They Will Seal The Case Sheets!

A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks. All of us want the same thing, but increasingly, doctors and patients are seeing each other on the opposite sides of a divide.

Recently there have been a spate of articles in the press regarding medical treatments having gone wrong, and reputed hospitals having to pay compensation. Apollo Delhi was ordered to pay one lakh rupees compensation for two cases. Ganga Ram hospital Delhi was ordered to pay twenty five thousand rupees to a patient for delaying her transfer.

A doctor's group is trying to mobilize opinion in the profession by circulating videos of a doctor being roughed up by some local chauvinists.

How are doctors affected when their treatment plans go wrong? What is the difference between complications, difference of opinion and negligence?

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They will seal the case sheets!

Last week, Dr.Zahir had been called to a dental clinic to give anesthesia for a routine case of dental extraction. The patient was very well to do and did not want any pain. Everything was routine, till Dr.Zahir tried to reverse the anesthesia. She never woke up!

He transferred the case to a big hospital where he was the head of intensive care and anesthesia, tried his best, got a second opinion from the professors in medical college but none of them could figure out what went wrong.

“In a way our department was lucky that a senior and reputed person like Dr.Zahir was faced with this rarest of rare chance complications, which is written in books. If it had been any lesser reputed doctor, he would be behind bars,” Dr.Singh, another senior colleague recounted how Dr.Zahir was a changed person after this episode.

“Will the family move the courts? Will they file a police complaint? How will I know if they have done so and what should I do if this happens?” Dr.Zahir was taking some advice from a lawyer, trying to cover up the loose ends, keeping the legalities in mind.

“Doctor! If the police is involved, you will come to know beforehand. They will seal the case sheets” the lawyer replied.

“ Once a FIR is lodged , your medical records will become evidence for the prosecution. But do not worry. I will apply for anticipatory bail,” the lawyer said in a matter-of-fact way. For him, it was just another of those cases which are increasing his legal practice.

The greying doctor summed up the courage to even go to the house of the deceased lady to convey his condolences.

“They could have beaten me up,” he said. “There were some young hot-heads around.”

But his quiet dignified manner and good reputation carried the day.There was no police-legal involvement. But Dr.Zahir was a changed person after those troublesome days, and used to be much quiet and reserved.

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I do not talk to my daughters anymore

It had all begun almost two years ago, when a lady came with pain in the abdomen.

“My wife had warned me against operating a person related to a policeman” Saurav, a young and dynamic surgeon recalled that fateful day which changed his life forever.

“You are a surgeon. If you start hesitating like this, what is the use of your training,” his colleague and assistant had egged him on. Saurav took up the challenge, operated the case, and everything went well in the postoperative period for two weeks.

Later the patient started having fever, was transferred to a medical college, where she was kept for a month, but died of complications.

The husband, a local policeman thought it better to proceed against the private surgeon rather than involve the big government hospital.

The right and wrong of the case got lost somewhere in the middle, long time back, with the police, local politicians, some tabloid press all taking out their frustrations and expressing their egos on the hapless doctor.

The SHO started calling Saurav for repeated prolonged interrogations, without booking any case.

“You doctors are all like this. No human feelings. Just business. Last month my friend’s mother-in-law’s paternal uncle's cousin brother was operated at Hardinge Medical college and the doctor cut her artery. When they went to Batra (a big private hospital) to show her the doctor charged money for the complications” the SHO thundered at Saurav, who quietly listened.

Later he told me, his confidante and silent moral support, “What can I do if someone had a complication. Am I to blame for everything? They cannot do anything against the big hospitals and public medical colleges and are taking it out on me.”

“In these two years, I have become quiet. The time when I should have spent with my family, playing with my little daughters, I spend preparing the legalities of the case. I do not talk to my daughters anymore.”

“I have told my father, that if I do not come back from work some day, do check up at the police station!”

He had been an idealist, wanting to do something for the rural community, and had set up a clinic outside the city limits. But over a period of time, some such incidents, a general lack of trust, and the inimical attitude of some local chauvinists egged on by some jealous non-qualifed quacks whose practice had been affected, who labeled him as an outsider making money has seen the hardening of his own attitudes, to be able to survive.

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An unhealthy chorus

The doctor-patient relationship is the cornerstone of the medical system -- nobody can be helped if doctors and patients aren't getting along. But increasingly, research and anecdotal reports suggest that many patients don't trust doctors.

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.

The distrust and animosity between doctors and patients has shown up in a variety of places. In bookstores, there is now a genre of ''what your doctor won't tell you'' books promising previously withheld information on everything from weight loss to heart disease.

Is there something known as follow-up and review of diagnosis? What is differential diagnosis? When manifestations of different diseases can be similar, the medical professionals draw up a differential diagnosis. Can the time spent in investigations, and follow-up to come to a definite diagnosis after ruling out the differentials later be used as a plea by a legal team for delay in diagnosis and then blame the treating-diagnosing team for the deterioration and progression of disease? Is it fair to do so?

Such attitudes have led to defensive medicine and more technology-based medicine as health care teams try to cover future liabilities.

''Nobody is talking to the patients,'' one doctor said. ''Everyone is so rushed. I don't think the doctors are bad people -- they are just working in a broken system.''

Is it a healthy atmosphere?