Thursday, December 27, 2018

The doctor-patient relationship is a contract of service

Relatives of a patient ransacked a hospital in Hyderabad on Monday after she succumbed to her illness. They allegedly broke the glass, entrance gates of the hospital. The 45-year-old deceased woman was suffering from lung disease and swine flu. She was admitted to the hospital on Dec. 18 in a bad condition. On Dec. 24 she was put on ventilator but around 9:30 pm she succumbed to her illness. Reportedly, right after her death the family went on a rampage and began destructing the hospital property. Meanwhile, the hospital claimed that they have been trying to save the woman but she was not responding and her condition deteriorated. A case has been registered against the family for ransacking the hospital. And further investigation in the case is underway, as reported in Times Now.

This story once again puts back the spotlight on the widening gap in the doctor-patient relationship. Lack of communication is right in the center of such disputes.

Consent is the authorization or grant of permission by the patient for treatment or any diagnostic, surgical or therapeutic procedure to be carried out by the doctor. A valid consent has three components: Disclosure, capacity and voluntariness i.e. provision of relevant information by the doctor, capacity of the patient to understand the information given and take a decision based on the adequate information without force or coercion.

A doctor has to take consent from the patient before proceeding with his treatment. It is an ethical and legal requirement. And, therefore no doctor practices without taking consent.

While informed consent taking is important, this story also indicates that probably there is now also a need for another document to be signed by the doctor as well as the patient and/or the family, in addition to the informed consent. This document, which may be termed a “contract”, should disclose all information to the patient and/or his family regarding the treatment and the establishment.

Complications or adverse events may occur at any time during the course of treatment. What is important here is the competency of doctors, or of the hospital in managing these complications or untoward incidents. The information related to the ability to anticipate, recognize and quickly manage any complication should be included in the contract.

The need of services of a specialist e.g. neurosurgeon, or a nephrologist or cardiologist may arise any time during treatment. If the hospital does not have these specialty doctors on its staff, then subsequent delays in procuring their services will increase risk of violence.

The chances of complications, including unforeseen complications, type of complications, delayed or immediate, should be a part of the contract. Every possible complication should be defined.

Chances of death during treatment or on the table, due to anesthesia or after surgery should be defined.

A small set-up may not have all facilities as their bigger and better equipped counterparts. The patient and/or family members must be informed about the facilities.

And, information such as round the clock availability of staff / specialists or infrastructure and the chances of accidents or mishaps such as system failure, oxygen failure, electrical failure etc. should be a part of the contract.

This information should be made available right at the time of admission. And, will reduce the chances of disputes or acts of violence against the doctor and the hospital.

The doctor-patient relationship is a contract of service, which is signed by both, the doctor and the patient. A well-defined “contract” will help the patient choose the hospital. If not, then at least first aid should be administered and the patient can be referred to appropriately equipped hospital.  

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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