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 .