Last week’s column in this series elicited two types of emotionally charged responses. People with similar stories of real and perceived malpractice, and doctors some of who said the malpractice claim was not clear-cut on medical grounds, and pointed accusatory fingers at the lack of adequate staffing and facilities at the San Fernando General Hospital.

Among them was a public service doctor who asked the stark question based on his experience: “What does a lone duty doctor do when four people are simultaneously admitted with heart attacks?”

Or, “What do I do when the family of a dying patient accuses me of malpractice when I don’t have basic life-saving equipment?”

And a patient who asks the question: “What do I do when I know my husband died under the care of doctor X and I am subsequently told by doctor Y (both in private practice) the drugs doctor X was administering hastened or even precipitated my husband’s death?”

What patients and doctors agree on is existing systems for dealing with complaints have failed dismally to the point of being non-operative. Most doctors, according to one medical source, take pride in their work. However, under the present system, the source says, the only checks and balances errant doctors face is ridicule from their peers, or an occasional letter of complaint to the Ministry of Health. Other than that they wrap around themselves a protective code of silence to maintain patient trust without which their profession would lose its credibility and accompanying monetary value.

Meanwhile, dissatisfied upset patients, or those with serious complaints end up airing their grievances to a passing nurse, a doctor in another ward or a security guard. All these positions support my renewed call for systems to the Medical Board to ensure accountability, transparency and recourse to patients.

The malpractice Board should be made up of at least three doctors, one nurse and two lay people. The board should be rotated on a staggered basis to avoid interference and ensure independence. A standard complaints form should be made available at all private and public health institutions and a written acknowledgment given to the complainant on submitting the form. Within a month, the complainant should be informed if he or she has a case. Within six months the complainant should have a final ruling on the matter that may be used for legal action either against doctors or the Ministry of Health. The malpractice Board should have the authority to discipline doctors in addition to ordering them to be struck off the list.

A malpractice Board would allow the patient recourse, if the doctor was at fault, and the doctor, vindication, if he was not. This Board would also show up deficiencies in both private nursing homes and public health system and could be the basis of a lobby to improve general health conditions.

In addition, the Medical Board should be exercising its responsibility to educate people on how to use public and private health effectively.

In their responses doctors have raised several points to this effect: that many patients fail to inform doctors of previous treatment; fail to take their medical summaries with them when switching doctors; don’t take their medication according to instruction, take treatments from two doctors at once with the (sometimes fatally) mistaken assumption the cure will be twice as effective; are unaware preventative care such as annual check-ups are much more effective than waiting until an ailment reaches chronic proportions and then are disappointed when their unrealistic expectations of a miracle cure isn’t realised.

The data bank on doctors should be published on a semi-annual basis.

The medical ombudsman would bring further checks and balances into the system and can be used as a measure of last resort for those who are unhappy with the decisions of the malpractice Board.

The Medical Board must play an effective role in guiding the profession towards primary and preventive care with a nationwide education programme. The Medical Board itself must be transparent and its power and responsibilities published for the benefit of doctors and patients, and their minutes should be made available.

Meanwhile, other than the malpractice issues, doctors’ standards of services need to be improved. I have taken the liberty of proposing a code of conduct based on the UK code. If one exists now, clearly the patients of this country don’t know about it because it hasn’t been published. In order for it to work, an effective monitoring and complaints systems will need to be put in place by the Board.

Doctors should:

If we allow the fatalism that comes with living in a small country, or the knowledge most people at a high level get by more by whom they know than what they stand for, then there is no hope for us. But if each of us starts to care about the rest of us, then there will be change, there will be growth, there will be hope.

Next week: The Patients’ Charter