Doctor's Duties

1. J Punjab Acad Forensic Med Toxicol 2012;12(2)
115
Review article
DUTIES AND RESPONSIBILITIES OF THE MEDICAL PRACTITIONER, REVISITED
Dr Dasari Harish, Professor and Head, *
Dr K H Chavali, Associate Professor, *
Dr Ajay Kumar, Assistant Professor, *
Dr Amandeep Singh, Assistant Professor, *
* Department of Forensic Medicine and Toxicology, Govt. Medical College and Hospital, Sector 32,
Chandigarh
Article history
Received Sep30, 2012
Recd. in revised form Dec 23, 2012
Accepted on Dec. 23, 2012
Available online Dec 25, 2012
Abstract
Even though, generally the doctors are held in high esteem by the
public, this perception is taking a big blow and the faith of the
public is slowly diminishing, to be replaced by distrust and
suspicion. Who is to be blamed for this? The authors are of the
view that this calls for an introspection to find the root cause for
such a turn-around. This article dwells on the essential legal
duties, responsibilities and liabilities of the medical practitioner
and suggests ways to regain the faith that the public had in our
profession and ourselves
Corresponding author
Dr.Dasari Harish
Phone: +919646121551
Email: dasariharish@gmail.com
Keywords: Duties, Responsibilities, RMP, Medico-legal, Doctor-
patient Relationship.
©2012 JPAFMAT. All rights reserved
Introduction
There is an old saying:
“With great power comes great
responsibility”And we, doctors have been placed
next only to God Himself - “Vaidyo Narayano
Harihi”. Just imagine our responsibility to the
society at large!
An eminent Radiologist, Robert
Hutchison’s prayer [1]:
“From… too much zeal for the new and contempt for the old;
From putting knowledge before wisdom; science before art:
Cleverness before commonsense;
From treating patients as cases and
From making cure of disease more grievous than the
endurance thereof: Good Lord, please deliver us”
Where are we heading? Open any
newspaper/news channel – every other day we
read and hear about our own brethren, in the
wrong light – be it negligence cases, cases of
infamous conduct – to out right greed,
culminating in crimes against the society. Of
course, the majority of our fraternity practices
our profession in “Good Faith” for the benefit of
the society, but these black sheep do bring bad
name to our noble profession.
We still have not properly recovered
from the attack launched by actor Aamir Khan
on a national channel in his serial “Satyameva
Jayate”. Our rightful indignation and damnation
of the same forced him to render a public
apology on 15th August, in the last episode of
the same serial.
The doctor – patient relationship is one
based on mutual trust and respect between the
two parties and that is why this is a Fiduciary
Relationship. However, the rapid changes in the
medical field and the corporatization of health
care system have strained the age-old good
relations between the patient and the treating
physician/ surgeon. The doctor treats his
patient only as a case/ client and for the patient;
the doctor is only a service provider. This has
developed distrust between the two and this
distrust is only increasing day by day. Hence
there is a need for a concerted effort to bridge
the “existing gap between the doctor-patient.”
To properly understand this, we must
go back to the Oath that we take when being
ordained in this noble profession and
understand the meaning of the words that we
automatically utter at that time. We must
introspect whether we are abiding by our Oath
or not.
Charaka’s Oath [2]: [7th Century BC, the
most ancient of the Oaths in our country.]
This oath was administered to the students at
the time of initiation of their studies, in the
presence of their “Guru” and “Adhyapaks”,
“Vaidyas” and invoking the sacred “Agni”.
“Thou shalt from envy, not cause
another’s death, pray for the welfare of all
creatures. Day and night, thou shall be engaged
in the relief of patients.
Thou shall not desert a patient or
commit adultery, be modest in your attire and
appearance, not be a drunkard or sinful and not
associate with the abettors of crime.
Thou shalt, whilst entering the patient’s
house, be accompanied by a person known to

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the patient. The customs of the patient’s house
hold shall not be made public.”
The legal, ethical and moral liabilities of the
doctors are enshrined in the Hippocratic Oath
that we take when being ordained in to the
medical fraternity. They are detailed in the
International Code of Medical ethics [3], The
Declaration of Geneva [4] as well as the Indian
Medical Council (Professional Conduct, Etiquette
and Ethics) regulations, 2002 (Amended up to
2010) [5] .
The main ethical principles (modified from
the principles of Bio-Ethics as described by
Beauchamp and Childress, 1977) [6] to guide
the medical fraternity in treating the patients
are:
1. Autonomy
2. Beneficence
3. Non-malfeasance
4. Compassion and
5. Justice
Autonomy:
The patient’s right to autonomy in
medical decision making is summarized in Judge
Cardozo’s words: “Every human being of adult
years and sound mind has a right to decide what
shall be done with his own body and a surgeon
who performs an operation without his patient’s
consent commits an assault for which he is
liable” [7].
The elements of informed consent
include: disclosure of information, competence,
understanding, voluntariness and decision-
making. A doctor provides information to a
competent patient, who after understanding the
information, makes a valid decision [8].
A doctor is duty bound to provide
autonomy to the patient to give him individual
freedom and liberty to make a free choice. For
this to be possible, the doctor has to give
complete information regarding his condition to
the patient, all the choices of treatment
available, the pros and cons of each and allow
him to decide on his own, based on the facts put
forward to him, without any coercion or
outward influence. The information supplied to
a patient must be easy for him/her to
understand. Technical details are not normally
grasped by patient and may be out of the range
of his experience. These, therefore, will not be
termed as “informing” [9].
Further, the doctor should ensure that
such information is truly comprehended by the
patient. True understanding, in addition to an
essential cognitive part, includes understanding
on an emotional plane, as well. It must include
some understanding by the physician of what
the diagnosis or condition means to patients:
not just what it is scientifically, but what it
connotes to and for patients: how it will be seen
to impact on their daily lives and what it means
emotionally for them, given their personal
views.
Informed Consent has become extremely
important in the present day settings. As the
doctor-patient relationship is primarily
contractual by nature, it requires agreement
between the parties as to the proposed medical
intervention, and hence, it follows that the
patient's consent is fundamental to lawful
medical interventions [10]. This includes the
physician’s ability to properly explain to the
patient regarding his condition and answer all
possible queries of the patient; combined with
the patient’s understanding of the same and
ability to form a valid decision (consent/refusal)
based on the facts put forward to him.
It has been reported that the physician’s
explanation and the level of patient’s
understanding of the same is directly related to
patient satisfaction/patient treatment
adherence and the treatment outcome [11].
Inadequate explanation may lead to disputes
between the two.
The purposes of this explanation to the
patient are many, the main ones are: obtain his
consent, secure patient’s right of self-
determination, explain factors related to
negative outcome and give medical treatment
guidance. This explanation by the doctor is a
legal requirement of patient care. Hence
improper or partial explanation is a breach of
this duty of disclosure.
In a number of cases,
improper/ partial or faulty explanation by
doctor results in distrust by patient and his
relatives, culminating in allegations of
substandard medical care; even though there is
no fault in the doctor’s medical judgment or
treatment skill.
In various kinds of medical and
surgical procedures, the likely hood of an
accident or misfortune leading to death can’t be
ruled out. A patient willingly takes such a risk.
This is part of the doctor-patient relationship
and the mutual trust between them. This forms
the basis for informed consent/ informed
refusal.
The principles of Privacy and Confidentiality
are intimately related to Autonomy as disclosure
and dissemination of a person’s intimate
information and thoughts destroys this
important Ethical and Moral Principle. The
patient, in fear of the dissemination of his
intimate secrets, would never confide in the
doctor and this will lead to a number of
problems in future – both to the doctor and to
the patient.

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Beneficence: A physician’s primary duty is
to relieve suffering, reduce pain, produce
beneficial outcome and enhance the quality of
his patient’s life.
Non-malfeasance: A physician should
always act in “Good Faith” and not cause pain to
his patient.
Good Faith has been defined under S. 52 of
the IPC [12]: “Nothing is said to be done or
believed in “good faith” which is done or
believed without due care or attention. The
important terms to consider here are “Due Care
& Attention”. To prove this, one needs to prove
that he has the requisite knowledge and skill,
followed the accepted norms and methods of
treatment and that there was no negligence on
his or his team’s part in the overall care of the
patient. If he fails to establish this, then he did
not do the act in good faith [13].
Compassion: Whenever dealing with the
patients, the physician is expected to be
compassionate towards the patient, try to
develop empathy and treat him with the respect
that he deserves. He should never behave as
though he is in any way superior/ father-figure
to the patient (paternalistic model of the
physician – patient relationship).
Justice: The principle of justice implies fair
distribution of the resources that are available
to the doctor in his health care-delivery system,
amongst his patients. It addresses the questions
of distribution of scarce healthcare resources,
respect for people’s rights and respect for
morally acceptable laws [14].
For this, the following criteria have been
established:
a) Likely hood of benefit to the patient.
b) Improvement in the patient’s quality of life.
c) Duration of benefit.
d) Urgency of patient’s condition.
e) Resources that is required for successful
treatment of the patient’s condition.
Doctor’s duty towards patients:
- Decide whether or not to undertake the
case.
- Decide what treatment to give
- Must take care in the administration of
that treatment [15].
Breach of any of these duties gives the
patient a right to action for negligence.
Persons who offer medical advice and
treatment implicitly state that they have the skill
and knowledge to do so, that they have the skill
to decide whether to take a case, to decide the
treatment, and to administer that treatment.
This is known as an “implied undertaking” on
the part of a medical professional. According to
the Hon’ble Supreme Court, every doctor has a
duty to “act with a reasonable degree of care and
skill” [16].
The doctor is duty bound to attend to
the injuries of the person produced before him/
record dying declaration where necessary/ hold
medico-legal or post-mortem examination,
when warranted. He is not at all concerned as to
who committed the offence or whether the
person brought to him is a criminal or an
ordinary person. His primary duty is to save the
life of the person and inform the police in
medico-legal cases [17].
Important duties of a medical practitioner:
1. Emergency Medical Service – The
physician has to immediately render
emergency medical care and protect life. He
cannot refuse this emergency life care
services to anyone.
The guidelines as laid down by the Hon’ble
Supreme Court [18] are:
a) A patient who needs emergency medical
care should be admitted.
b) In case there are no vacant beds, the patient
has to be given all due care.
c) The doctor/ medical officer shall make
necessary arrangements to get the patient
transferred to another hospital in an
ambulance –
 He will first ascertain whether the recipient
hospital has beds.
 Patient will be accompanied by an RMO
during the transfer
 In no case will the patient be left unattended
at any time for want of beds
 Attending doctor will document all details –
condition of the patient, treatment given,
etc. and will write his name in a clear,
legible hand and put his complete signature
with date and time.
The Hon’ble Supreme Court gave the following
directions in cases of RSA [19]:
 The medical aid should be instantaneous. It
is the duty of the RMP to attend to the
injured and render medical aid/treatment
without waiting for procedural formalities
unless the injured/guardian (in case of
unconscious/minor) desires otherwise.
 Effort to save the person and preserve life
should be top priority, not only for the
doctor but also for the police office/any
citizen who happens to notice such an
accident.
 The professional obligation of protecting life
extends to every doctor, whether at Govt.
Hospital/otherwise.
 The obligation being total, absolute and
paramount, no statutory or procedural

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formalities can interfere in discharging
these duties.
 Whenever better or specific assistance is
required, it is the duty of the treating doctor
to see that the patient reaches the proper
doctor as early as possible.
 Non-compliance of these directives may
invite prosecution under the provisions of
the Motor Vehicle Act or IPC
2. Disclosure of crimes - This is a very
important duty of a physician. Whenever,
during the course of treating his patients, he
becomes aware of the commission of or
intention of committing an offence,
punishable under the following sections, he
is duty bound to inform the police (S.39 Cr.
PC) [20]:
 Offences against public tranquillity
 Offences relating adulteration of food and
drugs.
 Offences affecting life (S. 302, 303 & 304 of
IPC), etc.
Any breach of this duty will attract punishment
U/S 176/ 202 or 177 of the IPC.
However, the doctors working in government
institutes do not have this privilege. The
following cases are to be reported to the police
and dealt with as MLCs by the doctor on duty in
the casualty [21]:
 All cases of injuries and burns –the
circumstances of which suggest commission
of an offence by somebody. (irrespective of
suspicion of foul play)
 All vehicular, factory or other unnatural
accident cases specially when there is a
likelihood of patient’s death or grievous
hurt.
 Cases of suspected or evident sexual assault.
 Cases of suspected or evident criminal
abortion.
 Cases of unconsciousness where its cause is
not natural or not clear.
 All cases of suspected or evident poisoning
or intoxication.
 Cases referred from court or otherwise for
age estimation.
 Cases brought dead with improper history
creating suspicion of an offence.
 Cases of suspected self-infliction of injuries
or attempted suicide.
 Any other case not falling under the above
categories but has legal implications.
In this context, it is to be stressed that: It is
the duty doctor’s legal duty to label the said case
as an MLC or a non-MLC based solely on the
facts of the case. There is no role of consent by
the patient/ relatives in labelling the case and
informing the police. Consent is required for
conducting the medico-legal examination
subsequent to the said labelling.
3. Collection of samples and information –
S. 201 of the IPC deals with punishment for
causing disappearance of evidence. While
performing any medical examination, the
doctor should always keep in mind the fact
that any such case may have legal
implications in the future and hence should
always collect whatever information/
samples that might be needed by the
investigative agencies.
4. A patient cannot be detained on grounds
of non-payment of hospital charges. This
may constitute the offence of illegal
confinement U/s 340-342 IPC.
Conclusion and suggestions: Since time
immemorial, the profession of the medical
practitioners has been considered a high-risk
profession. The ancient ways of physical
punishment have been replaced by the modern
methods of economic compensation for the
damage incurred by the patient/ his relatives.
The modern concept of corporatization of the
health care system has in a number of ways
eroded the faith and trust in the doctor – patient
relationship. The doctors themselves are
developing a tendency to forget that the self-
regulation which is at the heart of their
profession is a privilege and not a right and a
medical practitioner obtains this privilege in
return for an implicit contract with society to
provide good competent and accountable
service to the public. It must again be
emphasized that the onus of maintaining this
faith and trust of the public in our profession
vests in us.
Some suggestions are given below, which if
followed diligently, might help the medical
practitioner in regaining the lost faith in himself
and his profession
1. The police are to be informed whenever
necessary and all help necessary, should be
extended.
2. Documentation is very essential – condition
of the patient, consent, procedure
performed or treatment given, etc. at that
instant time & do not leave anything for
completion later on. It should be
remembered that: “If you have not
documented it, you have not done it.”
3. Legible copies of medical records should be
furnished, whenever required by the
investigative agencies, courts or the
relatives of the patients (on payment of the
requisite fees).
4. The legal procedures are to be followed and
all legal formalities completed.

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5. A legally valid consent is a must before
starting any intimate examination,
procedure or any case where a conflict in
future is anticipated.
6. The hospital documents should be
preserved for the prescribed period, as
given below by various authorities:
a) In-patient records for at least 5
years and OPD records for 3 years
[22]
b) 3 years from the date of
commencement of the treatment, as
per the MCI [5]
c) At least 3 to 5 years, as per Clinical
Establishments Act 2010 [23].
d) As per the “Hospital Manual” of the
DGHS [24]
i. Inpatient medical records:
0 years
ii. Medico-legal registers:
10 years
iii. Outpatient records:
5 years
7. Records and documents should not be
manipulated or tampered with.
8. The medical practitioner should refrain
from being a party to unethical or unlawful
acts.
9. In no case should the patient be neglected.
Finally, it should be clear that the above is
not an exhaustive list of the duties and
responsibilities of the medical practitioner. In
addition to the duties owed to his patient and
the patient’s relatives/ third parties, his own
professional colleagues, there are many
statutory duties imposed upon the physician by
the state, the violation of which constitutes
negligence and would warrant appropriate
action by the State.
Conflict of Interest
None Declared
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This article can be cited as:
Harish D, Chavali KH, Kumar A, Singh A. Duties and responsibilities of the medical practitioner, revisited.
J Punjab Acad Forensic Med Toxicol 2012;12(2):115-20.