On this Doctor’s Day, let’s pledge to change with the changing times

Patients are the most important part of the delivery of health care. They form the epicenter of the healthcare team and there is no stakeholder bigger than them in this relationship between patients, doctors and the healthcare team.

Today patients are more aware about their illnesses courtesy the Internet. Even this group of aware patients can be categorized into four based on their levels of awareness: Ignorant, Informed, Empowered and Enlightened.

·         Ignorant patients do not participate in decision making and depend on the doctor to make their decisions, with no questions asked.

·         Informed patients have questions for the doctor, but only few. These patients then usually agree to the line of treatment adopted by the doctor.

·         Empowered patients have many more questions, they cross check facts and are an equal partner in decision making regarding their treatment.

·         Enlightened patients seek the opinions of many are only then convinced about the proposed line of treatment. Convincing these patients involves several counseling sessions.

There has been rapid shift in from patients who are ignorant to patients who are enlightened. But, there has been no corresponding change in the attitudes and behaviors of doctors.

Miscommunication leading to mistrust is at the root of many doctor-patient disputes. This occurs when the level of awareness of the doctor and the patient do not match.

So, there can also be three types of doctors.

·         Doctors who expect patients to accept what they say.

·         Doctors give choices to patients and ask them to choose.

·         Doctors who give choices to their patients, but help them to choose the best option.

Enlightened patients are more legal-savvy. They are more aware of their rights. The obvious outcome is the rising numbers of medical malpractice claims against doctors.

Four judgements have created a paradigm shift in medical practice today.

Compensations amounting to more than one crore were awarded by the Supreme Court of India and National Consumer Disputes Redressal Commission (NCDRC) in three judgements.

·         In Nizam Institute of Medical Sciences vs Prasanth S Dhananka and Ors SC / 4119 of 1999 and 3126 of 2000, the Apex Court directed Nizam’s Institute to pay Rs.1 crore as compensation in lieu of medical negligence.

·         In Balram Prasad vs Kunal Saha & Ors on 24 October, 2013, the Supreme Court awarded a compensation of Rs. 6.08 crores to Dr Kunal Saha and this figure reached a staggering Rs. 11 crores after addition of interest.

·         Then, in the case of Dr. (Mrs.) Indu Sharma vs Indraprastha Apollo Hospital, April 2015, the NCDRC again awarded a compensation of Rs 1 crore to the parents of the child who was born with 95% disability.

Judgements of the Supreme Court of Pennsylvania in Shinal vs Toms and the United Kingdom (UK) Supreme Court in Montgomery v Lanarkshire Health Board and Dr Bawa Garba v General Medical Council have revolutionized the way we practice. These judgements were not delivered by any court of law in India, but the day is not far off when these would be considered relevant and become applicable in Indian settings also.

Shinal vs Toms said the consent is non-delegable and is the sole duty of the treating physician.

Montgomery v Lanarkshire Health Board negated Bolam’s law and has made it mandatory for UK doctors to inform patients of all possible risks, even though rare and benefits of the planned treatment including risks and benefits associated with the alternative treatment options and let the patient take a decision.

In Dr Hadiza Bawa-Garba vs GMC, the UK Supreme Court sentenced Dr Bawa-Garba to two years imprisonment after she was found guilty of manslaughter and convicted for gross negligence. The aftermath to this judgement is that to err is human is no longer a defense now in the UK.

The answer to all this lies in diligent informed consent to be taken at the time of the first consultation itself. Give detailed information to the patient. All material facts, which will help the patient to reach to an appropriate decision such as diagnosis, proposed treatment, risks and benefits of the treatment, alternative treatments along with their associated risks and benefits and also the risks of refusal should be disclosed. Some questions such as should the consultation be video/audio recorded by the doctor and the patient, can the patient call the doctor at any time of the day and can a junior doctor delegate by the doctor treat the patient in his absence? Also, limit your compensation beforehand.

The times and people have changed. We might not like how this has affected the doctor-patient relationship from when the doctor was the sole decision maker and his word was literally the law, which the patient was expected to accept and follow. From a paternalistic role, doctors have now to adjust to patients becoming equal partners in decision making.

These changes are here to stay.

Let us change with the changing times and accept them as they are …

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA