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Since ancient times, duties and responsibilities have been cast on those who adopt the medical profession, as exemplified by the Charaka Oath (1000 B.C.) and the Hippocratic Oath (460 B.C.). Understanding the doctor-patient relationship requires understanding the doctor's duties and obligations, the doctor-patient contract, and what constitutes professional negligence.
Prerequisites of medical practice: a duly qualified doctor may practise medicine, surgery and dentistry by registering with the Medical Council of the State they reside in. The State Medical Council can warn, refuse to register, or remove the name of a doctor sentenced for a non-bailable offence, or found guilty of infamous professional conduct — but no such action can be taken without giving the doctor an opportunity to be heard, in person or through an advocate.
Doctors' duties are drawn from ordinary law and various Codes of Medical Ethics and Declarations (the MCI Code of Medical Ethics, the Hippocratic Oath, the Declarations of Geneva and Helsinki, the International Code of Medical Ethics, and Government of India sterilization guidelines), summarised as:
Patients, in turn, are expected to disclose relevant information, co-operate with investigations, follow instructions, and compensate the doctor — failure to do so can free the doctor of legal responsibility and weakens a later negligence claim (contributory negligence).
The doctor-patient contract is almost always an implied contract (inferred from conduct), except where written informed consent is obtained (an express contract). A doctor-patient contract requires the doctor to continue treatment, exercise reasonable care and skill, not undertake procedures beyond their skill, and not divulge professional secrets. A doctor may lawfully discontinue treatment where the patient has recovered, does not pay fees, consults another doctor without informing the first, does not co-operate, comes under other responsible care, or where due notice of discontinuation has been given.
A professional secret learned in confidence must not be divulged, except as "privileged communication" to a proper authority with a corresponding duty to protect the public — e.g. as a witness in court, warning a spouse of an HIV-positive partner, or informing public health authorities of food poisoning.
Professional (medical) negligence is a breach of duty through an act or omission a reasonable, prudent doctor would not have committed. To succeed in a negligence claim, the patient must establish: the doctor owed a duty of care, the doctor breached that duty, the patient suffered actual damage, and the breach was the direct or proximate cause of that damage — the burden of proof rests on the patient/complainant throughout.
Criminal negligence goes beyond mere compensation — gross ignorance, gross carelessness or gross neglect for a patient's life and safety can support a charge under Section 304-A IPC (culpable homicide not amounting to murder). Classic examples include operating on the wrong limb/patient, leaving instruments inside the body, or transfusing the wrong blood group.
Proper documentation is a doctor's primary proof of appropriate treatment and the decisive evidence in most negligence allegations — as the saying goes, "poor records mean poor defense, no records mean no defense." Medical Council of India Regulations (2002) require indoor records to be maintained for 3 years, with copies furnished to a patient/attendant within 72 hours of a written request. Medico-legal case records should be retained until final disposal; special statutes (e.g. the PNDT Act) prescribe their own retention periods. Records are generally the property of the hospital, which must produce them on demand by the patient or a court — failure to do so can itself be treated as deficiency in service or negligence.
Consent can be given by any person conscious, mentally sound, and 12 years of age or above (Sections 88 & 90, IPC); consent given under fear, fraud, misrepresentation, or by someone under 12, is invalid. Implied consent covers routine examination only; express consent (oral or written) is required for anything more invasive, and written consent is mandatory for major diagnostic procedures, general anaesthesia, surgery, and medico-legal examinations.
Informed consent is the voluntary acceptance by a competent patient of a care plan, after adequate disclosure of its nature, expected outcome, risks, alternatives, and the effect of no treatment. It requires four elements — voluntariness, capacity, knowledge and an actual decision — and India has no explicit legislated consent age, leaving 12 (per Section 90 IPC) and 18 (per the Indian Contract Act) both cited in practice; most doctors treat a minor's own consent as sufficient for examination only, preferring parental/guardian consent for procedures. Exceptions to obtaining consent include genuine emergencies (Section 92 IPC), a patient's informed waiver, legal incompetence (substituted consent from next of kin, in order: spouse, adult child, parent, sibling, guardian), and certain court-ordered examinations.
Written consent should always refer to one specific procedure — a "blanket" consent obtained on hospital admission has no legal validity.
On 7 August 2009 the Supreme Court delivered its final verdict in the Anuradha Saha wrongful-death case, holding four Kolkata doctors and a private hospital (AMRI) liable for medical negligence and remitting the matter to the National Consumer Disputes Redressal Commission to determine the quantum of compensation, out of a claim of Rs. 77.7 crore plus 11 years' interest. Being an Article 141 judgment, it binds all Indian courts. Subsequent commentary noted that a February 2010 Supreme Court ruling dismissing a claim against a Delhi hospital did not establish any new legal principle and should not be read as weakening the Anuradha Saha precedent or the Rs. 1 crore NIMS vs. Prasanth Dhananka verdict (14 May 2009) — both remain good law. Indian consumer forums have continued to award substantial compensation in medical negligence cases in the years since.
Doctorshield members get expert legal representation at every stage — from Medical Council replies to the Supreme Court.