Meet the Expert : Dr VP Singh

Dr VP Singh is a medicolegal consultant working as an Assoc. Professor, at Dayanand Medical College & Hospital, Ludhiana, Punjab. He is qualified in Medicine as well as in Law. He did his MBBS and MD (Forensic Medicine) from GMC Patiala and LL.B. from UILS, Panjab Univ. Dr. Singh is a strong promoter of healthcare quality, patient safety, and medicolegal awareness amongst the medical fraternity. He is actively involved in teaching medicolegal issues to the doctors.

Dr VP Singh has been working in the medicolegal domain for over 17 years now. From his years of studies and experience, he has deep rooted understanding of medical laws and ability to provide effective solution to the medicolegal conflicts. He has delivered many guest lectures on various medicolegal issues. He has organized numerous CMEs on medicolegal issues, and workshops on medicolegal report writing.

Medico-legal cases are on the rise in our country. What are the reasons behind this?

India is witnessing a sharp rise medical negligence cases along high incidence of violence against doctors and hospitals. Such medicolegal cases indicate a breakdown of trust between patients and healthcare providers. Unrealistically high expectation of patients and the peculiar socio-cultural transference to a non-tolerant, litigious society and media hype has further complicated the issue. Some of the key factors related to the crisis include lack of dialogue between the doctor community, hospitals, legal professionals, and policy makers. It is imperative for doctors, medical associations, and hospitals to come together to identify and discuss the legal issues relating to medicine and to find practical and legally appropriate solutions

Most important reasons for rise in medicolegal cases against doctors are:

Improper Communication

Indian medical education system does not impart much emphasis on ‘how to have a dialogue with the patient’. Ignorance toward communication skills, which is a key feature of patient care results in unsatisfied and a confused patient. Patient’s expectation is much higher than his actual dialogue with the treating doctor. Malpractice litigation is high if such a patient suffers harm or the outcome is unexpected.

Invalid Consent

Law may consider the consent as invalid in case the healthcare provider does not explain the nature of disease, its prognosis, proposed treatment, expected results etc. — Patients commonly complain that they were just asked to sign the consent form and were not informed anything. Doctors must understand that just getting signatures on consent forms is not sufficient.

Unexpected Complications during the treatment

There are various reasons due to which complications may occur during the treatment. Some of them are avoidable but unfortunately many times these complications are unavoidable and may occur due severity of the disease, limitation of the medical science. However, due to lack of proper counseling of patients and unexpectedness of the harm, patients have the feeling of anger and betrayal.

Medical Errors

The issue of ‘medical errors’ is a grey area having a bleak line of distinction between mistake and negligent act. Improper handling of medical errors can create a disaster for the doctor especially in case the error resulted in harm to the patient. In case the information is concealed from the patient, such a behavior may be perceived by the patient as if he is being betrayed. Many studies have shown that being honest with the patient and proper counseling is a sound risk management strategy.

Mismanagement of Emergency and Life threatening situations

Emergency and Life threatening situations are the potential medicolegal domains where the chances of litigation and violence against doctor/hospital are high. In such case if patient is to be referred, there must not be any unjustifiable delay in referral. It is the duty of the referring doctor to suggest the patient about the specialist/ hospital capable of managing the case. Referring doctor is responsible to ensure safe transportation of the serious patient. At least MBBS doctor must accompany the patient till the patient is in safe hands. However, it is not a good practice to refer / transport the patient at a terminal stage when it is clear that the patient cannot survive. Delay in any aspect of the treatment process(investigation/diagnosis/treatment), non-professional behavior of hospital staff, miscommunication are the main triggering factors in resulting in mismanagement of the case.

In your opinion, do you think doctors are spending less time with their patients?

Time spent by a doctor with his/her patient is a key element in patient-doctor relationship, and it deserves more attention. Time spent by a physician in imparting health education and the effects of treatment has an important bearing on patient satisfaction. Studies have found that risk of medical negligence litigation is associated with visit length. Those who spent less time were more at risk of being sued. In the current practice environment, physicians encounter mounting demands on their time. In Indian healthcare system, being a physician always has been a busy job. No matter what demands a physician faces, there are only 24 hours in a day. With an increasing emphasis on quality in healthcare delivery, physicians must develop strategies to enhance the quality of care with the amount of time available. Quality time between physician and patient is an increasingly valuable resource.

Lack of documentation is one of the reasons why doctors are facing trouble. Would you like to share some tips regarding medical documentation?

Medical record is a vital component of practice of medicine. In medical negligence cases, Courts rely mainly on documentary evidence. Properly documented medical records can save the doctor from many unpleasant situations. In a Court of law good quality medical record forms a strong defense in favor of the treating doctor.

Unfortunately, in India, documentation is the least bothered and most neglected segment of medical practice. It must be remember that “Poor records mean Poor defense and No records mean No defense”. Physicians typically approach documentation with the goal of communicating effectively with themselves. This approach creates problems when malpractice allegations are made in a court of law. Physicians must realize that all medical records are potential legal documents that can either save or torment the physician depending upon the quality of care reflected in these documents.

Tips regarding medical documentation:

  • Make habit of writing thorough notes.
  • Document the decisions made, any discussions, information given, relevant history, clinical findings, patient progress, investigations, results, consent and referrals.
  • Handwriting must be legible and all the entries in the medical records must be in chronological manner along with identifiable signatures of the concerned healthcare provider.
  • Use only standard abbreviations. Avoid using abbreviations which are not universally followed.
  • Always date and sign your notes.
  • Don’t alter, erase or overwrite the notes. If you realize later that they are inaccurate, add an amendment.
  • Any correction must be clearly shown as an alteration. Endorse the correction with your complete signature along with date and time. Draw a single line through the error and sign your name beside the line. The person who signs must be the person who drew the line. Make sure that the original entry is still legible after the correction. Never use an eraser or correction fluid.

Please tell us about your new book on Medico-Legal issues.

It is my great pleasure to share information about the book “Legal Issues in Medical Practice: Medicolegal Guidelines for Safe Practice”. The purpose of writing this book is to empower the Indian doctors with “medicolegal awareness” as a tool. The book has presented essential medicolegal information that can be used as guidelines for safe clinical practice. Chapters on various medicolegal issues are written by the specialists who are well experienced in clinical as well as medicolegal domains. Most of the pertinent issues such as medical ethics, informed consent, medical documentation, medical negligence, and various laws applicable to the medical professionals have been elaborated in the book. A separate section on medicolegal issues related to various specialties has presented practice management strategies for safe clinical practice.

Key Features:

This book is a step-by-step guide that provides basic understanding of medicolegal principles in a simple language, and enables a busy medical practitioner to establish safe clinical practice. Salient features: • Chapters are written by medicolegal experts and clinicians with vast medicolegal experience • Simple and interesting presentation of complex medicolegal issues • Problem-solving approach to the medicolegal issues • Medicolegal tips and guidelines are provided to effectively solve the medicolegal conflicts • Risk management strategies are provided to prevent the legal implications • Authentic medicolegal advice based on relevant court judgments • Information provided in the book has been authenticated with references.

  • Twenty four chapters divided into five sections:

Sec. I : Medical Ethics and Law,

Sec. II : Documentation of Patient Care: The Legal Aspects,

Sec. III : Litigation against Medical Practitioners,

Sec IV : Medical Laws and Judgments Governing the Medical Professionals,

Sec V : Medicolegal Issues in Various Specialties.

Originally published at on October 15, 2015.