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 Table of Contents    
 
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 47
The growing legal responsibilities of a family physician

 
   Suggested precautions 
  1. Family physicians have different and in fact greater responsibility vis-ΰ-vis the other doctors. Ensuring that the diagnostic tests advised are duly performed by the patient and the patient is regular in proper follow-ups, especially in cases of serious, critical, or complicated ailments, are two such responsibilities that have been very specifically pointed out by the court in this case. (The court has very specifically taken note of the fact that the patient and her family members were taking treatment from the physician (OP) for the past 20 years, and hence, the court referred to and assumed him to be a "family physician" and further observed that "Sometimes family physicians are simply too busy to follow-up with patients. … In today's environment of ever-increasing complicated medicine, it is the responsibility of the family doctor to ensure that diagnostic tests are performed and follow-up is being made").
  2. The duty to refer the patient to another doctor/facility cannot be delegated by the doctor-in-charge of the patient to anyone else. In this case, the physician (OP) referred the patient to a sonologist for ultrasound (USG) and the sonologist referred the patient to another hospital. The court viewed this very seriously and observed that the physician (OP) "has delegated his duty of referral through the diagnostic center to send the patient to some other hospital; it appears that OP (physician) has waddled out of his responsibility".
  3. Miscommunication has increasingly been acknowledged as the source of medico-legal problems. The court has specifically observed in this case that "A communication lapse among physicians, their patients, and other health care providers is frequently the focus of medical negligence claims".
  4. Inform the patient specifically of the diagnosis, provisional or final. Record the same in the patient's medical records. (The court has held in this case that failure to communicate a diagnosis after it is made is negligence).
  5. Every patient who is referred must be given a referral note. The referral note must have the requisite information about the patient's history, treatment given, and so on.
  6. Hospitals must preserve the medical records carefully and produce them in the court at appropriate time. Failure to do so forces the courts to draw adverse inference against them. (In this case, the court has taken note of the fact that the physician (OP) did not produce a single document or medical record showing the past treatment of the deceased [patient]).



   Facts of the case Top


The patient and her family members used to take treatment from the physician (OP) for the past 20 years. The patient consulted the physician (OP) for severe abdominal pain as an OPD patient. Next day, the patient again consulted the physician (OP) and complained of unbearable pain in the abdomen. The physician (OP) referred her to a sonologist. USG was done on the next day and the sonologist telephonically informed the physician (OP) about the report. The patient was diagnosed with "chronic ulcer disease." The sonologist referred the patient to a hospital where another doctor referred the patient to a second hospital after examining the USG and this second hospital referred the patient to yet another third hospital where she was admitted. The patient expired at around 9:00 p.m. on the same day after being referred to three hospitals one after another.


   Patent's allegation/s of medical negligence Top


  • It was alleged that there was a delay in both diagnosis and referral by the physician (OP).
  • It was alleged that on the first day when the patient was examined by the physician (OP) or at least on the next day when she was examined, she ought to have been admitted in the nursing home, but was only referred for scanning by the physician (OP).



   Findings of the court Top


The court observed that as the physician (OP) was the family physician of the patient, it was his duty to:

  • Diagnose and make referrals at the appropriate time and also to communicate the same to the patient and
  • Ensure that the diagnostic tests are performed by the patient and the patient comes for follow-up.


The court drew adverse inference against the physician (OP):

  • For not producing in the court a single document about the treatment and advice given to the patient or about the past treatment of the patient;
  • For failure to advice USG during earlier visits; and
  • For referring the patient without giving any previous history.


The court also questioned as to how the sonologist could refer the patient to another hospital without the physician (OP) coming into the picture. The court observed that perhaps the surgeon (OP) had "delegated his duty of referral through the diagnostic center to send the patient to some other hospital; it appears that the surgeon (OP) has waddled out of his responsibility".

Hence, the physician (OP) was held negligent.



 

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