Medical Negligence : Why "Prevention is Cure" ?

Dr.Rupali Patil Jain

The Doctor of Medicine and Medical Law. ENT Surgeon  I  Healthcare Administrator  I  Lead Mentor : Medico-Legal Systems, The Art of Medicine Academy

Covid-19 or otherwise, the rising number of cases of medical negligence against doctors are a cause of concern. They raise two important questions : Are some of our doctors 'Careless', or is the public being more 'Conscious' ? 

Be it as it may - in an era of social media , a case of medical negligence can ruin a medical practitioner's career . It is important for a doctor and his or her team to be aware of the common pitfalls and learn how to avoid them. 

Welcome to Dr.Rupali's - first in a set of blogs, articles, course modules and webinars, on the issue of Medical Negligence - Prevention and Therapies.

The Background

“You learn from your mistakes” is a famous quote by Thierry Henry. However, in our medical profession, it is better we learn from the mistakes of others. 

We do not get an opportunity to undo a mistake once we have committed it, and chances are - if handled poorly, we might land in legal, professional, mental and financial trouble. 

It's so undeniably true that a doctor works really hard for to build a name in the fraternity and society. He or she is more worried for the credibility, reputation and practice restrictions - much more than any financial penalties. A name can be tarnished forever - once a legal proceeding is carried out against him or her in a court of law. 

He or she might even lose confidence. So 'prevention of acts of omission', is the biggest cure.

Medicine and Medical Law, are both "Imperfect Sciences". 

'To Err is Human', and a doctor is human. Mistakes can -and will, happen. The course of a patient's disease or a medico-legal case, are at most times unpredictable, and therefore "an Ounce of Prevention, is worth a Pound of Cure".

Medical Negligence : A Very Essential Revisit

In the judgement of A S Mittal and Ors vs State of UP , and Dr Laxman Balkrishna Joshi vs Dr Trimbak Babu Godbole ; The Honorable Court said that 

“A person who holds himself out ready to give medical advice and treatment, impliedly undertakes that he is possessed of skill and knowledge for the purpose. When consulted by a patient, he or she owes the patient certain duties ; Duty of care in deciding whether to undertake the case, duty of care in deciding what treatment to give, or a duty of care in administration of the treatment. 

A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care is what law requires.” 

And it's knowing what exactly law requires, is also very essential to have a healthy practise. So prevention by having a basic knowledge of Medical Laws is the only cure to prevent medical negligence cases against you.

There are still a lot of grey areas regarding particular laws. Apart from few acts like MTP, PCPNDT, organ transplantation act etc. some rules are still not explained by MCI / NMC nor any governing body. They have been given in various judgements delivered by the courts of India. It is not easy to read all these judgements delivered by the courts, for the doctors to read. So basic understanding of common laws is very necessary.

The Biggest Pitfalls in Court :

The most common areas where we land in trouble are :

  • Not taking proper Informed consent (mentioned in Samira Kohli vs Dr Prabha Manchanda judgement), 
  • Not maintaining proper documents (only documents speak in courts), 
  • Committing common medical and surgical errors ( most of which are carried by nursing staff but for which we are vicariously liable), 
  • Not able to handle deaths properly and 
  • Not being properly informed and aware of our responsibilities as a doctor.

The Big Precipitators of Medico-Legal Litigation :

Doctors who were once considered "Demi-Gods" are now finding it very difficult to build and maintain bonds of 'Trust' and 'Trust-Worthiness' with the patients.

There are multiple and varied reasons for litigations. 

Minor reasons :

  •  Long 'Waiting hours' despite being given appointments, 
  • Uncomfortable waiting rooms, 
  • Impolite behaviour of the receptionist and front-office staff.
Major issues :
  • Delayed or wrong diagnosis,
  • Prescribing for unnecessary investigations or
  • Conducting avoidable interventions and procedures. 

The Take-Away Message :

Have you ever wondered : Why a circular pizza is packed in a square box and eaten in triangles ? And there lies the secret of a successful career in medical practice.

It's knowing what exactly the patient, medicine and the law requires, to have a happy and healthy practice. And prevention by having a basic knowledge and understanding of Medical Laws, is an essential cure ;  to prevent medical negligence cases against you.

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Originally published October 16, 2021