Home > Public Health > Junior doctors admitting patients under their senior’s name — Whom to blame in case of some mishap?

Junior doctors admitting patients under their senior’s name — Whom to blame in case of some mishap?

November 6, 2012

It was December 1987, almost 25 years back, when Dr Prafulla B Desai (a renowned cancer surgeon) was charged for negligence and disowning his own patient. The case has been in news for all these years and has surprised people from each and every walk of life.

Here is a flashback, in case you are not aware about the whole hullabaloo around it. In December 1987, Leela Singhi, a cancer patient, was admitted to Bombay Hospital by Dr A K Mukherjee who was Dr P B Desai’s junior. The patient was set up for a surgery on the advice of Dr Desai who was in an adjoining operation theatre. But, when Dr Mukherjee realized that he couldn’t carry on with the operation because of some complications, he closed it on his senior’s advice. Leela Singhi’s health deteriorated and she died after 14 months. Lately, the Bombay High Court held the 78-year-old Dr Desai guilty of negligence.

Padma Vibhushan awardee Dr P B Desai has always highlighted that Leela Singhi was never his patient and it was a practice to admit patients under a senior doctor’s name, which is why he had to bear the brunt for all these years. All he did was just gave some advice, which acted against him. This has tarnished his otherwise brilliant career for which he has been fighting for a good 25 years.

Dr Rakesh Kumar Singh

Talking about the case, Dr Rakesh Kumar Singh, a general surgeon based in Surat, told AalaTimes, “The unfortunate patient died of advanced breast cancer for god’s sake, not by any of Dr Desai’s doing. Opening an abdomen and closing it without doing anything is perfectly alright, when circumstances are not favourable for surgery inside abdomen. She was doomed to die because of her advanced cancer and I do not think justice is being done with Dr Desai.”

He further said, “Suppose, just suppose, Dr Desai had admitted her and Dr Mukherjee had operated upon her, and then closed the abdomen without doing anything else after consulting Dr Desai, still he had done nothing wrong because that is how things are being done since ages in hospitals everywhere and one has to delegate work. There is something grossly wrong in the presentation or understanding of the case.”

The question arises why is such a practice being followed where a junior doctor is allowed to admit patients under his senior’s name and what’s the logic behind it?

Dr Tarun Mittal

Dr Tarun Mittal, a general surgeon at Sir Ganga Ram Hospital, New Delhi, told AalaTimes, “Such a practice is not prevalent, now. In this technology driven world, everyone is under scanner all the time, so the whole question of shifting blames and taking responsibility has taken an all new meaning.”

Dr Sanjay Chaurasia, assistant professor, surgery, Patliputra Medical College, Dhanbad, also felt that it is not a usual practice and a senior doctor is always aware when a patient is admitted under his/her name. “In any case a senior doctor directs his juniors and operating upon by a junior is a very rare thing. The duty of a junior is to assist a senior and not perform activities without being guided by his/her senior,” he told AalaTimes.

Dr Sanjay Chaurasia

Doctors work on a shift basis and many in the healthcare profession felt that it is not possible for a doctor to work for the whole day. Dr Chaurasia said that a junior practising under the name of his senior is completely wrong and very objectionable. “Even if a junior admits a patient, it is his duty to call his superior, inform and explain him about the case, and take directions which have to be followed at any cost. And, if the junior fails to follow the instructions and carries on the duties on his own, it will be nothing less than objectionable,” he added.

If one goes by media reports of the case, it would appear that the junior doctor might not have informed the patient that the senior doctor’s name was being used for the sake of it and that the actual surgery would be performed by the junior doctor. But, why is it that a patient or patient’s family is always unaware of what goes inside a hospital?

A doctor, who agreed to speak on the condition of anonymity, said that Dr Desai’s case comes wrapped in many mixed situations. She said, “There are many consultants who have made a very good name for themselves, which is why patients or their families want to get treatment from them. But they need to clearly understand that a doctor can’t be there all the time and every doctor has a team to fill in for him. In countries like US and UK, doctors are very open about the fact that they are not available round the clock. But, sadly, such a straight approach and transparency is missing in India.”

The doctor clearly stated that reputations get cases to doctors/hospitals as patients feel that one doctor is more competent than the other. She told AalaTimes, “It is unethical to use someone else’s name and a strict stand ought to be taken, but our system has failed big time to give doctors the respect they deserve. Our medical norms are not very strong and no regulatory body wants to keep ethics going. The only thing that is keeping the medical profession going in India is doctors’ own conscience and their sincerity towards the profession they have opted.”

The medical profession, according to healthcare professionals, has a lot more good than bad and highest level of care is delivered in India. Doctors are very particular, sincere and responsible. Many felt that juniors often outdo seniors many a times because of a sense of sincerity and zeal to learn. However, the question still arises that in the light of this case do hospitals plan to stop this practice where a senior doctor gets dragged for something he has not done in the first place?

The anonymous doctor said, “Comprehensive care is multi-layered and requires a very strong team work. The challenge to deliver great service is a coordinated team work in which one leads and a lot of others are involved in care. So, working without a team is just not possible. There is a strong network that informs a senior doctor about everything happening and it’s a complete lie if a doctor says he is unaware of some certain situation at the hospital. If you are a senior everyone listens to you and working against a senior’s direction is totally breaking the rule. How can a Prime Minister or a Chief Minister not take responsibility of adversities even if they were not involved or aware of it? Being a leader you are in command and should be ready to bear the brunt.”

If in future a senior’s name is used without his knowledge, who should be blamed in case some complications surface? Dr Chaurasia said, “Complete responsibility will lie on the doctor who handles the case. There was a possibility in the past that the senior could have been framed because of the lack of evidence, but now everything is tracked. From mobile phones to computers everything carries complete information, which makes it difficult to fool the existing system.”

Categories: Public Health
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