There is much discussion on social media and elsewhere regarding the Nepali government’s latest decision to hold physicians fully liable for medical ‘errors’ under their watch. Naturally the medical community, particularly physicians, are not happy about it. This move certainly appears to be more of a knee-jerk reaction to appease certain groups than to establish a system. It looks like the government is attempting to wash its hands of the responsibility instead of understanding the root cause and establishing an appropriate protocol. 

Blame game

Unfortunately, mistakes happen in hospitals and clinics on a daily basis, not only in Nepal but the world over. Even in the US, almost 100,000 lives are lost annually because of medical errors, but Americans don’t vandalise hospitals or threaten doctors. They use the legal system to punish the guilty and receive compensation. Also, doctors do have to admit that there are some within the medical community who practise medicine for the wrong reasons, or go about practising their trade in a questionable manner. But I also know that those who knowingly harm patients are exceptions rather than the norm. May be penalising those who compromise on proper care from the medical community would reassure the public.

There is no doubt that a majority of doctors do practise medicine to save lives. Sometimes, despite the best efforts, lives are lost even when there is no medical error. If a majority of doctors and medical facilities did not provide care the right way, we would not see the progress there has been in the health status of Nepalis. Doctors work hard and long hours for handsome rewards, but that alone is not the reason. It may not always appear so, but doctors do prioritise patients’ wellbeing before their personal matters more often than we know. 

I recently witnessed two incidents in two different hospitals in Kathmandu. Because lives were lost, there was vandalism at both these hospitals. While I certainly don’t condone malpractice of any kind, one has to honestly admit that vandalising medical facilities and beating up doctors and administrators is not reasonable or appropriate. But as I watched the destruction taking place, I thought about the financial cost and time it would take to bring those facilities back online. At the end of the day, it would be patients who would be affected. More importantly, if doctors had actually been at fault, the damage caused by the patient’s party would have gained more publicity and weakened the case against them. 

I do think vandalism and outbursts in the healthcare sector are also opportunities to demonstrate resentment towards the hierarchy fuelled by escalating healthcare costs, perceived lack of empathy and absence of respectful communication by medical personnel. Government officials too are often threatened and manhandled for things they are responsible for, besides things they have no control over. They represent the machine that is the government which does not always hear the voice of the voiceless.

Drawing the line

The medical structure is revered for the good it has done since the advent of modern medicine. Over the years, a sense of entitlement has developed among doctors for what they do, and for their hard-earned skills and training that qualifies them to save lives. This expectation has created a hierarchy, albeit perceived and informal. But the times are changing, and we have to change how we communicate with patients well ahead of unfortunate situations. People like to be part of the conversation when their lives are at stake. People today are more educated and informed about matters than in the past. Of course, it is not possible to involve patients or their relatives in the treatment protocol all the time, but historically physicians have been dismissive or short on explanations. That might be because doctors either think that patients lack knowledge about health matters, or they are pressed for time because of the large number of the sick they have to attend to. 

There is no doubt that we need a healthcare system that is equitable and affordable so money matters do not trigger unpleasant situations. Likewise, there is no option to having well thought out legal provisions and policies that protect both patients and doctors. Patients have to feel that the law will protect them if things go wrong. But who determines that? An expert committee not just made up of medical professionals but also representatives from the legal community and consumer protection entities. 

Increasing incidents of vandalism is making a good case for a medical malpractice insurance systems. It has to be available to doctors with appropriate caps on financial liability. Doctors and hospitals should not end up suffering due to outrageous compensation awards by the courts. That would be the ultimate deterrent for doctors to practise medicine in Nepal. There is no amount of money that can bring back someone from the dead or compensate for the loss; but it also should act as a cautionary provision for doctors to be careful. 

Of course, much deliberation is needed on this than what I have naively stated here. I leave that up to the experts. However, doctors going on strike might not be the best way to win back people’s confidence. Where do you draw the ethical line in this essential service sector? Doesn’t such a strike violate the international code of ethics? You are the most educated elite of society, and it is incumbent upon you to set appropriate standards. Your fight is against the asinine decision of the government, not the desperate patients who will be languishing in the hallways of hospitals and clinics in your absence.

- Pyakuryal teaches medical sociology at a private liberal arts college in the US