In the Defense of Doctors and Hospitals

Medical NegligenceFinally, the Supreme Court of India has bit the bullet. In a case of medical negligence, leading to death, the court has ordered a mind-boggling Rs 5.96 Cr as compensation to be paid by AMRI Hospital, Kolkata, to Dr. Kunal Saha, an Indian American doctor, who lost his wife in the hospital. The court decided that in this particular case, the doctors and the hospital were negligent in their conduct, which led to an unnecessary loss of life.

In the past, it has been very hard to prove medical negligence in a court of law. To be honest, even today it is quite difficult to establish deliberate negligence on the part of medical folks. Often, what looks like negligence can also be a momentary lapse of concentration, an error of judgment or just a genuine mistake. The consequences of the mistake can be horrendous but medical folks are like you and me, prone to errors. These errors can be reduced but never eliminated. Better training, superior technique, state-of-the-art technology, greater knowledge, enhanced processes can all help reduce the chances of a mistake, but mistakes do happen. The real question is how does one differentiate genuine mistakes from gross negligence?

While one welcomes the court’s decision, one has to say this, the courts must be very careful in distinguishing genuine mistakes from deliberate negligence and dereliction of duty.

A person, who loses a loved one unexpectedly, in a hospital tends to blame the hospital and the doctors. We see this kind of over the top reaction often enough. Most people find it hard to come to terms with the fragility of the human life and also do not realize that the treating doctors and other medical personnel are not perfect individuals. Most of the time, they are just trying to do their best in an environment of great uncertainty. They have the necessary knowledge and the skill to save lives, but surely they are not equipped to handle all the challenges that a human body throws their way. As consumers of health care services, we must always understand the simple fact that doctors can only do the best they can and sometimes their best may just not be good enough.

I fear that this judgment has the potential to become a lightning rod for many others, who nurse grievances against hospitals and doctors. If this leads to an avalanche of court cases against hapless doctors and hospitals, it will truly be a travesty of justice. I have worked with many doctors over the last dozen years or so and I have no hesitation in saying that I am yet to meet a doctor, who doesn’t take his patient’s and his responsibilities towards them seriously. In my experience, I have not come across negligent doctors. Yes, I have come across doctors, who are over-burdened with work, many who are over-confident and some, who are just incompetent, but never a single one who, to put it rather crudely, is out to kill his patients. All this at times leads to avoidable mistakes, some of those have terrible consequences and are irreversible, but never have I seen doctors deliberately hurting or maiming their patients. Before arriving at hasty and unwarranted conclusions about medical negligence, we must give the benefit of doubt to the doctors.

Medicine is an inexact science. Differences of opinion even among experts are common-place. Often, there are no right and wrong methods of treatment. It all depends on the knowledge, available information and the judgment of the treating doctor and often he is required to take a decision, which may be fraught with risk. However, he knows that not taking a decision is always a riskier option for the patient. In such a situation, if the decision does not produce an expected outcome, can it be later and with the benefit of hindsight be called negligence? The courts must put themselves in the shoes of the treating physician and examine the likely scenarios as they occurred to him rather than the distilled wisdom of other experts, proffered from the comforts of their offices and with the benefit of hindsight.

In short, medical negligence is a tricky thing to ascertain and the courts must always be more than satisfied about the intent and the real culpability of a doctor or a hospital before hauling him over the coals.

Why Hospitals are not Transparent?

communicateAs a consumer of healthcare services and also as a keen observer of the drama that unfolds in a hospital everyday, I have often wondered at the extent of opacity that I see around me. A hospital is usually as transparent as a black hole. Ironically most hospital swear by the maxim of ‘complete transparency’. This is rarely true.

Try getting a straight answer from a hospital executive or a doctor and you will straightaway run into a wall.  They are just not programmed to answer straight. Many a times, I would accept that it may not be feasible or advisable for a doctor to be completely transparent. However, there are times when a doctor must look the patient in the eye and say as it is.

Delivering bad news is never easy. It takes a lot of character and compassion to tell another individual that he is terminally sick. However, not telling or beating around the bush, while doing so is far worse. Than there is the matter of giving hope to those diagnosed with a rare condition, telling them that, while they are gravely ill, they need to put up a fight and the doctors, the hospital and everybody else responsible for their care will walk with them every step of the way.  I would like to believe that the ability to communicate and connect with the patients is a wonderful gift to have and it makes for some very happy patients.   Continue reading

On the Back of a Star

The star syndrome is a common phenomenon, which dazzles many a newly minted hospital.

I have been part of several start-up hospitals and have attended numerous meetings where all those who matter spout the now so familiar arguements about staying away from the ‘stars’ in the medical firmament. The arguements run something like this.

The star doctor (a well established doctor with a roaring practice) will be too set in his practices, will bring too much baggage and will never follow our pristine processes, which are far superior to his current practices. He will be a bad influence on everybody else. Another arguement goes that we do not believe in the ‘star’ system. Why should a ‘star’ enjoy priviliges, which are not available to our other doctors. A third arguement goes that we believe in growing our own stars. The hospital brand should be the real star and not individual doctors.   Continue reading

6 Ways To Get the Best Out of your Doctor

Doctors too are humans. Very often, when confronted with a medical crisis we tend to forget this simple fact. In my many years of experience of working closely with doctors in large corporate hospitals, I have learnt that by observing the following few simple rules one can extract the best out of ones doctors.

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