A doctor sitting in an OPD has two choices — either order one more test that won’t likely change the treatment but confirm their diagnosis or later get blamed for not encouraging one.The practice of medicine comes wi…

A doctor sitting in an OPD has two choices — either order one more test that won’t likely change the treatment but confirm their diagnosis or later get blamed for not encouraging one.The practice of medicine comes with an element of risk, one where the outcome is not absolutely certain.But lately these unexpected outcomes are becoming a source of dread among the whitecoats who are getting bombarded with lawsuits.While some cases deserve accountability, others can be misread. The constant fear of litigation can push doctors to ‘practice safely’, in a growing phenomenon called defensive medicine, which is harmful for any healthcare system.Around 65,000 cases of medical negligence were filed against doctors in the year 2025.These are not just clinical errors but also paperwork problems, informed Supreme Court advocate Mahendra Bajpai at the 18th Annual MedLegal Review, this February.Govt cannot keep super-specialist doctor bound to service for life without posting: Karnataka HCWhat is defensive medicine?When a healthcare professional deliberately departs from the standard practice to safeguard themselves against any legal attack, it is called defensive medicine.It could present itself as assurance seeking practice, including over testing, over medicating, or ruminating too long over a diagnosis, thereby delaying care or it could be the other way around and result in complete avoidance of a tricky or risky situation, for instance high risk surgeries or patients.It mostly arises from a bigger problem, perceived medical negligence. Tested under the Bolam test (1957), a doctor is found guilty of medical negligence if their care fails to conform to the practice accepted as standard or proper by a responsible body of medical professionals skilled in that particular art.However, there is a chance of patients overstating or even understating medical care, particularly if they don’t understand what standard care should look like.Not all errors are negligence “While the patients are right to report perceived negligence, not all clinical outcomes amount to negligence. This can also instill fear in doctors that any accidental or unfortunate event will be taken as one,” said Dr. Pankaj Khatana, a consultant in Internal Medicine, Marengo Asia Hospitals (Gurugram).Hence, the blurred lines between standard code of practice and perceived negligence tends to fuel unnecessary lawsuits in some cases.How Indians sue doctorsIn India, a patient can sue a medical practitioner through more than one route.As per reports, medical litigations have considerably increased beyond consumer forums.In a decision by the Supreme Court (1995), medical services provided by a private hospital or any doctor who charges a fee falls under the Consumer Protection Act (2019).Hence, under the judicial lens, patients can invoke their consumer rights for compensation if they perceive medical negligence of any kind.They can also use their constitutional rights and seek justice through civil or criminal liability, filing an FIR (under BNS section 106).If there happens to be no contractual relationship between the doctor and the patient, they can do so by invoking the Tort Law which provides protection in such cases.However, the final assessment of medical negligence is decided by a skilled panel of specialists.When an injury is not necessarily negligence A patient can sometimes get injured during a treatment without the doctor being negligent.These cases fall under the category of ‘iatrogenesis’, a condition marked by an injury or illness that occurs as a result of medical care.For instance, performing CPR (cardiopulmonary resuscitation) can sometimes result in broken ribs or placing an endotracheal tube for breathing can sometimes result in vocal cord injuries.In these cases, the caretakers or the patient, if conscious, may misinterpret unavoidable clinical outcomes as deliberate and causing intentional harm.But sometimes, these injuries may be the unavoidable collateral damage.But genuine negligence also happens The National Consumer Disputes Redressal Commission (NCDRC) had decided to review 253 recorded cases of medical negligence between 2015 to 2019. It found out that about 135 cases were legally recognized as negligence. Many of these patients were monetarily compensated.The findings also highlighted that highest cases stemmed from surgery and gynecology. Also, the most commonly reported errors were lack of skill set and absence of medical records.Many of the accidents reported, for instance, wrong blood infusion, surgical instruments left in the body, injuring major veins during routine procedures or a child choking on vomit after intake of anesthesia, were major mishaps and all largely avoidable. Such cases demand systemic accountability and compensation, experts have said.“In cases where there is clear proof of negligence such as poor communication and failure to meet the standards of accepted medical practice it is important to seek legal accountability,” said Dr. Rahul Chandhok, a senior psychiatrist at Artemis Hospitals.Proving negligence to get moneyNot all patients may want to sue their doctors but there is no other way to get monetary support for post treatment healing.Countries like New Zealand and Sweden have carefully created distinct pathways for processing medical negligence and monetary compensation for the patients who have suffered treatment-related injuries. They invoke the ‘no fault’ approach to deal with medical accidents.However, in India, for a patient to gain compensation for post injury care, they have to prove negligence on part of the medical team or a specific practitioner to get monetary help.Media trialAs per experts, misinterpretation of a medical mishap by the media can also put extra shame and public humiliation for the doctors under scrutiny, making them more defensive in their practice.“In medical journalism and social media, the critical line between an unfortunate medical complication and actual medical negligence is frequently blurred. Medicine is inherently uncertain, and even with flawless execution, bad outcomes happen, “ said Dr. Ashok B C, Plastic Reconstructive and Aesthetic surgeon at Aster Whitefield Hospital.“Witnessing peers vilified in public spaces teaches young doctors that their clinical competence will not protect them from a damaged reputation,” he added.Where are we today?With increasing instances of violence and litigations against doctors, there is a considerable increase in defensive practice.According to the Karnataka Journal of Surgery, it may look like follows:Over investigating the patients, asking them to undergo unnecessary tests to seek assurance for their diagnosis.Referring patients to multiple specialists to seek confirmation on their own findings.Overprescribing medicines, such as antibiotics, to safeguard them for any complication.Asking the patient to undertake invasive tests when not required.Extending hospital stays as a precautionary measure.Avoiding high risk surgeries or treatments.In simple words, increased hypervigilance around possible lawsuits can make young doctors doubt their skill, either become too over protective or too avoidant.“The threat of constant litigation is not making the system not transparent but doing the exact opposite, driving errors underground and creating a culture of denial and secrecy,” said Dr. Ashok B C.

Source: Deccan Herald