Doctors and VIP culture
The All India Institute of Medical Sciences (AIIMS) has opened a “new counter” to cater “exclusively” to patients recommended by the Officer on Special Duty (OSD) to Union Health Minister and “VIP references” from members of parliament. He also holds the post of president, AIIMS. In a circular issued by the AIIMS administration on February 23, it is mentioned that in order to address the concerns of OSD to President, AIIMS and to streamline the OPD registration (new and follow-up) of patients recommended by the OSD to President, AIIMS, and members of parliament, an additional counter shall be opened with effect from March 1, 2017. Just want to point out to you the results of this disgusting, discriminatory policy. About 7 months back, I referred a poor patient to AIIMS for the treatment of breast cancer. Forget treatment, she could not even get a diagnosis despite speaking to a Professor. Finally, I got her admitted to my “private Hospital” operated on her and paid for it from my pocket. The constitution of this country guarantees equal treatment for all. But it has been usurped by the “VIP” culture that afflicts us as a nation. Today we read in the newspapers, AIIMS opens counter for VIP cases sent by Health Minister OSD. The OSD in AIIMS is a parasite. Right from the times (if not earlier) when an unemployed lawyer was given employment as OSD, this foul practice has been going on. AIIMS may claim that it sees 10000 patients in a year in the OPD. What needs to be asked is, what happens to those patients? How many patients complete the treatment? I think that this latest move is a tragedy and a travesty of justice and that a minister of this government should create a false line of priority over citizens who need AIIMS treatment more than them is disgusting. All patients should get the same priority and there should be no VIP culture in health care. And anyway, as my experience of patient care in AIIMS is concerned, the “needy” are Health Ministry Officials as low down to a peon and various other government functionaries who have prostituted this system to benefit their own. Shame on the Health Ministry and its top functionary and shame on the courts of this country which shuffle patients to the private sector under a fraudulent EWS system. Shame on us for tolerating it and accepting it. Shame on the AIIMS Director and the AIIMS Faculty. If you cannot practice equity in healthcare, I dread for the future of this nation. It’s a method of driving people away from the government sector, privatize medicine and leave the poor of this country to their wretched fate. It was a sin to be born in this country.
- Capping of compensation allowable on alleged medical negligence cases
- Amendments in the present act to cap the maximum allowable compensation in any case of medical negligence.
- Mandatory screening of cases of medical negligence, before the case is admitted in the consumer court
- Mandatory provision of seeking expert medical opinion by the court before giving verdict on the technical issues
- Defining/ triaging the complaints into frivolous/ injurious/ grievous etc before submitting to the court of law
- Provision of penalty (to the Doctor/hospital) to be proportionate to the amount of compensation claimed
- The compensation is awarded on the basis of the income of the complainant. But irrespective of the income of the patient, the hospital always same amount for services. Hence the compensation should only be decided on the cost of the treatment.
- Health care Arbitrator: Just like insurance disputes are sent to arbitrators an alternative dispute resolution mechanism can be looked into. The provision will be for providers and patients to submit disputes over alleged malpractice to a third party other than a court. This will help compensate victims faster, more equitably, and with lower transaction costs (As of now the administrative cost of such law suits is approximately 53% of the total compensation claimed)
- Administrative Compensation Systems: It proposes to replace the current tort system with an administrative compensation system. The “health courts” model substitutes a specially trained judge as the finder of fact and arbitrator of law for the current system’s generalist judges and juries
- Judicial audits of the lower courts to assess fairness and judicious application of mind by the lower court
- A comparative analysis of the outcome of judicial verdicts given in past should also be carried out for better understanding of the effectiveness of the compensations awarded till date.
- The legal profession is kept out of the ambit of consumer court. Hence medical services should also be excluded from the consumer court
- Assault on Doctors-Central act for protection of clinical establishments and modification of IPC and CrPC similar to changes made to prevent crime against women
- Withdraw plans to start Bachelor of Science in Community Health (B.Sc Community Health)
- Amend PCPNDT Act: IMA demands the following amendments:
- The Act needs urgent modification to allow unambiguous and easy interpretation. The “Rules” need to be simplified and implemented uniformly across the country, and adhoc changing of rules by each local authority should be strictly prohibited. New rules must be logical and should apply to the entire country only after due discussion with the representative bodies. Time should be given for implementation of the new rules.
- The Act is to be directed only towards Obstetric Ultrasound and not any other applications of ultrasonography.
- The word “Offence” under this act has to be clearly defined. The word Offence should only mean the “actual act of sex determination or female feticide”.
- All other clerical/administrative errors should be classified as non-compliance (and not an offence). Strict penalties can only be imposed for the actual act of sex determination or female feticide and not for other errors. There is a need to redefine “what amounts to sex determination” as mere evidence of clerical error does not amount to sex determination.“Imprisonment” rules should be for the offence (of sex determination or female feticide) & not for non-compliance.
- Inspections should be conducted yearly instead of every 90 days. No NGO can conduct “raids” on doctors’ premises and there should be no impediment to doctors doing their practice during inspections.
- Ultrasonologists should not be restricted to working in only two centers.
- The doctors should have the right to report on those seeking sex determinations and action must be initiated against them immediately.
- Not to allow other system practitioners from practicing modern medicine through bridge courses and through government orders
- Clinical Establishment Act
- Accreditation rather than licensing should be the procedure:
- Fixing of rates for services
- The present Act though it does not admit, has a licensing character.
- IMA suggests that registration and upkeep of standards in health care delivery will be better saved through accreditation process.
- All health care institutions may be mandated to opt for a recognised accreditation process.
- IMA and NABH has already started a unique scheme to assist even small and medium hospitals to gain entry level accreditation and this accreditation process should be recognised by the Government
- The Government should exempt accredited hospitals from the licensing process.
- The Government should refrain from determining the fee for services provided by hospitals, which are not availing the above government schemes.
- The medical profession and the private hospitals have a right to fix their charges for their private patients.
- Single doctor establishments should be exempted from the Act
- Grievance redressal mechanisms are not legally correct platforms since alternative forums already exist.
- This mechanism will put the already harassed doctors and hospitals into severe stress.
- The onus of safe transport and the cost involved in emergency case management should be borne by the Government.
- The clinical establishments act should include provisions for promotion of healthcare institutions. It should be The clinical establishments (Registration and Regulation and Promotion) Act 2010.
- The high penalty rate determined in the law should be scaled down.
- Many of the rules and clauses only result in closure of small and medium level hospitals which are the backbone of India’s health care delivery system along with Government institutions.
- Increase budgetary allocation for health
- Strengthen primary health care/rural health service
- Make quality drugs available to public at affordable cost
There are many different professions. Each one tries to offer services and get paid.
The taxpayer pays for their education equally anyway, except for the ones who pay through their nose to get admission and degree in many of our (in)famous private universities. The under-the-table ‘fees’ might run into crores of rupees these days.
No human being is infallible; but why does society, and the courts, find fault for a wrong diagnosis? If my interpretation of the law is right, we are supposed to exercise due care to see that we do OUR best for the patient. Diagnosis in medicine is not as easy as it is made out in the press. There are no black and white areas in human physiology. Imponderables abound in the diagnostic arena. Even at the best centres in the world, where they pool the wisdom of many people in difficult cases, 12% of the patients’ diagnoses could only be made on the post-mortem table.
No patient’s death can be predicted, or prevented, by any doctor, however good s/he is. It is very difficult even to give a correct prognosis as the future is an imponderable in science. The future is yet to be born. No doctor can predict the unpredictable future of the patient, although we have been doing that to pander to our pleasant self-image.
We are, to a great extent, responsible for this exponential growth of consumer cases against doctors. Firstly, we deified ourselves and assumed greater powers than we really have and, many a time, claim to do wonders. We are no longer humble enough to state that we only dress the wound and nature (God) heals. We have taken medicine to the marketplace, to make big money. That has brought, in its wake, the market forces to our area also.
In truth, the medical world revolves round faith of the patient in his doctor. It is the coming together of two human beings, one who is ill or thinks he is ill, and comes to seek the advice of another, in whom s/he has confidence. This confidence works wonders even in healing. Unfortunately, today, in the corporate hospitals set-up, this holy relationship between those two human beings no longer exists. It is like the assembly line work. Modern medicine, in this century, has become a corporate monstrosity, according to a study done in London by Hillary Butler.
As long as the doctor is sincere, he works very hard to get at the diagnosis, taking into account all the available data; but if he still fails to arrive at the correct diagnosis, it is nobody’s fault. But the doctor should document all these efforts to show that he has done all that was needed to be done for ‘reasonable care’ of the patient.
Of course, in all these, there should be no wanton negligence at any stage. Communication skills are a great help in keeping the patient, and his near and dear ones, in the picture through the time that the patient is in the hospital or clinic. That would go a long way in avoiding unnecessary litigation. Where needed, a second opinion is another safeguard against litigation. In hindsight, one might be able to do better; but, in an emergency situation, there is the added element of urgency to intervene which will not be there for the reviewing doctor, court or a witness that the primary doctor was denied.
Another reason due to which the problem gets compounded is the jealousy of our own brethren who might inadvertently create a situation where the patient’s relatives become suspicious. If the patient gets worse and is then shifted to another hospital, someone there might inadvertently say: “If only you had come early, we would have been able to do lot for the patient.” This single sentence, though not the complete truth, is the single most important abettor of consumer complaints.
These days, the huge bills of most corporate hospitals work as seeds for litigations to grow. In some cases, the grievances are genuine. Keeping dying (and dead) patients in the intensive care units (ICUs) with tubes stuck into all possible orifices, or wheeling dead patients from operating tables into ICUs, to be kept there for some hours on ventilators before they are declared dead, admitting apparently healthy people for all sorts of tests and scans, removing the appendix for every minor pain in the abdomen, abdominal deliveries where normal delivery was feasible, operating on the wrong side or wrong limb, leaving operating instruments inside the patient’s body or administering dangerous wrong medications, the list of genuine consumer complaints is growing. But complaints, regarding the competence of a fully qualified and licensed doctor, fall in the grey zone.
The patient and the relatives must always be kept in the picture and documentation of all that is done kept meticulously will be the best insurance against consumer court cases.
The majority of the Doctors and paramedics, work hard under very odd and difficult circumstances even at times when they see hundreds of patients with meager facilities. Do our patients expect too much from health care providers? Most of the Hospitals run by state lack best practice standards, and protocols, no uniformity, and continuity in care across multiple individuals and levels. and audit from patients perspective whether particular prescribed costly ,medication or intervention was really indicated, presence of alternatives where there.was there any conflict of interest in such management..Such control of all activities is needed in order to detect and correct any undue deviation from pre-defined norms or evidence-based performance Standards and expectations. While in private hospital fear or suspicion of not being charged fairly, not many hospitals in private sector escape criticism of ordering unnecessary investigations, consultations, and even interventions. The physician is no more an angel, but a big trust deficit is eclipsing an altruistic attitude which had identified “medical profession as noble”, so what could be a dream hospital for you, me and any ordinary person who can’t afford four-star hospital but is sensitive to safety and quality of health. care.who can give me assurance on these issues of affordability, accessibility, and accountability. #When can I(being patient not as a recognized Physician) or any dear or near of ours walk in ED/clinic of any hospital/clinic/private hospital/nursing home, without introducing myself on social status, or position and being recognized as a prominent doctor and am assured that I get the same right treatment at right time by the right person by right methodology on the merit of my ailment not because of my position or status.Is there any hope for such a system in future? What do patients really want from health care? Share your views.
“Don’t Harm Me – Heal Me – Be Nice to Me”.treat me with dignity; with evidence-based practices within an affordable price.That’s what our patients want from the healthcare facility and in that order; Where can we find such a combination? The majority of the Doctors and paramedics, especially people working in the field, work hard under very odd and difficult circumstances even at times when they see hundreds of patients with meager facilities don’t know. Why our patients are not satisfied with state-run health services? Do our patients expect too much from health care providers? In hospitals run by state government; the problem of overcrowding, long waiting lists, lack of safety, infection control issues and quality standards and Quality of care varies dramatically between doctors and hospitals, but those differences are invisible to administrators. Most of the Hospitals run by state lack best practice standards, and protocols, no uniformity, and continuity in care across multiple individuals and levels. overall atmosphere ?..system which assures where receivers or providers both can expect to be respected, involved, satisfied and above all safe and appropriate care based on an individual’s needs, not on personal characteristics, or social status is lacking.. People (aam aadmi)have notion unless you are recommended or come from the private clinic of physician you will not get right treatment art right time from right person inadequate regulations, accountability undermine health care.,and if one goes to hospital he or she might get harm from lack of standards and evidence based protociols . For monitoring activity in any healthcare organization (Private or Governmental ), we don’t find a quality system of supervision,who is doing what ? no privilege granting system;who can do what? and audit from patients perspective whether particular prescribed costly ,medication or intervention was really indicated, presence of alternatives where there.was there any conflict of interest in such management..Such control of all activities is needed in order to detect and correct any undue deviation from pre-defined norms or evidence-based performance Standards and expectations. While in private hospital fear or suspicion of not being charged fairly, not many hospitals in private sector escape criticism of ordering unnecessary investigations, consultations, and even interventions. The physician is no more an angel, but a big trust deficit is eclipsing an altruistic attitude which had identified “medical profession as noble”, so what could be a dream hospital for you, me and any ordinary person who can’t afford four-star hospital but is sensitive to safety and quality of health. care.who can give me assurance on these issues of affordability, accessibility, and accountability. #When can I(being patient not as a recognized Physician) or any dear or near of ours walk in ED/clinic of any hospital/clinic/private hospital/nursing home, without introducing myself on social status, or position and being recognized as a prominent doctor and am assured that I get the same right treatment at right time by the right person by right methodology on the merit of my ailment not because of my position or status.Is there any hope for such a system in future?