Can Doctor Refuse To Treat Patient
Can a Doctor Deny Me Treatment? When, Why, and What are my Options? – Baizer Kolar Neiman P.C. Yes, a doctor can deny you medical treatment. Private doctors have some more leeway to deny treatment to patients than those in Medicare-compliant hospitals, but there are circumstances under which even doctors serving Medicare patients may choose not to serve a patient.
- 0.1 Can a doctor refuse to treat a patient in India?
- 1 What to do if GP won’t help?
- 2 Is it bad to ask for a referral?
- 3 Can you sue doctors in India?
- 3.1 Can doctors record patients without consent in India?
- 3.2 What happens if you have high blood pressure and don t treat it?
- 3.3 Do doctors keep conversations private?
- 3.4 Can a doctor miss something?
- 4 Why do I feel sick but doctors say nothing’s wrong?
- 5 How do I complain about my doctor UK?
- 6 What are the 4 pillars of medical ethics?
Can a doctor refuse to treat a patient UK?
If you can’t find a GP – When you try to register at a GP practice, the GP doesn’t have to accept you. If they refuse to accept you, they must have reasonable grounds and give you their reasons in writing. For example, they might not be accepting new patients.
Can a GP refuse to give a referral?
Your GP will only refer you to a specialist if they believe that specialist assessment or treatment is necessary. If they do not think it is, they do not have to refer you – either privately or on the NHS.
Can a doctor refuse to treat a patient in India?
Abstract – The element of consent is one of the critical issues in medical treatment. The patient has a legal right to autonomy and self determination enshrined within Article 21 of the Indian Constitution. He can refuse treatment except in an emergency situation where the doctor need not get consent for treatment.
Can you refuse to have your blood pressure taken?
Explainer Can doctors force patients to have rectal exams against their will? A construction worker from Brooklyn has filed suit against a hospital for subjecting him to a rectal exam against his wishes, According to his lawyer, the man begged, “Please don’t do that,” as he was held down, and he punched one of the doctors before being sedated and examined without consent.
The man allegedly developed post-traumatic stress disorder as a result of the experience.) Can doctors force a test or procedure on a patient? Not without a really, really good reason. A doctor can’t force anything on a patient who is competent to make medical decisions and refuses care. The idea of consent as a patient’s right goes back at least to 1914, when Benjamin Cardozo (who would later become a Supreme Court justice) ruled in a New York case that “very human being of adult years and sound mind has a right to determine what shall be done with his own body.” Without a patient’s permission, even a simple physical exam could technically be considered battery.
Taken to the extreme, this principle gives individuals the right to refuse life-saving treatment or to seek ” Do Not Resuscitate ” orders. Doctors rarely ask permission for routine matters like checking your blood pressure or listening to your lungs, though, on the grounds that they have your tacit consent.
They assume you’ve granted permission for a blood test when you cooperate by rolling up your sleeve for the needle. (This principle only applies to tests that can reasonably be expected in the course of an examination. A doctor can’t assume consent for an HIV test when a patient shows up with a cold.) For serious procedures like surgery, patients must consent in a formal way, usually with a signature.
So even if your appendix is about to burst, no one can stop you from saying “No, thanks,” and leaving the hospital. If you agree to have your appendix removed and doctors then discover a separate tumor during the operation, they might still need permission to do a biopsy—probably from a member of your family.
Doctors can act without a patient’s permission in some situations. If it’s an emergency, and neither a patient nor his family members are capable of making a decision on the spot, doctors might go ahead and presume consent. This could be because the patient is unconscious or because he or she lacks the mental capacity to make an informed decision (as determined by a mental-health professional).
When public health might be at risk, the government has some ability to override an individual’s wishes. Health officials can order that a person be tested for a communicable disease like tuberculosis, but cannot force treatment on anyone. However, as in the case of the honeymooner who crossed several international borders with drug-resistant tuberculosis, they can quarantine someone until the person is no longer a threat, which is a way of strongly urging treatment.
Can a doctor remove you from their list?
Removal of patients from GP lists – GP practices may apply to remove patients from their list if the relationship between patient and GP has broken down. Your GP will normally explain the problem to you and try to resolve it. They may ask to see you or may write to you.
If the problem can’t be resolved, the GP will normally advise you in writing that you may be removed from their list. Patients cannot be removed from a GP’s list because they’ve made a complaint. However, the basis of the complaint may mean that the relationship between patient and GP has already broken down.
If a patient has been violent or abusive, or has behaved in a threatening way towards their GP or a member of staff and the police have been involved, they may be removed from their GP’s list immediately without warning. Your GP’s practice leaflet may explain their policy for removing patients from their list.
What to do if GP won’t help?
What you can do if your symptoms are dismissed or ignored – All of these stories offer us valuable lessons. If you feel that your healthcare professional isn’t really listening or heeding your concerns, there are many steps you can take to get the answers you seek. Here are a few suggestions:
If your symptoms are ignored, ask, “What might this be?” And then ask, “What do I do if these symptoms get worse?” These type of questions help the doctor to stop and consider the options. Learning from Jennifer’s story, you might want to phrase it as, “What else might this be?” Just because you have one established condition, doesn’t mean that you can’t have a second issue that needs independent investigating. Try to find a medical practice you can trust. Healthcare professionals are under severe time constraints but that doesn’t mean they shouldn’t have time to hear their patients’ reasonable concerns and goals. If you feel that your doctor or nurse-practitioner is consistently ignoring what you have to say, even if your symptoms continue to progress, find another primary care practice. If you feel your primary care doctor doesn’t take your symptoms seriously, ask for a referral to a specialist or go to a different practice for a second opinion. A fresh set of eyes can be extremely helpful. Review how to present your symptoms factually, clearly, quickly, and without unnecessary minutiae. Sometimes symptoms aren’t ignored by the doctor, they’re just lost in a list that’s too long or includes what the clinician feels are irrelevant details. Ask them how to best present the information. Most importantly, put your symptoms into context, Learn about the types of screenings that should be performed routinely for patients of your age, gender, and race. Here is a link to a document that lists preventative screenings for adults by these criteria. Discuss it with your medical practice. If they refuse to do the relevant routine screenings, seek another medical practice that is more conscientious and aware of why different genders, ages, and races have different medical concerns. Speak up. Diana Cejas recognizes that her reluctance to share the depth of her concerns played a part in how long it took her to get diagnosed. However, she knows that many patients feel uncomfortable asserting themselves to doctors. Dr. Cejas says, “Be willing to fight for yourself and your body but don’t be willing to put on the boxing gloves” when you first walk in. Instead, she recommends you ask for help figuring out how to deal with your symptoms now and eventually find the cause of those symptoms. While it is important to learn about your symptoms from reliable sources, doing so doesn’t mean demanding specific tests or treatments for some rare disorder you haven’t been diagnosed with. Dr. Cejas recommends asking for help in dealing with your symptoms politely yet firmly.
The Society to Improve Diagnosis in Medicine (SIDM) catalyzes and leads change to improve diagnosis and eliminate harm from diagnostic error. We work in partnership with patients, their families, the healthcare community, and every interested stakeholder.
SIDM is the only organization focused solely on the problem of diagnostic error and improving the accuracy and timeliness of diagnosis. In 2015, SIDM established the Coalition to Improve Diagnosis, to increase awareness and actions that improve diagnosis. Members of the Coalition represent hundreds of thousands of healthcare providers and patients—and the leading health organizations and government agencies involved in patient care.
Together, we work to find solutions that enhance diagnostic safety and quality, reduce harm, and ultimately, ensure better health outcomes for patients. Visit our website at www.improvediagnosis.org, and follow us on Twitter or Facebook, Helene M. Epstein writes about patient safety and family health. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, Republish our Dx IQ articles for free, online or in print, under Creative Commons license. Please do not edit the piece. Ensure that you attribute the author and mention that the article was originally published by the Society to Improve Diagnosis in Medicine.
Why would a doctor not want to give a referral?
Perhaps it’s because your doctor thinks he/she adequately understands your symptoms and doesn’t believe there is cause for concern. Or, maybe you require a procedure he/she thinks can be sufficiently managed by your primary care practice.
Is it bad to ask for a referral?
Asking for referrals is a normal part of the job- or client-hunting process. You just have to know some things to avoid, and some best practices to follow. This guide will take you through everything you need to know about referrals and how to ask for one.
What is the difference between a GP and a specialist?
Quora “Dunno. That’s not my job.” Photo illustration by Juliana Jiménez. Photo by Shutterstock. This question originally appeared on Quora, the best answer to any question. Ask a question, get a great answer. Learn from experts and access insider knowledge. You can follow Quora on Twitter, Facebook, and Google Plus,
- Answer by Ben Howell, general practitioner, ex-R.N.: The easiest way to understand the differences between the various specialties in medicine is to identify the health questions they would answer with: “Dunno.
- That’s not my job.” Internal medicine and general practice are simply two of the many different types of medical colleges.
Other colleges include surgery, anesthetics, dermatology, intensive care, psychiatry, ophthalmology, public health, emergency medicine, radiology, pathology, obstetrics and gynecology, and pediatrics. Internal medicine specialists belong to the College of Physicians,
Physicians are the cardiologists, gastroenterologists, geriatricians, rheumatologists, etc. Physicians focus on the diagnosis and non-surgical treatment of a particular system of the body. They can even subspecialize and focus on a particular organ—for example, some gastroenterologists focus purely on the liver (hepatologists).
As you can imagine, the more you focus on a subspecialty, the deeper your knowledge in this area. If you approach a hepatologist and ask him about your liver, then you’ll have access to a greater wealth of information than if you asked that same question to a general practitioner.
However, the more someone focuses on a particular specialty, the more areas of medicine they ignore. If you ask a hepatologist about your eyes, he’ll respond with: “Dunno. That’s not my job.” There are still some general medicine physicians who dabble in a little bit of each internal medicine specialty.
However, there’s a still a big difference between these doctors and primary care doctors. Again, the difference is easiest to spot by focusing on what questions they won’t answer. These physicians don’t see kids—that’s the job of pediatricians. They don’t operate—that’s the job of surgeons.
- They don’t care for your mental health.
- They don’t look after your pregnancy.
- They won’t freeze or excise your skin cancers.
- There’s lots of things that these physicians don’t do.
- General practitioners, more so than any other specialty, do a little bit of everything.
- They see adults and kids.
- They look at rashes and broken bones.
They answer questions about your heart, lungs, skin, eyes, and mental health. They’ll help you through your pregnancy. They even perform some simple office-based “operations.” If you approach a general practitioner with a basic question about any area of your health, he’s much less likely to say, “Dunno.
That’s not my job.” However, this breadth of knowledge does come at a cost. General practitioners won’t have the same depth of knowledge as a specialist in that area. If you have a medical question that is complex or detailed, then a general practitioner is going to be stumped for an answer well before the relevant specialist.
Therefore, when a general practitioner is presented with a problem that is not basic, he will respond with, “Dunno. That’s not my job,” and refer you to a specialist who has the required depth of knowledge. There’s two ways to look at general practitioners.
You could look at their breadth of knowledge, whistle with awe, and think “Wow! Here’s a doctor who can sort out all of my basic medical problems.” Alternatively, you could look at the limitations of their knowledge and think, “I’m not going to see a family doctor. I’m going to see one of every type of specialist for each of my health problems.” Some people actually do this—usually people with more dollars than sense.
However, there’s a few problems with this philosophy. Firstly, it’s costly. Not just to you, but, also to the health budget of your country. Governments usually contribute more to the cost of a specialist appointments than they do to the cost of family doctor visits.
- If people decide to use one of every type of specialist for general checkups, then it will consume a much larger chunk of the health care budget than if they do the same checkup with a general practitioner.
- This is the reason a lot of countries require a referral from the general practitioner before you can see a specialist.
The referral is basically an agreement from the general practitioner that you have a problem that he cannot sort out by himself and, therefore, the extra expense to the health care budget is warranted. Secondly, it’s unnecessary. There’s a saying in medicine: “Common problems are common.” It’s typically a mantra told to medical students to protect against ” zebras ” but it applies here as well.
Your health problems are more likely to be common problems than rare ones. Primary care doctors are very good at handling common problems—they see and treat them all the time. There is simply no need to rush off to specialists for common problems. When you do have a complex or difficult health problem, then your primary care doctor will refer you to the appropriate specialist.
Thirdly, it’s risking that you’ll miss out on the importance of holistic care. The advantage that general practitioners have over specialists is that we see you for lots of different health complaints and get to know you. This is an underrated and massively powerful tool in medicine.
- If you suffer with a problem and choose to visit lots of specialists to have it investigated, then all but one will give you the answer, “Dunno.
- That’s not my job.” For example, if you have chest pain, then your cardiologist will perform some tests and tell you, “The pain is not coming from your heart.” Your gastroenterologist will put a camera into your stomach and tell you, “The pain is not ulcers or reflux.” Your respiratory doctor will scan your lungs and reassure you, “It’s not lung cancer.” A rheumatologist will run a battery of tests and advise, “It’s not an autoimmune disease or originating from your spine.” However, your regular family doctor, who has known you for most of your life, may not need any test results to be able to tell you, “The chest pain is your anxiety.” General practitioners have a breadth of knowledge about common medical problems—the ones that you are most likely to suffer from.
More importantly, they’re the type of doctor who is most likely to know you. Specialists are incredibly important, and primary care doctors will refer to them when your health complaints drift beyond their level of expertise, but it’s important to appreciate there are pros and cons of every type of specialty.
Internal medicine : Why do doctors become internists / general practitioners rather than specialists? Medicine and health care : Why are pharmacists so important when a doctor can do their job? Family medicine : Are the financial difficulties of physicians who practice Family Medicine overstated?
Can you sue doctors in India?
Medical Negligence In India: Laws And Remedy Next to creating a life, the finest thing a man can do is save one,- Abraham Lincoln It is an undeniable fact that medical profession is a noble profession as it deals with human life which is given the highest importance among anything present on earth.
It is the utmost responsibility of the medical practitioner to ensure their patients safety while treating them. However it should also be noted that To Err Is Human it is natural for human beings to make mistakes and doctors are no exception to it. Not every time but in some crucial circumstances there is a possibility of making mistake.
It is important for doctors to perform their duty with expertise skill and caution when there is failure in performing the duty it amounts to medical negligence. It is not good for them to handle their patients without proper technical training and specialization.
In the recent times the cases on medical negligence is being increased, whatever may be the reason but the ultimate sufferers are the innocent public who consult doctors with a firm belief of finding a cure to their health problems and it was found important to establish laws on medical negligence to provide with a relief to claim damages occurred to the patient and also punishments for the professionals negligent behaviour.
This article provides with the detailed explanation on the legal resource or legal remedies that is available against medical negligence. Various laws available under which the affected patient or the party related to the affected patient are as follows:
- Consumer Protection Act 1986
- Criminal law
- Other Laws
To whom it is Applicable? Persons to whom the above acts applicable are:
- To all the Medical Practitioners
- All private or trust hospitals, nursing homes and polyclinics
- The Government hospitals and doctors
- All laboratories, blood banks and x-ray clinics
- The nurses and paramedical staff
- Medical stores
- Pharmaceutical company
- Quacks jointly and severally.
- The aggrieved patient
- Legal heirs or legal Representative.
- State and Central government
There are some errors that are more frequently reported than others. The five most common examples of medical negligence cases are:
- The most common example of medical negligence is misdiagnosis or delayed diagnosis or failure to diagnose. Perhaps due to a loss of focus, incompetence, or unavailability of the right tools, some medical practitioners diagnose their patients wrongly, thereby hindering them from getting the right treatment they need for their condition. Failing to diagnose a patient correctly can prolong an ailment, cost the patient more money, and even cause a permanent injury to the person.
- Prescribing incorrect medication is one of the common cases of medical negligence reported. This may happen when a doctor write an incorrect dosage for a patient or prescribing of wrong drug for the patient’s illness or receives the medication of another patient.
- Anesthesiologists Not only do they provide pain relief for the patients, they also have control over the patient’s life functions, including breathing, body temperature, blood pressure, and heart rate. Anesthesiologists are responsible for the safe delivery of anesthesia to the patients. They are responsible for pre-operative evaluation, consulting with the surgical staff and post-operative management of the patients. Anesthesia mistakes happen with major operations as well as with common elective procedures. An anesthesia error can cause severe permanent brain damage or death to a patient. Anesthesia errors happen every day in hospitals, doctor’s offices, and surgical centres. Anesthetists and Anesthesiologists play a vital role in surgeries.
- Negligence during surgery is the most common case of medical negligence. Surgical errors may occur due to various reasons it includes improper preparation, Lack of skills, Taking shortcuts during surgery to save time or resources. Communication failures may include surgical staff not communicating properly with one another, mistakes such as the doctor marking the wrong site for the surgery, and miscommunication about medication dosage that the patient should have after surgery, performing the incorrect procedure, performing unnecessary surgery. Damaging other organs, nerves, or tissues during surgery, Leaving medical equipment and foreign objects inside the patient, providing inadequate post-operative care, including failing to recognize and treat the symptoms of surgical complications. Reasons may differ but the outcome does not provide any good to the patient.
- A consumer is a buyer who buys a good for consumption not having an idea of resale it also includes consumption of services. The consumer protection act was introduced in the year 1986 for public benefit, provide speedy remedy to the public, to recognise their rights, providing low cost remedy, to get compensation without any complicated proceedings.
- When it comes to medical negligence it was decided in a land mark judgement In the case Indian Medical Association vs.V.P. Santha-III (1995) CPJ 1(SC), service provided by almost every doctor is covered under this act. After this judgement an aggrieved person can claim damages for medical negligence against a doctor or a hospital.
- The remedy under this act is an alternative in addition to that already available to the aggrieved person by way of a civil suit. In the complaint/appeal/petition submitted under the act, a consumer is required to pay a nominal fee.
- The consumer forum consist of a 3-Tire structure of the National and state commission and district forums
Any aggrieved party shall claim for damages through the consumer forums
- It is established in each district of the state. There are three members, a district judge is the president of the forum and with other two members. The District forum can entertain claim up to 20 Lakhs. Appeal can be made to the State commission against the order of district forum.
- It is established in each state. There are three members, a High Court judge is the president of the forum and with other two members. The State commission can entertain claim from 20 Lakhs to 100 lakhs. Appeal can be made to the National commission against the order of State Commission.
- It is established in Delhi. There are five members, a Supreme Court judge is the president of the forum and with other four members. The National Commission can entertain claim more than 100 Lakhs. Appeal can be made to the Supreme Court against the order of National Commission. The time limit to file an Appeal is 30 days from the date of the order and it is not the date of pronouncement but the date on which the certified copy of the order was available.
- The Aggrieved patient or a Registered Consumer Organisation or the state or Central government, the legal heirs or representatives of the aggrieved patients can sue a doctor for medical negligence under the consumer protection act.
- Section 2(c) of the act provides that a complaint can be given for unfair trade practice or restrictive trade practice. In case of medical negligence wrong representation about qualification or facilities available may be called unfair trade practice.
- The time limit to file a complaint for medical negligence is 2years under the consumer protection act 1986 from the Date of injury.
Under Criminal law when it is proved that the negligent act is performed with Mens Rea (guilty mind) he shall be punished under the criminal law now because of Code of Criminal Procedure (C.C.P.) amendment – 1973, patient may get compensation too. The intention to behave in such negligent way shall be proved to make a doctor liable under criminal law.
- Many a complainant prefers recourse to criminal process as a tool for pressurizing the medical professional for extracting uncalled for or unjust compensation. Such malicious proceedings have to be guarded against.
- A private complaint may not be entertained unless the complainant has produced prima facie evidence before the Court in the form of a credible opinion given by another competent doctor to support the charge of rashness or negligence on the part of the accused doctor.
- The Investigating Officer, before proceeding against the doctor should obtain an independent and competent medical opinion preferably from a Doctor in Govt. service.
- A doctor may not be arrested in routine, unless his arrest is necessary for furthering the investigation or for collecting evidence or the Doctor would not make himself available to face prosecution unless arrested.
- Section 312 to 316(Causing Miscarriage), Section 319 to 322(Causing grievous hurt), Section 336 to 339(Act of endangering life or personal safety of others), Section 345(wrongful confinement) of the Indian Penal Code directly and indirectly deals with Criminal medical negligence.
- Any person incurred damages due to the act any doctor’s negligence can file a complaint with the respective council. However the council has the power to punish the doctor and cancel their registration for their negligent behaviour but does not have the power to provide compensation for the victim of such misconduct. Since last few years the Indian Medical Council has started taking harsh steps for improvement in standard of medical practice and medical ethics.
- Before the introduction of the consumer protection act the claims on medical negligence is claimed under the Contract law even in the present damages can be claimed under civil law but after the introduction of the consumer protection act the civil law remedy is given less importance. There is a specific contact between the doctor and the patient either be oral, written or implied terms agreed upon by the patient or his representatives and the doctor or hospital. Consent for treatment on payment of fees on the part of a patient can be treated as an implied contract with the doctor, who by undertaking treatment on acceptance of fees, promises to exercise proper care and skill. Breach of contract When a contract has been broken, if a sum is named in the contract as the amount to be paid in case of such breach, or if the contract contains any other stipulation by way of penalty, the party complaining of the breach is entitled, whether or not actual damage or loss is proved to have been caused thereby, to receive from the party who has broken the contract reasonable compensation.
- Indian Medical Association vs.V.P. Santha III (1995) CPJ 1(SC) As a result of this judgment, medical profession has been brought under the Section 2(1) (o) of CPA, 1986 and also, it has included the following categories of doctors/hospitals under this Section.
- All medical / dental practitioners doing independent medical / dental practice unless rendering only free service.
- Private hospitals charging all patients.
- All hospitals having free as well as paying patients and all the paying and free category patients receiving treatment in such hospitals.
- Medical / dental practitioners and hospitals paid by an insurance firm for the treatment of a client or an employment for that of an employee.
- It exempts only those hospitals and the medical / dental practitioners of such hospitals which offer free service to all patients.
- Further, this judgment concedes that the summary procedure prescribed by the CPA would suit only glaring cases of negligence and in complaints involving complicated issues requiring recording of the evidence of experts, the complainant can be asked to approach the civil courts.
- Also, this judgment says that the deficiency in service means only negligence in a medical negligence case and it would be determined under CPA by applying the same test as is applied in an action for damages for negligence in a civil court.
- As a result of this judgment, virtually all private and government hospitals and the doctors employed by them and the independent medical / dental practitioners except primary health centres, birth control measures, anti-malaria drive and other such welfare activities can be sued under the CPA.
- Fortis Escorts Hospital v Smt. Meenu Jain. FA: 747/12 – 14/5/13 Raj.
- Patient was forced to purchase injections from the hospital itself at Rs.18,990/-, which was available at 30% to 40% discount in the market.
- The contended that no money in excess to the maximum retail price was charged – hospital does not allow the patients to purchase medicines from outside in order to ensure the quality and genuineness of the medicines and for the welfare of the patients signed general consent form.
- It was held that in a critical condition, was not supposed to go through the terms and conditions of the admission and signatures in a routine manner. Hospital was in a dominating position over patient adverse inference of undue influence can very well be drawn against the hospital.
- Hospital authorities indirectly imposed unjustified and unreasonable conditions by way of compelling them to purchase the injections from the hospital. Amounted to restrictive trade practice and unfair trade practice.
- Also entitled to get from the hospital the information as to what was the price of the drugs or injections and what was their batch number and expiry date which were not furnished. direct the hospital not to repeat such unfair trade practice in future as it is within jurisdiction under u/s 14 (1) (f) of CPA.
- Heirs of A. Shah v Bombay Hosp.1992 (II) CPR 154.
- The complainant approached Medical Councils but they replied that they had no statutory power and authority to look into such case.
- It was observed that: we find that despite the frantic efforts on the part of the complainant to approach the different authorities, no cognizance of the complaint was taken by any medical organization, we are deeply grieved to note the inaction on the part of these highest professional bodies meant for the observance of the professional conduct of the practicing doctors and the hospitals.
- State of Haryana v Smt. Santra. I (2000) CPJ 53 (SC)
- Negligence has many manifestations – it may be active negligence, collateral negligence, comparative negligence, concurrent negligence, continued negligence, criminal negligence, gross negligence, hazardous negligence, active and passive negligence, will full or reckless negligence or negligence per se.
- It is defined in Black’s Law Dictionary as under: Negligence per se: Conduct, whether of action or omission, which may be declared and treated as negligence without any argument or proof as to the particular surrounding circumstances, either because it is in violation of a statute or valid Municipal ordinance, or because it is so palpably opposed to the dictates of common prudence that it can be said without hesitation or doubt that no careful person would have been guilty of it. As a general rule, the violation of a public duty, enjoined by law for the protection of person or property, so constitutes.
- It was also observed that where a person is guilty of negligence per se, no further proof is needed.
- Dr.Laxman Joshi v Dr.Godbole. AIR (1989) SC 128.
- A 20 yr. old boy had accidental fracture femur – doctor performed reduction without anesthesia, alleged excessive force caused shock and death – doctor contended that Inj. Morphine was given and death was due to Cerebral Embolism.
- The Trial Court held the doctor liable and observed that excessive force without anesthesia resulted in embolism or shock was the proximate cause of death.
- The High Court upheld and observed that doctor’s case that the boy died of cerebral embolism was merely a cloak used for supressing the real cause of death viz. shock.
- The Supreme Court Observed: The duties which a doctor owes to his patient are clear. A person holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for that purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case.
- A duty of care in deciding what treatment to give or a duty of care in administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest not a very low degree of care and competence judged in the light of the particular circumstances of each case is what law requires.
- Sukaroo Kobiraj. (1887) 14 Cal 566. Cut piles with ordinary knife lead to bleeding and the patient died
- Jugankhan. AIR 1965 SC 831. Homeopath, administered herbals, without studying its effect, death due to poisoning.
- De Souza. (1920) 42 All 272. Compounder without reading label of bottle prepared fever mixture (contained strychnine instead quinine) seven people died.
- State of MP v Jagdish Baloi.1992 Cr. LJ 746 MP. High speed car knocked down pedestrian walking on left side of road cause death car break down the Fencing stuck in ditch Res applied.
Place For Thought The concept of Bolam test arrived from the case Bolam Vs Friern Hospital Management Committee, Medical negligence cases are briefly decided under the basis of Bolam Test. The bolam test talks about the exercise of ordinary skill of an ordinary competent man exercising that particular art.
- A patient, suffering from depression was admitted to a mental hospital advised ECT but doctor did not warn about slight risk of bone fracture involved in accordance with normal practice the doctor did not administer relaxant or apply any form of manual restraint patient suffered bilateral fracture of acetabula.
- Complaint Alleged that the Doctor 1. Failed to administer, a suitable relaxant 2. Failing to warn the patient of the risk involved in ECT 3. Failing to provide sufficient manual control.
- Experts witnessed both the sides. The defendant witness provides that witness testified that there was a large body of competent medical opinion opposed to use relaxant,the more restraint there was more like hood there was of a fracture – it was not desirable to warn, unless asked.
- It was observed that: a man need not possess the highest expert skill, it is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.
- A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by reasonable body of medical men skilled in that particular art.
- A doctor is not negligent if he is acting in accordance with such a practice merely because there is a body of opinion that takes a contrary view.
- If proper practice requires some warning to be given, the second question is, if a warning had been given, would it have made any difference.
From the above case it can be noted that:
- The case made a Ruling that a doctor accused of medical negligence needed only to find an expert who would testify to having done the same thing.
- This test expects standards which must be in accordance with a responsible body of opinion, even if others differ in opinion. In other words, the Bolam test states that If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent.
- This test however subject to criticisms has it is overly relying on medical profession.
- Even though Bolam test is applied the doctor should not forget that when a patient is fully in a judgement of believing the words of the doctor and his ability he should carefully perform his duty with full care and skill.
- New standards on the application of the Bolam test shall be framed.
Medical Negligence (Truth Revealed): Medical & Law: Dr. Mahendra Joshi.
Can I file case against a doctor in India?
Negligence is simply the failure to exercise due care. It occurs when a doctor fails to perform to the standards of his or her profession. The three ingredients of negligence are as follows: 1. The defendant owes a duty of care to the plaintiff.2. The defendant has breached this duty of care.3.
- The plaintiff has suffered an injury due to this breach.
- A medical malpractice is a claim of negligence committed by a professional health care provider – such as a doctor, nurse, dentist, technician, hospital or hospital worker – whose treatment of a patient departs from a standard of care met by those with similar training and experience, resulting in harm to a patient or patients.
Yes in 1995, the Supreme Court brought the medical profession under the Consumer Protection Act 1986 and medical treatments were labeled as ?services?. In general, there are no guarantees of medical results, and unexpected or unsuccessful results do not necessarily mean negligence has occurred.
- To succeed in a medical negligence case, a consumer has to show an injury or damages that resulted from the doctor’s deviation from the standard of care applicable to the procedure. No.
- The Doctor cannot guarantee the complete success of any medical treatment as the same would differ in case to case, depending on the age and health of the patient, the stage of the Ailment and the body response of the patient,
Informed Consent from the patient is required in serious ailments and surgical treatment. In case the patient is unable to give consent, the same needs to be taken from the immediate family or attendant. However, medical treatment cannot be delayed in case there is no one available to sign the consent and the patient is unable to sign the same due to medical conditions.
You may first send written complaint to the Medical Superintendent (M.S) of the concerned Hospital with copy to Chief Medical Officer (CMO)/ Civil Surgeon of your area. If there is no reply or if you are not satisfied with the reply of the concerned official, then you should send a written complaint to the State Medical Council (SMC).
In case if you are not satisfied with reply of SMC then you can send your complaint to the Medical Council of India. MCI. If there is criminal type complaint then the affected consumer can file a complaint with the local Police Station. However, expert opinion will be required to register any police complaint.
You can also file a complaint with the Consumer Forum/ Commission, Civil Court and Criminal Court as the case may be, for seeking damages arising out of medical Negligence. You may approach the Consumer foras by filing a complaint bringing out facts from your first visit to the doctor till your last contact with him or her.
A second opinion from a Medical expert supporting the claim of negligence, along with the medical records will strengthen the claim. ? The patient?s rights as a consumer are as follows: ? Patients have the right to be told about their illness; to have their medical records explained.
- Patients should be explained about whatever treatment/medicines are prescribed to them.
- They should be made aware of the risks and side effects, if any.
- They have the right to ask questions and clarify their doubts about the treatment.
- Patients have the right to know a doctor?s qualifications.
- Patients have the right to be handled with consideration and due regard for their modesty when being physically examined by the doctor.
? Patients have the right to maintain confidentiality regarding their illness and can expect the same from the doctors. ? Patients have the right to a second opinion if they are doubtful about the medicines or treatment suggested. ? Patients have the right to know what a suggested operation/surgery is for and the possible risks involved.
If he/she is unconscious or unable to make the decision due to other reasons, informed consent needs to be taken from their nearest relatives. ? Patients have the right to get their medical records / case papers on request from the doctor /hospital. ? If the patient needs to be moved to another hospital, he / she has the right to know the reason for it and also has the right to make his or her own choice in consultation with the doctor.
? Patients have the right to get details of the bills they have paid for.
Can doctors record patients without consent in India?
Dr. MC Gupta answers, – 1—As a general legal principle, secretly recording somebody’s activities amounts to intrusion of his privacy. Privacy has been recognised by the Supreme Court of India as a fundamental right under the enlarged interpretation of Article 21 of the Constitution of India.
- On the 24th of August, a nine-judge bench of the Supreme Court delivered its verdict* in Justice K.S.Puttaswamy(Retd),
- Vs Union Of India And Ors., unanimously affirmed that the right to privacy is a fundamental right under the Indian Constitution.2—According to Dartmouth Institute for Health Policy & Clinical Practice, USA, i)-If you are doctor, there is a good chance that at least one of your last 10 patients recorded their visit – either with or without permission.
ii)-There may be two situations—when both parties consent or only one party’s consent is there. In ‘all-party’ jurisdictions, covert recordings, on the part of doctors or patients, are illegal as everyone being recorded must consent. In ‘one-party’ jurisdictions, the consent of any one party in the conversation is sufficient, so a patient can record a clinical encounter without the doctor or health care provider’s consent.
- Currently 39 of the 50 states and Washington, D.C., conform to the ‘one-party’ consent rule, while the remaining 11 are ‘all-party’ states.
- Iii)- Lability insurers are happy with recording patient-physician meetings.
- At the Barrow Neurological Institute in Phoenix, Arizona – one of the few health care organizations in the country to offer patients recordings of office visits – doctors who take part receive a 10 percent reduction in the cost of their medical defense, and $1 million extra liability coverage.
iv)-“Most people are sharing their recordings with a family member or caregiver, or they are listening to recording themselves, so they can better recall the information they received during the encounter. In fact, in a review of 33 studies of patient use of audio-recorded clinical visits, the Open Recordings researchers found that 71 percent of patients listened to their recordings, while 68 percent shared them with a caregiver.
- The studies also reported greater understanding and satisfaction in patients who receive recordings.
- V)-Health care overall is moving toward greater transparency and patient recordings are going to become more common**.3—As reported in a recent issue in JAMA ***, “For many clinicians, it is possible that some of their patients are recording their office visit, with or without permission.
In a cross-sectional survey administered to the general public in the United Kingdom, 19 of 128 respondents (15%) indicated that they had secretly recorded a clinic visit, and 14 of 128 respondents (11%) were aware of someone covertly recording a clinic visit.
- I)-Because every smartphone can record conversations, this may become even more commonplace.
- The motivation is often reasonable: patients want a recording to listen to again, improve their recall and understanding of medical information, and share the information with family members.
- Ii)-A review identified 33 studies (including 18 randomized trials) of patient use of audio-recorded clinic-visit information.
Audio recordings were highly valued; across the studies, 72% of patients listened to their recordings, 68% shared them with a caregiver, and individuals receiving recordings reported greater understanding and recall of medical information.” 4—Audio or video recording of consultation, if done with prior information / consent, is not wrong, unethical, or punishable.
- Such recording helps in transparency.
- It should be recommended rather than condemned.
- Source: *https://indiankanoon.org/doc/91938676/ **https://www.sciencedaily.com/releases/2017/07/170710135301.htm ***Elwyn G, Barr PJ, Castaldo M.
- Can Patients Make Recordings of Medical Encounters? What Does the Law Say? JAMA.2017;318(6):513–514.
doi :10.1001/jama.2017.7511 Disclaimer- The views and opinions expressed in this article are those of the author’s and do not necessarily reflect the official policy or position of M3 India. Content from the writer has been directly replicated on the website.
No edits have been made. The writer, Dr. MC Gupta is a practising lawyer specialising in medical negligence cases. He also has an MD Medicine from AIIMS, Delhi where he also worked as a faculty member for 18 years, later working another 10 years as a Professor and Dean at National Institute of Health and Family Welfare, New Delhi, before pursuing law.
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Why do doctors always take blood pressure?
Tracking your trends over time – By tracking your weight and blood pressure over time, your provider can see what is normal for you and what may be a red flag in your health. Over time, your weight and blood pressure provide valuable information. These key indicators help to tell:
- If you’re responding well to treatment
- If you’re being compliant with your recommended diet and exercise
- If your health is improving or declining
- If you’re at risk for diseases, such as cardiovascular disease, diabetes, kidney disease, obesity or stroke
This is especially important if you are at risk for cardiovascular disease or have been diagnosed with any chronic diseases. Two key risk factors for cardiovascular disease are high blood pressure and obesity. If your weight goes up, your blood pressure level may go up as well.
What happens if you have high blood pressure and don t treat it?
High blood pressure threatens your health and quality of life – In most cases, damage done from high blood pressure (HBP or hypertension) occurs over time. Left undetected or uncontrolled, high blood pressure can lead to:
Heart attack — High blood pressure damages arteries that can become blocked and prevent blood flow to the heart muscle. Stroke — High blood pressure can cause blood vessels that supply blood and oxygen to the brain to become blocked or burst. Heart failure — The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body. Kidney disease or failure — High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively. Vision loss — High blood pressure can strain or damage blood vessels in the eyes. Sexual dysfunction — High blood pressure can lead to erectile dysfunction in men and may contribute to lower libido in women. Angina — Over time, high blood pressure can lead to heart disease including microvascular disease (MVD), Angina, or chest pain, is a common symptom. Peripheral artery disease (PAD) — Atherosclerosis caused by high blood pressure can lead to narrowed arteries in the legs, arms, stomach and head, causing pain or fatigue.
Download the consequences of HBP infographic: English (PDF) | Spanish (PDF) | Traditional Chinese (PDF)
What happens if you ignore high BP?
The U.S. Centers for Disease Control and Prevention estimates that about one out of every three American adults have high blood pressure, or hypertension. Because high blood pressure is so common, it might be tempting to assume that it’s no big deal. But the truth is, that when left untreated, high blood pressure can put you at risk for potentially life-threatening complications.
- It raises your risk of heart attack and stroke, High blood pressure damages the walls of your arteries. This makes them more likely to develop deposits of plaque that harden, narrow or block your arteries. These deposits also can lead to blood clots. Blood clots can flow through your bloodstream and block blood flow to your heart or brain, resulting in a heart attack or stroke.
- It makes you more likely to develop heart failure, When your arteries are hardened or narrowed, your heart has to work harder to circulate your blood. This increased workload can cause your heart to become larger and fail to supply your organs with blood.
- You may experience chest pain, Chest pain, also called angina, occurs when the heart does not get the blood it needs. When people with high blood pressure perform activities such as walking uphill, going up steps, or exercising, angina can cause pressure, squeezing, pain, or a feeling of fullness in the chest.
- It can cause kidney damage. Your kidneys help your body get rid of toxins and regulate many of your body’s complex functions. High blood pressure can cause damage to the arteries around your kidneys. This can reduce their ability to do their job and, at worst, lead to kidney failure.
- You are more likely to develop vision problems. Your eyes are full of small blood vessels that can easily be strained or damaged by high blood pressure. It also can cause swelling of your optic nerve. Lowering your blood pressure sometimes can reverse vision problems. But high blood pressure left untreated can cause permanent vision loss or impairment.
- You could develop sexual dysfunction. High blood pressure can cause low libido in women and erectile dysfunction in men.
- It raises your risk for peripheral artery disease (PAD). PAD occurs when the arteries in your legs, arms, stomach, or head become narrowed and cause pain, cramping, and fatigue. If you have PAD, you also are at an increased risk of heart attack and stroke.
- You have a higher risk of hypertensive crisis. A hypertensive crisis is a medical emergency that causes your blood pressure to rise above 180/120 rapidly. If your blood pressure gets too high, it can cause damage to your organs and other potentially life-threatening complications. Symptoms of a hypertensive crisis include:
- Blurry vision or other vision problems
- Severe headaches
- Shortness of breath
- Chest discomfort or pain
- A feeling of anxiety or that something is not right
If you have any of these symptoms, call 911 or visit the nearest hospital emergency department right away.
Do doctors keep conversations private?
This post will go over some basic legal concepts that you need to know about doctor-patient confidentiality. Confidentiality between patients and physicians is a fundamental tenet of modern healthcare and medical practice. Knowing that your doctor will keep your personal information confidential is absolutely necessary for effective medical evaluation, diagnosis, and treatment.
Patients would not feel free to disclose certain things to their doctors without this safeguard. Most people are generally aware of the concept of doctor-patient confidentiality law. We sort of just expect our doctors to keep our personal information confidential, and we understand that some ethical rules require them to do that.
But few people are very familiar with the legal underpinnings of doctor-patient confidentiality. Confidentiality is more than just an ethical ideal that physicians are supposed to adhere to for their patients. Patients have an affirmative legal right to confidentiality.
Can my GP remove me?
The removal of a patient from a GP practice list should be a rare event. Reasons include:
- disagreement between the practice and patient, and an irretrievable breakdown of the relationship
- the patient has died
- the patient has moved outside the practice area
- patients have a right to change their practice.
Read our guidance on the special allocation scheme for the removal of violent patients.
Can a doctor miss something?
Just because a doctor missed a diagnosis does not necessarily mean that the patient suffered any injury. If the missed diagnosis did not result in any aggravation of the condition, unnecessary medical expenses, or other losses, it may be simply annoying, but not worthy of a legal battle.
Why do I feel sick but doctors say nothing’s wrong?
A hypochondriac is someone who lives with the fear that they have a serious, but undiagnosed medical condition, even though diagnostic tests show there is nothing wrong with them. Hypochondriacs experience extreme anxiety from the bodily responses most people take for granted.
How do I tell my doctor I have anxiety?
Path to improved health – Sometimes it can be hard to start a conversation with your doctor about your mental health. Here are some tips that can help you before, during, and after your appointment. Before your appointment:
Set reasonable goals for the appointment. Diagnosing and treating mental illness takes time. If you set a goal of having your symptoms go away immediately, you will likely be disappointed. Instead, set a few reasonable goals. These could include explaining your symptoms to your doctor, learning a possible diagnosis, and coming up with a treatment plan. Write down important information. Take some time before your appointment to write down what you’d like to talk about. This will help you make sure you don’t forget anything when you’re in the doctor’s office. Some things you can write down include:
Your symptoms. These could be physical, mental, emotional, or behavioral changes that you’ve noticed in your life. How your mood affects your everyday life Key personal information, such as traumatic events in your past, or current stressful situations you are facing. Your medical information, such as other physical or mental conditions you currently have. Also write down all medicines you are taking, including over-the-counter medicine and herbal supplements. Questions you want to ask your doctor
You can use this Start the Conversation Checklist as a starting point. Just print it off, fill it out before your appointment, and take it with you. You can give it to your doctor to read or use it as a reference when you’re talking about your symptoms. During your appointment:
State your concerns plainly. It’s important to tell your doctor all of your symptoms. But before you get into that, tell them what you think may be wrong. Use clear statements such as “I think I may be depressed” or “I am having trouble with anxiety.” This will help guide them and let them know what direction to go in. Be as open and honest with your doctor as possible. They can’t help you if they don’t know everything that is going on. It can be hard to open up about your feelings, especially with someone you don’t know very well. But your doctor is trained to deal with sensitive issues. They will be supportive and professional, and you won’t tell them anything they haven’t heard before. Refer to your notes. It’s common to forget half of what you were going to say once you get in the doctor’s office. That’s why it’s important to write things down beforehand. If you use the notes you’ve prepared ahead of time, you won’t have to worry about forgetting important details. Understand the diagnosis process. There is no simple blood test or scan that can tell you if you have depression, anxiety, bipolar disorder, or another mental illness. Sometimes it can be challenging for your doctor to be able to name the specific condition you have. Plus, you may have a combination of conditions that are causing your symptoms. For example, depression and anxiety often occur together. Bipolar disorder shares some symptoms with depression. And depressive illnesses often occur with physical conditions such as heart disease, diabetes, or cancer. Your doctor may ask you questions that seem unrelated to mental illness. This is all in an effort to make sure they get the diagnosis right. Bring someone with you. If you need support, invite a friend or family member to go to your appointment with you. They can help you understand and remember what the doctor tells you. They also may be able to tell the doctor about the changes they’ve noticed in you.
After your appointment
Follow through with treatment. After you’ve shared your concerns and your doctor has given their diagnosis, together you will come up with a treatment plan. This may include talk therapy, medicine, lifestyle changes, or a referral to a specialist. It is your job to follow through with the treatment. Schedule appointments with a specialist or a therapist. Get your prescription filled and take the medicine as directed. Give the lifestyle changes a try, even if you don’t feel like it. Follow up with your doctor. Your doctor will want to see you again in a few weeks to see if the treatment is working. It is important that you schedule a follow-up visit and go to the appointment, whether you are feeling better or not. If you aren’t feeling better, your doctor may have other ideas on ways to treat you. This could include changing your medicine, adding another medicine, or recommending other courses of action. You also should contact your doctor immediately if you have worsening symptoms or any negative effects from your treatment. Be patient. It is important that you are patient with yourself and with your doctor through this process. You might have to try different medicines or a combination of medicines. You might need talk therapy and a mix of self-care strategies. It can take time to find the right treatment plan for you. Just don’t give up. You will feel better as long as you keep trying to find a solution.
What do I do if the NHS is refusing to treat me?
Can I choose which mental health service I see? – You have the legal right to choose which provider and team you are referred to by your GP for your first appointment. There are times when you do not have a legal right to choose. These times include when:
you need urgent or emergency treatment, you already receive care and treatment for the condition you’re being referred for, the organisation or clinical team does not provide clinically appropriate care for your condition, you’re a prisoner, on temporary release from prison, you’re detained in a secure hospital setting, you’re detained under the Mental Health Act.
If you are not offered a choice you should speak to your GP. If you still feel that you are not being offered a choice, you can make a complaint to the Clinical Commissioning Group (CCG). You can also raise your concerns with NHS Improvement. NHS Improvement can provide advice about choice issues and may be able to resolve your issue.
How do I complain about my doctor UK?
Call 0345 015 4033 or visit www.ombudsman.org.uk for more information. If you have had a final response from either the practice or NHS England, and you feel like your issue still hasn’t been resolved, you can ask the Parliamentary and Health Service Ombudsman to look into your complaint.
What are the 4 pillars of medical ethics?
Ethical Guidance for Doctors While pondering what it means to be a good or immoral person, a philosopher may conclude there are not always right or wrong answers to questions of ethics., nonetheless, there are well-established ethical frameworks which must be followed to ensure patient safety and maintain trust in the medical profession.
- This article will provide you with a brief overview of the medical code of ethics and NHS ethics guidelines.
- The 4 Pillars of Medical Ethics Respect for autonomy, beneficence, non-maleficence, and justice – referred to as the four pillars of medical ethics – are likely the first ethical principles you may have come across before or during your medical education.
This is for good reason; these principles form the basis of clinical judgement and decision-making when confronted with moral problems in the medical field. Nevertheless, whilst they offer a common moral code relevant to ethical issues in a healthcare setting, they do not provide specific rules or guidelines which doctors can refer to.
- Good Medical Practice
- This is the overarching ethical guidance for doctors in the UK, outlining core ethical values and attributes. It is split into four domains:
- 1) Knowledge, skills, and behaviours
- 2) Safety and quality
- 3) Communication, partnership, and teamwork
- 4) Maintain trust
It is important all licensed doctors are well-versed in what Good Medical Practice entails for their medical care. This document also sets out what standards patients, colleagues and managers should expect of doctors. Furthermore, Good Medical Practice forms the foundation of and should always be referred to when thinking about your annual appraisals and revalidation.
- Use the minimum necessary personal information. Use anonymised information if it is practicable to do so and if it will serve the purpose.
- Manage and protect information. Make sure any personal information you hold or control is effectively protected at all times against improper access, disclosure or loss.
- Be aware of your responsibilities. Develop and maintain an understanding of information governance that is appropriate to your role.
- Comply with the law. Be satisfied that you are handling personal information lawfully.
- Share relevant information for direct care in line with the principles in this guidance unless the patient has objected.
- Ask for explicit consent to disclose identifiable information about patients for purposes other than their care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest.
- Tell patients about disclosures of personal information you make that they would not reasonably expect, or check they have received information about such disclosures, unless that is not practicable or would undermine the purpose of the disclosure. Keep a record of your decisions to disclose, or not to disclose, information.
- Support patients to access their information. Respect, and help patients exercise, their legal rights to be informed about how their information will be used and to have access to, or copies of, their health records.
There are, however, certain circumstance where you may disclose patient information without breaching confidentiality:
- The patient consents, whether implicitly or explicitly for the sake of their own care or for local clinical audit, or explicitly for other purposes.
- The patient has given their explicit consent to disclosure for other purposes.
- The disclosure is of overall benefit4 to a patient who lacks the capacity to consent.
- The disclosure is required by law, or the disclosure is permitted or has been approved under a statutory process that sets aside the common law duty of confidentiality.
- The disclosure can be justified in the interest.
Additional supporting pieces on confidentiality, designed for specific purposes – such as disclosing information about fitness to drive, serious communicable diseases, or gunshot/knife wounds – are readily available on the GMC page. Decision-Making and Consent Good Medical Practice promotes a holistic and patient-centred approach in healthcare.
- All patients have the right to be involved in decisions about their treatment and care and be supported to make informed decisions if they are able.
- Decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient.
- All patients have the right to be listened to, and to be given the information they need to make a decision and the time and support they need to understand it.
- Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
- Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. A patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements.
- The choice of treatment or care for patients who lack capacity must be of overall benefit to them, and decisions should be made in consultation with those who are close to them or advocating for them.
- Patients whose right to consent is affected by law should be supported to be involved in the decision-making process, and to exercise choice if possible.
The GMC has also set out guidance specific to bioethics, i.e. seeking consent to research, which you may wish to look into. Leadership and Management Part of a doctor’s job description is leading teams and supervising colleagues for the purpose of providing safe care to patients. Therefore, they are required to adhere to the following, no matter what role they are in:
- Engage with colleagues to maintain and improve the safety and quality of patient care.
- Contribute to discussions and decisions about improving the quality of services and outcomes.
- Raise and act on concerns about patient safety.
- Demonstrate effective team working and leadership.
- Promote a working environment free from unfair discrimination, bullying and harassment, bearing in mind that colleagues and patients come from diverse backgrounds.
- Contribute to teaching and training doctors and other healthcare professionals, including by acting as a positive role model.
- Use resources efficiently for the benefit of patients and the public.
Maintaining Professionalism As a doctor you are part of the professional culture present in healthcare. Developing professionalism is a process; from an early stage in your medical education, you are consistently required to demonstrate attributes, values, and behaviours expected of a physician until you come to think, act, and feel like a physician.
Doctors regularly face a variety of situation where they must remain professional, which is why the GMC offers a range of guidance to help you maintain appropriate boundaries, including on social media. Children and Young People Doctors must consider additional ethical and legal factors when dealing with children.
The GMC, the BMA, as well as the Medical Defence Unit (MDU) have developed guides to help you explore and act in the best interest of a child or young person. Comprehensive guidance for all doctors on 0 to 18 years old patients can be found on the GMC’s webpage.
- Good Practice in Prescribing As you are responsible for your signed prescription, it is in your best interest to ensure you are prescribing safely, particularly when prescribing controlled drugs.
- Do not prescribe for yourself or friends and family.
- Additional guidance can be found on the GMC webpage.
- End-of-Life Care This is a very sensitive and complex subject and you should consult the detailed guidance on provided by the GMC.
Overall, you must be aware of the Human Rights Act 1998 and its main provisions, as your decisions are likely to engage the basic rights and principles set out in the Act. In accordance with the pillar of justice, you must give patients who are approaching the end of their life the same quality of care as all other patients.
- You must treat patients and those close to them with dignity, respect and compassion, especially when they are facing difficult situations and decisions about care.
- You must respect their privacy and right to confidentiality.
- Candour and Raising Concerns All doctors have a duty to raise concerns where they believe patient safety or care is being compromised as well as encourage a culture in which staff can raise concerns openly and safely.
Concerns may stem from numerous sources, such as patients’ complaints or colleagues’ concerns. Upon receiving such information, you are obliged by medical law to act promptly and professionally by putting the matter right (if that is possible), investigating and dealing with the concern locally, or referring the matter to senior management or the relevant regulatory authority.
Ethical Guidance. General Medical Council. Available from:
Ethics. British Medical Association. Available from:
https://www.bma.org.uk/advice-and-support/ethics 3. Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994;309:184–184. doi:10.1136/bmj.309.6948.184 : Ethical Guidance for Doctors
Why are GP surgeries not seeing patients?
It’s no wonder I couldn’t see a GP: limiting access to services is the point | Kenan Malik I t’s a problem familiar to millions: the trials of trying to book a doctor’s appointment. Last week, suffering from a debilitating condition but not an emergency, I called the GP surgery to get it checked out.
- There were no slots available for that day.
- Nor could I book an appointment for beyond that day.
- Trying online, the best I was offered was a telephone call two weeks away.
- Online slots are so precious that by the time you choose one and input your details, it has already been taken.
- I eventually ended up in A&E, and thankfully everything turned out fine (fine enough, at least, for me to be able to write this column).
It’s a common tale, and one that millions endure every day. There are many reasons, not least the pressures imposed by Covid and lockdowns on the post-pandemic world and, perhaps most importantly, the shortage of medical staff. In the NHS as a whole, there are more than – almost 10% of its planned workforce.
Among GPs, with a planned, fully qualified workforce of almost 30,000, there are more than, And it’s the that are most lacking in GPs. Beyond such proximate causes, however, there lies a deeper reason, too, and one that shapes not just the difficulties in accessing health services but also many contemporary problems, from the rail chaos to the failure to mitigate the impact of soaring energy costs.
All are, at least partly, the product of the changing nature of the state. Political analysts have been talking for more than three decades about the shift from the “positive” or “command” state, which was employed in the immediate postwar decades, to the “regulatory state” that slowly came into being from the 1980s.
Where the postwar state directly intervened to secure what were seen as desired social and economic outcomes – from creating the National Health Service to the nationalisation of key industries, from railways to coal – the post-Margaret Thatcher regulatory state viewed desired outcomes as best shaped by the market and saw the role of the state less as providing services than in regulating the market and in “steering” it towards desirable outcomes.
A state that made rules rather than material interventions. A state that outsourced its capacity to get things done to the market and to non-governmental organisations, whether private or public. Over time, the process of regulation itself has been removed from the direct ambit of the government through the creation of independent quangos to provide the “steering”, from Ofgem to the Low Pay Commission.
The Grenfell fire inquiry has exposed the degree to which private companies rode roughshod over government regulations In his 1997 book The Audit Society, accountant and economist argued that Britain was becoming a nation more concerned with monitoring services than with their actual improvement. “Rituals of regulatory verification,” he argued, served as “empty assurances” for a public that had become distrustful of the judgment of professionals.
It is a process that has deepened over the past quarter of a century. The regulatory state has actually led to looser regulation and less capacity to achieve socially desirable outcomes. We can see this most dramatically, and tragically, in the, The inquiry into the fire has exposed the degree to which private companies not only rode roughshod over government regulations but also the degree to which regulators often colluded with the rule-breakers or at least turned a blind eye to their activities.
- The rise of the regulatory state has also made it more difficult for government to institute long-term planning, whether, or resilience against,
- At the same time, the outsourcing of government functions, and its reluctance to intervene directly, has undermined its capacity to respond to crises, leading, for instance, to the current paralysis over soaring energy costs, a paralysis that goes far beyond simply the chasm in governance created by the Tory leadership campaign.
The regulatory state has also created organisational incoherence and fragmentation. We can see this in the railways, the water industry and the energy sector. Perhaps most perniciously, we can see it in the NHS. The establishment of the “internal market”, the division between “commissioners” and “providers” and the setting up of a multitude of semi-autonomous organisations has all helped to create, in the words of, “a highly complex bureaucratic structure, in which responsibility is so widely dispersed that accountability is virtually impossible” and in which even those charged with its administration struggle to identify But, more than that, in the age of austerity, mechanisms of regulation have become the means less of ensuring good services than of restricting access to impoverished ones.
That is why the process of booking a doctor’s appointment seems designed to be as difficult as possible in order to limit access to a diminishing resource. Free market policies have placed market efficiency and the conditions for profitability above social need Free market policies and the entrenchment of the regulatory state are often celebrated as enabling greater democracy, enhancing choice and empowering the ordinary citizen.
What they have really done is place market efficiency and the conditions for profitability above social need. They have also been used in an attempt to insulate public institutions from democratic pressures. That is why the rise of the regulatory state has gone, hand in hand, with assaults on trade unions and the greater atomisation of society.
As early as 1975, the Trilateral Commission, an elite non-governmental organisation set up two years earlier by David Rockefeller and Zbigniew Brzezinski, whose aim was to shape global governance, had warned in a report, entitled The Crisis of Democracy, that a problem such as inflation is “exacerbated by a democratic politics”.
This is because the idea that “government should be responsive to the people creates the expectation that government should meet the needs and correct the evils affecting particular groups in society” and makes it impossible “to curtail spending, increase taxes and control prices and wages”.
The “crisis of democracy”, in other words, was that there was too much of it. It was necessary to shield the state from democratic pressures and to squash the expectation that the role of the government was to “meet the needs and correct the evils” afflicting citizens. The structures of the regulatory state have sought to do just that.
And, in so doing, they have turned as mundane a task as making an appointment with your doctor into a tortuous trial while allowing something as monstrous as the energy price rise to hit us without any serious forward planning to mitigate its impact.