Law > Medical Jurisprudence > Duties of Medical Practitioner
Medical profession is considered a noble profession in the world because it helps in preserving human life. Medical or Health issues requires a great attention as health and human life is very paramount and great universal value. A patient approaching a medical practitioner expects medical treatment with all the knowledge and skill that the medical practitioner possesses to bring relief to his medical problem. A medical practitioner owes certain professional duties to his patient and a breach of any of these professional duties gives a cause of action for the medical negligence against the medical practitioner
Hippocratic Oath:
The Hippocratic Oath is a sworn agreement made by physicians when they become doctors. It isn’t a law, but rather is a guiding principle for doctors. It was written by the Greek physician Hippocrates. It has been rewritten multiple times. Some use the original Greek oath, while others use the Declaration of Geneva or the Oath of Maimonides, both of which reference the original. Whichever version is used, virtually all medical schools use an oath of some kind.
The oath begins with an agreement by practitioners to openly share knowledge with the physicians that follow them, for the sake of the profession. Next it swears that treatments will be used for the benefit of the ill and not for harm. That’s the ‘do no harm’ part. Next, the oath says that doctors will allow specialists to complete surgeries, being aware of their own limits, and that they will not use their position to complete sexual acts or otherwise take advantage of their patients. Finally, the oath talks about doctor-patient confidentiality, requiring that doctors do not reveal details of their meetings, conditions, or treatments.
Significance of Hippocratic Oath:
Bioethics is a study of ethical issues that result from advances in biology and medicine. Many of the issues it deals with are controversial and create disagreements. This includes topics like abortion, euthanasia, surrogacy, and proper use of limited health resources.
The significance of the Oath is that it is the earliest document we have that gives details of medical ethics. The most famous clauses are those in which the doctor swears not to give abortive pessaries (it doesn’t ban abortion, only warning against pessaries); where the doctor swears not to give a deadly substance to anyone asking for it (that has been interpreted as euthanasia); and where the doctor swears not to speak of what he learns about a patient (the ‘confidentiality clause’). However much of the Oath is about the medical community itself: respect for one’s teacher, including looking after them in old age, and training the next generation. Incidentally, the words ‘First do no harm’ are not from the Oath, but from another treatise traditionally attributed to Hippocrates, the Epidemics.
Registered Medical Practitioner:
Under the Transplantation of Human Organs and Tissues Act, 1994 and the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994, the expression “Registered Medical Practitioner means a medical practitioner who possesses any recognised medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956 (102 of 1956), and who is enrolled on a State Medical Register as defined in clause (k) of that section;
Under Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954, the expression “Registered Medical Practitioner means any person,
- who holds a qualification granted by an authority specified in, or notified under, section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916) or specified in the Schedules to the Indian Medical Council Act, 1956 (102 of 1956); or
- who is entitled to be registered as a medical practitioner under any law for the time being in force in any State to which this Act extends relating to the registration of medical practitioners;
Declaration of Code of Ethics Regulation 2002:
The Medical Council of India, with the previous approval of the Central Government, made regulations relating to the Professional Conduct, Etiquette and Ethics for registered medical practitioners. At the time of registration with the Medical Council, each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same:
- I solemnly pledge myself to consecrate my life to service of humanity.
- Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.
- I will maintain the utmost respect for human life from the time of conception.
- I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.
- I will practice my profession with conscience and dignity.
- The health of my patient will be my first consideration.
- I will respect the secrets which are confined in me.
- I will give to my teachers the respect and gratitude which is their due.
- I will maintain by all means in my power, the honour and noble traditions of medical profession.
- I will treat my colleagues with all respect and dignity.
- I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. I make these promises solemnly, freely and upon my honour.
Duties or Responsibilities of Medical Practitioner:
General Duties of Medical Practitioner:
Chapter I of the Code of Ethics Regulation Rules, 2002 gives general responsibilities of the Medical Practitioner.
Character of Physician (Doctors with qualification of MBBS or MBBS with post graduate degree/ diploma or with equivalent qualification in any medical discipline):
- A physician shall uphold the dignity and honour of his profession.
- The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Who- so-ever chooses his profession, assumes the obligation to conduct himself in accordance with its ideals. A physician should be an upright man, instructed in the art of healings. He shall keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient, prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the actions of his life.
- No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council (s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form.
Maintaining good medical practice:
- The Principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. Physicians should try continuously to improve medical knowledge and skills and should make available to their patients and colleagues the benefits of their professional attainments. The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle. The honoured ideals of the medical profession imply that the responsibilities of the physician extend not only to individuals but also to society.
- Membership in Medical Society: For the advancement of his profession, a physician should affiliate with associations and societies of allopathic medical professions and involve actively in the functioning of such bodies.
- A Physician should participate in professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five years, organized by reputed professional academic bodies or any other authorized organisations. The compliance of this requirement shall be informed regularly to Medical Council of India or the State Medical Councils as the case may be.
Maintenance of medical records:
- Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.
- If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.
- A Registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2.
- Efforts shall be made to computerize medical records for quick retrieval.
Display of registration numbers:
Every physician shall display the registration number accorded to him by the State Medical Council / Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients. 1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.
Use of Generic names of drugs:
Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs.
Highest Quality Assurance in patient care:
Every physician should aid in safeguarding the profession against admission to it of those who are deficient in moral character or education. Physician shall not employ in connection with his professional practice any attendant who is neither registered nor enlisted under the Medical Acts in force and shall not permit such persons to attend, treat or perform operations upon patients wherever professional discretion or skill is required.
Exposure of Unethical Conduct:
A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.
Payment of Professional Services:
The physician, engaged in the practice of medicine shall give priority to the interests of patients. The personal financial interests of a physician should not conflict with the medical interests of patients. A physician should announce his fees before rendering service and not after the operation or treatment is under way. Remuneration received for such services should be in the form and amount specifically announced to the patient at the time the service is rendered. It is unethical to enter into a contract of “no cure no payment”. Physician rendering service on behalf of the state shall refrain from anticipating or accepting any consideration.
Evasion of Legal Restrictions:
The physician shall observe the laws of the country in regulating the practice of medicine and shall also not assist others to evade such laws. He should be cooperative in observance and enforcement of sanitary laws and regulations in the interest of public health. A physician should observe the provisions of the State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and Psychotropic substances Act, 1985; Medical Termination of Pregnancy Act, 1971; Transplantation of Human Organ Act, 1994; Mental Health Act, 1987; Environmental Protection Act, 1986; Pre–natal Sex Determination Test Act, 1994; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954; Persons with Disabilities (Equal Opportunities and Full Participation) Act, 1995 and Bio – Medical Waste (Management and Handling) Rules, 1998 and such other Acts, Rules, Regulations made by the Central/State Governments or local Administrative Bodies or any other relevant Act relating to the protection and promotion of public health.
Duties of Medical Practitioner to Patients:
Chapter II of the Code of Ethics Regulation Rules, 2002 gives responsibilities of the Medical Practitioner to patients.
Obligations to the Sick:
- Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.
- Medical practitioner having any incapacity detrimental to the patient or which can affect his performance vis-à-vis the patient is not permitted to practice his profession
Patience, Delicacy and Secrecy:
Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instance, the physician should act as he would wish another to act toward one of his own family in like circumstances.
Prognosis:
The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.
The Patient must not be neglected:
A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.
Engagement for an Obstetric case:
When a physician who has been engaged to attend an obstetric case is absent and another is sent for and delivery accomplished, the acting physician is entitled to his professional fees, but should secure the patient’s consent to resign on the arrival of the physician engaged.
Duties of Medical Practitioner in Consultation:
Chapter III of the Code of Ethics Regulation Rules, 2002 gives responsibilities of the Medical Practitioner in consultation.
Unnecessary consultations should be avoided:
- However, in case of serious illness and in doubtful or difficult conditions, the physician should request consultation, but under any circumstances such consultation should be justifiable and in the interest of the patient only and not for any other consideration.
- Consulting pathologists /radiologists or asking for any other diagnostic Lab investigation should be done judiciously and not in a routine manner.
Consultation for Patient’s Benefit:
In every consultation, the benefit to the patient is of foremost importance. All physicians engaged in the case should be frank with the patient and his attendants.
Punctuality in Consultation:
Utmost punctuality should be observed by a physician in making themselves available for consultations.
Statement to Patient after Consultation:
- All statements to the patient or his representatives should take place in the presence of the consulting physicians, except as otherwise agreed. The disclosure of the opinion to the patient or his relatives or friends shall rest with the medical attendant.
- Differences of opinion should not be divulged unnecessarily but when there is irreconcilable difference of opinion the circumstances should be frankly and impartially explained to the patient or his relatives or friends. It would be opened to them to seek further advice as they so desire.
Treatment after Consultation:
No decision should restrain the attending physician from making such subsequent variations in the treatment if any unexpected change occurs, but at the next consultation, reasons for the variations should be discussed/ explained. The same privilege, with its obligations, belongs to the consultant when sent for in an emergency during the absence of attending physician. The attending physician may prescribe medicine at any time for the patient, whereas the consultant may prescribe only in case of emergency or as an expert when called for.
Patients Referred to Specialists:
When a patient is referred to a specialist by the attending physician, a case summary of the patient should be given to the specialist, who should communicate his opinion in writing to the attending physician.
Fees and other charges:
A physician shall clearly display his fees and other charges on the board of his chamber and/or the hospitals he is visiting. Prescription should also make clear if the Physician himself dispensed any medicine.
A physician shall write his name and designation in full along with registration particulars in his prescription letter head. Note: In Government hospital where the patient–load is heavy, the name of the prescribing doctor must be written below his/her signature.
Duties of Medical Practitioners Towards Each Other:
Chapter IV of the Code of Ethics Regulation Rules, 2002 gives responsibilities of the Medical Practitioner towards each other.
Dependence of Physicians on each other:
A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants.
Conduct in consultation:
In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed towards the physician in-charge of the case and no statement or remark be made, which would impair the confidence reposed in him. For this purpose, no discussion should be carried on in the presence of the patient or his representatives.
Consultant not to take charge of the case:
When a physician has been called for consultation, the Consultant should normally not take charge of the case, especially on the solicitation of the patient or friends. The Consultant shall not criticize the referring physician. He / she shall discuss the diagnosis treatment plan with the referring physician.
Appointment of Substitute:
Whenever a physician requests another physician to attend his patients during his temporary absence from his practice, professional courtesy requires the acceptance of such appointment only when he has the capacity to discharge the additional responsibility along with his / her other duties. The physician acting under such an appointment should give the utmost consideration to the interests and reputation of the absent physician and all such patients should be restored to the care of the latter upon his/her return.
Visiting another Physician’s Case:
When it becomes the duty of a physician occupying an official position to see and report upon an illness or injury, he should communicate to the physician in attendance so as to give him an option of being present. The medical officer / physician occupying an official position should avoid remarks upon the diagnosis or the treatment that has been adopted.
Duties of Medical Practitioners Towards Public / Para-medics:
Chapter V of the Code of Ethics Regulation Rules, 2002 gives responsibilities of the Medical Practitioner towards public/para-medics.
Physicians as Citizens:
Physicians, as good citizens, possessed of special training should disseminate advice on public health issues. They should play their part in enforcing the laws of the community and in sustaining the institutions that advance the interests of humanity. They should particularly co-operate with the authorities in the administration of sanitary/public health laws and regulations.
Public and Community Health:
Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs a physician should not abandon his duty for fear of contracting the disease himself.
Pharmacists / Nurses:
Physicians should recognize and promote the practice of different paramedical services such as, pharmacy and nursing as professions and should seek their cooperation wherever required.
Liability for Breach of Duties by the Medical Practitioner:
Civil Liability:
Civil liability for negligence occurs when a person is said to omit to do something which a reasonable man would do when he is guided by the factors which originally regulate human conduct or when he does something which a prudent and a reasonable man would not do. The most common and potent basis of civil liability for medical practitioner cases is negligence. Thus, where a health care provider administers treatment to a patient negligently and injury is caused to the patient, he may sue for medical negligence against the medical practitioner for the injury suffered.
In law, a patient must establish three elements in order to succeed in an action for medical negligence, which are as follows:
- That the medical practitioner owed the patient a duty of care.
- That the medical practitioner was in breach of that duty.
- That the patient suffered injury / damages as a result of the breach.
A complaint for deficiency of service can be filed before the Consumer Forum under the Consumer Protection Act, 1986 and a Civil Suit for the Recovery of Damages in the appropriate Civil Court. A monetary compensation can be imposed under the general law by pursuing a remedy before appropriate Civil Court or Consumer forums.
Medical practitioner should practice the line of medicine in which he holds the required qualification. In Poonam Verma v. Ashwin Patel 1996 (4) SCC case, Pramod Verma, husband of the appellant, Mrs. Poonam Verma fell ill and complained of fever and so, Ashwin Patel, who was an authorized Homeopathic kept him under mediation and gave him some allopathic medicines for viral fever for two days. But even after these medications the condition of Ashwin Patel didn’t improve so Ashwin Patel shifted the medications from viral fever to Typhoid Fever because according to Ashwin Patel these two diseases were prevalent in the locality. But even then the condition of Pramod Verma deteriorated and so Ashwin Patel asked the appellant to shift Pramod Verma to Sanjeevani Maternity and General Nursing Home. Then Pramod Verma was shifted to Hinduja Hospital in an unconscious state where, after four and a half-hour of admission, he died. The Appellant therefore filed a petition before the National Consumer Disputes Redressal Commission, New Delhi. The issue was whether there was a breach of duty of care by Ashwin Patel in the treatment of Pramod Verma and whether this will amount to actionable negligence. The honourable Court found Ashwin Patel guilty for negligence and was made to pay compensation.\
In Jaspal Singh v. Post Graduate Institute of Medical Education and Research 2000 (2) CPR 300 case, the patient, blood group was A+ was give n B+ blood on two different fays, and he died soon thereafter. Here medical negligence is clearly seen and in such case the maxim “Res ipsa loquitur” is applicable. The respondent was convicted of negligence.
Criminal Liability:
There are various degrees of negligence and a very high degree of Gross Negligence is required to be proved beyond reasonable doubt for certain acts to be made punishable under the provisions of Criminal Law. A complaint under Section 304–A of the Indian Penal Code, 1860 in the appropriate Criminal Court or a complaint to the Medical Council of India or The State Medical Council for de registration of the doctor on account of negligence can be made.
Provisions of Section 304A of the Indian Penal Code, 1860, are general in nature and do not provide specifically for “medical negligence.” Similarly, other general provisions of IPC, such as Section 337 (causing hurt) and 338 (causing grievous hurt), are also often deployed in relation to medical negligence cases.