Medico Legal Principles

What is the basic check-list for observing basic medico-legal principles in medical practice?

Dr. M C Gupta says:

Three most important Dos and DON’Ts for doctors are as follows:

Three most important “DOs”

FIRST—Always document all relevant facts in sufficient detail. This is the single most important advice that I can give to doctors to avoid litigation. I have come across instances where doctors have performed surgery under general anesthesia but there are no operation notes or anesthesia notes. These are problem cases.

TWO—Always talk to the patient and the relatives in detail and with sympathy and understanding. Nobody comes to the hospital with a plan that he will first get treated and then will sue. Detailed briefing must be done at the time of consent itself so that it is really an informed consent. As a matter of fact, mere technical consent in the form of signature on a printed consent form has no legal validity. Talking to the patient and relatives at various stages of treatment, especially in surgical cases, decreases the scope for apprehension, suspicion, doubt and disbelief against the doctor.

THREE—Always buy sufficient indemnity insurance. No amount of careful treatment is sufficient to totally avoid negligence and other mishaps resulting in adverse outcome. No amount of talking to the patient and relatives will render them totally free of suspicion. No amount of best arguments in the court will rule out the possibility of bad judgments on the part of the judiciary. Like doctors, the judges also make mistakes.

Three most important “DON’Ts”

FIRST—Do not meddle outside your area. A gynecologist once phoned me for help. Her problem was that she had done gall bladder surgery and the patient had filed a complaint against her. That is a problem for me, too. There is a gynecologist in Kerala who has been performing breast cancer and head and neck surgery in well- known private hospitals. . It must be remembered by the owners of nursing homes that when courts award compensation, the amount is supposed to be paid by the hospital unless a part is specifically awarded against a particular doctor.

TWO—Do not transgress into other systems of medicine. A doctor qualified in one system but practicing a system in which he is not qualified is a quack as held by the Supreme Court. Doctors owning nursing homes need to remember the following:

“When a patient is admitted in a hospital, it is done with the belief that the treatment given in the hospital is being given by qualified doctors under the Indian Medical Council Act, 1956.  It is not within the knowledge of the relatives of the patient that the patient is being treated by a Unani Specialist.  We hold that it is clear deficiency in service and negligence by the hospital for leaving the patient in the hands of Unani doctor”. – (Prof. P.N. Thakur v. Hans Charitable Hospital, National Commission, 16-8-2007)

In a case before the National Commission, where I am trying to defend the surgeon, I wanted to have an affidavit from the resident doctors supporting the version of the surgeon. I came across an impossible situation where all the residents were Ayurvedic / Unani graduates! An affidavit from them would be inviting trouble!

THREE—When you receive a legal notice or when a case is filed against you in a consumer court, do not rush to draft your own replies. Law is a complicated thing and it is best to hire a lawyer. It would be ideal to hire a lawyer who has earlier been a doctor but such species is very rare. I remember a case where the complainant in the district consumer forum was a doctor who sued the hospital where he got his father operated. The opening sentence of the complaint stated—“My father was operated by Dr. ABC and the surgery was performed satisfactorily”. It is easy to imagine what the judge would think after reading such a complaint. There were several other weaknesses like this.  I was hired by the doctor in the final stages of the case. With great difficulty I obtained permission of the court to file further.