It took two long months for a Delhi hospital to throw in the towel. It took just two short days for Jayant K. Bhuyan, 58-year-old senior executive of the Confederation of Indian Industries, to lose his life on the operation table.

Number of complaints against doctors for negligence has gone up, but in the absence of information, no one really knows how many such cases occur.

Just because someone inadvertently put in a wrong tube of oxygen into his brain. Stunning as it was, it wasn’t a one-off. Just a few months back, the apex court hauled up a Hyderabad hospital for a surgery that left a man paralysed; in Chennai, a woman went in for tubectomy and lost her bladder; in Kolkata, a man died during chemotherapy after being injected in the spine instead of the vein; in Mumbai, a baby declared dead was found alive at the time of burial; the Delhi High Court brought to book a private hospital for the death of a boy due to “accidental” laser sparks from a machine; the apex court declared that patient’s consent is essential as a woman’s uterus was removed without her consent in Delhi.

Physician, heal thyself? The good news is, the medical fraternity is sitting up and taking note. “Mistake, mishap, mischief, call it what you may, the sacred covenant of trust inherent in the doctor-patient relationship is starting to crumble,” says Dr C.P. Kamle, a hospital planning and management expert based in Hyderabad.

Ever since the Supreme Court brought the patient-doctor relationship under the ambit of the Consumer Protection Act in 1995, the number of complaints against doctors has gone up. But in the absence of information, no one really knows how many such cases occur. Also, the law does not clarify the difference between “gross negligence”, “error of judgement”, “accident” and “recklessness”.

Of the 110 cases that came to the Delhi Medical Association between January 2007 and April 2008, negligence was proved in just 34. The 4 most common lapses that doctors across the country believe the medical fraternity needs to guard against and what needs to be done:

1. WHAT SURGEONS FORGET

The most common medical blunder in India. Scissors, gauze, towels, screws, forceps, metal clamps- the list of objects surgeons leave behind inside patients’ bodies is alarming.

“It’s one of the most persistent but poorly understood medical errors,” says Dr Arvind Kumar, professor of surgery at the All India Institute of Medical Sciences (AIIMS). New research shows that certain factors increase the risk of such mistakes. A 2003 study on 29 million surgeries published in The New England Journal of Medicine showed that items are more likely to be left inside in an emergency surgery or if there’s an unexpected change in procedure. The former was found to increase the risk of this type of error ninefold and the latter fourfold.

Prescription: Apart from stricter laws to penalise offending surgeons and heavy compensation for patients, hospitals need to streamline operation procedures.

2. COSMETIC GOOF-UP

Don’t treat a nose job or a breast augmentation as simple lunch-time procedures. These are real surgeries with the real risk of disfiguring your forever.

“Cosmetic surgery patients consider themselves consumers, not patients,” says Dr Sunil Chaudhary, head of aesthetic & reconstructive plastic surgery, Max Healthcare, Delhi. The five common cosmetic surgery mishaps are: inappropriate doses of botox injection that cause expressionless faces; cheaper breast implants that rupture or leak; excessive skin stretching during facelifts, giving a too-tight look; large volume liposuctions done in ill-equipped clinics that lead to fluid overload in the body and serious heart-lung complications; aggressive removal of nose cartilage, giving a pinched appearance.

Prescription: The Medical Council of India (MCI) must blacklist quacks and de-recognise such surgeons; patients need to be empowered with information on safety standards.

3. REMOVING WRONG PARTS

Doctors amputating the wrong foot or removing the wrong kidney-hundreds of such surgical gaffes occur every year.

An urban myth? Think again. There was a stream of reports last year on such surgical gaffes. This month, in a tragic mix-up, blood transfusion meant for one patient was given to another in a premier Delhi hospital as his bed had changed, causing severe blood reaction. “Most of these happen because doctors don’t listen,” says Dr Prashant P. Joshi, cardiologist with the IG Government Medical College in Nagpur. “A study shows 90 per cent doctors interrupt patients in the first 20 seconds of their conversation.” Besides that, in wrong-site surgery, several factors almost certainly come into play, from a series of small but crucial mistakes by several people who dealt with the patient to flaws in a hospital’s operating procedures. “It is individuals making several mistakes and systems not being able to prevent those mistakes,” adds Joshi.

Prescription: Apart from criminal action against rogue surgeons and hospitals, the MCI should cancel licences of the doctors involved. Also upgrading the checks in place for such operations is the urgent need of the hour.

4. NOT ENOUGH ANAESTHESIA

Waking during surgery and feeling pain without being able to cry out. Not just a horror-movie staple. They do happen in reality.

Many surgeons mention that they have faced this in the OT. Several studies have found “anaesthesia awareness” to be a 1-in-1,000 occurrence, with an estimated 20,000 to 40,000 patients waking up from general anaesthesia each year and one-fourth reporting pain. Anaesthesia typically consists of three medications: a paralytic to ensure the patient doesn’t move, a hypnotic to induce unconsciousness and a narcotic to numb pain. “It’s the combination of these drugs in their various doses that determines the depth of unconsciousness,” says Dr G.P. Dureja, anesthesiologist and head of the Delhi Pain Management Centre. Apart from faulty drug dosage, breakdown or misuse of equipment, patient health status and lack of expensive monitoring technology can also cause anaesthesia to fail, he explains.

Prescription: Make it mandatory for hospitals to install hi-tech monitoring devices, like the bispectral index, that enable doctors to know the depth of consciousness in a patient during an operation.

 

Source: IndiaToday

 

By Priya (13 Posts)