COURTESY MIRROR JUNE 24
DIAGNOSED WITH FEAR
Extra cautious against violence, doctors take to ‘defensive medicine’
City’s medical fraternity is increasingly seen asking for CT scans even for headaches, entire blood culture tests for minor illnesses, consent forms for random injections — all to avoid attacks or cases of negligence
| Vicky.Pathare@timesgroup.com
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Consent forms in hospitals and clinics of the city are no longer exclusive to risky invasive procedures. These days, medicos here are insisting on such formalities even before administering a tetanus injection — such is their desperation to absolve themselves of any responsibility in the face of the violent reactions regularly encountered at the hands of patients and their families. “Defensive medicine”, as they’ve termed this precautionary practice, is the new order of the day.
The cost of such an approach, both in terms of money, time and energy, is going to tell heavily on the entire healthcare system, doctors admit. Yet, their refrain is that the increasing inclination among patients and their relatives — to take the law into their hands for justice against perceived medical negligence or inflated costs — has left them with no option but to cover their backs in every possible way. This is the resonance of the pan-India protests against the abuse and assaults the medical fraternity is subjected to from disgruntled kith and kin of patients.
While the Indian Medical Association (IMA) is still in the process of putting together systems that could curb such violence against the fraternity, individual doctors and hospitals are rushing to secure themselves in the best way they can manage.
So, closed-circuit television (CCTV) cameras, written and video consents, limited entry to kin, referring to other doctors and hospitals for second and third opinions, putting the patient through multiple tests (even they may not be essential to diagnosis) are some of the features of this “defensive medicine”.
Despite a 28-year practice behind her, obstetrician and gynaecologist Dr Meenakshi Deshpande of Vatsalya Hospital on Sinhagad Road has recently made consent mandatory for every injection or vaccine administered to her patients. “We’ve included the consent form in every patient’s file. We are taking consent even for common vaccines and injections. Earlier, we’d merely counsel patients and their relatives. But now, pursuant to the counselling, we seek consent, particularly from a male relative. The consent is taken not just with a signature but also a thumb impression,” she told Mirror.
Deshpande added that security at her hospital has been alerted to keep out unnecessary crowding by relatives, even in cases of emergency. “They are required to log names, addresses and contact details of every person allowed in. In complex cases, we insist on videotaping kin. We put down every test required on prescriptions and leave it to the discretion of the relatives to run them. Many of these tests are expensive and if they show no anomaly, we fear being accused of generating unnecessary costs.”
Yet, the doctors are now recommending diagnostic tests or even treatment that may not necessarily be the best option for the patient, but merely do the function of protecting the physician against any legal recourse sought by the patient later. The battery of extra tests and procedures, being recommended in this rush for cover, not only weigh on the patients’ pockets, but are also jamming healthcare facilities, which in turn makes the process more protracted for patients. In other words, the longer wait for effective medical management is another side effect of the new cautious stance taken by the medicos.
Such is the state of affairs that Dr Sanjay Patil, an ophthalmologist who has been running his Dr Patil Eye Hospital at Swargate for 27 years now, has stopped taking walk-in patients. “We’ve installed CCTV cameras around the entire hospital. Appointments are given after vetting all details of the patients and their kin. We used to offer contact details of drug stores, ambulance services, laboratories and specialist doctors. Today, the contact number of the police tops this list,” Patil informed.
He too admitted to the circuitous route being taken for any diagnosis to be on the safe side. “If bespectacled patients come complaining of headache, though we know it may be due to a change in their eye power, to rule out other probable reasons for the problem, I suggest they also consult a neurologist and undergo a CT scan. The consent rule has been made very elaborate and mandatory. We don’t take chances with patients who may not have completed certain earlier treatments and also hide their medical history, landing them in trouble,” he explained.
Dr Avinash Bhondwe, a family physician with 36 years of practice, also talked of the changed approach to treatment. “These days, patients with fever who could be treated in OPDs are being admitted and run through blood, urine and other tests. In those showing symptoms of dengue, the protocol is to wait for seven days before doing blood tests. But given the aggression patients and their folks display when the tests come positive after the seven-day wait, we’ve taken to recommending the test at the very outset. Even for the flu, you need to wait for four-five days for prognosis. But we’ve given up on going by clinical observations as we did earlier to save costs for the patients. When there is possibility of two different lines of treatment, we simply ask the patients to take a second opinion,” he broke it down for Mirror.
Rounding up the current scenario, Dr Jayant Navarange, chairman of the medico-legal cell of IMA, Pune, pointed out, “With the Consumer Protection Act being applied to medical profession indiscriminately and the onset of aggressive consumerism focused on increasing amounts of compensation, and at a time when half-baked self-proclaimed medical knowledge is obtained from the internet, doctors are compelled to practice defensive medicine. This is purely due to the trust deficit created in the doctor-patient relationship by the above-mentioned factors. What we are seeing and experiencing now is just the beginning of defensive medical practice and soon its impact on community will be more intense. Getting investigations done even for minor and self-limiting fevers, consent for every injection and vaccine, frequent follow-ups, more paperwork documenting every minor detail, installing security cameras are just some of these fallouts. These pitfalls were pointed out before the Supreme Court in 1995 about the Consumer Protection Act being applied to doctors (VP Shantha vs IMA, November 13, 1995). But the court opined — “we do not think so”. Now, those fears are turning into reality.”