Iatrogenic Errors and its Disclosure

In a study conducted by S. K. Maithel, comparing the situation about iatrogenic errors and “Truth telling” in India and the US, it is clearly evident that a majority of Indian doctors never reported the medical error and most of them did not even know if any such office/department where a medical error is to be reported existed at all.

But if we look at the Indian scenario, the results of the study are not at all surprising. Most of Indian doctors even do not feel the necessity to discuss the ailment of the patient with him or his relatives, then how can we expect them to discuss the errors (read – blunders) which they have committed? Moreover, it is not possible to compel a doctor to do so.

One alternative will be that the judiciary should liberally use the doctrine of ‘Res ipsa loquitar’ in all cases where medical negligence is alleged. It means ‘It speaks for itself’ i.e. if the damage suffered by the patient is such that it could not have happened without medical negligence, then instead of the patient requiring to prove the doctor’s guilt, the doctor has to prove his innocence. So, to put a check on the conspiracy of silence prevailing in the medical profession, the benefit of this doctrine should be liberally given in all cases of alleged medical negligence.

Diagnosis of Death

In case of critically ill patients, when it comes to diagnosing the death of such patients who are on ventilators, due to a defect in the Human Organ Transplantation Act, the diagnosis of brain stem death can only be made in those patients who have consented for removal of their organs for transplantation. In all other cases, there suscitation process must continue till the heart stop beating. This defect must be corrected with immediate effect to prevent the ethical dilemma which arises every time in cases of non donor brain stem dead patients.

Confidentiality and Disclosure

The necessity of confidentiality in medical practice has not been properly valued until now in India. But, in the West due to the successful allegations by patients against doctors for not maintaining professional secrecy, the condition is far better. In India, patients also do not bother about this aspect except when it affects his treatment as in cases of an HIV positive patient. When the doctor discloses the HIV positive status of the patient, the news immediately spreads among the medical and paramedical staff, the relatives and also other patients occupying that ward. This affects the attitude of all these persons towards him and may finally result in his being “Thrown out” of the hospital, thus affecting treatment.

Besides, most doctors do not receive formal training to discuss a particular situation with the patient or his relations and this is more true when it comes to disclosure of bad news like the patient being afflicted with cancer, AIDS or any terminal illness.

Here, the dilemma is whether one should conceal the information from the patient and give him false hopes or explain in detail the diagnosis, stage of the disease, side effects of treatment and prognosis of the patient and in the process upset the patient as well as his/her family or should one take relatives in confidence and keep the patient in dark?

Breaking bad news therefore requires skill in communication and an understanding of the patient’s mind and preferences. Dr. K. M. Mohandas suggests : “Always give the patient hope, even when death seems at hand. He believes that if your time has not come, even your doctor can not take you away”.