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Medico Legal Case & Us:

Medico Legal Case & Us DR SAMBIT K DAS, CMS

WHAT is…?:

WHAT is…? FORENSIC: Derived from Latin meaning "of the forum" or market place. In ancient Rome the forum was where governmental debates and trials were held. FORENSIC Science means the application of natural and physical science to the resolution of the matter with a legal context MLC : Pre- labeled case: It is a case of injury or ailment where an attending doctor after taking history and clinical examination of the patient thinks that some investigation by law enforcing agencies is essential, so as to fix the responsibility regarding the case in accordance with the law (BPRD)

For Discussion :

For Discussion FEW IMP MLC CASE STUDY 5Ws of MLC AVOID PITFALLS in MLC by Doctors DOs & Don’ts for DOCTOR

Receiving an MLC :

Receiving an MLC A doctor can receive a medico-legal case – Brought by the police for examination and reporting. Already registered MLC referred from other health care system for expert management/advice After history taking and thorough examination, if the doctor suspects that the circumstances/ findings of the case are such that registration of the case as an MLC is warranted Directive of court.


Who? Any doctor who Possess permanent registration with MCI/SMC Some experience (preferable) The doctor who has -First contact with patient should prepare an ML case report In rape victims by the examination and preparation of MLC is done by female doctors.


Where? No specified area is defined for ML case Emergency Department is the area where majority of ML reports are prepared but sometimes may be in wards after detection of new findings


When? Some of the Pre-labeled MLC (as per BPRD) [This list is not comprehensive ] RTA’s, Rail accidents, factory accidents or any other unnatural mishap Suspected or evident homicides or suicides Suspected or evident poisoning Burn injuries due to any cause Injury cases where foul play is suspected Injury cases where there is likelihood of death in near future Sexual assault cases Suspected or evident criminal abortions Unconscious cases where cause of it is not clear Brought in dead cases where suspicion of foul play Cases referred from court

Consent in Medico legal cases:

Consent in Medico legal cases CONSENT FOR MEDICOLEGAL EXAMINATION TO BE TAKEN IN WRITTEN IN ALL CASES Exception : Cases brought by police being arrested on charge of committing an offence Person below 12 years/unsound mind- consent of guardian is to be taken.

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Life saving is the foremost duty of a doctor and a hospital, in accident or medico-legal cases (MLC). Patient treatment is priority Doctor has to do is to COMPLETE the injury sheet, which is a part of the assessment of the patient. NO DELAY FOR PROVIDING FIRST AID REMEMBER

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SUPREME COURT (Final Appeal) Appellate Authority over State Commission Revisional Jurisdiction NATIONAL COMMISSION Original Jurisdiction OverRs.20,00,000 Appellate Authority for District Forum Suo moto Revision STATE COMMISSION Original Jurisdiction over Rs. 5,00,000 up to Rs. 20,00,000 DISTRICT FORUM Original Jurisdiction up to Rs. 5,00,000 Structure of Consumer Forums / Commissions and Their Jurisdictions


LEGAL STANDING? Absence of a supreme court verdict on whether complaints against medical negligence can be decided by consumer courts is leading to ambiguity on the status of such disputes in these forums. Mr. Justice Balakrishna Eradi of the National Commission had ruled that doctors are covered by the CPA. The Madras High Court ( Subramaniam vs Kumaraswamy 1994) has ruled that medical practitioners do not come under the purview of CPA. Clause of the COPRA under dispute is the definition of the term ‘ service ’. The Act states ‘service means service of any description which is made available to potential users’. However, it adds, ‘ It does not include the rendering of any service free of charge or under a contract of personal service ’. It is being argued that the patient enters into a contract of personal service with the doctor.


LANDMARK CASE The NCDRC’s order did not accept the claim of medical professionals who argued that the doctor-patient relationship is similar to master – servant relationship , which is a contract of personal service that should be exempted from CPA. But the NCDRC’s order decreed that the doctor – patient relationship is a contract for personal service and it is not master – servant relationship. It is also said that the doctor is an independent contractor and the doctor, like the servant, is hired to perform a specific task.

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Supreme Court of India judgment in Indian Medical Association Vs V.P. Shantha and Others- As a result of this judgment, medical profession has been brought under the Section 2(1) (o) of CPA, 1986 2. Fatal Accidents Act, 1855 - Dr. Laxman Balkrishna Joshi v Dr. Trimbak Bapu Godhole - this Act was used to award damages to the heirs of the deceased patients. Whenever the death of a person shall be caused by wrongful act, neglect or default, and the act, neglect or default is such, as would (if death had not ensured) have entitled the party injured to maintain an action and recover damages in respect thereof, the party who would have been liable if death had not ensued shall be liable to an action or suit for damages, not withstanding the death of the person injured, and although the death shall have been caused under such circumstances as amount in law to felony or other crime. 3. The ‘ Bolam ’ test electro convulsive therapy - Mr. Bolam was advised electro convulsive therapy for mental illness. He was however, not warned of the risks of fractures involved in the treatment. There were two bodies of opinion. One preferred the use of relaxant drugs. Using relaxants, the patient sustained dislocation of both hip joints with fracture of pelvis. The doctor was not held negligent because he acted in accordance with practice accepted as proper by a responsible body of medical men skilled in that art. A doctor is not liable for taking one choice out of two for favouring one school rather than another. He is only liable when he falls below the standard of a reasonable component practitioner in this field, so much so that his conduct may deserve censure.

Paschim Banga Khet Mazdoor Samithi v. State of West Bengal, 1996 (4) SCC 37 & Pravat Kumar Mukerjee v. Ruby General Hospital (25.4.2005).:

Paschim Banga Khet Mazdoor Samithi v. State of West Bengal, 1996 (4) SCC 37 & Pravat Kumar Mukerjee v. Ruby General Hospital (25.4.2005). Obligatory for hospitals and medical practitioners to provide emergency medical care. no hospital or medical practitioner shall refuse to provide emergency medical care to victims of accidents or those in emergency medical condition on the ground that it is a medico-legal case or that the person is not able to pay immediately or that he has no medical insurance or other reimbursement facilities. initially screen the persons to decide if the persons require emergency medical treatment.

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If they do not require such treatment, the further provisions of the Act will not apply. If it is determined that the persons require emergency medical treatment, first they have to be stabilized and thereafter, they must be given treatment. USA also has EMTALA (Emergency Medical Treatment and Labour Act) or Patient Anti-Dumping Act. Mandatory duty on hospitals to give medical treatment to patients in emergency medical condition and women under labour, failing which the defaulter can be punished under the criminal law. After screening, if the hospital has no facilities, it must transfer the person to another hospital having necessary facilities.

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Papri De, a 4 yr girl, had accidentally swallowed a plastic pencil cap with which she was playing. The cap stuck in the trachea. CMRI- Calcutta Medical College and Hospital, where Papri was first taken, did not have a bronchoscope. The SSKM Hospital had a bronchoscope but it was not in a working condition. The child was finally taken to the expensive CMRI. For more than four hours the child cried and gasped for breath in her mother’s lap only to die  died on February 24, 1991 in CMRI. Dr. Mall, under whom Papri was admitted, arrived at 9.30 p. m. He did not perform the bronchoscopy recommended by the doctors at SSKM. Instead, he gave the child three injections of Calmpose and Decadron and left. DR S. S. Mall, a noted CTVS surgeon, was sentenced to two years rigorous imprisonment for criminal negligence PAPRI DE Vs DR MALL

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Tarun Kumar Pramanik v. Dr. Kunal Chakraborty & Ors - the complainant alleged that during operation for left inguinal hernia his left testis was removed negligently and without consent. On account of this pt suffered and has become handicapped. Basis of evidence placed on record, and opinion of expert witness held that the removal of testis was done of expert witness held that the removal of testis was done to avoid gangrenous infection, operation was done with reasonable care and skill and had not resulted in any handicap. Complainant was held to be vexatious and complainant liable to pay cost of 1st opposite party. Alleged removal of testes

Removal of testes:

Removal of testes Harjivanbhai Khoda Bhai Gohil v. Dr. Yogendra D Shah the complainant was operated for hernia and fistula by the opposite party. It was alleged that during surgery the opposite party removed his left testis along with its blood vessel without consent. case papers of the complainant reflected that the wound had healed well. Also, the consent very clearly mentioned the permission for removal of testis. The operation conducted subsequently by Dr. Parikh was for some other problem and not for nay defect in the surgery conducted by the opposite party Cost of Rs.5000/- awarded to Dr. Shah (opposite party) for ill-conceived complaint.

SRIDEVI’s Mother Vs Sloan- Kettering Hospital :

SRIDEVI’s Mother Vs Sloan- Kettering Hospital

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Pyare Lal Verma v. Dr. A.K. Gupta & Ors . The complainant, aged 72 years was advised surgery enlarged prostate by the opposite party. He was referred to Dr. Neeraj Nagpal , MD to opine about fitness to undergo surgery, who however, after necessary tests opined that there was no active contraindication for TUR surgery. After surgery, the prostate gland pieces removed were sent for biopsy report to Dr. Mrs. B.K. Aikat , who stated that there was benign hyperplasia of the prostate and no malignancy was seen. Subsequently, the complainant developed complications and after 6 months during review of the biopsy slides at the PGI it was discovered that the prostate was cancerous. The Commission held that there is nothing whatsoever to indicate Dr. Nagpal’s pre-operative opinion was palpably wrong or patently negligent. It was also conceded before the Commission that there inevitably would be chemical changes in the slides by the mere passage of time and dependent on the manner and method by which they were preserved, if at all. The Commission also held that a variation of exert medical opinion cannot be labeled as negligence.

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Alleged negligence in a case of chronic renal failure requiring kidney transplantation who has infection in thigh at the site of veinflon insertion through which dialysis was repeatedly being performed. There was an arteriovenous fistula formation and gangrene leading to amputation of the leg and later death. The opposite did not appear in court. Allegations made by the complainant were duly supported by the sworn affidavit of the expert witness Dr. Prakash Tathed who has an extensive experience in this field. A compensation of Rupees two lakhs was allowed Chronic Renal Failure

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C. Sivakumat v. Dr. Jalin Arthur & Anr : the complainant, a 23 years old boy approached Dr. John for blockage in passage or urine ( phimotic penis) who took him another clinic for operation. After the operation there was over-bleeding from the penis and ultimately he had to admitted to Jipmer Hospital. The hospital authorities reported the matter to the police. Here he came to know that his penis had been cut off (amputated) and only a small stump had been left, and he was passing urine only through an artificial hole made at Jipmer Hospital. He, in the process, had become permanently impotent. Compensation of Rs.8lakhs was awarded to be paid by the first opposite party. Amputation of penis

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Jayantilal Govindlal Parmar v. Managing Trustee & Ors , the complainant was operated for gall stones, but subsequently he developed stricture near the bulbous urethra due to which he could not enjoy sex and could not pass urine easily. He ultimately had to be operated at a Urological Hospital for relief and heavy amount had to be spent due to negligent performance of his first operation. Complaint was dismissed ON FOLLOWING GROUND absolutely no evidence to establish that there was any negligence on the part of the opponent in performing the operation o July 30, 1992 and that it was a result of such negligence that second operation became necessary on account of negligence in performance of first operation… no certificate of the doctor of Urological hospital at Nadiad wherein it is alleged to have been stated that second operation became necessary on account of first operation on record. if the complainant was suffering from intense pain as alleged by him, he would not have waited for seven months to consult Dr. Rajaguru .

SUBH LATA v. CHRISTIAN MEDICAL COLLEGE (Punjab SCDRC O.C. No. 14 of 1994 decided on 15.6.1994; 1994 (2) CPR 691; 1995 (1) CPJ 365; 1995 CCJ 512:

SUBH LATA v. CHRISTIAN MEDICAL COLLEGE (Punjab SCDRC O.C. No. 14 of 1994 decided on 15.6.1994; 1994 (2) CPR 691; 1995 (1) CPJ 365; 1995 CCJ 512 complainant alleged that her husband died due to the complications arising after kidney biopsy. The State Commission held that the complainant had suppressed the crucial facts in her complaint. Besides serious life threatening diseases, the deceased was already suffering from tuberculosis and staphylococcus aureus septicaemia (a serious infection of the blood by bacteria). These are very serious diseases with a very high mortality rate especially when the heart, lung and brain get infected. Hence, the complainant had not come with clean hands and thus disentitled herself to relief under this jurisdiction of the C.P. Act. Complaint dismissed with Rs. 1,500/- as costs


SHIVAJI GENDEO CHAVAN v. CHIEF DIRECTOR, WANLESS HOSPITAL & Anr. Complainant’s 18-year-old son was suffering from chronic renal failure and was advised renal transplantation. He was admitted in the hospital and dialysis was done for which a venous catheter was introduced in the right thigh and kept in situ (same position of the body) as he would require frequent dialysis. But due to lack of proper care like frequent dressing and medical attention, this site developed pus formation leading to A.V. Fistula, which resulted in gangrene of the right leg. In order to save the life of the patient, amputation of the leg was necessary. The patient died after 20 days. The opposite did not appear in the State Commission . The case was decided in favour of the complainant on the basis of the affidavits filed by the complainant and another experienced doctor who testified in favour of the complainant. A compensation of Rs. 2,00,000/- with Rs. 1,000/- as costs


C.J. LAWRENCE v. APOLLO HOSPITALS complainant was admitted in a private hospital for pain in the neck on the right shoulder. Investigations reveled that he was a diabetic and had right hydronephrosis with obstruction at right uretrovesical junction. The complainant underwent surgery by retroperitoneal approach. The affected portion of the ureter was removed and uretric reimplantation was done. During the postoperative period, the complainant developed high fever and further investigations showed that a stapler pin was seen in the gastrointestinal tract.

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The complainant got discharged against medical advice. The allegation was that the pin was left there during the operation. The surgeon stated that the surgical staplers are V or U shaped and used in clusters in surgeries involving large intestine. The stapler pin seen in the x-ray is not a stapler pin. It resembles the stapler pins used un food pockets. Evidently, this stapler pin should have been swallowed. The State Commission held that there is no negligence or deficiency of service on the part of the hospital and dismissed the complaint without costs.

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A physician can be charged with criminal negligence when a patient dies from the effects of anesthesia during, an operation or other kind of treatment, if it can be proved that the death was the result if malicious intention, or gross negligence. Before the administration of anaesthesia or performance of an operation, the medical man is expected to follow the accepted precautions.

PREVENTIVE MEASURES How To Avoid Litigation:



LAW n the DOCTOR The physician should be able to prove that he used reasonable and ordinary care in the treatment of his patient to the best of his judgment. He is, however, not liable for an error judgment. The law expects a duly qualified physician to use that degree of skill and care which an average man of his qualifications ought to have. LAW does not expect him to bring the highest possible degree of sk ill in the treatment of his patients, or to be able to guarantee cures . Not defending yourself and hospital is negligence. We should always make all possible points in defense in first instance of making a reply to the complainant. Subsequent points during hearing of the case are liable to be rejected.


TECHNICAL DEFENSES The medical service rendered was free of charge (now, this is applicable in certain situations only). Concurrent adjudication in another court. The court does not have pecuniary/territorial jurisdiction. Complaint is time-barred. Complicate issues involved, required recording of evidence of experts, hence case should relegated to a civil court. Such a plea must be taken at the beginning of the trial. The complaints frivolous and vexations and liable to be dismissed under section 26 of the Act. Inform your insurance company in writing with a copy of the complaint.


FACTUAL DEFENSES Mention your qualifications, training, experience, expertise etc. Support with relevant documents. Mention hospitals infrastructure facilities, special facilities, back-up support, it with documents. Complainant has not come to the court with clean hands i.e. he has suppressed material facts, e.g. previous illness, treatment etc. Inconsistence between notices sent directly or through consumer groups and the complaint made in the court. Written evidence of consent of the patient/relative/attendant to assumption of inherent and special risks in the treatment.

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Circumstances of the case; viz. There was emergency, lack of facilities (e.g. rural area) no one to give history of patient’s illness etc. Burden of proof of: ( i ) duty of care; (ii) breach of that duty; (iii) causation; (iv) damage, etc. is on the complainant. Reasonable knowledge, skill and care exercised (Rely/quote standard text books with attested photocopies). Consolation/treatment by patient from other doctor/other systems of medicine simultaneously. Many other reasons/more than on reason/for occurrence of damage. Contributory negligence

criminal liability:

criminal liability Criminal liability of a physician may result from a high degree of negligent conduct. What the law calls criminal negligence is largely a matter of degree; it is incapable of a precise definition. To prove whether or not it exists is like chasing a mirage.

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Indian Penal Code, 1860 sections 52, 80, 81, 83, 88, 90, 91, 92 304-A, 337 and 338 contain the law of medical malpraxis in India. When a FIR (First Information Report) is filed against a doctor for the death of a patient who was under his treatment, under this Indian Penal Code Section 304-A the doctor can be arrested. A doctor charged under this section can obtain bail if proved guilty, the doctor can be punished with a maximum of two years imprisonment or fine or bo th. But, if the patient is alive, the doctor is charged under the Indian Penal Code Section 337 and 338 .

The reasonable skill & care:

The reasonable skill & care There are 3 aspects of reasonable skill and care 1. Medical 2. Social 3. Legal

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Medical aspect- First and foremost it is imperative for every doctor/ hospital/ nursing home to exercise reasonable skill and care expected of an average person with equivalent qualification and experience in similar circumstances. Social aspect- We should always exhibit our reasonable skill and care to the patient/ attendants/ relatives, through expressions, body language, actions and discussions. These must be visibly palpable. We may be very sincere but failure to exhibit these gestures may lead to doubts in the mind of patients and their relatives.

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Legal aspects- This includes documentation about exercising reasonable skill and care in consultation, diagnosis and treatment. This can be done by making good clinical notes of findings on examination and treatment given. Where there is failure to follow instruction, refusal for nay investigation and failure to come for review on specified date should always be recorded in underlined way. These negative records act as important tool while defending our cases in court of law. Proper documentation- Please make sure that your handwriting is legible.

Taking Stock:

Taking Stock The 21 st Century Patient Can benefit from laws that are more patient-centric Has more access to information – internet and hence more informed with more questions seeking answers Likely to be more cost-conscious The 21 st Century Doctor Is faced with the uncertainties in the law May be feeling over-regulated May not be equipped to deal with the recent demands unless he changes his mindset , practice EBM & document all he does

Rights and Privileges of Registered Medical Practitioners Conferred by the Indian Medical Council Act, 1956. :

Rights and Privileges of Registered Medical Practitioners Conferred by the Indian Medical Council Act, 1956. Right to choose a patient Right to add title, descriptions of the academic qualifications to the name Right to practice medicine Right to dispense medicines Right to possess and supply dangerous drugs to the patients Right to recovery of fees Right for appointment to public and local hospitals Right to issue medical certificates Right to give evidence as an expert in a Court of Law

Taking Stock :

Taking Stock Good News - Doctors are still most trusted! Source – A survey done by the Business Ethics Institute of Malaysia (BEIM), 2006

The Future:

The Future No national comprehensive statistics to capture medico-legal cases. Obvious Questions: Should we expect more consent claims? Should we anticipate a drop in the number of doctors in the riskier specialities? Should we expect more extensive and meaningful patient-doctor discussions? Should we expect higher standards of healthcare?

Do’s for Doctors :

Do’s for Doctors

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Mention your qualifications/ training/ experience/ designation on the prescription. Qualifications mean recognized degrees/ diplomas as regulated by the Indian Medical Degrees Act, 1916 as amended from time to time. Mention of scholarships/ membership/ awards which are no qualifications should be avoided. Always mention date and timing of the consultation. Mention age and sex of the patient. In a pediatric prescription weight of the patient must also be mentioned. Always put your hand on the part that the patient/ attendant says is painful. Apply your stethoscope on him, even if for cosmetic reasons. Listen attentively. Look carefully. Ask questions intelligently. If, after completing the examination, the patient/ attendant feels that something has been left out or wants something to be examined, oblige him. Always face the patient. Do not stare. Some patients tolerate very little eye contact. Learn to observe out of the corner of our eyes. In case you have been distracted/ inattentive during the history taking, ask the patient/ attendant to start all over again. He will never mind it. As far as possible consultations should not be interrupted for non-urgent calls. Ask the patient to come back for review the next day, in case you have examined him hurriedly or if you are not sure about the diagnosis/ treatment. Mention “diagnosis under review” until the diagnosis is finally settled.

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In complicated cases record precisely history of illness and substantial physical findings about the patient on your prescription. If the patient/ attendants are erring on any count (history not reliable, refusing investigations, refusing admission) make a note of it or seek written refusal preferably in local language with proper witness. Mention the condition of patient in specific/objective terms. Avoid vague/ non-specific terminology. Record history of drug allergy. Write names of drugs clearly. Use correct dosages (by revising knowledge periodically) and mention clearly method and interval of administration. Here one must use local or sign language. Do not forget writing precautions like Ast./ p.c./ a.c./ locally/ with milk/ h.s.etc. in local language. If a drug is a poison (e.g., certain local applications), warn in writing.

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Mention additional precautions, e.g., food, rest, avoidance of certain drugs, allergens, alcohol, smoking, etc., if indicated. Give instruction to the patient in comprehensible terms, making sure that the patient understands both the instruction and the importance of strictly adhering to them, e.g., while prescribing to potent anti-inflammatory drug, warn that if he experience any stomach trouble he should stop taking the drug and consult a doctor immediately. Mention likely side-effects, and action to be taken if they occur. Remember to advise in writing pathological tests/ radiological tests at specified intervals for certain drugs which require such monitoring if such drugs are prescribed. Some examples are: Sodium Valporate, Carbamezapine, Gold Salts, Methotrexate and other immuno-suppressives, Chloramphemicol, etc.

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Always advise the patient not to stop taking a drug suddenly which is required to be tapered before it is stopped. Remember major drug interactions. Specifically mention review, SOS/or follow-up schedule. Mention if patient/ attendant are/ is under effect of alcohol/ drugs. In case a particular drug/equipment is not available, make a note. Prescribe with caution during pregnancy/ lactation. Adjust doses in case of a child/ elderly patient and in renal or Hepatic disorders. In case of chronic ailments, mention treatment to be taken immediately in case of an emergency. For example, a patient on anti-epileptic treatment should be advised to take an injection of diazepam when convulsions occur.

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In case of any deviation from standard care, mention reasons. Mention whether prognosis explained. If necessary take a signature of patient/ attendant, after explaining the prognosis in written local language. Mention where the patient should contact in case of your non-availability/ emergency. If you are not sure what disease a patient has after a through work-up, get a consultation. Develop a lost of physicians you trust and respect in each of the specialties. Nurture your relationship with them, and consult them about difficult cases. Whenever referring a patient, provide him with a referring note. In case of emergency/ serious illness, ring up the concerned doctor in the patient’s presence. Show your concern.Always keep with you and refer the latest edition of the standard text book of your branch of medicine. Always subscribe to at least one standard journal and participate in at least updates/ conferences every year.

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Update your knowledge and skill from time to time. If a doctor does not keep pace with recent advances, the quality of care suffers and does not measure upto the standards of reasonable care and skill. Many doctors tend to deteriorate in their knowledge, skills and attitude, over a period to time. Not only do they not make any attempt to update themselves but they slip downwards. (Doctors may become incompetent due to other causes: age, mental illness, addiction to alcohol or drug abuse.) Update not only your own knowledge and skill, but also that of your staff. Update the facilities and equipment according to prevailing current standards in your area.

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Preferably employ qualified assistants. If not available, impart proper training and skill at your or some appropriate centre and obtain a certificate for the same. Medication to relieve pain especially in post-operative and cancer cases must be carried our carefully. Always obtain a legally valid consent before undertaking surgical/ diagnostic procedure. Learn the difference between “informed persuasion” and “informed consent”. The first is legally wrong, through at times it may be medically correct. In case of MTP/ Sterilization, always follow the guidelines issued by the Government of India (See Appendix VI in Medical Profession and Consumer Protection Act, 1994 edn.)

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While administering an injection/vaccination always check: 1. Name of the injection (a wrong injection may be given by mistake or    oversight); 2. Expiry date; 3. Reconfirm the route of administration; 4. If it is to be diluted, check the dilution factor (1:2, 1:4 etc.); 5. Rate of administration (fast, slow, in drip, etc.); 6  Site of infection, e.g. antero-lateral, thigh, if age 1 year, gluteal region, deltoid, etc.; 7. That a disposable syringe and needle are used. If that is not possible, use syringe and needle after proper sterilization. 8. In case the patient is agitated/ not co-operating, restrain him properly with 1 or 2 assistants or wait until he calms down. It is not unusual for a broken needle leaking to a claim for compensation; 9. Confirm that it has been kept at the required temperature; 10 If required to be reconstituted, check the diluent and whether it has got to be cooled before using.

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Routinely advise X-rays in injury to bones and joints and related diseases of bones/ joints. Always rule out pregnancy before subjecting the uterus to X-ray. Always read reports carefully and interpret the results of tests/ X-rays properly and make a note of it. In all instances of “swab cases” and “instrument cases”, the surgeon in charge has been directly or vicariously held liable for negligence. The surgeon in charge must therefore personally ensure that such mishaps do not occur.The period for the responsibility of the surgeon extends to and includes the post-operative care. He must therefore ensure proper post-operative care to the patient. Always seek proper legal and medical advice before filing reply to the complainant referred to you from a consumer court

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