Defensive Medicine

DEFENSIVE MEDICINE: SPECIALITY OR A STATE OF MIND..

DR ANIL BHADORIA, Indian Medical Association

Indore MP

Everything can be purchased and so also health and health services. But, Time changed from an old era when health services were scarce and available medical facilities were thin. Scene has changed now and also the Mindset. It is expected by all & sundry that the treatment outcome of a disease can be achieved as wished. Possibly its not justified to think and expect. Earlier, simple infections were known to cost a life even in elite class families. Now trivial or major infections are cured with new generation drugs. Obesity can be cured with Robotic knife and insulin can be pumped through a device placed in body only in patients of Diabetes. We are facing new pattern of lifestyle diseases with subsequent complications resulting into multiple organ involvement and organ failure to let the patient succumb to his disease.Life style Disease range from Diabetes, Morbid Obesity, Hypertension and changed addictive habits like Alcohol and Narcotic drugs usage are more or less life long stubborn diseases where treatment is tough and costly while cure for such diseases is a difficult.

In a long run Life style diseases lend us to Organ failure state. Human Organ failure of Liver, Kidney or Heart are more familiar terms nowadays. Why it is common?Addiction to alcohol has increased so many folds in last few decades which has become a major cause for liver diseases and its failure in due course.

On the other hand, OTC Analgesic drugs available easily for small and trivial Pain has been having negative effects on Kidneys. Uncontrolled Diabetes or Hypertension definitely leads to many complications leaving no organ unaffected. People at large are driven by wrong or melacious advertisements guaranteeing a medicinal product to be Panecea for cure of Life Style Diseases like Diabetes, Hypertension or like any. OTC drugs which are marketed on eye catching note with making of false claims are known to cause injury to Liver and Kidney leading to compromised state of Health.

Incidents of road accidents have risen manyfolds due to good roads and powerful bikes and very powerful cars. In all such situations hospitals and treating doctors are held unduly responsible for any untoward outcome while trying to save a life. All such situations need high end care of patients in any of basic or advanced hospital set up. Such patients have to undergo variety of multi specialty diagnostic scans, interventions or pathology investigations along with an active involvement of more than one doctor of more than one speciality.

All such situations costs heavily to the patient’s family and long stay in hospital leads to a financial emergency when saving a life renders to keep assets on mortgage or sold to fill the bill of high end corporate hospital or succumb to the disease.

Any untoward incident leads to a result-rage against the treating Doctor who gets a physical misbehaviour or even a legal case of homicidal attempts under Indian Penal Codes. Hooligans gather after an unfortunate demise and held doctors as hostage to declare him responsible for unwelcome outcome. This is a known fact Science of healing is filled both with uncertainty and probability along with ever changing formulary and surgical advancements.

This medicine science is definitely uncertain and dubious yet has a proven efficacy despite all odds. Still with all these advancements and modernization, life cannot be guaranteed always with expense of money. Law of the land is prevailing and already safeguarding rights of benefactor Patient through Consumer Protection Act, Nursing home act, Transplantation of human organ act, Pharmacy act, Biomedical waste management act, Drugs and cosmetic act etc. Some state acts are also prevailing on practicing doctors to keep them under regulations.

Declaring patients as consumers has rendered doctors to become service providers. It has triggered a fear factor down the spine among the doctors to not to take a risk. Doctors under Hippocratic Oath or
recently acclaimed Charak Shapath already are morally bound to follow ethical practice.

These situations have caused a new state of mind called Defensive Medicine which is not a speciality but a state of fearful doctor not taking up critically ill patient as he foresees likely outcome on patient and with likely consequences on the Doctor. A premonition in the mind of treating Physician or a Surgeon will end up in a state, “Lets Go Safe”, to prevent any on-spot brutal beating or having an award against from Consumer Forum, later.

This new state of mind of Defensive Medicine will propagate a poor state of doctor’s clinical practice where a skillful professional will not throw himself to save a life in critical situation.Defensive medicine will let the treating Doctor to think first of his own safety to safeguard against Goons and other litigations and get a compensation award agaisnt from national or state forums. Defensive medicine will let the treating doctor to refer serious patients to higher centers immediately.

Defensive medicine may cause life to family when pregnant lady comes to a District Hospital or to a small nursing home which refuses to let the patient be admitted and conduct all interventions to save mother and child. This way the doctors community is being jeoparadized to save themselves first before they use their skillfull hands on the patients requiring surgery or intervention or even just planning on indoor patient admission or planning normal delivery. Manhandling and matters leading to litigation against the doctor or Hospital will restrict qualified physician and skillful surgeons to remain in a closed shell with an uncalled for speciality in Defensive Medicine.What to do then, what can be done?

Society must take a note and be made aware that this science of healing also has its limitations and even most skillful hands may fail. Informed consent before for intervervention & surgical procedure provide an immunity to Hospital for unlikely outcome yet, time can never spare anyone be it a patient or a doctor.Premium or high end corporate hospitals also cannot give a life saving guarantee. Same way doctors cannot guarantee a positive outcome for all times. Medical Insurance for one and all. If patient enters a hospital with an insurance coverage, the hospital rage reaction will be a little less in case of a consequential mishap during management of the patient.

Two way communication between the service provider and consumer has to be strengthened at all levels so that family of the patient remains fully informed about the diagnosis and prognosis. Patients family must be given with an open option left with them to get their patient shifted to a better healthcare facility or to a Doctor.

Hospitals are not God’s place or Doctors are not Gods either. Designating, Doctors as God has done more damage than any benefit. Doctors are not magicians or not conducting miracles to a scientific activity on human body through a skeptical science of healing.Govt of India may be suggested to come forward with a central act against Healthcare professionals and assistants against healthcare.