STEPS TO BE TAKEN IN ORDER IN ORDER TO AVOID GETTING ENTANGLED IN A LAWSUIT
- It is important to assess the needs/expectations of the patient from the treating doctor first and then proceeding to the specific management as it helps in addressing the basic needs of the patient.
- Patient's age, indication for the procedure, whether the expectations of the patient matches the expected outcome from the procedure, the possible complications are some of the basic considerations before any procedure.
- The doctor-patient relationship is always built on the foundation of ‘Trust’. Counselling the patient adequately is a mandatory pre-requisite and should be followed by a psychiatry consultation, though not a routine.
- Medical history of the patient, a detailed account of the cosmetic procedures under gone in the past and the level of satisfaction from those procedures should be enquired. This can help the dermatologist to assess the expectations and level of risk.
- All the available options should be put forth before the patient and they should be allowed to choose among them. In this stage, important information should not be withheld. A detailed discussion about procedure goes a long way in winning their confidence as well as giving them the comfort of knowing the procedure beforehand.
- The doctor should not only discuss the advantages, disadvantages and adverse effects and the generally expected outcomes of the procedure chosen for the patient but the patient’s responsibilities like post procedure care, fees payable etc. should also be discussed.
- One should encourage the patient to clarify their doubts. This interaction is equally important for the dermatologists to know his patient and avoid a potentially dangerous patient.
- Informed consent is important for ethical and legal reasons as well as to improve quality of care and patient satisfaction and should include the condition, need for treatment, other modalities of treatment, duration of given treatment, number of sittings, expected results; need to follow instructions before and after the procedure and possible side effects. Failure to obtain informed consent is one of the common allegations in medical malpractice suits.
- Brochures designed to provide comprehensive, objective information for specific procedures can help physicians avoid malpractice claims.
- The consent should always be taken prior to the procedure and by the dermatologists only.
- It should be written in simple and comprehensible sentences and in the language which the patient understands better.
- It should be signed by the patient, parent/guardian in the case of minors.
- In the case of teenagers (13-18 years), it is better to take the consent of both the minor and the parent.
- The dermatologist must have adequate skills to perform the procedure. Standard of care practiced by a dermatologist should be based on current best evidence available. Not only they are trained to handle the patients and perform procedures assigned to them, they should also be encouraged to report the errors when it occurs and not hide the facts for the fear of litigation. This facilitates the early appropriate intervention that could address the origin of poor quality practices.
- Post procedure care and patient responsibilities should be told clearly to the patient. Documentation of the advice is as important as the verbal communication. Physician should take great care to ensure complete and accurate records.
- Medical record documentation should mention the date, time and signatures of the individual /team. The operation notes should list all the steps and also the materials used for the procedure as it is considered as important evidence in the court of law.
LOSS OF EYE SIGHT DUE TO GIVING DRUGS WITHOUT EXAMINING THE PATIENT
In the case of Devi Rani V. Prakash Rao and Others, 2002 (III) CPJ 123, the doctor prescribes medicines by name “Amalar” to the patient who has a mild fever attack on inferring as symptom of malaria. As a result of taking the prescribed drug, the patient body gets swollen and some visible signs of Ammavaru (rashness like chicken pox) in some part of the body. The prescribes another medicine along with a bottle of glycerine, as a result of which the patient complains of swollen body figure, rashes and scratches on the body. The doctor gives treatment to the patient assuming the disease of SJS (Steven Johnson Syndrome which means a form of skin disease wherein skin gets peeled of skin). Consequently, the patient suffers loss of eye sight. Astonishingly, the doctor did not enquire whether the patient was allergic to drugs, nor did he ask the patient or his relative to observe if there was any reaction, report him immediately, he did not even examine and instruct the patient to take medicine in the first instance and wait for reaction before taking subsequent drugs.
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