Medical negligence in cosmetic procedure and legal procedure in India

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The demand for cosmetic procedures is ever increasing. In this modern era, cosmetic procedures are a fancy, a fashion; however, for some patients, it is their profession which compels them to undergo cosmetic procedures. Many other factors also contribute to this upward trend including the economic growth and thereby improved affordability, the booming middle class with high disposable incomes, the revolution in the mass media and thereby increased awareness about cosmetic procedures as well as the increase in medical tourism.

The present-day dermatologists, in addition to conventional skin physicians, are also dermatologic-surgeons and cosmetologists in their practice. The cosmetic procedures have the inherent risk of malpractice litigations leaving an unsatisfied patient and a troublesome lawsuit against the doctor.

Cosmetic procedures are ‘need felt.’ It is the innate desire to ‘look good’ that drives the patient to seek such aesthetic procedures. However, the treating dermatologist should not be over-enthusiastic, and need not succumb to the needs of an insisting and highly demanding patient. It is always preferable to play safe rather than being too accommodative. For every procedure, its alternatives and outcomes have to be discussed in detail beforehand with the patient.

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There is an ever-growing list of dissatisfied clients and obliging lawyers targeting the doctors. Keeping in mind that the patient’s safety is always of utmost importance, the doctor’s interest should also be simultaneously safeguarded, as their intention is not to harm the patient. The dermatologists, who have newly ventured into the cosmetic procedures, should be extremely careful and smart in handling the legal issues arising out of such situations. Although misdiagnosis of cancer is the commonest litigation, the present day dermatologists are performing increasing numbers of cosmetic procedures and surgeries, which have the inherent risk of malpractice litigations

Choosing the right patient for a cosmetic procedure is the most crucial step. The expectations of the patient from the treating doctor need to be assessed first. Patient’s age, indication for the procedure, whether the expectations of the patient matches the expected outcome from the procedure, the possible complications, are some of the basic considerations before any procedure.

Informed consent (IC) is important for ethical and legal reasons as well as to improve quality of care and patient satisfaction. Presence of a witness is always preferred while taking IC. It should include the condition, need for treatment, other modalities of treatment, duration of given treatment, number of sittings, expected results; need to follow instructions before and after the procedure and possible side effects.

Post-procedure care and patient responsibilities should be told clearly to the patient. Documentation of the advice is as important as the verbal communication.

The physician should take great care to ensure complete and accurate records.

Many cosmetic procedures have a ‘downtime’ which should be discussed with the patient during counseling itself, should be told once again so that the patient is well aware of the events that would follow.

The patient should be asked to report if any unusual/unexpected events occur. The doctor should be available for contact for the early diagnosis and management of the probable complications

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Even the most experienced and skilled dermatologist can have a bad day. Mistakes do happen even with the best hands!! In such a case, you are really better off acknowledging it. Be polite to the patient, listen to his complaints, counsel if necessary and redo or treat the patient. n India, patients have an easy method of litigation as the medical profession has been brought under the provisions of the Consumer Protection Act, 1986. The Indian Supreme Court ruled in 1995 that doctors could be sued in India’s consumer courts, for any service charged by the doctor. Only hospitals giving free service are exempted. A complaint can be filed in (1) the District Forum if the value of services and compensation claimed is less than 20 lakh rupees, (2) before the State Commission, if the value of the goods or services and the compensation claimed does not exceed more than 1 crore rupees, or (3) in the National Commission, if the value of the goods or services and the compensation exceeds more than 1 crore rupees.

The message to the dermatologist of this cosmetic era is clear – A cordial doctor-patient relationship, empathetic handling of patients, proper counseling, proficiency in skills, and adherence to established guidelines are the best insurance against litigation.

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