Patient-doctor relationship: Changing perspectives and medical litigation
The doctor–patient relationship is a central part of health care and the practice of medicine. . This means the doctor does not recommend what the patient should do, rather the patient's autonomy is respected and they choose what medical. This area of law has evolved over decades so that now a physician-patient relationship may be established even when the physician does not personally see. All malpractice related liability begins and ends with the doctor-patient relation- The American legal system does not impose any general duty upon us with re-.
City and Hackney Health Authority case, for the first time it was held that peer review alone could not decide medical negligence, but must accommodate patient's expectations in care by allowing rationality in medical decision making, and allowing judicial oversight in medical negligence, with the help of a variety of medical opinion.
The latest judicial trends are pushing the envelope even further, placing greater emphasis upon a patient's right to know and offering patients coherent choices, and the consultation is being looked upon as a business proposition. Recent English case law suggests that the Bolam test is being modified so that a court can reject medical opinion if it is not reasonable or responsible.
For example, in Smith vs. Tunbridge Wells Health Authority,[ 4 ] it was neither reasonable nor responsible for a surgeon not to mention the risk of impotence from rectal surgery, even if some doctors do not mention that risk. The Australian courts have held doctors negligent for failure to disclose risks in a number of cases but a doctor who fails to disclose a material risk will not be held liable on that account alone.
Patients must persuade the court that they would not have agreed to the intervention had they been told about the risk, although if a patient is too ill to testify then the jury can substitute the patient's opinion with their own.
Risks should be described in percentage terms where possible, or a broad band or range of figures, rather than by subjective terminology, such as small risk, slight risk, and rare. A risk does not have to be life-threatening to require disclosure. For example, a risk of feces leaking into the vagina, which is unpleasant but not life threatening, must be mentioned.
A doctor cannot discharge the duty to inform simply by providing pamphlets about a proposed procedure, such as a pamphlet mentioning capsulation, infection, asymmetry, or change in nipple-breast sensation as risks of breast enlargement. Each home has buttressed into a castle and each human as an island.
The need for communication has manifested in social networking groups and blogging which is a pretense of communication with no physical social angle or interface. It is still to early to decide what this implosion of communication will have upon society as a whole and humans as individuals.
But the trends in the post modern age are that despite the increased modes of communication covering travel, telephony, and telegraphy web, chatting, email etc.
We are talking more, writing more, and yet appear to be communicating less. This has led to more burdens placed upon professional advisors at all levels, which includes physicians as well. Even if the patient would like to treat the physician with deference, the need for communication overrides all others including that of proper medical care.
With the interpretation of the Consumer Protection Act,the Supreme Court paved the way for medical litigation in India with the landmark judgement as consumers in VP Shanta vs. The Supreme Court laid down that doctors could be sued for deficiencies in services rendered and defined that all medical consultation fell in the broad swathe of services. Furthermore, the Court went on to describe a distinction between free service and services paid for and said that Consumer Courts could only entertain the latter and not the former.
Even in these cases, the Court laid down that any establishment treating even part of its clientele with regular fees was liable to be sued even if the plaintiff had been treated free.
However, in a later judgement, the Supreme Court[ 8 ] drew a distinction between services rendered free and services rendered by an employer as a contractual obligation as part of conditions of service, by creating medical infrastructure and hosting medical professionals for the purpose and included these establishments under the Consumer Protection Act.
Moreover with the passage of time, Consumer Fora have been emboldened to include all manner of medical litigation and dealt even with negligence as a matter of routine. Furthermore, the Consumer Fora often dispense with the need for expert opinion, and in the interest of limiting the time required to decide cases, do away all together with cross examination of defendants or expert witnesses brought in by medical professionals. So, like Sita, the medical professional has to emerge unscathed from the fire of these consumer cases time and again, and like her has to fear banishment and needle of suspicion ever after.
Reputations take decades to create and running a practice is a life-time investment on part of the medical professional.
The Importance of Healthy Doctor-Patient Relationships
This can be lost without even an opportunity to be properly examined or allowed legitimate defence. George, Past President of the Indian Medical Association questions the concept of a three-tier committee of Consumer Courts that gives verdicts on medical negligence sans knowledge of medicine.
To corroborate his stand, he cited a case of a patient in Kerala who succumbed to a cardiac arrest following anesthesia. When the patient's family sued the doctor for medical negligence, the Consumer Court decreed that the patient died of starvation before anesthesia, as advised by the doctor.
Medicos vehemently oppose Consumer Courts' practice of accepting cases without any prima facie evidence of negligence. Says New Delhi-based Dr. Agarwal had faced a case of medical negligence inwhich was quashed in Negligent performance of anterior colporrhaphy surgery - total loss of vagina.
The female plaintiff was 68 years old when she underwent anterior colporrhaphy surgery performed for a cystocoele by the defendant urologist. The National Jury Verdict Review and Analysis Cook County, Illinois The plaintiff was a year-old male with a long history of impotency who was referred to the defendant urologist for consideration of a penile implant.
He also had Peyronie's disease. After the implant, the alleged injury was loss of penis requiring complete reconstruction of penis.
The plaintiff claimed record medical compensation. The jury charged under Anderson vs. Somberg, the pharmacist, the nurse, the hospital and the urologist. The plaintiff, who was undergoing the removal of penile warts, contended that a This claim was for negligence in follow-up for successive ureteral stents placed in situ to allow stones to be passed naturally at King George's Hospital and eventually they were removed by ureteroscopy.
The encrusted stent could not be removed and required surgery. The Claimant had suffered from incontinence, blood in his urine, and constant pain in his lower back. An expert in Urology concluded that there were repeated and unacceptable delays in providing effective management compounded by questionable clinical decision-making and lack of adequate resources. Departments of Urology have an obligation to maintain a record of patients with uretric stents and ensure that stents are removed or replaced before encrustation and impaction occurs.
The greatest percent of claims arose from the categories of inpatient, adult, and surgical procedures. Endourological procedures resulted in the greatest incidence of surgical claims. However, claims related to prostatectomy involved the most expensive claims. Of the surgical procedures, incidents defined as postoperative complications were the most common acts of negligence generating a malpractice claim.Bureaucracy strangling the patient doctor relationship
Urologists must strive to maintain open, honest, in-depth communications with their patients when occurrences with potential malpractice overtones arise. The summaries of recommendations of the Ipp Panel are given below: Establishment of thresholds of a percentage of permanent impairment before a person may sue at all.
Establishment of an indexed maximum for the recovery of economic loss. Establishment of a threshold and maximum for recovery of non-economic loss. Restrictions on the recovery of damages for gratuitous services. Fixing and in all cases reducing the rate of interest that can be awarded. Fixing and increasing the discount rate established by the courts for the determination of the present value of future loss.
Limiting the liability of a volunteer or a Good Samaritan. Restricting liability of persons who act in self-defence to criminal conduct. Providing that an apology cannot constitute an admission.
Most doctors are pressed for time today for a variety of reasons, but a doctor who rushes through your visit not only risks making uninformed decisions about your care and treatment, he or she also misses an opportunity to establish a meaningful relationship with you. If you feel rushed, unheard, dismissed, confused, or unsure during your visit, calmly let your doctor know. Remember that your doctor is a trained professional who needs to know the whole picture in order to accurately diagnose and treat your condition.
Also, keep in mind that healthcare providers are only human—being rude or aggressive toward doctors, nurses, and other healthcare personnel is not only distracting and stressful for these caregivers, it can also lead to medical mistakes. As difficult as your situation may be, the age-old expression applies: This is called shared decision making.
If you feel like your doctor is pushing you into accepting a specific treatment plan, this is a warning sign. When it comes to decisions large and small about your healthcare, your doctor should be your partner in the decision-making process.
Yet, delivering such news can and should be done honestly and with empathy. A doctor who is cold, arrogant, impatient, rushed, or who otherwise demonstrates a poor bedside manner can quickly lose your trust and leave you feeling unsure, anxious, frightened, angry, and alone.
- The Importance of Healthy Doctor-Patient Relationships
- Patient-doctor relationship: Changing perspectives and medical litigation
- Doctor–patient relationship
Perhaps he or she is very direct, talks faster than you can follow, or has a demeanor that makes you anxious or uncomfortable. Use your first visit as a test. For example, a doctor may strongly encourage the use of a particular medication that has side effects a patient considers unacceptable.
Or, because of religious beliefs, a patient may refuse a blood transfusion that could improve or prolong their life. As a patient, your doctor is ethically obligated to consider your wishes about your healthcare.
One or two lawsuits may not be cause for panic, but, if the physician or hospital has a history of lawsuits, this is a problem sign. Board certification through the American Board of Physician Specialties ABPS means the physician has earned a four-year medical degree from a qualified medical school, is licensed to practice medicine by a state medical board, has completed an accredited residency program of at least years, has passed exams administered by the ABPS, and participates in continuing education.
In particular, ask about drug reps and medical device manufacturers—who often influence doctors and physician practices to use particular drugs, often by wooing them with catered lunches and other perks. If your doctor sends you home with a bag of drug samples, this is a telling sign. Most clinics, hospitals, and medical practices have transitioned or are in the process of transitioning to electronic health records EHR systems, which help your doctor track your medical history and exchange information with specialists, among other functions.
Many of these systems also feature secure patient portals, through which patients can book and track doctor appointments, view medical records and lab results, send messages to their doctors, and request prescription refills.