During the International Youth Legal Forum, St Petersburg University experts propose to radically change the form of the patient’s medical consent
The International Youth Legal Forum has held a session ‘Medical Professions Operating under the Sword of Damocles: "Negligent Doctors" vs "Extremist Patients"’. The session brought together St Petersburg University experts.
The discussion brought together Igor Akulin, Professor in the Health Management and Medical Law Department and Head of the master’s programme Medical and Pharmaceutical Law at St Petersburg University; Piotr Yablonsky, Vice-Rector for Medical Activities at St Petersburg University; Nelli Diveeva, Professor at St Petersburg University; Pavel Kislyi, a nephrologist at the St Petersburg University Clinic; Vladimir Zhirnovoy, a lawyer; Tatiana Rozovskaia, Dean of the Faculty of Advanced Studies at St Petersburg Academy of the Investigative Committee of the Russian Federation; and Viacheslav Mamontov, a senior inspector of the Main Investigation Department of the Investigative Committee of the Russian Federation in St Petersburg.
Doctor is a high-risk profession, said one of the moderators of the session, Igor Akulin.
Some medical specialties are considered to be more difficult than the profession of a pilot. The outcome of treatment, especially if the doctor performs surgery, cannot always be predetermined. Even the right actions of a doctor can lead to unexpected consequences.
Igor Akulin, Professor in the Health Management and Medical Law Department and Head of the master’s programme "Medical and Pharmaceutical Law" at St Petersburg University
According to experts, this is primarily due to the fact that each person can react differently to medical interventions. Regardless of whether the doctor did everything right, when patients turn to lawyers, it is the doctor who bears the burden of proving his/her innocence to the investigating authorities.
Yet, as the participants in the session said, there are few cases in Russia that go to trial and even less so to convictions. The peak of reports of violations that came from patients or their relatives to the investigating authorities occurred in 2018. In 2018, there were more than 6,200 reports. According to Tatiana Rozovskaia, 2,229 out of 6,200 reports were criminal cases. According to statistics, about a third of the reports become criminal cases, and this number is decreasing year by year.
More often than not, courts consider cases under the article on: causing death by negligence; the provision of services that do not meet safety requirements; and causing grievous bodily harm. There is a small number of complaints regarding the negligence of doctors or the failure to provide assistance to the patient.
In 2017, St Petersburg University and the Investigative Committee signed a cooperation agreement. Scholars from St Petersburg University and representatives of the Investigative Committee are conducting joint expert project to study possible ways to prevent iatrogenic crimes.
The experts said that the vast majority of cases of harm to patients are unintentional. Among the reasons are the following: psychological pressure; unilateral decision-making; professional burnout; large volumes of paperwork; low qualifications; and excessive self-confidence that is typical to doctors with extensive experience.
Another reason is that doctors are increasingly guided in making decisions not by the interests of the patient, not even by their own interests, but by the economic interests of the medical institution. Having to achieve certain indicators and to report forces doctors to make decisions following the established standards, said Piotr Yablonsky. More often than not, this is what predetermines the allocation of quotas and funding volumes.
Another reason is attempts to over-standardise the processes of diagnosis and treatment. Although these standards are developed by doctors, sometimes it is impossible to follow them in practice, said Igor Akulin. For example, in coronary heart disease, doctors should prescribe several groups of drugs, while they are not recommended to all patients. ‘Standards are not developed often, and sometimes they do not keep up with the current state of affairs in medicine,’ explained Pavel Kislyi.
St Petersburg University offers an advanced training programme "Iatrogenic crimes: peculiarities of criminal prosecution". The programme is aimed at forming an idea of the criminal procedural and forensic foundations of investigating crimes against human life and health by medical workers.
During the discussion, the participants agreed that patients who complain about doctors do not have the necessary competencies and cannot therefore objectively assess the quality of treatment. What impression patients have from the medical consultations is influenced by the degree of openness in the dialogue between the doctor and the patient and the level of interaction.
In recent years, communication between a doctor and a patient has been complicated by the need to sign an informed consent for medical intervention. Having to sign the consent has long turned into a formality and does not protect either the patient or the doctor, the experts agreed. Pavel Kislyi emphasised that patients do not read the informed consent and sign it without even looking through it, because it is impossible for an average person to get the meaning of this voluminous and complex document. The participants agreed that it is necessary to simplify and shorten the consent by working out two main points: the patient does not deceive the doctor and follows medical recommendations.