Introduction
Statistics indicates that nearly 10 percent of inpatient admissions in various hospitals lead to an adversative event, but less than 2 percent of claims for medical malpractice handled by the health litigation authority proceed to the court evaluation (Bal, 2009). Nonetheless, the increased number of medical negligence as well as the total value needed to settle the litigation has made the issue to be of the enormous concern, and thus doctors should comprehend the factors that lead to the possible lawsuits for negligence. In this regard, the critical issue that exists in this matter is the duty of care that physicians owe to the patients. The concept of medical duty of attention has been subject to an intense discussion over the recent years and thus additional measures should be implementedto assist in understanding the issue. Primarily, the concept of medical duty of care was first initiated by Stevenson v Donoghue case in 1932 where in this case, Lord Atkin pointed out that there was an overall medical duty of care to ensure the provision of reasonable care to prevent the foreseeable injury to the neighbor (Klick &Stratmann, 2005). Briefly, in the analyzed case, a woman in Paisley drank some ginger beer in a bottle and at the bottom of the bottle, she came across a decomposing snail and as a consequence, she fell sick. Subsequently, a case was brought against the manufacturers of the ginger beer for the compensation purposes. In his judgment, Lord Arkin established that the company manufacturing the ginger beer became negligent and failed to ensure the safety of the woman, especially during the process of production. It was thus determined that a common duty of care was owed to the neighbor, and the neighbor was well-defined as somebody who might be rationally contemplated as directly and closely influenced by an act. In this case, it did not matter who bought the beer, but what was widely considered in the argument is the harm that the person who drank the beer suffered thus the ‘neighbor principle’ was essential.
Similarly, the neighbor principle can be appliedto the medical situation where doctors owe a duty of care to patients. Whether a duty of care exists or not is often established in the common law to assist in settling the dispute. Largely, the medical duty of attention is not often an issue when a relationship between a patient and doctor can be established. However, there are some instances whendetermining whether the doctor owes the duty of care requires a more comprehensive analysis. It encompasses, for example, when someone claims that there occurred the duty to third parties, concerning pure mental health, precise economic loss, as well as in the case of statutory agencies (Bal, 2009). In these scenarios, a comprehensive assessment of the medical duty of care shall be applied, or even the special statutory provision shall be executed(Klick &Stratmann, 2005).
Predominantly, a doctor’s medical duty of care should form the first key aspect of any inquiry that strives to establish whether he/she may become liable for any kind medical negligence. Hence, in any claim that may concern the doctors’ duty malpractice, a type of medical negligence, the core aspects are often the duty, the breach of that specific duty, whether there existed harm or not, and the desecration that leads to that injury of that particular person. Subsequently, the medical responsibility is the key criterion that any claim has tomeet. Physicians owe various duties of care, which mostly vary from one nation to another; the hospital set up or practices, as well as a specific locality. In addition, the law requires a physician to exercise considerable diligence as well as care during the application of such proficient skill and knowledge. In addition, a doctor shouldrely on the rational judgment in the performance of this aptitude and experience. It means that certain kinds of medical negligence claim may emerge when a physician is deprived of the ability or knowledge of duty of care, a letdown to execute adequate care, as well as failure to carry out one’s best verdict (Studdert et al., 2004). Finally, a medic’s duty to conduct substantial or ordinary care, skill, as well as diligence is needed regardless of the manifestation or not of reimbursement and thus relays even when the services are offered wantonly (Studdert et al., 2004). In order to answer the research questions, the present paper adopts a specific methodology that encompasses the library research, secondary materials, and academic websites that related to the research questions. Thus, the paper seeks to discuss the fundamental research questions regarding duty of care physicians owe to a patient, medical malpractice among physicians, and doctor-patient relations.
Brief Literature on Medical Duty of Care
According to Ruderman et al. (2006), doctors are professionals, and thus they owe medical obligation to the patients that are in need of particular treatment. Medical negligence case is often a serious matter and thus a patient must have enough evidence to support such claims that indeed some sort of professional negligent happened on the side of the doctor. Once a doctor reaches an agreement to treat patients, then the doctor has the professional mandate to provide a competent health care (Bal, 2009). More significantly, the complainant should be able to demonstrate the actual harm caused by the act of medical negligent so that it attracts compensation. The injury evidence may entail the physical results done by the alleged doctor in the malpractice claim and may as well encompass some forms of emotional elements. The compensation level regarding medical malpractice becomes a hugely contested. Moreover, the causation may as wellmeet an extremely beleaguered litigation because the medic may claim that the harm received by the patient might have resulted from some external factor and not just the medical negligent claim (Blendon et al., 2002). Numerous researches have also evaluated the laws governingmedical malpractice situations. For instance, the notion of respectable minority rules particularly in evaluating the performance of a medicdoes not exist in Jordan jurisprudence. The principle states that the physician is never slack just by choosing to trail one of the many acknowledged courses of treatment (Havighurst, 2000). Nonetheless, some studies have also indicated the error of judgment rule to assist in such cases (Studdert et al., 2004). The idea frees a medic from somecharges if certain kinds of negligenceare based on the medical doctor error in the verdict especially in selecting the various ways of treatment or in the identification of a specific condition (Moulton et al., 2010). Studies regarding medical malpractice show that the idea began many years but increased in the 1960s. However, several tort lawyers shifted the old conspiracy concept that excluded the medics from appearing in court trails of their colleagues or even serving as a court witness during medical negligent cases (Moore et al., 2000).
Key Research Questions
Medical negligent cases have attracted substantial attention in the recent decades due to the increased number of patients that claim doctors might have been on the wrong end for certain medical procedure or treatment. The numbers of people that have become knowledgeable about their medical rights that doctor owe to them have also increased in the contemporary society. However, key issues remain of vast concern and thus they need further comprehension to help make the public aware of these medical rights. Hence, evaluating the facts about medical negligence prerogatives needs indispensable expertise, and consequently, such types of claim tend not to be so palpable. To determine whether a medic was involved in any nature of medical negligent, it is vital to seek tort lawyers for the review of such assertions. Thus, the main research questions that this research paper shall answer are as follows.
- What duty of care does a physician owe to a patient?
- When does doctor-patient relationshipstart?
- When does medical negligence occur amongdoctors?
Discussion of Key Research Questions
What duty of care does a physician owe to a patient?
The medical occupation is regarded as a noble profession since it assists in maintaining people’slives. Most people believe that life is God-given. Therefore, a doctor works in the scheme of God in the attempt to preserve life. Doctors have broad responsibilities to their patients, and it would not be admissible when the issues regarding the medical duty of care arise in their profession(Klick &Stratmann, 2005). Primarily, the relationship between a physician and a patient is often regarded as a special one. In the real sense, many doctors work in the hospital set up and do not have patients admitted under their primary care. Usually, when a patient is admitted to a health care facility, a duty of care through relationship is established and can be applied to any physician that comes into contact with the patient and not even to the team that admitted the patient. Thus, it has been argued by many medical law scholars that any patient in a professional medical environment is owed a medical duty of care, and it does not just extend to the doctors but also those who are hired by the trust to deliver medical care. For instance, a patient who suffers from a cardiac problem in the hospital corridor is considered to be owed a medical duty of attention by any physician who bumps on the patients. Thus, the provision of assistance in such a scenario would possibly be expected and shall not be categorized as a good Samarian act.
A doctor owes a patient many medical duties that often change by locality and thus regardless of the location, it is clear physicians to be entitled to helping a patient particular when some of the relationships had been established. Mostly, a medic owes medical duty of care to a patient before even thecompetence in performing that dutycan be ruled. In countries like Jordan, an individual possesses no supporting role to help the injured individuals in the absence of the discrete relations with the attorney-client. Hence, for a patient to demonstrate that a doctor owes him/her a duty of care, they should be capable of depicting that indeed doctor-patient relationship took place at the time the alleged medical misconductoccurred. In broader terms, the doctor in his capacity must often be aware of certain rules that regard medical duty of care. For instance, while discussing on the absence of requisite qualifications of a homeopathic physician to carry out allopathy in Ashwin Patel and Ors vs. Verma (1996), the Supreme Court ruled that any person who does not have a requisite skill of a specific system of medicine but stays to practice in that same system is considered a quack(Havighurst, 2000). Thus, when an individual is guilty of any negligence per se, it requires no further evidence.
Doctors can also owe a medical duty of care to two patients at the same time, and itis majorly seen in childbirth cases and may emerge in cases of organ transplant as well as cases of conjoined twins. In addition, the medical duty of care on the doctor to act in a responsible manner also applies whether the issue regards diagnosis, treatment, and advice. In many cases, especially in the private health care facilities, a patient can have an agreement with a physician in line the treatment. However, in a situation where there is no explicit provision, the standard of health care is similar to that discussed above. Also, in a situation where a doctor guarantees a specific outcome then later fails to generate that result, the physician may be in the violation of agreement even if the physician has not been said to be negligent. For instance, a situation may arise when a surgeon wrongfully amputated a patient leg. In such cases, there is the presumption that the surgeon could be negligent, and it is up to her or him to prove otherwise.
When does doctor-patient relationshipstart?
To establish whether a medical duty of care occurs in a relationship that had existed between a doctor and a patient, a comprehensive assessment of the relationship is vital. For this reason, it is essential in any medical malpractice case to examine the doctor-patient relationship. Tough questions are often askedin relation to this matter at hand, and thus it is significant to know when a doctor-patient relationship begins. Primarily, the case-based law (common law) regarding the physician’s interaction with the patient in the borders of the patient-doctor relations is comparatively settled, and doctors have the statutory duty to adhere to the standards of reasonable care (Stratmann& Klick, 2007). The medical duty of care occurs between a physician and a patient in an ethical manner as well as on the general regulation and law. The meaning of patient’s interestis construed widely; a medical duty of care might exist between a physician and the future patients as well as between hospital patients and medical administrators. Therefore, in a health situation, a patient often approaches a physician based on his reputation or the required need. Anticipations of a patient are often two-folds. First, hospitals and doctors have an obligation to offer medical treatment with all the skill and knowledge to their ability and second, they shall not be expected to carry out something that harms the patient in a way either due to their carelessness or due to negligence (Stratmann& Klick, 2007).
Even when a relationship has been established, physicians might save the life of a patient in different contexts. Thus, they are widely anticipated to apply their special skills in the optimal way to maintain the interest of the patient who has entrusted their life to them. In this regard, doctors are anticipated to conduct a special assessment or even seek a report from a patient. Thus, the issue of informed consent comes in and unless it is regarded as an emergency, the doctor is expected to obtain the informed agreement of that particular patient before issuing a medication or even the surgical operation. A failure of a physician or a hospital to discharge the duty is fundamentally regarded as a tortious liability. A tort is defined as a civil wrong in contrast with the contractual duty, where a violation of this draws judicial intervention through awarding of damages. For example, countries like Jordan and Saudi Arabia have supported the tort reforms. These actions have the ability to monitor the level of loss that a patient mayconvalesce for non-economic losses such as suffering, pain, and punitive damages. Both Saudi Arabia and Jordan have even adjusted the principleof the locality rule to include both the evaluation of traditional practices of nativedoctorsand the assessment of the global medical requirements. Therefore, a patient has the right to obtain the medical assistance from physicians as well as hospitals. The relationship created takes the form of a contract in some manner since there is payment of a fee, informed consent, provision of medical treatment while retaining the key element of a tort (Stratmann& Klick, 2007). Consequently, once a doctor-patient relation has been created, the physician owes that particular patient a duty of care and treatment. The requisite level of skill and expertise under the circumstances is established by the “expert testimony” from other medics who share similartraining, skill, certification, as well as experience just like the allegedly physician doctor who has been accused in a medical malpractice case (Ruderman et al., 2006).
Certain aspects that may be applied to support the outcomes that a patient-doctor relationshipindeed happenedduring the time of alleged medical misconduct are the evidence (e.g. documents and testimony) showing that: the actual patient agreed to be treated by the alleged doctor, and that the medical attention by the doctor was ongoing. In addition, the patient accepted to the examinations for treatment regarding the health condition or even the conditions suffered by the patient. It is a suitable notion for any patient to obtain a copy of the treatment records that aims to indicate the complete course of the kind of therapy that took place. This becomes essential since it can act as a proof that indeed treatment occurred and doctor-patient relationship was also established. In certain situation, a patient may fail to gain a right that the doctor owed him/her medical duty of care particularly when the physician can confidentlyshow that the relationship was terminated before the mentioned date as purported in the medical negligence saga (Studdert et al., 2004).
When does medical malpractice occur within doctors?
In order to establish whether a form of medical malpractice has occurred among doctors, it is essential to verify some key aspects. The first thing that should be determined in the medical negligence case is that a physician owed the legal duty of care to a patient and the level of care that the doctor subjected the patient to that resulted in the doctors purported medical malpractice. To establish whether a physician owed a medical duty of care to a patient, the patient should be able to prove that the doctor-patient relations occurred at the time the claimed medical negligent took place (Kachalia et al., 2003). A doctor should adhere to the general medical standards of care. Specifically, in treating a patient, a physician or any other healthcare provider should use the extent of attention as well as skill to discharge his obligation. Another way to label the standards of care is grounded in the customary practices of the average doctor, where an average doctor would typically or customarily do in the same situation. Hence, a physician whose ability falls below the designated medical standards of care can be seen to have committed the medical malpractice, although some elements should also be determined before claims of medical malpractice can be staged. The medical standard of care has been considered as the original element of any medical negligent by a doctor and once the standards of care are determined, the offender’s failure to provide care that matches the specified standards, and the resulting injury to that plaintiff, should be verified in a prosperous medical negligence claim (Kachalia et al., 2003).
Alternatively, a doctor has the medical duty to communicate the necessary information to a patient, and itcan be achieved through disclosing or even providing some warnings to that patient in a very timely way. The physician also has the duty to tell the patient about some of the dangers that are linked to an individual drug and any other reasonable risks of the medical procedure. Also, a doctor has a duty to supervise some tasks delegated to the trained healthcare personnel, especially when other physicians would get it to be reasonable to do so in the similar circumstance. Therefore, a doctor has the legal duty to supervise adequately any medical duty that has been delegated another trained healthcare. In a situation where a duty of care has been violated, the liability for the medical malpractice may come up. The medical malpractice is a serious issue since the patients may get hurt when it occurs. The concept of harm is an essential consideration in determining medical malpractice, as the vast tortious allegations for medical malpractice that never succeeds often fail since they cannot determine that an injury has taken place as a direct consequence of the act or even failure to act (Kachalia et al., 2003).
To establish the medical negligence, a three-step test should be fulfilled. Firstly, a doctor must owe an individual duty of care. Secondly, a violation must exist if the doctor owed a medical duty of care to the patient indeed. Thirdly, due to that violation, a legally recognized injury should be caused. These procedures assist in determining the fault in the part of the physician. The claimant should identify the balance of possibilities that medical malpractice occurred by the defendant. In addition, the compensation is paid to ensure that the applicant returns to the states they would theoretically have been had the injury not taken place. There are some philosophical aims of encouraging accountability as well as ensuring the process of compensation prevents faults.
Various case examples have been used to expand the knowledge on medical negligence. For example, the case of Dr. TrimbarkBabuGodbole vs. Dr. LaxmanBalkrishna Joshi of 1969 and the case of State of U.P vs. A.S.Mittalof 1989 where it was specified that when a patient has consulted a physician, the doctor then owes to that patient some duties (Kachalia et al., 2003). These functions are medical duty of care regarding the case, the duty of care to decide what kind of treatment to provide, and duty of attention in the administration of the treatment. Therefore, a violation of any of the above duties may lead to medical malpractice and patient on that ground may recover some compensation from the doctor. In the above case, the court observed that negligence manifests in several ways. It can be in the form of active negligence, comparative negligence, collateral negligence, or negligence per se. Another case is that of Friern Hospital Trust v Bolam, which is another popular case in connection to medical malpractice (Klick &Stratmann, 2005). The case referred to some patient who during an ECT treatment, sustained fractures and alleged that the care under the anesthesia had been neglectful in some way since they had not offered muscle relaxation for that medical procedure and had not been informed of the dangers of the fracture. The court concluded, however, that medical malpractice could not be proven. Since evidence indicated that at that time it was not accepted to administer the procedure of muscle relaxation since there existed divergent opinions on the benefits of the proceedings. The court argued that if the doctor acted in line with the practice that had been regarded acceptable by the responsible body of physicians that was sufficient, and the plaintiff should demonstrate that no reasonable doctor in a similar situation would have acted in that manner (Kachalia et al., 2003).
Conclusion
In conclusion, the medical duty of care, doctor-patient relationship, and medical negligence are issues of the serious concern in the healthcare fraternity. In many instances, the cases regarding the legal duty of care have been analyzed, and doctors have been forced to defend themselves against medical malpractices. In a more common way, doctors owe patients a medical duty of care and failure by a physician in some ways can result in the medical negligence. In a special way, the paper has also established that a doctor-patient relationship is vital in any medical duty of care. The relationship can be attained in various ways. The relationship is fundamental in ensuring that the medical duty of care has existed. Therefore, the patient has the duty of attention in a situation where such connection had been established. Medical negligence can also emerge when a physician owes a patient duty of care; breach occurred when the doctor owed the patient duty of care and that breach has caused an injury. It can be asserted that medical malpractice is a three-stage test where the duty of medical care is owed to the patient because of the breach of that responsibility, a patient suffers injury. Hence, every part of the test should be fulfilled. Also, the research paper has indicated that civil consideration of medical malpractice need doctors to serve to a proper standard.
References
Bal, B. S. (2009). An introduction to medical malpractice in the United States.Clinical orthopaedics and related research, 467(2), 339-347.
Blendon, R. J., DesRoches, C. M., Brodie, M., Benson, J. M., Rosen, A. B., Schneider, E., …&Steffenson, A. E. (2002). Views of practicing physicians and the public on medical errors.New England Journal of Medicine, 347(24), 1933-1940.
Havighurst, C. C. (2000). Vicarious liability: relocating responsibility for the quality of medical care.Am. JL & Med., 26, 7.
Moore, P. J., Adler, N. E., & Robertson, P. A. (2000).Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions.Western Journal of Medicine, 173(4), 244.
Moulton, B., & King, J. S. (2010).Aligning Ethics with Medical Decision‐Making: The Quest for Informed Patient Choice.The Journal of Law, Medicine & Ethics, 38(1), 85-97.
Ruderman, C., Tracy, C. S., Bensimon, C. M., Bernstein, M., Hawryluck, L., Shaul, R. Z., & Upshur, R. E. (2006).On pandemics and the duty to care: whose duty?who cares?. BMC Medical Ethics, 7(1), 5.
Studdert, D. M., Mello, M. M., & Brennan, T. A. (2004).Medical malpractice.New England Journal of Medicine, 350(3).
Klick, J., &Stratmann, T. (2005). Does Medical Malpractice Reform Help States Retain Physicians and Does It Matter?.Florida State University Law School Working Paper.
Kachalia, A., Shojania, K. G., Hofer, T. P., Piotrowski, M., & Saint, S. (2003). Does full disclosure of medical errors affect malpractice liability? The jury is still out. The Joint Commission Journal on Quality and Patient Safety, 29(10), 503-511.
Stratmann, T., & Klick, J. (2007).Medical Malpractice Reform and Physicians in High‐Risk Specialties.The Journal of Legal Studies, 36(S2), S121-S142.