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    Suggested precautions
   Facts of the case
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 Table of Contents    
 
Year : 2016  |  Volume : 9  |  Issue : 9  |  Page : 149
A literate patient signing consent form - The best safety net for doctors

 
   Suggested precautions 
  1. Illiterate/less literate patients must be dealt with greater care and caution. Even mundane aspects need to be explained in detail and that too with greater care and clarity. It is advisable that consent of such patients is also attested by an independent witness. Such precautions are not that strictly required in case of literate patients. This case is an excellent illustration of the aforesaid. It was alleged that "consent was obtained from the patient and husband on the dotted line on a blank form." The court rejected this allegation observing that "It is pertinent to note that the complainant (patient) herself is an advocate and not an illiterate person, both have signed the consent form of their own volition."
  2. For all endoscopic/laparoscopic procedures, open surgery is also an alternative. The patient must be informed about both the options and consent must also be taken for both. (In this case, one of the allegations was that "instead of laparoscopic surgery, the OP (surgeon) performed open cholecystectomy").
  3. The patient must be given relevant information in comprehensible terms, given time to contemplate and take decision, and only then signature on the consent form must be taken. (In this case, one of the allegations was that "consent was obtained from the patient and husband on the dotted line on a blank form." The court found that the surgeon (OP) had "explained about surgery to the complainant (patient) and her husband in detail, thereafter both had signed the consent form" and hence rejected this allegation). ,
  4. Failure of the patient to follow medical advice must be specifically recorded. This protocol is all the more mandatory when advice is given for corrective actions for post-surgery complications or for complications during the course of treatment. (In this case, the patient developed extra hepatic obstruction to the bile flow after cholecystectomy. The court drew adverse inference as the patient was advised re-exploration for the assessment of complication and corrective surgery but the patient refused to get re-admitted and instead chose to go to other doctors and that too after 3 weeks).
  5. "Not all medical injuries are the result of negligence" observed the court in this case where the patient who had undergone cholecystectomy suffered post-surgery obstructive jaundice. The surgeon (OP) was not held negligent.



   Facts of the case Top


The patient was diagnosed with gall stones and approached the surgeon (OP) who performed cholecystectomy. The patient was discharged after 3 weeks. The patient developed extra hepatic obstruction to the bile flow, which subsequently developed into obstructive jaundice. The patient approached another hospital where an end-to-side jejuno-jejunostomy was performed.


   Patient's allegation/s of medical negligence Top


  • It was alleged that the consent was obtained from the patient and her husband on the dotted line on a blank form.
  • It was alleged that instead of laparoscopic surgery, as promised, the surgeon (OP) performed open cholecystectomy without explaining the consequences.



   Doctor's defense Top


  • It was stated that the surgeon (OP) explained in detail about the surgery to the patient and her husband, and thereafter, both signed the consent form.
  • It was pointed that iatrogenic injuries are noticed during postoperative follow-ups in more than 85% of cases of cholecystectomy. It was further stated that the complication was promptly diagnosed during the follow-up, and the patient was advised to get admitted for corrective measures but she did not do so.



   Findings of the court Top


  • The court found that the consent form was a printed one and was signed by the patient and her husband. The court observed that "It is pertinent to note that the complainant (patient) herself is an advocate and not an illiterate person, both have signed the consent form of their own volition."
  • The court agreed that extra hepatic obstruction is a known complication of cholecystectomy. The court observed that "the post-operative complication was not due to any negligence during surgery performed by the surgeon (OP)…Not all medical injuries are the result of negligence."
  • The court drew adverse inference as the patient was advised re-exploration for assessment of complication and correction; however, instead of getting re-admitted for corrective surgery, the patient chose to go to other doctors after 3 weeks after being advised to do so by the surgeon (OP).
  • Hence, the surgeon (OP) was not found guilty of negligence.



 

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