“How to prevent litigation in Medical Practice? Do’s and Don’ts for a doctor.”
In ancient times, Medical Practice was more of an art than anything else. At that time healers were considered God. Then the medical profession evolved as a science. Still the doctors were considered next to God. The relationship between doctor and patient was of faith and trust. But now it has become more of a Business. Modern Medical Science has ignored the healing of soul or psyche of a patient leading to patient dissatisfaction. Recently there has been marked development in the medical profession and the concept of Quality Care has emerged. Expectation of the patient has grown tremendously. In today’s world of consumerism the patient is very intelligent. He has a lot of medical information even before consulting the doctor. For him there is no difference between buying a car or getting the medical services. To add to the insult, our doctor colleagues are no less. Doctors generally criticize their colleagues without realizing the consequences. Patient becomes aware of the deficiencies in health sector, ultimately leading to increased litigation.
The nature of our profession is such that it is prone to litigation. We are dealing with life and death of humans and cannot get 2nd chance to rectify the mistake. We must take some active steps so as to prevent the litigation. Every doctor must be aware towards his legal duties and should take the following precautions in the medical practice: Don’t assure 100% results. Take informed written consent. In cases of medico-legal implications do inform the police and keep documentary proof of the same. Avoid giving prescription on phone. Give extra time to potential litigants. Get the necessary investigations done and keep the record. Full record of the patient should be maintained. Keep a photocopy of the certificate issued. Put a stamp on every prescription/certificate mentioning your name, qualifications, registration number. Write legible and complete prescription. Give proper instructions regarding dosage, duration and likely effect and side effect of the medicine. Take extra caution in case of emergencies. Always ensure that the drug to be administered is properly identified. If a serious patient is to be referred, do it fast and explain everything to the relatives. Keep track of the patient and show your concern. Do not delay the treatment particularly in serious patients.
In Malpractice Litigation, medical records are most important. Extra care should be taken in preparation handling and storage of the records. Always remember 5Cs in relation to medical records. They should be clean (legible), comprehensive, clear, correct and in chronological order. Take written, informed consent in a standard format. Informed refusal must also be documented. History in detail must be recorded. Date and Time are extremely important. All nursing care record (Temp charts, diet charts etc) must be maintained with date & time. Investigations ordered and their results must be maintained with date & time. Name & Signature of the treating doctor must be identifiable. Avoid Overwriting, white fluid. Cutting of any word should be done by putting a single line. Medical notes carry confidential information. It should not be left by the bedside of the patient and should be in the custody of responsible staff on duty. Photocopy is to be supplied within 72 hrs of written request. Hand over after verifying identity of the demanding person. Each page must be numbered and carry name of the patient.

A good prescription is one which is legibly written and includes the following:
1. Name, age and address of the Patient.
2. Date and Time of Prescription.
3. Name of the Drug, Strength.
4. Dosage form, Total amount.
5. Instructions, Warnings.
6. Signature, Name, Qualification and Registration No. of the doctor.

Analysis of 45 malpractice cases showed that most of the doctors who were sued, delivered information poorly and devalued the patient’s views. Doctors who can’t communicate well are more likely to end up in court. Good Communication a golden key. It Improves Physician – Patient relationship. A good communication is also likely to reduce the clinical errors and improve patient satisfaction. Research shows that 70% of communication efforts are not heard or rejected or misunderstood. Then how to communicate? Spoken Words, Body Language, Eye Messages, Written Words are various means of communication and all are equally important and must be taken care of while dealing with the patients or their relatives.
We doctors must take these active steps so as to improve the physician – patient relationship and thus preventing the litigation in medical practice. It is a well known principle of science that for every action there is equal and opposite reaction. And it is only the reaction, which is coming from the patients. If we can control/modify the action, definitely there will be no litigation against us.
Dr.V.P.Singh MD, LLB, PGDMLS. Medico-Legal Consultant