Dr Tseten Yonjen Tamang
Consultant Surgeon, Department of Liver transplantation and Hepatobiliary surgery, Shahid Dharmabhakta National Transplant Center
I believe there is no definite reply to this and I regret, my reply may be considered superfluous too and no matter how much I try, I will still have a medical point of view to this topic.
Medical negligence and malpractice claims have almost never been properly dealt with in the past. Vandalism or settling claims with monetary schemes have been the most common strategies. Both are condemnable and should be stopped. An actual legal investigation to find the reality and legal action against malpractice would be best. In Nepal though, legal process is an arduous, tenacious process, subject to numerous influences and may never see any conclusion. This discourages anyone from seeking legal help.
Situation in our medical community is a reflection of our society. Financial frustration, political instability, professional uncertainties, absence of professional growth have ruined us. Inability to handle crisis or grief is inherent to our country. A culture of distrust and lack of faith has risen. A mishap or complication is always confused with ill intent. It overshadows every other good work, incurs defamation and incites violence.
Dr Runa Jha
MD & President, Association of Clinical Pathologists of Nepal, Director, National Public Health Laboratory
I think commissions or “cuts” for referring patients to another doctor, laboratory, or diagnostic centre is a serious medical ethic malpractice. Being a laboratory specialist, I often hear unofficial complaints regarding how a private laboratory is expected to pay 30-60% or more kickback to referring physicians but nobody is willing to talk about it publically. Such practice is deep established in mainstream service that any one who tries to go against this will be the odd man out. This not only makes laboratory service costly, it also compromises the quality of result as the laboratory will come up with various means to compensate for this by cutting on quality controls measures which are not seen by customers but are highly essential and expensive as well. Also, it creates unhealthy competition as laboratories start competing with each other in the amount of cut offered rather than quality of service provided. Recently there are more middlemen involved who do not have lab of their own but collect samples from various clinics, pharmacies and even from homes and deliver them to various laboratories. It’s just like Foodmandu delivering food from various restaurants, but the difference is that you can see names of various restaurants and food menu with price from which you can choose what you want but this facility is not provided to the customer who gives their precious blood and trust. The more number of middlemen involved, the more a customer pays for service and the less a laboratory receives for service.
Any unethical practice exists because somebody gains from it. Those demanding and those providing cuts are both responsible for such unethical practice. It exists because patients are ignorant about such activities. The patients should execute their right to choose their own laboratory instead of someone else choosing it for them. Before giving a sample, the customer should make sure that their samples are being taken by a laboratory representative of their choice and not a middleman. If a middleman is involved the customer should transparently get a choice of laboratories with test menu and pricelist to choose from.
Dr Neil Pande
Dental Surgeon, Healthy Smiles & Smile Weavers
Before moving on to the issue, let us try to go into the cause of most malpractices. Some may have other components attached to it, but the main reason is financial. Society wants to see its doctors as suave, swanky, knowledgeable, kind and caring, someone who gives a lot of time, someone who is a saviour. They want an environment that is clean, comfortable and accessible.
A doctor on the other hand has to maintain their lifestyle so that society looks up to them as being successful, but unfortunately s/he has no means to do so, that’s why the malpractice happens. Besides maintaining a lifestyle, s/he has to spend considerable amount of time updating, studying and enhancing skills all the time, and that costs money.
When it comes to paying good fees to the doctor, society frowns upon it. We forget that taxi fares over the past ten years have quadrupled, but the doctor’s fees have hardly changed. We don’t have trouble paying Rs 2,000 for a simple meal in a restaurant but when it comes to spending that Rs 2,000 for a 20minute consultation, we call it bloody expensive.
If society valued the time and effort that the doctors have put into the service of a patient, then things would change. We do understand that it is not the same for everyone. For the people with limited affordability, it is the state’s duty to ensure that every person gets healthcare to the optimal level. It is the state’s duty to ensure that the working environment is maintained, equipment is functioning and the doctors are well paid. If that happens doctors won’t have to look anywhere for their own upkeep.
Some of the common ethical issues that are prevalent in our nation as well as around the world are miscommunication, over investigation, over prescription and over treatment, lack of referrals, unseen charges and management targets.
Dr Pravin Nepal
Consultant Orthopedic Surgeon, Norvic International Hospital
Medical malpractice refers to when a healthcare provider fails to provide appropriate treatment, take an appropriate action, or gives substandard treatment that causes harm to a patient. Negligence is when someone acts in a way that leads to harm of another person, but without the intent to harm. Errors are common in medical practice worldwide. In many countries there is strong consumer law that protects the consumers. At the same time there is malpractice insurance for medical practitioners which helps the health care providers. However, in Nepal both the consumer and the malpractice insurance are not very popular and strong so they are poorly used.
In Nepal, as the number of corporate hospitals increase, there are high possibilities of over-investigating the patients, unnecessary admissions or increasing the length of stay at hospitals which are the commonly seen malpractices in urban areas. Similarly, in rural areas overprescribing drugs is common. Health care should not be a business but a service.
To prevent all this, we need to have strong consumer protection act that should be frequently used by the consumers in need. Powerful government regulatory body to monitor healthcare institutions. Nepal Medical Council along with its subspecialty societies should have strong established standard of treatment protocol to have a uniform treatment system for all. The medical practitioners themselves should also be responsible towards the oath they have taken at the time of registration at the medical council.
Dr Sangeeta Kaushal Mitra
Director & Chief Consultant, Paropakar Maternity
and Women’s Hospital
Medical negligence is in fact a concerning scenario in the country. Early surgical intervention without informed consent of the patient is highly prevalent. If a patient is not informed about the medical procedure properly, medical misconduct takes place. A patient should have adequate information about the diagnosis, risks and adherence before practicing any surgical intervention.
First and foremost, I think such cases exist because of the sensitivity and psychological side of it that can be helped with effective counselling. Many people might neglect the most important initial phase before any surgery – getting an accurate diagnosis of the disease. Therefore, providing information, advice and assistance to patients is key.
Lack of taking required precautions and attention in spite of the knowledge can result in incorrect application and cause damage. Therefore, training and practical experience are critical under continuous and adequate supervision.
The road to a patient’s wellbeing does not only end after treatment, continuous supervision and follow up are crucial to cure a disease. Which means both health care providers and patients should adhere to after care service for total recovery.
These might seem to be very basic things however lack of implementation plays a huge role in the increment of malpractice in the country.