REVIEW ARTICLE


https://doi.org/10.5005/jp-journals-11003-0133
Journal of Medical Academics
Volume 6 | Issue 2 | Year 2023

Upcoming Medicolegal Challenges for a Practicing Surgeon in India


Sishir N Choudhury1, Mamadur MR Shankar2

11,2Department of General Surgery, Army College of Medical Sciences, Delhi, India

Corresponding Author: Sishir N Choudhury, Department of General Surgery, Army College of Medical Sciences, Delhi, India, Phone: +91 9002449568, e-mail: nagchoudhurysishir@gmail.com

Received: 14 October 2023; Accepted: 06 November 2023; Published on: 30 December 2023

ABSTRACT

Surgical practice is one of the main pillars of the medical profession. Surgery in India has been flourishing since ancient times, be it the examples of trephination found on skeletal remains at sites of Indus Valley civilization (2nd millennium BCE) to the surgical excellence of Maharshi Sushruta (Sushruta Samhita) in the 1st millennium AD to India becoming a hub for surgical (medical) tourism in the 21st century.

However, today in India, there is also a growing anxiety about the rise of medicolegal issues in surgical practice both among doctors as well as society in general, creating a trust deficit in the doctor–patient relationship. Hence, it is of paramount importance that clinicians not only are skilled in their profession but must also be acquainted with the latest medicolegal aspects to have an uneventful practice. The aim of this article is to analyze the evolution of medicolegal foundations in India, predict the likely course of medicolegal issues in the future and democratize this information to clinicians as widely as possible to ensure a healthy doctor-patient relationship in the Indian context.

How to cite this article: Choudhury SN, Shankar MMR. Upcoming Medicolegal Challenges for a Practicing Surgeon in India. J Med Acad 2023;6(2):66–68.

Source of support: Nil

Conflict of interest: None

Keywords: Bolam test, Doctor–patient relationship, Golden hour, Medicolegal, Medical negligence, Professional obligation, Telemedicine

INTRODUCTION

The term ”medicolegal” basically refers to the practice of medicine (surgery) within the confines of law. It may differ slightly from country to country depending upon the variations in different legal systems around the world. In India, it has its basis in the constitution (Fundamental Rights and Directive Principles of State Policies), various judgements of constitutional courts (Supreme Court of India and High Courts) and various laws enacted by the Parliament and different state legislatures.

LACK OF AWARENESS AMONG DOCTORS

Although the medicolegal principles have evolved considerably over the years, it has been realized in the field of healthcare that the doctors, nursing staff, paramedical and other support staff lack detailed knowledge about medicolegal issues in day-to-day practice. As per some studies, the majority of doctors have elementary knowledge about the basics of medical ethics and medicolegal issues but lack knowledge about the finer details of the subject.10

Since 1996, following VP Shantha’s judgment, the healthcare sector has been under the ambit of the Consumer Protection Act. Moreover, in today’s world, the healthcare sector in India is becoming more and more commercialized. Yet, doctors lack detailed knowledge of The Consumer Protection Act 1986, further adding to the trust deficit among patients.11

INSUFFICIENT FOCUS ON MEDICOLEGAL TRAINING IN THE MEDICAL CURRICULUM

It has been observed that the majority of Interns and Post Graduate trainees have very little knowledge about handling medicolegal cases independently. There is also an opinion within sections of medical undergraduate and postgraduate students that the present curriculum is not sufficient for dealing with medicolegal cases.12 This points toward insufficient focus on medicolegal training of medical undergraduates and postgraduates in their respective curricula.

INCREASING TRUST DEFICIT IN DOCTOR–PATIENT RELATIONSHIP

In recent years, there has been a significant rise in the number of medical negligence cases across India. There are various studies charting such cases across large parts of India that find certain specialties to be more prone to medicolegal cases like general surgery, gynecology and obstetrics, general medicine, and cardiology, as well as cases of composite negligence.13 Moreover, it has also been noted by some experts that the majority of the cases appear in the private sector and that most of the negligence cases are not being proven in courts.14 Thus, it is clear that the traditional dynamics of doctor–patient relationships have come under strain, and the trust deficit has increased in recent years.

WAY FORWARD

Medicolegal updates must be regularly included in CME conferences for practicing doctors to ensure maximum possible legal compliance on the part of clinicians so as to avoid unwarranted medicolegal litigations.

The MBBS curriculum must be redesigned so as to include basics of medicolegal topics for undergraduate students.

The postgraduate trainees must have separate training modules in this regard and must be sensitized with respect to their medicolegal responsibilities, especially in the surgical specialties mentioned above.

The nursing staff, paramedical staff and support staff must also be adequately sensitized and educated on these topics via various workshops and symposia.

In addition, there must be a charter of duties for all employees of hospitals outlining their respective duties clearly.

There must also be a charter of expected duties from patients to their attendants as far as possible.

This way, the trust deficit can be bridged, and the cordial nature of doctor–patient relationship restored so that future practicing surgeons in India may work with greater vigor and motivation than ever before.

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