Medico legal Aspects of General Practice

M.D.,D.G.O.,F.I.C.O.G.,L.L.B.

Who is General Practitioner ?

General Practitioner is a Graduate of one of the faculties of medicine like allopathy, homeopathy, ayurvedic etc. & having registered in respective council.Usually he is capable of treating paediatric to geriatic patients of either sex of any age. As he is treating every member of a family , he is better known as family physician

GUPTE HOSPITAL

Degree & Knowledge

• The G.P. should not practice other branch

of medicine as per the law of the land it

may be held as negligence per-se .

• Secondly, ignorance is no defence & a

G.P. should have reasonable knowledge in

relation to time place.

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Consent

The G. P.is treating all family members & it is presumed that implied consent of the guardian is always there as far as the minor members are concerned. It is limited & the limit should not be crossed

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Home Visit

Is he bound to honour every call for home visit?

No but if the patient is under his treatment & unable to move then perhaps yes. All principles of negligence do apply here also

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Can he refuse to treat the patient?

a) When he is not well.

b) Busy with other case.

c) Consent refused by the patient.

d) Treatment refused by the patient.

e) Odd hours.GUPTE HOSPITAL

Not to refuse treatment in life saving emergencies.

(P.Katara v Union of India. Air (1989) Sc 2039)

Emergency treatment

GUPTE HOSPITAL

A patient had cough , weight loss & haemoptysis-treated as bonchitis by his G.P. for quite a long time –worsened- patient consulted a specialist- diagnosed T.B. Expert testified that when there was haemoptysis, T.B. could not be ruled out without further investigations – held liable

Connoly v Rubra .(1937 ) 1 Lancet 1005.

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Sadler v Henry.(1954)1BMJ 1331

A 26 yr. Old patient had cold & earache- G.P. examined with aurioscope found no perforation- prescribed medicines & drops next day, developed headache, vomiting & sounds in a ear- re-examined ear & found better-third day patient was worried but no clinical findings- diagnosed hysteria- died.

Cont..

GUPTE HOSPITAL

In P.M. found meningitis with suppurative otitis media. It was held that no signs or symptoms which could reasonably have led doctor to suspect meningitis- diagnosis of hysteria was a mistake, but one which others might have made – failed in difficult circumstances which only P.M. could disclose- not negligent.

Allergy

Medical Negligence – Treatment - Deceased Asthma patient, allergic to penicillin administered inspite of objection - Basic Precautions not observed by O.P. – Test dose proved fatal to patient allergic to penicillin –Deficiency in service proved – Complaint allowed by Forum – Order upheld in appeal .

Cherian (Dr.) v.Fatima MaryJanuary 2006

Investigation

Poonam Verma v Dr. Ashwin Patel. 1996(1) CCC 418.SC.

A doctor pleaded that he had advised the investigations & patient did not go for that . It was observed that ‘ We can not ignore that usual practice of almost all the doctors that when they want pathological (or other) tests to be done

Cont..

GUPTE HOSPITAL

they advice in writing on the prescription. Admittedly, the doctor had not done so in writing. He says that he had advised it orally.. This cannot be believed as this statement is contrary to the usual code of conduct of medical practitioner

Prescription

1) Case of Flutamide

2) Case of Lasix

Knowledge

1 Case of Pavulon Injection

2. Case of Amicacin

Referral

1) Case of Jaundice

2) Case of Pediatrician

Injections

1)Abscess

2)Needle Breakage

3)Paralysis

4)Reaction

Medical Negligence - Treatment - Alleged , vision lost due to medicine reaction – Allegation not supported by documentary or expert evidence - Illness of child was due to insufficient and deficiency of vitamin A and not on account of medicine Reaction, proved - Complaint dismissed.

Mangalsinh Ratansinh Gohil v. Kanubhai Joshi (Dr.)January 2006