Doctor is Answerable to(separately or jointly)

• Medical Council

• Criminal Court

• Civil Court

• Consumer Redressed Forum

• Janata Durbar! (most dreaded)

Medical Negligence

• If a doctor commits any act which other reasonable doctor of his standard would not commit

ORThe doctor omits to do something which other doctor would certainly do

• Res Ipsa Loquitor (Gross) : utter disregard for human life

What is demanded is a reasonable & average care of a prudent doctor in similar circumstances

What is demanded is a reasonable & average care of a prudent doctor in similar circumstances

Non — Negligence• Difference of opinion

• Wrong diagnosis in spite of diligence

• Accidents : detected, attended &

• managed reasonably in time

• Unexpected results

• Misjudgement

• Professional charges

More the expertise claimed — more the care demanded

More the expertise claimed — more the care demanded

Vicarious Liability

• Whatever is done by the staff

• Whatever is done by partners, associates (locum)

• Whatever happens in your premises

• Defective service, due even to contractor’s problems

Prevention of ClinicalMedico legal Problems

• Attention : Additional opinions

• Behaviour : Bill & Behaviour

• Communications : Consent &

• Certificate

Documents• Expertise; Efficiency

C CONSENT

• Essentials of a valid consent

• Free consent- without coercion, undue influence, misrepresentation, fraud or mistake.

• Capacity to enter contract

• Adult of sound mind -Minor- by guardian

• Child -7 to 12 years ????

Consent• Valid consent

– Competent person

– Major / guardian

– Child 7—12 yrs

• Witnesses — 2

• Simple / any language / specific / clear / unambiguous

• Mention common complications / alternatives

• In emergency...

• Sterilisation / castration — both spouses

• Amputation — second opinion

C CONSENT

• Written consent OR Implied consent• Informed consent relevant information of illness

and treatment has to be explained• Significant material risk has to be explained• Alternative modalities• Unusual or special risks may not be explained• Exceeding consent-- Think of Postponement ,

Operate only if urgent

Consent• Why doctor should feel shy of informing & taking

written statement to that effect?

• BOLDLY document the non-compliance of any

of your advice

• Consent of a child after (7) 12 years is a must,

along with Guardian’s.

C CERTIFICATE- Care while

issuing • On Letter pad only- Doctor’s Name,

Qualification,Address and Registration no.

• Mention Date, Time, and Place of issue

• Issue only on demand and for legitimate cause

• It should be TRUE and CLEAR Without ambiguity

CERTIFICATE_Care while issuing- continued

• Identification mark of the patient and/or The thumb impression

• Period of illness should be clearly mentioned• Keep Duplicate copy• You can charge for the certificate (except for the

Death certificate.)• Diagnosis- Disclosure only after patients express

consent unless required by the law

Death Certificate• NO FEES

• CONFIRM DEATH PERSONALLY

• SUSPECED HOMICIDEINFORM POLICE

• GET ACQUAINTED TO NEW FORMAT

• CARDIO-RESPIATORY ARREST ETC. NOT A CAUSE

• DO NOT ISSUE DUPLICATE

Medical fitness “will document”

• Issue to a known person only , Otherwise confirm identification

• Take thumb impression + signature of the the person executing the will.

• Ascertain mental stability of the person.• Always put date time and place.• Make counter entry by making a formal case

paper for your record.

D MEDICALDOCUMENTS• Should be -- Clean- Avoid overwriting.

• Correct and Comprehensive.

• Chronologically correct - Put date & time.

• Complete and Confidential.

MEDICAL DOCUMENTS• Preservation • M.L.C. s ----- for ever ( 30 years )

Administrative papers -- Registers etc 10 years

• Indoor ----- 5 Years

• O.P.D. ----- 3 Years • Identification Mark on paper is important

D MEDICAL DOCUMENTS

• Whose Property -

• Hospital has right over papers but• Should provide copy to court / police on

demand OTHERWISE • It is a confidential communication and• cannot be released without his permission

MEDICAL DOCUMENTS

• Patient has a right to demand it at a reasonable fees and in reasonable time.

• DO NOT SAY NO TO THE DEMAND

MEDICAL DOCUMENTS - Discharge card

• Short history, clinical notes, summary of

• operation and/or treatment.

• Instruction on discharge card HAVE to be more elaborate.

• Always write to report back date --- etc OR report if----

MEDICAL DOCUMENTS - Prescription

• As far as possible- Neat ,Good hand writing

• Drugs in CAPITAL LETTERS

• Strength of medicine must be written

• Correct dose With clear instructions of frequency of intake.

• Address and registration No - must

• Preferably give follow up date

MEDICAL DOCUMENTS-Referral Notes and Transfer notes

• Carbon Copy should be kept.

• Put Date and time at time of Transfer.

• Write treatment summary & Your assessment of patients condition.

Any -- ??????????

Earnestly Invited from the

audience

THANK YOU ***********************************