Doctor’s vast experience trumps medical literature

  • Posted on: February 08, 2019

Arun suffered injuries in both legs in a car accident and visited Inscol Health Services where Dr. Narula performed X-ray which showed very minimally displaced fractures of the proximal tibia of left leg with good articular congruity and incomplete non displaced fracture of right proximal tibia with no articular incongruity. X-ray of the right leg showed an incomplete non-displaced fracture. The doctor used a knee brace and POP slab on the left knee.

After about sixteen weeks, the patient complained of pain and visited the doctor who performed CT scan which showed that the fracture had not united and a surgery was advised. The patient however, did not heed to the advice and visited PGI where the same surgery was performed.

The patient, as soon as he was on his feet, rushed to Chandigarh State Consumer Disputes Redressal Commission and blamed Dr. Narula’s treatment which necessitated second surgery. It was alleged that instead of inserting plates which was necessary due to multiple fractures, the doctor simply plastered the left leg and didn’t perform any procedure on the right leg. It was further alleged that the CT scan showed that the fracture had not healed and this itself proved negligence on part of the doctor.

Dr. Narula, an experienced orthopaedic surgeon, was sure about the treatment he provided to the patient. He stated that the splints used were enough to immobilize the patient’s knee and relieve the pain while allowing it to heal. The doctor further stated that as a general rule surgery is an exception in cases of fractures and plaster is enough for the union of bones.

Continuing his defence, the doctor stated that the patient was advised after nine weeks for gradual graded partial weight bearing and knee mobilization, and he was improving symptomatically and didn’t complain of pain in any of follow up visits. The doctor added that even X-rays taken during follow up visits didn’t show any sign of non-union of bones. However, after sixteen weeks when the patient complained of pain during partial weight bearing, a CT scan was advised which showed that the bones had not united. A surgery was advised, but the patient didn’t come for any further advice or follow up. The doctor concluded by stating that even PGI’s admission card noted diagnosis as mal-united fracture and not non-union, which signifies that radiologically or otherwise the fracture seemed to be united.

The Commission saw force in doctor’s arguments as it stated the following: “Dr. Narula is a well-qualified doctor and has been in practice for more than twelve years in the same discipline. He has vast experience to his credit in handling routine cases and has conducted cases of spine & joint replacement surgeries. He applied his wisdom to treat the said patient by applying a brace and POP plaster”.

“Moreover the patient is a chronic smoker due to which healing of the fracture may take a longer time or may not. More importantly, while the patient produced medical literature to show that every kind of fracture is treatable with surgery, which may have or may not have authenticity to believe but the expertise of the treating doctor matters a lot in such cases”.

Dr. Narula’s vast experience overpowered patient’s allegations as he was declared not negligent

Source: Order pronounced by Chandigarh State Consumer Disputes Redressal Commission, Chandigarh on 31st December, 2018

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