The Supreme Court day before yesterday, in a medical negligence case, awarded about Rs. 6 crores to the plaintiff, the highest ever in Indian medico-legal history.
Eerily, it was just last week that I wrote about the “shidori” lecture I had given to the new 1st MBBS batch in GS Medical where I spoke about “empathy and respect” for oneself, family and then patients. I cannot re-emphasize this.
Death and complications cannot be avoided. Medicine is the art of making judgment calls based on data and science. And judgment calls often go wrong. Most times, patients and relatives accept this reality, but sometimes these misjudgments snowball into lawsuits and civil and criminal charges, especially when doctors or hospitals are seen to be grossly insensitive, either because of gaps in communication or perceived lack of empathy.
Historically, there has always been a lack of transparency in the practice of medicine in India. This is most evident in the poor communication between doctors and patients, which may arise due to a variety of reasons, ranging from lack of time to language constraints to a genuine feeling that patients will not understand issues irrespective of how much we explain.
It is also so easy for doctors to fall prey to the God complex, especially when patients say things like “aap to Bhagwan ho. Aapko jo karna hai karo”. We shrug off simple questions asked by patients, perform procedures without taking consent or force relatives to sign on consent forms without bothering to explain anything. And when patients or relatives ask questions, it is so easy to get them to toe the line, with statements like, “if you don’t give consent right away, there is no guarantee he will survive for the next 2 hours” or “if you don’t like what I am doing, you are free to take him away” or, “do you think you are the only one here? Don’t you see how busy I am?”
The reason our ability to communicate with patients is not improving fast enough is because 99% of them still don’t complain or voice their displeasure for fear of possible harm or ill-treatment, and not knowing whether the next doctor or hospital they go to will be better or worse.
But times are changing. Especially when catastrophe strikes and there is harm done, negligent or otherwise, patients do strike back and demand culpability and damages.
While there is no way to completely avoid this, there are several ways to mitigate lawsuits and complaints. The most important of these is simple, direct and constant communication at all times with respect and empathy and if necessary apology. It does not mean having to answer the phone at 2 AM to take care of a running nose, or being available 24/7, but it means spending the time required to satisfactorily answer all questions during a consultation, before every intervention and saying sorry in time, if things go wrong.
With communication comes documentation. All communication between doctors, patients and relatives must be recorded and documented in some form or the other so that there is a clear trail of what has been said, understood and accepted. This will be of immense help to all concerned if and when things go wrong.
Doctors are incredibly bad at both communication and documentation. Rs. 6 crores should be enough motivation to get our act together. And if doing so adds to patient costs, so be it! It will still be in the patients’ best interests. And the doctors’!