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630 An Overview of Legal Issues in Hypertensive and Diabetic Patients

alitigation being cast upon practising physician and For a patient who is undergoing a surgical procedure
here again this two metabolic disorders really needs it is important that both hypertension and diabetes
the physician to spend time on the first occasion at will have to be evaluated totally before the patient-
least, when he is diagnosing. We need to explain to proceeds in for a surgical procedure.It is a young
the patient about the disease nature, the complica- age or a middle age and if you find Hypertension,
tion that is likely to happen ifit’s not treated properly. it is important that ECG, renal parameters, ECHO
In the present days quiet a number of patient always cardiogram will have to be performed before the pa-
enquire about the alternative system of medicine or tient under goes a surgical procedure. Be it a small
the other of various modality for treating their hyper- sterilisation, or a major Whipple’sprocedure, the total
tension and diabetes All the allopathic practitioner evaluation ofon cardiac status if he is going to hyper-
will have to inform is that it is ailment which is life tension is absolutely necessary. The patient may not
long and nothing can be done other than three mo- have complication or a normal ECG but we needed
dality of treatment which is almost education of the documentation of normal ECHO to prove the patient
disease, life style modification and medicines. If the was normal prior to surgery. If the patient develops
patient wants to have other modality of treatment ei- any complication intra operatively it is not the oper-
ther ayurveda, siddha and homeopathy the patient is ating surgeon and anaesthetist who are responsible
free to undergo to the treatment but please inform but also the physician or the cardiologist who gives
them that crosspathy by the patient is at their risk. the fitness for the patient for the procedure.

The treating physician will have to inform the patient, For a Diabetic patient to be subjected for a surgical
that if the patient undergoescrosspathy treatment on procedure both renal parameters and cardiac param-
his own, the treating physician is not responsible for eters will also have to be assessed with biochemi-
any of the adverse effects that can happen to the cal analysis of urea createnine as well as ECG and
patient. One of the most important factors, docu- ECHO cardiogram to prove that the patient is fit for
mentation in all this patient isan absolutely necessity. surgical procedure. All we need is documentation of
The poor patient compliance for drug and followup the physical status of the individual to undergo the
is the hall mark of a classical Indian citizen or the surgical procedure.
Indian patients, who reports to the doctor. In uncon-
trolled diabetic and uncontrolled hypertension, the
physician always, informs him to visit atleastonce a
month to have a proper follow up.Please documentin
the prescription that you have requested the patient
to come for regular followup and mention when he
is to come for follow up.If the patient reviews at a
later date or delays himself by three months or six
months and come back with uncontrolled Diabetes
and Hypertension,the prescription should carry the
information of poor patient compliance for drug and
followup. This is very important for the future in case
the patient develops complication and sues the Doc-
tor on medical negligence. This one document can
save the Physician at the appropriate time. Medical
council of India now advocates computerising your
records. A copy of such prescription will be of great
value in the legal issues.
In an inpatient set-up,Hypertension and Diabetes are
the two major co-morbid conditions for all the pa-
tients in the intensive care,orfor the patientswho are
going in for surgical procedure.It is easy in an inten-
sive care to inform the attenders, that the patient is
suffering from Hypertension and Diabetes based on
the investigations, advice that outcome depends on
the recovery of the patient on these two modalities.

GCDC 2017