My grandfather once told me that it was not money that added to a doctor’s wealth, but the good wishes from patients. Medicine, in his view, was to be seen as a noble profession not to be equated with a commercial enterprise. Fast forward twenty-five years, and the situation for doctors is more complex. Medical practitioners have to worry not just about patients’ health, but also about several external risks typically associated with commercial units. Patients, especially in the Metros, are now less deferential and demand more accountability. From my conversations with doctors, I realise that there are a few risks that weigh on their minds.
Fighting legal cases
Litigation from patients is one such major risk. Medical outcomes for individual cases are difficult to control and predict. Unfavourable outcomes are emotionally draining for patients and their families. Often, they attribute the negative outcome to the doctor’s negligence. Increasingly, patients litigate and demand compensation. Courts often decide in favour of patients. The Supreme Court, in a high compensation case, asked three doctors and the hospital to pay over Rs 11 Crore to a patient, who lost his wife while undergoing treatment.
The court observed, “Before parting with the judgement, we are inclined to mention that the number of medical negligence cases against doctors, hospitals and nursing homes in the consumer forum are increasing day by day…the right to health of a citizen is a fundamental right guaranteed under Article 21 of the Constitution of India.”
Irrespective of whether doctors win or lose cases, they have to hire lawyers to defend themselves in these suits. This can be time-consuming and expensive. A professional indemnity insurance protects doctors from patients’ claims related to omissions, negligence or errors. The insurance covers defence costs during the investigation, and expenses related to representation and compensation, if any, awarded by the court.
In fact, a good insurer will also have a panel of lawyers that can defend the doctor. The coverage costs about Rs 5000 for a Rs 50 lakhs sum assured for a general surgeon. The premiums vary by the risk inherent to the doctors’ speciality.
Protection from physical assaults
Off-late, incidents of doctors being physically assaulted have also become frequent. In one medical association magazine, an advertisement offered bouncer services to protect doctors. A survey done by the Indian Medical Association indicates that 75 per cent of the doctors have been at the receiving end of verbal abuse, of which 12 per cent have been physically abused. In June, about 8 lakh doctors across India went on a strike after a junior doctor was brutally assaulted in West Bengal, by the relatives of a deceased patient. More recently, a post-graduate doctor in Bengaluru was attacked by a mob. Of course, such situations have to be prevented. So, doctors must insure themselves against accidental injuries and disabilities. An individual personal accident insurance cover of Rs 1 crore would cost around Rs 14,000 . If an association comes together to buy personal accident for its members, the cost would be a fraction of the above due to economies of scale.
Then there is a fire hazard, which could happen with any establishment. Clinics and hospitals, however, suffer more. In case of an accident, patients may not be evacuated quickly. The fire incident in Kolkata’s AMRI hospital is still a daunting image. The incident saw 90 persons lose their lives. The hospital had to deal with several litigation cases. To cover such risks, doctors need to buy a fire insurance policy to cover damages to the assets owned by them, and a public liability insurance to cover injuries and property damage to others, while at their premises. Fire insurance of Rs 25 lakh costs Rs 2500 and public liability insurance of Rs 50 lakh costs Rs 6000. Several clinics have expensive equipment and these can be insured for burglary as well, in the same property insurance.
The four policies – professional indemnity, personal accident, property and public liability – put together would cost a doctor less than Rs 25,000 annually. Several medical associations realize the importance of such insurance policies to make their members’ practice more secure. Professionally run hospitals already invest in these products.
My grandfather’s dream did get fulfilled, when my brother became a doctor. My brother tells me that it is not easy to run a medical practice these days. The middle class demands a high level of care and attention. Because the number of doctors are so few – India has about one-fourth the doctors per capita as compared to what the US has – the average face-time that a patient gets with the doctor is low. While patients complain about high cost of OPD (out-patient department) consultations, the average doctor earns substantially lower than her school friend working in an MNC. Doctors try to make it up by working long hours. This leads to a pressure cooker-like situation for the practitioner. She ends up being at the receiving end of the patients’ wrath rather than receiving good wishes. Doctors must proactively address these risks to develop a sustainable practice. Insurance is just one part of this.