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Friday, November 30, 2007

Do's & Dont's for Doctors

Having trained ONLY to heal, Doctors are not very mediquettes savvy and inspite of having done justice to the problem at hand may leave the patient with a feeling that enough time/ attention was not given. Doctors always wonder what they should do and what they should not do. Following are some of the guidelines.

Do's for Doctors
* Mention age & sex of the patient. In a pediatric prescription, weight of the patient must also be mentioned.
* Always put your hand on the part that the patient / attendant says is painful. Apply your stethoscope on him, even if for cosmetic reasons.
* Listen attentively. Look carefully. Ask questions intelligently.
* If, after completing the examination, the patient / attendant feels that something has been left out or wants something to be re-examined, oblige him.
* Always face the patient. Maintain eye contact that is comfortable to the patient. Some patients tolerate very little eye contact. Learn to observe out of the corner of your eyes.
* In case you have been distracted / inattentive during the history taking, ask the patient / attendant to start all over again. He will never mind it. As far as possible, consultations should not be interrupted for non-urgent calls.
* Ask the patient to come back for review the next day, in case you have examined him hurriedly or if you are not sure about the diagnosis / treatment.
* Mention "diagnosis under review" or "quot;under evaluation" until the diagnosis is finally settled.
* If the patient / attendants are erring on any count make a note of it or seek written refusal.
* Record history of drug-allergy.
* Write names of drugs clearly. Use correct dosages and mention clearly method & interval of administration and mention side effects.
* In a particular drug / equipment is not available, make a note.
* Prescribe with caution during pregnancy / lactation.
* Adjust doses in case of a child / elderly patient and in renal or hepatic disorders.
* Mention where the patient should contact in case of your non-availability / emergency.
* If you are not sure what disease a patient has after a thorough work-up, get a consultation with a referring note and show your concern.
* Update your knowledge and skill from time to time. Many doctors tend to deteriorate in their knowledge, skills & attitude, over a period of time. Not only do they make any attempt to update themselves, but also they slip downwards.
* Preferably employ qualified assistants.
* Always obtain a legally valid consent before undertaking a surgical / diagnostic procedure.
* It is mandatory to screen every patient for Hepatitis B/ HIV infection before every surgery, blood transfusion so that false claims are not made at a later date.
* In case of MTP/ Sterilization, always follow the guidelines issued by the Government of India.
* Routinely advise X-rays in injury to bones & joints and related diseases of bones / joints.
* Always rule out pregnancy before subjecting the uterus to X-ray.
* Always read reports carefully & interpret the results of tests / X-rays properly and make a note of it. In case of any doubt, recheck with the lab / diagnostic centre.
* In all instances of swab cases & "instrument cases", the surgeon incharge is generally held directly or vicariously liable for negligence. The surgeon incharge must therefore personally ensure that such mishaps do not occur.
* The period for the responsibility of the surgeon extends to and includes the post-operative care. He must, therefore, ensure proper post-operative care to the patient.
* In case of death of a patient occurring while undergoing surgery / diagnostic procedure, the higher hospital authorities / police authorities must be informed without loss of time. In such cases, autopsy/post-mortem is mandatory.
* In case the hospital / clinic claim to provide 24-hour emergency service, availability of necessary equipment in working order and competent staff within reasonable time is mandatory.
* Always seek proper legal and medical advice before sending reply to the notice sent by the patient or his representative or to the complaint referred to you from a consumer court.

Dont's for Doctors

* Don't prescribe without examining the patient.
* Never examine a female patient without the presence of female nurse / attendant, especially during genital & breast examination.
* Don't insist on the patient to tell the history of illness or be examined in presence of others. He has a right to privacy and confidentiality.
* Don't prescribe a drug or indulge in a procedure if you cannot justify its indication.
* Don't prescribe or administer a drug which is banned, e.g. Analgin, Oxyphenbutazone etc.
* Don't over-prescribe - too much of the drug, too large a dose, for too long.
* Don't under-prescribe - not prescribing the needed drug, dose is too small, length of treatment is too short. Calculate proper dose, esp in children.
* Don't prescribe multiple drugs. Such prescription may be due to inability to form a correct diagnosis or other causes. Possibilities of drug interactions increase with polypharmacy.
* Don't write instructions on a separate slip. Don't allow substitutions.
* Don't do anything beyond your level of competence. Competence of doctors, nursing staff is defined by their qualification, training, experience and competence of a hospital/nursing home is defined, in addition to the competence of its doctors and nursing staff by the availability of various equipments in working order and back-up support, e.g. handling of cases of accident/emergency, severe reaction to drugs, anesthesia, etc. and availability of resuscitative equipment., etc.
* Don't refuse if the patient/attendant wants to leave against medical advice. It is their right. Document this properly.
* Never avoid a call for help from a nurse on duty at night. In all probability, a genuine emergency may be there.
* Don't refuse the patient's right to know about diagnosis & treatment of his illness.
* Don't withhold information, however harsh & difficult, in seriously/ terminally ill patients. It must be conveyed with compassion & gradually, if time permits.
* Don't leave at the time of death. There is a tendency, especially on the part of the senior doctors, to go away at this time when their presence and experience are most needed.
* Don't hesitate to extend your condolences and sympathies to the bereaved persons.
* Don't forget to provide genetic counselling to couples and parents with known family history/children having genetic abnormalities, e.g. Thalassemia, Hemophilia, etc.
* Don't issue death certificates unless you have yourself verify death.
* Don't refuse the patient's right to examine and receive an explanation about your bill regardless of the source of payment; whether it is reimbursed by the government or by his employer/insurance company.
* Don't refuse the patient's right to know about the hospital rules & regulations.
* Don't dump hospital garbage including used disposables in the open. It should be properly incinerated / destroyed to prevent spread of disease or reuse by unscrupulous persons.
* Don't refuse first-aid/medical care to accidents & emergency cases even if it is a medico-legal case. It is a primary duty of every doctor/hospital to provide treatment upto his/its true level of competence in such cases before referring them to a higher centre, if required.
* Never talk loose of your colleagues, despite intense professional rivalry. It is bound to come back to you and patients also do not appreciate it.


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