August 2023 Issue

Dear IMA GSB Friends,
Seasons’ Greetings.
Wishing you Happy Janmashtami, Ganesh Chaturthi & Jal Zilani Ekadashi in advance.
Preparations for HCG GIMACON-2023 (28 & 29 October-2023) are in full swing.

Recently, I had gone to Khazakhistan on a pleasure trip with doctor friends for a few days. Unfortunately I met with a small
accident and have safely returned home, but with multiple fractures -around shoulder and knee. Both these fractures are not much displaced and so are being treated non-surgically. But, I am in bed at home with plaster on my leg and the arm being in the sling. It would take some 6 weeks before I can walk with some support. Beg your pardon for my partial absence.

Dealing with unruly and violent patients:can refuse to treat them ?

Physical assaults and verbal abuses on doctors and other health care professionals, are increasing rapidly and have become rampant in many states. This has grave consequences on the society, status of the medical community in the society and physical and mental wellbeing of practising doctors. Many state governments have legal provisions for punishments for such patients and their relatives. Recently published National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023,now also offer guidance to doctors when they can refuse treatment of their patients in certain situations.

When the patient or their relatives are abusive, unruly, or violent towards the doctor or the medical staff, doctor can refuse treatment to such patient. The doctor should inform the patient about the reason for refusal and suggest alternative options for treatment.

The doctors need to follow a procedure of properly documenting and reporting the violent behaviour of the patients or their relatives before
they can refuse to treat them.

The documentation should include the details of the incident, such as the date, time, place, nature, and extent of the violence, the names and identities of the perpetrators and witnesses, and the impact of the violence on the doctor and the medical staff.

The reporting should also be done to the appropriate authorities, such as the police, the hospital administration, or the medical council.
The documentation and reporting about refusal for treatment will also help to create awareness and deterrence against violence in hospitals, clinics and other health care settings.

NMC Regulations 2023 also list other situations where doctors can refuse treatment to the patients. These are as follows:

1. When the doctor is not competent or qualified to treat the patient’s condition. The doctor should refer the patient to another doctor who
   has the necessary expertise and experience.
2. When the doctor has a conflict of interest with the patient or their relatives. The doctor should disclose the conlict and advise the patient
   to seek another opinion.
3. When the doctor is unable to provide adequate care due to lack of resources, facilities, or equipment. The doctor should inform the
   patient about the limitations and help them ind another suitable facility.
4. When the doctor is legally or ethically prohibited from treating the patient. For example, if the patient is a minor and does not have
   parental consent, or if the patient is involved in a criminal case and the doctor is a witness or a suspect.

Let us be aware about the new rules that can impact our clinical practice in future and be careful.
Jay IMA, Jay Garvi Gujarat, Jay Hind.

For more information download bulletin PDF