-: Importance of Record Keeping :-
If any legal problem arises than properly maintained records are of utmost importance. They are proof of what one has done actually for his patient. Record includes.
a.) Informed consent.
b.) Chronological order of progress of disease and treatment, investigations, opinions, X-rays etc.
c.) Details of procedure or surgery or anesthesia given.
Record of investigations be it
radiological, pathological or reports of
CAT or MRI or any other opinion of specialist or consultant.
e.) Record includes record of refusal of treatment or investigation or surgery.
f.) Records of adult patients are maintained for 3 years and children for 21 years. (3+18 years).
Importance of investigations: In modern time a proof of establishing diagnosis is most essential. A documentation of such diagnosis can be done by well-planned out investigations. One must avoid unnecessary investigations. One must prefer non-invasive investigation or invasive one. Routine investigation to get basic knowledge about patients condition is essential. Legally speaking investigations speaks and vouches for correct diagnosis and indication for treatment and surgery performed by doctor.Few rules for asking investigations are in following fruitful and beneficial manner:
1. Define the diagnostic dilemma or differential diagnosis properly.
Ask yourself that after getting the
results of investigation you will narrow
down in your diagnostic dilemma or
3. Avoid asking special investigations routinely. Only Basic investigations like: Blood count. Stool, urine, etc. could be under taken routinely. Diseases caused by bacteria should be cultured
4. Is precise diagnosis must before proceeding for management and treatment or gross diagnosis will be sufficient.
5. What difference it will make if particular investigation is not done will it harm patient?
6. What possible harms can be done to patient while undertaking particular investigation. Can it cause death?
7. Will cost of investigation burden patient more than it will benefit him ?
8. Is investigation required urgently or can it be postponed ?
9. Is there any way to reach to diagnosis e.g. follow-up etc. which could avoid investigation.
10. All the circumstances related to in terms of its need, urgency, cost, benefit should be told to patient.
If time and condition of patient permits one should obtain expert opinion in ” out of the routine” cases and all serious patients. Importance of seeking medical history and information from relatives and patients as described and annexed to consent from. Why reference to specialist is needed and when?
1. For confirmation of the diagnosis and management plan of a particular patient.
All serious patient should get
benefit of specialist so as to avoid
“missed chance” situation later
patient becomes worse.
3. All unusual cases must be referred to specialist.
More than one persons opinion, if
opinion concurs, has better value in the
law courts in case of any legal
problem, if any, arises later on.
References are made to specialist
if any procedure can not done with out his
help. Special skill is needed for
the procedure which only specialist can offer. eg. Venesection, Lumber puncture
KNOWN AND UNKNOWN COMPLICATIONS OF DISEASE, INVESTIGATIONS AND PROCEDURE: One is expected to take reasonable standard care for known complication and must explain patient and relatives in detail and to their satisfaction all these complications. Unknown complication arise out of a situation must be tackled in goodfaith, sometimes with adventure to save life. One should do utmost to save life and let it be known and felt by patient and relatives. Few rules to remember while tackling complications:
Calculate drug does properly as per kilo of body weight particularly for drug, which have depressant action on respiration and heart. Give these drugs after proper dilutions. Give drugs very slowly if needed to be given intravenously so as to avoid any unknown complications.
Anticipate known complications and be prepared to tackle them in time and effectively.
Keep ready life support system.
Life threatening unknown complication should be tackled with out fear of ” what people will think ” Patients life is of supreme importance and one can not even wait for consent in unusual life threatening situations.
(Unforseen complication teaches a lesson to each doctor and may help in advancing medical treatment).
Law courts are not going to hold you responsible for any untoward incident or even death as a sequel of any unknown complication or any error of judgement or misadventure. What is required of a doctor is standard, reasonable medical care of an average medical professional.
Insurance and Doctors:
Insurance is a special contract where payment by insurer is contingent on liability arising out of contingent loss. Insured pays consideration in terms of premium to insurer. On same principles of insurance doctors indemnity policy is based.
Doctors indemnity policy:
Any liability arises out of civil litigation insurance company will pay for the insured amount (indemnity covered for). Limit of insured amount per case during the year or all cases during the year should be same. Minimum premium is for physician and is double for surgeon, triple for plastic surgeon. There are number of exclusion clauses which must be studied before taking indemnity cover from insurance companies. Generally it is RS 1000/= for RS. 10,00,000/+ of insurance for physicians.
Doctors composite package insurance: It covers building, contents of dispensary or hospital and consulting room including furniture, fixture, fittings, stocks of medicines, medical instruments and kits and electronics items, neon sign board and doctors professional indemnity etc. Same contents can be covered for burglary, housebreaking and theft, finality guarantee for cashier, compounder or other authorized employees. Limit for fidelity is 20,000/= also covers money lost in transit.
Other insurances:a.) Mediclaim: Covers disease, which needs hospitalization, all expenses during hospital stay.
b.) Personal accident policy: covers any type of accidental injuries or death anywhere in world and provides for weekly compensation for the loss of income incurred due to accident.
c.) Motor car insurance policy
Any patient having claims less than/equal to five lakh rupees can approach district consumer forum for redressal which is situated in each district.
A patient with claim more then RS. 5 lakh but less then /equal to RS. 20 lakh approaches state commission or prefers an appeal against in 30 days of district forums order.
A doctor can also appeal to state forum against forum’s order with in 30 days.
Patient having claims of more than 20 lakh may approach national commission are appeal with in 30 days from the order state forum.
Doctors receive copy of complaint filed by patient from consumer forum and have to file written statement return reply with in 30 days of receipt to commission.
This may be extended upto 15 more days.
Complainant is asked to adduce evidence on affidavit so also the opposite party.
Most of the time simple clean cut deficiency of services is tried before consumer forum and complaints involving complicated issue of law and evidence are referred to civil court.
1. A Doctor is a consumer if he buys goods and services for his own consumption or use.
2. A Doctor is consumer as far as following services are concerned:
Insurance claims including
doctors indemnity and doctors
composite policy and mediclaim.
b] Banking services.
c] Postal and telecommunication services.
d] Electricity services.
e] A Doctor is a consumer for the purpose of the equipment he buys for use for his patients. He can also
approach Monopolistic and restrictive trade practices commission, MRTP House, Shahjahan Road, New
f] So in conclusion whatever doctor buys for the benefit of his patients he can now claim to be consumer
if any defect in goods or deficiency in service is found.
ONE CAN CHOOSE INFORMATION FROM FOLLOWING MODEL INFORMATION SHEET OR MODIFY I_______________________________________________________________ Born on________________________________ female, Married/single/divorced. R/o________________________________________________________ ____________________________________________________________ Occupation _________________________________________________________ CANCEL “NO” IF “YES” THEN GIVE DETAILS: WRITE N.A. FOR NOT APPLICABLE
1. Do you have diabetes? NO/___________
2. Do you have blood pressure (Hypertension) No/_____________
3. Do you have heart trouble? NO?_______________
4. Do you have lung trouble. (asthma etc.)? NO/_________________
5. Did you have abnormal bleeding after extraction/surgery/injury? NO/____________
6. Did you have allergy/reaction to any medicine /injection (e.g. penicillin, sulfa etc.)NO/_________
7. Are you taking any drug or medicine? NO/_______________
8. Did you have serious illnesses or operation? No/_______________
9. Did you have fits/fainting attacks/giddiness? No/_____________
10. Did you have jaundice? NO/______________
11. Are you HIV positive? No/_______________
12. Are you Australia Antigen positive? No/______________
13. Do you have rheumatic disease? NO/____________
14. Do you suffer from hay fever, eczema or any other Allergy? NO/___________
15. Are you an expectant mother/breast feeding? NO/____________
16. Is there any matter you wish to discuss? NO/__________
17. Number of deliveries_____________
Nature of deliveries
Date of last Menstrual period: / /
19. Menstrual period: Regular/irregular/painful/scanty/too much_____________
20. History of birth defects in any children: No/____________
21. Did you have swelling of feet/swelling eyelid : NO/______________
Did you have Eclampsia/vesicular
23. Are you suffering from anaemia : No/_____________
24. Do you have ulcer/acidity : NO/__________
I hereby declare that I
have not concealed and
fully disclosed all material facts regarding the status of my health relevant to medical /SURGICAL/MEDICAL
SAMPLE OF IDEAL CONSENT FORM: ONE CAN CHANGE TO SUIT INDIVIDUAL DOCTORS REQUIRMENT
I hereby employ Dr.____________________________ for the personal services for my MEDICAL/SURGICAL treatment. I____________________________________________________ R/o _________________________________________________ _________________________________________________ I hereby declare that I am more than 18 years of age. I hereby consent to the performance of SURGICAL /MEDICAL treatment upon myself or my____________________________________________________ Daughter/wife/ward/niece/neighbour or any other _________________________ Such treatment to consist of______________________________________ ______________________________________________ I further consent to such other or additional treatment, whether or not described above as may be indicated by reasonably standard and prudent SURGICAL/MEDICAL practices if during the course of treatment described above unforeseen conditions are discovered or unusual conditions develop. If the use of anesthesia is indicated, I consent to the administration of such anesthetics which may be of surface anesthesia/infiltrate/block local anesthesia/general anesthesia/conscious sedation or any anesthesia as the doctor may deem advisable and proper. I further consent to the taking of photographs and roentgenograms/X-rays sonography, CATscan or my other pathological investigations or my other investigation for the treatment to be performed, or for SURGICAL/MEDICAL educational or scientific purposes and the demonstration and publication of such rontgenograms or photographs etc. The nature and purpose of the treatment to be rendered the possible hazards involved and alternative methods of treatments have been fully explained to me and I am free to ask an explanation of treatment. No assurance/guarantee/warranty has been made to me that the results will be to my complete satisfaction although it is believed that the results will be satisfactory. I have not concealed and fully disclosed all material facts regarding the status of my health relevant to SURGICAL/MEDICAL treatment. All ANESTHESIA /Medical treatment/procedures/operations carry inherent risks. I am advised to consult any other physician/surgeon/doctor before treatment. I consent for taking IV/IM Injection/drugs/tablets/capsules/syrups/or any other medicines prescribed for treatment/Operation.
I certify that to the best of my belief treatment/SURGICAL/MEDICAL services have been completed to my satisfaction.