Medical Negligence - - - Searching for the root cause

Ramkrishna Paramhans had said that there are three kinds of physicians , one who prescribes drugs and forgets ,has nothing to do as what has happened to the patient . The second category are the ones who hand over the medicines to the patient and lastly the ones who will forcefully make the patient gulp the medicines . In today’s scenario of lack of faith on doctors , last kind of medical practice is better forgotten .

Medicine is a noble profession . Medical negligence literally means neglect of a patient by his physician . Professional negligence or medical negligence may be defined as want of reasonable degree of care or skill or willful negligence on the part of the medical practitioner in the treatment of a patient with whom a relationship of professional attendant is established, so as to lead to bodily injury or to loss of life.

By and large no doctor will ever neglect a patient wilfully . A doctor will always try to do his / her best to help a patient . However in present day on and off we come across the news about medical negligence . The root of this dreaded disease is quite deep . The negligence is far more than just forgetting scissors in patients tummy . Negligence means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance, which is required to be maintained by or under any law for the time being in force .

Why should a doctor neglect a patient ? Either he is not trained well enough to take care of his patient , or he is well trained but is not able to devote sufficient time due to other responsibilities like family or social or he is over burdened with work . The training starts at the institute from where he has graduated . Let us have look at the medical training institutes.

Hippocrates oath states that a doctor should practice medicine without bias on caste , creed , religion or sex and without fear . But right from admission to medical colleges this oath is corroded at the fundamentals . Admission in medical colleges in graduate and post graduate courses is based on caste and if the wishes of our politicians materialise , then soon we will have religion based admissions.
In all the medical colleges in India , there is no teachers training program like B.Ed. (bachelor of education ) . So the medical students are taught by the teachers who are not trained in teaching at all. Naturally the undergraduate students are often taught by the post graduate students who do not touch the basics of medicine and teach whatever they have learnt from books or their limited experience .

The teachers in medical college are supposed to take rounds in wards , see patient in outpatient departments , attend emergency calls , do administrative duties , attend medico-legal cases , guide PG students , up date their knowledge in latest in medicines , and also fulfil the national health programs like leprosy eradication etc . It is hard to believe but a bitter truth is that most of the time of medical teacher is wasted in the corridors of power in preventing transfers or getting promotions . So they have very little time and energy left for teaching the students .

With proliferation of private medical colleges , the teachers from government set up are resigning to join these institutes for better salary and better perks . There is awful shortage of teachers in medical colleges . In order to get sanctions for medical courses from MCI ( medical council of India ) the colleges show the number of teachers by unethical means . These include the government medical colleges who transfer and retransfer the teachers in order to show the adequate number of teachers prior to inspection by medical council.

The curriculum in medical courses are vague . Take an example of curriculum in medicine in M.B.B.S. course , it states cardiovascular system but does not define the limits where the cardiovascular system begins or ends .
The studies in medical colleges are not research oriented. So there is very little research work going on in medical colleges . Thesis written by post graduate students lack depth and often repetition of some work already done earlier .

Because of poor payment structure , the teachers from medical colleges tend to leave colleges and start private practice which gives them both money and stability . So the bitter truth prevails – there is exodus of quality teachers from medical colleges . The lack of good teachers in medical colleges and hence poor training is one of the root causes of medical negligence .

Once a student graduates or post graduates and thinks of starting practice he has already a significant burden on his shoulders . Burden of finances – during admission for basic medical course or post graduate course a medical student has already spent lot of money in studies even when his non medico counter part pursuing other courses have started earning their livelihood . So naturally here is a situation where a doctor is interested in recovering his money even before he has actually started practice .

The establishment cost for doctors is high . The lack of basic infrastructure like constant electricity and water supply interrupts smooth functioning of his practice . Exorbitant cost of instruments topped with high taxes like octroi on the instruments , high interest rates for loans besides the cost of developing infrastructure which includes purchasing power generators in power starved states makes him indebted to financial institutes for ever .
A medical practitioner today is in extreme tension to meet financial challenges . In view of this he has to work more to pay back loan .

For a beginner it is difficult to get patients directly so he has to stress on referral from other doctors which feeds milk to the nasty serpent called “cut practice”.After all these , once the patient has come , he has to be looked after , operated upon and also has to be provided with round the clock supervision in a decent environment . So the doctor needs to employ more staffs . This adds to financial burden .

A doctor also has to look after few non-medical aspects of his practice that includes maintaining his establishment , taking care of environment , paying taxes , paying dues to employees provident fund , paying professional tax , renewing license of hospital with municipality or corporation , getting registered with labour department , attending medico-legal cases etc. Unfortunately all these government offices are located at different places and have different time frames of last dates . All these non-medical aspects are often more important than the practice itself as the neglect on these fronts have serious consequences .

The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. The doctor has to be of good quality , well trained , - so also the juniors assisting him . – it is difficult to get well qualified MBBS doctors as assistants – so doctors untrained in allopathic medicine like BAMS and even BHMS doctors are employed to look after the patients treated by practitioners of allopathic medicine . Hence there is every chance that something might go wrong .

Treating Medical Negligence ! !

Medical negligence has become a matter of concern . Let the meritorious students opt for a noble profession like medicine . Give them all the support from social and government level. Let the doctors concentrate on seeing patients and not waste time on standing in a que for getting clearances from government agencies .
There is a need to look in to the problem of medical negligence . I have few suggestions -
a. Reduce cost of medical studies basic courses like MBBS as well as post graduate diploma and degree , reduce fees structure , abolish donations ,
b. Abolish caste and religion based admission to medical courses .
c. Allow the graduates of other pathies to work as assistant to allopathic doctors by including the basic allopathic courses in their curriculum
d. Include teacher’s training program in post graduate level before a doctor is allowed to teach medical students
e. All medical establishments should be provided with uninterrupted electricity and water supply .
f. All government offices should have single common window system so that doctor need not be harassed at various government offices and need not waste time on non-medical issues.
g. Give loans to doctors at cheaper rate and waive off the taxes from life saving medical instruments
h. Recruitment of medical teachers and their promotion should be only on the basis of merit and experience and on no other criteria like caste , creed and religion .
i. Liberal scholarships to economically backward students

King for a few moments !

By default , I was a king for a few moments .

It was a flight from Nagpur to Mumbai by our ‘ international’ domestic carrier . As I entered into the air craft , I handed over the boarding pass to the air hostess .Interestingly and to my surprise , after seeing the boarding pass , she bowed down and respectfully ushered me to a seat . She asked me with respect with a divine smile on her face , ‘ How do you do , Sir ? ‘. She was an edifice of humility .

Soon followed another hostess , she presented me with ice cold towel to clean my face with . After a grueling day at Nagpur , it was refreshing indeed . As I finished , another beauty followed with a tray , ‘ What you will like to have , Sir , fresh lemon juice or water melon juice , sir ?’ I obliged her and asked for water melon juice .

By now I grew suspicious , am I dreaming ! Am I in a real world or in a wonderland or did I rub a magical lantern like Aladdin ?

I have flown to Mumbai on innumerable occasions but never did I have such a grand welcome . I looked around . The seats were broad , spacious , very comfortable , a separate tray holder with each seat , had extra leg space . The seat cushion was more than comfortable . Oh , at last our national carrier has changed its style of functioning - could be due to tough competition from other airlines . Competitions are really beneficial to passengers - so I thought .
As I was getting adjusted to new kind of unusual VIP treatment , I was further pampered by another air hostess , ‘ Sir , which magazine will you like to read please ! ’ said she in a melodious voice . She had brought 15 chronicles to choose from . ‘ Wow , great . The airline has definitely changed for good !! ’ , I thought .

Now time was ripe for the air craft to leave Nagpur .

An officer from the ground staff came to check the number of passengers in the air craft .Soon he was dialing to the air port check in counter , “ Sir , you said 2 executive class passengers , I find three here . ”

Now the things became crystal clear to me . I was offered a wrong seat , in place of usual cattle class , I mean business class , I was ushered on to executive class seat by mistake and hence all the pampering .

Soon I was back to my original seat in poor cattle class with congested seats , neglectful ‘ care you not ‘ air hostesses , torn outdated news papers in the cabin , passengers sitting next to me had dry parched throats , no one offering water even after asking , forget about fruit juices , ice cold towels and up to date chronicles .

I sighed a sense of relief when passengers of both the classes reached same destination i.e.
‘ aamchi Mumbai .’