The community and patients tend to forget that the clinicians and other healthcare personnel are also human like them. Every human makes an error while performing his or her task, accurately reporting the performance and due to general forgetfulness. However, the consequences of errors in medical practice are potentially serious for both patients and doctors alike.

1. Medical Negligence or Error
Dr (Brig) Man Mohan Harjai

3. Medical errors
• The community and patients tend to forget that the
clinicians and other healthcare personnel are also
human like them
• Every human makes an error while performing his or
her task, accurately reporting the performance and
due to general forgetfulness
• However, the consequences of errors in medical
practice are potentially serious for both patients and
doctors alike.

4. Medical errors
• Errors are an inevitable and unfortunate reality of
medical practice
• The errors in medical practice are as old a medical
practice itself
• During the older times, the doctors were considered
next to god and the doctors were rarely victimized or
accused of an error made during the practice

5. Medical errors
• But with increasing complexity of healthcare sector, the times
have changed
• Patients have become more aggressive and demand
compensation for even inevitable, unforeseen errors
• Sections of judiciary as well as medical fraternity already
know that even though there is a human factor in the error
• Perhaps, this whole situation warrants that clinicians must
know well about the errors in legal perspective too
• This will enable entire medical fraternity to systematically
tackle these errors wherever possible

6. Types Of Error
The primary error differentiation can be done on
the basis of the time when the errors occurred.
They are
• Error of Planning: The error occurred during
planning which transpired into a medical error
• Error of Execution: The action as planned was
not carried out and transpired into medical error.

7. Types Of Error
Secondly, the error differentiation is based on the how the medical
error happened
• Active error: The error that occurs at the level of an operating
clinician. Generally, the effects of these errors are felt
automatically. Some of the examples are inadequate anaesthesia,
incorrect incisions etc
• Latent error: The error is a result of a design, training or
maintenance defect that leads to operator errors. These errors stay
dormant and generally not addressed for a longer duration. Some
of the examples include faulty diagnostic devices, errors in the
medical record system etc.

8. Types Of Error
• Two criteria mentioned above regarding the error
classifications are perhaps the most important for any
clinicians to address
• It has been found that active errors compounded with
either error of planning or execution result in a medical
negligence claim from a patient
• However, clinicians need to be aware that many times
latent errors, i.e. faulty equipment, inadequate training,
errors in medical record trigger the clinicians into making a
wrong decision or while choosing a wrong pathway for
treatment

9. Measures to prevent errors

10. Adequate training for staff
• In an individual practice or a large setup, the
persons who directly represent the clinicians
should be provided with adequate training
• Right from the receptionists to medical
assistants, all should have the formal education
that is requisite for their role
• Employing any persons below this requisites can
transpire in the medical error in the future.

11. Timely maintenance of equipment
(Small setup)
• Individual clinicians (general physicians) generally have only
a handful of diagnostic devices
• These include stethoscope, sphygmomanometer, pen-
torch, weighing scale and sometimes a portable ECG
machine
• Clinicians need to timely check all these and if possible,
calibrate them time to time
• This can be easily done by having an additional device and
calibrating the primary machine with that machine from
time to time.

12. Timely maintenance of equipment
(Large setup)
• In a large setting though, all equipment should be subjected to
timely maintenance by professionals
• It would be best to avoid dodgy local maintenance firms, who tend
to fix the fault but generally do not fix the problem of the machine
• It is advised that equipment logs for large and critical equipment
should be maintained for at least 5 years
• The clinicians should timely report any unaccounted faults or errors
of such systems to the administration
• Timely reporting is appreciated legally, as it can reduce the burden
from the individual clinician.

13. Adequate and requisite records management
• Inadequate or incomplete patient data sometimes throws
clinicians in the loop of repetitious testing of the patients
and inaccurate treatment planning
• In addition, previously identified procedural or treatment
contraindications can easily get overlooked by the clinicians
• Hence, proper management and an adequate standard of
documentation are also warranted
• In addition, the documentation is the most important
component for any possible legal matter

14. Appropriate data transfer
• Often patients present with a complaint and describe the condition quite
explicitly. But then, these patients are referred to another physician or a
specialist
• It is recommended that each clinician should have a template for
examination of the patients
• When a referred patient is seen, the information should be transferred in
missing fields of the template by expeditious investigations.
• This approach can resolve the oversight from critical diagnostic
presentations and help break the link of errors. This approach is also
helpful in understanding and updating in-house checklists
• In legal perspective, more, accurate and to-the-point documentation is
given a fair go.

15. Summary
• Practice of medicine is not like before
• With prevalence of internet patient do come to you
with knowledge even though they may not understand
• The type of family practice also so different. Now
however good the family doctor patient may straight
away seek super specialist.. That bring problem to
everybody
• Previously specialist see the patient after completely
worked out case
• That puts super or specialist in stress on two counts
-one ego of superiority and second always tend to
make rare condition

16. What to do
• Common thing first
• Always have a back up
• If in doubt admit it and tell the patients the need for more investigation or
second opinion
• Always reveal every thing to patients
• You can refer internet to clear your doubts
• When you are called for emergency always think about the case you are
asked to attend (what we call as stair case thinking.)
• Maintain good record and never contradict or critical of other doctor in
the case sheet
• Write your opinion without directly hurting comments
• Never deal with a case which is you are not expert, tell the patient or refer
• Try to be honest and when you get time always update yourself
• Now in modern era you can update from your home
• Always take some break from your practice time and again
• Which ever your speciality always keep in touch with your teacher of your
choice.

17. Conclusion
• Its very essential to update ourselves, training of staff,
equipments calibration periodically plus the database.... Every
thing counts
• Defending one's error amounts to committing another error
• Always take patients relations in your confidence of
understanding of the case for management
• Modern docs are "men behind machines”. They have no time
to examine a patient in a holistic manner, this way many
errors can be averted
• Reporting from CT MRI Investigations should be very accurate
and correct in which the consultant relay, if any goes wrong in
reports the doctors are misguided sometimes which leads to
negligence
• One thing is very clear that whatever may be the
advancement in diagnostic modalities, after all, proper
communication, clinical examination, clear documentation
always play a great role to provide strong defence against all
litigation

18. Following SOP and accreditation
definitely reduces incidences but will
never avoid it altogether. Its the after-
effect which can be tackled well by
good rapport and counselling