Law and No Order
Dr. Rupali Sachdev
Emergency Medicine
My first interaction with the law, medical law to be specific, was in the 2nd year of medical school in the dreaded forensic medicine lectures. I went into it, thinking this was going to be so badass – like a scene straight out of ‘Dexter’. Boy, was I wrong.
We had some of the dullest forensics professors known to mankind. We had the same lectures over and over again, where our eyes would glaze over in boredom – about the laws and IPCs because 1.5 years to do a short subject like forensics and toxicology was just ridiculous. They would drone on and on about paperwork and how to fill death certificates with the several different areas for causes of death. Why does our law require seeming redundant causes of death? Primary, secondary etc etc? Obviously, to make our lives difficult as medical students. Boy, was I wrong.
My second distinct memory of medico-legally interesting cases came from my very first rotation in internship of Obstetrics & Gynaecology. I was in my peak med-ed influencer era, constantly coming across emergent patients with a myriad of presentations. My seemingly unending 24 hour shifts were full of running around the departments and I would still find a few minutes to share my experiences.
On my very first day, I came across a case of medical termination of pregnancy. India, seeming has quite progressive pro-choice laws when it comes to abortions but the on-ground reality is far from what the laws dictate. My residents had involved the family of the woman in the decision to have a MTP when legally it isn’t required. It is supposed to be an independent decision of the woman to ensure there isn’t any coercion. This was something that I put up on social media (ensuring no patient details were shared) and was found by a senior resident who happened to follow me. What followed, was chaos. I was asked to obviously take it down and the explanation I was given was that families would often come back to blame doctors that they never wanted the abortion and the women who underwent the procedure would stay mum. I was unconvinced by the explanation but that’s when I realised – there are a lot of laws in India, but not enough order. It’s very grey and wildly different from what was taught (or not taught) to us in the classroom.
Fast forward to the beginning of my professional career as a casualty medical officer, rife with tensions and medico-legal conundrums. It was like we were thrust into the deep end with no life jackets and essentially told “figure it out”. This was my first experience of performing post-mortems, doing documentation in cases of assaults, injuries, abuse and many more.
Our forensic department would shirk responsibility and our own administrative superiors were too busy playing politics to actually teach us the approach to these cases but they were first to blame us when things went wrong – and they did quite often. This is the story of young doctors across the country. Nobody prepares us for the legalities of the medical world and it hits like an avalanche when you first start dealing with it.
One of my greatest learnings from that time was – paper is king. People will turn on you in a minute especially when it comes to protecting their own jobs especially when you have to proof of the conversation. It’s a dog eat dog world in a government hospital and especially in the administration, it’s every man for himself.
The second greatest learning was – everybody has an agenda. The police, the seniors, the politicians, the goons. In India, money, power and politics takes presidence over patient care, but do not let it corrupt you. Stick to your values and stand up for them. A lot of pressure will be put on you throughout your career and courage is an important quality to develop.
I believe my education fell far too short in preparing me for the legal realities of medicine. Nobody taught me that I, like countless other peers of mine, would come close to being assaulted because of administrative issues. And that we would laugh about it because we were so de-sensitised.
I believe my education fell far too short in explaining the ethics of becoming a doctor. I saw practices in several hospitals that are far from what is expected from doctors and that is the sad reality of our country. Being a part of the administration opened me to several realities of practising medicine in India and how the law takes a back seat.
I hope, maybe foolishly, that my education would someday take the inputs of us young doctors and what the reality of practising medicine is like.
I hope, maybe foolishly, that my education would someday empower young doctors to better understand the legalities and ethics of medical practice, beyond the practice of learning IPC numbers for an entrance exam.
I hope, maybe foolishly, that my education would someday allow us to speak up against the malpractices inside and outside the hospital walls instead of teaching us to keep our head down and focus on getting ranks and gold medals.
In our classrooms, there are a lot of laws. However, in the halls of our hospitals, there is no order.
