What's the most common cause of Complaints against doctors? Here's what NMC says

New Delhi: Explaining why doctors get sued, the National Medical Commission (NMC) recently observed that one of the most common causes of complaints against doctors is a communication gap with the patient or the relatives of the patient.

The Apex Medical Regulator further referred to the unique nature of the "Doctor-patient relationship" and mentioned that it requires a lot of trust between both the doctors and the patients. In case of trust deficit, the situation ultimately leads to litigation against the doctors, NMC mentioned.

These observations were made by the Commission in its recently released E-Book "Professional Conduct Review- Lessons from Case Archives", which was released by the Ethics and Medical Registration Board (EMRB) of NMC on October 05, 2023.

While discussing a previous case where a 14-year-old boy died and consequently the doctors were sued despite proper treatment and timely referral, NMC observed that in most of the instances, the doctors, in spite of their good intentions, failed to explain to the patients and their relatives about diagnosis, treatment plan etc.

NMC emphasised that "In majority of cases, the most common cause of complaints against doctors is due to a communication gap."

Medical Dialogues had earlier reported that altogether nine (9) case archives were discussed in Volume I of the NMC's E-book. In respect of each and every case, NMC discussed different topics including Communication Between Doctor and Patient's Relatives, Allegations of Wrong Diagnosis Leading to Delay in Treatment, Specialty Practice-Without Adequate Qualification/Training etc.

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For each of the cases, the book elaborates on different aspects such as the keywords, context/category, abstract, summary of the case, discussion, decision of State Medical Councils or NMC Ethics Board, lessons learned from the case, take-home message, etc.

Among these 9 cases, NMC at first discussed about the importance of communication between doctor and patient's relatives, while referring to a case of a 14-year-old boy.

The patient was taken to a Primary Health Centre (PHC) with complaints of diarrhoea, fever, dizziness, and light-headedness. He was found to be febrile with low blood pressure and therefore, blood investigations and medications were advised. The patient returned to the PHC with persistent symptoms and he was found hypotensive. The doctors ruled out Malaria and dengue infections and referred the patient to the District Government Hospital on the same day. 

At the District Hospital, the patient was managed with IV fluids, antibiotics, and symptomatic treatment. However, the patient's condition did not improve and he was again referred to a tertiary care hospital in a state of shock. A provisional diagnosis of acute gastroenteritis with thrombocytopenia and leucopoenia was made.

After the patient was admitted to the tertiary care hospital, investigations were done. Following this, the patient developed severe breathing difficulty and he was shifted to ICU for intensive care. The condition of the patient continued deteriorating despite ventilatory support and intensive care. The relatives of the patient were informed about the poor prognosis and soon after, the patient died. 

Consequently, the relative of the patient approached the State Medical Council (SMC) and they filed a complaint of medical negligence against the doctors of the tertiary care center. However, after considering the case, the State Council found no evidence of medical negligence, and the doctors were exonerated.

Challenging the order of the State Commission, the relative of the patient appealed to the Ethics Board of NMC. However, EMRB, too, did not find any evidence of medical negligence and it upheld the State Council's order.

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NMC Observations: 

Referring to the case in the recently released e-Book, NMC noted that the concerned patient was initially taken to the primary center, where the patient was managed and a timely referral was made to the District Hospital. Thereafter, proper investigations and treatment were carried out at the District Hospital as well. 

Despite this, the condition of the patient deteriorated and the patient was referred to a tertiary care hospital, where immediate investigations were carried out and the patient was treated with the standard of care acceptable in such cases. Despite all this, unfortunately, the patient died and this negative outcome led to litigation.

At this outset, NMC observed that, "The doctors should be aware that in spite of adequate care and their best intentions, litigations may occur. Effective communication and proper documentation will mitigate the risk of such litigations."

The Commission emphasised on the need for proper communication between the doctors and the patients/relatives of the patient and noted, "Doctor-patient relationship is very unique in itself. It requires lot of trust between doctors and patients. If there is trust deficit, it leads to litigation against the doctors. In majority of cases, the most common cause of complaints against doctors is due to a communication gap."

"In most instances, doctors fail to explain to the patients and their relatives about diagnosis, treatment plan etc. in spite of their good intentions," further observed the Commission.

Apart from this, in respect of this particular case, the Apex Medical Commission also clarified that the doctors are expected to bring a reasonable degree of skill and knowledge and they are also expected to exercise a reasonable degree of care.

Clarifying when to hold a doctor liable, the Commission mentioned in the book, "Neither a very high nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires. A Medical Practitioner would be liable only when his conduct falls below that of the standards of a reasonably competent practitioner in his field."

"Medical Professionals are entitled to get protection as long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the Medical Professionals," further mentioned NMC.

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