6.0 cr. The New Value of a Life and the Cost of Poor Communication

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’!

17 Comments

  • for every 6Cr awarded as damages (once so far) there are atleast 6Cr. such cases of negligent culpability out there which go scott free. I was walking my girls to school yesterday and happened to catch a snippet of conversation between two elderly folk “they make so much money, and more often than not nowadays they have no children so after they die what happens? A trust is setup to donate and aid the poor…. why can’t doctors reduce their greed and stop running from one hospital to another, focus on treating properly and not on the profit margins…. they can then still enjoy the full gratitude of thankful patients while still alive.”….. it’s the mad rush from one hospital to another to another to another clinic with the meter constantly down that causes accidents and doctors know that, they just can’t bring themselves to be happy content beings….. but then why should they it costs so much to become a doctor today!!!

  • Dr. Awesh wrote:

    Things just can’t be one sided always. There should also be cases and lawsuits against patients who have given wrong information to doctors, or hidden important facts, even patients can cause mental agony and stress to doctors by not showing up on time, the “no show”, not following given instructions etc.
    Increasing number of doctors are falling prey to heart attacks due to increased work stress and negligence on the part of the patient also often adds to this stress.
    All will be fair only if we hear about some court verdicts giving compensations to doctors too for negligence by patients, afterall doctors are humans too.

  • Sorry and shocked to hear about the doctor who had to suffer mental agony and a heart attack because of patients not showing up Dr. Awesh. I guess you do have a point, doctors should start suing patients for all the unprofessional conduct…….. but wait doesn’t suing involve court appearances, face time with lawyers and generally practice suffering…. oh ok that explains why no doctor ever complains about bad patients…

    Trust me, on a serious note now, if all doctors started caring for their patients rather than being bean counters that they have become of late there would be no stress either way.

  • H.L. Chulani wrote:

    Mr. Imtiaz is right on both counts.

  • It is interesting to see court directing the hospital to give compensation of Rs.6Cr. to the complainant for negligence on the part of doctors resulting in death of a patient.Believe me everyone is after money.Doctors/professionals/Biz men/artists/politicians/Priests/Educational institutions etc.Let me know whether the compensation if given can bring back the life of the person dead? While I agree with various facts stated by you between Doctor/patient,the fact remains that even if the person suffering from any ailment not able to speak out to Doctor/specialist,it is for the doctor to correctly diagnose and ascertain the line of treatment incl surgery.Correct diagnosis lead to right prognosis.Law suits/complaint lead nowhere except winning the case by the patient or Doctor/hospital.Patients take opinion from 2 or 3 experts/specialists before getting admitted for treatment or surgery.Leave accident cases.BUT people suffering from dreadful diseases like cancer of any part of body,kidney failure,brain tumour,liver sclorasis,breast cancer etc should ascertain the treatment from at least two to three specialists only to have correct line of treatment but of course with no guarantee of cure or life.

    What I am trying to emphasise is that doctors are bacteria spreading their presence in Metros/urban/rural areas working with Govt hosp or having own hosp only to spin money.Gone are the days doctors had ethics of profession some concern for their patients and dedication in their job.

    As people spend in lacs to get admission for medical college/to get a degree the doctors churned out of medical colleges have one aim.To recover the money spent in their career to become a doctor.Doctors pursuing post graduation and getting MD/MS/superspeciality degree are worse than GP.Medical degree is bought and sold in some States in India,What quality or service one can expect from such doctors.

    I beg to differ with you about patients communication with doctor.Assuming patient does not reveal/lies about the ailment it is for the Doctor to quizz and find out the real cause/nature of illness.Doctors can not getaway saying patient did not co-operate or did not disclose facts.The truth is that in many cases the patient succumbs due to negligence on the part of doctors giving medicines/lack of expertise in treating complicated cases.Compensation of any amount does not increase value of life.Life has its natural value when one is healthy

    Dr Awesh being a doctor would advocate case being slapped on patients.Ridiculous as it sounds.When a person enters clinic/hospital for treatment it is the DUTY of the concerned doctor to advise/treat/decide line of treatment.

    Last but not the least.Doctors differentiate poor/rich/politically influential/Film stars/Ministers etc with different yard stick.But goal is the same.Cut/slice/loot/rob the patient maximum for the treatment whether he/she lives or dies or gets cured or not.Dr Awesh says doctors are human too.Whether he has doubt?
    If this is true why fleece patients.How DrMandke famous heart surgeon met his fate.Ill gotten money from poor patients or even from rich patients will not last.Doctors have to pay a price in their lifetime.

  • Jayesh Desai wrote:

    There is need for perspective here. The amount granted takes in to consideration individual’s earning capacity and natural life expectancy. Late Dr. Mrs. Saha was US based medical professional. This should be highlighted. Because ambulance chaser will misguide hapless people who have already suffered due to negligence. Doctors must take their profession more seriously and perform by minimum set standards. Unfortunately, neither Government nor medical professional themselves bring out standard protocols which are updated at least every year or two. So it becomes difficult for doctors as well as patients to decide where genuine mistakes occur or limitations of science and socioeconomic lead to negative outcome or there was negligence. But the onus lies majorly on doctors shoulder. This is where documentation and communication comes in as very rightly pointed out by you.
    I hope people like you can motivate fraternity to come out with standard protocol for disease treatments and procedures.

  • Given empathy and answers to even deemed silly questions will go a long way in preventing ambulance chasers. But often the doctors brush off questions or do not make eye contact and just slip away when the relative wants some information from the consultant coming out of the ICU. Communicate with the patient.

  • Neelakantan wrote:

    I read recently that in Chennai a radiology seat was auctioned among prospective candidates and one of the parent quoted Rs 1 Crore- yes, Rs 1 Crore- and took the seat for his son. With this kind of investment it is no surprise that the once noble profession is turning into a commercial venture. The callous behaviour from some medical professionals is due to this state of medical education.

  • Dear Bhavin,
    Earlier i used to receive ur email on friday, but now i receive it only after having read ur article in today’s paper.

    My father (who is 87 yrs. at present) got operated this Aug. 2013 at mulund west hospital for hernia. He was in the hospital for around 4 days. The hospital is owned in partnership by the Surgeon who operated on my father. I was at the hospital on all the 4 nights giving company to my father. The Dr. used to come to check my father around 11-30 p.m. every night, always (invariably every night) continuously talking on his mobile, not even talking a word with us, just nodding his head and goes away each night.
    Later on while checking the bill we came to know that he had charged from us, separately Rs.3,000/ every night (the total bill came to more than one lakh).

    What i want to say that even after charging so much he did not even have the courtesy to talk even for a second either with the patient or with me. This is too much.
    You charge exorbitantly but you can’t even spare one second for your patient. This is ridiculous. As you have rightly said, some of them (not all), think of themselves as God.

  • Dr Vaibhav Dedhia wrote:

    @Mr Ravi…always admit your relatives in ISO certified hospitals, where you will be provided a rate card of charges according to the class you choose. Charges in small nursing homes are not regulated and you are likely to end up paying more for every service you avail including doctors charges.

  • mehool mehta wrote:

    From the above discussion …one can easily see the immense mistrust of doctors and palpable anger against medical industry as a whole ….This is understandable as for ages Doctors have been labelled as Noble profession but now every doctor is perceived as being highly commercial ..but then which segment or profession in this country is above board ..begins with politicians/builders/ bureaucrats/govt officials/CA /Lawyers /priests/teachers etc all seem have have become bean counters ..however it is a wake up call for all doctors and I think it is time we seriously consider introducing Communication skill& record/data keeping as a small topic to be covered in medical education .
    also it is time we do something to reign in the pvt medical colleges run by politicos who get away by charging upto 2-3 crores for a PG seat ..this is where all inflation begins and it only builds up as one goes into pvt practice ..

  • Will not spell out my two piece worth, as everything is covered/taken care by 99% of the comments above.
    Must highlight Mr. Imtiaz and Mr. Laxman’s
    comments which clearly indicates the state of affairs and the real image a doctor portrays this present day.
    Mr. Ravi’s plight is experienced by every innocent patient all over the country.
    I would equate these kind of doctors with kasais (butchers).
    They should realize that ripping off patients like this will not get them very far. Each one of us has to pay for what we do to another.
    That is why this type of ill gotten money is left for others to throw away, and pay for another seat.
    I am not surprised that doctors like Awesh try to put the blame on the patients for their lack of experience/knowledge.
    Trust me in my field, if we are unable to perform. We are just thrown to the wolves.
    And that too these are machines. Yet we can feel their pulse and we don’t ask them what is their problem. We find out. And that is what a professional is supposed to do and be. Not look at the money, even after their patient is no more. SHAME……

    Bhavin this is written in plain simple English. Not a parable. So please do not say that U have not followed. Thank U.

  • Im a doctor. I do communicate with patients. I explain detail about disease. I do help poor patient by giving money sometimes by giving them medicine sometimes asking laboratory to reduce their rate or pharmacist to charge less.I think many of doctors do this but do not say it to anybody. Some doctors may be doing wrong as many have written their experiences. I have seen it happens in corporate hospitals.For example if cardiologists is attached with hospital then that hospital authorities force doctors to do angiography/angioplasty,like 40 or 45 per month otherwise they will sue him..and total share from 2 lac the get is 25 thousand.Also I want to ask govt also why is infrastructure lacking in govt hospitals. Why advice facilities not available in govt hospitals. Why research & investigation labs are lacking. Why there is no heath insurance for all people.In India doctors to patient ratio is very low so why do govt is reducing medical sets.Doctors nursing staff others facilities should be improved. One thing I want to say is we all believe in God , he had already decided the fate of everyone.Doctors are not God they cannot give life or save life,they can just try there best to help patient.Today some people have made doctor patient relationship as business.I’m worried about future.I have lots of thing to say but couldn’t explain in shot.

  • I have been fortunate to have mostly interacted with wonderful doctors with very good communication skills. My husband had a hernia and was operated, the doctor who did the surgery was brilliant and very clear in what he was saying. My gynac who delivered both my kids (one was a C-section) was also very skilled and explained everything she was going to do and why she had to do it very clearly. My dentist is the best I have ever met, knows his subject inside out and is so clear and absolutely fantastic in communication. But sometimes it’s just unfortunate that one comes across doctors who cannot communicate and worse doctors who are condescending and get angry if you happen to disagree with them. It took me 16 years and meeting several doctors until I finally found one who diagnosed my condition as SLE. Even then evry doc I met about it insisted on putting me on immuno suppressants without explaining what they were doing. They were quite unconcerned about the side effects and just vaguely touched upon them. When I insisted to one rheumatologist that he should not be using the word ‘cure'(he kept saying ‘take this and you will be cured in three months) as the medicines he was prescribing could not cure but could only be used for managing the disease he got very angry. Some doctors don’t want you to have any knowledge about your condition. They just want you to accept what they are saying without questioning. They tend to treat you like morons or at best slightly demented children. Sometimes a person may have a doctor in the family or may have studied or be in a profession that is related to medicine like pharmacist, researcher, medical student, physiotherapist etc and have some knowledge about what is going on, to have a doctor treat him/her like a village idiot is infuriating to them.

  • Gaurang Bhatt wrote:

    I am not a doctor nor none of my close friends or relatives. I am not taking sides with them either.

    Medicine is noble profession, doctors should have empathy,behave ethically and not run after money is a bogus theory.

    In our country doctor to patients ratio is very low so experienced surgeons and specialists will always be busy and in demand.

    My father was in coma for 15 months in 2006-07. Out of that 4 months he was in hospital ICU. Luckily I made a good friendship with ICU in charge and he explained me difference between diagnosis and prognosis. He made me understand how and why he will not recover and survive. Senior neuro never had time to talk, would just shrug off, at times clearly avoid us but never failed to charge bi weekly visit.

    After that entire experience, my inference is,

    1. Allopathy is best corrective option.
    2. There are lot of interns in big hospital, they should be made counselor who act as conduit between doctors and patients. They can learn how to talk to patients and empathies with them, explain and guide them about course of treatment and outcome.
    3. In moment of crisis, you need somebody to talk to who knows the field.
    4. Doctors call ‘practice’ for what they do. As Bhavin mentioned, it is judgment call. Someone from doctor side can explain this to patients and relatives.
    5. For Doctors like Lawyers,CA and other professionals time is money as they can’t delegate work. More senior and experienced they are, more so.

    Patients need doctors and doctors need patients. Rather than blaming each other, a comprehensive solution should be sought.

  • M R Sundaram wrote:

    I have had mixed experience with doctors. Some treat patients as nincompoops,or get angry when asked about details of sickness and rationale of treatment. Fortunately the present crop of doctors I’ve met treat patients as intelligent and share information on illness and treatments freely. Apart from quacks , I think the approach of doctors to patients is improving considerably, with younger doctors in the field. Let us hope for the country’s sake, this trend improves.

  • M R Sundaram wrote:

    I have had mixed experience with doctors. Some treat patients as nincompoops,or get angry when asked about details of sickness and rationale of treatment. Fortunately the present crop of doctors I’ve met treat patients as intelligent and share information on illness and treatments freely. Apart from quacks , I think the approach of doctors to patients is improving considerably, with younger doctors in the field. Let us hope for the country’s sake, this trend improves.

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