What was to be a fairly routine operation for removing a tumor turned into a fight between the patient's relatives and hospital authorities at Yashoda Hospital in Malakpet, Hyderabad. The incident, which took place on Tuesday evening, was the result of failure by doctors to properly inform the patient on the nature of the procedure, which involved removing the patient's kidney.
This particular case from the Telangana hospital highlights the importance of informed and written consent as well as the need for proper communication between the doctor and patient. Shiva Prasad Goud was admitted for an operation to remove a tumour from his stomach. Prior to surgery, he had been informed by doctors that if the tumour had spread to his kidney (as they suspected) then it would be removed as well. Though the family signed a statement, there was miscommunication, due to which the patient's relatives began protesting thinking that the doctors had removed the kidney without prior intimation. They also alleged that his kidney was probably sold.
What should your doctor be telling you? What are the questions you should be asking?
To start with, prior to any exchange of information, a doctor must ensure that the patient is familiar and comfortable with the language in which the information is being explained. If not, then a translator must be engaged accordingly.
Doctors should introduce themselves and give their designations to help establish a good rapport. Technical information should be explained in simple terms, without using too much medical or scientific jargon. Many times, patients and their families feel overwhelmed prior to surgeries, which is natural, so the doctor must speak to them and ensure that they are made comfortable and understand the procedure and the risks involved.
“Patients should be encouraged to ask questions. While people have generally gotten more comfortable asking doctors questions, there are still so many who find it difficult to do so. They should be encouraged to ask any doubts they have,” explains Dr Murali Chakravarthy, Director, Department of Anaesthesia, Fortis Hospital, Bengaluru. It is also important that consent is not just orally explained, but is also written down and verified. “This is just to ensure that there is documentation which is evidence that the patient and doctor have had this discussion about the procedure and that any queries the patient has had have been answered,” adds the doctor. “In some extremely rare circumstances, such as an emergency situation where it is a matter of life or death, we can obtain oral consent, but there are procedures to follow up with after this,” he says.
“In the court of law, verbal consent is not valid as it can be refuted. For the sake of the doctor and patient both, it becomes important to obtain valid, written consent. It is also the doctor’s responsibility to ensure that the patient has no questions and has been made aware of the procedure they are about to undergo,” stated Dr Madhushree Vijayakumar, a consultant obstetrician and gynecologist from Motherhood Hospital in Sahakar Nagar, Bengaluru. She further adds that it also is a method of maintaining official documentation that a patient has been informed of their condition.
“Doctors had explained to the patient that they would assess the extent of the tumour during the operation, and if it had spread to the kidney (as they had previously suspected), it would be removed,” said an official from Yashoda Hospital.
While no official police complaint was given, police officials from Malakpet and Chaderghat stations had been called in to help control the protesting family. Police spoke to the doctors and family to understand what had occured.
“There was a tumour in the stomach and it was a critical operation. The problem had spread to the kidney, the doctors informed the family about this. The doctor made the family sign a document in which it was written that kidney removal was a possibility. The family is just angry that the patient is now on ventilator," Inspector G Nagaraju of Chaderghat police station told TNM.
After police became involved and the reason behind the removal of the kidney explained to the patient’s parents, the issue was resolved.