The Consultation Room

Prof. Dr. CMK. Reddy

General & Vascular Surgeon, Halsted Surgical Clinic, Chennai, Tamilnadu, India

Chapter 56: Medicolegal procedures

There is no bar against a private practitioner to treat accidents, poisonings or other medicolegal cases, provided prescribed procedure is followed. As mentioned already, the Doctor has to exercise extreme caution in taking history given by them for granted. Proper recording of history, physical findings and initiate immediate treatment required.

At the earliest opportunity, Police has to be informed as to the nature of the incident, either by phone or a letter of intimation. The time, date of phone message, name, designation & the service number of Police officer received, has to be noted. If a letter is delivered, an acknowledgment of time received on the counterfoil, with the seal of the Police Station, is essential.

When a Police officer arrives to take statement from the patient &/or attendant, the Doctor has to certify that the patient is in a physically and mentally fit condition to make the statement to the investigating officer. After the first aid, the Doctor shall decide if the patient requires hospitalization, for further management.

If the patient is critically ill, with uncertain outcome, the investigating officer may invite a judicial officer to record dying declaration from the patient or if a judicial officer is not immediately available, he may decide to record the declaration himself and proceed with further investigation. In any case, you have to certify that the patient is physically and mentally fit to make the declaration.

We all know that ‘an apple a day, keeps Doctor away’ but in the present scenario, it’s more important for the Doctor to keep the ‘lawyer away’. Fortunately in Indian law, if there’s a complaint against a ‘qualified, registered’ professional, the burdon of proof lies on the plaintif.

In USA, it’s the other way, the professional has to prove that he’d done the right thing, which makes all the difference. The Supreme Court of India clearly stated that saving a patient’s life is more important duty of the Doctor than the legal formalities and provided immunity against any subsequent harassment by the investigating officer.

These are some examples, when complaints against doctors are commonly leveled by the public or the government:

Professional negligence, incompetence or deficiency of service.

Performing additional procedures without patient’s consent.

Deliberately issuing wrong or misleading certificate.

Unlawful behavior with patients of opposite gender.

Performing procedures, such as prenatal gender determination, abortion without valid medical indication or for female genocide, organ transplantation with commercial interest etc.

Chapter 57: Accident register & wound certificate

Accident Register is more relevant in Govt institutions, otherwise the method of recording usually followed by you may be acceptible, but in a more detailed manner. On the written requisition of the investigating officer, the Doctor has to give him a summary of history and treatment details, including a proper wound certificate of the patient, as early as possible.

The accidental wounds are classified by their severity and risk to life, as simple, grievous, dangerous or fatal. Dangerous implies, without prompt treatment, the wound may be fatal.

When I was doing residency in US, working in emergency room, a 5-yr child was brought with an injury to forearm. Finding no fracture in the x-ray, I called the consultant for advice.

To my surprise, he asked me to take x-rays of all the limbs for the child. The reason given by him was shocking; after leaving the hospital the father might intentionally break the other forearm or leg of the child, get an x-ray in some other hospital and sue this hospital for ‘missing’ a fracture. Unfortunately, we are living in materialistic world and such atrocious things can happen.

Chapter 58: Request for postmortem examination

If the patient expires in the consultation area, with or without treatment, the matter has to be reported to Police and request for a postmortem examination. Such forethought would avoid much afterthought, in terms legal formalities and responsibilities.

The sequence of events from the time the patient came or brought into consultation room, have to be noted in detail and preserved for future use. Another advantage of requesting for an autopsy is, it gives a clear indication of transparency of your action, besides being educative.

Inspite of your written request, if autopsy was not done for some reason (at the discretion of the investigating officer), it’d serve as a strong point of defense, in the event there’s any litigation against you later.

Chapter 59: Visit of law enforcing officers

Any Govt. officer belonging to Police, Local Administration, Pollution Board, Labor, Income Tax, Professional Tax, Electricity Board, Water & Sewerage dept. may visit your office. It’s prudent to cooperate with them, offer them coffee to keep them in ‘good humor’.

If they find any deficiencies or problems, you can request them to suggest remedies and assure them that those suggestions would be complied as soon as possible. Most of the issues arise out of improper documentation. Of course if the problem is so gross that may invite penal proceedings, you have to face them as best as you can, with the help of your lawyer or auditor.

It’s important to know the Labor laws, in giving minimum wages, other allowances and benefits for your staff, including weekly leave, paid maternity leave, provident fund (if the total number of staff exceeds 20) and retirement benefits. Different Registers have to be maintained to show your compliance to the rules, which will be periodically perused and endorsed by the visiting Officers.

Chapter 60: Visit by social friends

A system has to be evolved to handle someone coming on a personal matter, such as a friend coming to give invitation card to a marriage, a function or dropping in for a courtesy call. Since it’s unfair to make them wait for too long, the receptionist has to be instructed to bring such cases to your notice as soon as possible and dispose them early.

Also it’s important that the Doctor doesn’t spend too much time in casual chat with them, in the midst of busy consultation time, forcing the waiting patients to become impatient. Sometimes after they come in as a ‘social’ visit, they start talking about their illness.

The matter has to be dealt diplomatically, without hurting their feelings and give them an early appointment to see them in ‘detail’, asking them to bring their old medical records for review.

The Consultation Room