Indian Journal of Health Social Work
(UGC Care List Journal)
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EFFECTS OF MEDICAL LITIGATION ON SOCIETY
Neelam Prasad Yadav
Medical Social Worker cum Lecturer, Department of Community Medicine (SPM), Silchar Medical College, Silchar, Assam
Correspondence: Neelam Prasad Yadav, e-mail: yadav.neelamprasad@gmail.com
ABSTRACTMedico legal problems in India are gaining more and more importance. Society as whole is always guided by certain ethic and it is so in case of health care providers as well. Medical profession, through the ages, was believed to be the noblest one as it demands great responsibility, trust and has a unique opportunity to serve the diseased and the downtrodden and bestow upon them the light of health and peace. Doctor are now becoming subject of various litigations accountable for their dearth or adequate clinical acumen, professional misconducts and medical negligence. Patients and their relatives are now provoked by some groups of people and have joined to form a forum to fight against medical injustice shown to them. However, adequate communication with the patient party and a written patient’s consent form are definitely important3 to prevent such litigations. The social work professional with deep insight of knowledge about society and its values can play vital role in the overall solution of problems. Social work practitioners can play a vital role in analyzing the situation, improving the doctor patient relationship.
Key words: CPA (Consumer Protection Act), MCI (Medical Council of India).
INTRODUCTION
Medical profession, through the ages, was believed to be the noblest one as it demands great responsibility, trust and has a unique opportunity to serve the diseased and the downtrodden and bestow upon them the light of health and peace. In other “Doctor” almost had an image next to god, the Almighty. He was the sole “friend, philosopher and guide”. Patients with full trust and confidence used to give written or unwritten consent and submit themselves to his treatment. Doctor on the other hand with full sincerity and good faith did the utmost for his This Godly image of the Doctor is gradually fading into oblivion. Nowadays people claim“ health for money” and gradually mistrust and suspicion is suspicion is creeping into the Doctor – Patient relationship. Doctor are now becoming subject of various litigations accountable for their dearthoradequate clinical acumen, professional mi s conduct s and medical negligence. Gradually medicolegal problems in India are gaining more and more importance, despite poverty, lack of health education and unsatisfactory infrastructure in most health care set-up. In 1986, the Supreme Court of India included the medical profession under Consumer Protection Act (CPA), adding fuel to the fire.
WHAT IMPACT DO THESE MEDICAL LITIGATIONS
On Our Society:
1. People have taken the medical care services as a commodity in this commercialized society. They cannot trust the doctors, and undertaken a procedure of “Doctor Swapping” (going from one doctor to another), taking multiple advices before arriving to a decision.
2. Medical services are becoming costly for the patients because of unnecessary ex penses i n doing t roubl esome diagnostic procedures.
3. In case of mishap, people usually become emotional without analyzing it rationally and the outlet of grief is through aggression and anger against the medical personnel and set-up.
4. Running to the court with every flimsy ground and asking for compensation has become easier for the party as it does not involve any money. Unfortunately some of them are provoked by other physicians due to professional rivalry, which is against medical ethics.
5. Patients and their relatives are now provoked by some groups of people and have joined to form a forum to fight against medical injustice shown to them.
However, adequate communication with the patient party and a written patient’s consent form are definitely important3 to prevent such litigations.
On Doctors:
Medical litigations have both bad and good effects on the practicing doctors. Bad Effects: 1. With increasing trend of medical litigations, the doctors all over the world have started looking into each patient they treat as a potential litigant. They are under tremendous stress and practicing “evidence based defensive medicine”. Even though they can assess the patient clinically, they have started becoming more dependent on expensive unnecessary investigations for keeping evidence and to save their skin thereby increasing the cost of medical care.4
2. New doctors are avoiding trial of labor as it carries risk and as a result the rate of cesarean section is greatly increased. Forceps delivery is almost abandoned. However, contrary to the common belief, high cesarean section rates have not contributed to an improved pregnancy outcome as shown in 2005 WHO global study.5 a higher rate of cesarean section in this study was associated with greater risk of maternal and newborn illness and death. In the private practices set-up, this change in the trend is thought as a means of financial gain by the patient parties resulting in suspicion against the doctors.
3. Students and junior doctors a re forget ting the art of manipulative obstetrics, which is very necessary, Particularly in the rural set-up. They are very much dependent on the diagnostic gadgets thereby losing their clinical acumen.
4. Due to apprehension of litigation there is suppression or forgery of documents, keeping the public unaware of the actual events, resulting in fallacious medical audit. This will have a tremendous impact on future health policies.
5. Junior doctors are now taking up less risky field of medicine. In USA, UK and other developed countries there has become dearth of specialists in the clinical fields like gynae, obstetrics, surgery, orthopedics, anesthesiology, etc. onethi rd of the Uni ted States hospi tal residency positions were found to be empty in 2005.6 ACOG professional liability survey revealed 62 percent American obstetricians stopped thei r practice before 55 years and 31 percent dared to continue beyond 45 years.
Good Effects:
A doctor is expected to have a “reasonable skill” adopting the “ordinary skill” and must practice with “ordinary care”7 He can only be sued if it is proved that he was negligent in his duty, and did not offer the required medical care and the patient suffered from actual damage for which he is responsible.
1. Threat of litigations has improved the awareness of the doctors in good patient care. They now counsel their patients properly, keep themselves update about recent development and maintain adequate records.
2. Medical Council of India (MCI) has now become very strict in scrutinizing the complaint s lodged by the patient s thoroughly. They have also set many regulations to identify fake doctors and also to keep doctors updated.
On Politics:
1. High cost of medical services owing to the fear of medical litigation is putting a tremendous burden on health care budgets and adversely affecting the health care system, especially in the Govt. and semi Govt. set-up which are meant for poor people. Hence, privatizations of Govt. hospital for supporting the diagnostic facilities are going on.
2. Doctors are not willing to go to the rural hospitals without adequate infrastructure, clinical support and adequate facilities for transport and referral services.
3. Taking advantage of this deplorable condition many insurance companies are coming up l i k e mushrooms and complicating the health care set-up.
4. Many forums are set up to help the patients to go to the court for medical litigation.
ROLE OF MEDIA
Any health hazard going up to the court, is becoming “spice’ for the media. Medical litigations always get extensive coverage, irrespective of the nature of the case. Media reporters doesn’t hesitate to humiliate the doctor emotionally and professionally even before any concrete evidence thereby developing a public opinion against the medical profession and making people more suspicious and tarnishing the doctor – patient relationship.
How to Minimize Medical Litigations in Future? Doctors are human beings, so complications may occur in spite of excellent professional care and infrastructural support. Medical Litigations cannot be avoided altogether but can certainly be minimized to some extent. As per law, doctors are only accountable for his acts of omissions causing civil or criminal offences.
MEDICAL LITIGATIONS IN FUTURE
1. All medical students must be taught to keep detailed record of the patient whom they are treating. They must know how to communicate with the patient and their aggrieved relatives and how to break bad news.
2. Before every operation the patient and the husband should sign an informed consent written in the vernacular language.
3. Proper selection of the medical students must be made on merit and aptitude tests in entrance examination.
4. Media reporters must have adequate medical knowledge and analyze the case properly an rationally before publishing it in the press.
5. Before the final verdict Judges should also consider expert medical opinion.
6. Medical ethics should be a part of undergraduate and postgraduate medical curriculum.
7. All practicing doctors must have medical indemnity policy to protect them from financial loss.
8. A Govt. authorized organization must be set up for legal protection of the doctors.
CONCLUSION
In the present era of CPA “Doctor – Patient” relation has turned into “consumer seller” relationship. Doctors look at their patient as a potential litigant whereas patient look at the doctors with lot of suspicion and often challenging their honesty. Doctors alone can try to restore the age old health doctor – patient relationship. People, media and the government should jointly contribute to it. Doctors must be transparent, honest, sincere and sympathetic to their patients and would not involve themselves in professional rivalry; cultivate the values which can bring back respect to our noble profession. The role of Social Worker is also carries a high importance.
REFERENCES
Chervena k, J L (20 07 ) , Overview of professional liability.
Hoyote P,(1995),Unsound practice. The epidemiology of medical negligence.
Kataria Mrit yunjay, Kataria Prashant(2003;11(SC) Journal 1, negligence: criminal liability of the doctor and establishment.
Mavroforu A, Koumantakis E, Michalodimitrkis E, (2005) ,Phys i cians ’ liability in obstetrics and gynecology practice.
Pear lman MD, (2006) ,Patient safety in obstetrics and gynecology: An agenda for the future.
Sue Scheible,(2005),The Patriot Ledger.
Villar J, Vallarades E, Wojdyla, Zavaleta N, CarroliG, Velaz coA, et al,(2006),Cesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey o n maternal and perinatal health in Latin America.
Conflict of interest: None
Role of funding source: None
A doctor is expected to have a “reasonable skill” adopting the “ordinary skill” and must practice with “ordinary care”7 He can only be sued if it is proved that he was negligent in his duty, and did not offer the required medical care and the patient suffered from actual damage for which he is responsible.
1. Threat of litigations has improved the awareness of the doctors in good patient care. They now counsel their patients properly, keep themselves update about recent development and maintain adequate records.
2. Medical Council of India (MCI) has now become very strict in scrutinizing the complaint s lodged by the patient s thoroughly. They have also set many regulations to identify fake doctors and also to keep doctors updated.
On Politics:
1. High cost of medical services owing to the fear of medical litigation is putting a tremendous burden on health care budgets and adversely affecting the health care system, especially in the Govt. and semi Govt. set-up which are meant for poor people. Hence, privatizations of Govt. hospital for supporting the diagnostic facilities are going on.
2. Doctors are not willing to go to the rural hospitals without adequate infrastructure, clinical support and adequate facilities for transport and referral services.
3. Taking advantage of this deplorable condition many insurance companies are coming up l i k e mushrooms and complicating the health care set-up.
4. Many forums are set up to help the patients to go to the court for medical litigation.
ROLE OF MEDIA
Any health hazard going up to the court, is becoming “spice’ for the media. Medical litigations always get extensive coverage, irrespective of the nature of the case. Media reporters doesn’t hesitate to humiliate the doctor emotionally and professionally even before any concrete evidence thereby developing a public opinion against the medical profession and making people more suspicious and tarnishing the doctor – patient relationship.
How to Minimize Medical Litigations in Future? Doctors are human beings, so complications may occur in spite of excellent professional care and infrastructural support. Medical Litigations cannot be avoided altogether but can certainly be minimized to some extent. As per law, doctors are only accountable for his acts of omissions causing civil or criminal offences.
MEDICAL LITIGATIONS IN FUTURE
1. All medical students must be taught to keep detailed record of the patient whom they are treating. They must know how to communicate with the patient and their aggrieved relatives and how to break bad news.
2. Before every operation the patient and the husband should sign an informed consent written in the vernacular language.
3. Proper selection of the medical students must be made on merit and aptitude tests in entrance examination.
4. Media reporters must have adequate medical knowledge and analyze the case properly an rationally before publishing it in the press.
5. Before the final verdict Judges should also consider expert medical opinion.
6. Medical ethics should be a part of undergraduate and postgraduate medical curriculum.
7. All practicing doctors must have medical indemnity policy to protect them from financial loss.
8. A Govt. authorized organization must be set up for legal protection of the doctors.
CONCLUSION
In the present era of CPA “Doctor – Patient” relation has turned into “consumer seller” relationship. Doctors look at their patient as a potential litigant whereas patient look at the doctors with lot of suspicion and often challenging their honesty. Doctors alone can try to restore the age old health doctor – patient relationship. People, media and the government should jointly contribute to it. Doctors must be transparent, honest, sincere and sympathetic to their patients and would not involve themselves in professional rivalry; cultivate the values which can bring back respect to our noble profession. The role of Social Worker is also carries a high importance.
REFERENCES
Chervena k, J L (20 07 ) , Overview of professional liability.
Hoyote P,(1995),Unsound practice. The epidemiology of medical negligence.
Kataria Mrit yunjay, Kataria Prashant(2003;11(SC) Journal 1, negligence: criminal liability of the doctor and establishment.
Mavroforu A, Koumantakis E, Michalodimitrkis E, (2005) ,Phys i cians ’ liability in obstetrics and gynecology practice.
Pear lman MD, (2006) ,Patient safety in obstetrics and gynecology: An agenda for the future.
Sue Scheible,(2005),The Patriot Ledger.
Villar J, Vallarades E, Wojdyla, Zavaleta N, CarroliG, Velaz coA, et al,(2006),Cesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey o n maternal and perinatal health in Latin America.
Conflict of interest: None
Role of funding source: None
It’s a matter of great pride for me that All India Association of Medical Social Work Professionals is launching first issue of “Indian Journal of Health Social Work” on the auspicious occasion of 6th Annual National Conference of AIAMSWP, 2019.