DH talkback: Stringent law needed

I saw the article on medical negligence dated March 24, 2019, which is well crafted. Firstly, let me thank you for bringing up this issue and creating awareness. I lost my son aged 1 year 4 months at a corporate hospital based in Bengaluru due to the unethical practice of a surgeon, who prescribed a very high dosage of injection without being physically present in the hospital. No test dose was given, all medical documents were covered up, including the death summary, to cover up the case.

I took this case to Karnataka Medical Council (KMC) way back in 2011, where KMC gave me an order just warning the doctor and hospital for the violation of the code of medical ethics and service deficiency.

I also filed a case at the consumer forum, where I was awarded Rs 10 lakh compensation in February, 2018. But again the opponents filed the appeal before the State Consumer Forum. 

I feel doctors have an upper hand in getting away even after being found guilty of the act. Secondly, the compensation in cases like this is too small for the kind of mental trauma and agony that the family undergoes. It is very difficult for the patient to also get the evidence as this is purely in control of the hospital and the doctor.

Also, the most important thing, medical negligence and violation of the code of medical ethics are two different things. This is something which cannot be put in the same basket as negligence is a procedural error (human error), where the treating doctor has not paid attention.

Violation of the code of medical ethics is pretty serious as the standard protocols and medical procedures are let down in spite of knowing this would harm the life of the patient. This cannot be treated as negligence or error. We need a law, which is more stringent in cases like this.

Chethan, Bengaluru

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Send them behind bars

The medical profession is a unique profession in that it involves caring and treating of humans by humans. This profession, therefore, needs a deep understanding of the human being and the human relationship. Unfortunately, this is missing in the Indian medical profession. Your report (DH March 24, 2019) summarises the problem very well. There are several reasons for this state of affairs.

1. Most doctors practising in India are those who have got into medical colleges through payment and most of the meritorious ones have left the shores. Making quick money and recovering what is paid for admission is their primary goal, which in a way, cannot be questioned. After all, becoming rich is the primary goal in every profession. One can see in many clinics signs posted 'Don’t waste the doctor's time. There are others waiting', although the doctors’ fees are not small.

2. Doctors in corporate hospitals are notorious for routing patients from one section to another for unwanted tests and investigations, as these high-paid doctors have to earn their salaries by these unwanted routes. Identifying the problem and sending the patient out as quickly as possible with minimum time and expenditure is not in their rule book. In government hospitals, it is just apathy all around. The solution to improve the medical profession and reduce malpractices is to follow the practice in the west. If a few of those doctors are sent behind bars in quick time, that might have improved things but that cannot be done in India. Sometimes, patients’ relatives take the law into their own hands. That is undesirable. The agencies controlling the profession are only defensive but do not try to solve the problem.

There are many good doctors in the profession for whom money is not the only factor. Service is their motto but then, they too have limitations. We need more such doctors but….

P Tauro, Mangaluru

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People may take to violence

Apropos the interview of Akhila Vasan. Her free and frank opinion about the state of affairs in the medical profession needs to be appreciated. She hit the nail on head when she says that "Now it is so normalised that nobody thinks it is morally reprehensible that somebody is profiting out of a person's misery."

The present-day doctors have become so inhuman that they can carry out cold-blooded murder of their patients if it profits them or carry out some unnecessary procedures on their patients and make them suffer a lot, and nothing can be done to these doctors. A totally immoral, unethical, unscrupulous bunch. They have not only turned into `human vultures’  who feed on their patients' carcass but also openly terrorise them with total impunity. Since legally almost nothing can be done to them, some people out of sheer frustration take law in their own hands and physically assault them. If no effective remedy of this malaise is found, this may be the only way left for common people to address their grievances.

Lt Col A M Uniyal (retd)

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Irreparable damage

This is to inform you that your multi-page article (DH March 24, 2019) has caused irreparable damage to the state's health services. In what it appears as an attempt to pull down a Member of Parliament by publishing a three-year-old case, the article has unnecessarily mentioned controversial things. This is going to create more trouble in healthcare than any benefit. Hence, we urge you not to trouble an essential service like healthcare while your real aim is something else.

Sudhindra Mananje Rao

(The article was not directed/targeted at anyone, let alone any MP; we had only public interest in mind when publishing this article. The objective was not to cause any trouble in essential services but a small attempt and hope, to set them right)

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Painting doctors as villians

I appreciate your journalism for highlighting issues of common people, but does every story need a hero and a villain? A forced villain who is never asked his side of the story. He does his work silently, earns his living and never tells his hardships. In your case, you have painted doctors as villains which reflects on the whole community as apathetic people. However, I beg to differ, just open your eyes and see all around you, without being choosy for storytelling. You will find an overwhelming majority of clinicians who take care of patients with utmost empathy. This type of journalism is to a large extent responsible for violence against the doctors. I request you to be more practical and responsible in your columns.

Amit

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Doctors are also humans

It is observed that journalists repeatedly enjoy destroying someone's good name and fame for cheap publicity. Yes, there are a few incidents where the doctors have gone wrong or committed a mistake. But open your eyes and see.

Thousands of doctors are working hard to save the life of serious patients. They take heavy risks knowing very well that no one would thank them if the patient survives. They would just say it was his or her duty. However, if the situation goes bad then they start shouting, beating, assaulting the doctors and then suing. If we were to believe all the cases in our country, believe me, the population of the country would have gone down. Unfortunately, the facts speak otherwise.

Most of the judiciary, journalists and editors would have had medical treatment at some point of time in their life. And they are alive today only because of that, to point fingers against the same people who saved them, their children, parents and wives.

A simple errata published in the next edition of your paper is good enough to take care of a wrong publication in your paper. 

The professional and financial success of doctors breeds a complex amongst many other people and professionals which leads them to behave in such a fashion.

Do not be judgemental. Try to understand and report in proper perspective. Don't forget that doctors are also humans. The same doctor against whom you have reported today may be the one to save your or family member life tomorrow. Do not try to be GOD.
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Hard feelings

Show me one professional who has not enjoyed impunity. Some diseases when diagnosed in later stages definitely have a poor prognosis. Not all medical professionals are bad. Every profession has journals for updating recent advances. Anyway, I have hard feelings on reading this article.

Deepak Chiradoni 

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Medical profession shown in poor light.

At the outset, I want to compliment that DH is a reputed newspaper with a large number of readers and what the paper publishes has an impact on them. Having said that, I am also of the opinion that the editor's job is tough, as every article should be critically scrutinised for the content, truth of the claims and its impact on the mass public. However, on behalf of the public like us who read the paper and believe it, I request you to have a keen eye on articles that bear negative and offending remarks on some fraternity.

I am writing this email in response to an article published in your paper titled "Medical profession enjoys the highest level of impunity" by Akhila Vasan. It shows the medical profession in poor light. The article tarnishes the image and reputation of the entire profession and not just a few guilty ones. There are many doctors who sacrifice their personal life for patient care. They work day and night to save lives.

They have no ulterior motive when they do this. They have to earn a decent salary to run the family. Isn't it wrong on our part to blame them and damage the reputation just because one person is not satisfied with the type of medical care he or she gets? I do agree there might be some doctors who may make mistakes, show negligence. There are laws from hospital and government to correct that and they take stringent actions if needed. But putting up an article to blame the whole of the medical field is wrong. She also writes and compares the US health system. It is ideal to have it but why only health system? Why not media? 

India is a developing nation and still needs lots of changes in all fields. I urge the editor to look into these matters seriously and prevent damage to society as a good samaritan and responsible citizen. It's our duty too.

Harish Kulkarni
 
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Good you published this

I am happy you have published this article at this time when most of the public is really concerned about hospital care. Earlier, patients used to be worried about the hospital charges. But now the anxiety is also about the complications arising out of negligence by the medical staff. Recently, my wife was admitted to a hospital for surgery. The hospital's negligence caused bedsore which is yet to heal. This has cost me heavily in terms of money as well as mental agony. Who's to bell the cat? The Ministry of Health and Family Welfare should consider stringent punishment to hospitals in such cases.

S Ramajayam

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Hospital: a commercial market trying to sell its products

It is heartening to see a reputed newspaper like Deccan Herald serving the cause of common people and standing by them. Like every week, this week's Insight also covered an important issue that every citizen is angry about. These days, hospitals look like a commercial market trying to sell their products with the least concern for the people. We expect the medical professionals to have a certain level of empathy considering the job they do. While basic traits like courtesy, building confidence can't be seen anymore, it has become a profit-driven industry.

It is not easy for a newspaper to write about such issues because doctors and hospitals have a strong network and they will not like them being shown in a negative light. But you have done the right thing and we appreciate it. I appreciate that you have raised the right questions through the article which will have some impact. Continue shedding light on the issues of importance.

Achyut K

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Issue of proving medical negligence

I read with interest the sensational article 'In tales of medical negligence, one charge is constant: Apathy' dated March 24, 2019. Neither on Page 1 nor Page 4, the extensive article failed to mention the basis of any medical negligence that is the Bolam v Friern Hospital Management Committee [1957]. The Bolam test is derived from the above mentioned English Tort Law case that lays down the typical rule for assessing the appropriate standard of reasonable care in negligence cases involving skilled professionals (doctors). It states that "If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. This is the basis of proving medical negligence. Thus evidence required to prove negligence: proof of a doctor-patient duty, deviation from the standard of care that caused injury and the cause was directly due to the deviation.

Another aspect not covered is the understanding that there are differences between medical errors and medical negligence. The Institute of Medicine in 2000 released "To Err is Human," which asserted that the problem in medical errors is not due to bad people in healthcare — it is that good people are working in bad systems that need to be made safer. A clinical error is defined as ‘the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim’.

Your article adds to the impact of violence against doctors on the practice of medicine in India with a consequence like improving systems but also that is undesirable and unaffordable - defensive medicine. This will lead to increased costs and refusal to treat complex problems when lives could be saved.

In your defence, it will remind us physicians to review our society granting a special professional space in society. Society granted us professional status to practice our science and art for the good of society whose definition demands four elements: highly intellectual and long years if not continuous education, a code of ethics (commonly misused assisted by media), self-regulation by peers and elders, and finally a social commitment to serve and keep our patient at the centre of our profession.

Society must work with the medical fraternity, not in conflict mode, as we will destroy trust in the doctor-patient relationship and India cannot afford this healthcare system you drive us towards inadvertently.

I hope you are able to publish this in reply to your extensive article. Please note I write as a concerned physician and my views are personal.

Dr Sanjiv Lewin, Bengaluru