Digital Signature Licitness for Physical Exam Consent in United Kingdom

How to eSign a document: digital signature licitness for Physical Exam Consent in United Kingdom

[Music] so let us talk about one more important area which is very very important area for all of you for all of us right consent consent so highly highly important this consent what they say is we can say two or more people two or more person they consent right when they agree when they agree same thing in same sense in the same thing in the same sense you agree then it is called as consent you can say that both have consent it is given not by Indian Penal Code it is given by AA that means Indian contract act section 13 IP IA doesn't matter it's not so important just know concern what is concern consent is something where you give agreement you are agreeing to something or it is giving permission you are giving permission to something you asking conscent patient gives you conscent patient gives you permission you can go ahead with the procedure you agreeing to something you're giving permission to something you are complying right it is agreement permission compliance APC agreement permission complaints so in medical practice why do you need conscent you need conscent for each and everything everything in medical procedure medical practice for examination you need concern for investigation you need concern your for any procedure you need concern for treatment you need concern everything that you need consent if suppose you are either examining the person or if you are if you are treating the patient without consent it amounts to what is called as assault you have assaulted the patient right it amounts to what is it is amounts to what is called as salt and it is punishable under 352 IPC 352 IPC so let us learn something in detail about consent what are the different types that we have got let us look at the types of consent the first consent is called as implied consent wherein the body language the gesture of the patient gives you the consent right the patient does not tell you anything orally the patient does not give you anything in writing it is based on the body language of the patient you can assume that the patient has given consent it is implied you ask the patient I want to examine your chest the patient removes the shirts and shows you then that means he has given you consent right I want to exam you I I want to do abdominal examination or pelvic examination the patient lies on the couch by himself or herself that itself will tell you the patient has given conscent it is basically by means of the body language and this is applicable only for General physical examination you can't apply for any other procedures beyond that right you can use it for any transfusion or any specific inv invasive procedures we can't use this this is only for General physical examination the second type of consent is called Express consent wherein the person specifically expresses he specifically expresses right how can he Express he can express in the form of oral we call it as verbal consent or the person can give it in writing that is called return return consent right oral consent and return return consent the oral consent or written consent do remember normally these consent should be obtained in the presence of disinterested third party disinterested third party basically it is about having a witness right because later the patient may tell that I've not given consent for that you need to have a witness ideally right the person has to be a disinterested third party fine oral consent written consent and written consent see if they ask you which is the best consent always the best consent is written best form of consent is written consent right we have one more important consent that is called open consent also called as generic consent also called as blanket consent right at the time of admission itself see this is an open consent completely open completely blanket you are giving blanket permission open permission for the doctor to do all the procedure that is needed that is required okay so this is a blanket consent given at the time of admission itself when the patient goes to the hospital at the time of admission patient is given one blank consent form right blanket consent in that blanket consent that that the patient is trusting the doctor doctor I trust you completely see whatever that is needed you are free to do everything in the interest of the patient right so the patient is giving consent completely that is called blanket consent also called as open consent at the time of admission for all procedures one concern for all procedure that is needed right the doctor can do all investigation until doctor can do all the investigation all the treatment modalities until the patient is revoking the consent back until the patient is sing okay sir no let us not do more than this right something like that fine so this is called open consent Gary consent also called as blanket consent and do remember this type of consent is invalid in India right it is invalid in India right is followed in certain countries like us and but it is in India it is not valid right there is one more consent that is called substituted consent what do you mean by substituted consent here the patient is not giving consent the consent is given by another person right another person why the patient is not giving concern because the patient might be mentally ill the patient may be under influence of some drugs or any alcohol right or the patient is very small child less than 12 years or something minor in all the situation if the person is giving concern that is not valid it so in that place in the place the parents of the Guardian gives consent that is called substituted consent you can say parent of the Guardian that is called substituted consent that is called substituted consent fine here the consent is not given by the patient himself patient himself now among all these types of concern which is the best concern what is the best consent do remember the best consent is basically return right not not just return consent it has to be return informed consent right return informed consent what is the one word that I've added that is informed what do you mean by informed what are you informing the patient before getting concern you need to give complete information to the patient suppose if the patient has come to you with a particular condition you need to tell the patient about the condition that is diagnosis and you need to tell the prognosis of the condition you need to tell what are the treatment options available and you need to tell what is the benefit and risk of each type of treatment you need to tell what is the proposed treatment that you are planning for the patient and you also need to tell what is the benefit of the proposed treatment you need to tell what is the cost of the treatment you need to tell the patient the risk of not taking treatment after telling all these things you should also tell the patient has got the right to say no right the patient has got the right to refuse so all these things you tell that is called return informed consent and this is called the best consent right this happens to be the best consent in clinical practice right return inform consent now let us see what are the doctrines that we have got the first Doctrine is called doctrine of full disclosure you are disclosing everything to the patient okay complete information A to Z complete information is given to the patient and then you get try you ask the patient to give consern complete information is given to the patient every information just now I told you the diagnosis the condition the treatment options available benefit and the risk the cost refusal everything that you get give to the patient then you try to get the consent Remember full disclosure complete information is given full disclosure right complete information is given to the patient the next one is doctrine of partial disclosure right doctrine of partial disclosure it means see the the term itself tells you what it is you are not completely disclosing everything here you are disclosing partially right which is also called as therapeutic privilege which is also called as therapeutic privilege the doctor has got the privilege to decide how much information is given to the patient and do remember it is done for the benefit of the patient right not for the benefit of the doctor it is done for the benefit of for the benefit of the patient see this kind of uh thing is usually applicable in case of psychiatric condition conditions in case of psychiatric conditions this Doctrine is usually applicable psychiatric disorders this Doctrine is usually applicable you disclose what is needed for the patient to know but at the same time it is it get done for the benefit of the patient at the same time the remaining information is given to the guardian the remaining information is given to the guardian that is very important it's called partial disclosure this is basically an exception of full dis closure I told you ideally you need to give full disclosure to the patient this is one exception right we call it as partial disclosure also called as therapeutic privilege right also called as therapeutic privilege the third important Doctrine is that doctrine of informed refusal right doctrine of informed refusal just because you have see you s with the patient you explained everything about complete information is given to the patient right you gave complete information to the patient after giving complete information you are asking concern from the patient does the patient has got the right to refuse yes the patient has got the right to refuse patient has got the right to refuse right you cannot compel the patient to get treatment you cannot compel the patient to go ahead with the procedure right the patient has got the right to say no right fine so that is called inform refusal why it's called informed refusal that is because after getting everything all the information from the doctor then the patient has got the say right this right to say no right that's called informed refusal and one more important doctrine that is called doctrine of extended consent doctrine of extended consent what is a doctrine of extended consent do remember in this situation the doctor extended the consent why because say for example in a particular uh situation the patient consented for a particular procedure patient patient consented for a specific procedure only for that specific procedure but maybe let us say investigation during that specific procedure or investigation some new issues have cropped up right during a specific procedure during that particular procedure new issues new further issues that needed intervention that needed intervention right here the doctor's extended consent doctor has extended con consent and he has done the additional procedure as well right doctor has extended the consent I underline it it is called extended he has extended the consent and he has done additional procedures also right we call it as doctrine of extended consent fine right now for this Doctrine I would like to give you an example of a case see few years back what happened there was a case there was a 44e female who went to a gynecologist with history of abnormal menstrual bleeding right the doctor consulted her she gave medicines and it did not go well the the the condition vers and the patient was advised by the oian the patient was advised by the doctor for Diagnostic laparoscopy diagnostic laparoscopy right and patient was asked to come on a specific day patient went to the hospital on a specific day with her mother right the patient went with her mother this procedure was done the concern was taken in the con was mentioned that Diagnostic laproscopy and diagnostic operative laproscopy maybe if laprotomy if needed right in the concern it was mentioned that laprotomy if needed and then uh during the process procedure the patient was uh mean taken to the procedure during the procedure the oian found out that the doctor found out that there was severe endometriosis and everything was so plastic and she needed removal of the uterus she needed EST stromy the doctor principal doctor the surgeon right told his assistant to go out to the patient's mother asking concern for this particular procedure the assistant went out mother gave consent and isy was done homy with bilateral selfinger ectomy was done after recovering from the NCA this procedure is done after recovering from the anesthesia the patient got to know that homy was done and bilateral sing Goomy was done the patient got soard she fought with the doctor right and what happened was after 2 three days a doctor filed a case in the police that the patient Upson from the hospital without paying the bill and she also filed a criminal case stating that some of the known person of the patient went to the hospital they threatened her they threatened the doctor so all these criminal F case were also soli within few weeks the patient went to the National Consumer National Consumer commission dispute redressal commission filed a complaint against the doctor stating that without proper consent of the patient the instruct toy was done the patient I have given concern only for the laproscopy diagnostic laproscopy doctor told me that let us see this diagn laproscopy then we'll plan for the further management this is the statement told by the doctor so I gave concern only for Diagnostic laproscopy I did not give consent for ectomy without proper consent from me the doctor has removed the uterus along with the ovary I have lost reproductive activity and uh I'm about to get married within few months so this is a big damage to me so I want uh the doctor to be punished and this is the case which was filed by the patient in the National Consumer commission right now this case in the the National Consumer commission has uh ruled out the case in favor of the patient without adequate without proper concern from the patient doctor should not have removed the should not have removed the uterus okay I've given you the wordings of the sub judgment it is so highly important to lead this you can see that the concern given for only for a diagnostic procedure cannot be considered as a concept for therapeutic treatment right when your diagnosis it's only for diagnosis not for operative treatment concern given for a specific treatment procedure will not be valid for some other treatment procedure you're going to do one procedure do that procedure alone that will not be taken as a concern for additional procedure in the particular patient the fact that this additional unauthorized additional surgery is going to be beneficial for the patient it is going to save time for the patient expense for the patient is not a valid ground is not a valid ground for the negligence Act of the doctor right such kind of unauthorized removal will be will be amounting to negligence of the doctor and these kind of defenses you cannot say that it is going to be beneficial for the patient it is going to save time of the patient it is going to save the money of the patient is not going to be valid this will not be a valid defense for the doctor right so that is highly highly specific but again do remember this kind of additional procedure unauthorized additional procedure can be done when it is necessary to save the life of the person only when it is necessary to save the life of the person this kind of additional procedure can be done and in this case it is not a so emergency procedure it is not a so emergency procedure you can as well conclude the laparoscopy procedure get a new consern get a concern from the patient if she is consenting to the Esty you could have done Esty you you should not have done Esty with the consent meant for the laparoscopy this is the Judgment given by the Supreme Court and the doctor was guilty of the medical negligence right so do remember this is one very important judgment that you need to know and important point is that every concern has to be a specific concern it cannot be a broad concern it cannot be a broad concern it has to be a specific concern and you need to do only for that procedure right what is the next important Doctrine the next important do is called therapeutic waiver wherein the patient waves his right right he is waving his right to someone else right wherein you don't have to get a concern from the patient emergency Doctrine what is that emergency Doctrine if the in case of emergency situation right patient has met with an RTA patient has gone for unconscious state where the patient is got extal hemorrage you need to immediately do craniotomy remove the CLA there is no relative around there is patient is is not conscious patient is unconscious can you go ahead with the surgery or not yes you can go ahead with the surgery this is called emergency Doctrine consent is not needed in case of emergency procedures right right to save the life of the person that is so important to save the life of the patient that is very very important this is given by 92 IPC but you should also know the situation should be in such a way that you're not able to get consult from the patient or from the relative that means if there is no relative and the patient is unconscious then only you can apply this 92 IPC if there are relatives patient is conscious you definitely have to ask concern even though if it is a life- saving procedure if the patient is denying conscent if the patient refusing concern you cannot do the procedure even though it is life saving procedure it can be applicable only when you're not able to get consult from the patient or there is no relative around to give consent that is again very very important now the next important Doctrine is that doctrine of locco parentis Right Moving parent locco parentis moving parent what is a locco parentis they can also call it as local parent means what see this is applicable in a situation where if a suppose a child is less than 12 years who has gone who studying in a residential school right and the child is becoming ill child has been brought to hospital who will give concern because AS resal school will not be available who will give consent it is the person who's in charge right person who's in charge will give consent for example the teacher who's in charge or the warden right or the principal head mistress will give consent the person whom is in charge will give consent that is called locco parentis locco parentis again very very important Doctrine this can be applicable even for children going to school tour where one of the child is becoming ill who will give consent the teacher who's in charge will give consent the teacher who's in charge will give consent let us learn about what are the different rules of consent that is again important let's learn about that what are the different rules of consent see the first thing for General physical examination General physical examination the minimum age to give consent is 12 years right General physical examination General physical examination the minimum age is 12 for any other procedure any major procedures like surgery and all in this situation the minimum age to give consent is 18 years right 18 years including per vaginal and per rectal examination per vaginal and per rectal examination the minimum age is 18 right serery 18 any major procedure 18 MTP whatever it is right major procedure the minimum age is 18 right suppose if there is autopsy right in medical legal autopsy do remember consent of the relatives not needed consent of relatives not needed whereas if it is pathological autopsy you need to get consent from the relatives right consent is not needed consent is not needed if it is pathological autopsy or clinical autopsy or academic autopsy consent of the relatives is mandatory you have to get consent from the relatives fine suppose if suppose you are dealing with a sexual assault case right suppose if you're going to do a medical examination medical examination with related to medical examination there is one important section that you have to remember 53 a crpc what does it tell you the 53 a crpc it tell tells you that it is examination of rape accused right it discusses about examination of rape accused where if you are getting the request from the police not be not below the rank of sub inspector you can use reasonable Force for examination you can use reasonable Force for examination right that means consent is not mandatory consent is not mandatory but how much force that is reasonable that is not given by the law they have just mentioned using reasonable Force consent is not mandatory but at the same time this is for the accused but at the same time there is another person right victim Survivor right he in this case it is applicable under 164 a crpc where if the victim is not giving you consent if victim is refusing to give consent you cannot examine her consent is mandatory for the victim right consent is mandatory accus is not mandatory but victim it is mandatory it is mandatory right suppose if you are going to do medical termination of pregnancy act right as per if you're going to do termination as per medical termination of pregnancy act termination of pregnancy you have to get concern from the you have to get concern from the pregnant women mandatory right compulsory but what about husband do you have to get consent from the husband consent from the husband is not compulsory it is not needed right husband consent is not needed husband consent is not needed if it is for medical termination of pregnancy right fine likewise suppose if you are going to see let me tell you one important section what is that important section 87 IPC 87 IPC a person about 18 years can give consent can give consent for any acts for any act which is not intended which is not intended or not known to cause death or griev the person above the person above 18 years can give consent for any act that is the point provide that act is not meant for causing Grievous H or death or the ACT is not known to cause Grievous H or death right what is not known to cause death or griev said they can give you consent I give you consent you take you can take gun and shoot me right I have given you consent I have given you consent you take a gun and shoot me right but this taking a gun and shooting me in the head that will cause death right so that is not applicable in 87 AP 87c is applicable for an act which is not intended or not known to cause death and griev so that is again important another section that we have to know is if a child if a child is less than 12 years of age right you cannot get consent from the child you need to get consent only from the guardian consent from the guardan has to be applied has to be obtained right this is given by the section 89 IPC that is because why you need to get concern from the guardian If the child is less than 12 years that is because a consent given by a child less than 12 years it is not valid right it is not valid invalid consent that is a reason why you cannot get consent from the child less than 12 years you are getting consent from the guardian and this is invalid consent is not only for child less than 12 years if the consent is given under Insanity insane person right or if the consent is given under influence of threat or death or if the consent is given under intoxication right drug into intoxication or any alcohol intoxication conscent is given in all the situation that consent happens to be an invalid consent this is given by 90 IPC right I told you 87 IPC I told you 89 IPC 90 IPC and I have told you another one more IPC is 92 IPC which is applicable in terms of emergency situations right I told you it is applicable in terms in terms of Emergen situations you're going to save the life of the person you're going to save the life of the person now going forward suppose if the person is brought for medical treatment or examination and the person happens to be an under trial prisoner right the person happens to be under trial prisoner is not a convict is is not a convict it's an under trial prisoner brought by the prison Authority for examination or treatment right for you to examine the person for you to treat the patient do you have to get consent from the under trial prisoner yes you have to get consent from the under trial prisoner because he is not yet convicted he's only under trial so he has got the right you have to get concern from that particular person even before suppose if the police is asking you PO is asking you the findings of the examination what happened about the condition without the consent of the underr prisoner you cannot just disclose it to the prison authorities but at the same time if it is a convict patient is convicted already has given punishment he serving his sentence in the prison in that situation patient is becoming ill the prison authorities jail authorities bring bringing the patient to the hospital right for examining the person for treating the person the consent is not mandatory consent not mandatory because he's a convict right you can get consent from the prison Authority and you can go ahead with the procedure right and if suppose you're examining the convict and you want to you want to disclose the examination fining to the prison authorities we can disclose even without the consent of the patient right because this person is a convict so do remember the difference between under trial prisoner under convicts right okay now let us let's talk about medical records preservation of medical records maintenance of medical records right there are two important uh uh I mean uh timeline given in two two different areas one is as per nmc one is as per nmc another one is dghs but let us say let us see what is what does nmc says nmc says that you have to keep the record of inpatient impatients record of all medical records of all impatients you need to maintain the medical records of all impatients up to a duration of 3 years up to a duration of 3 years and during which time see suppose if the patient has got treatment from you patient got discharged after a few months the patient relative or the patient is asking copy of the medical record copy of his health record copy of his SK it can you can you give it to the patient or should you give it to the patient or can you refuse this is my document I will not give can you tell like that no remember suppose if any patient or authorized patient attender is asking you the copy of the medical records the medical records copy should be provided to the person copy of the medical records should be provided to the patient within 72 hours within you can say three days you can remember 3 years 3 days within 3 days you have to provide within 3 days of request right otherwise that itself is a punishable offense right it can amount to unethical act as well remember within 3 days the hospital has to provide the copies of the medical records maybe you can charge for taking zerox copies of the medical records but it has to be provided Hospital cannot refuse hospital hospital authorities cannot refuse Hospital authorities cannot ref this is as per nmc this is as per nmc let's talk about dghs right director general of Health Services it says that for all op and IP patient minimum you need to have a have the medical records maintained at least for 3 years minimum minimum right and ideally after that basically what we have to do is digitalize all the records and you can store it forever if it is about medical legal case right if it is either case about medical legal reports or medical legal cases minimum 10 years or until the cas is getting completed in the court until the trial of the case is complet in the court either 10 years or at least till the case trial is getting over in the court of law right but what is so important is you need to remember this is very important given by nmc within 3 years you need to maintain and within 3 days you need to provide the copy of the medical records right so we have discussed about civil negligence we have discussed about criminal negligence I told you civil negligence simple negligence gross negligence that is that is Criminal negligence right in civil negligence patient can file see generally what happens see I told you simple negligence civil negligence gross negligence criminal negligence it doesn't mean that patient will either file either in the Civil or in the criminal it doesn't work like that the patient for the same case he can file a complaint in a civil court for getting compensation right or he can file the same case in the criminal court for taking criminal action on the doctor right or the patient can go to the SMC as well to remove the license of the doctor for the same case the patient can approach any of this all three also he can approach he can go to civil court asking for monary compensation he can can go to Criminal Court taking legal action against a criminal action against a doctor simultaneously can go to State Medical Council file a complaint on the doctor for the removal of his name from the State Medical register all the things can be done the same case right usually it happens like that okay