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Dear friends posting 25 points which I feel every clinician should follow;

1.

Do not prescribe medicines for more then 30 days even for out station patients. Out station patients demanding late follow up should be referred to a fellow consultant based at new address or nearby Medical College specialty Dept

2.

For Govt. Hospital doctors, dispense medicines only for 15 days.

3.

While referring our case to a Physician/ Surgeon avoid writing name/address of consultant. If negligence occurs at his place you are also held responsible.

While referring just write

To,

Consultant Physician (M.D. Internal Medicine)

Let patient choose the consultant. If you suggest and he falters or overcharges or patient is unhappy he can blame both for cut practice.

Or

Keep list of qualified doctors with receptionist and let them choose by their own judgement and according to financial capacity.

4.

Always give option of referral to govt/municipal/ charitable hosp.

5.

Insist on pathologist (MD/DCP ) run laboratory. He should personally sign all reports. Other labs have been declared illegal by Supreme Court since 12 Dec 2017. Do not mention name of pathologist. Patient may blame both of cut practice. Keep a list of qualified pathologists in your suburb/ town. Let patient choose or bargain.

6.

Write chemical name with brand name in capital letters.

7.

Document on OPD paper/prescription that you had advised mandatory investigations. Patients not getting investigated may blame “doctor never advised tests”

8.

Basic physical findings have to be documented on prescription or your OPD record. If not documented, it may be considered that you did not do it. Avoid short or fancy medical jargon in OPD notes.

9.

In case of medico legal case, never overwrite/ correct/ add notes. It is considered as tempering with evidence and not good in law.

10.

You can ask for self attested copy of photo identity (ADHAR) while registering. This is helpful if you have to give certificate in future or appear in court cases as an expert witness. Cases of fake identity have been noted which may put the physician in trouble.

11.

At least three identifiers must be mentioned on each page of prescription, indoor record, OPD record and certificates.

E.g. (any three)

A). OPD no./ Indoor No

B). First name

C). Middle name

D). Family name

E). Age

12.

Always write summary of investigations you advised/ got done/ findings noted on prescription or OPD record. Loose test reports are not produced by lawyers when it does not suit them.

13.

Document special precautions, diet or life style changes, complete rest, avoid driving instructions if advised.

14.

Don’t advise / prescribe medicines on phone/ WhatsApp /email with out examining the patients. Don’t issue “ct all” prescription to close relatives for their parents, siblings, spouses or children. No proxy. Don’t succumb to emotional blackmail by relatives. Pt can avail medical leave to attend your clinic.

15.

Don’t give admit note to RMO with out examining the patient. All responsibility of job done by an untrained/ unqualified staff rests with the owner.

16.

Display your fees schedule, time, appointment status, degrees, MedCouncil certificate in clinic reception area.

17.

If giving injections in OPD, ensure that emergency kit has not expired, Cylinder is not empty and suction working.

18.

Encourage behavioural feedback about relatives from receptionist/ nurse / counselor before patient enters your cabin. This will give you ample time to change your stretegy while dealing with probable trouble maker relatives/ patient.

19.

Do not prescribe Ayurvedic/ Homeopathic medicine. You may be punished by Council of Indian Medicine for cross pathy.

20.

Mention only Medical Council Registered qualification on letter head. Regn number is a must on letter head or rubber stamp. If you are practicing specialist ensure that your additional qualification is duly registered with Medical Council.

21.

If called for a psychiatry reference, first ensure that physical/ neurological health and vital parameters are okay. If not, do preliminary physical exam, document your findings and write the referring doctor to do the needful. In case of Psychiatry diagnosis inform the referring doctor about strict rules under new Mental Health Care Act (MHCA 2017), which have been implemented all over the nation on 29 May 2018.

22.

Don’t write any history, clinical note, diagnosis which may be detrimental to the dignity of the patient & may hamper his privacy, on prescription. You may note this in technical language in your private OPD/IPD/Counselling record. This must not be given to patient. Keep this away from the IPD treatment Sheets, copy of which many patients and TPAs ask for. Charge reasonably for giving copy of medical record.

23.

Preserve OPD record for 3-5 yrs in electronic or physical form. IPD record for 10 yrs. Medico legal and on going litigation cases to be preserved for indefinite period. Old Records may be destroyed only after due notice in local news paper.

24.

Doctors prescription and certificates are legal papers. Even if you print ” Not for legal purpose”, it is an important piece of evidence. Ask for written application for any document mentioning “why they need it?”. Mention name of patient & applicant ADHAR no. Identity mark and purpose in the certificate. Keep carbon copy or photo copy yourself (don’t rely on relative to submit it later). Get acknowledgement on carbon/photo copy.

25.

Be compassionate towards patients & worried relatives. Instill & assert rules & discipline when needed. Ultimately all this is for the welfare of our patient.

– Dr. Deepak Rathod

Senior Psychiatrist & Management Trainer

Sahyadri Neurosciences Hospital, Kalyan