duties of patient
TRANSCRIPT
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DUTIES OF PATIENT Provide all information Must cooperate Carry out all instructions
Free from responsibility of treatment Pay the practitioner
Doctor can sue the patient
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PROFESSIONAL NEGLIGENGE
Civil negligence - compensation
Criminal negligence - serious injury or death
Contributory negligence - concurrent
Corporate negligence - institutional
Vicarious responsibility
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PROFESSIONAL NEGLIGENCE
OMISSION TO DO SOME THING WHICH A REASONBLE DOCTOR WOULD DO
Act of omission COMMISSION OF SOME THING WHICH A REASONABLE DOCTOR WOULD NOT DO
Act of commission
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PROFESSIONAL MALPRAXIS
Lack of reasonable care and skill Willful negligence on the part of practitioner Health or life of patient endangered Not mere neglect or carelessness where there is legal duty Failure in this duty caused damage/injury
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♦♦♦♦ ♦ ♦ PRO
FESS
ION
AL M
ALPR
ACTI
CE
Dim
inis
hes
chan
ces
of r
ecov
ery
Prol
ongs
illn
ess
or in
crea
ses
suff
erin
gsD
eath
If n
o da
mag
e no
com
pens
atio
n ev
en if
do
ctor
is n
eglig
ent
Aver
age
degr
ee o
f sk
ill
Gen
eral
or
spec
ialis
tEr
ror
in d
iagn
osis
no
negl
igen
ce
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DAMAGE DAMAGES
Assessed by courtPhysical Loss of earningMental power future and present Actual cost
Financial Pain and
Reduction insufferings quality of life
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MUST ESTABLISH TO COURT
Doctor owed him a duty Derelict and breached duty Suffered actual damage Doctor’s conduct direct cause of damage Patient can prove this –awarded
damages
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RES IPSA LOQUITAR Doctor considered innocent except
Without negligence injury does not occur Plaintiff did not contribute to own injury Doctor exclusive control of instrumentalities
Doctor has to establish innocence rather than patient has to prove doctor’s guilt
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RES IPSA LOQUITAR Foreign bodies or instruments Burns from heating modalities Injury to body part outside field of treatment Prescription of toxic drugs
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CASE BROUGHT IN
In Civil courts
In Criminal courts
Consumer courts
Medical Council
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CIVIL NEGLIGENCE
Sue in civil court for compensation
due to negligence of doctor in case
of damage or death of patient
Patient refuse to pay fee on
grounds of negligence
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FAILURE IN CONTRACTUAL OBLIGATION
When doctor agreed to treat
person
Burden to prove lies with patient
Want of competent care and skill
Leads to bad results
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DIAGNOSIS Failure to x-ray in cases of fractures or injury to joints
Failure to use ophthalmoscope
Failure to refer
Failure to consult specialist
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TREATMENT
Care while using dangerous
drugs
Excessive exposure to radiation
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CRIMINAL NEGLIGENCE
Death or serious injury due to negligence Undue interference in the treatment Death- Gross ignorance, gross carelessness, rash or
negligent act 304-A IPC Drunkenness or use of drugs Serious injury 336,337 or 338 IPC
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CRIMINAL NEGLIGENCE
Gross negligence during Treatment, anesthesia, operation or
postoperative
Not doing sensitivity test when needed Injecting basal anesthesia in fatal dosage or wrong tissue Amputation of wrong finger or limb
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CRIMINAL NEGLIGENCE
Removal of wrong organ Errors in ligation of ducts Operation on wrong patient Leaving instruments or sponges Leaving tourniquets too long
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CRIMINAL NEGLIGENCE
Giving wrong or infected blood Gangrene after too tight plaster Dressing with corrosives Performing Criminal abortion Performing criminal operation Mismanagement of delivery under influence of drugs or alcohol
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• • • CO
NTRIBU
TORY N
EGLIG
ENCE
Simultaneous negligence by the patient
and doctor and there is harm or
delayed recovery of patient If contributory negligence patient loses right for com
pensation totally or partiallyD
octor should foresee and warn patient
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CONTRIBUTORY NEGLIGENCE
Without warning no pleading of contributory negligence Good defence for doctor Burden of proving CN with doctor Did not give correct history Did not follow instructions Patient to blame himself for his condition
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CARPORATE NEGLIGENCE & VICARIOUS RESPONSIBILITY
Liability exists in the absence of blameworthy conduct on the part of master Master/hospital management responsible for negligent acts of his servants within scope of employment -interns, junior residents and non medical staff but not for consultants
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VICARIOUS RESPONSIBILITY
Hospital management not responsible for senior staff if they exercised due care in selecting them Physician responsible for interns and junior residents if act carried out under his supervision Negligent choice in referring- physician responsible
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PRECAUTIONS AGAINST NEGLIGENCE
Diagnosis should be confirmed by laboratory tests
X-ray routine in cases of injuries to bones or
joints
Consultations
Immunization considered wherever required
Sensitivity tests performed
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PRECAUTIONS AGAINST NEGLIGENCE
Drugs checked before administration
No experimentation without prior consent
No procedure beyond competence
Meticulous record keeping of all being done on the patient, preserved for three years
Informed intelligent written consent taken
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PRECAUTIONS AGAINST NEGLIGENCE
Take an undertaking from patient that test reports and x-ray films have been handed over to him
Keep a record of all treatment and investigations even of OPD treatment
Doctor’s are protected under Section 80 IPC as they are doing the lawful act for the benefit of the patient with consent and Sec 92 IPC when without consent.
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DOCTOR’S INDEMNITY INSURANCE
Whenever charge of negligence inform the society or insurance company
Should not express regrets in such cases as it may considered admission of liability
Has to pay premium but keeps free from tensions
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DOCTOR’S INDEMNITY INSURANCE
He should inform the court that he is insured and submit copy of the insurance policy so that insurance company can made a party
Sometimes advocate of insurance company does not know about medical facts, should brief him and keep a tab on proceedings and better to have your own advocate also
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PRACTITIONER & PATIENT
When a patient comes to doctor -Implied contract – doctor patient relationship Doctor patient relationship not in cases: In an emergency Pre-employment checkup Court orders for examination of accused Request of attorney for law suit purposes
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CONTINUE TO TREAT UNLESS Patient is well Under other responsible care Given notice by doctor Intention of changing the doctor Patient not cooperating Patient does not pay fees Consults another doctor without permission Disease is feigned
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REASONABLE CARE Use proper and clean appliances
Furnish suitable medicines or legible
prescriptions
Full directions in simple language
Suggest consultations
Warning patient, spouse family employer- if he
is danger to himself or to others AIDS, epilepsy
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CONSULTATIONS Obscure and difficult case Diagnosis in doubt Case takes a serious turn Operation dangerous to life Case of criminal assault Affect intellectual or reproductive function Termination of pregnancy over 12 weeks
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CONSULTATIONS Criminal abortion Destructive operation of unborn child Suspicion of poisoning or criminal act Apprehensive or neurotic patient- full disclosure not possible and no person to get consent Do not resuscitate orders to be issued Dowry deaths – post mortem cases
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REASONABLE SKILL Average degree of skill Not responsible for error of judgement Reasonable skill and knowledge Adopt any theory in which he believes No experiment without consent Specialist: special degree of skill and knowledge and current knowledge
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• P
RO
FESSION
AL SEC
REC
Y
Professional secret
is the
secret w
hich a doctor comes to know
about the patient during his practice in his professional capacity Should not divulge itU
nethical and illegalLiable to dam
ages for divulging it
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PRIVILEGED COMMUNICATIONS
When a doctor is justified to make this communication It is a communication made by a doctor to a proper authority who has corresponding legal, social and moral duties to protect the public It must be sealed and labeled privileged communication
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PRIVILEGED COMMUNICATIONS In a court of law Moral or social duty In doctor’s own interest Assist in apprehension of criminals In certain other cases Servant sent by master Insurance purposes
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IN A COURT OF LAW
If judge rules: doctor must disclose
this information otherwise it will be
contempt of court
Doctor can write this information
and hand over to the judge
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MORAL OR SOCIAL DUTY Bar maid open tuberculosis Hotel waiter has typhoid Hypertension or epilepsy in bus driver Colour blindness in engine driver Communicable diseased person entering swimming bath Partners of AIDS patient Tendency to commit violent crimes
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In doctor’s own interest Must notify births, deaths, communicable diseases, food poisoning or contamination of drinking water. Must notify cases of homicidal poisoning and others if death likely to police If in govt. job notify all types of poisoning to police
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Assist in apprehension of criminals
If called to treat victim or accused of serious crimes like robbery or murder etc (Section 39 CrPC) Criminal abortion Person dies after attempted suicide
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IN CERTAIN OTHER CASES
When a servant sent by
master
Insurance reports
Inquiries
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When a servant sent by master Affect capacity of work Confined to those matters which may affect the work Fitness to work Necessity for leave Extent of disability When a worker claims compensation
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♦
♦
INSURANCE REPORTS Can write anything found on examination to insurance company
Cannot write with his previous knowledge about the patient but better to refuse examination b y reason of previous knowledge
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INQUIRIES Should not answer queries by Insurance companies, solicitors or any
body else without the consent of the patient
Parents and relatives Cause of death without the consent of
nearest surviving relative
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EUTHANASIA Mercy killing
Putting a person to painless death in cases of incurable sufferings or when life is purposeless as a result of mental or physical handicap
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EUTHANASIA
At birth
At terminal stages
Severely impaired as a result of brain damage