Transcript Medicolegal Issues - Jabalpur Divisional Ophthalmic Society

MEDICOLEGAL ASPECTS IN
OPHTHALMOLOGY
Dr. S. C. Batalia
Ethics
Unethics
Batalia Eye Hospital
Dr. Batalia Road,
Jabalpur.
INTRODUCTION
 Gone are the days when doctors were considered next
to GOD. There was a general belief that he is LIFE Savior.
 BUT NOW A DAYS With changed circumstances the
doctors are given suspicious look. Inspite of the
thorough knowledge
 Specialization in the subject and with the best efforts
invariably has to undergo many allegations.
 Doctors should always accept cases only in which he has
mastered.
 A medical council registered doctor is not allowed to
undertake any other business or profession.
IMPORTANCE OF INFORMED CONSENT
 CARRYING OUT A SURGERY without informed consent
would result in criminal liability as well as civil liability
for paying compensation.
 Obtain written consent for any procedure that carries
risks, hazards, complications, or that has an alternative
surgical procedure; determine what reasonable prudent
patient would want to know about proposed procedure;
if procedure refused, document informed refusal with
supporting evidence, and KEEP a copy as evidence and
data that support decision to perform procedure;
documentation that you “discussed with patient per
usual customary practice”, what you discussed.
COMMUNICATING WITH PATIENTS
Use lay language, not medical terms (particularly
for informed consent); do not criticize previous
physician’s
actions;
maintain
user-friendly
telephone system; make sure patients have
emergency access to physician; ensure access for
those with language or physical barriers; return all
calls
MEDICAL RECORD
Acts as “number one” witness in litigation; contains
documentation of examination, information used to
make diagnosis and treatment plan, and results of
continuing treatment; records should be as thorough
as possible; note and date any changes to chart and
reason for change
Endophthalmitis occurs in best of hands
in best of set ups.
Only people who do not get
endophthalmitis are those
who do not operate.
INTRA-OCULAR INFECTION
Intra-ocular infection has always brought disrepute to
the ophthalmologist and this problem is not only
rampant at eye-camps but also in hospitals, which
include the five star ones. Only surgeon who does not
have endophthalmitis is the one who does not
operate. The problem is general and it is not the
surgeon who is to be blamed although he is
responsible for surgery. Despite the best possible care,
mishaps cannot always be avoided because the error
in one link of the entire chain may sometimes result in
a disaster.
IF YOU HAVE A MISFORTUNE OF INFECTION THEN
HOW TO SAVE YOURSELF ?
 Record all findings including vision-including projection of rays,
intraocular pressure, status of cornea, anterior chamber
reaction, pupillary reaction, details of iris, IOL (if present) and
fundus. Get B-Scan ultrasound done.
 Record them daily and keep a copy with you.
 Do not do telephonic treatment. eg. if patient calls up in the
night and complains of pain, redness, watering and if you tell
him to continue or add steroid drops, then this is asking for a
disaster. That means that instead of giving telephonic
treatment tell the patient to go to nearby ophthalmologist
available and show to him.
IF YOU HAVE A MISFORTUNE OF INFECTION THEN
HOW TO SAVE YOURSELF ?
 Patient who is on treatment for endophthalmitis, see him daily
and always write on the prescription to report SOS. If patient is
from far flung area write on his card or prescription slip that in
case of any pain or redness or decreased vision or unusual
symptoms report to nearest ophthalmologist and mention “do
not ignore.”
 Even at the cost of … please document, document & document.
 When in doubt seek peer review, refer to retinal surgeon or
hospital.
 Involve multiple people or hospitals to safeguard you.
 Greatest malpractice risk associated with endophthalmitisAnalysis of claims show that liability arises from a delay in
diagnosis or treatment, including a delay in referring the
patient to a vitreo-retinal specialist.
1. A Doctor is not guilty of negligence if he has acted in
accordance with a practice accepted as proper by a
responsible body of medical men skilled in that
particular art.
2. It is also held that in the realm of diagnosis and
treatment there is ample scope for genuine difference
of opinion and a doctor is not negligent merely because
his conclusion differs from that of other professional
men. It was also made clear that the true test for
establishing negligence in diagnosis or treatment on
the part of a doctor is whether he has been proved to
be guilty of such failure as no doctor of ordinary skill
would be guilty of if acting with ordinary care.
Chief Justice of India Bench
After laying down the law, the learned Chief Justice Shri Lahoti
opined that in cases of criminal negligence where a private
complaint of negligence against a doctor is filed and before the
investigating officer proceeds against the doctor accused of rash
and negligent act, the investigating officer must obtain an
independent and competent medical opinion preferably from a
doctor in Government service, qualified in that branch of
medical practice. Such a doctor is expected to give an impartial
and unbiased opinion applying the primary test to the facts
collected in the course of investigation. Hon'ble Chief Justice
suggested that some statutory rules and statutory instructions
incorporating certain guidelines should be issued by the
Government of India or the State Government in consultation
with the Medical Council of India in this regard.
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DEFINITION OF ETHICS
Medical ethics is an area that has particular interest
for the general public and as well as the medical
practioner, and issues concerning medical ethics
seem to be constantly in head lines.
English lexicons trace it to the Sanskrit word
“Swadha” which briefly connotes a sense of self
respect that as a mere custom denies you the right to
do anything wrong.
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it is of utmost importance to remain within the
accepted norms. With the growth of population,
the size of cities number of doctors and the
specialty in our subject has increased. Besides
the expenditure as capitation fee for admission
in
Medical
college
and
enormous
cost
of
ophthalmic instruments to equip a new eye
clinic one would definitely like to recover the
cost at the earliest by all means.
Ethics
Unethics
WHERE TO BALANCE :
The Technology and machine dependency is
another factor influencing our ethics. In the
company of our gadgets we become machine like
and behave machine like. The tension of very high
investment and competition and high bank
installments compel us to change our attitude to
the patients sitting across the paper. We become
market driven forces and accept so many unethical
practices as normal.
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Where to Balance :
How the Ethics play role in technologies let me take the specific
causes in points
(No individuals, Organizations or Institutions are
Implied please excuse)
The mostly widely quoted technology to hit the
market is the use of Phaco in cataract surgery. Wide
publicity has given the patients a feeling that this is
the ultimate laser cataract surgery. False premature
claims have been made not only in the press and
media but putting big hoardings Waveform Phaco,
Cold Phaco, ICE Phaco better than Cold, Micro coaxial
phaco.
Cataract removal in 30 seconds. Similar
gimmicks keep appearing to project oneself as great
surgeon and researcher.
Where to Balance :
How the Ethics play role in technologies let me take the specific
causes in points
(No individuals, Organizations or Institutions are
Implied please excuse)
Pain Less
Suture Less
NO INCISION Cataract Surgery
Where to Balance
How the Ethics play role in technologies let me take the specific
causes in points
(No individuals, Organizations or Institutions are
Implied please excuse)
 With the introduction of Lasik surgery there has been an
outburst of advertising in the lay press by projecting the
names of the surgeon in place of hospital. Patient
awareness of the different procedures and their benefits
and limitations are often flawed. One doctor says that he
doing Zyoptix and the other doctor is doing LASIK. It is well
known to all of us that lasik is name of the operation may
be by wavefront, fematosecond or by any costly laser
machine.
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NEW CLINIC OR HOSPITAL
It is admitted that the people have the right to
know not only the opening of new clinic or hospital
but the development of latest equipments and new
operations & researches. For this purpose press
conference can be organized.
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Dr. P. N. Nagpal says : The media is already ridiculing the medical men for
greed & neglect. The phenomena of fall of prestige of
this so called “Noble Profession” needs to be explored
and investigated. Are we loosing the ethics of this
profession? Are we getting more commercial & business
like? Are we playing with the Hippocrates oath?
 He further quotes Ethics the science of morals are a very
must for every profession and infact for the smooth
running. Unfortunately, ethics as a subject has no
definition and no discipline. Ethics also tend to differ
with time, place & culture.
Communication with the public must be accurate. They
must not convey false, untrue, deceptive or misleading
information
through
statements,
testimonials,
photographs or by means particularly through the news
media & PAID NEWS. Communication must not
misrepresent ophthalmologist’s credentials, training,
experience or ability, and must not claim of superiority
Some people work on the hypothesis that
there is nothing ethical or unethical, only
thinking makes it so. Also, it will be wrong to
presume
that
whatever
is
not
illegal
is
ethical, since there is a wide gap between
ethical and lawful activities. Every unethical
practice by any member of profession /
society
will
harm
the
already
reputation of the medical profession.
fading
 At one time known as “Healing Physicians” we are
slowly converting into commercial corporate with
specialties, doctor, opticians & pharma as partners.
 We have guided missiles but misguided men
 Ethical practice is decided by one thing and only one
thing “Good of the patient and community”
GOLDEN RULES
To reduce medico-legal problems for ourselves, it is
important to practise the Golden Rule in our
professional life:
1. Do not do to your colleagues what you do not wish
them to do to you
2. Avoid cheeky remarks and criticisms.
3. Recognise that complications do occur even in the
best of hands. "The only surgeons who does not
have complications is the surgeon who does not
do any surgery.
4. Do not say to the patient that the best person to do
this kind of surgery is Dr so-and-so.
GOLDEN RULES
 Be demonstrably true in all respects.
 Not be misleading vulgar or sensational
 Maintain the decorum and dignity of the profession
 Not contain any testimonial or endorsement of
clinical skills.
 Not claim that one doctor is superior to others nor
contain endorsements for any particular doctor.
 Avoid aggressive forms of competitive persuasion,
such as those that prevail in commerce and industry.
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