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Apr-Jun2002-10(2)
LETTER FROM CHENNAI
Consummate justice or complete
folly? Doctors and Consumer Protection Act
George
Thomas
At the end of a panel discussion on the Consumer
Protection Act held during the recent annual conference of the Tamilnadu
Orthopaedic Association, the audience was asked to vote on whether they thought
the act good or bad. Not surprisingly, the vote was overwhelming in considering
the act bad. What was surprising was, that when the panelists were asked to
vote, two out of three doctors on the panel felt it was good. The lone lawyer
felt it was bad!
Doctors' concerns
The doctors on the panel were all active in the
Indian Medical Association. The reasons they gave in favour of the act were
revealing. They felt that unethical practices had become common in the medical
profession, and the Medical Council of India, which should have been active in
policing the profession, was itself corrupt and therefore inactive. One of them
said that the manner in which doctors became members of the Council presently,
itself ensured that only the corrupt would succeed. The doctors also felt that
the Act had forced an improvement in the equipment of nursing homes. The lawyer
felt that the present act was imperfect and needed fine-tuning.
The main reasons given by those who opposed the Act
were: the difficulty of proving negligence, the difficult circumstances in which
doctors worked and the inability of the members of the consumer forums to
understand the intricacies of medical decision making. The lawyer said that most
forums were very scrupulous in analyzing complaints. It was not necessary that
the latest treatment was followed; only an acceptable method at an acceptable
level of competence was necessary. It was always essential for the complainant
to prove negligence.
The panel discussion was one of the best-attended
events of the conference. It was supposed to last for two hours but went on for
well over three and had to be guillotined. It was clear that the act was a
source of much discomfort to doctors. Orthopaedic surgeons are one of the most
sued. Only obstetricians and anaesthesiologists out do them. It was interesting
that the chief cause of litigation was instigation by another surgeon. This was
the unanimous view of all the panelists.
All the doctors on the panel felt that an important
cause of patient dissatisfaction was the failure of the doctor to communicate
properly with the patient. Patients felt bitter that the doctor had hidden facts
from them. One of the doctors in the audience felt that informed consent was
just a farce because if one revealed all the possible complications, even the
rare ones, most patients would never consent to surgery.
The central issue
Although the discussion was interesting, it seemed
to me that it skirted the central issue. Half a century after independence, we
have failed to develop a system of medical care that will ensure a reasonable
result for almost all patients. What we have at present is absolute chaos. The
consumer protection act is relevant only to a small group of patients who can
afford to pay for private care. Even this small group is unsure of how to access
competent care. Most people are guided by the reputation of the doctor or the
hospital. In order to develop this reputation, doctors and hospitals market
themselves in many ways, almost all of them unethical. Thus the potential for
malpractice is built into the system. We are faced with the sad irony of under
treatment in the public sector and over treatment in the private. The public
hospitals are over crowded. It is impossible with the current doctor-patient
ratio to do justice to the patients. On the other hand, the poor patients are
sometimes used as guinea pigs when the doctor wishes to learn a new treatment or
procedure. As one doctor put it: "learning curve in the government hospital and
earning curve in the private hospital!" In the private sector, too many doctors
are chasing too few patients. The desire to ensure that the patient does not
move to another doctor is a powerful motivation to malpractice. There is no
security of income for a young doctor just beginning practice. This is a sure
method of ensuring that at least some will be tempted to unethical
practice.
If doctors wish to get away from the
infirmities of the Consumer Protection Act, tinkering with it will not be a long
-term solution. We have to be in the forefront of working for a system in which
both patients and health personnel are benefited. This is the only sure way to
reduce if not eliminate malpractice.
Dr George Thomas, Railway Hospital, Chennai 600023
Email:george@medicalthicsindia.org