28 Revenge is double edged

The Farmer and the Fox: A farmer was troubled by a fox that kept stealing his fowls at night. He set a trap and caught the fox. As a punishment, he tied a bunch of tow to its tail and set it on fire. The fox ran helter-skelter through the ripe cornfield. The field was soon on fire and the farmer lost his harvest.

A community of a consumerist society was greatly annoyed by the health care providers who, they felt, were exploiting the ill and vulnerable to accumulate wealth. Once, in a case of negligence in obstetrics (midwifery), the jury felt it justifiable to slap a stiff penalty on the erring doctor and send a clear message to all the doctors. The penalty was so stiff that the insurance premium for obstetric negligence skyrocketed. Most of the obstetricians migrated to neighbouring states rather than pay such high premiums for insurance cover. The end result was that the community had to travel 100 to 200 Kms to a neighbouring state for delivery under proper obstetric care.

Comments

Prof S Chandrasekar, my guru, used to tell us, "There are no guarantees in Medicine. For us, 'Always' means most of the time and 'Never' means hardly ever.” This reality has to be understood by the professionals and accepted by the society. Under the present tort system of redressal, the 'victim' has to prove that the care provider was negligent. The system promotes 'ambulance chasing lawyers' who specialise in finding faults in the health care services to get compensation awarded to the client. Doctorpatient trust gets ruined in the process (see Chapter 19 for a discussion on

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accountability).

Universal no-fault health and life insurance is a better way of compensating those who experience an adverse outcome after diagnostic or treatment procedures. No-fault insurance is already practised in India and many other countries to provide compensation for traffic accidents. A similar system should be evolved to cover health care mishaps. The practice of defensive medicine (overuse of tests and therapies) may then reduce greatly.

Revenge hurts both the parties and kills doctor-patient trust. No-fault insurance is a way out. We have to campaign for it. But who will bell the cat? The consumer activists can do it. They should.

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