The Telegraph
Since 1st March, 1999
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Doctors decide to get choosy
- Journal prescribes patient refusal as safety shield

S.C. Majumdar, a cardiac patient also suffering from cirrhosis of liver, was refused emergency surgery in three city hospitals a few weeks ago because doctors were “scared” to wield the knife and then ‘court’ trouble if the operation went wrong. Majumdar was finally admitted to a fourth cardiac centre (in Alipore), where he was operated on and saved.

Recalcitrant taxi-drivers are not the only ones with a ‘right to refuse’. For doctors — armed with some “professional advice” from insurance firms — now look set to march up refusal road.

The medical profession, pushed to the wall — and towards insurance firms — by the spate of cases in consumer and other courts, has just got hold of a “textbook” that many doctors predict could assume enormous significance. Published by a firm helping doctors fight legal and other battles, the journal urges them to pick and choose their patients.

The Medico-Legal Journal: Defence for the Medical Professional makes no bones about its aim in the preface itself. “Provisions of the Consumers’ Protection Act are being frequently invoked to seek redressal,” it states, explaining the ‘refusal’ prescription.

Extracts from verdicts delivered by the National Consumer Disputes Redressal Commission and other courts, along with Medical Council of India guidelines, comprise most of the advice to the doctors, often explained through frequently-asked questions (FAQs).

Sample one: “Does refusing to attend (to a patient) constitute negligence'”

The answer: “A doctor is free to choose who he will serve. Not only this, he should exercise due care before deciding to accept a patient for treatment.”

Doctors are also advised “not to accept a task beyond his level of competence”. It, however, cautions that the right to refuse does not extend to emergency cases.

Cardiologist Susovan Haldar admitted that doctors have definitely become choosy. “The refusal syndrome is basically a defence mechanism that doctors are using because of the growing legal complications,” he explained.

Admitting that the trend was growing by the day, Indian Medical Association joint secretary (headquarters) R.D. Dubey, however, said all its members had been asked not to refuse patients. “Legally, a doctor has the right to choose patients but ethically, it isn’t a good idea,” he clarified.

Patients, of course, are bearing the brunt. People for Better Treatment (PBT), used to receiving around five refusal cases every month till a year ago, now has clocked a monthly average of 20. “We are guiding refused patients, especially those requiring emergency attention, to legal redress,” said Moloy Ganguly of PBT.

The journal doling out the refusal pill for doctors also addresses the question of patient priority. “Does a doctor have a right to decide which patient to examine first'” runs the query. The answer, based on a verdict from the national redressal commission, grants doctors the “absolute right” to decide which patient needs examination first.

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