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Al-Ahram Weekly 13 - 19 April 2000 Issue No. 477 
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Published in Cairo by AL-AHRAM established in 1875 |
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Al-Ahram Weekly 13 - 19 April 2000 Issue No. 477
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| Published in Cairo by AL-AHRAM established in 1875 |
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Egypt Region International Economy Opinion Culture Books Features Travel Living Sports Profile People Time Out Chronicles Cartoons Letters Safe and sound?
The mufti has issued a fatwa asserting the legitimacy of doctors obtaining insurance against malpractice lawsuits. They may need it more than ever before. Mariz Tadros investigates
Few patients in Egypt's hospitals could afford to sue their doctor for malpractice -- assuming they knew they had been victims. Yet accusations are flying nevertheless. Reported cases of negligence, ignorance or unnecessary operations are increasing. Almost everyone has a story to tell about a relative or friend falling victim to malpractice.
Nor is anxiety restricted to patients alone. A doctor at a leading children's hospital in Egypt, for instance, speaking on condition of anonymity, said that doctors are administering oral rehydration solution improperly to babies with "catastrophic consequences, and there is no sign that this will end."
The solution is supposed to replace nutrients and water lost when the baby has diarrhoea, but many doctors, the source explained, are using the solution to prevent diarrhea, and encouraging mothers to do so, which is very hazardous to the baby's health. "Excessive intake of the solution increases the sodium levels in the blood, with serious implications for the brain and/or kidneys," asserted the doctor, who has seen babies die in the hospital after overdoses, while others have been afflicted with epilepsy or mental retardation. The medicine itself has many positive, often life-saving effects, but not when it is used in large quantities. "This is because doctors are ignorant. They are not administering the medicine wisely because they have not received proper training," she said.
According to one estimate, at least 500 court cases are filed against doctors for malpractice every year -- and these must be just the tip of the iceberg. Dr Hamdi El-Sayed, head of the Physicians' Syndicate, admits that there may be an increase in cases of malpractice, though no statistics have been compiled. El-Sayed argues, however, that such an increase does not indicate neglect and unethical behaviour. "There are five million surgical interventions every year, operations and procedures are becoming more complicated, and so there is of course an increased risk of technical errors and complications occurring," he explains.
The syndicate's way of avoiding malpractice suits has been to urge physicians to get liability insurance. "This is a form of protection for doctors as much as patients. Sometimes they face legal problems and end up having to pay huge compensation, which they simply do not have the money for," El-Sayed exclaims. The syndicate has launched a campaign to let doctors know about the benefits of insurance, and alert them to the risks of being sued. Despite such efforts, few physicians have taken out insurance policies. According to one estimate, fewer than one in 1,000 practicing doctors are insured. Heated disputes erupted among syndicate members, furthermore, when some doctors expressed their opposition to insurance against malpractice, arguing that it violates the Shari'a. They argued that human lives are in God's hands; therefore, it would be blasphemous to try to insure against something outside the realm of their power. To end the controversy, El-Sayed asked Nasr Farid Wassil, mufti of the republic, for a fatwa (religious opinion) on whether it was legitimate for doctors to seek insurance against accusations of malpractice.
Wassil confirmed that obtaining a liability disclaimer is compatible with the Shari'a and is a necessary protection for doctors.
Religious arguments are rarely cited, however. El-Sayed points out that most doctors cannot imagine being accused of malpractice and taken to court. Is that because they know they can get away with making mistakes? Absolutely not, he exclaims. "If the doctor makes a mistake, he can be held accountable by the hospital, the syndicate, the court, the general prosecution... I wish doctors had immunity like MPs, so that they wouldn't have to go through so much harassment."
The Physicians' Syndicate is supposed to be one of the first bodies to receive complaints of malpractice from patients and/or hospitals. If its disciplinary committee finds the doctor guilty, s/he can be suspended from practicing for a certain period, or even permanently. Dr Omar Shahine, head of the disciplinary committee of the Physicians' Syndicate, said that last year, 50 doctors were held accountable for malpractice -- some for flagrant violation of medical ethics. Examples included conducting a surgical operation in a private clinic, rather than a properly equipped theatre, or performing an operation a doctor has not been trained to do.
However, "the syndicate can organise seminars and workshops to discuss and enhance physicians' skills, but we cannot compensate for the lack of proper medical training due to the large numbers of graduates and the inadequate training opportunities. We cannot correct the mistakes of the educational policy," shrugged Shahine.
Shahine nevertheless insisted that the press has blown cases of malpractice out of proportion. It is because of this bad publicity that doctors need insurance so badly, suggests Dr Rifaat Rifaat Kamal, professor of general surgery at Ain Shams University and prominent liver specialist. "We have reached a stage where people have lost confidence in medicine... They have had enough bad publicity," he notes. Rifaat argues that cases of malpractice should be first discussed behind closed doors in the syndicate, where medical experts can assess whether doctors' technical errors were serious and whether ethical mistakes were made, before stories are published in the papers.
Doctors, he emphasises, are blamed for malpractice when patients are oblivious to the fact that there is "a percentage of acceptable complications that happen." Many of the court cases brought against doctors would have been unnecessary had there been communication between doctors and patients. For a time, Kamal explains, doctors were not taught to communicate -- they were supposed to be wise and informed, taking decisions on behalf of the patients. "We have to spend a considerable amount of time talking to patients, and if you are sincere and open, patients make the right decision. If they know it is their decision, they share the responsibility with you." Many malpractice cases, indeed, can be attributed to some doctors' paternalistic belief that they have the right to withhold information.
This patronising attitude is especially evident with patients from underprivileged backgrounds, who are thought to be incapable of grasping facts and making the right decisions by themselves. Kamal also suggests that many mistakes are made because there is "no organisation, no system." If the rules were followed rigorously, many problems could be avoided. Another problem, he suggests, is the lack of uniformity in medical training.
