Medical Negligence in India: Guest Blogger Dr. Dheeraj V. Mulchandani

A fair amount of material has been written about medical negligence in the past, and it is a topic guaranteed to continue in writing in the future. Purely from the Indian perspective (since each country has its own laws), negligence is often declared via the various forms of media.

Such is the state of our governing bodies in the medical field that most cases reach the print media before they reach our regulatory agencies. A huge bias exists on both sides of the fence, with most of the medical fraternity willing to stand behind the accused, and the rest of the population siding with the media.

You may have heard this many times, but it warrants repetition. Doctors, in general, would not intentionally harm their patients simply because their entire career depends on their reputation and word-of-mouth publicity. It defies logic that they should then perform acts that would sully the very reputation that they toil so hard to build.

This, by no means, abdicates his responsibility towards errors in judgment and lack of communication skills. This, according to me, is the crux of the problem in most countries, but especially in India.

The doctor-to-patient ratio precludes a successful and unwearied hearing of [s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] the problems faced by each patient, often leading to incomplete history-taking and hasty diagnoses, just to accommodate the ever-growing line outside the doctor’s office.

This causes problems right from the diagnosis, then to treatment options and consent-taking. The resulting action is usually treatment first, and then re-investigation if the treatment doesn’t work, which then makes the doctor look deeper and more thoroughly. If this deeper investigation were done in the first place, many of the problems doctors are facing today would vanish.

Taking consent before a procedure is often taken too lightly in the medical field. The task is usually delegated to the most junior member of the medical team, who goes about it considering it as just another form to be signed by the patient before getting on to the real business of the procedure at hand. Rarely, if ever, are the risks and complications completely explained to the patient and their relatives for routine cases. Of course, major heart and brain surgeries, where the risk is proportionately higher, are usually handled differently, with more attention paid due to the real risk involved at the doctor’s end as well. Consequently, most general surgeries and out-patient procedures are carried out with blanket consent, where the patient trusts the doctor with all he’s got.

This is where the problem emerges. If something now goes wrong, the patient feels like his trust has been shattered. The person with whom he trusted his life turned out to be untrustworthy. Friends and relatives start giving their valuable opinions on which better doctors they could have suggested who would “never” reach this situation. People start suggesting that the patient and relatives consider legal action to recover costs. Yes, it is about the money, and anyone who says otherwise is living in denial.

Once a lawyer gets involved, the situation only worsens because it’s in the lawyer’s best interest to keep the case running as long as possible or to secure a win. There is no option of compromise or losing, initially.

Nine times out of ten, the patient still trusts the doctor to make it right, or in the worst-case scenario, believes that the doctor did all he could to fix the initial problem. It is almost always outside intervention that leads to medicolegal escalation.

Fortunately, avoiding this entire scenario is completely plausible. Communicate with the patient at each step of the way, and trust his ability to deal with harsh news. Often, we try to soften the blow, but this is not required. If the patient can deal with coming to a doctor, they can deal with bad news if given in a timely manner. Explain the procedure, if any, and talk them through all the possible risks involved, even minor reactions. They will respect you for it and will understand if anything happens. The primary thought in the mind of a patient who is suing you is, “Why did he not tell me about this?” Allay their fears, support them, and leave the decisions to them at all times. Even when their life is in danger, it’s their choice to decide with their relatives. Of course there are situations, such as immediate life-threatening danger, that are exceptions to this rule, but in general, give the power to the patient, and they will trust you more.

These suggestions don’t change with children either. Children tend to be treated as if they are not in the room and don’t understand. They will surprise you. Tell them what to expect, warn them that there will be pain if there will be, and after a bit of crying, they will cooperate—and beautifully so. They will also return with a renewed trust because you did not lie to them. The same concept applies to the geriatric population and cancer patients.

The bottom line: Communicate. We were given the power of speech; let’s learn to use it effectively.

Dheeraj Malchandani Dr. Dheeraj V. Mulchandani M.B.B.S., M.S., D.M.A.S. F.A.L.B.S. is currently an Associate Consultant in General and Laparoscopic Surgery and Hospital Administrator in South Mumbai. He also has an M.B.A. in Corporate Management in Healthcare and Hospital Administration and is the Medical Director for Dr. Mulchandani’s Medical Services.

[/s2If]

Log in or register for free to continue reading
Register Now For Free Already Registered? Log In
This entry was posted in Blog, Practice Management and tagged , . Volume: .

7 Comments

  1. teja chandra gudivada
    Posted Jul 2014 at 2:53 am | Permalink

    Well said sir communication is the best tool with the patient but the real problem lies in the way we communicate and the literacy of the patient which are the main problem in a rural practise.

    • DR Dheeraj V. Mulchandani
      Posted Jul 2014 at 4:07 am | Permalink

      Hi, Thanks for your comment. Actually the literacy is not the problem at all. Illiterate people, more than others, deserve to be informed about the consequences. Literate people at least can ask questions. If you are in rural practice, it is the duty of the doctor to learn the local lingo to an extent where he can communicate effectively with the patient.
      I have a large gulf practice and I have made it a point to learn arabic so I can communicate with them

  2. Thomas Kuruvilla
    Posted Aug 2014 at 4:03 pm | Permalink

    A good article. But I would like to point out two areas where problems can & do arise. One is where the patient or relatives are given erroneous information or get half baked information from the internet or other sources. When things go wrong, people who one may consider the most reasonable can become extremely unreasonable & even aggressive, refusing to even see the doctor’s point of view. These cases often land up in the courts if the patient or the relatives can afford the same. Another situation is where a doctor does commit an error, either big or small. Doctors are also humans & are bound to make mistakes. Moreover, in the hierarchy of management there are a great number of people involved like assistant doctors, nurses & the hospital itself. So mistakes can & will continue to happen. An increasing number of people, especially among the more educated & well to do, cannot accept the fact that doctors & medical science itself are not perfect. It’s because of this most doctors are now practising “defensive” medicine. I do not know if there are any well conducted studies to see whether fewer mistakes are made when one practises medicine logically or when practised in a “defensive” manner. It would be interesting to know this. I agree that frequent cross checks & protocols will decrease the number of mistakes but that will not eliminate them. Probably so-called error free situations can only occur when everything is computerised.

    • DR Dheeraj V. Mulchandani
      Posted Aug 2014 at 4:10 am | Permalink

      Hello, thanks for your comment.
      While I agree that mistakes will happen, I’m not too sure you can blame the internet for the vast rise in the number of cases. Yes, there is half baked information out there but it is information that was not available before to the patients. Most of my patients do read up on the disease they think they have but do so to be able to discuss it with me in a more coherent manner. If we as Doctors would devote time to them and offer them the same information who do you think they would trust more? The only reason they read up online (and I encourage this) is because we are short on time to spend with them with the long queue of patients we tend to have. Again communication is the key and even if mistakes have happened,a good conversation would kill all hostility well in time before the internet has a chance to influence the mind of patients and relatives.
      Secondly, computers will reduce error but can hardly be relied upon to eliminate them. At a very basic level, computers work on the principle of GIGO – Garbage in, garbage out! All entries to the system will still be made by overworked underpaid staff who are prone to make mistakes due to the sheer load of patients on them.
      The solution is not simple but needs to be worked on urgently. Build up our government and municipal hospitals to handle loads better by better compensation to the doctors visiting there and restrict the number of patients seen in the out patient department per day. If the airlines can restrict pilots’ flying hours, why can’t we when we deal with lives just as they do?

  3. milind shah
    Posted Aug 2014 at 5:54 am | Permalink

    Firstly congratulations on a very good article and having initiated a healthy and constructive discussion.
    there is no doubt that communication is the key to allay the fears in the patient’s mind. to be frank with the situation renders you trustworthy. it is always a pleasure to discuss the condition with an informed patient. it also keeps us on our toes.
    it is also not enough to remind the patient that the doctor is only human. he will accept it only as long as no mistake is commited while he is being treated.to reduce mistakes one needs to adopt all the patient safety guidelines and protocols that have been formulated after various studies. following practise guidelines also is a good defense whenever a complication occurs.

  4. Jagdish Chinnappa
    Posted Sep 2014 at 2:38 pm | Permalink

    I feel one of the major issues other than communication,is documentation.
    Very few doctors document what they have done and why.
    This forms the basis for negligence and the courts insist on this

  5. manjunath doddannaiah
    Posted Sep 2014 at 9:57 am | Permalink

    Your last line touched me the most, to “communicate with patients”. A large number of doctors don’t greet his/ her patients when they walk in to the consultation room. We use too many medical jargons trying to explain the disease rather than addressing the patient’s chief concerns. When patients air concerns, most of the time our standard answer is “don’t worry” or ” take these medications and come back after a week”. I seriously consider that our medical schools should teach graduates how to communicate with patients and their family.

Post a Comment

You must be logged in to post a comment.