Day 1: Patient gasping in Casualty.
“Doctor, Please do whatever is the best for him” said the tearful daughter and accompanying family in casualty. Multiple phone calls by medical, paramedical and nonmedical relatives about this patient.
Day 3: Patient recovering, stable but has fever in ICU.
“Doctor, how come he has fever in hospital? How long will it take to respond?”
Day 4: Insurance rejected due to some preexisting addiction / illness.
“Doctor, can’t you change the details on his case paper?” .
Upon denial to write false details:
“Doctor the bills are very high. Insurance is rejected, please give us concessions”.
Day 7; Patient went home walking. Relative fuming and cursing the doctor for the bills.
“Were all these tests necessary? Why? Explain why each test done and medicine given to him”.
“My life is screwed because of this procedure” said this 35 year old, who had undergone an arthroscopy on a knee. Prior to this he had had no problems, he described. His limp was disproportionately worse given his normal examination, he walked almost normal if distracted, and most of his complaints “since after scopy” were unlikely to be related to the knee in any way : giddiness, imbalance, neck and back pain, numbness in the other leg etc. Many specialists have found his examination normal, and most relevant tests are normal too.
Upon further “detailed” assessment, he has had umpteen loans and is in a financial mess. He has fights and litigations related to property with his family. He needs medical certificates often to skip court dates. He has been stressed and depressed for many years now. He has found his solution in the medical blame game.
This “Chakra” has become routine in almost all corporate and other hospitals now. Misplaced anger against the doctor for everything medical has become a fashion. Here are some reasons patients / relatives hold the doctor responsible and waste time at both ends. Possible solutions are also mentioned.
*Patient’s illness (Not the doctor’s fault).
*Complications arising from past known or unknown, neglected illnesses (Not the doctor’s fault, do regular check ups and modify lifestyle).
*Complications arising from addictions, unhealthy lifestyle, self-neglect or self-medication (Not the doctor’s fault. Quit addictions, take good care of your body and mind).
*No response or poor response to the treatment (Not always the doctor’s fault: take another opinion too).
*Prolonged hospital stay (No patient is forced to stay in any hospital, one can take the patient home or to another hospital, doctor whenever they wish).
*Unforeseen complications in the hospital like infection, blood clots, aspirating food into windpipe, bleeding, reaction to medicines etc. (Most doctors take precautions to prevent and promptly attend all these, but cannot be held responsible for any of these. There are rare cases where “unthoughtful” actions by doctors may result in medical complications, which ofcourse is the doctor’s responsibility).
*Any new medical condition arising. Any person anywhere can have heart attack, stroke, fits or many other sudden medical emergencies. Patients admitted in hospitals are not free of such occurrences, especially the elderly, who have more chances of new problems and worsening of old problems.
© Dr. Rajas Deshpande
*Age-related decline in the patient’s health (Not the doctor’s fault). Many 70 or 80 year old patients and their relatives expect that if they do not have diabetes, high blood pressure or addictions, they should stay forever young, and as active. Our body starts to wear and will continue to, in every case, irrespective of our intellectual, educational, socio-political of financial status. Accept.
*Insurance being declined: The insurance companies have their own way to assess and sanction funds for a patient’s admission, upon which the treating doctor has no control. Insurance is rejected in many cases because of prior addictions, undisclosed medical conditions, limited coverage etc.(Not the doctor’s fault).
*“Cashless admission and treatment” is an alluring term used by many companies that mislead the patient / family into thinking that “Every treatment upon earth is available indefinitely without any payment for every medical condition” for them, and as the patient is ill, the shocked and panicking family misdirects all the anger of “rejected insurance coverage” upon the treating doctor.
*Worsening with some medication: many neurological conditions are treated with medicines that may be double-edged, causing opposite or unpredictable actions in a given patient. We have not yet understood Human Brain and its functions completely, and the standard treatments are based upon years of experience in this field. No one can guarantee a predictable response of many medicines used for most conditions. (Not the doctor’s fault).
*In all serious medical conditions, there always is a risk of a complication either due to the condition or during the procedure / treatment / surgery. If this risk is to be avoided completely, one must not go to the hospital at all. Almost all doctors and hospitals explain this risk, obtain consents for any planned treatment, but still the relatives almost always hold the doctor responsible for any complication arising. Not all complications can be predicted for any medical condition.
*Death is universal, more common among the elderly and the sick, especially trauma, heart and brain related illnesses. The doctor cannot be automatically held responsible for every hospital death. Many use a patient’s death or medical complication to claim non-payment of bills, threatening defamation. This has become quite common, oiled by some political clans. Death is a complication of many apparently simple diseases, but if the doctors start mentioning that for every patient, it will be a mentally traumatic and exaggerated legal precaution.
© Dr. Rajas Deshpande
*There is no justification of medical negligence. It is the responsibility of the treating doctor to properly examine the patient, do the necessary tests, advise and explain the illness, treatment, and wherever possible the usual complications. It is also the doctor’s responsibility to communicate with the relatives of admitted patients everyday atleast once, and answer any relevant queries. If any complications arise, or if the patient is critical, the responsible and well behaved relative must be informed in writing, and given an option for second opinion. A patient must be able to go to the Medical Director in every hospital and sort out / file complain if medical negligence is suspected, and must also receive an answer as early as possible. “Violence because of grief / bereavement / emotional state” is unjust in all cases.
*If the Judge decides the case against someone, is it justified to beat up the lawyer or the police officer? Do people break the courts or government offices or press for some mistake? Then why this different approach towards the Doctors or Hospitals? Someone’s getting sick, developing a complication or not having money for treatment is NOT the doctor’s fault. In many cases doctors do not own the hospitals and have no control over the billing process.
Issued in a hope to improve doctor-patient dialogue and explain what the doctor cannot be held responsible for. Wishing best health and happiness to all doctors and patients!
© Dr. Rajas Deshpande