The Consultation Room

Prof. Dr. CMK. Reddy

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

Chapter 61: Visit by medical representatives

Specific time may be allocated to see medical representatives, to avoid interruptions during regular times. It’s ethical that we don’t make them wait inordinately in our office, since they are considered as ‘paramedical’ professionals.

It requires a restrained mindset, not to accept ‘gifts’ from them, who expect some ‘favors’ and the Medical Council strictly prohibits such ‘transactions’. It requires some level of maturity, not to be influenced by such ‘gestures’ in your prescription pattern.

Often the other way is true, since we are already supporting them by prescriptions strictly by professional considerations, they may want to show their gratitude. To request them to bring sample medicines for personal use is very tempting and may not be very objectionable. Similarly asking them sponsor a medical conference or CMEs, is also not desirable, but may be better than asking for personal favors.

Chapter 62: Attitude towards co-practitioners

This subject of giving appointments to a Doctor coming as patient or accepting fees for professional services has already been discussed. In Indian scenario, one of the common causes of litigations against medical profession is the attitude of ‘one-upmanship’ by the Doctors. A loose, uncharitable remark made by a Doctor, about the treatment given by another Doctor, sets the ‘legal ball’ in motion.

This kind of attitude is often seen in consultants practicing in large or corporate hospitals. It’s neither ethical nor good ‘business’, sitting in ‘ivory towers’, to pass an unfair judgment on the practitioner treated the patient earlier (or who might actually have referred the patient to the hospital, you’re working), not realizing under what working conditions the Doctor might be practicing or gave such treatment.

In legal parlance there’s an expression called ‘benefit of doubt’. It means, when there is a doubt if a particular witness should be relied upon or not, the benefit of such doubt has to be given to the accused. But it’s a pity that we don’t give that kind of benefit to our own colleagues (due to professional jealousy), not realizing that tomorrow we may be at the receiving end, in this free world.

When a patient puts very insinuating questions about the treatment given by the previous Doctor, in all wisdom, it’s best to brush them aside by saying ‘he had done what he thought was best, under those circumstances and no point in discussing it now, let’s see what has to be done further’.

A generous minded Doctor may even go one step above and say that ‘under those circumstances, I also might have done the same thing’. This statement should put all their doubts and possible legal thoughts to rest. Certain expressions to be avoided during counseling of a patient or in discharge summaries, are indicated in Chapter 35.

Chapter 63: Issuing certificates

Any Registered Medical Practitioner (RMP) has to be extremely careful while issuing a medical certificate. The common purposes for which a medical certificate is required : illness, fitness, disability, old age pension, vaccination, estimate for treatment/surgery, leave from work, court attendance, accidents, medicolegal matters, death and postmortem.

Medical certificate is very valuable that utmost care has to be exercised without falling prey to helpful temptation, monetary consideration, compassion, humanitarian feelings or any extraneous pressure.

Our teachers cautioned us that while issuing a certificate, at least verify for yourself, if such a person exists at all, the question of illness or other details mentioned, can always be debated.

Secondly, since no one can question your judgment, once a certificate is given and you honestly think it’s true and just, stick to your opinion, to any level.

A Professor of Forensic Medicine was called to court, to give expert evidence. The opposition lawyer pointed out that some opinion expressed by him (Professor) was contrary to what was given in a standard text book (Modi’s Jurisprudence).

The professor replied ‘what I said was my opinion, what’s in that book was his opinon. Only differene is, that guy had the time to write a book. You take whatever you want’.

Chapter 64: Updating CMEs & Workshops

It’s said that every year, 10% of scientific information we have, becomes outdated or obsolete. Hence if we don’t often keep updating our knowledge and skills, after some time, what we think or what we do, may not be acceptable scientifically or legally.

Further, we are living in the era of evidence-based medicine and we should restrain treating patients out of our anecdotal experience. With the mind-blowing information technology, you can access any subject any time.

It’s really astonishing how the Google has compiled so much information about virtually anything and everything under the sky and may be beyond. Of course, other venues of knowledge updating is by standard books, monograms, scientific journals and continuing medical education (CME) programs. It takes profound determination by the Doctor, to adopt evidence-based protocols at all times, overriding strong personal beliefs and convictions.

Generally patients prefer Doctors who have academic bent of mind, interested in attending conferences, give lectures, contribute articles in journals, give TV interviews on health matters etc. If a Doctor can strike a ‘healthy’ balance between academic interest and delivering expedient service, tailored to individual patient, he will be very successful. Someone explained why they’re called Workshops : if there is no work, we can do shopping!

Chapter 65: Periodic recertification

The Govt of India, on the recommendation by the Medical Council of India (MCI), had passed a rule in 2002, that every Medical Practitioner should renew his licence to practice once in 5 years and during this period, by attending minimum 30 hours (one hour every 2 months) of CME, preferably in his specialty, conducted by a Medical Organisation, recognized by the State Medical Council, for the purpose.

Unfortunately, neither the 10 lakh-odd Practitioners in India nor the State Medical Councils have made serious attempt to implement it, though it’s for their own good in improving the quality of medicare, especially in rural and suburban areas. It’s an irony that we can’t drive a car without renewing licence, but we can practice medicine, with the knowledge acquired in the medical school, even after 50 years.

If the State Governments are sincere in implementing this, first they should provide regular CMEs in Districts, with the help of nearby Medical Colleges, to encourage Doctors to update themselves. This is the first step the Govt and the Medical Councils should have taken, before insisting on minimum attendance of CMEs and periodic recertification for the Doctors, who may be interested, but have no access to updating facilities in their areas.

The public and law makers, who make hue and cry, if a Doctor is found to be inefficient or deficient in knowledge, don’t realize their responsibility to create facilities for updating their knowledge and skills, especially for Doctors practicing outside the cities. With the unutilized funds lying with State Medical Councils, the Govt can easily provide such services to medical profession, ultimately for the benefit of public at large. Respecting the seniority, this condition has been waived for Doctors over 70, but they have to send communication to their State Medical Councils that they are ‘still alive’, to keep their records updated. Blissfully, thanks to the complacent Medical Councils, our Doctors are not put to ‘hardship’, trying to enforce the rule of recertification.

The Consultation Room