The ongoing Russia- Ukraine conflict has generated a discussion about a sub-plot, which links to India’s medical education. There have been reports that there are 18000 Indian medical students in Ukraine. People are wondering why Medical Students from India need to go to Ukraine for studying medicine. Answer is quite simple and does not need an Einstein Brain. It is the steep fee that private medical colleges charge from students which is unjustified and beyond any logic. It just needs a sincere ‘Government Will’ to implement the justified fee for MBBS seats in private medical colleges in India. Medical colleges in Ukraine, Georgia, Kyrgyzstan, Bangladesh, Philippines and China have been benefitted because of the severe exploitation of medical students in India.
It needs a sincere and honest assessment of the fee and expenditure of medical college and education rather than a permission for heavy profiteering. If honest calculations are carried out, the fee should not be more than one fifth of present rates, taking into account the hospital services expenditure.
Why do Indian students go to Ukraine to pursue courses, especially MBBS? Because of affordability, says Manjula Naidu, proprietor of a firm that helps send students to Ukraine’s Bukovinian State Medical University. Usha Rani, an Anekal resident whose son is in first-year MBBS at Zaporizhzhia State Medical University, said she wouldn’t have sent him to Ukraine had she been able to pay nearly Rs 80 lakh for an MBBS course in Karnataka. Though Karnataka has more than 9,000 MBBS seats, government quota seats account for not even 40%, forcing many aspirants to opt for countries like Ukraine, Georgia and Kyrgyzstan. What students and their parents find attractive is the Rs 25-30 lakh package for the entire course. Besides there are consulting agencies to help them with loans and the medium of instruction is English. On the other hand, the first fee slab for an MBBS seat in a government college is Rs 59,000 per year, followed by the second slab of government quota seats in private colleges (Rs 1.4 lakh per annum). The next fee slab is of private seats (management quota) in private colleges that varies from Rs 10 lakh to Rs 25 lakh a year. Even more expensive are the NRI quota seats and those in deemed universities.
In an era when doctors are being punished for small mistakes or merely perceived negligence, the blunders committed by administrators are not even noticed. Doctors are not paid for four months and for protesting the same, they were given termination letters. It seems that doctors need to live with blatant injustice all their lives.
Any punishment for the administrators for mismanagement? Looks impossible but punishment to the sufferers is on the cards.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
Doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The indifferent behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
New Delhi: Doctors, nurses and paramedical staff of East Delhi Municipal Corporation-run hospitals continued their protest on Thursday as well over non-payment of salaries for four months. Meanwhile, an order issued by the medical superintendent of Swami Dayanand Hospital, Dr Rajni Khedwal, stated that services of all senior and junior resident doctors would be considered terminated from February 4 and fresh interviews would be conducted accordingly. The order also stated that all Diplomate of National Board (DNB) residents and contractual doctors would be marked absent.
“We all were there in the protest, none of us went for our duties. We have also asked the administration to speak on our behalf because they are too part of the hospital. Maybe the matter will be resolved tomorrow. Unless we get a concrete statement regarding salary, we will continue the protest,” said Dr Atul Jain, president of the hospital’s resident doctors’ association.
Meanwhile, EDMC commissioner Vikas Anand said that no order had been issued regarding the termination/suspension of the striking doctors’ services so far. The termination order is only for the DNB workers and for the rest of the medical staff, it is based on ‘no work no pay’ as per the SC rule, he clarified.
“The salaries will be provided at the earliest. We have a very good team of doctors at Swami Dayanand Hospital. The only request is that they should join back and resume services,” said the commissioner.
Anand also said that the salaries for the months of February and March would be paid on time. “EDMC is going through a financial crisis and even in such difficult times, the corporation is sensitive towards the interests of its employees. Their due arrears will be paid in the month of May as per the availability of the funds,” he added.
In an act of revenge that took over two years, a doctor with a government hospital in Yavatmal – 650 km from Mumbai – was shot dead, allegedly by a family member of his patient who had died under the doctor’s supervision two years ago.
Attacks and assaults on doctors is an indicator of a lawless, uncivilized society, poor governance and broken health system. Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. The impunity with which criminals can dare to take law into their hands and punish doctors instantly at will is a blatant disrespect to courts and judicial system. In absence of strict laws for protection of doctors, health care workers have become vulnerable to assaults and revenge.
Doctors have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to the people and security to doctors. The rickety system hides behind their hard working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors is really appalling, should be shameful to law enforcing agencies.
Role of media, celebrities, film stars and prominent personalities in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable. They project single stray incident as an example and portray poor image of medical profession as generalization just to earn money and fame for themselves.
Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who are unable to retaliate to the powerful media machinery. Role of doctor associations, parent institutes have been spineless and not encouraging.
The demonstration of the cleft that separates doctors from the actual overpowering controlling medical industry and administrators is not given, in order to maintain the prejudice with its dangerous bias towards doctors, who are in forefront and are visible to public.
Family members of the patient had alleged that it was due to the negligence of Dr Hanumant Dharmakare, medical officer at the R P Uttarwar Kutir Hospital, that their son Arbaz (20), who had met with a bike accident, died in May 2019.
The police are on the lookout for the main suspect, Aifaz Shaikh, the elder brother of Arbaz, who is believed to have shot the doctor.On January 11, Dharmakare was shot dead in broad daylight by an unidentified person on the Umarkhed – Pusad Road in Yavatmal. The police team found that the application concerned the death of his nephew Arbaz.When the police questioned Tousif further, they found that his nephew Arbaz had met with an accident on May 4, 2019. Arbaz had been riding a bike with his brother Aifaz (then 22) and a relative Moshin, when the accident took place.The family had rushed the trio to the local hospital, where Dharmakare was the on-duty doctor. The family alleged that due to negligence on the part of the doctor, Arbaaz lost his life. The family even had a fight with Dharmakare and they allegedly threatened that he would have to pay for his actions. Bhujbal said that during the police investigation, they found that for the past two years, the family had been looking for an opportunity to get back at Dharmakare. They had kept an eye on his movements even earlier this year, following which they decided to allegedly kill him last Tuesday. It was Arbaz’s elder brother Aifaz who allegedly fired at the doctor and fled from the spot on the bike.
Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations, human right organizations, parent hospitals and institutes.
Good Governance lies in prevention of such incidents. Knee-jerk policing activities after every incident are of limited benefit. Moreover the impunity with which people dare to take law into their hands and tend to punish doctors instantly for perceived negligence, is a blatant disrespect to courts and judicial system.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
At a time when Political groups, terrorists, drug addicts, celebrities commit crimes and get a priority hearing by courts and speedy relief (whether deserve or not worthy), doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The barbaric response of Police towards peacefully demanding doctors has unmasked the real indifferent attitude of Government and administrators as well as apathy of courts towards medical profession. The cruel behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
It also shows the scant concern of the Government to provide a real good health care system despite showing a verbal concern for medical services. It also explains why successive Governments irrespective of political moorings have terribly failed to provide healthcare to its people. Why patients fail to get a bed, oxygen, doctors or nurse is consequence to the misplaced priorities of administrators.
Who would be the worst sufferer of the apathetic attitude of the Government? Doctors will suffer initially till they continue to choose medical profession. Once they also become apathetic like administrators, it would be the patients.
A day after resident doctors protesting delays in NEET-PG counselling alleged that they were assaulted by the police, doctors from the All India Institute of Medical Sciences (AIIMS) as well as those associated with the Federation of All India Medical Association (FAIMA) have decided to join the stir.
Doctors from AIIMS, one of the only big tertiary-care government medical college hospitals that had stayed away from the protest, in a letter to the Union health minister, said that they would withdraw from all non-emergency work on Tuesday if no concrete steps are taken.
“It’s high time for the government to release a report of what has been done till date, and what are the government’s plans moving forward for expediting NEET-PG counselling. If no adequate response from the government is received within 24 hours, AIIMS RDA shall proceed with a token strike on 29/12/21 including shutdown of all non-emergency services,” the letter read.
This would hamper patient care in the city further. With emergency departments of big hospitals like Safdarjung and Lok Nayak affected by the strike, patients were being referred to the AIIMS for treatment.
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In addition, FAIMA called for its resident doctors’ association to withdraw from all work, including emergency services, after Monday’s incident. The protest began with withdrawal from outpatient department (OPD) services in November end by two national organisations – the Federation of Resident Doctors’ Association (FORDA) and FAIMA.
The protest slowly intensified with doctors boycotting even emergency work, following which on the insistence of the government the strike was paused for one week.
The strike resumed on December 17 as FORDA members withdrew from all services.
Non-uniformity of medical education is treating medical students as slaves and killing enthusiasm of young doctors.
Medical profession is an extremely strenuous and highly specialised field that requires individuals to dedicate their lives in the service of others. As part of medical professionals’ education and training, they are necessitated to undertake training across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government. In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman for proper pay and working conditions.
Great disparity in stipend at Govt. Private Colleges
Medical education is one field where one can notice the extreme variations of the unimaginable magnitude that are beyond comfort.
Falling standards of medical education is the most important side effect which should be an important issue, but sadly it is the last priority on the list of administrators. Each and every medical college can be different and student passing out of many colleges receive below average medical education.
Another important variation is in the stipend and remuneration of young trainee doctors receive. It varies from college to college, city to city, state to state as well as North to South and East to West. Besides being a cause for heartburn. it is a cause for extreme dissatisfaction among medical students.
Needless to say the arbitrariness exercised by various authorities to pay them at their will is a reflection of grave injustice imposed by administrators.
Another arbitrariness reflecting injustice is variation in fee of medical colleges. The steep fee charged by private medical colleges and restrictive bonds of Government medical colleges in name of expensive medical seats need a sincere and honest introspection by authorities. The basis for calculations of the cost of medical education should be transparent and shown in public domain.
Needless to say that medical students have been sufferers of poor and arbitrariness of inept administrative policies. Just because they decided to be doctors, they have to endure poor, unjust and arbitrary policies.
Ironically as a child decides to be a doctor, he is exploited in name of such policies of unreasonable high fee, poor education and low pay. That too while working in extremely inhuman conditions, long and hard working hours. Strangely these medical students suffer grave injustice inflicted by the society since start of their medical education, but when they become doctors, everyone expects sympathy, empathy and honesty.
In absence of proper Governance and rules, the young doctors are thrown at the mercy of cruel businessman.
Still the sufferers of grave injustice themselves are expected to impart justice to everyone along with burden of mistrust.
Ensure uniform stipend to Interns: Great disparity in stipend at Govt. Private Colleges
Binoy Viswam, Rajya Sabha MP, has urged Union Health Minister Mansukh Mandaviya to ensure equity in payment of internship to medical students in private and government medical colleges across the country.In a letter to the Minister, Mr. Viswam said that the National Medical Commission’s Draft Regulations on Compulsory Rotating Internship, 2021, issued on April 21 and gazetted on November 18, had said that all interns shall be paid stipend “as fixed by the appropriate fee fixation authority as applicable to the institution/university/State.”
Ambiguity
“The phrasing of this provision allowed for great ambiguity and arbitrariness. It may also result in management of private colleges denying stipend to the interns as they have complete discretion without any safeguarding mechanism. The ramifications of the same are already being seen in colleges across the country as great variance exists in stipend amounts being paid in government colleges as opposed to private colleges,” he pointed out.
A right, not charity
Mr. Viswam said that medical profession was an extremely strenuous and highly specialised field that required individuals to dedicate their lives in the service of others. “As part of medical professionals’ education and training, they are necessitated to undertake internships across various settings. In this context, a stipend is paid as a matter of right and not charity. It is therefore essential that parity and equity be maintained across all medical institutions, whether run by private bodies or by the government,” he said.
The MP requested the Minister to consult with all stakeholders, including State governments, medical college managements, medical professionals, and students to formulate a policy that ensures equity among medical students. A uniform stipend to all interns would ensure that, he added.
The erstwhile Medical Council of India had come up with a public notice on January 25, 2019, on Graduate Medical Education Regulations, 1997. The Board of Governors that superseded the MCI was considering a provision that said “All the candidates pursuing compulsory rotating internship at the institution from which MBBS course was completed, shall be paid stipend on par with the stipend being paid to the interns of the State government medical institution/Central government medical institution in the State/Union Territory where the institution is located.” However, it was not gazetted until the Board was dissolved.
In present era, Doctors and Nurses have become sitting ducks for assaults, punishments and harassment for every reason, inept medical system, whether right or wrong. An unfortunate example of not only plight of health care workers but the strange kind of governance, is the arrest of doctor and nurses at Ahmed Nagar -Pune blaming them for fire in the hospital. Strangely, the administrators and staff responsible for the maintenance and infrastructure safety are not in the picture.
Making health care workers scapegoats for such tragedies just reflects not only the inept governance and poverty of justice but also the callous attitude of authorities towards real issues.
Ahmednagar hospital fire: Medical officer, 3 nurses arrested
A medical officer and three staff nurses were arrested Tuesday on charges of causing death by negligence and culpable homicide not amounting to murder after 11 people lost their lives last week in a fire incident at a hospital in Maharashtra’s Ahmednagar district. Medical officer Dr Vishakha Shinde, and staff nurses Sapna Pathare, Asma Shaikh and Channa Anant were arrested under sections 304 and 304A of the Indian Penal Code (IPC), said Manoj Patil, Superintendent of Police, Ahmednagar rural police.
Quoting Ahmednagar police, HT earlier reported that 70% of deaths were caused by smoke from the fire while the remaining died after directly getting caught in the blaze that broke out in the Intensive Care Unit (ICU) of the Civil Hospital. Most of them were senior citizens undergoing treatment for coronavirus disease (Covid-19). In connection with the incident, an FIR was registered against unidentified persons under Section 304(A) of the IPC.
The fire broke out last Saturday at 11am on the ground floor of the hospital, where 17 patients were admitted, of which 15 were on either ventilator or oxygen support. While 10 patients died in the blaze at the spot, one person later succumbed to injuries.
Dr. Anil Athare, president, IMA, Ahmednagar said it was shocking that clauses of Section 304 and 304A were applied against the medical officer and the three nurses, remarking that doctors and nurses were “always made scapegoats” in such cases.
“Instead of accusing the medical staff on ground, why is anyone not questioning the officials of the Public Works Department (PWD) and Electrical Department regarding wiring and maintenance works which caused the fire in the first place,” said Dr. Athare, demanding that the arrested medical personnel be released immediately.
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.
The medical profession and education have become a business and now the regulation of medical education has also gone that way which is the nation’s tragedy, an anguished Supreme Court said on Tuesday, giving one chance to the Centre to put its “house in order” and take a call on reversing the changes made to the NEET Super Speciality Examination 2021 syllabus.
The apex court was not satisfied with the justification given by the Centre, National Board of Examination (NBE) and National Medical Commission (NMC) on making the last minute changes after the notification for examination was issued in July.
“This is how botched up our education system has become,” it said.
A bench of Justices D Y Chandrachud, Vikram Nath and B V Nagarathna in an over two hour hearing gave time to the Centre, NBE and NMC to come up with a solution by Wednesday morning and said it will continue hearing the matter to avoid any prejudice to the young doctors.
“This matter is part heard and you can still put your house in order, we will give you time until tomorrow. We will not adjourn the part heard matter now as this will only cause prejudice to the students but we hope better sense prevails. If there is a sense of obduracy, then we are armed with law and they are long enough to reach out to the obduracy. We are giving you one opportunity to reform,” the bench said.
The top court was hearing a batch of pleas of 41 Post Graduate doctors and others who have challenged the last minute changes made to the syllabus after the notification for examination was issued on July 23 for the test to be held on November 13 and 14.
Additional Solicitor General (ASG) Aishwarya Bhati, appearing for the Centre, said the court should not get the impression that the last minute change in syllabus was done to fill vacant seats in private colleges and they will try to persuade the court to dispel this notion.
“We are getting a strong impression that the medical profession has become a business, medical education has become a business and the regulation of medical education has also become a business. That’s the tragedy of the nation,” the bench said.
The authorities should show some concern for the students, as these are the students who do not start preparation for these course two or three months in advance but right from the time they join a Postgraduate course, they aspire for a super speciality, which requires years of commitment, it said.
The government has to balance out the investment made by the private sector in these medical colleges but it should equally think in the interest of the medical profession and the interest of students, the top court said.
“The interest of students must weigh far higher because they are the people who are going to be a torch bearer of providing medical care and it seems perhaps we have forgotten them in the whole process,” it said.
The top court said that prior to 2018, 100 per cent questions came from the feeder courses; from 2018 to 2020 there was major modification under which 60 per cent marks were from super specialisation and 40 per cent from the feeder super specialisation courses.
“Now what is sought to be done is one hundred per cent questions will be from primary feeder speciality which is general medicines. It is completely overlooking the facts that you are fundamentally changing the examination pattern and you are doing it for an examination announced to be held in November, 2021,” it said.
The bench added that NBE and NMC are not doing any favour in asking the court to push back the examination by another two months.
It told Bhati, “It does not matter as these doctors will join the Super Speciality courses two months later, so long the seats are filled up it does not matter. This shows us the length to which your clients are willing to go to ensure that seats are filled up. Nothing should go vacant”.
Bhati said that seats going vacant is not the only consideration that has weighed on experts but it is the comparative opportunity and comparative ease which will be in larger public interest of the students that has weighed with the experts.
The bench said, “So what really happened is this for all specialisation of super speciality, starting from critical care medicines, cardiology, clinical haematology and other courses the specialisation is only going to be and the examination will be on general medicines.”
“The idea is that general medicine has the largest pool, the largest group in PG, so tap and fill up the vacant seats. That seems to be the logic behind this, nothing more and nothing less”.
The top court said, “You may have a rationale; we are not saying you may not have a rationale. The question is that all changes, which you have brought has caused serious prejudice to the students. Problem is that you didn’t plan for the future. You did not have a vision and all that you do is that just because you have a certain degree of authority you will exercise it in whatever time you want”.
The bench asked Bhati and senior advocate Maninder Singh, appearing for NBE, what was the great hurry to do it for this year as heavens would not have fallen except for the fact that some 500 seats would have remained vacant in some private medical colleges.
On September 27, the top court said, “Don’t treat young doctors as football in the game of power,” and warned the Centre that it may pass strictures if it is not satisfied with justification for last minute changes to the syllabus.
As in last few decades, patients are defined as consumers and Medical Consumer Protection Act takes roots, the whole system of medicine and healthcare has changed. All the new changes in regulation, insurance and legal system have resulted in facilitating and exercising an easy control of medical industry over health care, each revision has affected doctors adversely. They have been reduced to just only one small component of the industry, who deliver care and remain at receiving end for poor outcomes. Other important stake holders are patients. How this change has been beneficial for patients?
Suppressed professionals can be used to work more, get less paid and can be dragged to courts easily. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario, act smart and are able to entrench themselves in changed business and legal milieu.
Disadvantages of medical consumer Protection Act (Negatives, cons)
1 .Promotes Defensive medicine: Every patient with any illness has a potential for complications. Progression of any disease state can cause death. If doctors start looking at every patient as a potential litigant, especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients. Worst scenario of excessive fear will be refusal of very sick patients in emergency situations or non-availability of doctors.
2. Erosion of doctor-patient relationship: Stray and occasional Incidents about negligence, the cases in courts or their outcome attract wide publicity in media. People are unable to understand the correct application of such stray incidents to themselves. But they always try to imagine themselves being in the chaos or scenario projected. Because of prejudiced notions, a sense of mistrust gradually creeps in, which then extends into and involves their own imagination and circumstances. This sense of mistrust multiplies manifold whenever there is some adverse or even small unpleasant event. Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
3. Increased cost of care: With the increasing need for defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to increased medical costs. Insurance companies, medical industry and lawyers have positioned themselves in between doctor and patients. They charge everyone on both sides, heavily for allaying the fears, both patients (medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
4. Enhanced insecurity in medical profession: Needless to say, consumer protection act has increased the anxiety and insecurity of the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career, will result in professional hanging or a media trial. There is a real probability of being entangled in these problems in present era in day to day practice.
5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons, for example the sense of revenge or to extract money or simply for avoiding to pay for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These ideas are further stoked by the incidents of previous high compensations granted by courts .
6. Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a day more worried about completing paper work as well. Initially it was a symbolic documentation, but now there is requirement of mammoth paper work. It leads to consumption of time that was meant for real discussions for the benefit of patients.
7. Doctors used as scape-goats for revenge: Any unsatisfied patient can vent his anger by putting complaint or case against the doctor. This is done to some extent for revenge or just finding a human factor which can be punished. Not uncommonly doctors are used as scape- goats to have a concession on the patient treatment by administrators. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
8. Distraction of doctors from the primary point of intention: Nothing else ever has distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight. Complex medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intentions ‘the treatment.
9. Early retirement or burn out: Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the doctor’s whole life.
10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career to risk, why should anyone put himself in that difficult position? Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
11 .Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight. All patients, who are unsatisfied or with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
12. Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking for, whom to blame among themselves. All of them will try to pinpoint each other’s mistake. Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately a mutual understanding and team work takes a hit.
13. Doctors converted to cheap labour:
Hugely benefitted are medical industry, law industry and administrators; The ease with which doctors can be harassed has lead to rampant misuse of consumer protection ac and t has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip against the doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain the maximum out of doctors hard work. Benefits to law industry and lawyers are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
14. Confusion while treating; Right decisions ? A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering. What was medically right and judicious decision at that real time situation may be looked as wrong later, especially when retrospective analysis is done over years with fault finding approach. So taking medical decisions is becoming more difficult amid future uncertainty of disease.
15. Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem, but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed. Delay in surgeries or therapies are a common outcome.
16. Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations. This encouragement and instigations of lawsuit against doctors is a major setback for medical profession.
17. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous training and then suddenly find themselves starting the work in a hostile environment. They find it strange to find themselves at the receiving end of public wrath, law and media for reasons, they can’t fathom. They work with continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
18. Doctors have become ‘Sitting ducks’ for continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes. Mistakes are always easy to be pinpointed with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
19. Demoralization of medical professionals – as selectively applied: strangely it applies only to doctors. All of other professions are out of it. Selective application is what demoralizes doctors. Considering the uncertainty and kind of work of medical profession, actually it should be other way around.
The consequences are like victimization.
Advantages of Medical Consumer Protection Act: (Positives, Pros)
1. Redressal of grievances: patient will get satisfaction, if there is a genuine negligence case
2. Better quality of care ; medical systems will improve as they will need to lessens the errors and court cases. Better systems from abroad are also copied to improve the efficiency.
3. Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.
4. Training of medical professionals: it will be difficult to put errors under carpet. Doctor will like to get trained better as no one want to be in soup.
5. Future learning from court cases: each and every court decisions is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.
6. Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.
7. Better documentation and communication: for doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting much. But now there is lot of stress on documentation.
Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and achieve better results. The real problem lies in the fact that in this age, anxiety prevailing more for care givers, a sense of injustice prevails . Stress generated can alter the ways, the patients get treated. If the core of the health care (medical hands) are harmed, no one can benefit in the long run.
Attacks and assaults on doctors appears to be one of the indicators of a lawless and uncivilized society and poor governance. Doctors have become punching bags for all the malaise prevalent in the health system. A failing and inept system, which is unable to provide health to people and security to doctors. The system hides behind their working doctors and presents them as punching bags. The impunity with which attendant easily and brutally assault doctors and vandalize hospitals is really appalling. Similar violent incidents all over should be shameful to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission and similar organizations.
Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling.
Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as generalization, just to earn money and fame.
Empathy, sympathy, compassion and trust of the doctor towards the patient, will definitely get a hit after these incidents. Everyday the news of assaults on doctors, court cases against doctors, negative projection of the medical profession in the media are viewed by doctor’s community anxiously..
Merely taking some token action and showing protest will not solve the problem. It does not compensate for the damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be the ultimate sufferer, does not need a Einstein brain to predict.
This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients. Why would someone try complex surgeries, if there is greater risk involved? Few will limit themselves to follow protocols. Going extra mile along with risk, which not everyone will like to take. Many will become health managers or do something else than do active clinical work. Who should risk his life while doing routine work?
Patients might get their revenge for the naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.
Relatives were booked for vandalising the Navi Mumbai Municipal Corporation (NMMC) hospital in Vashi following the death of a 50-year-old man. Of the seven, the four men were arrested. The patient, Venkatesh Suryavanshi, a resident of Juhu gaon, was shifted from a private hospital in Koparkhairane to the NMMC hospital on Tuesday afternoon. At the time of admission, Suryavanshi, who had tuberculosis, was in a critical condition and had very low oxygen levels. An antigen test had declared him negative for COVID-19.“At the time of admission, after checking his condition, vitals and the history papers, we had said that his chances of survival are very less. He was admitted to the ICU ward,” Prashant Jawade, medical superintendent, NMMC hospital, said.Suryavanshi died during treatment around 3.45 a.m. on Wednesday. After getting to know about the death, his sons Rupesh (22) and Sandesh (20), along with their friends Pankaj Jadhav (22) and Rohit Namwad (32) entered the ICU ward and started vandalising the department. Three women who followed them assaulted security guard Satish Dere.“I was told that they also carried a few sharp weapons with them. The security guard has received injuries. Our engineers are analysing the damage and finding the losses that we incurred,” Mr. Jawade said. Chief Medical Officer Majur Shaikh and a few other hospital staff were also allegedly attacked.
According to the police, the seven had vandalised three ventilators, one dialysis machine, two fans, one table fan, and two nurse stations.
Evolution of Medical profession-Extinction of good doctors 