Should doctors bear the burden of blame when patients die?


Bo

How does a doctor who left his house to save life end up in the news for all the wrong reasons?

Wednesday March 18 2020

When Baby Jonathan was admitted to hospital under the care of Dr Daudi* in critical condition, he took pains to study the child’s medical history. He examined the child and conducted numerous investigations, but the cause of the baby’s illness remained elusive. The child was put on various treatments targeting possible causes of his illness, but none worked. The baby’s condition deteriorated, and two days later, he succumbed to the unknown illness.

During a postmortem requested by Dr Daudi, it was discovered that Jonathan had been suffering from a rare disease. At the time of his death, doctors had been waiting for results of tests for that particular disease, but the boy died before the results which take three days to be ready, came back from the lab. Jonathan’s parents intend to seek legal redress.

In another case, Dr Salim*, an anaesthologist lost a patient on the operating table after she developed a nasty allergic reaction to one of the anaesthetic drugs.

The patient and her husband had signed consent forms for general anaesthesia with all its attendant risks, but when the patient died, her husband sued the doctor for negligence resulting in death.

How does a doctor who left the house in the morning to save a life end up on the front pages of the dailies with accusations of malpractice? Is there a mentally stable doctor who leaves their house in the morning with intent to harm a patient?

Newly graduated doctors take the Hippocratic Oath before they are released to the public to use their knowledge and skills for the good of humanity.

OATH BINDS DOCTORS TO PROTECT

The oath binds doctors to protect patients by upholding professional integrity at all times. The oath binds doctors to do no harm. To care for the patient and to maintain the utmost level of confidentiality even in death.

To attend to the patient without consideration of their age, race, religion, colour or walk of life; yes, even if the said patient is a murderer or rapist, one cannot compromise the quality of care.

Yet, despite such a stringent declaration, doctors are always on the receiving end of medical malpractice. In the face of bad medical outcomes, the finger is always pointed at the doctor. Why do doctors shoulder such a huge burden of blame?

Like in other professions, there is a hierarchy of responsibility, and the buck stops with the most senior doctor in the room. This is why complaints arise in big hospitals and rarely in the small health centres that refer complicated patients to the bigger facilities, yet these patients’ fate could go either way.

Regulations on the practice of medicine are not for the 95 per cent of doctors who wake up every morning to serve in accordance with the Hippocratic Oath.

They are for the rotten five per cent whose actions result in preventable mortality and morbidity.

The latter will be unavailable when on duty; careless with procedure; disregard the contribution of their peers and the rest of the care team in the patient’s management; fail to call for help in a timely manner; fail to update themselves on current practices; or take on procedures outside their skill set with disastrous results.

The law exists to deal with them.

For the 95 per cent, in their daily struggle to save life, errors of commission will happen as in the case of Dr Salim, and errors of omission will happen as in the case of Dr Daudi, both of which may be beyond human control. Institutional protocols exist to minimise these errors.

When errors happen, the court of public opinion is extremely harsh. Harsh judgment has robbed us of many great and humane doctors, especially those who rush to intervene when they are off-duty.

They walk in a dark tunnel wondering why they got involved in the first place when they had every reason to stay out of it. Many have opted to immerse themselves in non-clinical medicine such as research, policy and administration to avoid such mishaps.

Consumers of medical services must remain vigilant to ensure that this lifesaving profession maintains the highest standards of care at all times.

However, we must be careful not to break the doctors with the very skills we require when we lie on the bed and they are the only people between us and the grave.