A patient has the right to know why a test is needed; what
the expected results are; how much it costs; and how it can change her treatment
options
Sample
these reported cases reported in the media:
In October 1989, Zairunnisa
Parekh got admitted for treatment of a tiny 1-cm stone in her kidney at Jaslok
Hospital, Mumbai. She died 35 days later of peritonitis. Her husband Yusuf and
son Mushtaq filed a case of negligence against the doctors, stating that the
hospital denied them a copy of her medical records.
In
another such case, Bhagwati Raheja died after a by-pass surgery at Mumbai’s
Nanavati Hospital. The deceased’s husband maintained he was refused a copy of
his wife’s medical records.
On 11 July 2001, Sandhya Karmakar, 36, mother of a
ten-year-old boy, died at the SSKM hospital in Kolkata. She had been admitted
for appendectomy on 26 June. The surgery went fine, but a surgical mop was
‘inadvertently’ left behind in her abdomen. Surgeon M L Shaha had to perform a
second surgery to remedy the error on July 3. A leakage developed and to fix
that, a third surgery had to be done on July 7. It was later discovered that
the doctor who had performed the appendectomy had left the entire
post-operative process, including suturing the wound, to his nursing staff.
In
these, and several other such cases, patients or their families had to seek
intervention from the Courts in order simply to access their medical records -
documents that were legally their property. When complications occur, hospitals
invariably deny wrong-doing and the onus shifts to the patient’s family to
prove that what went wrong was a result of the doctor’s or the hospital’s
negligence. Without concrete evidence in their possession, this can Patients
and their families often complain that a particular doctor is keeping them in
the dark about the diagnosis or prognosis of a disease. A busy doctor, walking
away from anxious relatives with nothing more than a pat on the shoulder (and
sometimes not even that), is unfortunately a very common sight in our
hospitals. Patients commonly complain that a physician orders a battery of
tests or procedures, without explaining why they are needed, how much would
they cost; what results are expected; and how these would affect their line of
treatment. When this basic information is not readily forthcoming, the outcome
can be frustration that leads to growing discontent with the doctor and the
hospital.
The reporting of several incidents of medical
negligence and subsequent cover-up attempts by hospitals and doctors have
resulted in patients being better informed about their legal rights. Patients
are now demanding a more transparent and accountable doctor-patient
relationship. According to a Supreme Court directive, patients and their
relatives have the right to be informed and this consent is meant to educate
the patient, not be almost impossible.
Patients
and their families often complain that a particular doctor is keeping them in
the dark about the diagnosis or prognosis of a disease. A busy doctor, walking
away from anxious relatives with nothing more than a pat on the shoulder (and
sometimes not even that), is unfortunately a very common sight in our
hospitals. Patients commonly complain that a physician orders a battery of
tests or procedures, without explaining why they are needed, how much would
they cost; what results are expected; and how these would affect their line of
treatment. When this basic information is not readily forthcoming, the outcome
can be frustration that leads to growing discontent with the doctor and the
hospital.
The
reporting of several incidents of medical negligence and subsequent cover-up
attempts by hospitals and doctors have resulted in patients being better
informed about their legal rights. Patients are now demanding a more
transparent and accountable doctor-patient relationship. According to a Supreme
Court directive, patients and their relatives have the right to be informed and
this consent is meant to educate the patient, not just protect the doctor and
hospital. Merely asking the patient to sign a piece of paper thrust in front of
him by a nurse on his way to the Operation Theater will not serve the purpose.
Patient-advocates can help doctors to build a
rapport with the patient, so that there can be a full and frank discussion of
the risks and uncertainties which are inherent in any medical treatment.
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The Truth, the Whole Truth, and Nothing but Truth… Sometimes,
withholding the harsh truth from the patient is not a result of medical
paternalism, but arises out of the doctor’s sincere desire to protect the
patient from emotional distress.. It’s not always easy for a doctor to know
how much truth the patient can tolerate and this can create a dilemma for the
doctor, as the following story, “The doctor’s word” by R K Narayan
illustrates: Dr. Raman diagnoses his close friend to be critically ill. The
doctor knows that the patient has a good chance of recovery if his condition
does not deteriorate during the night. Now the ethical dilemma confronting Dr
Raman is - should he tell the patient the truth about his dire prognosis, or
should be wait until the next morning? The patient has already expressed his
wish to write a will. The good doctor is in a fix. He resolves it by deciding
to deceive the patient, and tells him that he can easily write the will the
next morning, since there is no urgency. The patient is relieved, and
survives What is the moral of the story? The doctor needs to use his judgment
as to whether or not to disclose information that has the potential to harm
the patient
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