Council For Fair Business Practices

Important Information :

Recent Events Held :

Seminar on "Consumer Unfriendly Practices in Medical Profession"

Mr. V.B. Haribhakti, President welcomed all present and proceeded to comment on the perceptions and practices of the medical profession. Today not many medical practitioners have time for poor people, and altogether their attitude to those in need of care is not “consumer friendly.”

Whilst people themselves look upon a doctor as God, individuals in medical practice prescribe unnecessary tests, treatments and medicines which are not affordable, are undesirable and in several instances not required at all. When medication might suffice, surgical invasion is undertaken.

It is the common perception of many people, that in general, too many medical practitioners are unethical.

Mr. Haribhakti next requested Mr. Apurva Aggarwal to make a presentation on laws pertaining to medical practice.

Laws Applicable to Medical Profession:

Law relating to medicine is not watertight compartment
Cuts through traditional barriers of law

Specific statutes relating to medicine:

Indian Medical Council Act,1956,
The Fatal Accidents Act, 1855
The Drugs (Control)Act, 1950
The Homeopathy Central Council Act, 1973
The Pharmacy Act, 1948
The Pre Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994
The Transplantation of Human Organs Act,1994

General Laws applicable to medicine:

Indian Penal Code, 1860
Indian Evidence Act,1872
Indian Contract Act,1872
Tort Law
Consumer Protection Act, 1986

Who is a Doctor

The very term Doctor is a misnomer as there is no definition of a Doctor anywhere
The Indian Medical Council Act defines a Medical Practitioner
A Medical Practitioner is supposed to be registered with the Indian Medical Council (“IMC”) and have the requisite qualifications
A Medical Practitioner is entitled to practice in the Country but he has to observe the code of ethics

Who is a Patient?

A patient is anyone who consults a medical practitioner
The moment a person consults a medical practitioner he becomes that medical practitioners patient

Rights of a Medical Practitioner

The right to refuse treatment
Right to refuse treatment is available only to individual practitioners.
Physicians working in Government hospitals cannot refuse to accept and treat a patient.
The right to be reimbursed
The physician has the right to be reimbursed for the service rendered to the patient.
The right to withhold information
A physician relationship is fiduciary and requires confidentiality
The physician is not expected to divulge information about his patient
This right to withhold information is not absolute

Exceptions:

It must be bonafide and without malice, e.g.,

as a witness in a court of law;
warning spouses of AIDS patients and those found infected with HIV;
informing public health authorities of food poisoning from a hotel etc;
assisting apprehension of a person who has committed a serious crime;
informing law enforcers about medico-legal cases, etc.

Duties and Obligations of a Medical Practitioner

Duties and Obligations

Enlisted under various laws of the land and Codes of Medical Ethics and Declarations Indian and International, which are :

Code of Medical Ethics of Medical Council of India
Hippocratic Oath
Declaration of Geneva
Declaration of Helsinki
International Code of Medical Ethics
Government of India Guidelines for Sterilization

The duties can be summarized as under :-

Duties to Patient
Duties to Public
Duties towards Law Enforcers
Duties not to violate Professional Ethics
Duties not to do anything illegal or hide illegal acts
Duties to each other

Duties to Patients: -

Standard Care
Providing Information to the Patient / Attendant
Consent for Treatment
Emergency Care

Duties & Obligations

Duties to Public:

Health Education
Medical help when natural calamities like drought, flood, earthquakes, fire etc.
Medical help during train accidents,house collapse, road accidents
Compulsory notification of births, deaths, infectious diseases, food poisoning etc.

Duty not to do or hide anything illegal

Not calling Magistrate for recording dying declaration
Unauthorized unnecessary, uninformed treatment and surgery or procedure
Sex determination

Duties of a Patient / Attendant

When a patient (consumer) hires or avails of services of a doctor for treatment, he has the following duties :-

He must disclose all information
He must co-operate with the doctor for any relevant investigations required to diagnose and treat him.
He must carry out all the instructions as regards drugs, food, rest, exercise or any other necessary aspect.
In the case of a private medical practitioner he must compensate the doctor in terms of money and money alone.

Moral considerations apart, failure on the part of the patient / attendant to do his duty:

Will enable the doctor to terminate patient physician contract and that would free him from his legal responsibilities,
Will be construed as contributory negligence, and weaken the case of the patient for compensation.

Doctor Patient Contract

A doctor cannot be forced to treat any person
He has certain possibilities for those whom he accepts as patients
It is an implied contract

Continue to Treat

Responsibility towards a patient begins the moment a doctor agrees to examine the case.

He must not, therefore, abandon his patient except under the following circumstances

The patient has recovered from the illness, for which treatment was initiated.
The patient / attendant does not pay the doctor's fees (in case of a private practitioner).
The patient / attendant consults another doctor without the knowledge of the first attending doctor.
The patient / attendants do not co-operate and follow the doctor's instructions.

Reasonable Skill:

The degree of skill a doctor undertakes is the average degree of skill possessed by his professional brethren of the same standing as himself.
There is an implied contract between the doctor and the patient when the patient is told in effect : “ Medicine is not an exact science. I shall use my experience and best judgement and you take the risk that I may be wrong. I guarantee nothing.”

MEDICAL PRACTITIONER & THE CONSUMER PROTECTION ACT

The Consumer Protection Act, 1986 came into force on 15th April, 1987
The aims and objects of the Act is for better protection of the interests of the consumer and for settlement of consumer disputes
It provides for speedy and inexpensive settlement of disputes within a limited time frame, as against civil actions which are costly and take years in coming to a settlement
Provisions of the Act are in addition to and not in derogation of any other law
Complaint means Any allegation, in writing made by a complainant that the services hired or availed of or agreed to be hired or availed of by him suffer from deficiency in any respect.
Complainant means a consumer who or which makes a complaint.
Deficiency means Any fault, imperfection, shortcoming or inadequacy in the quality, nature, and manner of the performance.
Service means of any description which is made available to potential users and includes the provision of facilities but does not include the rendering of any service free of charge or under a contract of personal service.
Although medical profession has not been included under the term “service” but in many of the decided cases medical services have been deemed to be included in the definition of service in view of the expression; 'servicemeans service of any description'.

Dr. R.C. S. Khandelwal, stated that in Municipal Hospitals prior to an operation, the written consent of the patient or from his / her relatives must be obtained. On many occasions, illiterate patients do not understand the procedure and after the operation is over, patients have been known to complain that their consent for the operation was not given. In such situations, doctors are subjected to unnecessary harassment and they convince the patient that surgery was done in his / her own interest. In some accident cases a patient is brought to the hospital without a family attendant or relative; in such instances the hospital Administrator In-charge gives his consent on behalf of the patient for an emergency operation or treatment. In the event of the patient's death, relatives are known to lodge complaints against the doctors saying the surgery was done without their consent. If the general public are educated about this kind of situation, there will be a change for the better, for all concerned.

According to Dr. Manohar Kher, Founder Member of ACASH, malpractices are rampant in and by members of the medical profession. Money, more than human care and service, is the sole criterion in practice. The very high cost of medical education is a primary cause of the malady. In order to recover these expenses, doctors take recourse to high fees from their clients. Dr. Kher made the following suggestions, in order to bring about change and improvement.

Reduce the medical education fee in private hospitals to minimum as in Municipal and Govt. Colleges.
Select students only on merit
Poor students to be adopted by Banks and Companies
Compulsory service of 5 to 7 years in villages and semi urban areas after completion of medical graduation
Impose severe penalty for negligence and crime by Doctors
Educating the Medical Students on Medical Ethics

One of the other major problems in the medical profession at present is the practice by unqualified doctors. Making this diagnosis, Dr. Prakash Kawli, President, Indian Medical Association, indicated that such malpractice is found particularly in rural and semi -urban areas, where adequate numbers of qualified doctors are not available. Moreover Homeopaths and Ayurveda specialists, dabble in allopathy. The rural population tends to believe that such practitioners are “cheaper” and treat more patients than a qualified MBBS doctor. Such people expect instant treatment at minimal cost. They need to be educated and cautioned about approaching non-qualified doctors.

In this context Dr. Kawli pointed out another concern. Normally, a patient does not disclose a full case history or the pre-existence of disease. This results in a incorrect diagnosis and when anything goes wrong the doctor is penalized.

Dr. M.S. Kamath, Member, CGSI, drew the attention of the audience to the rampant corruption in the Maharashtra Medical Council, and its ineffective functioning. At present, in fact, the MMC stands suspended. Dr. Kamath emphasized that the medical profession is a noble one, and professionals must rise above their own wants and place the needs of the public first. If money is the sole aim, then a profession becomes a business for profit. Dr. Kamath understands that the public views the doctor-patient relationship as one between brothers. Any deviation from this perception is looked upon as negligence on the part of the doctor.

Ethics in the medical profession must be rigidly adhered to and is morally binding on professionals. Today there is rampant misuse of medication for even the slightest headache or diarrhoea by ordinary people and this can lead to harmful side - effects and in some instances to complications. Dr. Kamath ended his talk on a humorous note with the quotation: “A pill for every ill. Beware of the Bill and be ready to execute a Will.”

Consumer activist and advocate Mr. Anand Patwardhan, believes that the attitude of patient to doctor and vice versa of doctor to patient, is a fundamental, in the relationship. There must be mutual trust in order to develop a bond between them. What happens today is that the cost of treatment in many cases is expensive. Besides, after the introduction of the Consumer Protection Act, doctors started prescribing numerous tests for diagnosis. In several instances a second opinion is sought and patients are required to undertake more tests. Like in every profession, there is negligence. So too, in the medical profession. However, such negligence is difficult to establish, because other doctors are unwilling to come forward to give an unfavourable opinion against a member of their fraternity. Advocate Uday Wavikar, taking up the issue of medical negligence towards patients, cited the example of a boy with a hand fracture which was put in plaster without proper treatment. Gangrene set in and ultimately the hand was amputated. Negligence caused not only suffering but the patient was ‘made’ handicapped. It is necessary that reasonable care and skill are provided to prevent negligence, and that expert medical advice and treatment reach the patient in time so that his / her condition is not worsened.

Many a time, a wrong pathological report results in wrong diagnosis. The patient suffers immensely. It is therefore essential for doctors to be made accountable for their acts of negligence, and therefore, for the profession to fix responsibility.

The audience raised some interesting questions and made several suggestions and comments.

Questions, Answers, Comments & Suggestions

Why are patients charged higher prices for medicines supplied by hospitals when they are cheaper outside?
In his reply, Dr. Prakash Kawli explained that many companies manufacture medicines and antibiotics which are the same but which are marketed under different brand names and for which the prices vary.

Why do hospitals not return left - over medicines procured for a patient during hospitalisation?
Dr. Kawli answered that the hospitals provide such medicines from their own reserves and these are replaced by what the patients bring.

Why do hospitals assure patients that leading doctors will perform surgery and collect fees accordingly, when this does not actually happen?
In reality junior doctors conduct the surgery. This is a clear breach of trust.

Why is Medical Education so expensive?
The Government should be urged to reduce the cost.

Why do doctors not adhere strictly to appointment timings which they give?
Doctors must make themselves available as indicated and avoid inconvenience to patients.

Why is corruption rampant in ambulance services, particularly in cases of cardiac emergencies?
This malpractice must be curbed.

Why are some harmful medicines banned in many countries, still available in India?
The Food & Drugs Administration (FDA) should initiate action to ban such drugs in the public interest, in India.

Why do doctors give unbranded medicines to patients?
They are possibly spurious, and obtained from unknown companies. Steps must be taken to avoid this practice.

Vice Pesident, Shri Dinesh Parekh gave a hearty vote of thanks to all present.

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