Deadly doctor assault at #NRS-Hospital-Kolkata: doctors- save yourself


The condition of the intern, who was admitted to a hospital, was stated to be critical . After Death of Patient, Relatives Clash With Junior Doctors in  #NRS-Hospital-Kolkata-west-bengal Hospital Over ‘Negligence’

An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as clashes broke out over the death of a 75-year-old patient.

        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.  Role of doctor associations, parent institutes have been spineless and not encouraging.  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 normal routine just to earn money and fame. Ultimately doctors have been left to fend for themselves individually or with friend groups. 

Kolkata: A clash erupted between junior doctors and relatives of a patient at a state-run hospital here late Monday night after the 75-year-old died due to alleged negligence, police said Tuesday. An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as the junior doctors began a sit-in, demanding better security, they said.  Family members of Mohammed Shahid, a resident of Tangra, allegedly assaulted some junior doctors at around 11 pm last night after he died. As a result, a clash broke out, virtually turning the hospital premises into a battleground, the police said. Shahid’s family members were also angry over a delay in handing over his body, they added.

A large team of police personnel from Entally police station intervened and restored to lathicharge to bring the situation under control, a senior Kolkata Police officer said. More than 50 doctors shut the gates of the medical institution and began a sit-in on Monday night, demanding “protection”, the police said. The condition of the intern, who was admitted to a hospital, was stated to be critical, they said. Services at the hospital, including the emergency services, were affected on Tuesday as the junior doctors’ continued their protest.
West Bengal Medical Education Department director, Dr Pradip Kumar Mitra, visited the hospital and tried to persuade the doctors to withdraw their protest, but in vain.


    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. Recent senseless attack  on doctor  at NRS Hospital Kolkata again a warning to children, who wish to be doctors.

      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 with risk involved? Few will limit themselves to follow protocols. Going extra mile 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.

 

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   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 sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi,  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naïve or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  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  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  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.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors by application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

Today the global  system of medical regulation, 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 known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  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. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

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#Doctor-wife-killed-by patient #Warning to Doctor/medical profession- becoming a victim of easy revenge


Any patient who visits hospital carries a static or progressive risk of death, howsoever little his illness looks to be . A genuinely poor prognosis or progression of disease or routine complication can cause or result in death. But by application of average wisdom of the people who do not have an idea about complexity of medical field, can easily blame doctors. So doctor even when doing his best is at risk of revenge or harm from public as well as authorities. A fundamental question about such situations will come to doctor’s mind naturally. What happens when doing some good work by our self causes harm to ourselves? Here you are trying to save some one. It is a happy situation for him if you are successful. But due to some reason patient dies or there is poor outcome. He has all the rights to harm you in more than one way. What if he happens to be a powerful person, a VIP, criminal or a goon. What if he becomes revengeful towards you. Doctor will turn into an object of revenge. Money a doctor receives in “what so ever risky situations” or even for saving a life is peanut. But if patient decides to sue him, court may ask to pay something , doctor may not earn in his life time. Or in extreme cases physical violence and even killing the doctors is also some thing which is not unheard off and is on the rise. And this process can happen any minute, any day and continues for years till he continues to work the whole life. Even single mistake in entire career, that too unintentional is enough to cost name, fame or even life. Even it may not be a mistake, or just be a naturally poor prognostic disease, which can be interpreted as an error easily. For people who do not treat patients, how so ever learned they may be, are unable to recognize the difference between the negligence or genuinely poor prognosis. Thanks to media and our celebrities, who have created a doctor- patient mistrust for their own populist gains. An impression is being created, as the poor outcome is because of doctor’s mistake by selective projection in a certain manner.

not-satisfied-with-treatment-man-kills-doctor-s-wife Irritated that a doctor, who wasn’t able to cure his itch for six months, was away in Delhi, an Indore man stabbed to death the doctor’s wife and injured her son. According to the police, the incident happened at the clinic of Dr Ramakrishna Verma in the Malwa Mills area of Indore, on Thursday morning. The doctor ran his practice from home. Tukoganj city superintendent of police (CSP), BPS Parihar said, “The accused Rafiq Rasheed (45) was suffering from an itchy skin disease for which he was getting treatment from Dr Ramkrishna . Verma for the past six months, but without any results. When he went to the clinic at about 11 a.m, Verma’s wife Lata informed him that her husband was in Delhi. This apparently angered Rafiq who got into an altercation with Lata (50) and stabbed her repeatedly with a knife he was carrying. As Lata screamed for help, her son Abhishekh (19) came out and Rafiq stabbed him too and ran away. However, some people who came hearing the screams managed to nab Rafiq and handed him over to the police.” The locals took both mother and son to a nearby private hospital where Lata was declared brought dead. Abhishekh’s condition is said to be critical, police said.

Being revengeful against doctor is very easy. They have become sitting ducks for revenge. Verbal abuse, physical harm, legal remedies, disciplinary actions, punishments, social mudslinging, court cases and legal harassment are common remedies easily available. In absence of support, lack of law and order enforcement, physical assaults and even murder is also not a distant possibility. Here it was just a treatment failure or may be a poor response to treatment, which resulted in killing of doctor’s family. If trying to treat some one can result in harm to one self, why should the doctors will choose to treat. More over why should one become a doctor at all. Such incidents of extreme violence are not merely disaster for a family, but they are warning signs to whole of profession.

Many in such unfortunate situations must have a thought in mind “ why should one become a doctor and treat patients?”

1,000 people at Delhi’s RML Hospital for anti-rabies shot in a day #dogbite#straydogs


Until last year, Ram Manohar Lohia (RML) hospital used to get around 200 patients daily for anti-rabies vaccination. This number has grown manifold over the last six months and on Monday it crossed 1,000. Hospital authorities blamed the unavailability of anti-rabies vaccine at state and municipal corporation-run hospitals for this surge and said if the vaccine wasn’t made availabile at all centres soon, it could lead to a fullblown crisis

“There is a limit to how much we can stretch our resources,” said Dr V K Tiwary, the medical superintendent of RML hospital. At Safdarjung hospital also, which is run by the Centre, officials said there has been significant increase in the rush of patients for the vaccination. Anti-rabies vaccine is needed to prevent the development of disease in persons who have been bitten by an infected animal, The first dose of anti-rabies vaccine has to be injected within 24 hours of the bite — the sooner the better. However, people who had queued up at RML on Monday said they had been running from one hospital to the other in search of the vaccine but to no avail. “I went to two government hospitals in east Delhi. Both said they didn’t have the vaccine. I cannot afford private treatment,” said Kavita Singh, a resident of Mandavali, east Delhi. While government hospitals give anti-rabies vaccine for free, it costs nearly Rs 1,500 for five jabs at private facilities. For patients with severe and deep bite, the administration of anti-rabies serum is required in addition to the vaccines, which costs above Rs 2,000. Authorities in at least two big state-run hospitals — Guru Tegh Bahadur (GTB) in East Delhi and Lok Nayak in central Delhi — confirmed the crisis. “For the last two weeks, there is no anti-rabies vaccine in our hospital,” Dr Arvind Mohan, deputy medical superintendent of Lok Nayak hospital said. He claimed the shortage is from supply side itself. “The vaccine shortage has been there for almost six months but we were managing things by making local purchase initially. Now, even the local suppliers have given up,” Dr Mohan said. Dr Sunil Kumar, medical director of GTB hospital also confirmed they are also running short of anti-rabies vaccines. “We are issuing tenders to purchase the vaccine,” he said. There is no anti-rabies vaccine at municipal hospitals either, senior civic agency officials from both the north and the south corporation confirmed. “The government manufacturer is not supplying the vaccine from last few months due to nonavailability. Patients are either being told to purchase it privately or being referred to other hospitals,” said an official ,Delhi, as per the last annual report of all municipal corporations combined, had witnessed over 27,407 dog bite cases from February 2018 to February 2019. South Delhi was worst affected. Real numbers are expected to be much higher as the figures do not include patients that go to private clinic or hospitals that are not bound to report, said a source. In April, Safdarjung hospital had stopped accepting new cases of dog-bite due to the rush. “Situation has improved a little over the last few weeks. But steps are needed to restore or arrange supply of the vaccine in all anti-rabies clinics to avert crisis situation,” a doctor said.

“Dog lover” but lack love towards human child? #straydogs #Rabies #dogbite #infections


In a very recent incident, while out  for a routine morning walk in a Delhi park, I was suddenly jolted by violent barking sounds of dogs. The loud barking sounds were intermixed with cries of a child. I just saw the child running and screaming  for his life. Two stray  dogs were near him,  trying to hunt  him as a prey. As they got nearer to him, I somehow managed to get some stick from a plant and managed to save the child and shoo away the dogs. The nine year old child just clung to me, almost pale, dizzy and his eyes closed with fear. His football was in his lap, which he was trying to use as shield. A shield which society, government, courts and so called “dog-lovers” failed to provide. This child must be the life for his parents and could have been in a great trouble that day because of apathy of few “Animal Lovers”. For whom animal love is like a hobby to be projected for hollow public applause. I looked around, a gentleman was comfortably sitting  with his small dog and reading newspaper. He did not even bother to look at what was happening. He was the person, who used to feed these stray dogs and claimed himself to be a “Dog lover”.  He was totally unperturbed by the fact that a child was about to lose his life because of these wolf like dogs roaming freely. Fed by him, the stray dogs were like friends to him and used to attack others who did not feed them, or were new or  oblivious to the danger. What was bothering was his apathy to the child and victims  and the fact that he continued to feed that violent stray, unperturbed during  the incident.  Similar apathy has been displayed by government and courts with a result that thousand suffer from dog bite every day.

Is it not hypocritical that you care for a violent stray who is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans.  Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate  sense of hatred towards such dog lovers is a consequence and  a natural thought.

Apart from the injury part, Rabies is a disease spread by dog bite, which is not treatable. Getting anti-Rabies serum becomes another Herculean task.

Courts have also upheld animal rights. That is right  but they did not formulate  policies to ensure guard safety of  humans from these violent strays.

           Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

Animal lovers  while pretending  of “dog love” have  formed NGOs and have  donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from  such preventable cause raise a question on this issue.

    Apathy of these so called dog lovers towards humans is appalling. 

Besides dog bite and injuries, animal and dog poop is an health hazard. Following are the diseases which occur in community because of animal poop.

Problem of animal poop with dust : It is all around us.  It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Even owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

       Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infections. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like  Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms,    Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry  poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment.  This may be an important cause of high rates of community acquired infections among our population.

SUGGESTION: the Government, NGOs  and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the  dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives  and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights  should be limited accordingly.

Medical Consumer Protection Act: Root of “Us and Them Syndrome”. Effect on medical profession


In present scenario, when patient is no more “patient” and  defined as consumer, doctors is not more than a service provider. With  Medical Consumer Protection Act acquired roots,  the whole system of medical delivery  and healthcare has changed. Most striking is this  entire fiasco is the “Us and Them” syndrome that seems to afflicted  every one. Doctors are pitted against every one, for example,  Doctors vs administrators, doctors vs patients, doctor vs managers. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component  of the industry, who deliver care and remain at receiving end. Other important stake holder are patients. How this change has been beneficial for patients? Suppressed professionals  can be used to work more, get less paid and can be dragged to court. So fear of all kinds will make them more  careful. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario and act smart in  changed business and legal milieu.

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Negatives effect on medical profession: cons or disadvantages of  medical consumer Protection Act

  1. Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones,  practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics  and even  sometimes even refusal to treat very sick patients. Worst scenario of excessive fear will be  refusal of very sick patients in emergency situations or non availability of doctors.
  2. Erosion of doctor-patient relationship: stray and occasional Incidents about negligence and the cases in courts or  their outcome are given wide publicity in media. People are unable to understand the correct  application of such stray incidents to themselves. But they always try to imagine themselves in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in,  which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is  some adverse or even small unpleasant  Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
  3.  Increased cost of care:   With the creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated  medical costs.  Insurance  companies and lawyers have positioned themselves in between. They charge everyone heavily for allaying the fears , both  patients(medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs , need for insurance, medicolegal suits, high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
  4. Enhanced insecurity in medical profession : Needless to say,  consumer protection act has increased the anxiety  and insecurity in  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
  5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g  for sense of revenge or to extract money or simply for not having to pay for services.  In an era where family members , brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These are further stoked by the incidents of previous high compensations granted  by courts .
  6. Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a days more worried about completing paper work as well. Initially it was a symbolic documentation , but now there is requirement of mammoth paper work. It leads to consumption of time  that was meant for real discussions for the benefit of patients.
  7. Doctors used as scapegoats 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  trying to find some   human factor which can be punished. Not uncommonly doctors are used as  scapegoat to have  a concession on the patient treatment by health organizations. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
  8. Distraction of doctors from the primary point of intention:  Nothing else ever has  distracted doctors  more than these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky  decisions which may later be proved wrong by retrospective analysis, complex  medico-legal situations are endless distractions that have creep in and are enough to distract doctors from primary point of intention.
  9. Early retirement or burn out:  Becoming a doctor and practicing 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 medico-legal complexities in older age. Taken to court for a genuine decision by self  is enough to spoil and tarnish  health, wealth and fame earned by  grilling the whole life.
  10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding position?  Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
  11. Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight.  All patients with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
  12. Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking  for whom to blame  among themselves. All of them will try to pinpoint other’s mistake.  Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately  a mutual understanding and team work takes a hit.
  13. Hugely benefited are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medico-legal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work.  Benefits to law industry are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
  14. Right decisions or wisdom of hindsight?; A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering.  What was medically right and judicious decision at that real time situation may look wrong later  retrospectively, especially when retrospective analysis  is done over years with fault finding approach.
  15. Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed only to repent later.  
  16. Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in  developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigation of lawsuit against doctors is a major disadvantage for medical profession.

 

  1. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous  training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and  media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  2. Subject of continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes.  Mistakes are always easy to  pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for  any kind of

 

 

 Positives, Pros or advantages of medical consumer protection act:

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

  1.     Quick  redressal of grievances:  patient will get satisfaction, if there is a genuine negligence case
  2.  Better quality of care will increase;  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. 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. 7. Better documentation and communication: Doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting. But now there is lot of stress on documentation.

   Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and  achieve  better results.   The real problem lies in the fact that In this age of  anxiety prevailing more for care givers,  do not get enough relief  from stress.

        But sad thing about this kind of learning is that it is at the cost of few, unfortunate doctors, who were in difficult situation, actually suffered, did not know the legal implications  of  their acts or  situation. Most of the time, it is a system failure, but blame can be pinpointed to doctor.

May be The Act has good intention, but its practical application in its present form may cause more harm than good.    If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

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


With patient defined as consumer  and  Medical Consumer Protection Act takes roots,  the whole system of medicine and healthcare has changed. From regulation, insurance and legal system, every change has affected doctors adversely. They have been reduced to just only one component  of the industry, who deliver care and remain at receiving end. Other important stake holder are patients. How this change has been beneficial for patients? Suppressed professionals  can be used to work more, get less paid and can be dragged to court. So fear of all kinds will make them more  careful. It should be a win-win situation for all, except doctors. Therefore everyone makes merry, while doctors sulk, except those who can mingle with the present scenario and act smart in  changed business and legal milieu.

Negatives, cons or disadvantages of medical consumer Protection Act

  1. Promotes Defensive medicine: Every patient with any illness has potential to complications. Progression of any disease state can cause death.  If doctors start looking at every patient as a potential litigant, especially those who are dealing with very sick ones,  practice of defensive practice is a natural consequence. This may manifest as excessive investigations, more use of drugs and antibiotics  and even  sometimes even refusal to treat very sick patients. Worst scenario of excessive fear will be  refusal of very sick patients in emergency situations or non availability of doctors.
  2. Erosion of doctor-patient relationship: stray and occasional Incidents about negligence and the cases in courts or  their outcome are given wide publicity in media. People are unable to understand the correct  application of such stray incidents to themselves. But they always try to imagine themselves in the scenario applied. Because of prejudiced notions, a sense of mistrust gradually creeps in,  which then extends to and involves their own treating doctor .This sense of mistrust multiplies manifold whenever there is  some adverse or even small unpleasant  Ultimately doctor and patients move forward together with a strained relationship and the treatment goes on with a surmounting sense of mistrust.
  3.  Increased cost of care:   With the creeping in of practice of defensive medicine, there is a need to document everything and to offer everything possible in the world, leading to inflated  medical costs.  Insurance  companies and lawyers have positioned themselves in between. They charge everyone heavily for allaying the fears , both  patients(medical insurance, lawyer fee) and doctors(indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs , need for insurance, medicolegal suits, high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall increased cost of health care.
  4. Enhanced insecurity in medical profession : Needless to say,  consumer protection act has increased the anxiety  and insecurity in  the medical profession. One keeps wondering which patient will prove to be his bane and finish his total career or will result in professional hanging or a media trial, with these having real probability in today’s day to day practice.
  5. Unnecessary litigation: Legal cases can be put on doctors for various trivial reasons e.g  for sense of revenge or to extract money or simply for not having to pay for services.  In an era where family members , brothers and sisters fight for money, it will be naïve to think that idea of making money from doctor does not exist. These are further stoked by the incidents of previous high compensations granted  by courts .
  6. Increased paper work: excessive documentation and time consumption: crucial and large chunk of time of doctors and nurses, goes in completing documentation. Needless to say, this time previously was dedicated solely to patient service. Management is now-a days more worried about completing paper work as well. Initially it was a symbolic documentation , but now there is requirement of mammoth paper work. It leads to consumption of time  that was meant for real discussions for the benefit of patients.
  7. Doctors used as scape-goats for revenge : Any unsatisfied patient can vent his anger by putting complaint or case  against the doctor .  This is done to some extent for revenge or after finding  human factor which can be punished. Not uncommonly doctors are used as  scape- goat to have  a concession on the patient treatment by health organizations. Everything can be easily put on doctors as they are universal final link to a patient’s treatment and adverse effects.
  8. Distraction of doctors from the primary point of intention:  Nothing else ever has  distracted doctors  more than these medico-legal cases and punishments. In many cases, saving themselves becomes more important than saving a patient. Uncertainty of prognosis, grave emergencies and split second life saving and risky  decisions which may later be proved wrong by retrospective analysis, complex  medico-legal situations are endless distractions that have creeped in and are enough to distract doctors from primary point of intention.
  9. Early retirement or burn out:  Becoming a doctor and practising has become a tough job. After people have reached a point of financial security or when near point of burn out, doctors tend to leave practice. No wise man will like to face medicolegal complexities in older age. Taken to court for a genuine decision by self  is enough to spoil and tarnish  health, wealth and fame earned by  grilling the whole life.
  10. Reluctance to do emergency, risky work: If the decision to decide or act or help someone in an emergency situation, puts ones own life and career to risk, why should one put oneself in that deciding position?  Therefore increasingly, financially secure doctors are staying away from the riskier jobs.
  11. Only Doctors are sufferers of the act: Patient can have poor outcome because of any reason. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. But retrospectively doctors can easily be blamed because of wisdom of hindsight.  All patients with unrealistic or unexpected outcome can go to courts. Whatever court decides, harassment of doctors is full and permanent. There is no compensation possible for the sufferings and agony spanned over years, even if court decides in favour of doctor.
  12. Spoils teamwork among doctors; Whenever there is adverse outcome in any patient, all the doctors involved may start looking  for whom to blame  among themselves. All of them will try to pinpoint other’s mistake.  Such situation produces a bitter and worst kind of disagreements among various teams or specialties. Mutual understandings take a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity. Ultimately  a mutual understanding and team work takes a hit.
  13. Hugely benefitted are medical industry, law industry and administrators; Rampant misuse of consumer protection act has instilled a sense of deep fear in mind of medical professionals. The act has been used as a whip for doctors by all these three stakeholders. Fear of medicolegal cases has reduced doctors to cheap labour. Industry has used the protective systems to gain out of doctors hard work.  Benefits to law industry are obvious and don’t need to be elaborated. Besides this, even insurance industry has collected money both from doctors and patients by creating the fear.
  14. Right decisions or wisdom of hindsight?; A certain element of doubt always remains in minds of doctor whether he will get justice in the long run, or will end up being victim of sympathy towards patient or clever lawyering.  What was medically right and judicious decision at that real time situation may look wrong later  retrospectively, especially when retrospective analysis  is done over years with fault finding approach.
  15. Delayed treatment in emergency situations: Due to prejudiced minds, it is not uncommon for patient’s relatives to keep seeking second opinion, thereby delaying consent for procedures, surgeries and treatment. Though doctors know this problem but they obviously cannot proceed without necessary documentation. With increasing mistrust, even emergency treatments are delayed only to repent later.  
  16. Instigation by law industry; Windfall profits for lawyers and law industry at the cost of doctors is a disadvantage for medical profession: One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in  developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements. There is no dearth of such relatives, lawyers who are ready to try their luck sometimes in vengeance and sometimes for lure of money received in compensations.  This encouragement and instigations of lawsuit against doctors is a major disadvantage for medical profession.

 

  1. Hostile environment for young impressionable doctors: The young and bright doctors complete their long arduous  training and then suddenly find themselves working in a hostile environment, at the receiving end of public wrath, law and  media for reasons they can’t fathom. They face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.
  2. Subject of continuous blackmail: Even with routine complications amongst very sick patients, a threat looms over doctor’s head. People do not accept even the genuine complication, what to talk of unintentional mistakes.  Mistakes are always easy to  pinpoint with retrospective analysis and with lawyers pondering over it for years. In such situations , doctors are sitting ducks for  any kind of

 

 

 

 

 

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

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

  1.     Quick  redressal of grievances:  patient will get satisfaction, if there is a genuine negligence case
  2.  Better quality of care ;  medical systems will improve as they will need to lessens the errors and  court cases. Better systems from abroad are also copied to improve the efficiency.
  3. Better introspection by medical profession: although doctors from the beginning are sensitive about their work and always look at how better results can be achieved. But act will make this process more formal and official.
  4. Training of medical professionals: it will be difficult  to put  errors under carpet.  Doctor will like to get trained better as no one want to be in soup.
  5. Future  learning from court cases:  each and every court decisions  is viewed carefully by medical fraternity. Improvement in protocol and policy making is a natural consequence.
  6. . Eye openers for medical profession: court cases and decisions have acted as eye opener for medical profession. It gives an idea, how law looks at medical treatment. It has made clear that medical science and medical law are a bit different. In real time, things are easier to be said than done.
  7.  Better documentation and communication: for  Doctors to save themselves, documentation is the key. Previously doctors were doing everything, but not documenting. But now there is lot of stress on documentation.

   Stress itself is not a bad thing. It can often help us perform at our best, expand beyond our limits and  achieve  better results.   The real problem lies in the fact that In this age of  anxiety prevailing more for care givers,  do not get enough relief  from stress.  If the core of the health care  (medical hands) are harmed, no one can benefit in the long run.

Black coat vs white coat. What if money part is taken out of medico legal cases?


What if  financial part  is taken out of medico-legal issues, like compensation and lawyers fee?  The cases will drop down drastically?  If money part is zero, only errors will be identified and punished. Few  will remain only for idea of revenge.  In an era where people cheat their brothers, sisters and spouses for money, it will be naïve to think that idea of money extracting from doctors does not exist.

Financial  zeroing  can be done  in larger public interest to  keep down the cost of medical expenses.  It is  because of career building of few professions, that medico-legal cases are being fueled. Medical errors and complications are integral part of the treatment . Even simplest of diseases carry some amount of risk.  These  will still remain, even if doctors are hanged to death. Natural complications, poor prognosis can be attributed to errors by clever lawyering and because of benefit derived by other professions.

     Many careers  are  shining in name of preventable deaths  and medical errors at the cost of medical profession.  The managers, right activists, media   and lawyers  have made their career and wealth out of it. Ask any doctor really, are these issues really preventable after a point.  The  line separating errors or natural complications is really blurred and arbitrary. People who work in life and death situation know it well that  even natural poor prognosis can be labelled and proved as error by retrospective analysis and wisdom of hindsight and more certainly with luxury of time at disposal for lawyers and courts.

     Lawyers  and courts  should also be given those fraction of moments to decide same as is available to doctors. Otherwise it becomes a unbalanced match specially when the amount of money which was paid to doctor to save a life was peanuts as compared to now being paid to punish him.

Illegal Organ (Kidney)transplant trade : Defined as crime, but saves life


A paradox, where a defined crime saves a life and following law and regulation correctly will result in end of life. If some one is asked to choose between a certain death or follow regulations, the choice will be very predictable. A patient , who has an irreversible organ failure, will try to defy death at all cost. People who can afford, can not see their children or loved ones to die, just for the sake of following law and regulations. Genuine concern here will be that If a patient can be cured of disease, why he should be left to die for just regulations. The wish to live is the basic reason, why the procedures, which are termed illegal, will flourish. They will thrive underground or in countries, where laws are lax. Touts, agents and liaison managers are people, who will be beneficiary and mint money by organization of the procedure. The people who can afford, get gift of life, in the bargain.

Organ transplant may be termed illegal, in certain circumstances as defined by Law. But legal or illegal, it gives life . It gives another chance to people to live or have their kith and kin, children , spouses and parent to live another life. Because of gap in demand and supply, when legal means do not help, adoption of illegal means becomes a compulsion. If following law and rules means death, they are unlikely to be complied with.

The gap in demand and supply of organs is the reason behind these activities. Nearly four lakh people suffering from end stage kidney failure need transplant and only 8000 get it. (Times of India). The recipient has two choices for Kidneys. It can be living donor and deceased donor or cadaveric in cases of brain death. 90% come from relatives, rest are cadaveric. The rest has to undergo repeated dialysis to survive.

After the enactment of The Human Organ Transplantation Act of 1994, transplants became less in India. But it was followed by booming market of donors In other countries like Pakistan, Philippines .

But given the circumstances of life and death, the underground market may still be existent.

The ACT also allows unrelated donors to give one of the kidneys if there is sufficient evidence to show that they know the recipient for a long time and are donating organs out of affection. The loophole has potential to be exploited. The affection or the papers for affection can be easily generated in today’s era in lieu of money or other favors in case of high profile cases. Therefore, the mediator’s work becomes easier to generate the papers projecting affection and tutoring and training of donors and recipient.

Alternatively, the procedure can be done in nearby countries. Therefore the role of doctor or surgeon doing a transplant (although the key point) is much smaller than the agent organizing the whole process. Thereby the agents , who can manage and organize the show, are thriving. The wish to defy a certain death is stronger than following the regulation. That will remain so till demand supply gap reduced , better awareness for brain death, medical infrastructure, organ retrieval and transport and supporting facilities are uplifted. Till it happens, even if it is defined as crime, the fruits will outweigh the risks, because of shear margin of money temptations and wish to live.

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