Medical profession deserves dignity, fair play

KK Talwar

Former Director, PGIMER, Chandigarh

Medical professionals have enjoyed a high degree of respect in society, owing to the nature and importance of their work, as also the dedication and sacrifice which the profession demands. A sense of nobleness is often attributed to the profession, and for good reason. Unfortunately, recent events in Dausa, Rajasthan, leading to the death by suicide of a doctor, have completely shaken the confidence of medical professionals. The case is a shocking one, where the law enforcement authorities went to the extent of registering a case of murder against a medical professional, even though the death in question occurred on account of a recognised medical complication following delivery. Thrown to the winds was the prudent caution advocated by no less than the highest court in our country, to seek expert view of the medical care given to the patient before registering a case.

The ramifications are grave, with the very dignity, confidence and safety of medical professionals being at stake. Unless ameliorative action is taken, the reverberations will be felt not only by the medical fraternity but by society as a whole. A bright professional has been lost through sheer apathy and negligence in the handling of the matter by the local authorities, perhaps under some pressure from powerful quarters. The incident is a blot on our system. One cannot begin to imagine the harassment and mental trauma suffered by the doctor, who felt compelled to end her life.

Even in the past, incidents of violence against doctors, and even the arrest of doctors, have been reported. A few years ago, a doctor at the civil hospital in Gorakhpur was arrested following an unfortunate tragedy in the neonatology wing of the hospital. Thankfully, the Allahabad High Court came to his aid, and strongly ruled that there was no basis for making out a case of medical negligence. Of course, the damage was done and cannot be compensated.

It is vital for all of us to realise the limitations of medical science, and the immense pressure that doctors operate under. I am reminded of the words of William Osler, who is considered the ‘father’ of allopathic medicine. He said: “Medicine is a science of uncertainty and an art of probability.” Even with the best possible education and training, no doctor can be a miracle worker. Despite the best intentions and efforts of doctors, and with all our scientific and technological advancements, favourable outcomes cannot be guaranteed. Such is the very nature of things.

I wish to draw attention to a perceptive and sagacious judgment by the Supreme Court delivered in 2005, in a case titled Jacob Mathew vs State of Punjab. The SC not only quashed the criminal prosecution of the doctors, and held that in such cases the investigating officer should before proceeding against the doctor accused of negligence, “obtain an independent and competent medical opinion preferably from a doctor in government service, qualified in that branch of medical practice”. The judgment is extremely well considered and balanced, and worth reading in its entirety. In arriving at the above conclusions, the court carried out a detailed analysis of the law relating to negligence, with particular reference to allegations of negligence against professionals. It wisely observed that the subject of negligence in the context of medical professionals “necessarily calls for treatment with a difference”.

Two paragraphs from this judgment, which bring home certain basic truths, are worth quoting in extenso: “A medical practitioner faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence before a medical practitioner is charged with or proceeded against criminally. A surgeon with shaky hands under fear of legal action cannot perform a successful operation and a quivering physician cannot administer the end-dose of medicine to his patient”; “If the hands be trembling with the dangling fear of facing a criminal prosecution in the event of failure for whatever reason — whether attributable to himself or not, neither can a surgeon successfully wield his life-saving scalpel to perform an essential surgery, nor can a physician successfully administer the life-saving dose of medicine. Discretion being the better part of valour, a medical professional would feel better advised to leave a terminal patient to his own fate in the case of emergency where the chance of success may be 10% (or so), rather than taking the risk of making a last ditch effort towards saving the subject and facing a criminal prosecution if his effort fails. Such timidity forced upon a doctor would be a disservice to society.”

Solemn issues have once again been brought to the fore by the tragedy in Dausa. There is no gainsaying that accountability for negligence must be ensured, but this can, in most cases, be achieved through suitable professional oversight mechanisms.

We must reconsider whether the existing regime of legal liability serves us well. Quite apart from the liability under criminal law, the inclusion of doctors under the consumer protection laws has serious and adverse consequences and should be reviewed. It has already led to a mushrooming of unnecessary investigations, inquiries and litigation. Unfortunately, people appear to be routinely approaching consumer forums, in the hope of monetary awards. Cases drag on for years, creating a sense of fear and frustration in the minds of doctors. Even naturally arising complications during the course of treatment are now viewed through the lens of suspicion, as in the Dausa case.

Another harmful effect of the present system is that it makes medical professionals adopt an unnecessarily defensive approach and prescribe avoidable tests and investigations which merely add to the cost of treatment. The inclusion of health services in the Consumer Protection Act has not helped society but only created mistrust in the patient-doctor relation. Health services should be thus excluded from the purview of this Act. There is no doubt some truth to the belief that, over the years, the medical profession has witnessed unethical practices. The beast of commercialisation has certainly not left the medical profession unaffected. The National Medical Council needs to seriously debate and initiate the necessary reforms to bring back the glory of this noble profession.

Albert Einstein once said that in the midst of every crisis lies great opportunity. One can only hope that the sacrifice of Dr Archana Sharma is not allowed to go waste. 

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