GHOST SURGERY ( GRP 8 ).pptx

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1. PHYSICIAN SUBSTITUTION AND GHOST SURGERY - GROUP 8

2. 241. SURESH POOJA 242. SUTHERSON, VISHAL 243. SYED, THAHASEENA 244. TAMILARASI MARIMUTHU, OVIYA 245. TARING, TAME 246. Telugu, VARALAXMI 247. THANEDAR, ABDUL RAHIMAN 248. THAVASIMUTHU SUBRAMANIAN, SNEGA 249. THIRUCHELVAM, SARME REGITHA 250. THIRUMENI, NITHISH 251. THOMAS HENRY DOSS, SAM CALVIN 252. THOTA, FRANCIS 253. THOTA, SUSHMA SUPRABHA 254. TIPALE, VIJAYKUMAR 255. UDHAYAKUMAR, SNEKA 256. UPASANA 257. VADIVEL MURUGAN ABIRAMI, KEERTHANA 258. VAMPUGADAVALA, SHALINI 259. VASANTHA PANNEERSELVAM, AASHRITHA 260. VEER, ONKAR RAMCHANDRA 261. VEERASELVARAJ, ROSHNI DURGAA 262. VELMURUGAN TAMIL INIYAN 263. VELU, VISHNU PRIYA 264. VENKATACHALAM, NAVEENA 265. VENKATESAN, SANJEEV 266. VENKATRAJAN SINNU, BARKAVI 267. VIJAYAKUMAR, CHARAN 268. VIKRAM KUMAR MADHAVAN 269. VISWANATHAN, KEERTHI 270. WADEKAR, SEJAL ROHIDAS 271. WATEKAR, NINAD ASHOK 272. YARLAGADDA, ABHISHEK JOSEPΗ 273. YOGANANTHAM, RISHINATH 275. PATIL SAPANA PARAMAGOUDA GROUP MEMBERS

3. CASE SCENARIO: • IMAGINE THIS SCENARIO. RAJESH'S MOTHER IS SUFFERING FROM A BRAIN RELATED DISEASE. THANKFULLY HE HAS THE MONEY TO SEEK AN APPOINTMENT WITH A RENOWNED DOCTOR PRESENTLY WORKING AS THE HEAD OF THE DEPARTMENT OF AN EQUALLY RENOWNED HOSPITAL. HE (TERMED AS TREATING DOCTOR HEREON) ADVISES IMMEDIATE SURGERY, ASSURES RAJESH OF LITTLE RISK AND, OF COURSE, HIS HIGH COMPETENCE. THUS ASSURED RAJESH ADMITS HIS MOTHER THERE. ON THE DAY OF THE OPERATION AFTER SOME TIME TWO JUNIOR DOCTORS APPEAR BEAMING FROM THE OPERATION THEATER

4. IF OPERATION WENT WELL WITHOUT ANY COMPLICATIONS IF OPERATION DOES NOT GO WELL

5. IN BOTH THE SCENARIOS RAJESH'S MOTHER IS MOST PROBABLY A VICTIM OF GHOST SURGERY. UNKNOWN DOCTORS (MAYBE NOT EVEN DOCTORS BUT TRAINEES!) OF UNKNOWN COMPETENCIES HAVE OPERATED UPON HER, PERHAPS TO GAIN THE MUCH VALUED EXPERIENCE IN THE PROCEDURE. WHILE LUCKILY THE FIRST SCENARIO ENDED WELL AND SO MAYBE NEVER CAME OUT, THE SECOND LED TO SERIOUS CONSEQUENCES.

6. WHAT IS GHOST SURGERY • A GHOST SURGERY IS A SURGERY IN WHICH THE PERSON WHO PERFORMS THE OPERATION, THE "GHOST SURGEON" OR "GHOST DOCTOR", IS NOT THE SURGEON THAT WAS HIRED FOR AND IS CREDITED WITH THE OPERATION. THE GHOST DOCTOR SUBSTITUTES THE HIRED SURGEON WHILE THE PATIENT IS UNCONSCIOUS FROM ANESTHESIA WITHOUT TAKING ANY CONSENT FROM THE PATIENT.

7. WHY DOES GHOST SURGERY HAPPENS? Well, this article, written way back in Times of India in 2013 sets out some of the reasons for it..at root is the rampant commercialization of the "noble" medical profession where in the guise of a cure basic values are being given the go by, and lives are being risked.

8. THE REASONS INCLUDE : • INCREASED PRESSURE ON HEALTH SERVICES, WITH A BURGEONING AND MORE AWARE POPULATION, AND A CREAKING PUBLIC HEALTH 'SYSTEM'.

9. TO MAKE MORE MONEY, DOCTORS ARE TAKING MULTIPLE ENGAGEMENTS BEYOND THEIR WORKLOAD CAPACITY.

10. NO CLEAR PROTOCOLS : When does a Cardiac Surgeon become a Senior" Cardiac Surgeon, or a "Head" of the Cardiac Surgery Department? Similarly for other specialties.

11. THE DESIRE OF "JUNIOR" DOCTORS TO "POLISH" THEIR HANDS ON UNSUSPECTING PATIENTS. SINCE ONLY THEN CAN THEY GET MORE EXPERIENCE AND CONFIDENCE AND, IN TURN, EARN MORE!

12. IS THERE STILL A PHYSICIAN PATIENT RELATIONSHIP BETWEEN THE REFERRING PHYSICIAN AND PATIENT IN CASE OF PHYSICIAN SUBSTITUTION?

13. YES EVEN IF THERE'S A SUBSTITUTION, THE REFERRING PHYSICIAN MAINTAINS A PROFESSIONAL RELATIONSHIP WITH THE PATIENT. THEY'RE STILL RESPONSIBLE FOR COORDINATING CARE AND OVERSEEING THE PATIENT'S TREATMENT PLAN,ENSURING CONTINUITY OF CARE AND COMMUNICATION BETWEEN ALL INVOLVED PARTIES. BOTH THE AMERICAN MEDICAL ASSOCIATION (Α. Μ.Α.) ΑND THE AMERICAN COLLEGE OF SURGEONS STATE THAT IF A RESIDENT, RATHER THAN THE SURGEON RETAINED BY THE PATIENT, ACTUALLY PERFORMS THE SURGERY, THE PATIENT MUST BE MADE AWARE OF THE FACT AND MUST CONSENT TO THE SUBSTITUTION. IN ITS MANUAL ON MEDICAL ETHICS THE A.M.A. STATES: UNDER THE NORMAL AND CUSTOMARY ARRANGEMENT WITH PRIVATE PATIENTS, AND WITH REFERENCE TO THE USUAL FORM OF CONSENT TO OPERATION, THE SURGEON IS OBLIGATED TO PERFORM THE OPERATION HIMSELF, AND HE MAY USE THE SERVICES OF ASSISTING RESIDENTS OR OTHER ASSISTING SURGEONS TO THE EXTENT THAT THE OPERATION REASONABLY REQUIRES THE EMPLOYMENT OF SUCH ASSISTANCE. IF A RESIDENT OR OTHER PHYSICIAN IS TO PERFORM THE OPERATION UNDER THE GUIDANCE OF THE SURGEON, IT IS NECESSARY TO MAKE A FULL DISCLOSURE OF THIS FACT TO THE PATIENT, AND THIS SHOULD BE EVIDENCED BY AN APPROPRIATE STATEMENT CONTAINED IN THE CONSENT.

14. THE AMERICAN COLLEGE OF SURGEONS IN ITS STATEMENT OF PRINCIPLES STATES THAT: IF A RESIDENT IS TO OPERATE UPON AND TAKE CARE OF THE PATIENT, UNDER THE GENERAL SUPERVISION OF AN ATTENDING SURGEON WHO WILL NOT PARTICIPATE ACTIVELY, THE PATIENT SHOULD BE SO INFORMED AND CONSENT THERETO. IT IS UNETHICAL TO MISLEAD A PATIENT AS TO THE IDENTITY OF THE DOCTOR WHO PERFORMS THE OPERATION. BOTH THE A.M.A. AND THE AMERICAN COLLEGE OF SURGEONS SEEM TO BE SAYING THAT RESIDENT SURGERY IS ETHICAL PROVIDED THAT THE PATIENT IS MADE AWARE THAT A RESIDENT WILL BE OPERATING ON HIM.

15. THE JOINT COMMISSION ON THE ACCREDITATION OF HOSPITALS (ACCREDITATION MANUAL FOR HOSPITALS) IN ITS SECTION ON PATIENTS RIGHTS STATES: THE PATIENT HAS THE RIGHT TO REASONABLY INFORMED PARTICIPATION IN DECISIONS INVOLVING HIS HEALTH CARE... THE PATIENT SHOULD NOT BE SUBJECTED TO ANY PROCEDURE WITHOUT HIS VOLUNTARY, COMPETENT AND UNDERSTANDING CONSENT.. THE PATIENT HAS THE RIGHT TO KNOW WHO IS RESPONSIBLE FOR AUTHORIZING AND PERFORMING THE PROCEDURES OR TREATMENT. THE KEY WORD HERE IS "RESPONSIBLE." THE ACCREDITATION MANUAL SEEMS TO BE SAYING THAT THE REQUIREMENTS OF INFORMED CONSENT ARE SATISFIED SO LONG AS THE PATIENT KNOWS THE NAME OF THE PHYSICIAN ULTIMATELY RESPONSIBLE FOR THE OVERALL CONDUCT OF THE OPERATION, AND HAS CONSENTED TO THE ASSUMPTION OF THAT RESPONSIBILITY BY THAT DOCTOR.

16. WHAT ARE THE LIABILITIES OF THE REFERRING PHYSICIAN AS WELL AS THAT OF THE SUBSTITUTE PHYSICIAN TO PATIENT?

17. LIABILITY FOR IMPROPERLY MANAGED REFERRALS : REFERRING A PATIENT TO ANOTHER PHYSICIAN GENERALLY RELIEVES THE ORIGINAL PHYSICIAN OF RESPONSIBILITY FOR THE PATIENT’S CARE AND REDUCES HIS OR HER LIABILITY. HOWEVER, IF THE REFERRAL IS NOT MADE CORRECTLY, THE LIABILITY OF THE REFERRING PHYSICIAN MAY INCREASE. THE REFERRAL MUST BE ACCEPTABLE TO ALL THREE PARTIES INVOLVED: THE REFERRING PHYSICIAN, THE RECEIVING PHYSICIAN, AND THE PATIENT. (IF THE PATIENT REQUIRES EMERGENCY CARE OR IS IN LABOR, THE REFERRING PHYSICIAN MUST COMPLY WITH THE FEDERAL EMTALA LAW.) PATIENTS HAVE THE RIGHT TO REFUSE REFERRAL WITHOUT RELIEVING THEIR ATTENDING PHYSICIAN OF RESPONSIBILITY FOR THEIR CARE. TO REFER PATIENTS AGAINST THEIR WISHES AND THEN WITHDRAW FROM THE PATIENT’S CARE CONSTITUTES ABANDONMENT. HISTORICALLY, ABANDONMENT DID NOT RESULT IN SUBSTANTIAL TORT LOSSES BECAUSE PATIENTS COULD USUALLY FIND SUBSTITUTE CARE. THIS IS NO LONGER TRUE IN MANY PARTS OF THE UNITED STATES. ABANDONED PATIENTS, PARTICULARLY PREGNANT WOMEN, MAY NOT BE ABLE TO FIND CARE UNTIL THEY CAN QUALIFY FOR EMERGENCY CARE UNDER THE FEDERAL LAWS. REFERRALS MUST BE MADE SO THAT THE PATIENT IS ENSURED OF THE AVAILABILITY OF ONGOING CARE. WHEN A PATIENT REFUSES TO BE REFERRED TO ANOTHER PHYSICIAN, THE ATTENDING PHYSICIAN SHOULD FIND OUT WHY AND ATTEMPT TO CORRECT ANY PROBLEM. IF THE PATIENT IS OPPOSED TO THE SPECIFIC PHYSICIAN RECOMMENDED, ANOTHER PHYSICIAN SHOULD BE SOUGHT. IF THE PATIENT’S INSURANCE WILL NOT PAY FOR THE CARE, THE ATTENDING PHYSICIAN SHOULD HELP THE PATIENT DEAL WITH THE INSURANCE CARRIER. IF THE PATIENT DOES NOT WANT TO CHANGE PHYSICIANS, THE ATTENDING PHYSICIAN SHOULD CAREFULLY EXPLAIN TO THE PATIENT WHY THIS CHANGE IS NECESSARY (PERHAPS THE PHYSICIAN DOES NOT HAVE THE SKILLS OR RESOURCES NEEDED TO CONTINUE THE CASE.) THE PATIENT SHOULD UNDERSTAND THAT AFTER MAKING APPROPRIATE CARE AVAILABLE, THE ATTENDING PHYSICIAN WILL WITHDRAW FROM THE CASE. A PHYSICIAN MAY REFUSE A REFERRAL FOR A VARIETY OF REASONS BUT NOT IF HE OR SHE HAS A PREEXISTING DUTY TO CARE FOR THE PATIENT. THE NEUROSURGEON WHOSE HOSPITAL STAFF PRIVILEGES ARE DEPENDENT ON HIS ACCEPTING REFERRALS FROM THE EMERGENCY ROOM, FOR EXAMPLE, HAS A DUTY TO TREAT AN ACCIDENT VICTIM REFERRED FROM THE EMERGENCY ROOM. IN PRACTICE, THIS DUTY DOES NOT HELP THE EMERGENCY ROOM PHYSICIAN OR THE PATIENT IF THE NEUROSURGEON REFUSES TO COME IN. THE EMERGENCY ROOM PHYSICIAN MUST CARE FOR THE PATIENT UNTIL APPROPRIATE SPECIALTY CARE BECOMES AVAILABLE.

18. THE ATTENDING PHYSICIAN SHOULD ENSURE THAT THE RECEIVING PHYSICIAN WILL ACCEPT THE PATIENT BEFORE MAKING THE REFERRAL. THIS MAY BE ON A PATIENT-BY- PATIENT BASIS OR THROUGH AN ONGOING AGREEMENT. IF THE RECEIVING PHYSICIAN REFUSES TO ACCEPT THE PATIENT, THE REFERRING PHYSICIAN MUST MAKE OTHER ARRANGEMENTS. THE EMERGENCY MEDICAL TREATMENT & ACTIVE LABOR ACT (EMTALA) IS A HEALTHCARE LAW SPECIFIC TO SCREENING, STABILIZING, AND TRANSFERRING (OR ACCEPTING) PATIENTS WITH EMERGENCY MEDICAL CONDITIONS AND ACTIVE LABOR. THIS LAW, CONTEXTUAL TO MEDICARE-PARTICIPATING HOSPITALS, ENSURES PUBLIC ACCESS TO EMERGENCY MEDICAL SERVICES, REGARDLESS OF THE INDIVIDUAL’S ABILITY TO PAY. THE DEFENSIVE MEDICINE (DM) MODEL AND PHYSICIAN RESPONSIVENESS TO STANDARD-OF-CARE REFORMS (PRSRS) MODEL ARE TWO MEDICAL MALPRACTICE FRAMEWORKS LEVERAGED IN THIS PAPER. THE NODES OF THESE FRAMEWORKS COMPRISE OF THE TREATMENT-VERSUS-NO-TREATMENT DYNAMICS AND CUTOFF THRESHOLDS. CUTOFF THRESHOLDS ARE SPECIFIC TO HEALTH RISKS AND TREATMENT PRICE RATES. HEALTH RISKS STEM FROM THOSE WITH TREATING OR NOT TREATING A PATIENT AS WELL AS THOSE INHERENT FROM THE PATIENT’S AILMENT. TREATMENT PRICE RATES ARE SUBCATEGORIZED INTO CUSTOMARY AND EFFICIENT PRICE RATES. GIVEN THE ABOVE NODES OF THESE FRAMEWORKS, THIS PAPER EXAMINES HOW THE ABOVE MEDICAL MALPRACTICE MODELS SYNCHRONIZE AND SEQUENTIALLY ALIGN WITH THE LEGAL OBLIGATIONS OF THIS LAW. THIS PAPER, FURTHERMORE, CONTEMPLATIVELY DESCRIBES HOW THE INCENTIVIZE/PENALIZE DYNAMICS INTERRELATE TO THE PUSH/PULL DYNAMICS OF THE PRSRS MALPRACTICE MODEL.

19. THEREAFTER, THIS PAPER APPLIES THE ABOVE PUSH/PULL DYNAMICS CONTEXTUAL TO THE THREE SPECIFIC OBLIGATIONS OF THIS LAW, ESSENTIALLY, SCREENING, STABILIZING, AND TRANSFERRING (OR ACCEPTING) EMERGENCY CARE PATIENTS. CONCLUSIVELY, THIS PAPER ILLUSTRATES THE ABOVE NETWORK IN A CASCADING ALGORITHM THAT LIGATES THE NODES OF THESE FRAMEWORKS TO EMTALA'S OBLIGATIONS. COMMON REFERRAL ERRORS THAT CREATE LIABILITY FOR PHYSICIANS: DOCTORS AND SPECIALISTS WHO REFER PATIENTS FOR CONSULTATION ARE TYPICALLY NOT HELD LIABLE FOR THE MALPRACTICE OF THE CONSULTING PHYSICIAN. THAT DOES NOT, HOWEVER, ABSOLVE THEM OF LIABILITY FOR THE REFERRAL ITSELF. HERE ARE FOUR WAYS IN WHICH REFERRAL LIABILITY CAN EVOLVE FOR REFERRING HEALTHCARE PROVIDERS. 1. MISREFERRALS CLINICALLY INAPPROPRIATE REFERRALS CAN HAPPEN WHEN PHYSICIANS DO NOT HAVE ENOUGH INFORMATION ABOUT SPECIALISTS OR WHEN THEY LET PERSONAL RELATIONSHIPS SERVE AS THE BASIS FOR REFERRALS. THEY CAN ALSO OCCUR WHEN PATIENTS ARE REFERRED TO

20. 2. Unqualified or unlicensed providers Providers who are too busy to schedule timely appointments Providers with a record of disciplinary action or professional censuresMisreferrals cost at least $1.9 billion each year in unnecessary co-pays and lost wages, experts say. In some cases, misdiagnoses or failures to diagnose by the referring physician are also factors. 3. Insufficient Communication This can include failing to provide medical findings, test results, and patient history to the specialist who is accepting the referral. It can also include failing to communicate when: The referring physician and specialist have conflicting findings. It is clear that the specialist is unable to treat or address the patient’s condition.

21. JANE, A 45-YEAR-OLD WOMAN, NEEDS TO UNDERGO A SURGICAL PROCEDURE TO REPAIR A HERNIATED DISC IN HER SPINE. DR. SMITH, A NEUROSURGEON, IS SCHEDULED TO PERFORM THE SURGERY, AND JANE HAS PROVIDED HER INFORMED CONSENT BASED ON DR. SMITH'S QUALIFICATIONS AND EXPERTISE. ON THE DAY OF THE SURGERY, JANE IS PREPPED AND TAKEN INTO THE OPERATING ROOM. HOWEVER, DUE TO AN EMERGENCY IN ANOTHER PART OF THE HOSPITAL, DR. SMITH IS CALLED AWAY, AND DR. JONES, ANOTHER NEUROSURGEON WHOM JANE HAS NEVER MET, IS ASSIGNED TO PERFORM THE SURGERY INSTEAD. UNFORTUNATELY, JANE IS NOT INFORMED ABOUT THIS LAST-MINUTE CHANGE IN THE SURGICAL TEAM DURING THE PROCEDURE, COMPLICATIONS ARISE, AND JANE EXPERIENCES NERVE DAMAGE THAT RESULTS IN LONG-TERM PAIN AND DISABILITY. RESPONSIBILITY AND LIABILITY: IN THIS SCENARIO, SEVERAL PARTIES MAY BEAR RESPONSIBILITY FOR THE INJURY AND POTENTIAL MEDICAL MALPRACTICE RELATED TO GHOST SURGERY:

22. SURGEON (DR. JONES): DR. JONES, WHO PERFORMED THE SURGERY, MAY BE HELD ACCOUNTABLE FOR ANY NEGLIGENCE OR ERRORS THAT CONTRIBUTED TO JANE'S INJURY DURING THE PROCEDURE. PRIMARY SURGEON (DR. SMITH): DR. SMITH, AS THE PRIMARY SURGEON ORIGINALLY SCHEDULED FOR THE PROCEDURE, MAY ALSO SHARE RESPONSIBILITY IF HE FAILED TO NOTIFY JANE OF THE CHANGE IN SURGICAL TEAM OR IF HE DID NOT ADEQUATELY OVERSEE THE SUBSTITUTE SURGEON'S ACTIONS. HOSPITAL OR MEDICAL FACILITY: THE HOSPITAL WHERE THE SURGERY TOOK PLACE COULD BE LIABLE FOR FAILING TO ENSURE PROPER PATIENT CONSENT AND FOR NOT ADEQUATELY MANAGING SURGICAL TEAM ASSIGNMENTS. INFORMED CONSENT: JANE DID NOT CONSENT TO DR. JONES PERFORMING THE SURGERY, ASSUMING DR. SMITH WOULD BE THE OPERATING SURGEON. THIS LACK OF INFORMED CONSENT RAISES ETHICAL AND LEGAL CONCERNS REGARDING PATIENT AUTONOMY AND THE RIGHT TO CHOOSE ONE'S MEDICAL PROVIDERS

23. WHO WILL BE HELD RESPONSIBLE IF AN INJURY OCCURS? IN GHOST SURGERY GHOST SURGERY REFERS TO A SITUATION WHERE A DIFFERENT SURGEON THAN EXPECTED PERFORMS A SURGICAL PROCEDURE WITHOUT THE PATIENT'S KNOWLEDGE OR CONSENT. THIS CAN HAPPEN IF A SUBSTITUTE SURGEON STEPS IN UNEXPECTEDLY, WITHOUT PRIOR DISCLOSURE OR CONSENT FROM THE PATIENT. RESPONSIBILITY FOR INJURIES OR COMPLICATIONS THAT OCCUR DURING A GHOST SURGERY SCENARIO CAN VARY DEPENDING ON THE SPECIFIC CIRCUMSTANCES AND LEGAL JURISDICTION. HOWEVER, SEVERAL PARTIES MAY BE CONSIDERED RESPONSIBLE: SURGEON: THE SURGEON WHO PERFORMS THE PROCEDURE, WHETHER PLANNED OR AS A SUBSTITUTE, MAY BEAR RESPONSIBILITY FOR ANY NEGLIGENCE OR MALPRACTICE THAT OCCURS DURING THE SURGERY. PRIMARY SURGEON: IF THE PRIMARY SURGEON KNOWINGLY ALLOWS A SUBSTITUTE SURGEON TO PERFORM THE PROCEDURE WITHOUT INFORMING THE PATIENT, THEY MAY ALSO BE HELD LIABLE FOR FAILING TO OBTAIN PROPER CONSENT AND FOR ANY RESULTING HARM. MEDICAL FACILITY: HOSPITALS OR MEDICAL FACILITIES WHERE THE SURGERY TAKES PLACE MAY BE HELD RESPONSIBLE FOR THE ACTIONS OF THEIR STAFF AND FOR ENSURING PROPER PATIENT CONSENT AND CARE. INFORMED CONSENT: THE PATIENT HAS THE RIGHT TO BE INFORMED OF ANY CHANGES TO THEIR SURGICAL TEAM AND TO PROVIDE CONSENT FOR ANY SUBSTITUTE SURGEON INVOLVED IN THEIR CARE. IF PROPER INFORMED CONSENT WAS NOT OBTAINED, THE HEALTHCARE PROVIDERS INVOLVED MAY BE HELD ACCOUNTABLE. LEGAL AND ETHICAL STANDARDS: VIOLATIONS OF LEGAL AND ETHICAL STANDARDS REGARDING PATIENT CONSENT, DISCLOSURE, AND STANDARDS OF CARE CAN RESULT IN LEGAL LIABILITY FOR THE RESPONSIBLE PARTIES. IT'S ESSENTIAL FOR PATIENTS TO BE INFORMED AND INVOLVED IN DECISIONS REGARDING THEIR MEDICAL CARE, INCLUDING THE CHOICE OF SURGICAL TEAM. IF A PATIENT EXPERIENCES HARM OR INJURY DUE TO UNAUTHORIZED OR UNEXPECTED SURGICAL PRACTICES, THEY MAY HAVE LEGAL RECOURSE TO SEEK COMPENSATION AND ACCOUNTABILITY FROM THE RESPONSIBLE PARTIES.

24. LEGAL IMPLICATIONS: IN CASES OF GHOST SURGERY RESULTING IN PATIENT HARM, LEGAL IMPLICATIONS MAY INCLUDE: MEDICAL MALPRACTICE CLAIMS AGAINST THE RESPONSIBLE SURGEONS AND HOSPITAL. ALLEGATIONS OF LACK OF INFORMED CONSENT AND PATIENT RIGHTS VIOLATIONS. INVESTIGATIONS BY MEDICAL BOARDS OR REGULATORY AUTHORITIES. POTENTIAL FINANCIAL COMPENSATION FOR THE PATIENT TO COVER MEDICAL EXPENSES, PAIN, SUFFERING, AND LONG-TERM CONSEQUENCES OF THE INJURY

25. CURRENT BILL OR LAW/S ON GHOST SURGERY IN THE PHILIPPINES, INDIA AND ITS RAMIFICATIONS ON RESIDENCY TRAINING

26. THE HOUSE OF REPRESENTATIVES COMMITTEE ON HEALTH HAS APPROVED IN PRINCIPLE A BILL WHICH SEEKS TO PROHIBIT THE PRACTICE OF GHOST SURGERIES BY MEDICAL DOCTORS AND HOSPITALS. HOUSE BILL 742 DEFINES GHOST SURGERY AS A PRACTICE WHERE A SURGEON DELEGATES THE SURGERY TO ANOTHER SURGEON WHICH THE PATIENT DOES NOT KNOW OR HAS NOT EVEN MET BEFORE. REP. LUIS R. VILLAFUERTE (3RD DISTRICT, CAMARINES SUR), AUTHOR OF THE BILL, SAID GHOST SURGERY HAPPENS WHEN BUSY AND POPULAR SURGEONS WOULD SCHEDULE THEIR SURGERIES IN TWO TO THREE HOSPITALS WITH OVERLAPPING TIME FRAMES. VILLAFUERTE SAID THAT SINCE THERE IS NO WAY THE SAID SURGEON CAN BE PHYSICALLY PRESENT IN ALL THESE HOSPITALS AT THE SAME TIME, HE WILL JUST TAKE THE TIME TO SHOW HIS FACE WHILE THE PATIENT IS STILL AWAKE BEFORE THE ACTUAL SURGERY. "THE SURGEON THEN LEAVES THE HOSPITAL AND THE PATIENT MEANWHILE PRESUMES THAT SAID SURGEON WILL BE HIS/HER OPERATING SURGEON NOT KNOWING AND WITHOUT HIS CONSENT THAT A DIFFERENT DOCTOR WILL DO THE OPERATION ON THE PATIENT," VILLAFUERTE SAID. THE BICOL SOLON SAID ANOTHER METHOD IN WHICH GHOST SURGERY IS CARRIED OUT IS WHEN AN ATTENDING DOCTOR WHO IS NOT A SURGEON ADMITS A PATIENT FOR SURGERY IN A HOSPITAL BUT IT WILL BE A SURGEON-COLLEAGUE OR A RESIDENT SURGEON WHO WILL DO THE ACTUAL SURGERY. "DURING THE WHOLE OPERATION OR SURGERY, THE PATIENT IS LED TO BELIEVE THAT THE SURGERY WAS ACTUALLY PERFORMED BY HIS OR HER ATTENDING DOCTOR," VILLAFUERTE SAID. HE SAID THAT IN GHOST SURGERY, THE ATTENDING SURGEON AND THE OPERATING SURGEON WHO HAD AN INTERNAL ARRANGEMENT ON THE CASE SPLIT THE DOCTOR'S FEES.

27. VILLAFUERTE ADDED THAT ANY WELL KNOWN AND BUSY ANESTHESIOLOGIST CAN LIKEWISE BE GUILTY OF PRACTICING GHOST ANESTHESIA FOR THE SAME REASONS AS THAT OF GHOST SURGEONS AND THAT FEE-SPLITTING IS ALSO WIDELY PRACTICED IN THIS CASE. "THE HOSPITALS WHERE SUCH UNETHICAL, ILLEGAL AND IMMORAL PRACTICES ARE PERFORMED ARE VERY MUCH AWARE OF THE GHOST PRACTICE AND FEE-SPLITTING," HE SAID. VILLAFUERTE SAID THE LIFE-THREATENING RISKS, POST OPERATION HAZARDS, POSSIBLE FAILURE AND OTHER RELATED GRAVE CONSEQUENCES ON THE PATIENTS AND THEIR FAMILIES WHO MAY BE VICTIMS OF GHOST SURGERY WILL BE DAMAGING NOT ONLY TO THE INDIVIDUALS AND FAMILIES CONCERNED BUT TO THE WHOLE SOCIETY AS WELL. HE SAID THAT "GHOST SURGERY IS A LEGALLY AND ETHICALLY DANGEROUS PRACTICE THAT MUST NOT BE PROMOTED

28. PROFESSIONAL MISCONDUCT BY MEDICAL PRACTITIONERS IS GOVERNED BY THE INDIAN MEDICAL COUNCIL (IMC) (PROFESSIONAL CONDUCT, ETIQUETTE, AND ETHICS) REGULATIONS, 2002, MADE UNDER IMC ACT, 1956.7 MEDICAL COUNCIL OF INDIA (MCI)AND THE APPROPRIATE STATE MEDICAL COUNCILS ARE EMPOWERED TO TAKE DISCIPLINARY ACTION WHEREBY THE NAME OF THE PRACTITIONER COULD BE REMOVED FOREVER OR BE SUSPENDED. PROFESSIONAL MISCONDUCT IS, HOWEVER, A BROAD TERM WHICH MAY OR MAY NOT INCLUDE MEDICAL NEGLIGENCE WITHIN ITS FOLD. FOR INSTANCE, IN THE CONTEXT OF LAWYERS, IT IS NOT ONLY A PROFESSIONAL MISCONDUCT BUT OTHER MISCONDUCT ALSO WHICH MAY LEAD TO IMPOSITION OF DISCIPLINARY PENALTIES, FOR EXAMPLE, VIOLATION OF PROHIBITION ON LIQUOR UNDER BOMBAY PROHIBITION ACT, 1949, BY THE ADVOCATE; 8 AND PERHAPS A COROLLARY MAY BE EXTENDED OR CASES OF MEDICAL NEGLIGENCE BY MEDICAL PROFESSIONALS

29. THE BILL PROVIDED FOR SUBSTANTIAL CHANGES IN THE AREA OF INFORMED CONSENT. THE PROPOSED LAW REQUIRED DISCLOSURE TO THE PATIENT OF THE FUNCTION STATUS, AND IDENTITY OF ALL MEDICAL PERSONNEL PARTICIPATING IN THE OPERATION AND INCLUSION OF THIS INFORMATION IN THE CONSENT FORM. THE PROPOSED LAW, IF ENACTED, WOULD HAVE REQUIRED THE DOCTOR TO INFORM THE PATIENT THAT HE MAY LIMIT THE ROLE OF ANY PERSON PARTICIPATING IN HIS SURGERY BY MODIFYING THE CONSENT FORM. IN OTHER WORDS, THE BILL REQUIRED THAT THE PATIENT BE INFORMED THAT A RESIDENT WILL PERFORM A MAJOR PART OF HIS SURGERY AND BE ALLOWED TO CONSENT OR TO OBJECT TO THE RESIDENT'S PARTICIPATION. TO ENSURE COMPLIANCE, THE PROPOSED LAW PROVIDED THAT IF ANY ATTENDING SURGEON TO WHOM CONSENT WAS GIVEN KNOWINGLY PERMITTED ANY PERSON NOT NAMED IN THE CONSENT FORM TO PERFORM SURGERY OUTSIDE OF HIS DIRECT AND IMMEDIATE SUPERVISION OR OTHERWISE THAN IN ACCORDANCE WITH THE CONSENT FORM, HE WOULD BE GUILTY OF PROFESSIONAL MISCONDUCT, WITH THE CONSEQUENCES THAT SUCH A FINDING INVOLVES UNDER NEW YORK LAW. AFTER THE BILL DIED IN COMMITTEE IN THE STATE SENATE, PUBLIC INTEREST IN THE TOPIC DIED DOWN FOR A TIME. THE LEGAL ISSUE INVOLVED IN THE PRACTICE OF SURGERY BY RESIDENTS IS WHETHER DISCLOSURE OF THE RESIDENT'S IDENTITY and the extent of his participation in the surgery is necessary for truly informed consent.

30. TEACHING EMPATHY IN MEDICAL SCHOOLS IS CRUCIAL FOR PRODUCING WELL-ROUNDED AND COMPASSIONATE HEALTHCARE PROFESSIONALS. HERE ARE SEVERAL APPROACHES THAT CAN BE USED TO EFFECTIVELY TEACH EMPATHY IN MEDICAL EDUCATION: 1)Integrated Curriculum: Embed empathy training throughout the entire medical curriculum rather than as a standalone module. Incorporate empathetic communication skills training into clinical skills sessions, case discussions, and patient interactions. 2)Role Modeling: Faculty members and practicing clinicians should serve as role models for empathy. Demonstrating empathetic behavior in clinical settings can have a profound impact on students' understanding and practice of empathy. 3)Experiential Learning: Provide opportunities for students to engage in real-world experiences that foster empathy, such as volunteering in underserved communities, participating in patient support groups, or engaging in reflective writing exercises. 4)Simulation: Use simulated patient encounters to allow students to practice empathetic communication in a safe environment. Provide feedback and debriefing sessions to help students reflect on their interactions and improve their empathetic skills.

31. 5)SMALL GROUP DISCUSSIONS: FACILITATE SMALL GROUP DISCUSSIONS FOCUSED ON EXPLORING THE EMOTIONAL ASPECTS OF PATIENT CARE. ENCOURAGE STUDENTS TO SHARE THEIR EXPERIENCES, CHALLENGES, AND INSIGHTS RELATED TO EMPATHY IN HEALTHCARE. 6)Narrative Medicine: Incorporate literature, art, and personal narratives into the curriculum to help students develop empathy and a deeper understanding of patients' experiences, perspectives, and emotions. 7)Reflective Practice: Encourage students to engage in regular reflection on their experiences with patients, including both positive and challenging encounters. Reflective writing, group discussions, and mentorship can help students process their emotions and develop empathy. 8)Interprofessional Education: Provide opportunities for students to learn alongside other healthcare professionals, such as nurses, social workers,and Psychologists Collaborative learning experiences can enhance students' understanding of the importance of empathy in interdisciplinary care.

32. 9)FEEDBACK AND ASSESSMENT: INCORPORATE EMPATHY INTO THE ASSESSMENT CRITERIA FOR STUDENTS' CLINICAL PERFORMANCE. PROVIDE CONSTRUCTIVE FEEDBACK ON STUDENTS' COMMUNICATION SKILLS, EMPATHY, AND BEDSIDE MANNER, AND ENCOURAGING SELF-REFLECTION AND IMPROVEMENT. 10) Continuing Education: Offer opportunities for practicing healthcare professionals to continue developing their empathy skills throughout their careers through workshops, seminars, and online courses.

33. EMPATHY IN MEDICAL EDUCATION, COMMUNICATION, AND PATIENT CARE, INCLUDING BEDSIDE MANNERS, IS ESSENTIAL FOR FOSTERING TRUST, IMPROVING PATIENT SATISFACTION, AND ULTIMATELY ENHANCING HEALTH OUTCOMES. HERE'S HOW EMPATHY CAN BE INTEGRATED INTO THESE ASPECTS OF HEALTHEARE: 1 Medical Education: Curriculum Integration: Incorporate empathy training throughout the medical curriculum. This includes theoretical understanding of empathy, practical communication skills development, and experiential learning opportunities. Role Modeling: Faculty members should demonstrate empathetic behavior in their interactions with students, patients, and colleagues, serving as role models for compassionate care. Interdisciplinary Learning: Offer interprofessional education opportunities that allow students to learn alongside nurses, social workers, psychologists, and other healthcare professionals to understand the importance of collaborative and empathetic teamwork.

34. 2. COMMUNICATION: Active Listening: Teach active listening techniques, including maintaining eye contact, nodding, paraphrasing, and asking open-ended questions to demonstrate understanding and validate patients' experiences. Empathetic Responses: Encourage students to respond empathetically to patients' emotions, concerns, and needs. This involves acknowledging patients' feelings, expressing empathy, and offering support. Cultural Sensitivity: Emphasize the importance of cultural competence in communication. Students should be trained to recognize and respect cultural differences in verbal and nonverbal communication styles, beliefs, and healthcare practices.

35. 3. PATIENT CARE: Patient-Centered Approach: Promote a patient-centered approach to care that prioritizes patients' values, preferences, and goals. Encourage students to involve patients in decision-making, respect their autonomy. and tailor care plans to meet their individual needs. Building Rapport: Teach strategies for building rapport and trust with patients, such as introducing oneself, explaining procedures clearly, and demonstrating empathy and compassion. Emotional Support: Provide emotional support to patients and their families during challenging times. This includes acknowledging and validating their emotions, offering reassurance, and connecting them with appropriate resources for additional support.

36. 4. BEDSIDE MANNERS: Warmth and Empathy: Encourage students to convey warmth, compassion, and empathy during bedside interactions. This involves greeting patients with a smile, using comforting touch when appropriate, and creating a supportive and empathetic environment. Respect for Dignity: Emphasize the importance of treating patients with respect, dignity, and kindness. Students should be taught to address patients by their preferred names, maintain privacy and confidentiality, and preserve their sense of autonomy and agency. Clear Communication: Teach students to communicate clearly and effectively with patients and their families. This includes using plain language, avoiding medical jargon, and ensuring that patients understand their diagnoses, treatment options, and care plans.

37. BY INTEGRATING EMPATHY INTO MEDICAL EDUCATION, COMMUNICATION, PATIENT CARE. AND BEDSIDE MANNERS, HEALTHCARE PROFESSIONALS CAN CULTIVATE COMPASSIONATE AND PATIENT-CENTERED PRACTICE, ULTIMATELY LEADING TO IMPROVED PATIENT SATISFACTION, ADHERENCE TO TREATMENT, AND HEALTH OUTCOMES

38. Thank You For Listening …