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Powerless Doctors; need to practice evidence based medicine

Powerless Doctors; need to practice evidence based medicine

Physician treats sick people with dedication, but feels totally powerless about himself and own family! Professional burnout among physicians has reached a dangerous proportion, with more than half of physicians affected as per a study. Burnout rates, depressive symptoms, suicidal ideation, and dissatisfaction with work–life balance were among the measured characteristics. 46.9% of physicians had a high score for emotional exhaustion, 34.6% had a high score for depersonalization, and 16.3% had a low score for personal accomplishment. Only 6% were fully satisfied with so called noble profession. Can a stressed and dissatisfied doctor provide best care to his patients?  While many have started shirking to attend the patients in emergency, some have given up their medical practice altogether. Most doctors do not choose to send their children for medical profession. Why? Society must move to give due respect, respite and security of various kinds to the toiling doctors, who have been reduced to punching bags. During times of illness patient’s mind is filled with loneliness, and he wants to depend on his doctor to hold his hand during his dark moments. But who comes to the rescue of the doctor in similar situations?

 

A middle-aged man comes to the doctor with complaints of burning sensation in his chest after eating food, which radiates all the way to his neck. The doctor diagnoses him with indigestion, suggesting a change in diet and some pills. But the patient seeks guarantee against heart attack. The doctor, although convinced that his diagnosis is right, orders several tests to rule out a heart attack. The tests cost Rs.20, 000 , although not medically necessary, they protect the doctor in case of any future claims of insufficient advice. Another case comes to this doctor, a young woman with pain abdomen demanding immediate relief. Doctor administer pain killers and other supplements, patient feels better but comes back again with similar complaint. Doctor repeats the treatment and asks her if she could get some tests done. She says she is poor and cannot afford tests. She further retorts that she does not require tests since her ailment is minor and more so the tests are done only to get ‘cuts and commissions’. Doctor feels diffident and refers her to a specialist. She avoids going to a specialist for one month, thinking the referral to be another ploy to earn kickback. When she is unable to bear the pain she goes to a specialist, who orders MRI scan and other tests. She is diagnosed as a cancer of intestine, having spread to other areas, which cannot be operated and she succumbs to her condition in due course. Her husband files a case against the first doctor for negligence and second doctor for malpractice. The court upholds her claim, observing ‘first doctor is guilty because he did not order MRI scan and failed to diagnose, leading to deterioration of her condition. Second doctor was also found guilty, since he ordered too many tests just to make money, at a stage when the treatment could not save her life! Who is at fault?

The laws push the patients and doctors to an unholy confrontation. But doctors have no option, but to save their own skin by practicing defensive medicine. However defensive medicine can corrode the basic trust between doctors and patients. “Doctors and judiciary speak in very different languages,” says an expert. “Typically, doctors respond to court summons by apologizing. But to the judiciary, that’s an admission of guilt.” Most doctors do not have their own legal officers. Hospitals also do not have advocacy cells, to communicate with patients amicably. The problem with most hospitals is that they never have settlement in mind. But hospitals lose cases, and litigation carries on for years. The two ways of getting compensation are through the law of torts (personal injury) and Consumer Protection Act of 1995 (COPRA). The COPRA is for all consumers of goods and services-broken toasters to patients dying of medical negligence all balled up in the same can of worms and the language is “quality of service provided”. “As a result, there’s an enormous volume of work for the judges,” he says. “They neither have the time nor the expertise to go deep into medico-legal cases. There is no scope for cross-examination. Judges just go by affidavits or reports.”
All doctors , even the hardworking, conscientious ones feel vulnerable to litigation. The doctor-patient relationship is turning adversarial. It has become an article of faith among many doctors that patients kick up a fuss as an easy way to settle spiraling bills. “This is one of the most common things we see and this is true across the country, especially the metros,” says a doctor. “Doctors are under tremendous pressure. Any bad outcome today gets labeled as ‘medical negligence’, with friends and family of the patient threatening to call television channels to scare a doctor into waiving off their bills. Supreme Court in 2010 held out a ray of hope for doctors. A bench of Justices Dalveer Bhandari and H.S. Bedi had pointed out the need to protect doctors from “malicious prosecution”: “It is our bounden duty and obligation of the civil society to ensure that medical professionals are not unnecessarily harassed or humiliated so that they can perform their professional duties without fear and apprehension.” But the fears still persist undiminished.

  • A speedy modification of COPRA and rejection of Clinical Establishment Act by all concerned would bring some respite to healthcare professionals.The need is to frame laws for the welfare of doctors as well, so that they could work without fear and offer their best, instead of practicing defensive medicine.

 

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