Shield for noble Hands...

Professional Relationship

  • Dimensions of relationship
    • Contractual relationship: Once a relationship is initiated, it is subject to the principles of the law of contracts.
    • Consensual relationship: doctors are required to obtain competent informed consent from their patients before care and treatment can be provided.
    • Quality assurance: concerns require that the doctor apply appropriate standards of care in providing service to the patient
  • Relationship under consumer protection acta
    • In 1995, the Supreme Court decision in Indian Medical Association Vs VP Shantha brought the medical profession within the ambit of a 'service' as defined in the Consumer Protection Act, 1986. In this case, the question raised was whether a medical practitioner could be said to have been rendering services as defined under Section 2(1) (o) of the Consumer Protection Act of 1986.This defined the relationship between patients and medical professionals as contractual. Patients who had sustained injuries in the course of treatment could now sue doctors in 'procedure-free' consumer protection courts for compensation.
    • As a result of the judgment given in this case, medical profession has been brought under the Section 2(1) (o) of CPA, 1986 and also, it has included the following categories of doctors/hospitals under this Section:
    • All medical / dental practitioners doing independent medical / dental practice unless rendering only free service.
    • Private hospitals charging all patients.
    • All hospitals having free as well as paying patients and all the paying and free category patients receiving treatment in such hospitals.
  • Relationship under law of tort
    • Reasonable Care
    • Reasonable skill
    • Professional secretes
    • Reasonable care
    • A doctor must use clean and proper instruments, and provide his patients with proper and suitable medicines if he dispenses them himself. If not, he should write the prescriptions legibly, using standard abbreviations and mention instructions for the pharmacist in full. He should give full directions to his patients as regards administration of drugs and other measures, preferably in local written language. He must suggest /insist on consultation with a specialist in the following circumstances:
    • When the case is complicated.
    • When the question arises about performing an operation which may be dangerous tolife or requiring amputation.
    • Operating on a case in which there has been a criminal assault.
    • Performing an operation which may affect the intellectual or reproductive functions of a patient.
    • In cases where there is suspicion of poisoning or other criminal act.
    • When desired by the patient / attendants.
    • When it appears that the quality of medical service is required to be enhanced.
    • When there is no one from whom informed consent can be obtained.
    • Reasonable Skill
      • The degree of skill a doctor undertakes is the average degree of skill possessed by his professional brethren of the same standing as himself. The best form of treatment may differ when different choices are available. There is an implied contract between the doctor and the patient when the patient is told in effect: "Medicine is not an exact science. I shall use my experience and best judgment and you take the risk that I may be wrong. I guarantee nothing."Not to undertake any procedure beyond his skill - This depends upon his qualifications, special training and experience. The doctor must always ensure that he is reasonably skilled before undertaking any special procedure / treating a complicated case. To quote an example, a doctor who is not sufficiently trained or qualified should not administer anesthesia.
    • Professional Secrets
      • A professional secret is one which a doctor comes to learn in confidence from his patients, on examination, investigations or which is noticed in the ordinary privacies of domestic life. A doctor is under a moral and legal obligation not to divulge any such secret except under certain circumstances. This is known as privileged communication which is defined as a communication made by a doctor to a proper authority who has corresponding legal, social and moral duties to protect the public. It must be bona fide and without malice, e.g., as a witness in a court of law; warning partners or spouses of AIDS patients and those found infected with HIV; informing public health authorities of food poisoning from a hotel etc; assisting apprehension of a person who has committed a serious crime; informing law enforcers about medico-legal cases, etc. In rejecting a purely contractual approach, the common law recognizes the power imbalance between the parties by protecting the patient from the risks of arm’s-length bargaining. In its place, the law imposes a set of non-negotiable tort and fiduciary duties on the physician as the more powerful party. The duties that the courts impose may not always achieve optimal results, but the law assumes that externally imposed terms governing the relationship are more likely to lead to an efficient result than terms negotiated by the parties themselves.
  • Existence of relationship
    • Thus relation can be implied or expressed. The relation between the two are established when any patient is brought to the doctor and in case of accidents the relation between the doctor and patient is established when the thing about the accident is informed to doctor and thus from then the relation between him and the patient is being established. And when the board of 24 hours service is being kept then it is an open offer for the patient thus then when the patient is brought to the doctor then the relation comes into existence.
  • When there is no relationship
    • The knowledge of the thing that when the relation is not established between the doctor and the patient. It is clearly mentioned in Code of Medical Ethics, that a doctor is not bound to render service to everyone.
    • Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
    • Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties.
    • In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should Endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient.
    • No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.
  • Continuation of relationship
    • Till the patient requires the treatment and in the operative case it is extended up to the post-operative period
  • Termination of relationship
    • The relationship can be terminated when,
    • Treatment is not required by the patient.
    • When the patient is dead.
    • It can come to an end with the consent of the patient.
    • With proper notice the relationship can come to an end.
    • It can be then limited by the contract.
    • By going to a new doctor
    • If treating doctor’s death occurs.