One afternoon, Dr. Dev (Fictional Name) received a registered letter from a lawyer. The lawyer claimed to represent a patient Dr. Dev had operated, three months ago in the government hospital for fissure-in-ano. The lawyer had written, as a side-effect of the wrongly done operation, his client had developed intractable eczema which had made his life horrible.
The lawyer instructed Dr. Dev to pay his client INR 50,000/- as compensation for the cost of treatment and the mental agony the patient is facing because of eczema developed due to the faulty operation. In comparison, Dr. Dev’s entire pay for one month was INR 35,000/- at that time. Also as the operation is done in the government hospital free of cost, Dr. Dev did not receive any extra money for doing any operation there. Dr. Dev was also surprised by the allegation of developing eczema after fissure-in-ano.
For Non-Medicos: In fissure-in-ano, a small cut develops in the sensitive inner lining of the anus. This is very painful at the time of passing stools. In the operation for the anal fissure, the anus is generally dilated manually or by dividing the muscle surrounding it, making the anus wide which helps in healing of the cut. The side-effect of the operation is generally incontinence, i.e. the patient is not able to voluntarily control his act of defecation or passage of stools. There is also the chance that the cut may not heal in few patients, who may then require further treatment. Eczema developing as a side effect of the operation for fissure-in-ano was not possible.
Dr. Dev tried to remember if he had operated on any patient with fissure-in-ano and eczema. He recalled that he indeed had seen and operated on a patient with fissure- in-ano who was suffering from chronic eczema long before the fissure developed. With the patient’s name from the letter, Dr. Dev searched the hospital record and got a certified copy of the patient’s entire case-record from the hospital.
On-going through the record to his dismay he found that in the inpatient case-sheet the ward in-charge junior resident had only written; Diagnosis: Fissure in ano; History: Painful defecation x 2 months, no bleeding per-rectally; On Examination: Fissure in ano at 6’ O’clock position; Operation done: Anal Dilatation under spinal anaesthesia. The junior resident had not recorded the presence of the previous eczema in either the history or the examination of the patient.
Not losing hope, he went further through the hospital record. Going further, he found attached the patient’s consultation slip when he had consulted Dr. Dev at his clinic. In Dr. Dev’s personal note made at the time of consultation at his clinic, it was clearly mentioned that on examination of the patient Dr. Dev had found that along with fissure-in-ano, the patient was also having perianal and buttock region eczema skin disorder. On enquiring the patient told that he is having the eczema for many years which cause itching and occasional bleeding and pain, which was also recorded in the OPD slip.
Dr. Dev asked the patient to first consult a skin specialist before the operation of the anal fissure. He also recorded the fact in the patient’s OPD slip that the person is suffering from chronic (long-standing) eczema for which skin reference had been advised. In meanwhile he advised some medicines for temporary relief for the fissure.
Sometime later, the patient again consulted Dr. Dev. He showed a skin specialist consultation sheet in which the dermatologist had given clearance for surgery, as the eczema was allergic and not infective. This fact was also recorded in the OPD slip.
Armed with this evidence, Dr. Dev consulted his lawyer. The lawyer sent an official reply to the patient’s lawyer that the patient is misrepresenting facts. He was suffering from eczema long before the operation. This fact has been recorded in the OPD slip. The patient will not get any money from Dr. Dev. In fact, Dr. Dev is considering a defamation case against the patient.
A meeting between the two lawyers was done at which Dr. Dev’s lawyer produced the copy of Dr. Dev’s OPD slips as a proof. Faced with this evidence the lawyer decided to withdraw the case against Dr. Dev. Instead of going in further litigations and wasting his time and money in court, Dr. Dev also agreed to not file a defamation suit against the patient.
Tip: Always record any pre-existing illness or condition in the patient’s case-sheet; however it appears unrelated to the patient’s present illness. This is valid even in non-medical situations. When you join some organization or project, do an active ‘witch-hunting’ and report all pre-existing problems at beginning so that later you may not get blamed for them.
For example, when a new CEO of a nationalized bank joined as head, in the next quarterly report there was a sudden jump in the non-paying borrowers and bad loan reported by the Bank. What happened was that the CEO setting strict standard declared the entire previous borderline or under review borrowers and loans given during the previous CEO’s period as non-paying borrowers and bad loans at the onset of her tenure. This will prevent these bad loans and borrowers from showing in her tenure if declared later on. So the first quarter result declared under her was very bad, but she did not got any blame for it.
Tip: Even though it may be work of your junior to complete the case sheet or basic workup, do keep a check on them and make a complete record yourself if necessary. In the above-mentioned case, it is Dr. Dev’s comprehensive notes which saved him. The junior resident had treated the case as only a simple minor case and wrote only a minimal basic record.
Tip: When confronted with any legal notice or litigation, it is better to let your lawyer work as a mediator and not deal directly with the opposite party even in a case clearly in your favor. This may increase your cost but creates an atmosphere that you are serious about confronting the opposite party in court if necessary. There is also a lot of legal jargon that which we are not familiar with.
Tip: Have a personal insurance cover even when working in government sector, as the court or patient may hold you personally responsible for any compensation.
(Based on true incident)
— ND
© Author. All rights reserved.
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost.
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.
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