Garg Kanwaljeet, Sharma Ravi, Raheja Amol, Tandon Vivek, Katiyar Varidh, Dash Chinmaya, Bhatnagar Rishi, Khullar Mohan Kumar, Raju Bharath, Nanda Anil, Kale Shashank S
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi.
2Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar.
Neurosurg Focus. 2020 Nov;49(5):E10. doi: 10.3171/2020.8.FOCUS20592.
Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.
An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.
A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).
This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.
尽管印度医疗法律挑战呈上升趋势，但印度在这一问题上的文献却极为匮乏。作者进行了一项调查，据他们所知这是首次此类调查，旨在评估印度神经外科医生对日常实践中所面临医疗法律挑战的看法。
通过谷歌表单进行的匿名在线调查通过电子邮件和社交媒体平台在印度执业的神经外科医生中广泛传播。问卷包含38个问题，涵盖神经外科实践中涉及的医疗法律问题的各个方面。
共收到221份调查回复，其中214份回复纳入最终分析，排除7名在印度无工作经验的回复者。根据工作安排和工作经验对回复者进行分类。在所有回复者中，20人（9.3%）面临≥1起针对他们的医疗事故诉讼。超过90%的回复者认为印度的医疗事故诉讼在增加。近一半的回复者认为远程会诊的出现进一步增加了医疗事故诉讼的风险，66.4%的回复者觉得他们在住院医师培训期间未得到充分培训以应对医疗法律问题。大多数回复者（88.8%）认为，与在私立部门工作的神经外科医生相比，在政府部门工作的神经外科医生面临诉讼的可能性较小。与在政府部门执业的回复者（22.8%）相比，自由职业和私立机构的回复者（45.1%）以及有多个附属机构的回复者（61.3%）更常报告获取同意视频证明的做法（p<0.001）。与政府部门的同行相比，在私立部门工作的神经外科医生更有可能改变治疗方案并将患病患者转诊至高流量治疗中心以避免医疗事故诉讼（分别为p = 0.043和0.006）。还发现私立部门的回复者在法律准备方面的做法也明显更多（p<0.001）。
这项调查凸显了印度神经外科医生对医疗事故诉讼增加以及随之而来的防御性神经外科手术增加的担忧，尤其是在私立部门。建立一个更强大的法律框架，以便快速解决患者投诉，同时遏制 frivolous 医疗事故诉讼，对于减轻这些担忧大有帮助。迫切需要对神经外科医生进行关于法律准备的系统培训，这应在住院医师培训期间开始。
