Oncologist and head and neck surgeon Dr. Vishal Rao writes about the recent increase in the number of attacks on Indian doctors and what the country needs to do for patients and the medical fraternity.
The hardest part of being a doctor is you could be the difference between someone living and someone dying!
The recent years have seen a rise in attacks on doctors/medical establishments.
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While this issue has several facets to it, it is worrisome to notice the impact it may have on practise of defensive medicine or reluctance of the medical fraternity to treat patients boldly. Recently, a hospital in a small town hesitated to admit a serious patient fearing the possibility of public rage/violence if they were unable to save the patient. The patient succumbed in the ambulance trying to reach to nearest and the next-best hospital.
Justice Katju in the Supreme Court judgement brought to light a pertinent issue: “A medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence before a medical practitioner is charged with or proceeded against criminally. A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient.”
“When a patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals, what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalised for losing a case provided he appeared in it and made his submissions.”
While it is prudent to take necessary steps to punish unethical practices, it is also our duty to protect the rightful ones who may hesitate due to fear of attacks.
Picture for representation only. Source: Flickr
Several instances have been heard where the hospitals feared admitting the patients in emergency due to fear of mob attacks but referred to other centres leading to loss of life and severe adverse effects to life function.
Towards this and to protecting healing hands, the state government brought into place “THE KARNATAKA PROHIBITION OF VIOLENCE AGAINST MEDICARE SERVICE PERSONNEL AND DAMAGE TO PROPERTY IN MEDICARE SERVICE INSTITUTIONS ACT, 2009”. Section 3 of the act makes any attack on the doctor or hospital property a cognizable and non-bailable offence.
To strengthen the implementation of this Act, the Director General of Police on a request letter from Indian Medical Association issued an order to all the police departments across the state to strictly implement the act. Every act of violence against doctors should be condemned. Any grievance on the part of the patients or families should be addressed to appropriate authorities and with a legal course respecting the individual rights rather than resorting to physical harm to life or property.
To further strengthen the implementation of the Act, it would be necessary to have a nodal officer (SHO- Station House Officer) for the Act at every police station.
Thus, giving equal opportunity for justice to prevail for hospitals/doctors to be protected, but also to facilitate any action to bring the wrongdoer medical practitioner to a fair trial before the medical council.
There is a strong need to reinstate the faith of the community and society at large in the medical fraternity. Dissuaded society blames the 3C’s – Commercialisation, Concern and Communication. With current trends of clinical practices, increasing malpractice, and lack of evidence-based practice of medicine – the integrity of medical community has been questioned globally.
Hence, there is a strong need to bring a balance to medical care through a combined approach of improved value- based medical education and increasing vigil of the medical council. Better patient communication, shared and informed decision making with patients and adhering to evidence-based guidelines may hold the key to minimising both patient-related litigations and reducing the practise of defensive medicine.
The Flexner Report of 1910 compiled by Alexander Flexner under the aegis of Carnegie Foundation transformed the nature and process of medical education in America. The impact of the report on the medical education system was profound and resulted in the elimination of proprietary schools and the establishment of the biomedical model as the gold standard of medical training.
A huge transformation occurred in the aftermath of the report, which embraced scientific knowledge and its advancement as the defining ethos of a modern medical practise in the United States. Many American medical schools fell short of the standard advocated in the Flexner Report and, subsequent to its publication, nearly half of such schools merged or were closed outright.
India needs to take a very serious look at the foundation of the quality of its Medical education system.
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In current times of rapid technological evolution, trained hands would need to use the power of communication and advances in technology to serve the human race with their healing touch. Edmund Pellegrino’s lament that doctors had become neutered technicians with patients in the service of science rather than science in the service of patients must be proven wrong through practise of inspired medicine.
Throughout our medical training and career, we have all been inspired by great teachers – surgeons and physicians alike. There are those who toil day and night caring for patients, compromising family time and life, to bring a smile to patients or to touch their lives. Every time such an instance of heinous crime happens to a doctor, it hurts the very soul of the art and science of medicine, demotivating an entire fraternity. Healing the wound of a patient is a doctor’s foremost duty, but it is equally vital for him to maintain his dignity and stand for his rights when he performs the act of service.
(Written by Dr. Vishal Rao)