MEDICOLEGAL ASPECTS IN MEDICOLEGAL ASPECTS IN

OPHTHALMOLOGYOPHTHALMOLOGY

Dr. S. C. BataliaDr. S. C. BataliaBatalia Eye HospitalBatalia Eye Hospital

Dr. Batalia Road,Dr. Batalia Road,Jabalpur.Jabalpur.

EthicsEthics

UnethicsUnethics

Gone are the days when doctors were considered next to GOD. There was a general belief that he is LIFE Savior.

BUT NOW A DAYS With changed circumstances the doctors are given suspicious look. Inspite of the thorough knowledge

Specialization in the subject and with the best efforts invariably has to undergo many allegations.

Doctors should always accept cases only in which he has mastered.

A medical council registered doctor is not allowed to undertake any other business or profession.

INTRODUCTION

CARRYING OUT A SURGERY without informed consent would result in criminal liability as well as civil liability for paying compensation.

Obtain written consent for any procedure that carries risks, hazards, complications, or that has an alternative surgical procedure; determine what reasonable prudent patient would want to know about proposed procedure; if procedure refused, document informed refusal with supporting evidence, and KEEP a copy as evidence and data that support decision to perform procedure; documentation that you “discussed with patient per usual customary practice”, what you discussed.

IMPORTANCE OF INFORMED CONSENT

Use lay language, not medical terms (particularly

for informed consent); do not criticize previous

physician’s actions; maintain user-friendly

telephone system; make sure patients have

emergency access to physician; ensure access for

those with language or physical barriers; return all

calls

COMMUNICATING WITH PATIENTS

Acts as “number one” witness in litigation; contains

documentation of examination, information used to

make diagnosis and treatment plan, and results of

continuing treatment; records should be as thorough

as possible; note and date any changes to chart and

reason for change

MEDICAL RECORD

Endophthalmitis occurs in best of hands

in best of set ups.

Endophthalmitis occurs in best of hands

in best of set ups.

Only people who do not get

endophthalmitis are those

who do not operate.

Intra-ocular infection has always brought disrepute to the ophthalmologist and this problem is not only rampant at eye-camps but also in hospitals, which include the five star ones. Only surgeon who does not have endophthalmitis is the one who does not operate. The problem is general and it is not the surgeon who is to be blamed although he is responsible for surgery. Despite the best possible care, mishaps cannot always be avoided because the error in one link of the entire chain may sometimes result in a disaster.

INTRA-OCULAR INFECTION

IF YOU HAVE A MISFORTUNE OF INFECTION THEN HOW TO SAVE YOURSELF ?

Record all findings including vision-including projection of rays, intraocular pressure, status of cornea, anterior chamber reaction, pupillary reaction, details of iris, IOL (if present) and fundus. Get B-Scan ultrasound done.

Record them daily and keep a copy with you. Do not do telephonic treatment. eg. if patient calls up in the

night and complains of pain, redness, watering and if you tell him to continue or add steroid drops, then this is asking for a disaster. That means that instead of giving telephonic treatment tell the patient to go to nearby ophthalmologist available and show to him.

Patient who is on treatment for endophthalmitis, see him daily and always write on the prescription to report SOS. If patient is from far flung area write on his card or prescription slip that in case of any pain or redness or decreased vision or unusual symptoms report to nearest ophthalmologist and mention “do not ignore.”

Even at the cost of … please document, document & document. When in doubt seek peer review, refer to retinal surgeon or

hospital. Involve multiple people or hospitals to safeguard you. Greatest malpractice risk associated with endophthalmitis-

Analysis of claims show that liability arises from a delay in diagnosis or treatment, including a delay in referring the patient to a vitreo-retinal specialist.

IF YOU HAVE A MISFORTUNE OF INFECTION THEN HOW TO SAVE YOURSELF ?

1. A Doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.

2. It is also held that in the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and a doctor is not negligent merely because his conclusion differs from that of other professional men. It was also made clear that the true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.

1. A Doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.

2. It is also held that in the realm of diagnosis and treatment there is ample scope for genuine difference of opinion and a doctor is not negligent merely because his conclusion differs from that of other professional men. It was also made clear that the true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.

Chief Justice of India Bench

After laying down the law, the learned Chief Justice Shri Lahoti opined that in cases of criminal negligence where a private complaint of negligence against a doctor is filed and before the investigating officer proceeds against the doctor accused of rash and negligent act, the investigating officer must obtain an independent and competent medical opinion preferably from a doctor in Government service, qualified in that branch of medical practice. Such a doctor is expected to give an impartial and unbiased opinion applying the primary test to the facts collected in the course of investigation. Hon'ble Chief Justice suggested that some statutory rules and statutory instructions incorporating certain guidelines should be issued by the Government of India or the State Government in consultation with the Medical Council of India in this regard.

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English lexicons trace it to the Sanskrit word “Swadha” which briefly connotes a sense of self respect that as a mere custom denies you the right to do anything wrong.

DEFINITION OF ETHICS

Medical ethics is an area that has particular interest for the general public and as well as the medical practioner, and issues concerning medical ethics seem to be constantly in head lines.

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it is of utmost importance to remain within the

accepted norms. With the growth of population,

the size of cities number of doctors and the

specialty in our subject has increased. Besides

the expenditure as capitation fee for admission

in Medical college and enormous cost of

ophthalmic instruments to equip a new eye

clinic one would definitely like to recover the

cost at the earliest by all means.

it is of utmost importance to remain within the

accepted norms. With the growth of population,

the size of cities number of doctors and the

specialty in our subject has increased. Besides

the expenditure as capitation fee for admission

in Medical college and enormous cost of

ophthalmic instruments to equip a new eye

clinic one would definitely like to recover the

cost at the earliest by all means.

EthicsEthics

UnethicsUnethics

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The Technology and machine dependency is another factor influencing our ethics. In the company of our gadgets we become machine like and behave machine like. The tension of very high investment and competition and high bank installments compel us to change our attitude to the patients sitting across the paper. We become market driven forces and accept so many unethical practices as normal.

WHERE TO BALANCE :WHERE TO BALANCE :

How the Ethics play role in technologies let me take the specific causes in points

How the Ethics play role in technologies let me take the specific causes in points

The mostly widely quoted technology to hit the

market is the use of Phaco in cataract surgery. Wide publicity has given the patients a feeling that this is the ultimate laser cataract surgery. False premature claims have been made not only in the press and media but putting big hoardings Waveform Phaco, Cold Phaco, ICE Phaco better than Cold, Micro coaxial

phaco. Cataract removal in 30 seconds. Similar

gimmicks keep appearing to project oneself as great surgeon and researcher.

(No individuals, Organizations or (No individuals, Organizations or

Institutions are Implied please excuse) Institutions are Implied please excuse) (No individuals, Organizations or (No individuals, Organizations or

Institutions are Implied please excuse) Institutions are Implied please excuse)

Where to Balance :Where to Balance :

How the Ethics play role in technologies let me take the specific causes in points

How the Ethics play role in technologies let me take the specific causes in points

Pain Less

Suture Less

NO INCISION Cataract Surgery

(No individuals, Organizations or (No individuals, Organizations or

Institutions are Implied please excuse) Institutions are Implied please excuse) (No individuals, Organizations or (No individuals, Organizations or

Institutions are Implied please excuse) Institutions are Implied please excuse)

Where to Balance :Where to Balance :

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With the introduction of Lasik surgery there has

been an outburst of advertising in the lay press

by projecting the names of the surgeon in place

of hospital. Patient awareness of the different

procedures and their benefits and limitations are

often flawed. One doctor says that he doing

Zyoptix and the other doctor is doing LASIK. It is

well known to all of us that lasik is name of the

operation may be by wavefront, fematosecond or

by any costly laser machine.

How the Ethics play role in technologies let me take the specific How the Ethics play role in technologies let me take the specific causes in points causes in points

How the Ethics play role in technologies let me take the specific How the Ethics play role in technologies let me take the specific causes in points causes in points

Where to BalanceWhere to Balance

(No individuals, Organizations or Institutions (No individuals, Organizations or Institutions

are Implied please excuse) are Implied please excuse) (No individuals, Organizations or Institutions (No individuals, Organizations or Institutions

are Implied please excuse) are Implied please excuse)

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It is admitted that the people have the right to know not only the opening of new clinic or hospital but the development of latest equipments and new operations & researches. For this purpose press conference can be organized.

NEW CLINIC OR HOSPITAL

The media is already ridiculing the medical men for greed & neglect. The phenomena of fall of prestige of this so called “Noble Profession” needs to be explored and investigated. Are we loosing the ethics of this profession? Are we getting more commercial & business like? Are we playing with the Hippocrates oath?

He further quotes Ethics the science of morals are a very must for every profession and infact for the smooth running. Unfortunately, ethics as a subject has no definition and no discipline. Ethics also tend to differ with time, place & culture.

Dr. P. N. Nagpal says :-

Communication with the public must be accurate. They must not convey false, untrue, deceptive or misleading information through statements, testimonials, photographs or by means particularly through the news media & PAID NEWS. Communication must not misrepresent ophthalmologist’s credentials, training, experience or ability, and must not claim of superiority

COMMUNICATION TO THE PUBLIC

COMMUNICATION TO THE PUBLIC

Some people work on the hypothesis

that there is nothing ethical or

unethical, only thinking makes it so.

Also, it will be wrong to presume that

whatever is not illegal is ethical, since

there is a wide gap between ethical

and lawful activities. Every unethical

practice by any member of profession /

society will harm the already fading

reputation of the medical profession.

At one time known as “Healing Physicians”“Healing Physicians” we are slowly converting into commercial corporate with specialties, doctor, opticians & pharma as partners.

We have guided missiles but misguided men

Ethical practice is decided by one thing and only one thing “Good of the patient and community”

At one time known as “Healing Physicians”“Healing Physicians” we are slowly converting into commercial corporate with specialties, doctor, opticians & pharma as partners.

We have guided missiles but misguided men

Ethical practice is decided by one thing and only one thing “Good of the patient and community”

To reduce medico-legal problems for ourselves, it is important to practise the Golden Rule in our professional life:

1.Do not do to your colleagues what you do not wish them to do to you

2.Avoid cheeky remarks and criticisms.

3.Recognise that complications do occur even in the best of hands. "The only surgeons who does not have complications is the surgeon who does not do any surgery.

4.Do not say to the patient that the best person to do this kind of surgery is Dr so-and-so.

GOLDEN RULESGOLDEN RULESGOLDEN RULESGOLDEN RULES

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Be demonstrably true in all respects. Not be misleading vulgar or sensational Maintain the decorum and dignity of the profession Not contain any testimonial or endorsement of

clinical skills. Not claim that one doctor is superior to others nor

contain endorsements for any particular doctor. Avoid aggressive forms of competitive persuasion,

such as those that prevail in commerce and industry.

GOLDEN RULESGOLDEN RULESGOLDEN RULESGOLDEN RULES