MEDICAL LAWSUITS FOR COMPENSATION: ARE DOCTORS SOFT TARGETS ?


Doctors save the patient, but save yourself also.

In an era, when family members, brothers and sisters fight for money among themselves, it will be naive to think that idea of extracting money from the doctor does not exist. With courts giving millions in compensation, lawyers are ready to fight cases on zero fee and divide the booty later. There may be many relatives, lawyers who are ready to try their luck, sometimes in vengeance and sometimes for the  money received in compensations. This encouragement and instigation of lawsuit against doctors is becoming a major disadvantage to doctors. Here is a news from a paper showing the problem.

Dentist accused of botching up an implant, produces video of complainant feasting at gurudwara langar: Senior citizen claims Rs 35 lakh from her dentist saying her implant was botched up and she was unable to eat; the doctor produces a video of her feasting at a gurudwara langar; cops close case.

In this case the doctors was really smart and lucky. The doctor was able to generate some evidence .  but  most of the time, things lie in grey zone and it becomes very difficult for the doctor to defend. Unfortunately  sympathy of the court and public sentiments runs against doctors . Thanks to media and celebrities for the  negative and  campaign against medical profession.

Many a times problems are just part of genuine poor prognosis or just bad course of disease or simply complications of the treatment.  Public has failed to realize that during treatment of  human body, complications  are inevitable and will always happen.  Retrospective analysis and wisdom of hindsight, always throws better light. But during treatment all this luxury is not available to doctor. Genuine complications can be easily labeled as mistakes of the  treating doctor. Unfortunately, if there is a lawsuit against a doctor, he will be wasting all his time with lawyers and courts, which will takes years to sort out.

Problem is that, there is no deterrent for patients to put cases on a doctor. Even when  case is  just with a intention to harm, revenge or extortion. Harassment of the doctor is full and permanent, even if he is not at fault. Lawyers and patient’s  relatives can always have a field day, at the cost of doctors. Society may be slow to anticipate their long term loss at present.  Till that time, doctors will have to  find ways to save themselves, as this doctor did!

 

 

Misdiagnosis of health care, wrong and misdirected treatment of real problem


       Yesterday, there was a painful news in paper about the death of a child due to rabies.  It is really painful  loss of life due to a preventable disease. Every one sympathizes with child and parents. But equally strange was the suggestion  that action will be taken  against the  doctor.  Newspaper also  fails to raise a point that,  why at all a preventable disease should happen?  Similar trend we always see in media, when some death occurs due to diseases like dengue and malaria, it is a doctor, who treated the patient or trying to fight with the advanced complications is punished or made a scapegoat and projected as a villain in the story by media.

  No one including administration,  government, courts or media raises a point, that why at all the diseases which  are  completely preventable,  should happen and  keep on happening.  In my previous article, I mentioned the misplaced priorities of media about the same.  At least public, who is suffering should understand that dog bite and mosquito bite is preventable. Therefore more emphasis should be on preventing these bites. That should be made a priority. If  that bite is not prevented and no action is taken to prevent that, these diseases will keep on happening in  a large proportions.  Beds  and doctors are limited in number and will be unable to treat it, specially in advanced stage. So we need really good people to make a proper diagnosis  of our health care. Every time such cases happen and these are preventable disasters, doctors are sacrificed as scapegoats.  Some one sensible need to do a root cause analysis of preventable deaths.  Media people will  have to  find the correct remedy  and demand for it. Otherwise it is not going to help and treat sufferings of common people.

NMC bill, Medical crosspathy and antibiotic resistance : recipe for potential global catastrophe


   Genesis of a system, where every body will suffer and no one is beneficiary.  There has been lot of debates going on  about the Government willingness to allow crosspathy. There has been indications in newspapers about possibility of government  allowing Ayurvedic,  homeopathic and Unani medicine graduates and others  to practice modern allopathic medicines.  Most importantly which medications will be allowed to be practiced? Will  thousands of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications. It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy. No one is bothered about the fact that every allopathic medicine is a potential hazardous chemical, if not used properly.

              It will be done through some bridge course. The structure and effectiveness of the said course is yet to be knowm. Whether it will be of 3 days or 3 months?  Who will be able to do it ? whether some level of efficiency  will be expected or every body will be allowed to just dispense allopathic medicine. What ever some one may argue, bridge courses can not be substitute to proper training for these complex diseases and drugs. Following may be side effects of dilution  of medical education and crosspathy:

  1. Alternative or ayurvedic medicine systems themselves: detrimental to these systems themselves because of many reasons. If  the  ayurvedic doctors   start allopathic practice, how we expect ayurvedic stream to florish and respected. It will be diluted to no end. After few years no one will be left will ayurvedic practice.  In my opinion it is a death sentence to ayurvedic system.

       Secondly,  the decision is not respectful to ayurvedic stream itself. Stream of                Ayurveda will suffer.

  1.  Public and patients: crosspathy clearly means a diluted and suboptimal medical services. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs.
  2. Allopathy will be clearly a sufferer. If every body can practice allopathic medicine, why one should go for rigorous training. It will discourage the people who have opted and got admission to allopathic courses. They are paying and slogging hard for their training.
  3.  Dangerous to human race and potential global catastrophe:  All  allopathic medicines are hazardous chemicals in inexperienced hands. But  incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When  all over the world,  need is being  felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it can be a catastrophic to human race world over by causing antibiotic resistance.
  4. have our public and people given consent for such diluted medical  excellence and services? It is  public  ultimately who  accepts  a decision for suboptimal medical service. Government may create few area of need and implement the scheme in selected areas, and selected simple drugs. But that also has not been planned.

 

Hammurabi’s medical regulation code (1750 BC): Noble profession has always been regulated cruelly ?


Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times. the ancient rulers always blamed the physician for the poor patient outcome and also made regulations to regulate medical profession, and this was when the medical science was not even developed enough to deal with most diseases.

A great military commander, Hammurabi consolidated small states in the vicinity after ascending to the throne on the death of his father. Sometime around 1780-50 B.C., the Babylonian king Hammurabi promulgated the now famous  Code of Hammurabi, covering both civil and criminal law.

Hammurabi’s Code of Laws was considered the first documented Code ever used by human civilization in Mesopotamia, the cradle of civilization, the land of Assyro-Babylonian culture. This era first saw the interface between medicine and law in the dawn of civilization.

Among the 282 laws in Hammurabi’s Code, nine (215-223) pertain to medical practice:

 

HAMMURABI’S CODE OF LAWS :

  1. If a physician performs eye surgery and saves the eye, he shall receive ten shekels in money.
  2. If the patient be a freed man, he receives five shekels.
  3. If he be the slave of some one, his owner shall give the physician two shekels.
  4. If a physician performs an operation and kills someone or cuts out his eye, the doctor’s hands shall be cut off.
  5. If a physician performs an operation on the slave of a freed man and kills him, the doctor shall replace the slave with another slave.
  6. If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
  7. If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
  8. If he were a freed man he shall pay three shekels.
  9. If he were a slave his owner shall pay the physician two shekels.

 

As we can see, it did  not take into account  the earlier works or contribution of doctors to society. It also did not take into account the  uncertainty of medical science and uncertainties of the outcome.  The regulatory system was based on  principle of revenge and punishments.

Deselection of providers: Hammurabi’s Codex specified the harshest form of deselection possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. This severe punishment for negligence supposedly weeded out physicians incapable of delivering adequate care. In addition, it prevented these physicians from practicing in a different locality. Obviously, such a penalty discouraged a physician surplus.

Since ancient civilization, medical regulation has been always cruel to doctors.   Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical profession.

Today our system  is becoming somewhat  similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects.And this is despite the fact that now we are very well conversant with the workings of the human body and despite cognizance of the poor prognosis in certain disease states.

In an effort to institute managed healthcare, our society is in a way re-entering the realm of an ancient medical care system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body.

 

 

https://en.wikipedia.org/wiki/Code_of_Hammurabi

Code of Hammurabi. (2017, December 18). In Wikipedia, The Free Encyclopedia. Retrieved 16:58, December 23, 2017, from https://en.wikipedia.org/w/index.php?title=Code_of_Hammurabi&oldid=816023447

 

 

Max Hospital Delhi handed over dead baby : Is “ Lazarus syndrome” a possibility?


 

        There are lot of discussion going on about live  baby handed over to parents by Max Hospital  Delhi, as dead.  Every one including  media has as usual  jumped on to the favorite  topic of  doctor bashing.  Facts are still under investigation. But as a doctor, I can not reach conclusions without scientific discussion, least possible by media  talking superfluously. There can be number of possibilities, which we will  know with time after proper investigation. But whatever the result, doctors bashing had already been done by media , with or without knowing facts.

Life and death are still far beyond the reach of science and obviously  of doctors as well. There are still a lot more unknown than known story about human life. I just wish to draw the attention of my readers about an entity, which is quite mysterious.  Condition is  called     “ Lazarus syndrome”. Also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation.

A little bit about  this rare phenomenon.      

 

Lazarus syndrome, also known as auto resuscitation after failed cardiopulmonary resuscitation, is the spontaneous return of circulation after failed attempts at resuscitation. Its occurrence has been noted in medical literature at least 38 times since 1982. It takes its name from Lazarus who, as described in the New Testament of The Bible, was raised from the dead by Jesus.

Occurrences of the syndrome are extremely rare and the causes are not well understood. One hypothesis for the phenomenon is that a chief factor (though not the only one) is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR). The relaxation of pressure after resuscitation efforts have ended is thought to allow the heart to expand, triggering the heart’s electrical impulses and restarting the heartbeat. Other possible factors are hyperkalemia or high doses of epinephrine.

Cases

-A 27-year-old man in the UK collapsed after overdosing on heroin and cocaine. Paramedics gave him an injection, and he recovered enough to walk to the ambulance. He went into cardiac arrest in transit. After 25 minutes of resuscitation efforts, the patient was verbally declared dead. About a minute after resuscitation ended, a nurse noticed a rhythm on the heart monitor and resuscitation was resumed. The patient recovered fully.

-A 66-year-old man suffering from a suspected abdominal aneurysm who, during treatment for this condition, suffered cardiac arrest and received chest compressions and defibrillation shocks for 17 minutes. Vital signs did not return; the patient was declared dead and resuscitation efforts ended. Ten minutes later, the surgeon felt a pulse. The aneurysm was successfully treated and the patient fully recovered with no lasting physical or neurological problems.

-According to a 2002 article in the journal Forensic Science International, a 65-year-old  deaf Japanese male was found unconscious in the foster home he lived in. Cardiopulmonary resuscitation was attempted on the scene by home staff, emergency medical personnel and also in the emergency department of the hospital and included appropriate medications and defibrillation. He was declared dead after attempted resuscitation. However, a policeman found the person moving in the mortuary after 20 minutes. The patient survived for 4 more days.

-Judith Johnson, 61, went into cardiac arrest at Beebe Medical Center in Lewes, Delaware, United States, in May 2007. She was given “multiple medicines and synchronized shocks”, but never regained a pulse. She was declared dead at 8:34 p.m. but was discovered in the morgue to be alive and breathing. She sued the medical center where it happened for damages due to physical and neurological problems stemming from the event.

-A 45-year-old woman in Colombia was pronounced dead, as there were no vital signs showing she was alive. Later, a funeral worker noticed the woman moving and alerted his co-worker that the woman should go back to the hospital. A 65-year-old man in Malaysia came back to life two-and-a-half hours after doctors at Seberang Jaya Hospital, Penang, pronounced him dead. He died three weeks later.

-Anthony Yahle, 37, in Bellbrook, Ohio, USA, was breathing abnormally at 4 a.m. on 5 August 2013, and could not be woken. He was given CPR, and first responders shocked him several times and found a heartbeat. That afternoon, he coded for 45 minutes at Kettering Medical Center and was pronounced dead. When his son arrived at the hospital, he noticed a heartbeat on the monitor that was still attached. Resuscitation efforts resumed, and the patient was revived.

-Walter Williams, 78, from Lexington, Mississippi, United States, was at home when his hospice nurse called a coroner who arrived and declared him dead at 9 p.m. on 26 February 2014. Once at a funeral home, he was found to be moving, possibly resuscitated by a defibrillator implanted in his chest. The next day he was well enough to be talking with family, but died fifteen days later.

Implications  The Lazarus phenomenon raises ethical issues for physicians, who must determine when medical death has occurred, resuscitation efforts should end, and postmortem procedures such as autopsies and organ harvesting may take place.

Medical literature has recommended observation of a patient’s vital signs for five to ten minutes after cessation of resuscitation before certifying death.

In Popular Culture

In the TV show Grey’s Anatomy, a patient had a heart attack and after 42 minutes of resuscitation efforts they declared her dead. And 20 minutes after death has been declared, the patient vital signs returned and regained consciousness.

Source

Lazarus syndrome. (2017, September 2). In Wikipedia, The Free Encyclopedia. Retrieved 16:51, December 4, 2017, from https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

https://en.wikipedia.org/w/index.php?title=Lazarus_syndrome&oldid=798456668

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and   especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.

  1. Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
  2. Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
  3. Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.

Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.

Take for example the latest news of “ Alive Baby declared dead.”

http://timesofindia.indiatimes.com/city/delhi/alive-newborn-declared-dead/articleshow/59208765.cms

Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”

link   http://www.dnaindia.com/india/report-no-medical-negligence-in-case-where-newborn-was-declared-dead-2479826

Above news just conveys the complexity of situation, doctors often face. My aim here is to convey  that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.

 

Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).

Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities.  Because of all  these sensitive issues, emotional aspects and legal dimensions of death being  huge, so need more attention. .

In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.

Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios.  It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.

Harassment is tremendous. Therefore   doctors, be careful – save the patient, but save yourself also.

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