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Defensive Doctors

In the face of increasing litigation due to allegations of medical negligence, doctors have become extra-cautious as noted in “Are Doctors Defensive?”

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- John B. Monteiro

Are Doctors Defensive?

By John B. Monteiro

This is the way that physicians mend or end us,

Secundum artem: but though we sneer

In health – when ill, we call them to attend us,

Without the least propensity to jeer.

 - George Gordon Noel Byron, English poet (1788- 1824).

 Physicians, of all men, are most happy: Whatever good success soever they have, the world proclaimeth and what faults they commit, the earth covereth. – Francis Quarles, English poet (1592-1644).

 Centuries since the above lines were penned, the situation of physicians, or doctors, has seen a sea-change. Instead of sneering, doctors are being snared. The earth does not cover their faults in a hurry. There is post mortem and causes of death can be laid at the door of doctors, with hefty claims of compensation and threats of physical violence. Thus, doctors, today, resort to, instead of curative practice, defensive practice. In the process, some patients are passed on to public hospitals to avoid risk of being hauled up for medical negligence and stiff compensation claims. This scenario is vitiating the traditional role and image of doctors as angels of healing. But, first the facts.

 In an exclusive report in The Times of India titled Defensive Medicine on the Rise in Mumbai, Sumitra Deb Roy notes that  “pre-surgery forms, battery of tests…doctors grow cautious as more negligence suits are filed.” He cites the case of urologist Dr. Hemendra Shah, and his wife Rashmi, who were sued for alleged medical negligence in 2008, 20 months after the patient they had operated on for kidney stones died in a Mumbai hospital. It came as a bolt from the blue for the Shahs when the police came knocking at their door to book them for causing death by negligence. Dr. Hemendra said: “Our statements were recorded by the police. We had to sit and recollect every detail and convey all this to the police.” After the initial shock, anguish and stress, the Shahs have moved on. Their first appearance in court is yet to come.

 Many doctors in Mumbai, like the Shahs, have become extra-cautious on the job to avoid litigations which have become a professional hazard. Over the last few years, there has been an annual rise of 10 t0 15 % in litigation against doctors in Mumbai – which is pushing the medical fraternity back to the wall. 2009 saw more than 200 cases in Mumbai in which doctors were accused of negligence and dragged to court, with some even being physically roughed up. In the backdrop of such risks, doctors are now going the way of the West by documenting every step of treatment offered. In certain clinics, the pre-surgery consent form runs up to five to ten pages.

 Dr. Lalit Kapoor, adviser to the medico-legal cell of the Association of Medical Consultants, said: ‘The situation is quite alarming as patients are not accepting fatality. Almost every death in a hospital bed tends to get labeled as medical negligence…Doctors have become mistrustful of patients and are apprehensive of going that extra mile to save a life as they fear a backlash. But, most threatening now is physical violence.” Another doctor said: “Threats from patients and pressure from local politicians have become the rule and not exception. Litigation is one f the main reasons why critical cases invariably get referred to public hospitals – as doctors are scared to treat them.” Another aspect of defensive medicine involves doctors and hospitals asking for a minimum of 15 to 20 tests even for minor ailments. Who stands to loose in terms of delayed treatment and expensive battery of tests?

 The subject is open to many views. What are yours? Over to you.