Defensive Medicine

DEFENSIVE MEDICINE: It is the tendency on the part of us to order every test /investigation, even if remotely indicated just in order to safeguard ourself from possible negligence suit. Like ordering CT/MRI for routine headache, barium studies for routine abdominal pain etc.. Increase in litigation cases by consumer protection act resulted in such practice. Though legally right, how far ethically it is justifiable ?




When Dr Rao mentioned my name,amidst ' hot'discussions , I am a bit surprised . Then it occurred to my nindthat iti's just one of those toutine referrals to a skin specialist ,as the theme involves " saving (one's) SKIN " ! I am yet to see , a 'coin with one side ' - "Do you.. ?" . ' A simpleton lady visited once a govt hospital and was mistakenly marked for ENT OPD. The foc, with his head gear light on , straightawy asked her to open her mouth, utter some sounds , as he thrusted differrent mirrors into her mouth , scribbled ' a presription' and said ( impationtly) NEXT !. The bewildered lady , had this surmise to make... "How advanced is the science !" " The doc diagnosed (!) a complint ' down below ' by looking ' up above' !. Sounds as exaggeration ? To me too.... .Yet the feeling is that there is ' lurking truth ' somewhere 'down the story lane.' My driver once told that when he went to take an appointment from an orthopedecian known to him regarding back ache of his wife , he was asked to bring her along with an MRI scan done' ! Worse still is that he complied with when the doc decared ' nothing wrong with her back' and prescribed rest for want ofwhich only she got the ache.! ' Were we not treating ailments ere the CTs and MRIs '@ made in roads into owr daily practice ?' Where did the clinical skills tought so laboriously go ? Honestly how many busy doctors spend time to arrive at atleast DD for an ailment? CTs And MRIs made docs ' lazy' ! I am not talking of the honest participents here- I am talking about those whom every ne of us surely have enough to show an accusing finger at. It must not however be forgotten that ' when u point one finger against somebody, the rest of the fingers are pointing towards u.! Why consumer act has come into force ? Is it not growing awreness of ' consumerism' ? Initially, the docs thought that it is ' others' who indulge in malpractices. Their dreams were belied when despite ' hue and crys' docs were brought uder the act ' ispite of their noble profession ' ! .... But why.. ? " The black sheep" amogest ourselves.! " Don't like it.. ? But 'the proof of pudding is in eating.' There r so many laws around, do they scare us ?. Nay.. ' because we are ' honest citizens ' !. Then why fear this law' if u 'continue to be honest'. I know ur prompt answer- ' The growing litigants and vandalism anong pts.' . " Honesty should be not only there , " but it should appear to be there " !. Do we care to discusfreelyte pros and cons of the suspected diseasewith the pts? Do weconvince ' the absolute necessity ' of a costly investigation and their written consent b 4 the same ? " A convinced and consented pt never complains. ". U may argue that it it is only ' half truth '. There is a remedy still which we don't care to follow ' despite the big talk we make about it. It is good documentation and full justification on paper b 4 any procedure or investigation is done. If u say all does this , ' it is the biggest lie on the earth '. See busy docs papers. They never write full observations made them not to put a probable diagnosis. ' They r conscious of their reputation which prevents them from making any ' commitment to a provisional diagnosis'...or is it because they r not sure of themselves..? Or are they callous not to do what lesser docs do ?. Good documentation, full justification, frank apraisal of the situation to the pts, taking pts into confidence, using our best discretion b 4 rushing to costly and avoidable investigafions, why should we ' cry wolf ' at the consumer law ? Ponder over this and u r sure to come out of the ' phantom fears ' about the consumer law. This is a fact known to all but ' the problem is that we refuse to see the resaon ' out of ' fright and flight reaction ' to an imaginary disaster , ' that could be averted even if it happens at all. " Don't like the post ? No problem... ' It is to my liking. '.

Thank you sir for your bold and straight forward comments which may not be digested by most of our colleagues. I would like to ask my colleagues whether there is any decrease in vandalism against doctors even after adopting such a costly investigations and prescriptions for a long duration. ?.

Ethics have been changed now a days due to consumer protection act. As per medical ethics are concerned remotely indicated investigations are not at all justifiable... but society and CPA compells us to fallow the changed ethics.... Very unfortunate!!!!

This is what has tied a physicians hand

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Violence against doctors and healthcare providers in India has been on the rise in recent years. Doctors, nurses and paramedics are today putting their lives at risk in the course of duty because they are susceptible to verbal and physical assault from patients and their relatives

I agree with dr s shinde Ethics. Standards ..principles all change their values with change of time..the value of 1000 rupees 10-15 yr back is now equivalent to 100 rupees now..previously getting TLC dlc and urine was sufficient.. But now with change of time it has become standard to get tested hep b hep c hiv Even today pt z expectation of standards is diff from So ethics principles change face value with society..time..persons So today ordering elaborate testing is no wrong

Thanks sir !!!

For the sake of saving one's own skin one should not forget our medical ethics which we are supposed to uphold.

Dr shinde sir U r 100% right Today's pt deserve no symphthy..u befool them they will praise u......u advise them out of ethics..they will think it ur less hold on subject

I fully agree with Dr S Shinde

Thanks sir !!!

Right sir

If people claim 1 crore compensation howcome a doctor will give. It may be like his lifetime savings. I play safe. For other i dont know

Yes sir u r right A pt who had wasted months with street corner rmp expects wonder from us becoz we are qualified.. And we do not get full tests done out of ethics You go on following ethics and he starts cursing u within days So we should follow Amitabh Bachan z dialogue." Kitabon main chhappte hain chahat ke kisse..hakeekat kee duniya mein chahat nahin hai"

@Dr. Asv Prasad is requested to comment

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