Duties of a doctor

Duties of a doctor

Duty refers to the obligation to act or refrain from acting in such a way that a patient’s medical condition is appropriately diagnosed and managed so that a patient is not exposed to an unreasonable risk of injury.

The following are the various types of duties of a doctor:

Duties of a doctor to Exercise a Reasonable Degree of Skill and Knowledge

The duty of care arises simply by examining someone for signs of illness or trauma or even by accepting a patient onto a list of existing patients.

As soon as a doctor gives advice and counseling over the telephone, a legal duty to the patient arises, If no advice is given, no duty arises. Exception might be made in cases of acute emergency where life-saving instructions are given over the telephone. For hospitals, a duty will usually arise once the person has been admitted, but in the case of an accident or emergency unit, a general duty of care is owed to the patient.

Duties of a doctor to the child holds good even when engaged by his father. Duties of a doctor holds good even when patient is treated free of charge. It neither guarantees cure nor an assured improvement. A practitioner is not liable because some other doctor of greater skill and knowledge would have prescribed a better treatment or operated better in the same circumstances.

CASE: (1) Whiteford V. Hunter and Gleed (1950): A consulting engineer of London was examined by a consulting surgeon who diagnosed enlarged prostate by doing rectal examination and advised operation. The surgeon did not use a cystoscope or make a biopsy.

On opening the bladder, he found an inoperable carcinoma and opined the expectancy of life to be only a few months. The person gave up his business and went to U.S.A., where a cystoscopic examination showed a prostate with a median bar, and the pathological examination revealed chronic cystitis.

An operation was performed and the calcareous material was removed from the diverticulum. There was no evidence of cancer. The patient sued the doctor for negligence and was awarded damages. The surgeon appealed and the Court of Appeal held that a mistake in diagnosis was not enough to justify negligence.

(2) Wood V. Charing Cross Hospital: A drunken person was hit by a Truck. The doctor who examined him found no clinical evidence of bone injury or any abnormality, but the stethoscope was not used. The person died 2 days later, and the autopsy showed fracture of one clavicle and 9 ribs on each side and congestion of lungs. The Court found the doctor negligent in not exercising reasonable care in his examination.

(3) Paynee V. Helier: A patient was kicked in the abdomen by a horse. He went to the hospital 9 hours after the injury, where he was examined by the Casualty Officer, who was qualified 2 years ago. He found a bruise in the right iliac fossa, but did not find any body or visceral injury. The person was sent home, who became very ill after some days and was operated but died later. The Court found the doctor negligent as he made a wrong diagnosis due to his failure to exercise reasonable skill and care.

Duties of a doctor with Regard to Attendance and Examination

When a practitioner agrees to attend a patient, he is under an obligation to attend to the case as long as it requires attention. He can withdraw only after giving reasonable notice or when he is asked by the person to withdraw. He cannot withdraw without the consent of the person except for valid reasons, such as:

• That he himself becomes sick.
• That he is convinced that the patient is malingering.
• Remedies other than those prescribed by him are being used.
• That his instructions are being ignored.
• That previous financial obligations are not being fulfilled by the patient.
• That another practitioner is also attending the patient.
• That the patient persists in the use of intoxicants or poisons.

If a physician is unable to treat the patient when his services are needed, he may provide a qualified and competent substitute doctor to give the services. If the practitioner cannot cure a person, he need not withdraw, if the person desires his services.

He should not get his patient examined or operated upon by another doctor without his permission. If the doctor is called by the police to attend a case of accident, he may give first aid and advice, but here no doctor-patient relationship is established. A medical practitioner need not accept as patients all who come to him for treatment.

He may arbitrarily refuse to accept any person as a patient, even though no other physician is available. However, he should know that the Code of Ethics requires that in an emergency, no physician should refuse to treat a patient. There is no law to compel a doctor to attend a patient except during military necessity.

CASE: Newton V. Central Middlessex G.H.M.S.: Newton was taken to the hospital after an accident. A doctor examined him but failed to diagnose the fractured patella and wrote, ‘No clinical fracture’ on the hospital card. Later, the person saw two other doctors at the hospital, who relying on the hospital card, did not examine the knee, though the patient had complained of pain in the knee.

The patient sued both the doctors for negligence. The Court held that the first doctor was not guilty because the patient went to him only for a dressing. The second doctor was held negligent as he failed to examine the knee himself.

Duties of a doctor to Furnish Proper and Suitable Medicines

If the doctor has his own dispensary, he should furnish the patient with suitable medicines. Otherwise, he should give a legible prescription, mentioning full and detailed instructions. The doctor is held responsible for any temporary or permanent damage in health, caused to the patient due to wrong prescription.

Duties of a doctor to Give Instructions

The doctor should give full instructions to his patients or their attendants regarding the use of medicines and diet. He should mention the exact quantities and precise timing for taking medicines. Patients should be instructed regarding the adverse reactions and to stop the drug in case of reaction, and to approach the doctor immediately.

Case: Ball V. Howard: The plaintiff was operated for appendicitis. The surgeon did not call another surgeon for consultation (though the patient requested for the same as he developed some complications), and went away without leaving proper instructions as to what was to be done. The patient called another surgeon, who performed a second operation after which the patient made a good recovery. The Court held that the first surgeon was negligent in not attending to the patient with reasonable promptness and in going away without giving instructions.

Duties of a doctor to Control and Warn

A physician has to warn patients of the dangers involved in the use of a prescribed drug or device. If the doctor fails to inform the patient of the known or reasonably foreseeable dangerous effects of a drug or device, he becomes liable not only for the harm suffered by the patient, but also for injuries his patient may cause to third parties.

If a drug is administered which might affect a patient’s functional ability, such as driving a car or operating machinery or equipment, the doctor should explain the danger to the patient, and/or to someone who can control the patient’s activities, such as the family, an employer, or the authorities. Similarly, when a doctor detects a medical condition that may impair the patient’s ability to control his activities, one of the duties of a doctor is to warn the person, family, employer or authorities.

The duties of a doctor is to warn the patient about his medical condition and treatment that could injure others, e.g., the doctor treating epileptic patient may be liable for injury to others caused by his patient, due to failure to advice the person of the risks of engaging in dangerous activities, under the concept of “Reasonable foreseeability”.

Duties of a doctor to Third Parties

If a person suffers from an infectious disease, the doctor should warn not only the patient, but also third parties known to be in close contact with the patient. These include relatives, friends, co-workers, and/or proper authorities who can protect these potential victims.

Duties of a doctor Towards Children and Adults incapable of taking care of themselves

When applying hot water bottles to children, special care should be taken, for the child may be injured. Special precautions should be taken in case of adults who are incapable of taking care of themselves due to insanity or some physical disability. Precautions should be taken to prevent accidents or harm.

Case: A woman was placed in a bed after an operation in which a hot water bottle was negligently left, due to which she was severely burnt between her shoulders. The surgeon came to see her while she was recovering from the anesthetic. She complained to the surgeon about the pain between her shoulders, but he paid no attention to her. The Court held the doctor negligent and awarded damages.

Duties of a doctor Under Geneva Conventions

In Geneva, in 1949, four conventions were agreed upon. Each convention lays down that the persons it protects, whether the wounded or sick of the armed forces (first convention), ship-wrecked persons (second), prisoners of war (third), or civilians of enemy nationality (fourth), are to be treated without any adverse distinction based on sex, race, nationality, political opinions or any other similar criteria. Priority is authorized only for urgent medical reasons.

Duties of a doctor in Connection with X-ray Examination

As far as possible, all cases of accident, unless they are very minor, should be X-rayed. Wrong interpretation of an X-ray has been held negligent.

Case: Fraser V. Vancouver General Hospital: A person was X-rayed after a traffic accident. The casualty officer, who was not competent, gave opinion that the neck was not broken. The Court held him negligent in not diagnosing a broken neck.

Duties of a doctor with Regard to Consultation

Consultation should be advised preferably with a specialist in the following conditions.

• If the patient requests consultation.
• In an emergency.
• When the case is obscure or has taken a serious turn.
• If the quality of the care or management can be considerably enhanced.
• When an operation or a special treatment involving danger to life is to be undertaken.
• When an operation affecting vitality of intellectual or generative functions is to be performed.
• When an operation is to be performed on a patient who has received serious injuries in a criminal assault.
• When an operation of mutilating or destructive nature is to be performed on an unborn child.
• In homicidal poisoning.
• When a therapeutic abortion is to be procured.
• When a woman on whom criminal abortion has already been performed has sought advice for treatment.

The consent of the patient must be taken. The doctor must tell the patient, whether he is being transferred to the consulting physician or only consulting, or it will be joint participation, and whether it will be on a continuous or intermittent basis.

A referring physician is relieved of further responsibility when he completely transfers to another physician. The referring physician may be held liable under the doctrine of ‘negligent choice’; if it can be proved that the consultant was incompetent or had a reputation as an “errant” physician.

All information about the patient must be transferred to the consultant by the referring physician. This is an essential part of the Duties of a doctor. The consultant should advise to return to the practitioner who has referred him. If he refuses, the consultant should talk to the referring doctor and settle the matter.

Case: Molseworth’s Case: The patient engaged a senior surgeon for hernia operation, but he was operated upon by a house-surgeon. The Court held that the house-surgeon had operated without the plaintiff’s consent; that for an unauthorized person to do, in competent manner, an act which another was authorized to do, was technical form of trespass and patient was awarded nominal damages.

Duties of a doctor to Inform Patient of Risks

A mentally sound adult patient must be told of all the relevant facts. If the treatment or operation proposed carries special risks which are known to the doctor but are probably not known to the patient, the doctor should inform the patient of these risks and obtain his consent. The inherent risk is one of a number of known adverse effects (or injuries) that may result from the mere use of an individual drug or the mere proper performance of a diagnostic procedure or surgical operation.

A material risk is a particular inherent risk, i.e. one known adverse effect or complication associated with a drug, procedure or treatment, that physician knows would be a significant factor in a person’s decision whether to reject or accept treatment. But under certain conditions arising out of psychological factors, some facts have to be withheld.

Case: Kankan V. Beharelal: A prescription was given to Kankan for ear trouble, which was used as directed by the doctor. The patient developed pain and acute sensation in the ear after a year, and on examination, the drum of his right ear was found destroyed. The evidence showed that the doctor has prescribed a new and dangerous mixture for a petty complaint, and if the mixture had been used after thorough shaking, no harm would have resulted. The High Court held the doctor negligent, as he failed to warn the patient of the risk involved.

Duties of a doctor with Regard to Poisons

Poisons should be handled carefully. Each poison should be kept in a separate bottle, properly labelled and kept in a separate cupboard or upon a separate shelf. When a doctor is called upon to treat a case of poisoning:

• He should give immediate treatment, and
• He should assist the police in determining whether the poisoning is accidental, suicidal or homicidal.

Duties of a doctor to Notify Certain Diseases

A doctor is bound to give information of communicable diseases (smallpox, chickenpox, cholera, plague, typhoid, measles, diphtheria, yellow fever, food poisoning) births, deaths, etc., to the Public Health authorities. If a doctor fails to conform to the statutory or administrative requirements, he will be liable not only for criminal penalties, but also for negligence in civil suits brought by injured parties.

Duties of a doctor with Regards to Operations

• He should explain the nature and extent of operation and take consent of the patient.
• He should take proper care to avoid mistakes, such as performance of operations on the wrong patient or on the wrong limb.
• When a surgeon undertakes to operate, he must not delegate that duty to another.
• He must not experiment.
• He must be well-informed of current standard practice and must follow it.
• He must operate with proper and sterilized instruments.
• He should make sure that all the swabs, instruments, etc., put in are removed.
• He should take proper postoperative care and should give proper directions to his patient when discharging him.