Defensive Medicine in the Context of the Indian Health System

Defensive medicine; although a recent concept, is slowly beginning to cement its place in the Indian health system. An interaction of multiple factors has paved way for this form of practice. Need for certainty of the diagnosis, lack of hierarchy in medical care, exponential growth of micro/super specializations and private/corporate health institutions, incentive-based practice, increasing incidences of violence against health personnel, rising trend of defamation suites against doctors, bad publicity by media, and interference by elected representatives have jeopardized the situation. This has led to decline in practice of clinical medicine, increased burden of investigations, especially in already compromised public facilities, and high out-of-pocket health expenditure. As much as ethical medical practice, standard patient management protocols, strict protection of interest of medical practitioners by law, responsible role of media and elected representatives are the need of the hour; we need to find ways to accept and incorporate defensive medicine into the modern medicine. Different stakeholders are required to come together and take substantial steps to understand the phenomenon and preserve the art and science of practicing medicine in its true form.

Analyzing the Role and Liability of Paramedics in the Indian Healthcare System

The Nursing and staff serves as backbone of a healthcare system. Despite being central to any healthcare system, not much has been written about them, especially on the issue of their regulations and legal liabilities emanating from their professional activities. Though they are governed by National and State councils, the implications of their acts are different in Civil Law, Criminal Law and under their respective regulations. These differences are primarily the subject matter of this paper.

The impact of blood-borne occupational exposure to the medical personnel on individual cognitive / 中国实用护理杂志

Objective To discuss the influence of individual cognitive on medical personnel blood-borne occupational exposure protection action from the angle of behavior operation.Methods Medical staff of 14 hospitals in zunyi were investigated by questionnaire designed based on the theory of health belief model,and analyzed the data by structural equation model.Results Sample data and the assumption model was ideal,the blood-borne occupational exposure protective behavior of medical staff could be explained variance of 87％ by susceptibility,severity,behavioral benefit and barrier cognition.The order of influencing factors from high to low were behavioral benefit,severity,behavioral barrier and susceptibility to cognition,and path coefficients were 0.39,0.27,-0.21,0.03.Conclusions Susceptibility,severity and behavioral benefit cognition have positive effection on protective behavior,the behavioral benefit cognition have more influence on blood-borne occupational exposure protective behavior of medical staff,and behavioral barrier cognition have negative effection,the results of health belief model can explain blood-borne occupational exposure protective behavior of medical staff better.

Analysis on influence factors of medical staff blood-borne occupational exposure based on structural equation modeling / 中国实用护理杂志

Objective To analyze the influence factors of medical staff blood-bome occupational exposure by structural equation modeling,in order to improve medical staff of blood-borne occupational exposure protection performance of the system to provide the theory basis for operation.Methods The influence factors of medical staff blood-borne occupational exposure and their correlation were analyzed by exploratory factor analysis and structural equation modeling fitting.Results Model fitting was ideal,hospital decision-makers and department management directly affected the behavior intention of medical staff,department management greatly influenced by the behavioral intention to the medical personnel,path coefficient was 0.27.Hospital decision-makers of behavioral intention to the medical personnel directly affect smaller,path coefficient was 0.03,but its indirect impact on behavioral intention by department management.Behavioral intention of occupational exposure protection action,the path coefficient was 0.80,behavioral intention determined the basic medical personnel blood-borne occupational exposure protection behavior.Conclusions Hospital should improve the system of standards and to establish effective communication channels,at the same time enhance the care ability.Enforcement departments should improve the standard system,equipped with adequate safety equipment,for the medical staff to provide the best working environment,so as to improve the medical staff of blood-borne occupational exposure protection behavior compliance.

Consumer Protection Act – Awareness.

Background: With the inclusion of health care services under Consumer Protection Act, a spurt in litigations arising out of breach in medical/dental profession is seen. Thus, it becomes imperative for health professionals today to be aware of such laws. Objective: To assess and compare the awareness about Consumer Protection Act among dentists (dentists in teaching institutions and dentists in private practice.) Material and Methods: A questionnaire survey was carried out on a total of 224 dentists [112 dentists in teaching institutions (DTI)] from Manipal and Mangalore and 112 dentists in private practice (DPP) from Udupi and Mangalore, Karnataka, India]. Statistical Analysis was done using SPSS version 10. Chi- square test was used to compare between the categorical variables (P<0.05). Results: A total of 69.6% of DTI and 76.8% of DPP reported to be aware of Consumer Protection Act but subsequent analysis of responses did not reveal the same. Awareness (> 75%) about rules and regulations of Consumer Protection Act was found to be low in both the dentist group. No difference was seen in awareness based on gender, degree and type of practice (P>0.05). Significantly higher percentage of DPP as compared to DTI (90.7% Vs 69.2% ; P< 0.05) were observed to rely upon regular consent. Conclusion: There is a need to raise the awareness of health professionals about such laws so that their increased professional concern and practice conforms to welfare of patients.

A review of second medical opinion cases and its attribute to medical negligence: A retrospective study.

Today the number of cases of medical litigation is increasing and already it has become a great problem for surgeons, anaesthetists and obstetricians. The general practitioners and physicians are also facing the problem and in coming years the profession may turn into a nightmare. SMS Medical College is the biggest and oldest medical teaching institution in Rajasthan. The department of Forensic Medicine handles all types of medico legal works and there is a separate established Medical Board under the chairmanship of the Head of the department. Here we receive second opinion cases from different law enforcing agencies including the hospital and public administration. In this paper we have reviewed the second opinion cases with a primary focus on medical negligence cases in the time period of 2005 t 2009. Total 55 cases were identified out of which 42 were dead and 13 were alive. Maximum numbers of cases were observed in the age group of 21-30years. The number of female cases outnumbered the number of males. Maximum numbers of cases were related to surgical practice (OG-21, Surgery-8, Ortho-6, Neurosurgery-3, ENT-2, Opthal-1 and Urology-1).

Consumer protection act (CPA / COPRA) related to medical profession.

With the fast pace of commercialization and globalization on all spheres of life, the medical profession is no exception. Since the passing of the Consumer Protection Act in 1986, the doctor-patient’s relationship has deteriorated significantly and litigation against doctors is increasing day by day. This review article enlightens medical practitioners regarding Consumer Protection Act and how to prevent litigations.

Medical Data Privacy Protection Act should be Reappraised

The government had a plan to set up a new medical information law last October, which allows hospitals to share medical records of patients with given consent. The aim of this act is to manage and protect medical information effectively. However, civic groups and medical organizations strongly claim that there is a high possibility of leakage of individuals' private medical information that can raise conflicts of interest under the medical information act. Computerization of personal medical information is essential for the business efficiency, however, it may cause a serious damage to the society as well as to individuals should the information be used without the individuals' consent. In the age of knowledge and information, the improved medical service and its effectiveness via informatization is an unavoidable choice, however, it is also hoped that the issues of human rights be thoroughly considered in the process of medical informatization to prevent a potential aftermath to the people and the society.