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surgeon and challenges presented at IAGES Raipur 2018
- 1. 10 February 2018 IAGES Raipur M G Bhat Consultant Surgeon Manipal Hospital Apollo Spectra Hospital, Koramangala Bangalore, India Greetings From… Dr. M G Bhat MS, FRCS(England & Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics) 1
- 2. M G Bhat Surgeon & Challenges 10 February 2018 IAGES Raipur 2
- 3. M G Bhat 310 February 2018 IAGES Raipur SURGEON Future • Regulation • Universal Health Violence Legal Issues Corruption Media • Very Different to elsewhere • Public and Private • Rich and Poor • Customized Treatment • Consider Affordability • 70% in Private
- 4. M G Bhat 410 February 2018 IAGES Raipur Changing with times… Doctor….Next Only to God …(NOTG) From NOTGto Friend ..Philosopher…and Guide Respectable Professional Service Provider to Health Consumer (Business)
- 5. Patient and Doctor M G Bhat 510 February 2018 IAGES Raipur The Public is losing their TRUST in us. They see us as money minded. They feel we don’t listen to their concerns anymore and don’t Bother about their needs.
- 6. 10 February 2018 IAGES Raipur M G Bhat 6 • Human Relationship Patient and Doctor Communication • Is the key for successful Practice • Good Relationship • Avoids all Problems
- 7. Case: 1 - An Honest Truth : M G Bhat 62/F - Underwent Hysterectomy and Incisional Hernia Repair Dealing with Complications Tell the truth to patient: No hiding facts Walls have ears! 10 February 2018 IAGES Raipur 7 Patients will understand an honest mistake if the doctor tells the truth
- 8. Negligence • Low Standard of Care Causing Harm to Patient • Misrepresenting the skills they do not have • Failure to act in time • Indifferent handling of case • Not Seeking Expert Help in time • Poor documentation and Communication A mistake by a medical practitioner, which a reasonably competent doctor would not have done is NEGLEGENCE
- 9. 10 February 2018 IAGES Raipur M G Bhat 9 Communication • Clear and make patient and other members understand • Regular Continuity communication to the same group • Remember most times they have Not understood! So, document your discussion points • Never get Angry!
- 10. M G Bhat Case: 3: • Cancer • Lose Talk by Colleagues 10 February 2018 IAGES Raipur 10 • 23/F with Liver Abscess • Haemangioma-
- 11. 10 February 2018 IAGES Raipur M G Bhat 11 Communication 1 c Patient- Doctor Relationship Poor co ordination amongst doctors Case 2 : 87/M with Recurrent Cholangitis
- 12. M G Bhat10 February 2018 IAGES Raipur 1. Prove Not Negligent 2. Be involved and proactive 3. Prepare well. 4. Help the lawyers 5. Have Supporting Evidence 6. Pick a good and committed lawyer 7. Be confident and sure Dealing with Courts and Medical Council 12
- 13. 10 February 2018 IAGES Raipur M G Bhat 13 Dealing with Complications and Colleagues Cases: Dealing with Others Complications
- 14. M G Bhat 14 Facts to Remember…. • In Problem Cases Get a Colleague involved •Sympathize with patient and help • Lack of Communication reason for Litigation 10 February 2018 IAGES Raipur
- 15. Documentation M G Bhat 1510 February 2018 IAGES Raipur • Clear and Legible • All facts • No Later Corrections! • Documentation - is our responsibility • OPD Notes ?
- 16. Informed Consent M G Bhat The Value of consent is realised only when there is legal scrutiny Is the most important document in Surgical Practice 10 February 2018 IAGES Raipur 16
- 17. M G Bhat 17 Consent ….Contents - 2 • Documented in Legible way • Make them Understand • Signature by patient • Signature by Witness ( Relation) • Signature by Doctor • No Corrections 10 February 2018 IAGES Raipur
- 18. M G Bhat Consent & Documentation Gross Medical Negligence & Punishable 10 February 2018 IAGES Raipur 18
- 19. 10 February 2018 IAGES Raipur M G Bhat 19 • Bristol Cardiac Surgery Scandal
- 20. Violence M G Bhat 2010 February 2018 IAGES Raipur • Anxious Relations • Aggression • Lack of Trust • Unhappy with the Treatment • Financial Burden • Mob Mentality
- 21. M G Bhat 2110 February 2018 IAGES Raipur Violence • Anticipate & Be Prepared • Inform Admin and Police • Calmness • Discussion & Explain • Be involved and Sympathetic • Assist them • Safety of Doctors • Doctors are at the receiving end of this growing menace. (usually the Junior Doctors)
- 22. M G Bhat 2210 February 2018 IAGES Raipur Behavior in the wards • Nurses and Doctors talking Loud • Laughing and fun in ward • Discussion in front of the patient • Discussions outside the room and patient able to listen •Doctor and Doctor •Doctor and Patients •Doctor and Nurse •Doctor and Admin
- 23. M G Bhat 2310 February 2018 IAGES Raipur Professional Fee • Uniformity of Fee • Unreasonable Charges
- 24. Corruption M G Bhat 2410 February 2018 IAGES Raipur • Targets Driven Unethical Practice • Industry & Pharmacy Benefits • Benefits for Referrals (Hospital, Doctors, Labs)
- 26. M G Bhat 2610 February 2018 IAGES Raipur • On Starting Practice • On Change of Type of Practice • On Changing Address • On Temporary Absence • On Resumption of Practice • On Succeeding to another Practice • Public Declaration of Charges Advertisements & Doctors
- 27. Media both Positive and Negative M G Bhat 2710 February 2018 IAGES Raipur • Effective use of media • Internet, Social media etc • Also can be harmful & Damaging
- 28. M G Bhat 2810 February 2018 IAGES Raipur Publishing and Presentations • Scientific Presentations • Media Presentations • Plagiarism ?
- 29. M G Bhat 2910 February 2018 IAGES Raipur What is our reality? • No Audit • MCI - Not Effective • Associations - No Authority • No Governance • No Uniformity in Care • Health Care Regulation ? Self • We have the Best & the Worst
- 30. M G Bhat 3010 February 2018 IAGES Raipur Laws For Doctors (MCI) • Patient-Doctor Relations –Negligence • Sexual Misconduct • Advertisements • Incentives to get Patients • Incentives from Labs and others • Research and Benefits • Pharma Gifts
- 31. M G Bhat 3110 February 2018 IAGES Raipur Who regulates? • Self • MCI • Health Authority • Medical Universities • Hospitals • Associations • Guidelines
- 32. M G Bhat 3210 February 2018 IAGES Raipur
- 33. 10 February 2018 IAGES • Be a Good Doctor • Good Human Relations • Communicate well • Honest and Sincere • Accountable • Knowledgeable • Skilled M G Bhat 33 Solutions • Regulation • Universal Healthcare
- 34. M G Bhat 3410 February 2018 IAGES Raipur A Patient • Patients are human beings with hopes and Fears • In the Hospital, they are outside their normal place • Their valuables and belongings are taken away • They feel “miserable, scared, helpless Francis W. Peabody. MD In a 1927 lecture to Harvard Medical Students
- 35. M G Bhat 3510 February 2018 IAGES Raipur Lord Moynihan of Leeds An Operation for surgeon is a days work For the patient it is a question of life or death
- 36. 10 February 2018 IAGES Raipur M G Bhat 36 1. Learn to Communicate 2. Patience with Patients and family 3. Spend time with ”sick” Patients A Doctor needs some bad cases to mentally drain; Increase the pressure on life and become Miserable and Unhappy. Time spent on dealing with the Family is much more than the time spent in surgery etc. Money Will not bring the happiness! It is the success which brings glory and happiness
- 37. 10 February 2018 IAGES Raipur M G Bhat Consultant Surgeon Manipal Hospital & Apollo Spectra Hospital, Koramangala Bangalore , India Thank you… Dr. M G Bhat MS, FRCS(England & Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics) 37 drmgbhat@gmail.com www.drmgbhat.com www.bariatricsurgerybangalore.com
Editor's Notes
- In my mind, the doctor-patient relationship is sancrosanct. There is no relationship where the bond of trust should be so strong, outside ofmatrimony. As physicians, patients rely on us to help them make life-savingdecisions. And we need patients to be honest with us so that we can give thehighest quality medical advice. Yet, there has been an erosion in thisrelationship over recent years. Doctors are no longer held in such highesteem as they were decades ago. Even our own Commander-in-Chief,President Obama, alluded to the fact that doctors have financial incentive todo more surgeries. The public is losing their trust in us. They see us asdriven for profit. They feel we don’t listen to their concerns anymore anddon’t care what they want or need.. Why has the public lost trust in doctors? ♦Third parties are often making decisions. For example, they dictatetheir own formularies, and we often have our hands tied as to whatmedications we can prescribe. I often have patients ask me for the “strong Stuff.” They don’t realize that doctors are limited in prescribinghabits, and we are not withholding the Best medications. But, we arethe ones in direct contact with the patient. ♦Outlier doctors have been gaming the system. Most doctors truly putpatients’ care first, before profit. But, there are a few whoinappropriately use their medical degrees for profit. Just look at Dr. Oztrying to get rich promoting weight loss products with no provenbenefit. These doctors make us all look bad. ♦There are many mandates imposed on us that affect patient care.One example is meaningful use. Doctors now have to document manymetrics, inputting data into our EHR systems, in order to meetrequirements. Patients take this lack of eye-to-eye contact as a sign thatwe are more interested in their digital record than them. They feel weare no longer listening to them. They don’t realize that we don’t want tobe doing this. It has been opposed on us from on high, and we will bepenalized if we don’t. ♦HMO’s have greatly cut reimbursements to doctors. In order forpractices to stay afloat financially, we have to see more patients. Weneed to find more and more room to see these extra patients if wewant to stay afloat. Patients feel this and take it as an indication that weare pushing them through for profit and don’t care about them. ♦Media tends to portray doctors in a bad light. There are big storiesabout the pill mill doctors and those arrested for fraud or harassment.There are so many more amazing stories of heroic doctors around thanthe bad apples. But the press does not give them attention. Peoplerather see the bad than the good. This too tends to paint us all in anegative light. Medical diseases are becoming more complex, and people are living longer.There has never been a time where patients need to trust their doctorsmore. All doctors need to remember their oath and put the patient back incenter focus. We all need to take a stand against those doctors who areabusing the system for their own gain. Patients need to learn that the vastmajority us care about our patients and have their best interests in mind.We all need to become a team again. Patients need to regain our trust, andour profession needs to re-establish its integrity.