We still address them as Doctor Saab! They continue to be a well respected community in our society. And yet they are feeling threatened from all quarters – the public, the government and the politicians. One gets a sense that the medical fraternity is in disarray, panicky over the hostility they perceive around them. This notion was reinforced by proceedings of the 5th Annual Conference of the Medicos Legal Action Group (MLAG) held at the IMA Complex in Sector 35 Chandigarh on Sunday.
Not only the theme of this year’s conference “Defending Doctors In The Era of Increasing Trust Deficit”, but also the crux of various talks by experts from around the country, like one on whether Nursing Homes will survive in today’s corporate and insurance driven healthcare, and another on alternative career options for doctors in India, seemed to paint an uncertain future for the once elite and one of the noblest professions.
Photos By : Life In Chandigarh
Even the chief guest for the day, Justice Ajay K Mittal of the Punjab and Haryana High Court underscored this dangerously deteriorating doctor-patient relationship, while tracing the genesis of the disconnect to the advent of corporate hospitals in the country. The increasing commercialisation of the healthcare sector had resulted in the communication between a healthcare provider and his clients becoming mechanical, which is the root cause of the public mistrust for the medical fraternity, he observed.
The rising litigious culture in society, signified by the wave of frivolous complaints filed in courts against health providers alleging medical negligence were worsening the relationship, even when the actual percentage of cases of medical negligence was very small, Justice Mittal added.
He, however, held out hope for reversing the trend, suggesting that besides laying down clear cut guidelines for clinical practice, there was a need to teach students of medicine empathy towards the patients and not just clinical behaviour. He also came out in support of mediation as a very good alternative to court litigation, asserting that it provided a win-win proposition for the litigants, the defendants and the courts.
Abolish PCPNDT Act
In a discussion following a talk on “Restrategizing PCPNDT Act” by Dr K Narsimha Rao, a practising orthopaedic surgeon, there was a strong demand from the doctors’ community, supported by examples from across the country, for abolishing the Act since it had failed miserably in improving the adverse sex ratio in the country.
The recent Supreme Court guidelines on passive Euthanasia also came in for attack during another presentation on “Euthanasia, Living Will: Current Status In India” by Dr Gladstone D’costa from Goa, who described them as “crazy, and so convoluted and complicated that they were practically not implementable.”
Spurious & Substandard Drugs
In his talk on “Legalities And Implications Of Spurious Drug Use”, Dr Ashwani Setya, senior consultant and programme director at Max Saket, asserted that the problem of spurious or substandard drugs was so rampant in India that one-third of the total spurious drugs in the world were attributed to India, where one-fifth of the total pharma production was said to be falling in this category.
Quoting glaring examples of mass sterilisation deaths in Chattisgarh and eye infections during surgeries in Telangana, he said bulk purchases had resulted in government healthcare institutions becoming dumping grounds for spurious or substandard drugs. During the discussion that followed doctors pointed out that the problem of substandard drugs was also rampant in Jan Aushadi Kendras in government hospitals.
Meticulous Documentation Needed
Speaking on the subject “Mistakes Doctors Make Which Lead To Legal Trouble”, senior advocate of the Supreme Court and honorary director of the Institute of Medicine and Law Mahendra Kumar Bajpai emphasised the need for doctors to meticulously document even minute details of all significant events as they happen during the course of their medical practice to safeguard themselves against litigation at a later stage.
Quoting a case which led to the highest compensation ever due to medical negligence of Rs 12 crore being awarded against a Kolkata hospital, he informed that in the same case a Mumbai hospital got scot free due to their diligent paperwork.
Senior arbitration lawyer PC Markanda talked about alternative dispute resolution in medical malpractice through negotiation, mediation and arbitration. It was pointed out during the discussions on the subject that 90% of cases of medical negligence were settled outside courts in North America. But there was a word of caution as well with others counselling doctors to resort to out of court mechanism only under court supervision, otherwise it will not have any legal sanctity and would be counterproductive.
Delivering the MLAG Dr Laxmi Garg Oration on “Medico Legal Dilemmas Of Clinical Practice In India”, Dr Hitesh Bhatt, a medico-legal practitioner, in his humorous style, while quoting several examples, emphasised that in all situations, right to life will always take precedence over right to privacy in the eyes of the law.
Will Nursing Homes Survive?
Surprisingly, most doctors in the audience raised their hands when, beginning her presentation on the subject “Do Small And Medium Healthcare Establishments Have A Role To Play In Today’s Corporate And Insurance Driven Healthcare”, Dr Sangeeta Pikale asked how many of them felt that nursing homes are likely to close down. She, however, gave them heart saying that would not be the case if these small and medium medical establishments kept reinventing themselves and filled in the loopholes in their systems to meet the requirements of the evolving health insurance sector.
She suggested small hospitals to become the healthcare boutiques of tomorrow and revive their neighbourhood friendly doctor image to establish a separate identity for themselves. Bed strength of between 50 and 100 would be a lean model, proving to be most cost effective. They would have to be accessible, affordable and accredited. Their staff will also have to be up skilled to cater to all three categories of patients – minimally sick, moderately sick and terminally sick.
Small groups of such hospitals could form conglomerates by pooling their specialities or super specialities with common billing as was being done by some hospitals in Bangalore, she said, adding that home healthcare or dependent care was another potentially windfall area for them to explore as it is expected to grow phenomenally in the next five years or so.
Dr Pikale advised medical facilities with 5 to 15 beds to close down and repackage themselves as specialised providers of preventive care or as centres of early diagnosis pickups or post operative care.
Earlier, making the first presentation of the conference on “Media Defamation Of Doctors”, Dr Satish Bhat from Mangalore while lamenting the failure of the medical fraternity to regulate itself as suggested by courts from time to time, felt that individual doctors and hospitals need to become proactive in recognising potential events which can cause adverse media publicity and remain accessible to the media to get their version across. Cultivating harmonious media relations does help in the long run, he added.
Should News Media Be Paid Off?
During a panel discussion on the dos and donts to be followed in handing cases of adverse media publicity and complaints of medical negligence filed in courts, moderated by chairman of the organising committee of the conference Dr Neeraj Nagpal, it was emphasised that every patient is a potential trouble-maker or litigant, so doctors should always remain alert to any eventuality.
Laughter followed a panellist describing the task of choosing a lawyer to defend a case akin to choosing a wife – very difficult!
There was unanimity that all small or big false claims should be contested because the reputation of an individual doctor or an institution is at stake. If multiple doctors are involved the defence should ideally be common.
Another question reflected the current state of affairs in the news media – should news media be paid off to suppress negative reportage? The answer was an emphatic no. The issue should be addressed on merit, came the prompt advice.
 held at the IMA Complex in Sector 35 Chandigarh on Sunday.){kind=link}