such circumstances?   That raises  another question , as many  Government  Hospitals are also without ventilators in the periphery. Should Govt doctors also  refuse surgeries without an ICU setup?  Any Surgery or even normal delivery in rare circumstances can get complicated and  the patient may require ventilator. Usually anaesthetist use Ambu-bag for an emergency situation and transport the  patient to other facility. So absence of a  ventilator is not life threatening in a real sense.     In peripheries, a large number of  deliveries are conducted  by ANMs, and nurses, and complications may arise occasionally.  So what are the facilities expected and available at a sub-centre? In reality   almost nothing is available.      Merely having a ventilator  does not solve the problem and  is not enough . The hospital  requires much more  arrangements to keep a patient  on ventilator.  Do all Govt hospitals where surgeries are  being done have ventilator and trained doctors  and support staff to operate those ventilators? It needs round the clock trained  doctors  and nurses, ABG  machine, portable X-ray , bed side Echo dialysis etc. Doctors in ill-equipped Govt   centres  are forced to conduct deliveries.  What should be the SOP in such circumstances? A real and honest data would be an eye opener and interesting.

Doctor need to  ponder over the issue of saving themselves before they save the patient.

 

 

Medical Negligence: Karnataka Court Convicts Three Doctors For Death Of Woman Operated Without Ventilator Facility & Other Life Saving Equipment* “A Judicial Magistrate First Class court in Bidar district of Karnataka recently convicted three doctors for causing the death of a woman who was operated on by them without having a ventilator facility in the hospital and other life saving equipment. BIDAR: Four people, including three doctors, have been handed jail terms and slapped with fines by a local court for a botched surgery which claimed the life of a woman.The II Civil (senior) and JMFC Court judge Abdul Khadar sentenced well-known medical practitioners Dr Rajshree Biradar and Dr Vaijinath Biradar, and Saibanna, to two years imprisonment and fined them Rs 10,000 each. If they fail to pay the fine, they will have to serve an additional six months in prison. Dr Rajshekar Patil was sentenced to six months imprisonment and fined Rs 5,000. He will have to serve additional imprisonment of one month if he fails to pay the fine.The case dates back to October 12, 2014, when Sampavati, wife of Ghaleppa Auradakar, got herself admitted to Sushrut Nursing Home in the city for a hysterectomy procedure. But after a five-hour surgery, she died due to alleged medical negligence.However, without disclosing her condition to the family, she was shifted to Dr Rajshekhar Patil’s Shree Hospital in an ambulance. Dr Patil continued the treatment without disclosing her condition, it was alleged in the chargesheet.

Nursing home was negligent in not having ventilator: Court

Later, it was revealed that Sampavati had died at Sushrut Nursing Home itself due to the lack of ventilator facility. The court, while convicting the accused, observed that the nursing home authorities were negligent in not having a ventilator facility for such a risky procedure.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Medical Consumer Protection Act: A Loss making deal for patients too?


       With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades.  Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new.  Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.  

      Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years.  It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome. 

           One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money.  Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.   

    The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over   the system is not robust enough for such a change.   To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment. 

          Rather than   developing a system to promote   good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care.   Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous,  just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the   scenario projected.  It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.

    There is a growing mutual mistrust; doctors too have started 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. 

    With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs.  To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.

           Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from 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 inflated cost of health care.

       Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.  

       Medical consumer protection act has increased the anxiety and insecurity among   medical professionals.   Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying 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 doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.

     Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.

     Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes.  Mutual understanding takes 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 among medical professionals.

    The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the  doctors by all, including  medical industry, law industry and administrators.  Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible.    The industry has used the protective systems against medicolegal cases to gain  maximum benefits  out of doctors’ hard work.   

      In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being  a victim of sympathy towards patient or clever lawyering.  So taking medical decisions in critical situations is becoming more difficult  in view of the future uncertainty of disease.

             Windfall profits for lawyers is a strong  incentive   for  law industry to promote   instigation  of patients by against doctors .  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 on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations. 

       Consequently doctors are now an easily punishable human link for poor outcomes.  Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.

  Strangely  Medical Consumer Protection Act applies  only to doctors, that too selectively. All  other professions and services  are   out of it, not even other constituents of health services. Selective application is what is  demoralizing the doctors.  Considering the uncertainty and kind of work done by  medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.

            Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult  by uncertainty of prognosis,  grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach.  The possibility of complex medico-legal situations in doctor’s  mind are enough to distract doctors from their primary point of intentions ‘the treatment’.

          Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person 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  entire  life.     

     Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides,  while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years.  Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.

        If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult  position?  

         Medical Consumer Protection Act  has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But  it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run.  The consequent insecurity among doctors, practise 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. As a result,  now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.

          Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses.  Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

The Book-‘At the Horizon of Life & Death’: Doctors’ struggle with death


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.

Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

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


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

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

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

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

   Justice eluded doctors at all stages.

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

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

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

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

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

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Medical Negligence? Doctor removes kidney instead of stone


Doctor- save the Patient but save yourself also

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

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

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

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

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

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

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

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

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

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

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

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

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

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Tragedy at Varanasi: comparison of multiple healthy deaths due to civic negligence vs one in hospital due to disease


                There is a stark  difference in  the kind of  media  projection, burden of negligence and accountability of preventable multiple healthy deaths by civic negligence   as compared to one hospital death by disease. In fact the burden of   negligence here in healthy deaths is massive and  these deaths are unpardonable. But reality is opposite.  Strangely   “alleged and perceived negligence” ( with no proof and no investigation )  in death of someone already having disease  and death in hospital  during treatment attracts more scrutiny and   stringent  punishment   a naked “negligence  in deaths of healthy people” in such cases  of civic negligence.  

In an unfortunate incident at Varanasi , at least 19 people were crushed to death and more than a dozen injured after two concrete beams fell off 40 foot-high pillars at an under construction flyover in Varanasi on Tuesday evening. Massive civic negligence  again leading to  entirely preventable loss of lives. These incidents bring fore to my mind the misplaced priorities of media and society  which too have  contributed to  some extent to these unabated ongoing preventable   deaths  of  hundreds of  healthy people.

Multiple  Deaths  in healthy people by civic negligence :

Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. These deaths  of people are in thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of   negligence here is massive and  these deaths are unpardonable.  It’s time media took it upon itself to bring to fore these issues before accidents, so that many innocent lives. Timely action can prevent these deaths. 

       Single  Death in Hospital due to disease:

The  media has always, instead, focused on the stray  and occasional incidents of perceived alleged negligence  in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault.  Media has been responsible for  creating a misunderstanding about the whole process of treatment. They have ignored other important things like civic negligence and has instead trained their entire energy in  blaming the doctors  in an effort  to get something sensational out of nothing.

The whole blame  is cleverly put  on doctors. Even after doing everything possible, doctor may be running for his life, trying to save himself from goons. He may be an object for revenge. He may be running after lawyers, if a medical lawsuit is filed. Even if court give the judgement after decades in favour of doctor, harassment of the doctor is permanent and irreversible damage is  done  to doctor. He is already punished.

Here it will be seen later, whether some one can be punished or not.

Point to ponder-Misplaced priorities:

Who is to be  blamed for  the deaths of healthy people which occur because of civic negligence? Here relatives may be helpless and  the vital questions  may go unanswered or taken as a routine.  There are no punching bags like doctor  for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by  doctors. But media instead chose to defame medical profession by igniting the emotions of people by sensationalising death of diseased and ill,  who probably were already at risk of death and did not give due importance to highlighting prevention of healthy  and absolutely 100% preventable deaths.

Right issues raised at right time will save thousands of healthy preventable deaths. Multiple  healthy deaths should carry more burden of negligence than  one death due to disease.

      

 

Two doctors from Fortis Hospital arrested – How doctors may save themselves by learning from such cases.


Doctor,  do save the patient but save yourself also.

Doctors continue to treat and save  many patients in the years they work. But present law and regulatory system does not take into account those years of  good and hard work. It does  treat doctor as a petty criminal for some single mistake or unfortunate incident. Law just deals with it in a harshest possible manner.  Patient may have died because of disease, but when in side the hospital, it is very easy to relate death with actions or inaction of doctors.  Specially because inquiries are always done  with  retrospective analysis, with wisdom of hindsight. Although there is a feeling among doctors that what is really happening these days, something may not be very appropriate, but there is no room  for leniency here.

News of this kind brings tsunami of fear in minds of doctors all over. It can be anyone in such situation, where  it is just   that a particular doctor did not have that eye for danger in that moment. The  doctor did  not realize or anticipate the gravity of  the consequence and outcome of the patient in real time. It may be difficult to pick up or just not take the situation very seriously. That can simply be poor training or working without good application of mind. But  looking retrospectively, situation becomes clear.

Two senior doctors of Fortis Hospital in Haryana’s Gurgaon were arrested on Friday for a “delay in administration of emergency medicines” to a 51-year-old woman, who died of cardiac arrest last year, police said.

 

      Lessons to be learnt:  What options doctors have at present? Because they are at receiving end always. They have to learn from such cases and do something in their routine to prevent disasters. How can they save themselves?

  1. All patients to be seen by primary consultants or someone from concerned unit at the earliest. It is important as emergency doctor may  not be equipped to deal with specialty  problem.  Prompt diagnosis by specialty doctor and written findings are important.
  2. Initial assessment should be quick and with in minimum time.
  3. Good communication and documentation of the problem.
  4. Assess the patient and make a note of treatment to be given.
  5. Document the plan of action, that is investigation and management.
  6. Avoid phone call consultations and leaving treatment loosely. Well thought documented plan should be in place.
  7. Situation may be different for smaller nursing homes. Treatment of an emergency will remain same, whether patient goes to bigger or smaller hospital.   Nursing homes may not be equipped for all the emergencies. So challenge before the smaller hospitals will be to identify the problem and diagnose them quickly  and  if required send them to proper  hospital, rather risking themselves in today’s times.
  8. Aspiring doctors can have a cue about what they are getting into. So as to adapt to prevalent adverse circumstances for doctors, if they aspire to be one.

 

Doctor, do save the patient but save yourself also.

 

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