While the doctor patient relationship is one of mutual trust and respect, many a times patients or their relatives take the kind doctor for a ride e. g. they may refuse to pay the agreed fee, fail to observe appointed time or miss the appointment altogether, be rude or demanding, impatient and impolite, attend phone calls during consultation etc. Some patients do not respect the doctor’s schedule, or comprehend that Doctor is a busy person. If a doctor remains under stress due to such unreasonable demands, there is bound to be early burn out. With increasing number of assaults on doctors and governments inability to provide security there is a need to have his/her life and property protected. Instances of assault have been reported where doctors were unable to see a patient out of turn, oblige for a false medical bill/certificate or ambulance was caught in traffic jam.
Physician burnout is a term that has weighed heavy on the healthcare field, especially in recent years. Physicians are dealing with an incredible amount of work stress as they confront growing administrative burden, rising operating costs, new technology adoptions and the increasing patient demand for satisfactory care or unethical favours. Burn out entails physical and emotional exhaustion i e doctor is emotionally drained, depleted and worn out by work. The Development of a negative, callous and cynical attitude toward patients and their concerns can be another effect. The cardinal sign here is cynicism, sarcasm and feeling put upon by the patients. There is a tendency to see the work negatively, without value or meaningless and see themselves as incompetent. In a recent study it was found 33% jump in the rate of physician burnout among family medicine doctors under 35, compared to only two years ago. A fear of litigation hampers the doctors’ personal and professional life. The increasing burden of documentation and patient communication is taking a toll of every doctor’s life. Politics looms, Bureaucracy dictates the course of physician’s career, especially, those who are working in government set up or corporate sector. Many of the physicians are not able to keep pace with fast-growing digitization of healthcare sector. Surveys in the reports show higher rate of burnout among female doctors than males. Negative interaction with patient, colleagues and family is also a cause of female burn out. Most of them regretted their choice of medicine as a career and said they would choose another profession if they were starting all over again. Sometimes they feel they have not enough training for the medico-legal aspects, contracts insurance and moreover the professional leadership they are exposed to in their workplace. Maintaining a healthy lifestyle for the doctors may help reducing burnout. Lacks of social support in the form of friends, associations are important components leading to burnout. The fatigue leads to detrimental consequences like high suicide rates, drug abuse, high rate of marital separation etc. Most doctors feel low self esteem and low financial security coupled with allegations of corruption, which is taking a heavy toll. Work Life Balance and healthy boundaries between work and non-work life areas is required.
Rising litigation: Do’s and Don’ts
The basic reason is that medical care is costly. Those who pay high fees expect quick and guaranteed relief. When fee is high, the anger against non-relief is high. To make things worse, the government and the politicians keep on telling doctors to provide free treatment, particularly in emergencies. Free treatment to patient is not free in the hands of doctors. They have to be compensated by the state if the patient cannot pay. Doctors, like any other citizen, have to abide by law, including the 2002 ethical regulations. Medical care is given by a service provider (physician) to the beneficiary of service (patient) under a contract of service against consideration (fee). When a patient does not pay, they are fully entitled to sue the patient to recover money. On the other hand, if emergency services are provided to a patient as mandated under the Clinical Establishments Act, while the patient does not pay or is unable to pay, the doctors should send a bill to the government. Law Commission had envisaged an appropriate compensatory mechanism to the providers of such services.
Three most important “DOs” 1)—Always document all relevant facts in sufficient detail. 2)—Always talk to the patient and the relatives in detail and with sympathy and understanding. Detailed briefing must be done at the time of consent. Talking to the patient and relatives at various stages of treatment, especially in surgical cases, decreases the scope for apprehension, suspicion, doubt and disbelief against the doctor. 3)—always buy sufficient indemnity insurance. Three most important “DON’Ts” 1)—Do not meddle outside your area of specialization. 2)—Do not transgress into other systems of medicine. 3)—when you receive a legal notice or when a case is filed against you in a consumer court, hire a lawyer. Do not panic. Inform the insurance company immediately. Do not think of compromising with the complainant by paying a certain amount of money. Even though you engage a lawyer, it is extremely important that you should take an active interest in pursuing the case and not leave it to the lawyer alone. You should prepare a file of all the documents related to the treatment of the patient in a chronological order. Such evidences in the form of photocopies would need to be supplied to the lawyer. You should try to get written and signed expert opinions from medical experts who are specialists in the field concerned.
By following the Do’s and Don’ts you can ward off many problems and make life easy.