jousting

Provocation by colleagues- professional jousting-frequent cause of malpractice litigation.

 A Surgeon had to convert a Lap Cholecystectomy into open surgery because of difficulties.

Post-surgery, after a couple of months, recurrence of abdominal pain led to further investigations including CT scan abdomen and a retained abdominal mop was diagnosed.

Patient was unwilling to continue treatment with the same surgeon and went to another surgeon.

Laparotomy was performed by this surgeon and the mop retrieved.

The surgery was videotaped by the surgeon.

Subsequently; the relatives of the patient confronted the first hospital very aggressively and demanded compensation.

One of the relatives flashed a CD and said they had a video recording of the mop removal surgery and threatened to splash it in the media.

Left with no choice, the hospital and the surgeon made a financial settlement.

A Gynecologist performed a hysterectomy for multiple uterine fibroids.

A few months later the patient consulted another gynecologist for vaginal discharge and abdominal symptoms.

The patient was re-operated and a retained abdominal sponge was removed.

After displaying it to the not inconsiderable number of relatives present, the mop was put in a fancy glass bottle (much in the fashion of a hunting trophy!) and handed over to the husband of the patient.

Almost soon after, a large mob, which included activists of a political party, stormed into the office of the first gynecologist and brutally assaulted him.

An accompanying TV channel crew filmed the entire proceedings which were duly telecast the next day and the day after.

A Gastroenterologist admitted a patient to hospital for acute pain in the epigastrium.

On the basis of history and clinical examination a diagnosis of ? Acute cholecystitis? Acute pancreatitis was made. 
Treatment was started accordingly and relevant investigations were ordered. 
WBC count of 20,400 and presence of fever supported the diagnosis. 
Some abnormality in the ECG was attributed to previous IHD 14 years ago. 
Liver enzyme levels were abnormal though USG did not reveal any abnormality. 
CPK enzyme was found to be raised.

The patient responded to standard line of treatment and was discharged after 8 days, being asymptomatic now.

After about two and a half months, the patient consulted a cardiologist in another hospital for chest pain.

This time the ECG revealed fresh ischemia for which he was treated appropriately.

However, the cardiologist allegedly remarked that he was “….shocked at the treatment given at the previous hospital “and in his opinion, the patient had in fact suffered a myocardial infarct at the time of the previous admission and the doctors had misdiagnosed it as cholecystitis.

Subsequently, the patient filed a complaint before the National Commission claiming Rs. 55.90 lakhs as damages for gross negligence in diagnosis leading to severe damage to his heart and thus necessitating a heart operation.

The cardiologist, whose remarks had provoked the litigation, gave his comments in writing and even filed an affidavit in favour of the complainant.

An Orthopaedic surgeon gave a local steroid injection to a lady suffering from severe Tendo Achilles tendinitis.

A month later, the patient developed rupture of Tendo Achilles for which she was advised repair.

On taking a second opinion from another Orthopaedic surgeon, she was told unequivocally that this had occurred because of wrong treatment.

Local injection is never, never to be given and hence she had a good case to claim damages from the doctor.

He said he was willing to say so in writing. The inevitable happened and the orthopedic surgeon had to face a lot of unpleasant music !

A Neurophysician, quite recently, diagnosed Hansen’s disease in a patient with foot drop and other neurological symptoms after due investigations including EMG, etc.

He prescribed Dapsone to the patient after testing the patient for G6PD deficiency.

Shortly thereafter, she developed Stevens- Johnson syndrome.

A Dermatologist whom the patient consulted wrote
on his letter-head ‘No evidence of Hansen’s’ and said there was no need to have administered the drug.

Soon after , a crowd of 20-25 persons trooped into the doctors ‘consulting room , intimidated him and informed him that they were admitting the patient to a high-profile Corporate hospital and since the complication had occurred because of his mistake , he ought to bear the cost of the entire medical treatment hereafter.

The relatives of the patient browbeat him into giving a cheque of Rs. 1 lakh in favour of the hospital where they proposed to admit him. 
And they promised to return for more money on an SOS basis!

Orthopedic implant failures, incomplete MTPs, limb amputations —– the entire gamut of cases where the common feature was the unintended, or sometimes intended (!), off-the cuff remarks which instigated patients to make a beeline to an Advocate, marking the beginning of tortuous litigation and mental and physical harassment of the concerned doctor.

Undoubtedly, a fair percentage of medico-legal problems have their genesis in critical comments by doctors against the previous treating doctor.

In the USA, such provocation of patients has been given a name.

They call it “Professional Jousting”
Definition: Jousting has been defined as the unfortunate practice of one health care professional making critical / derogatory comments about another provider’s care, either to the patient or relatives, without having reviewed all the pertinent records and without discussing his or her concerns with the previous physician.

Jousting is not always oral.

Criticism recorded in a patient’s case paper can be just as damaging , in fact more ,since it forms part of the documentary record and will become evidence in case of litigation.
Please avoid jousting,  as all r human , and can make judgement/ treatment error.
Help your colleagues and don’t get into jousting,  as it can be u next time.

 

— 
With warm regards, 
Prof ( Dr ) R K Sharma
MBBS (AIIMS) , MD ( AIIMS), FIAMLE , FICFMT , 
Medico-Legal Consultant
President, Indian Association of Medico-Legal Experts , New Delhi
Former Head, Department of Forensic Medicine, All-India Institute of Medical Sciences, New Delhi
Director , Supreme Medico-legal Protection Services Pvt Ltd
e mail medicolegalhelpline@gmail.com
website www.smlps.in
tel no 0091-9891098542

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