In developed countries, billions of dollars are sought in malpractice suits every year, and stories of unethical behaviour in healthcare continue to mount. Trust between physicians and patients helps avoid being caught up in the trend. But can mutual trust be fostered between the two sides?

There are many reasons for malpractice. The first is that healthcare providers are only humans and as liable to make mistakes as those involved in any other profession. But, more importantly, it could be that no proper system is in place to catch medical mistakes. Third, and no less common, is easy availability of medical practitioners who should not be practicing due to their lack of knowledge, skills and facilities. Ethically, service providers who make mistakes should be held accountable. Instead, a code of silence is being followed, even if the patient has the right to know what mistakes were made or the reasons behind a particular medical accident. The majority of patients in Nepal feel disrespected by the breezy manner of doctors. Or the patients are miffed when they learn that they were told lies. They patients want and deserve to know the complete truth from doctors, but increasing patient load is a huge barrier to conveying full truth.

Many reports have been published that report of errors within the medical system that either result in serious harm or death of patients. But, in some severe cases when death of the patient is inevitable, relatives do not want to accept the bitter truth. On other occasions, death is caused by lack of attention or mistakes of attending doctors or nurses. The fear of malpractice litigation is the most significant obstacle to open reporting of medical mistakes. Without open reporting, however, the root causes of medical errors cannot be found

out, thus undermining efforts at implementing safeguards for minimising future mistakes. Efforts to prevent medical mistakes, therefore, must first address the fear of malpractice litigation among healthcare professionals.

Healthcare institutions must decide whether it is appropriate to inform the patient of a medical error. The barriers to disclosure are aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liability. However, admission of medical errors is the only ethical way and may even be required by law. On close examination, barriers to disclosures have little merit, and, in fact, lawsuits and liability may actually be reduced by informing the patient of medical errors.

Patients should be aware of medical or surgical complications that may not have resulted from the offered treatment. Therefore, a healthcare institution should have a written policy to disclose medical errors. To reduce errors, healthcare policy should be strict, transparent and professional and based on scientific parameters. Trust is the foundation of physician-patient relationship, and trust can only be based on truth.

Dr Sharma is associate professor, Kathmandu Medical College