What makes a doctor a GOOD Doctor? NMC explains with a case

New Delhi: Specifying what makes a Registered Medical Professional (RMP) a "Good Doctor", the National Medical Commission (NMC) has emphasized the need for understanding, compassion, and empathy by doctors while dealing with the families of patients in catastrophic events.

Further, the Apex Medical Commission opined that in cases of emergencies, a continuous communication channel must always be available. NMC also advised the doctors to ensure proper documentation to avoid litigations in the future.

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.

Taking cue from a previous case, NMC pointed out that the condition of a patient can be perceived differently by the family and may not be correct when compared to scientific evidence even if all standard operating procedures are followed by qualified RMPs and their team. 

"At times, it may be possible they are misinformed by limited knowledge available on the internet and other resources," the Commission highlighted in its E-Book.

Also Read: Professional Conduct Review - Lessons from Case Archives: NMC unveils its first publication

One of the nine cases mentioned in the book concerned the treatment of a 58-year-old male patient, who suffered acute Myocardial infarction and ultimately died despite undergoing angioplasty.

The concerned patient had no co-morbidities. He was suffering from chest pain and perspiration. ECG was conducted and it revealed Myocardial Infarction. Therefore, Thrombolysis was attempted but the pain persisted.

Thereafter, the patient was referred to a tertiary care hospital, where angiography and angioplasty were carried out by a qualified cardiologist in view of hemodynamic instability.

Initially, the patient was recovering well and on the 3rd day, he was shifted to a ward. However, later in the night, he collapsed while coming from the washroom. He was resuscitated with Defibrillator, and CPR, and a repeat angiography showed still patent stent without evidence of thrombus or blockage.

Although the patient was managed in the ICU on ventilator and inotropic and regained consciousness on the 3rd day, he had poor perfusion and remained hypotensive despite Intra-aortic Balloon Pulsation, medications, and medical management.

Later he developed renal failure with fluid overload and was managed on slow dialysis. Ultimately, he developed multi-organ dysfunction and ultimately succumbed.

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Upset over the death, the relatives of the deceased patient blamed the hospital and the RMP. They suspected that the stent used for angioplasty was less than the size of the artery, and poor management in ICU.

They were also disturbed by the fact that they were overcharged and were threatened by the hospital to withhold treatment for defaulting on payment of fees due to the hospital. 

When the complaint reached the State Medical Council, the RMP submitted that there was no negligence and he defended his team and the hospital in providing the best care to their capability. This was further corroborated by the expert. First the State Medical Council and later the Ethics and Medical Registration Board (EMRB) of the NMC exonerated the RMP after hearing both parties and experts' opinions. It was decided that all standard procedures were followed.

NMC Observations: 

However, referring to this case in its E-Book, NMC highlighted the importance of documentation and communication with the patient and relatives with empathy.

Addressing Myocardial infarction, NMC mentioned that it is one of the catastrophic events that require immediate management through qualified health professionals and involves quick, accurate decisions with the foresight of complications and their appropriate management and an ongoing line of communication. The Commission further mentioned how the caregivers need to be appropriately informed.

Pointing out how the patient's family can be misinformed and perceive the condition of the patient differently, the Commission observed, "This case highlights that condition can be perceived differently by the family and may not be correct when compared to scientific evidence even if all standard operating procedures are followed by qualified RMPs and their team. At times, it may be possible they are misinformed by limited knowledge available on the internet and other resources."

In respect of this case, the Commission noted that the stent was kept after angioplasty to prevent collapse of the narrowed vessel which was also found to be patent during check angiography. The decision on the treatment was made by RMP and multi-disciplinary team of ICU doctors and experts and was appropriate in the given situation.

NMC noted that all Standard Operative Procedures were followed and the case was also heard adequately by the SMC as well as the EMRB, NMC corroborating with the opinion of a senior cardiologist.

While discussing the takeaways from this case, NMC stressed on proper communication, and proper communication and noted, "A continuous communication channel must always be available in case of any emergency."

"Documentation, as has happened in this case, is an integral part of avoiding litigations," the Commission further noted.

The Commission also listed down the qualities of a good doctor and emphasised on qualities like compassion and empathy on the part of the doctor. It noted, "Besides documentation, understanding the state of the family in catastrophic events and dealing with them with compassion and empathy will always make an RMP a "Good Doctor"."

Also Read: NMC Advice: Doctors should Carefully Document Patient's Case History, Examination Findings

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 the Doctor and Patient's Relatives, Allegations of Wrong Diagnosis Leading to Delay in Treatment, Specialty Practice-Without Adequate Qualification/Training etc.