Medical Complications
JUL 29 -
As a practicing orthopaedic surgeon, I prescribe medicine and physiotherapy to the majority of my patients. There are others who require treatment in plaster casts, while still others need surgery. Although the objective of these—and any treatment, in fact—is to help patients recover, there are always a few cases in which treatment can be associated with certain unwanted problems. These are known as medical complications. While counseling patients and their relatives prior to surgery, I routinely list the more common risks involved in the procedure. For example, when counseling a patient with a fracture of the arm bone before surgery, I explain the possibility of acquiring superficial wounds and deeper bone infections in the post-operative period. I also explain to them the fractured bone sometimes does not unite, despite the surgery’s attempt to fix these fractures. There is also the possibility of causing injury to important nerves and vessels in the vicinity. These are all potential complications that could result from operative treatment.
Many times, my patients and their relatives ask me if I can guarantee that all will go well in the course of treatment. And I always tell them that no doctor can ‘guarantee’ a perfect outcome. Such a thing does not exist in medical science; it is only possible to predict the complication rates or success rates of a particular treatment based on statistical evidence in medical literature.
For example, there is a 98 percent chance that there will be no infections following surgery. However, if I were to perform a 100 such surgeries, it is inevitable that two percent of these cases will become infected. This is the law of statistics. The percentage of infection might be slightly lower in some of the best institutes in, say, the US, but it can never come down to zero percent. One cannot eradicate complications; we can only maintain them at an acceptable level. An infection rate of less than two percent, for instance, would be considered acceptable. But for patients with deep-rooted post-operative infection of the bone and joints, it could be devastating in terms of financial costs, days away from work, physical and emotional suffering. As a result, patients and relatives can often be upset and accuse doctors of negligence, leading to ugly scenes. We have witnessed it many times in our practice.
A doctor cannot claim to be using the highest possible degree of skill while treating all his patients, as there may certainly be persons more learned and skilled than him. But he does need to possess a reasonable and competent level of expertise. And sometimes, even proper treatment can result in failure, and in such times, the doctor cannot be accused of negligence. It is instead an act or its omission in the treatment of a patient by a medical professional that deviates from the accepted standard medical care that is defined as medical negligence.
Of course, this is not to say that medical negligence does not exist in our country; it does, as in all countries. The various levels of medical manpower—doctors, nurses and paramedics—have different training backgrounds and competency levels, having come from different institutes inside and outside the country. It is the job of regulatory bodies to standardise the quality of medical delivery and give impartial professional opinions when asked for such in a court of law, and they must also strive to improve on their efficiency and functioning. The regulatory body of medical doctors—the Nepal Medical Council—is already working in that direction.
On the other hand, it is also up to the state to devise and deliver a fair and impartial consumer protection act in the interest of both health care providers and recipients. Present-day Nepal, where CDOs pronounce judgments on medical malpractice suits, often brings to mind a kangaroo court, lacking as these judgments are in any scientific basis.
So the next time you come across someone complaining about the course of their treatment and throwing accusations of medical negligence, you can ask them, gently, whether they are aware of the difference between medical complications and negligence. Similarly, if you come across a suave doctor boasting that he has never had to deal with medical complications in his practice, you can safely assume that he is not telling the truth.
Dr Lakhey is Professor of Orthopaedics and an orthopaedic surgeon at the Kathmandu Medical College
Posted on: 2012-07-30 10:15
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