Dr KK Aggarwal

Recipient of Padma Shri

The historical manslaughter conviction of a UK doctor related to a case in which a six-year-old boy died at Leicester Royal Infirmary in 2011 that found her guilty of manslaughter by gross negligence in 2015, has opened a large number of issues of importance to Indian medical practice.

One of the issues of concern is the handling of Dr Bawa-Garbas case linked to reflective writing from her e-portfolio, which was reported to have been used in evidence. Though her medical defence organization has made clear that information from the e-portfolio was not used but notes made by her duty consultant on a meeting with Dr Bawa-Garba after the event to discuss and learn from it, formed part of his witness statement. 

In UK, GMC requires that all doctors in training must write reflections, especially when there are things that do not go well. This is an essential part of training and is needed to progress through a postgraduate training program. A failure to record reflections honestly could give rise to a referral to the GMC. It’s like the log book in DNB training in India.

It is an unwritten law that a doctor should avoid using patients’ names or initials, dates of birth, or “any unique condition or circumstance of that patient in a reflective log, but it is often ignored.

Also, during writing doctors should “try not to be judgmental” or say “I made a mistake, I made an error, I got things wrong”, but it’s also very important not to say in any way “I was negligent.”

Doctor’s reflections are potentially disclosable to courts, tribunals and coroners. The Crown Prosecution Service initially decided not to charge Bawa-Garba in 2012, but the decision was reviewed after the coroner’s inquest into Jack’s death and she was charged in 2014.

This issue now also has generated safety concerns. Patient safety is going to be affected if the medical profession is unable to reflect honestly and openly on mistakes for fear of being left open to prosecution; though reflective writing is not a norm in India.

The issue has raised concerns in reporting in AEFI (Adverse events following Immunization), PvPI (Pharmaco Vigilance Program of India) and Sentinel Events reporting under NABH accreditation. Unless a legal immunity is provided, based on Dr Bawa case, doctors may withhold many such reporting.

It is true that in PvPI the submitted ADR report does not have any legal implication on the reporters. Also, the patients’ identities are held in strict confidence and protected to the fullest extent. But courts can ask for the reports. There is no legal immunity for the reporting.

MCI Code of Ethics Regulations 7.14 The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his / her profession except –

1. in a court of law under orders of the Presiding Judge;
2. in circumstances where there is a serious and identified risk to a specific person and / or community; and
3. notifiable diseases.

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA