Wednesday, April 6, 2011

Medical Ethics?

Hospital is one place where you and me would definitely don't want to bid farewell with a "See you again". The mere mention of it would surely give you a pang. The whiff around it; the sick people; the sober mood and the seriousness makes it eerie and fearful.

Few months ago, when I had to visit my doctor she greeted me with "Hey there, long time no see!" I was happy that she remembers me among hundreds of patients she consults everyday. But at the same time, a twitch and my mind asked "Is she actually asking you to visit the hospital quite often? Does that mean I must be sick quite often?"

I have always been uncomfortable with the idea of visiting hospital even when sick. I always thought they make my condition worse. The pungent odor of the phenol, the prickly injection, the serious look on the nurse's face while measuring your pulse, those bitter tablets; there is no one good reason to feel cheerful about the hospital.

Well, I had to go to the hospital to visit a relative of mine who has had a surgery. Walking in with laptop to the hospital was a bit awkward; the nurses were quick to figure out I was educated bit among the lots there. Being invited with painful faces and medicinal odor was what I was prepared for. As I was chatting with my relative, a nurse came by and placed the medical history report beside his bed for the doctor in visit.

I have a habit of picking up anything that has words and would start reading it. My inquisitive nature quickly grabbed the report and I was turning the pages to read the history. Prior to that; my relative showed me the MRI scan report and other miscellaneous stuffs. I was reading this report which seemed like a neatly and legibly written essay in a examination answer sheet. I was just appreciating the fact how "doctor's" writings have improved and is now readable when a nurse walked to me and said

Chechi, padikkanda. Doctor vazhakku parayum

The nurse requested me not to read the content as the doctor would scold them. I was perplexed. I did not argue with the lady or bother asking her anything further because I realized that it was not the staff's fault. She further went on to say that doctors don't approve even the nurse reading the report. I just smiled back at her and diligently closed the report and kept it aside; which she stealthy removed it from the bed and took it along with her; so that I do not prod again.

Why would the doctor stop anyone from reading the report. My relative mentioned that even he is not allowed to read it. What is so secretive about it that even the patient and his close relatives/guardians are not allowed to read it? Professional ethics? I doubt it. Trust the doctor. Yes we do, but why stop someone capable of reading and understanding a medical report.

Those few lines I could read of that one page summary were not difficult to comprehend at all. I dont believe it is at doctor's discretion. It somehow seems to me that such instructions might have come from the highest level - from management to doctors to nurses to support staff. Be it education organizations, hospitals, charity organization; they all seem to be driven purely for business reasons. It is sad and helpless situations for these support staff to kill their ethics and morality to cooperate with these money-minded sharks.

Exaggerate a sickness, recommend unwanted tests and charge exorbitantly. Another thing I noticed was each tests recommended to my relative was charged 20 times more just because his was a cashless hospitalization and his insurer would take care of it. This seems to be the norm off late. I once visited a clinic which also had a diagnostic lab. The physician was prescribing all kind of tests even for a mere high temperature.  Not all are bad. I have had really good experience in terms of service and hospitality as well. But this business minded (dis)service is becoming a fad.

Someone has rightly come up with a concept in a medical insurance advertisement being aired off late. Better be rich if you want to get sick!


  1. Our Doc antony is incommunicado , else he is the person who can comment on the post.

    First thing I want not to happen for me is to be hospitalised. Well destiny is not entirely at our beck.Certainly the last place to be in is the hospital. I admire the doctors who are selfless.
    As for the strangulation , the nexus is too deep to fight. The moment a hospital come to know of the insurance policy they are sure to make a windfall.
    We sometimes give much , too much credence and respect for the physician,his idiosyncrasies and his tantrums that we fail to extract the truth the info.The information we rightfully must know. And we lose out there.

  2. Oh My!! That's weird!! Not allowing the nursing staff or the patients to read the reports is unheard of! And "See You" in a hospital!! :|

    Yeah, there are hospitals, which are so very money driven... their exorbitant bills are more deadly than the diseases!

  3. legally we are allowed to read everything it is their duty to tell us everything.
    problem in India is delay in getting justice in India.
    fine amount is less for metal harrasment
    non development of law of torts
    like this there are many reasons.
    excellent article.

  4. Hehehe...maybe the doctor was scared that you may find out that the report is untrue or that there are errors in it :-P

  5. Health care system in the USA is so corrupted. Docs ask for all unnecessary tests and in turn Insurance company raises premium and pay less for tests. So they ask for more tests....we are in such a mess. India is following US on this too but more aggressively.

  6. Nice post, as always. I beg to differ with you. Doctor's report should be told/read/shown to the patient but not to the relatives. It is a privacy issue.

    This is a crude example. Please excuse me for that. Suppose you are hospitalized with a symptom of HIV Positive or VD, I don't think you want all your visiting relatives reading that report.

  7. Hmm the weird thing is a patient not allowed to read his own repoert , Others i can understand all this data protection etc that has come up.

    SO that is weird, here too No one can read or know the report Till i as a patient give a WRITTEN consent till then its between me and my doc..

    Insurance yeah this is insurance scam.. people charge more when insurance has to pay and they in turn put the premium up the next time. So end of the day its all coming out of our pockets..

    Its jsut not in medical its everywhere the moment they know its insurance who will pay the bills are trippled or more ..

    I guess its not about being educated or anything like that in reading the report its how we percieve whats in the report what might be a big thing for us might just be a trivial issue in medical terms or vice versa.


  8. Re not permitting you to read the report, the right persons to comment on it would be of the medical profession.

    Re medical insurance - it is the same old story. It is a business and like most of the 'successful' businesses, it too hasn't any ethics or morals. I can vouch for the fact that the banking sector is the same - what about yours, B? Does Bill Gates have any ethics? Somebody said - 'legally illegal'. Thats what the entire world is.

  9. I firmly believe that reports should be given to the patient if he/she requests it. I always ask for the report and my kids too. I too read all and sometimes even search net to learn more.

    Once I took my daughter to a clinic for high temperature and rashes. Since we have insurance card, the doctor wrote for all tests. I told on his face that he is absurd and took my daughter to another doctor. She got well with just Panadol and Calamine lotion for the rashes. The first doctor had told me ... that we should test for Scarlet fever too...I felt like kicking his face...

  10. I too dread going to hospital ... // content as the doctor would scold them// ohh didn't know about this fact.
    I have never ever tried understand doctor's handwriting ... the strain on my eyes is too much to bear :P

  11. Thankfully, my family doctor doesn't make us go through many (unnecessary) tests but I have seen my aunts and cousins suffer because of money minded hospitals. And about not letting to read the reports... that's something I'm hearing for the first time.

  12. "I was reading this report which seemed like a neatly and legibly written essay in a examination answer sheet. I was just appreciating the fact how "doctor's" writings have improved and is now readable" - Lol to those lines! :D

    Yeah what you have mentioned is indeed true. Doctors just make it sound like the patient will need some sort of expensive tests or his/her condition might worsen. It's so infuriating. I ancient ages doctors were treated as Gods because they helped save Human lives but now the scenario has taken a 180 degree flip.

    Rightly said - "Better be rich if you want to get sick."

  13. anil,

    Yup Doc would be the best person to clear few of my queries.

    Yes Anil, thats why I did not prod further or debate over it. Its obvious that its not the nurse or the doctor or their seniors dictating it. We are at loss.


    Yes I was shocked as well. Falling sick is a luxury now :)


    Yes, but it doesnt work that way in India.


    Maybe they dont want others to find out. Its so secretive.




    Thats exactly is what is happening in India as well and this started about a decade ago.


    So are you saying that the patient's spouse/guardian/children/kids should also have no clue about the patient's condition? Then who the heck should know?

    I am not telling that all the relatives should know. I am only questioning why even the immediate relatives or the patient himself not know?


    Yes that weird. Its more about the fear of finding out irrelevant jargon mentioned in the report. Thank you


    I dont even mind not permitting me to read the report. I understand the privacy issue. Anyway I am not his immediate relative. But how about the patient himself? He mentioned he is not allowed to read it as well.

    Aaha you asked for it Bala so I am going to write on ethics in my field. Keep tuned in :)

  14. Stranger,

    Yes thats the trend now. With advances in science and technology at disposal, we are taken for a ride.


    Yes thats exactly what the nurse told me. :-) Hahaha well I guess what I read was probably not written by the doctor himself.


    Yup not all are worse as well. Yes, I found it weird as well.



    Yeah its just a way to make money now. :) and I seriously feel that getting sick is a luxury.

  15. First time here!! But great post. Being the daughter of a doctor, I tend to be biased.

    Every thing is way corrupted today, isn't it? You have the right to read the report, no matter who doesn't like it. You should have told the nurse this!

    Then again, a simple fever can turn out to be tonnes of different things. Any doctor can give you a simple Antibiotic and send you home. In most of the cases, the tablets will work. But if and when they don't, who are you going to blame? When doctors recommend you 40 tests for a single cold, they are only being cautious! And that too, for your sake!!

  16. very true!!

    They either tell us or they keep the reports in their store rooms.
    Recently I went for an eye check up and this was a high tech hospital.

    After the check up, I was so glad that I could take the report back home because it had almost all the details in it.

    Little did I know that I have leave the report to them and just take a card which holds my employee ID ..err patient ID ;)

    I mean, whats the use of that report?? Its for our future reference right?? Whys do we have to leave it there?I understand it will be useful for future reference, but we always carry old reports to the docs whenever needed/required.

    Also if the case is complicated, then I understand keeping the reports at the docs end...

    nonetheless, rules I say :)

    Nice post. Docs will have their own opinions and we have ours :):)

  17. It is for the patient to tell his/her relatives if he/she wants to. If I am seeing a psychiatrist for a particular reason, I may not want to even tell my spouse. What I am saying is relatives have no "right".

  18. I totally agree. This post reminds me of an incident...I was prescribed few medicines by a doctor, I went to my local chemist to buy them, it was really costly. Since, he knows me for a long time, he told me to buy the cheaper and equally effective version. I said arre nahi doc ne yahin lene bola, he said arre ab doc k ghar jaogi toh naya TV dekhogi...these people have tie-ups, yeh wala bhi accha hain.

    Since then, I always listen to just 50% of what they say. Having said that, I would say that the older generation docs (65-80 years old) are very good and believe in medical ethics. Sad the present generation docs dont follow them.

  19. Dear bad girl,

    You have not yet enabled subscription to the blog posts by email! :P

    Dearest good girl (the one who responds sweetly to readers' sweet requests),

    Again, that I got to read this blog post entirely is an outcome of a fortuitous visit to your blog, because of the aforementioned bad girl who's being so bad as to not activate subscription to your blog posts through email leaving the chances of my reading them entirely on occurrence of some lucky coincidence.

    Anyway, let me not pay inordinate attention to the aforementioned bad girl, lest I forget what I wanted to say, and that being that the aforementioned bad girl is being *bad*!!!


    I think I've told you several times that the level of ethics in the medical profession (as they are in most professions in India) is very, very disappointing. I really wouldn't know doctors' paranoia with regard to layperson's reading any report. But it could have many reasons:

    1. It seems you were not into one of the really huge, corporate Hospitals, but maybe something still a bit more old-fashioned [so as to have *hand-written* reports!!! :O ]. And if I'm right about my guess, then, this hospital must also be employing doctors who, unlike in corporate hospitals can afford to get haughty. Such places have a very strong culture of hierarchy, where consultants are truly the kings (or the culture might be more so down South). So, laypersons reading reports would always irritate the doctors as that would lead to blurring of the perceived knowledge/status gap. And that will not be good for the doctors' ego. :)

    2. But there are some valid reasons as well for doctors getting irritated by laypersons reading reports, i.e., having to answer lot of questions. Also, many tests are just a very small part of the over clinical picture of a patient, and the same test result in differing circumstances can have differing interpretations, and such subtleties are difficult to explain to the patients. As it is, medicine is indeed a very complicated subject, and half-baked knowledge of anything is bad. So, misunderstanding by the patients can lead to undue anxiety or mistrust in doctors' treatment, which would result in lack of compliance (not following doctors' instructions properly, skipping medications, etc.). Also, patients might get anxious reading some of the medical terms which have very simple meanings (e.g., 'febrile' = "having fever"; 'afebrile' = "not having fever"! :D ), actually. So, not letting the patients read the reports and clinical notes might be a generic practice, and it's possible that what you wrote was not complicated to understand for you was a coincidence [and then, don't underestimate your intelligence :) Just because you found the report simple to understand doesn't mean everyone would :) ].

    3. Anything signed my a doctor and/or written on a Hospital's letterhead is treated with lot of care in the hospitals. E.g., whenever we draft a report and the consultant would find some error with the report upon signing it, we would ensure that that report is torn off. So, in general, if the hospital does not maintain multiple copies of any report (which is lot more likely with a hand-written report), they would be really afraid if it gets stolen/lost, etc. Because, though I don't remember properly, everything done to the patient in a Hospital needs to be documented and saved for future retrieval for next 5 years at least.

    Above were some of the possible reasons the said Hospital doctors might've been so stringent about the report thing, though I must say that attitude seems quite the opposite of what I had seen in Delhi. :)

    And of course, with none of what I wrote, I was hinting that there is not a problem with ethics in Indian medical industry. :)

    Aforementioned bad girl is no better than the said doctors as she does not want readers to read her blog and that is why she does not enable subscription to her posts by email. :P

  20. a patient can read his is his right..and I can understand if the doctor stops the relatives from reading the report as many tend to panic..the best way out is to inform the relatives about the condition of the patient and then show the report..but hiding it as you have charged someone bomb is not allowed!!

  21. wow bindu...u r going to write about ethics in ur field?, now this is the post which I will definitely wait for...i somehow like reading about unethical practices in different fields, don't know why :)

  22. It really is sad. Quite a few hospitals forbid the patient or their kith and kin from reading the medical reports. Sometimes the reason they cite is that "so that the relatives do not get alarmed by the medical jargon and ask unnecessary questions"
    Weird, right?

  23. Priya,

    Welcome to B Log.

    Yes i dont deny the fact that everything is corrupted. The medical thing grabs attention because they are dealing with people and life :)

    Yes, I could have had my way out and read the report but again, I ethically dont have the right to do so even though my relative didnt mind me reading it. what irked me was even he being the patient was not allowed to read it

    Totally agree on that Priya, the doctors take extra care and precautionary measures and is appreciable. But agree or not; nowadays more often than that its a way to milk money :)
    And yes if you notice, I dont blame the doctors but the nexus. Even the doctors are helpless.

    Thanks again for your views.


    Its sad indeed. But I would not blame the doctors unless its a privately run clinic where the doctor is the owner as well. He rules there but in bigger hospitals, the scene seems to be directed by management


    What if the patient is not in a condition to 'tell' the spouse/relatives? anyway my irk is because the patient himself is not allowed to read the report.


    Thats sad. Now that you said I remember, whenever i went to consult a particular doctor; I would see equal number of medical representatives as patients waiting for her time. And these representatives always got higher precedence than the patients :) what more to say


    I shall reply to you tomorrow :)
    I need to rake up my brain :-P


    Yes that was weird and unacceptable.


    Yeah pending for sometime now :) I shall surely post it as my next write up.


    Great to see you here after a long time.

    Yes, maybe they are right. But forbidding the patient himself is weird.

  24. Medical record information is confidential and privileged information, and is legally protected from disclosure. As we use the medical record information and discuss patients with our colleagues, we are advised to make sure to do so in a private area. Even accidental release of information is unlawful disclosure.

    Yesterday morning, I had to call the ICU of another hospital to get some information about a patient. One of our staff nurses had her brother admitted to the ICU, following a serious lung problem , had undergone a lung resection and placed on ventilator. She had got some information already, and the patient’s wife herself was a nurse at the same hospital. With reluctance, I called the ICU and got the nurse in charge. I introduced myself and then he asked me
    “What is your relationship to the patient?
    My explanation was not satisfactory and the he said” I am sorry, doctor, but I am not allowed to disclose information about any patient”.
    I didn’t feel bad about it at all, instead, felt good that nurse was aware of his responsibilities. But then, finally when I got the doctor in charge who was a friend of mine, the information was not that good. The patient was alcoholic and had tuberculosis for which part of his lung was removed and the doctors were facing difficulties to take him off the ventilator. My colleague nurse had kept all this information away from her workmates and myself.

    The purpose of a physician's ethical duty to maintain patient confidentiality is to allow the patient to feel free to make a full and frank disclosure of information to the physician with the knowledge that the physician will protect the confidential nature of the information disclosed. Full disclosure enables the physician to diagnose conditions properly and to treat the patient appropriately. In return for the patient's honesty, the physician generally should not reveal confidential communications or information without the patient's express consent unless required to disclose the information by law. There are exceptions to the rule, such as where a patient threatens bodily harm to himself or herself or to another person. Moreover, maintaining patient confidentiality is a legal duty as well as an ethical duty.

    The general rule regarding release of a patient's medical record is that information contained in a patient's medical record may be released to third parties only if the patient has consented to such disclosure. The patient's express authorization is required before the medical records can be released to the following parties: patient's attorney or insurance company; patient's employer, unless a worker's compensation claim is involved; member of the patient's family, except where the family member has been appointed the the patient's attorney under a durable power of attorney for health care; government agencies; and other third parties.

    Any breach in confidentiality—even one that seems minor—can result in mistrust and, possibly, a lawsuit and/or disciplinary action.
    I think you remember the story of the patient who had kept his cancer hidden from his family?
    Can you believe that at some places you need the consent of the patient to do tests like the HIV test?

  25. Doctor Ketan,

    :-) Aaha I am so sorry. I need to check for that widget. Let me do that now.

    :-P 'the one who responds sweetly to readers' sweet requests' :-P Well well....I am feeling good :)

    1. I dont know; the hospital was huge. It seems multi/super specialty clinic but the report was yes old-fashioned. I have not seen such behavior in any other hospitals. The patient at the least is allowed to read his medical history.

    2. Yes, I do get this and doctors have always expressed this fear factor. Laymen misunderstanding the terms, getting anxious for no reason and such. Its their responsibility and duty to treat and cure patients and they take utmost care which is truly appreciable. Yet, not letting the patients read the report? So what would the patient be told about his/her symptom? would the condition the patient is downplayed or aggravated?

    Haha you say I am underestimating my intelligence? :-P I doubt if I am the level of being called an intelligent person.

    3. My third point again would be not letting the nurse read the report. Maybe the nurse doesnt have to know the whole thing. but I hope they are at least given a brief. If for instance my supervisor asks me to work on a problem in a software, I wouldnt blindly work on it unless I am allowed to know its history, the root-cause and such.

    This bad girl is surely going to have a feed burner or a widget of that sort Doc. :)

    Thanks a lot for your comprehensive explanation. It helps.


    Thank you so much for enlightening us all through the procedure. What surprised me was that the patient himself was not allowed to read the report. According to him; he was told to sign few papers without being allowed to read. This does seem a bit weird to me. As for disclosing information to relatives; I agree with you. That is why I did not even debate or argue with the nurse. thanks so much

  26. Me late , my work schedule is like that ...but still love to visit my fav. blogs.
    reg. your post, recently my husband had an allergic cough and mild fever. Immedialtely the doctor wrote a big list of tests. My husband asked him what is the need to do all the tests. The young so wild and started shouting telling that as we are educated we are questioning him . He said 'see all the villagers who come here, no one questions us, you people ask questions get unnecessarily tensed up and no wonder the mortality rate among the educated is high.:/ such an attitude. A doc should never voice such words. We have decided not to visit him again.

  27. Despite of the pungent smell, presence of deathly germs and nearness of patients, I liked the ambiance of a hospital, if it is not crowded, and if I have a separate room. perhaps, that might be an abnormality of me only..

  28. Chitra,

    Very shameful behavior by the said doctor. Your decision to not visit him is absolutely appropriate.

    It's possible that he might be getting 'cut' (commission) for ordering so many tests.

  29. chitra,

    That was way too rude. Right decision made.


    Hmmm interesting. Not many would like a hospital :)


    On your public demand, I have the 'subscription by email' widget installed :-D

  30. Insignia,

    Aha! The good girl slays the bad girl! :D

    Just noticed that you had prefixed my name with "doctor" in the above reply. That's tad embarrassing. :)

    Just in case, if it appeared that I was trying to justify the doctors'/hospital's behavior, then, I was not. :)

    In all of my *speculations*, I have attributed from charitable to most degraded motives behind not letting the patients read the reports. While commenting, I'd totally forgotten about the instructions to not let even the nurses read the reports. Frankly, more than audacious, this instruction is totally silly and impractical. There is no way nurses can be prevented from accessing the reports. And moreover, that is a gross insult of nurses, who are actually pretty well trained and educated in that they have nearly the same curriculum that doctors have during MBBS, though nurses have it a bit truncated. In the US, specialized nurses are even allowed to carry out operations and administer anesthesia.

    Sorry for digressing, but I myself see most of my doctor-colleagues wanting to force down their 'superiority' over other professionals. And I really, really hate that. Unfortunately, I can't be much vocal about it in real life (though I occasionally drop hints of how that is silly and unacceptable behavior), lest I be labeled as a black sheep doctor, which in turn would lead to lack of cooperation in midst of very, very tight work schedule. :(

    May the aforementioned bad girl's soul rest in peace. :P

  31. Started writing a comment. then deleted it, and it became a separate post on my blog.

  32. Ketan,

    Oh doctor; I am sorry doctor. Didnt mean to embarrass you :)
    No no, your comments were rational and you in no way tried to justify their behavior.

    Well you said it. Someone doctors have their air around them and behave 'superior' and their branch of study supposedly complicated. Maybe! but each one his/her own. This superior behavior - I dont know how it helps them; maybe give them a high!

    And yes, I killed that bad girl :-P


    Thank you very much. I read your post. :)


I'd love to know what you thought :-) Please shoot!