Do's and Don'ts for Doctors

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Do’s for Doctors

Always advise the patient not to stop taking a drug suddenly which is required to be tapered before it is stopped.
Remember major drug interactions.

Specifically mention review, SOS/or follow-up schedule.
Mention if patient/ attendant are/ is under effect of alcohol/ drugs.
In case a particular drug/equipment is not available, make a note.
Prescribe with caution during pregnancy/ lactation.
Adjust doses in case of a child/ elderly patient and in renal or Hepatic disorders.
In case of chronic ailments, mention treatment to be taken immediately in case of an emergency. For example, a patient on anti-epileptic treatment should be advised to take an injection of diazepam when convulsions occur.
In case of any deviation from standard care, mention reasons.
Mention whether prognosis explained. If necessary take a signature of patient/ attendant, after explaining the prognosis in written local language.
Mention where the patient should contact in case of your non-availability/ emergency.

If you are not sure what disease a patient has after a through work-up, get a consultation. Develop a lost of physicians you trust and respect in each of the specialties. Nurture your relationship with them, and consult them about difficult cases.
Whenever referring a patient, provide him with a referring note.
In case of emergency/ serious illness, ring up the concerned doctor in the patient’s presence. Show your concern.Always keep with you and refer the latest edition of the standard text book of your branch of medicine. Always subscribe to at least one standard journal and participate in at least updates/ conferences every year.
Update your knowledge and skill from time to time. If a doctor does not keep pace with recent advances, the quality of care suffers and does not measure upto the standards of reasonable care and skill. Many doctors tend to deteriorate in their knowledge, skills and attitude, over a period to time. Not only do they not make any attempt to update themselves but they slip downwards. (Doctors may become incompetent due to other causes: age, mental illness, addiction to alcohol or drug abuse.)
Update not only your own knowledge and skill, but also that of your staff. Update the facilities and equipment according to prevailing current standards in your area.
Preferably employ qualified assistants. If not available, impart proper training and skill at your or some appropriate centre and obtain a certificate for the same.

Medication to relieve pain especially in post-operative and cancer cases must be carried our carefully.
Always obtain a legally valid consent before undertaking surgical/ diagnostic procedure. Learn the difference between “informed persuasion” and “informed consent”. The first is legally wrong, through at times it may be medically correct. (For details on consent, see under “Preventive Steps Against Litigation” in “Medical profession and Consumer Protection Act”, 1994 edn.)In case of MTP/ Sterilization, always follow the guidelines issued by the Government of India (See Appendix VI in Medical Profession and Consumer Protection Act, 1994 edn.)

While administering an injection/vaccination always check:
1. Name of the injection (a wrong injection may be given by mistake or oversight);
2. Expiry date;
3. Reconfirm the route of administration;
4. If it is to be diluted, check the dilution factor (1:2, 1:4 etc.);
5. Rate of administration (fast, slow, in drip, etc.);
6 Site of infection, e.g. antero-lateral, thigh, if age 1 year, gluteal region, deltoid, etc.;
7. That a disposable syringe and needle are used. If that is not possible, use syringe and needle after proper sterilization.
8. In case the patient is agitated/ not co-operating, restrain him properly with 1 or 2 assistants or wait until he calms down. It is not unusual for a broken needle leaking to a claim for compensation;
9. Confirm that it has been kept at the required temperature;
10 If required to be reconstituted, check the diluent and whether it has got to be cooled before using.
Routinely advise X-rays in injury to bones and joints and related diseases of bones/ joints.
Always rule out pregnancy before subjecting the uterus to X-ray.
Always read reports carefully and interpret the results of tests/ X-rays properly and make a note of it.
In all instances of “swab cases” and “instrument cases”, the surgeon in charge has been directly or vicariously held liable for negligence. The surgeon in charge must therefore personally ensure that such mishaps do not occur.The period for the responsibility of the surgeon extends to and includes the post-operative care. He must therefore ensure proper post-operative care to the patient.
Always seek proper legal and medical advice before filing reply to the complainant referred to you from a consumer court.