Here I am trying to explain how Medical Negligence and Medical Ethics are interlinked and why doctors must do all they can to defend our ethics. I am sharing case history, every day clinical examinations and management of common illness to explain why they are unethical medical practice. Since I published a letter in 1996, critisising the use of preprinted assessment sheet, allowing nurses to work like doctors in the NHS(UK), the number of deaths, complications and wrong doings has escalated to catastrophic proportions. Doctors who continue to work are suffering in silence. The ones who raised concern were systamatically harassed, bullied and ostracised. The institutions, associations, nursing council and the Royal Colleges and the WMA have ignored their duty to protect fellow human. I do not think we can claim to be members of a "Noble Profession" if we allow this un-ethical medical practice continues. The General Medical Has not only ignored their duty to protect fellow human but also discriminated doctors passing out from Non-European medical schools by allowing nurses to work like doctors. This institution has failed to define the word "Doctor" and has inflicted pain and suffering to doctors who defend their moral and ethical duty. Our profession and our lives are threatened by emerging and antibiotic resistant infections. We must join hands and defend our profession. By allowing nurses with no medical school training or skill to clinically examine patients to diagnose and prescribe drugs, we have failed to protect fellow human who trust our profession. This is substandard, un-ethical medical practice that has brought us shame must be stopped. Please leave your comments and criticise me if I am wrong. As a Hindu Brahmin, it is my religious duty to defend "Dharma", protect the sick and vulnerable. Please watch this presentation and ask your self have you fulfilled your promise and are you defending your faith?

1. NEGLIGENCE
By Dr Kadiyali M Srivatsa
Ethical duty of a doctor is to protect
human rights and dignity of the patient
Physician’s must “Disobey Law”
that demand “Un-Ethical Behavior”

2. ACT OF COMMISION
To Do Something
Which A Prudent
Man In
Similar
Situation
“Will NOT DO”
- Alderson 1843 -

3. ACT OF OMISSION
Not Do
Something Which
A Prudent Man In
Similar Situation
“WILL DO”

4. DILIGENCE
Diligent Behavior Is Indicative Of
“WORK ETHICS”
You must understand “Diligence” before
you can understand all about ethics
A Belief That “Work Is Worship”
Ref: Keith E. Thurley, Sek Hong Ng (1996), "The Concept of the Work Ethic",

5. DILIGENCE
Steady, earnest, conscientious
application of one’s energy
to accomplish what have
been undertaken
Exercise of investing
all energy to
complete the
assigned
tasks.

6. DILIGENCE
Continue to work hard and vigilant
Avoid errors and stay focused on the task
Pays careful attention to details
Dedicated to achieving quality results.
Committed to transform vision into
reality.
Work hard towards goal.
My Vision: “Bring Tears Of Happiness”

7. DILIGENCE
”The Seventh Heavenly Virtues”
A zealous and careful nature in one's actions
and work.
Decisive work ethic, steadfastness in belief,
fortitude, and the capability of not giving up.
Budgeting one's time
Monitoring one's own activities
Upholding one's convictions at all times -
especially when no one else is watching
“This is called Integrity”

8. FACTORS THAT INFLUENCE DILIGENCE
 Discipline
 Motivation
 Concentration
 Responsibility
 Devotedness
Ref: H Bernard, DD Drake, JJ Pace (1996)

9. DILIGENCE IN BUDDHISM
 Strive on with Diligence
 Diligence is an integral part of Buddhism
 The Fourth of paramita (wisdom)
 “Diligence is the third paramita that lead
to Liberation
 Diligence will bring an increases of
quality
Je Gampopa (1994), Gems of Dharma, Jewels of Freedom, Altea Publishing, p. 163

10. EIGHT FOLD PATH

11. DILIGENCE IN CHRISTIANITY
Diligence and Faith are two sides of a mystery

12. DILIGENCE IN CHRISTIANITY
 Effort to do one's part
 Diligence and faith are two sides of a mystery.
 One doesn’t know how, despite one's effort, it all
works out.
 When combined with faith assures spiritual
success.
 One of seven virtues describes thoroughness,
completeness and persistence of an action,
particularly in matters of faith.
1. How do we live the Christian Life? David Sper (2002)
2. Andreas J. Kšstenberger (2011), Excellence: The Character of God and the Pursuit of
Scholarly Virtue.

13. DILIGENCE IN BIBLE
 Show this same diligence to the
very end to make your hope sure.
 Do not become lazy
 Imitate those who through faith and
patience inherit what has been
promised”.
The Holy Bible: New International Version. International Bible Society,
(1973), THE LETTER OF PAUL TO THE HEBREWS 6:11-12

14. SEVEN HEAVENLY VIRTUES
 To oppose the seven deadly sins
 Psychomachia or Battle of the soul or the Battle
between Good Virtues & Evil Vices
 Work in middle ages helped to spread the
concept in Europe.
 The Virtues are chastity, temperance, charity,
diligence, patience, kind ness and humanity
 Practicing these seven virtues is said to protect
one against temptation from seven deadly sins.
Ref: Aurelius Clemens Prudentius, a Christian governor who died around 410 A.D.,

15. DILIGENCE IN ISLAM

16. DILIGENCE IN ISLAM
That man can have nothing but
what he strives for; the fruit of his
striving will soon come in sight.
He will he be rewarded with a
reward complete.
The Quran; An-Najm 53:39-41

17. DILIGENCE IN HINDUISM
Discover and live a “Dharmic life”.
Live with right intention and diligence
Have “Concern for well being of others”
1. Brian Hatcher (2008), Bourgeois Hinduism or Faith of the Modern Vedantists, Oxford University Press.
2. Hatcher, B. A. (2007). Bourgeois Vedānta: The Colonial Roots of Middle-class Hinduism. Journal of the
American Academy of Religion, 75(2), 298-323.

18. DUTY OF A HINDU
Every Hindu Will
1.Jnana Yogi : Acquire Knowledge
2.Bhakti Yogi : Dedication
3.Karma Yogi: Work is Worship
4.Raja Yogi: Universal Self.
Hindu who acquire knowledge and
dedicate his life is “Karma Yogi”
He will transcend the limits of the finite
self will embrace universe as the King
“Raja Yogi” before Mohksha

19. BRAHMAN AND MAYA
• Brahman is the key metaphysical concept in various
schools of Hindu philosophy.
• It is the theme in its diverse discussions.
• METAPHYSICS: What is ultimately real, and are there
principles applying to everything that is real?
• Brahman is the ultimate “Eternally constant reality”
• Observed “Universe is constantly changing”.
• Maya pre-exists and co-exists with Brahman
• Ultimate reality, Highest Universal and Cosmic Principle

20. MAYA & BRAHMAN
• Maya is “perceived reality”, one that does not reveal the
hidden principles, the true reality is – The Brahman.
• Maya is unconscious, Brahman-Atman is conscious.
• Maya is the literal and the effect, Brahman – the principle and
the cause.
• Maya is born, changes, evolves, dies with time
• Brahman-Atman is eternal, unchanging, invisible principle,
unaffected absolute and resplendent consciousness.
• Maya concept is "the indifferent aggregate of all the
possibilities of emanatory or derived existences, pre-existing
with Brahman", just like future tree pre-exists in the seed of
the tree.

21. HUMAN RIGHT (1948)
• Started with United Nations in 1945
• The Universal Declaration of Human Rights
1948 define human rights.
• Ethical duty of a doctor is to protect the
human rights and dignity of the patient
• Document that defines human rights has had
its effect on medical ethics.

22. ETHICS & MORALITY
ETHICS
•Ethics is the study of morality
•Systemic reflection on and analysis of moral decisions
and behavior whether past, present or future.
MORALITY
•NOUN: Rights, Responsibility, Virtues
•ADJECTIVE: Good, Bad, Right, Wrong, Just & Un Just

23. MEDICAL ETHICS
Ethics is a Matter of KNOWING
Morality is a matter of DOING
Rational criteria to DECIDE or BEHAVE
Higher standards of behavior than LAW
Ethics Require Physicians DISOBEY LAW
that demand UN-ETHICAL BEHAVIOUS

24. MEDICAL ETHICS
 Moral Principles that apply values and
judgments to the practice of medicine.
 Practical application in clinical settings as
well as work on its history, philosophy,
and sociology.
“ If I have to or forced to “Do Something” a
prudent man will not do or “Do Not Do
Something” a Prudent man in similar
situation “Will Do”, I feel very uncomfortable
and so must be “Un-Ethical.”

25. HINDU MEDICAL ETHICS (600
BC)
Study of science to attaining virtue, wealth
and pleasure.
Help relief pain and suffering inflicted upon
fellow human who walk in the path of
“Righteousness”.
Duty to defend & protect “Righteousness”
Gain knowledge of truth, acquire spiritual
merit to help humanity.
“Knowledge of Health is Knowledge of Life”
Ref: Medical ethics - as prescribed by Caraka, Susruta and other ancient Indian physicians.
HANDBOOK ON MEDICAL ETHICS

26. HINDUISM & MEDICINE
Medicine is a life long study of life with no limits.
Must apply thyself to it with diligence.
Learn the skill of practice from another without carping.
The entire world is the teacher to the intelligent and foe to
the unintelligent.
You should listen and act according to the words of
instruction of even an unfriendly person, when they are
worthy.
“Good physician should always persevere to do his best in
the acquisition of the true qualities of a physician so that he
may be a real giver of life to people’

27. ETHICS & RELEGIOUS TEACHING
“Hippocratic Oath” – A Promise
“Formula Comitis Archiatorum”
Code of ethics 5th
Century
Islamic scholors wrote the Conduct of a
Physician, 1st
Book Of Medical Ethics.
Jewish and Christian thinkers describe
case-oriented analysis Catholic moral
theology.

28. EUROPEAN MEDICAL ETHICS
1800-1900
Moral self-conscious discourse.
Thomas Percival
Modern code of medical ethics in UK
Pamphlet with the code in 1794
Expanded version “Medical Ethics” 1803.

29. CAVEAT EMPTOR
Let the buyer, purchaser or
receiver (patient) make
diligent survey or assessment.
The duty of seller or provider
of service (doctor) must be
honest and share information

30. NURSE DRUG PRESCRIBINGApril2006

31. NURSES FAILED BOLAM
TEST
Nurses I identified to have inflicted pain and suffering to
fellow human failed “BolamTest”,
It is “My Duty” to raise concern about wrong doings as a
prudent doctor in a similar situation will do.

32. NURSE DO NOT NEED DOCTORS BACKUP

33. CRIMINAL ACT

34. NURSE ON CALL - 2006July2006

35. NURSE ON CALL - 2013

36. UN-ETHICAL BEHAVIOUR

37. SEPTICEMIA - 37,000 DIE

38. SUB-STANDERD CARE

40. BREACH OF DUTY
Nexus Between Damage & Negligence

41. NEGLIGENT CARE
Un-Ethical Medical Practice
 Community nurses in UK were trained for six months
to clinically examine patients by senior nurses
 NO Formal Medical School Training or experience
 7000 Independent Nurse Practitioners were employed
by the NHS to work as doctors and prescribe drugs.
 Nurses with no formal emergency care training
diagnose, triage patients with medical emergency
 The number of patients referred to A&E, specialist has
doubled since 2006.
 Wrong diagnosis – treatment result in delay,
prolonged pain, suffering and complications.

42. UNETHICAL
“SUBSTANDARD CARE”
 Independent Nurse Practitioners: Not trained or supervised.
 Nurses are used in A&E / ER in hospitals to perform initial
assessment and discharge, admit or refer to doctors
 “Walk In Clinics” managed by “Nurse Practitioners since 2006.
 Clinical errors, complications, deaths, hospital admissions has
doubled since 2006.
 Avoidable death has increased.
 Majority of hospitals are bankrupted by escalating cost.
 Compensation payment has increased to £1.5 Billions
 The best health care system in the world is now crumbling

43. BOLAM TEST
 A doctor need not possess the
highest expert skill.
 It is sufficient if the doctor exercise
the ordinary skill of a competent
doctor exercising that particular art
 Must use knowledge, clinical
examination, diagnosis, treatment or
advice as another doctors in similar
situation” Will Do”

44. UNETHICAL

45. Medical School
 Year 1: Acquire in-depth knowledge of Anatomy (human
body), Physiology (How body works), Biochemistry
(chemical changes in body)
 Year 2-3: Pathology (abnormal functions), Microbiology
(bacteria and infections), Pharmacology, Forensic,
Orthopedics, Ophthalmology and dermatology
 Year 3-5: Clinical Skill training (How to examine patients
and diagnose illness and how to treat using drugs.
Pass Final Examination before they can work
as doctors under supervision in hospital

46. Junior Doctor In Hospital
 Year 1: Pre-registration house officer (PRHO) - 1 year
 Year 2: Senior house officer a minimum of 2 years
 Year 4: Specialty Registrar in general practice: 3 years
 Year 5: General practitioner: total time in training: 5 years
 Years 6-8: General practitioner after passing Examination
 Year 9: Consultant total time in training: 7-9 years
After completing they are expected to pass examination to
prove they are safe to work independently as a consultant
and not under supervision

47. Nurse Training
• Theoretical and practical training to nurse
• No formal training to clinically examine and diagnose
• No in-depth knowledge of pathology or drugs
• Learn to take care of patients personal, physical and
psychological wellbeing
• Trained to offer treatment as advised by doctor
• Educated by senior nurses and NOT BY DOCTORS
• Registration as typical nurse is four years
• Specialist Nurse Prescriber: Six months course to
learn what doctors spend 10-12 Years!!!

48. DOCTOR & NURSE
DUTY OF NURSE
Nurses job is to look after people who are ill. Hospitals are
full of sick people who need social care to help them get
better. These sick people are called patients. Many nurses
work in hospitals taking care of patients
DUTY OF A DOCTOR
Doctor in the hospitals find out about patients illness and
then the doctor tell the nurse what to do to help the patient
get better. The nurse carry out doctors order and care for
the patient until they are well enough to go home

49. Early Diagnosis, Treatment & Referral To Specialist Care

51. 1. WEEK
NURSE
Initial Diagnosis
and Treatment is
wrong – Delay
2. WEEK
DOCTOR
Doctor start from
assessment,
investigation,
diagnose and
treat – Failure
3. WEEK
Process to Refer
to Specialist start.

52. WHY DISOBEY LAW?
• Antibiotics resistant bacteria is threatening our very existence.
• Knowing abusing this drug by allowing people who are not
trained to clinically examine, perform tests and diagnose
infections is helping bacteria develop resistance
• Prescribing antibiotics claiming to be based on evidence based
medicine is not safe and not in the interest of our profession
• Wrong dose result in helping resistant strains colonisation
• Excessive use result in antibiotics pollute environment
• Ignoring and allowing people in power to continue “Un-Ethical
Medical Practice” is immoral and unethical
• Physician’s duty is to “Disobey Law” that demand “Un-Ethical
Behavior”

53. STANDARD OF CARE DIFFER
• Primary care physician and Consultant
• Physician and Surgeon
• Junior doctor and Consultant
• Nurses and Doctors
• Place the Treatment is given (Primary
care and Hospital care)
When Medical Errors Are Committed, The Court Has To Decide
Whether The Injury Caused Was Accidental Or Non-Accidental Injury

54. ACCIDENTAL INJURY
• Accidental injury or misfortune
without criminal intent is not an
offence.
• Accidental injury is not an offence or
neglect.
• Doing a lawful act in a lawful manner
by lawful means with proper care and
caution is not neglect

55. MODE OF TREATMENT
Two School of Thoughts for given
situation
If doctor adopts one of them,
he/she is justified and Not
Negligent

56. ACCIDENTAL INJURY
•Who did it?
•Whom it was done?
•Where was it done?
•When was it done?
•How was it done?

57. ACCIDENTAL INJURY
• If the answers to all the questions
are satisfactory then you can plead
the injury as accidental injury and
not neglect
• If Answers to all the questions are
favorable and still something goes
wrong then it can be regarded as an
accident

58. REO Vs. MINISTER OF HEALTH (1954)
 Anesthetist used spinal anesthesia (Procaine) which was
stored in a solution of phenol.
 The incidence took place in a hospital in 1947.
 Patient developed diplegia (paralysed below waist)
 In 1951, the hospital discovered cracks in the ampules
that were stored in phenol.
Doctor was not found to be negligent because he had
adopted standard practice recommended in 1947.
The standard of practice is to be judged at the time and
date of the incidence and not the date of trial.

59. BOLAM Vs. FRIERN HOSPITAL (1957)
Mental health patient advised ECT
He was not given anesthesia
Patient sustained fractured hip and claimed
compensation
Court Ruled sufficient skill exercised accordance with accepted
practice by “Reasonable body of medical men defending”.
Doctor was not negligent, because other skilled in the particular
art have opinion adverse to it.

60. DUTY OF CARE

61. DAMAGE
• When DAMAGE is not direct but
REMOTE and the REMOTNESS of
the consequence could be
FORESEEN or PRE-RECOGNISED
• The Doctors will be held
RESPOSIBLE even for
REMOTE CONSEQUENCE

62. CONTRIBUTORY NEGLIGENCE

63. DOCTOR’S RESPONSABILITY
• Duty of doctors is to raise concern if patients suffer pain,
demeaning treatment, torture or harm inflicted by others.
• If a doctors does not raise concern, he or she can be held
responsible for contributing to negligent care.
• Doctor or nurse performing procedure, committed error in
diagnosis or prescribed a drugs that I in a similar situation
would not have - Then this is Commission “Negligent care”
• Doctors or nurse did not act, prescribe or refer patients to
hospital when I in similar situation would have – This is
Omission and so could be labeled “Medical Negligence”

64. WHY NURSE FAILED BOLAM TEST
Nurses Working As Doctors
• Nurse need not possess the highest
expert skills.
• Nurse did not exercise the ordinary
skill of an ordinary competent doctor
exercising that particular art and so
inflicted pain and suffering to fellow
human.

65. ACT OF COMMISION
Nurses Did Something which
a General Practitioner in
similar situation Will Not Do.
“MEDICAL NEGLIGENCE”

66. ACT OF COMMISION
Labeling Infections Or Illness As URTI, LRTI, Cough,
Cold, GE And Antibiotic Prescribed Is An Act Of
Commission Because These Are Not Accepted As
Illness or Disease By Doctors All Over The World.
Patients Can Take Legal Action

67. ACT OF OMMISION
Prescribing Antibiotic For Viral Infection Result In Patient
Colonizing With Antibiotic Resistant Bacteria. If The Patient
Develops Septicemia Due To Resistant Strain And Die, Relatives
Can Take Legal Action Against The Doctor because “Doctors Did
Not make the correct Diagnosis”

68. ACT OF OMMISSION
Doctor or Nurse who Does NOT DO what
another doctors in similar situation “WILL DO”

69. ACT OF OMMISSION
Doctor or Nurse who Does NOT DO what another
doctors in similar situation “WILL DO”

70. ACT OF OMMISSION
Doctor or Nurse who Did NOT DO what another
doctors in similar situation “WILL DO”
This 18 Years old girl
presented with history of
Anxiety and Hoarse voice
Doctors and nurses failed to undress and examine
Her chest for almost 2 years but refered her to
Speech therepist

71. ACT OF OMMISION
Wrong Diagnosis And Treatment
25 years man with rash on his cheek and neck
went to local walk in clinic and consulted a nurse.
Diagnosis: “Shingles and advised acyclovir cream
and paracetamol
Two days later, he was seen by doctors in surgery
Diagnosis “Septic Shock” with low Blood pressure
Doctors in similar situation would have diagnosed “Imedigo” and prescribed th
right Antibioitc and advised isolation. This is “Act of Omission” resulted in
complication and almost death and so “Negligence”

72. ACT OF OMISSION
Wrong Diagnosis & Treatment resulted
in spreading infection to others in the
family

73. ACT OF OMISSION
Diagnosed But Treatment Not Given
 2 years old child taken to local walk-in-clinic on Saturday. Seen by a
nurse and told the child has chest infection. No treatment given but
asked to consult doctor in the surgery on Monday morning.
Child seen on Monday morning as an emergency.
The child was unwell, grunting and breathless with mild
fever.
Clinically “Serious lobar pneumonia” due to delay and not
offering antibiotics early.
The nurse should have offered antibiotic or refer to hospital care.
The nurses are not allowed to treat children less than 2 years in the
walk in clinic, so the nurse did not do what a prudent doctor in a
similar situation would do (Ref to refer to specialist care in a
hospital). This is an “Act of Omission” and so “Medical Negligence

74. ACT OF OMMISION
Correct Diagnosis But Not Managed Well
 District nurse visit terminally ill patient at home. He is on high dose of
codeine phosphate and opioids for pain relief.
 This patient complaints about pain in supra-pubic area and unable to pass
urine and severe constipation.
 District nurse diagnose “Constipation and Retention of urine”
 She tried to catheterize bladder but fails to empty bladder
 She calls “Nurse-led practice” and came to know I am on holiday. She
speaks to “Independent Nurse Consultant”
 No Action taken, patient left at home to suffer for 15 days. They wait for
me to return from holiday.
This is “Act of Omission” because a doctor would have tried to catheterize, if
he failed, he would have performed “Supra-pubic cystectomy” to reduce
pain by emptying bladder or referred him to hospital care, and so
“Negligence”

75. COMMISSION OR OMMISSION?
Girl aged 23 years consulted a Nurse as
emergency Nurse-led Practice.
She complained of vomiting, high fever,
passing dark urine and thought she has
jaundice.

76. The Consultant Nurse Practitioner,
 Did not think the girl has jaundice
 Prescribed paracetamol and advised to drink lots of fluid.
 Did not advice isolation
 Not reported to Infectious disease team
 2 days later, the girl returns to consults locum doctor.
 The doctors request LFT (Liver function test)
Result of Blood Test (LFT) were abnormal.
Locum doctor accused her of abusing paracetamol.
COMMISSON OR OMMISSION?

77. PRUDENT DOCTOR WILL
Diagnose Jaundice and asked about the travel and
the color of her stool to differentiate obstructive from
non-obstructive jaundice.
She was passing pale stool with dark urine & No h/o
travel so refer to hospital “?Obstructive Jaundice”.
Will not routinely prescribe paracetamol
Refer to specialist care or admit in hospital
Prevent her getting dehydrated
Inform “Infectious Disease Surveillance Team” to
prevent spread of infection in community.
Investigate to make the correct diagnosis to prevent
complication (Obstructive jaundice is serious illness).

78. NEGLIGENT CARE BY NURSE
“Act of Omission” because the nurse
“Did not Do” what a prudent doctor in a
similar situation would have done
 “Act of Commission” because the
nurse “Did” what a prudent doctor in a
similar situation would “Not have Done”

79. NEGLIGENT CARE BY LOCUM
DOCTOR
“Act of Ommission”
 Locum doctor diagnosed an illness, investigated but “Did Not
Do” as another Prudent Doctor in similar situation would have
done.
“Act of Commission”
 Patient is seen regularly with the same proble
 Doctors requested blood tests, noticed abnormality but accused
of abusing paracetamol
 Did not refer, isolate, inform infectious disease survelence team
 Assess patients physical and prevent dehydration
 Not differentiated obstructive from un-obstructive jaundice
 Fail to take “Do” what a prudulent doctor in similar situation will
do

80. ACT OF COMMISION & OMMISION
Wrong Diagnosis, Treatment, Interpretation of Result and
Management
• Girl Aged 12 years with tiredness
was seen by Nurse & later by
Doctor. Both diagnosed Anemia but
DID NOT Clinically Examined her.
• Blood test result was seen but filed
in as normal when it was obviously
abnormal and not acted upon.
• 2 years later she was seen and
examined by another doctors.
• On examination, this girl had huge
kidney and was on kidney failure.
• Now she has lost one kidney and is
hypertensive drugs

81. ACT OF COMMISSON & OMMISSION
Missed Pregnancy & Prescribed CI Drug in Pregnancy
 52 years old Pakistani married women consult a nurse
practitioner with history of tummy pain and vomiting.
 Diagnosed as gastritis she was advised antacid.
 Two days later, she returns to consult a locum doctor.
 Diagnosis gastritis and prescribed anti-emetics.
 A week later she consulted another doctor.
 Based on history, he asked her if she was sexually active. The
women was embarrassed but told him she was.
 After clinically examining her abdomen, the performed
Pregnancy test which was positive.
 She terminated pregnancy (against her religious belief)
because of fear of congenital abnormality in the fetus.

82. “Act of Ommission”
Prudent Doctor would have ruled out “Pregnency”
Clinically examined the abdomen before diagnosis
“Act of Comission”
Did what a prudent doctors would not have done
in a similar situation.
Prescribing toxic drugs that affect fetus

83. VICARIOUS LIABILITY
Healthcare Providers Are Said To Be Vicariously
Responsible but The Nurse will be held responsible if
the patient takes legal action. The nurse will have to
relay on his/her notes and documented information

84. VICASIOUS LIABILITY
Difficult To Prove Who Is Responsible, “BE PREPARED”
• Liability instead of another person
• Each person is liable for his own deeds but there are
circumstances when acts are committed by one
person and liability comes on to another
• Two Principles
• He who does an act through another is, in law deem to
have done it himself
• Let the superior be responsible (they will always say NO)
If a Doctors allows a nurse to diagnose, advice and treat a patient,
the Doctor is Held Responsible for the injury caused by the nurse.

85. LISTEN TO PATIENTS AND ACT

86. PEOPLE WHO OFFER MEDICAL ADVICE WITHOUT
PROPER TRAINING IN MEDICAL SCHOOL OR LICENCED
TO PRACTICE COULD BE SUMMENED TO COURT

87. FINAL THOUGHT
• Always listen to patients they know what is wrong with them
• Majority of patients know what to expect.
• Think of hidden agenda but offer treatment only if necessary
• Mentally ill patients do not have insight and can mislead you
• Common symptoms are common but rare ones are rare
• Patients with serious illness present with common symptoms
• Think and DO NOT ASSUME
• As a doctor you acquire knowledge from patients
• Doctors are not GOD who save lives but mastered the art of
postponing death

88. “The world will
not be destroyed
by those who do
evil, but by those
who watch them
without doing
anything”
Albert Einstein

89. We Bring Tears Of
Happiness

90. THANK YOU
Dr. Kadiyali Srivatsa