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Besides doing the post mortem of the dead, let us turn our attention
towards post mortem of our own-selves. Are everything running as it
should be in our day to day lives; be it professional or social. While
addressing your social "do's" and "Do not do's" could be beyond the
scope of my periphery but, I feel, I certainly deserve to kindle the
issues pertaining to "do's" and not to do's" in our profession. Let us
browse through the followings:
WHAT ARE WE ACCOUNTABLE FOR ?
Medical profession is morally, ethically and legally accountable to
the patient in particular and society in general. In no way can we get
out of the obligation. This aspect has to be kept in mind every time
you treat a patient.
HOW SHOULD WE COMMUNICATE ?
Doctors are poor in communication. Many of the causes of litigatSons
arise due to lack of proper communication. It is always better to
create a good "Doctor - Patient Relationship". Necessary information
regarding the disease and the treatment should be communicated to the
patient. All their doubts have to be cleared. Try to avoid ambiguity
at ail times. Be always ready to answer their questions. Never neglect
the relatives and bystanders.
HOW SHOULD WE MAINTAIN RECORDS (DOCUMENTATION)?
Even though we are taught the theory and practice of proper clinical
examination of patients and the record keeping during our student days
many of us do not follow them in our daily practice. In the O.P.D
Ticket the symptoms, findings and diagnosis should be written before
prescribing medicines. If need be more than one diagnosis could be
entered and the prescription must be to deal with the conditions
mentioned in the diagnosis. Provisional or tentative diagnosis must be
written if no conclusive diagnosis could be given. While prescribing,
the name of the drug, its dose, the route of administration etc should
be written clearly. Signature of the doctor with date and time must be
affixed. During successive visits the dates and progress should be
mentioned. The results of X-Ray and other investigation findings
should be entered or attached.
Please see that the prescription contains the following points.
(1) Name and Qualification of the doctor (qualification recognized by
the Medical Council of India) Non Clinical P.G. degree or diploma can
be entered but in bracket the subject should be written.
(2) Name, Sex & age of the patient.
(3) Complaints in brief.
(4) Important and relevant past history.
(5) Examination findings - important positive as well as negative,
(6) Provisional diagnosis.
(7) Advice for investigation, if any X-Ray, ECG and Lab ; finding,
(results can be written or attached).
(8) Treatment fitting to diagnosis.
(9) Any other advice like rest, follow up, surgery etc.
(10) Recording of unwillingness for hospitailzation, any other
relevant matters as Drug reaction, further consultation etc.
(11) Signature of the Doctor.
(12) Date of examination at the top or with the signature.
In
the case of in-patient also all the above details should be entered.
But history and findings should be in more detail. Daily progress and
new findings must be entered with the initials of the doctor. While
referring to another specialist, address the specialist and mention
why you are referring in the form of a reference letter with your
signature at the bottom. The specialist on seeing the patient must
write the relevant findings, opinion and advice with signature.
On
discharge enter the discharge summary, final diagnosis, advices and
follow up instructions if any.
If
the patient has undergone any surgery, operation notes should be
written. On discharge always give a discharge card containing date of
admission, date of discharge, final diagnosis and advice, pathological
investigation with follow up instructions.
It
is better to have the 1.P. chart and the case sheet in a book form.
In
all case sheets the entries should be in the same pattern. In case of
random check up of case sheets by an investigation officer, if one
particular case sheet contains more entries and if the others differ
in pattern, suspicion is bound to arise. In case of a complaint or
mishap, never manipulate the case sheet, as it is likely to be found
out and vitiate your veracity.
WHERE SHOULD WE GIVE OUR CONSENTS ?
Consent, before any complicated diagnostic or invasive procedures,
anesthesia and surgery, is a must except in rare circumstances such as
life threatening medical emergencies, on a court order or at request
by police. The consent should be in local language and signed by
patient or close relatives. The procedure should be explained to them,
An "informed consent" is the ideal. At least when complications are
expected, an informed consent preferably written by the dose relatives
of the patient is preferable. If possible, signature of the witnesses
should be obtained.
HOW TO REPLY THE QUERIES ?
Please deny all allegations of negligence and carelessness in to in
the first para itself. You can write as "I am in receipt of the notice
dated ................... sent by you with certain allegations of
negligence and carelessness attributed to the treatment given to Sri/Smt.
........................................ and as the allegations are
frivolous and baseless they are denied."
In
the second Para write a detailed account of the incidence in your
version in simple language.
You should emphasise that you have taken extreme care and caution to
each stage of the treatment.
In
the third para attend to all the allegations one by one with your
counter statement and argument.
In
the fourth Para write some of your arguments against the petition in
general and some of the general facts of treatment.
If
the reply is filed in the Consumer Forum ask for the cost on the
ground that it cause mental agony to you by quoting Section 26 of CP
Act 86 which permit compensatory loss upto
Rs.l0,000/-.
WHERE ARE WE VULNERABLE ?
(a) What is Gross Negligence ?
The following are considered gross negligence and hence avoid at all
cost.
1.
Operating on the wrong limb, or organ on the wrong side as eye, ear
etc.
2.
Leaving the mop inside after operation.
3.
Administration of drugs which are likely to produce sensitivity
without test dose.
4.
Sterilization operation without consent and proper examination.
(b) What Litigation mean to us ?
Litigations are mainly in the nature for compensation. Before taking
the case to the Consumer Forum, a notice may be sent to the doctor.
This may be sent by the patient, relatives or through a lawyer. There
will be a time limit. Usually it will be 30 days. For this the doctor
should give a reply. If the time limit is too short or if you want
more time, after sending a initial reply and denying the charges, you
can ask for extension of time for 15 or 20 days. Then the detailed
reply should be sent. Each point of the allegations should be answered
separately. Abbreviations should be avoided and scientific
explanations should be made in simple language. Also you should
ascertain that you have taken reasonable care and skill and you have
treated the patient in good faith.
Never get panicky when you get a notice. It will be better that you
consult with a senior OMSA colleague and draft the reply. Never
entrust the job of drafting the reply to an advocate. An advocate can
be employed but you should draft the reply first, take it with you to
the advocate, show it, explain to the advocate discuss with him and
then if necessary, make some alterations. But the essential points
should be of yours. There is no need to incorporate too many legal
points.
Sometimes after our denied reply, the matter may not proceed further
or they may drag the case to the consumer court. At times the Notice
wiil come directly from the consumer forum for which also you have to
give reply in the above lines. There again if time is not sufficient
you can ask for extension. You need not employ an advocate in the
Consumer Forum provided you can go and present yourself. In case if
you find it difficult, a sensible co-operative, level-headed advocate
may be employed. You with your colleagues should have discussions with
the advocate. A copy of the case sheet or 0,P. ticket may be produced
to the advocate. You can suggest to put the names of your willing
senior colleagues of the same discipline as your witnesses. You should
be very careful in not committing the fault, negligence or mistake in
your reply.
(c) How we should not be out dated ?
This aspect is very important. You have to attend the CME sessions and
try to update your knowledge since drastic changes are taking place
routinely in the medical field.
What should we never do?
1.
Never give the original case sheet to the patient or relatives. It can
be given to police or court on written request. In that case keep a
photocopy and get vouchers.
2.
Never issue a false certificate.
3.
Never give full assurance of complete cure.
4.
Never operate a patient without consent.
5.
Never underestimate anybody.
6.
Never loose your temper even on provocation.
7.
Never sign a statement without reading it.
8.
Never do MTP without licence for you and to the institution.
9.
Never blindly trust fully the version of the hospital staff.
10. Never prescribe contraindicated or banned drugs or medicines with
irrational combinations.
11. Never experiment on patients.
12. Never forget your limitations.
13. Never comment on your colleagues or their treatment.
14. Never hesitate to refer the case if it cannot be managed by you.
15. Never prescribe Ayurvedic drugs or those of other systems of
medicine.
16. Never examine the patient under the effect of alcohol.
17. Never do an internal examination of female patients by a male
doctor in the absence of a female attendant.
18. Never give general anesthesia without anesthetist.
19. Never exhibit qualifications not recognized by MCL
20. Never advocate or advertise your professional skill.
21. Never sonologicaily identify and reveal the sex of the baby ante-natally.
22. Never sell samples.
23. Never indulge in trade practices or get involved in commission
rackets.
24. Never use outdated medicine.
25. Never overload yourself lest you faultier in judgement.
26. Never deviate from the prescribed norms.
27. Never give Injection like penicillin, adrenaline without keeping
written consent from the patient.
28. Never treat serious and live threatened patient without keeping
written consent either from the patient or from his relatives.
29. Never conduct post mortem before sunrise or after sunset.
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Never conduct post mortem without going through the police requisition
personally.
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Never conduct post mortem under pressure of the higher authority from
your department or from any other departmental authority.
30. Never ignore the law of the land.
31. Never resort to UNETHICAL PRACTICE.
Finally, I have to warn you
"Whenever you are treating a
patient consider that she/he is likely to be your future litigam".
By
Dr. Siba Prasad Singh
Govt. Hospital, Kakatpur Puri |
