The doctor-patient relationship and medical negligence

 Dr. Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

Nowadays it has become a fashion to say that doctors are not noble and dedicated towards their profession. Most of the time people are too judgmental and biased in their opinion about doctors. These days, a section of people are frequently harassing, physically and mentally abusing doctors in the slightest pretext for alleged negligence without going into the merits of a case. People are becoming increasingly intolerant and appear to be in a mood to pick up a quarrel with doctors over any petty matter. It has become increasingly common for doctors in India to be jostled, roughed up or beaten by angry relatives of patients. Unfortunately, a large section of our society does not understand the philosophy of the medical profession.

One has nothing to disagree with on the issue of medical negligence. Negligence is prevalent in all professions. There may be some degree of malpractice or negligence by some doctors. A doctor never causes injury to a patient for his/her benefit. We all know that medical practice comes under the consumer protection act. If any doctor commits any kind of malpractice or medical negligence, the doctor can be prosecuted under the law.

As statistics reveal, a large number of medical injuries and deaths in the State are due to medical negligence, so it is important to create awareness among people against medical negligence. In developed countries, the authorities concerned meticulously examine the data about medical negligence to bring down the incidence of medical negligence. But, in our state, there is no such medical tribunal (or a similar platform) to deal with cases of medical negligence. The authorities concerned the State should take steps to reduce the incidence of medical negligence. There is a need for a medical tribunal in the State to deal with such cases properly and rationally. Many a time, a fatal situation may not be due to a doctor's negligence. So, a medical tribunal is the need of the hour to get justice for both the doctors and patients. The doctors of the State shouldn't be defensive about their negligence or errors being examined and recorded.

Medicine bridges the gap between science and society. Doctors are one important agent through which that scientific understanding is expressed. No one can deny the services and contributions of doctors dealing with health issues. Doctors do their best to save human lives. Many human lives are saved due to doctor's services. No doctor has any personal interest in seeking his or her patient's death. Doctors look forward to filling up a discharge card, not signing a death certificate. Moreover, doctors may commit mistakes as they too are human. If any doctor commits any kind of malpractice or medical negligence, the doctor should be prosecuted under the law instead of people taking the law into their hands.

No doubt, there are a few rotten fish that do charge excessive fees, prescribe unnecessary and costlier medicines, advise unnecessary investigations, have unholy nexus with diagnostic setups and pharmaceutical companies, mislead patients for their benefit, take advantage of the helplessness of patient or their families, misbehave with the patient and their relatives, refuses to admit their mistake, neglect the duty of care, do an inhuman act of illegal abortions after prenatal sex determination. These rotten fishes are degrading this noble profession and tarnishing the doctor's image. But still, most doctors' top priority is the well-being of their patients. The public should be aware and cautious in future of these money-minded, selfish doctors; such a doctor is a disgrace to the entire doctors' fraternity. The public shouldn't form a generalized negative opinion of the entire doctors' fraternity, because of a few black sheep. Such generalized negative views demoralize and discourage dedicated medical personnel. People's appreciation acts as fuel for doctors to work hard and improve to provide valuable health services to society. Dedicated doctors must be given a fair chance to serve people better.

Trust is the single vital ingredient in a doctor-patient-people relationship. Being a doctor myself, I request all doctors to be aware and cautious in future and to be dedicated to their profession, so the trust and respect return that the public had in doctors. For this to happen, one must pursue 'Good medical practice (GMP)' as a set of values, behaviour and relationship. GMP has several components like medical professionalism (competence), doctor-patient relationship, good communication, judicious use of investigations, good prescribing and practising within medical ethics. Medical professionalism underpins the trust the public has in doctors. Medical professionalism includes how to provide the patient, and their family, with relevant but complex information, discusses management options and reaches appropriate ethical decisions that are commensurate with the available resources. Continuous professional development (CPD) with up-to-date knowledge of the subject to maintain competence and expertise is another component of medical professionalism. A doctor-patient relationship is in itself therapeutic; a successful consultation with a trusted and respected practitioner will therefore have beneficial effects irrespective of any other therapy given. Good communication is one of the most important components of good medical practice because it identifies problems quickly, defines expectations, and helps to establish trust between the clinician and patient. Failure in communication leads to poor health outcomes, strained working relations, widespread dissatisfaction among patients, their families and health professionals, anger and litigation. Sadly, poor communication is commonplace in the most healthcare system and has become the root cause of most complaints.

The best possible GMP is that where compassionate healthcare can be provided to patients or a community within the available resources in a specific setting, doing justice to the profession staying within ethics, respecting people and their autonomy, telling truth with informed consent, keeping confidentiality and giving maximum benefits to the patient with no malfeasance. To end the conflict between the doctors and the public; we the doctors should be a little more patient in dealing with patients and answering their queries. A tolerant, for-bearing and polite approach can go a long way in restoring the lost faith in doctors.