Sunday, November 24, 2013

The Second Opinion & Facebook

Every patient has a right for second or third opinion. Likewise, when approached by a patient, doctor too has the privilege of giving his opinion. Patient has the liberty to choose the treatment from the doctor he/ she trusts.However, patient or his relatives have NO RIGHT to malign the first opinion/ defame the doctor on the social networking sites. It is also a punishable offence under section 66 (A) of the Information Technology Act for causing damage to public image.

A patient is brought to a hospital with an ankle injury. Orthopaedic Surgeon examines the patient, after X Ray, patient is advised to undergo internal fixation by surgery. However, patients husband decides to seek second and third opinions, where non operative management was advised. Upon hearing the second and third opinions, patients husband posts the x ray with his version of the story, ridiculing the first opinion, thereby indirectly suspecting the motives, ethics of treatment of the hospital/ surgeon who gave the first opinion.
The post goes viral on the Facebook (in fact patients husband runs an application based on facebook- besides the point!), within 2 days with 22000 shares.

Question here:
is not about the validity of first/ second or third opinions on the patient/ x ray in question. It is about the gross misuse of a social networking site, for maligning an institution- hospital, defaming an orthopaedic surgeon of repute. Sadly, Dr Attique Vasdev (Manipal University Alumnus) who was at the receiving end of the facebook post, is not on facebook. He came to know about the post through his friends & Orthopaedics- Manipal University Alumni group on facebook. All efforts to post Dr Attique`s version of the incident, were promptly removed by the patients husband.

Dr Attique Vasdev`s version:
“The patient was referred to me by an old patient and came into the ER on the eve of 18th of November. I recommended an X-ray which indicated a Lateral Malleolus Fracture with Syndismotic Disruption. In view of the fact that this kind of fracture can lead to degenerative changes or painful joints, as per the AO [Arbeitsgemeinschaft für OsteoDePuy Synthesefragen or translated to Association for the Study of Internal Fixation ] guidelines of fracture management for ankle injuries the recommended strategy is surgery as the best course of action. My opinion was in the best interest of the patient, and the patient alone. I did not at any point state whether this was a ‘grade 3 fracture’. That is not terminology we use and was not used in your case.”
Dr Ashok Rajgopal, Chairman, Bone and Joint Institute, Medanta :The Medicity has reviewed the case and his view is as follows, "I am honestly shocked at the contents of the post going viral. The x-rays show a very clear indication for intervention. Anyone with experience in fracture treatment and who has attended any AO [Arbeitsgemeinschaft für OsteoDePuy Synthesefragen or translated to Association for the Study of Internal Fixation] course, which is the bible of fracture treatment, would endorse, whole heartedly, the opinion given by Dr Attique."
Medanta Medicity (post on FaceBook):(however removed by the patients husband): 
“It is extremely unfortunate that irresponsible statements of this nature have been disseminated. We uphold the highest standards of professionalism and ethics. Your post attempts to malign the reputation of the doctor concerned and the institution, on the basis of allegations that are patently false.”

Note from this Blog Editor:

Of late it has become a fashion to criticize the treatment protocols, treatment options suggested by the doctors. Remember that medical profession is guided by many regulatory bodies apart from highest level of practice of ethics by the professionals. There are periodic checks to ensure adherence to current treatment protocols. It takes many years for a surgeon, before he can build his practise & repute. It is also true that difference of opinion is common in the medical science, hence the patients have been provided with the privilege of second opinion, under patients charter of rights. Now, professional bodies (IMA, MCI, State Medical Councils) should pass resolution, that if a doctor is defamed on the social networks before complaining to the statutory bodies, the complaint should not be registered.

Defamatory posts on social networking sites, can do little damage to the reputation of the surgeons/ hospitals, however it can definitely cause a major damage to the most essential link in the treatment chain – TRUST.


vishwasdiary said...

Dear sir, u are right.everything which is useful also is liable to be abused.Anyway I liked the way you have used it to educate we doctors. MANY OF US ARE VULNERABLE TO BE VICTIMISED.

Anonymous said...

Dr Vasdev should take this patients husband to court for defamatory charges

Naveen Manglur said...

Nobody likes to defame a doctor. Only pray doctors learn to bec patient with their patients ! Most dont even care to listen. Clarifying patient'sdoubts is out of the question. The exceptions I have met are in the Karnataka Institute of Diabetology - a Govt Hospital in Jayadeva Campus, Bangalore headed by Dr. Narasimha Shetty. KID beats any Corporate Hospital hands down.

vinutha kiran said...

Gud one kiran sir..nice of u to share so as to re educate the so called educated...

Anonymous said...

Hi Kiran, I think Aatique should not take this lying down and resort to legal course as it will act as a deterant for such people to malign doctors in the future

Sanjeev Chhabra said...

Very well stated, Dr. Acharya

Sanjeev Chhabra said...

Well stated, Dr. Acharya.

Rohini Nayyar said...

The root of this problem is much much deeper.I hope the doctor send hospital management do realise that the common word out there is that the medical and pharmacology professions are just wanting to mint money out of patient.Question is why has the God like image changed so drastically in last 10 years.So much do that no one can trust no one.And specially when a patient is suffering from a fatal disease, they feel there is no way out but to just hope that the doctor is acting in there best's called Hopelessness v.s. Blind Faith which patients once had on their treating doctors.

So, the picture is bigger and the work required to change this picture is big too.Small steps like creating this blog to put an explanation forwards is important as well.It depicts sense of responsibility and that truth prevails.

But in all honesty we all know Medical Professionals have to do extra to win their people's trust and one of those things is to LISTEN to their patients and treat them as individuals not just the disease.


Shainoor83 said...

Recently my Uncle was admitted in 'X' hospital & Doctor's decided to amputate both the legs. He was taken to Operation theatre but at the last moment Family decided to check out after consulting 'Y' hospital.After one month of treatment & 2 operations in 'Y',No legs were amputated & Patient is absolutely normal.Second Opinion of family & correct diagnosis of Y saved the patient life.Diagnosis & decision making of X was negative.It is the right of patient to take second opinion if possible.Sometimes emotions of patient,family comes out because Doctors behaviour,attitude & seriousness may be lacking.

Dr Kiran K V Acharya said...

@ Shainoor83:
1. Amputations as a rule need agreement by TWO surgeons. It has to be in writing.
2. Patient definitely has the right to a second opinion. As doctors we respect that. However, with the social network sites at fingertips, one should not venture into defaming the doctor. Also, never lose the time frame in the treatment of a patient...many deaths have taken place, many complications result due to delay in treatment. Any busy surgeon encounters about 10 % of his patients, visiting him with the sole intention of "second/third" opinions. It has even led to the birth of a terminology "shopping for treatment".
3. Remember that the doctor is trained and groomed to give the "best possible treatment".

KP Arya said...

The facebook post is not a defamation post. It is simply warning the helpless common man against the money driven powerful (medical) corporates. Why two- three independent medical opinions should differ so widely (almost apposite). Is medical science not a SCIENCE yet?

Mohit Lila said...

Dr. Acharya, you may have cited an isolated incidence but it has to be seen that even your opinion was contradicted by two other surgeons. Agreed, there may be a difference of opinion and there may be cases when every treatment has pros and cons and the doctor has to take a call. But do you think the profession is really above board and favouring the patients? Day in day out, cases of wilful "negligence", luring attendants for surgery which could have been otherwise elective, prolonged hospitalization, prescribing costlier medicines under pressure of pharma companies are seen in life. What if you do not agree with this on public platform but in private, the doctors bitch each other for such things.

Anonymous said...

People are talking about a lot of things on social networking sites -- nations, politicians, cricketers, companies. Does it mean that all these posts are trying to defame someone / somebody? and that a lawsuit be filed against all of them? Does one have the right to put forth his opinion, ideas and experiences on social networking sites? No relation to any comment made by anyone. Some simple queries to a man of respect. Thank You.

srikanth said...

Dr acharya, While i agree with you that social media should not be used to defame by naming doctors, in this particular case, instead of jumping straight to surgical options if the doctor concerned had suggested a gravity lateral view(well described and published) and then if unstable it would have been less controversial. Of late in India it has become fashionable to say surgery every time somebody walks in. it just shows how much these doctors are exposed to best practices while training- no offence but training goes both ways.i am aginst spoon feeding. the students of late(at risk of generalisation!!) i see are more inclined to amassing wealth rather than the hard path of knowledge acquisition and

dryogesh said...

Thanks for sharing .

dibyaranjan said...

Dr Acharya keeps saying patient can have a second opinion. Well why doesn't the doctor himself give a second alternative? If there are two possible ways of fixing a thing and one suggests the costlier option, people are definitely going to doubt his/her intentions. And public's anger, it's not just coming out of nowhere. They are seeing it day in day out. You went on wrote a blog to voice your opinion. That guy also did the same thing. It's just that more people can connect to his case.

Dr Kiran K V Acharya said...

Patient went to Medanta hospital- they did not invite her.
Patient paid consultation fee to Dr Attique, he gave the advise.
Taking the advise or rejecting it is the decision of the patient.
Point here is: defaming the doctor for his opinion!
I still stand by my statement: Patient/ her husband has NO RIGHT to defame anyone.

Anonymous said...

Dr Kiran, see your attitude. Patients go because they are in pain. You guys have an issue. You don't talk to patients. You order them. If the same guy would have been told that there are these 2 options : Surgical and non surgical and that those were risk and benefits, the person would have given better treatment to you guys.