Complications and failures

Complications during treatment are just like road or domestic accidents. No one in their right mind wishes to have an accident. Similarly, no patient or doctor or hospital would like to get complications during treatment. However, despite the best will in the world, facilities and expertise, complications do happen during the course of treatment.

Reasons for complications are myriad. They could be due to the doctors, hospital staff or the patient themselves. Errors from doctors and staff are wrong diagnosis, illegible prescription, inadvertent administration of incorrect medicine, over dosage, manufacturing errors, laboratory or imaging errors, not following the safety standards and inefficiency in performing a procedure or operation.

All these are avoidable mistakes and are due to inadequate training, incompetence, faulty equipment, overwork & fatigue or rarely sheer negligence. There are various standards for hospitals and doctors to minimise these errors by having proper background checks before employing doctors or staff, regular training programs, equipment maintenance and auditing all the mishaps.

Complications are fraught with heavy penalties for everyone concerned, directly or indirectly. No hospital or doctor can afford to have repeated mistakes. In the present competitive environment, hospitals and doctors are proactive in trying to prevent and minimise any complications.

Majority of complications are due to the patients’ failure to respond to treatment or abnormal response to standard treatment. Even though all the medicines go through various phases of trials, before they are approved for clinical usage, small proportion of patients respond in a completely unexpected manner; called idiosyncratic reaction. Some people may get allergic reaction to the medicine.

All medicines have side effects. In addition to the wanted effect, they can give unwanted side effects. Just a simple example; it is common to prescribe blood thinners to patients having heart or brain strokes, to prevent further strokes. These medicines may cause bleeding in some patients, which sometimes can lead to significant treatment and cost. This again varies from patient to patient.

The nature of the disease, its severity and the patient’s innate immunity may not be conducive to quick and smooth recovery. Some patients do not respond in a predictable way. When the patient is not responding to treatment or gets a complication, doctors always try to do various things to get the patient better. Longer the hospital stay, especially in an ICU, more likelihood of further complications and bad outcome.

In these patients, the treatment gets prolonged and the costs pile up. When the outcome is bad, relatives or the patient see the treatment as futile. Most people do not want to pay any further money to the hospital when a patient dies. Hospitals wish to recover their bill for the services provided, despite the outcome. This becomes a sore issue. In their grief and emotional outbursts, they start blaming the hospital.

Doctors are caught in the crossfire and are accused of wrong treatment and negligence. For the doctors who have tried their best, this is extremely hard to digest. On one hand they feel bad that they are not able to make the patient better, on the other hand they have to face these baseless allegations and they have to face the internal scrutiny of the hospital administration.

All these will make the doctors risk averse and make them defensive in their attitude. They become less “patient centric” and concentrate more on how to safeguard their own skin. It is not uncommon for the ICU doctors to spend more time with the patients’ relatives explaining them what is happening to the patient, than the time spent on patient care!

One major issue is not having a quick and fair redressal system when there is actual or perceived negligence or wrong treatment. Because of this people are resorting to quick justice by gathering a mob or trial by politicians/media. This is not a proper solution. A quick, efficient, impartial, and thorough enquiry should be carried out and compensation given to the patient/relatives when there is a lapse in healthcare delivery.

Honorable supreme court has categorically ruled that failure of treatment is not to be construed as negligence. Until this is understood by all the concerned people and a fair redressal system is in place, doctors will be hounded, will be defensive and may not take up seriously ill and high-risk patients.