3.consumer Health, Safety & Doctor - Patient Relationship

3.
CONSUMER HEALTH, SAFETY & DOCTOR - PATIENT RELATIONSHIP
RELATIONS BETWEEN PATIENT AND DOCTORS
The Doctor patient relationship in our country has undergone a sea change in the last decade
and a half. The lucky doctors of the past were treated like God and people revered and
respected them. We witness today a fast pace of commercialization and globalization on all
spheres of life and the medical profession is no exception to these phenomena. As a result,
the doctor-patients relationship has deteriorated considerably. Earlier too, doctors were
covered by various laws, i.e. the Law of Torts, IPC etc., but since the passing of the
Consumer Protection Act in 1986, litigation against doctors is on the increase. The medical
profession is definitely perturbed by this and a rethink is necessary on standards of medical
practice or ‘defensive medicine’.
Surgeons/Urologists busy themselves in acquiring knowledge, perfecting operative
techniques and assimilating the newest technologies that are evolving so rapidly. Sometimes
the course of the disease or therapeutic decisions does not run along predictable lines. The
patient-doctor relationship is then put to test.
Doctors practicing ethically and honestly should not have any reason for fear. Law whether
civil, criminally or consumer law, can only set the outer limits of acceptable conduct i.e.
minimum standards of professional care and skill, leaving the question of ideal to the
profession itself.
Since the ancient times, certain duties and responsibilities have been cast on persons who
adopt the sacred profession as exemplified by Charak’s Oath ( 1000 B.C.) and Hippocratic
Oath ( 460 B.C.). In order to understand the complexities of the doctor-patient relationship it
is necessary to know about the Duties and Obligations of a Doctor, Doctor-Patient contract
and what constitutes Professional Negligence.

DUTIES AND OBLIGATIONS OF DOCTOR
Duties and obligations of doctors are enlisted in ordinary laws of the land and various Codes
of Medical Ethics and Declarations - Indian and International, which are- Code of Medical
Ethics of Medical Council of India, Hippocratic Oath and in other code.
I. Duties toward Patient - These are : Standard Care, Providing Information to the Patient
/Attendant , Consent for Treatment, and Emergency Care.
(A) Standard Care - This means application of the principles of standard care which an
average person takes while doing similar job in a similar situation :
i.Due care and diligence of a prudent Doctor. ii.
Standard, suitable, equipment in good repair.
iii. Standard assistants : Where a senior doctor delegates a task to a junior doctor or
paramedical staff, he must assure himself that the assistant is sufficiently competent and
experienced to do the job, and fulfills the prescribed qualifications. iv. Non-standard drug is a
poison by definition.
v. Standard procedure and indicated treatment and surgery.
vi. Standard premises, e.g. Nursing Home, Hospital , must comply with all laws
applicable as imposed by the State and these must be registered wherever required. vii.
Standard proper reference to appropriate specialist.
viii. Standard proper record keeping for treatment given, surgery done, X-ray and
pathological reports.
ix. Standard of not to experiment with patient ( See Declaration of Helsinki in Appendix IV).
x. Anticipation of standard risks of complications and preventive actions taken in time.
xi. Observe punctuality in consultation.

(B) Duty to provide information to patient / attendant
1.Regarding necessity of treatment.
2. Alternative modalities of treatment.
3. Risks of pursuing the treatment, including inherent complications of drugs, investigations,
procedure,surgery etc.
4. Regarding duration of treatment.
5. Regarding prognosis. Do not exaggerate nor minimize the gravity of patient’s condition.
6. Regarding expenses and break-up thereof.
(C) Consent for treatment - Various types of consent and implications thereof are discussed
in
(D) Emergency Care - A doctor is bound to provide emergency care on humanitarian
grounds, unless he is assured that others are willing and able to give such care. It may be
noted that prior consent is not necessary for giving emergency / first-aid treatment. In
emergency medico-legal cases, condition of first being seen by medical jurist is not
essential.
II. Duties to the Public
1. Health Education
2. Medical help when natural calamities like drought,flood, earth-quakes, etc. occur.
3. Medical help during train accidents.
4. Compulsory notification of births, deaths, infectious diseases, food poisoning etc.
5. To help victims of house collapse, road accidents, fire,etc.
III. Duty towards Law Enforcers, Police, Courts, etc.

1.To inform the police all cases of poisoning, burns,injury, illegal abortion, suicide,
homicide,manslaughter, grievous hurt and its natural complications like tetanus, gas-gangrene
, etc. This includes vehicular accidents, fractures, etc.
2. To call a Magistrate for recording dying declaration.
3. To inform about bride burning and battered child cases.
IV. Duty not to violate Professional Ethics
1. Not to associate with unregistered medical practitioner and not allow him to practice what
he is not qualified for.
2. Not to indulge in self-advertisement except such as is expressly authorized by the M.C.I.
Code of Medical Ethics.
3. Not to issue false certificates and bills.
4. Not to run a medical store / open shop for sale of medical and surgical instruments.
5. Not to write secret formulations.
6. Not to refuse professional service on grounds of religion, nationality, race,party politics or
social status.
7. Not to attend patient when under the effect of alcohol
8. No fee sharing ( Dichotomy).

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3.

CONSUMER HEALTH, SAFETY & DOCTOR - PATIENT RELATIONSHIP

RELATIONS BETWEEN PATIENT AND DOCTORS

profession is definitely perturbed by this and a rethink is necessary on standards of medical

practice or ‘defensive medicine’.

Surgeons/Urologists busy themselves in acquiring knowledge, perfecting operative

patient-doctor relationship is then put to test.

and what constitutes Professional Negligence.

Ethics of Medical Council of India, Hippocratic Oath and in other code.

/Attendant , Consent for Treatment, and Emergency Care.

average person takes while doing similar job in a similar situation :

i.Due care and diligence of a prudent Doctor. ii.

Standard, suitable, equipment in good repair.

v. Standard procedure and indicated treatment and surgery.

Standard proper reference to appropriate specialist.

x. Anticipation of standard risks of complications and preventive actions taken in time.

xi. Observe punctuality in consultation.

1.Regarding necessity of treatment.

2. Alternative modalities of treatment.

3. Risks of pursuing the treatment, including inherent complications of drugs, investigations,

4. Regarding duration of treatment.

6. Regarding expenses and break-up thereof.

(D) Emergency Care - A doctor is bound to provide emergency care on humanitarian

II. Duties to the Public

3. Medical help during train accidents.

4. Compulsory notification of births, deaths, infectious diseases, food poisoning etc.

5. To help victims of house collapse, road accidents, fire,etc.

III. Duty towards Law Enforcers, Police, Courts, etc.

, etc. This includes vehicular accidents, fractures, etc.

2. To call a Magistrate for recording dying declaration.

3. To inform about bride burning and battered child cases.

IV. Duty not to violate Professional Ethics

he is not qualified for.

2. Not to indulge in self-advertisement except such as is expressly authorized by the M.C.I.

Code of Medical Ethics.

3. Not to issue false certificates and bills.

5. Not to write secret formulations.

6. Not to refuse professional service on grounds of religion, nationality, race,party politics or

7. Not to attend patient when under the effect of alcohol

8. No fee sharing ( Dichotomy).

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