for the subsequent questions: WHAT could have been done differently.

well, there are a lot of actions that should have been done in this particular case. first, given that the patient was 20 yo and her first pregnancy, then the family must have consulted the doctor in the district hospital. and also upon the problem, the family and the patient herself must have wondered what is really the problem to the patient and thus must seek for medical care in other institutions.

for the doctors, the doctor must have paid attention, assessed properly or to the very least, refer the patient if it was his/her conviction that he can't diagnose the patient himself/herself. The doctor must have considered that factors that jyotsana is only 20 yo and it was her pregnancy and it was only her eight month and so fever and abdomen pain are indeed indications that there is a problem.

also, prenatal check up system in small villages must be reviewed and modified to the point that at this level, any problem that may affect the pregnancy of any patient will be detected so that delays will be prevented and prompt management will be provided.

rai, i think 20 is not yet safe to be pregnant...at least 23-24 y/o ...i am not sure...will look for literatures about that...

I agree with thea...about the doctor not doing his/her job well of assessing the patient. on the other hand I think Jyotsana should have asserted her right as a patient to know everything about her condition..or better yet if she's not satisfied with the service done to her, then she should have made the initiative to look for another doctor and have herself be assessed again.

okay girls.. i think we all agreed on the underlying causes for Jyotsana'a death. (age, pregnancy being uneventful and it was her first pregnancy, the doctor who is not competent enough to diagnose the disease, inaccessibility of the health facility and delay in the decision making)
Let us now answer the next question..

it was stated in the case that the doctor didn't assess Jyotsana well. Since the doctor did not assess her well, he can't come up with a diagnosis. Afraid of giving a wrong diagnosis could be a factor as well.

yup i agree...but angel, i thought female who are 20 years old are considered to have a mature reproductive system compared to those who are below 20..

i agree about the age...

even if the doctor is busy, i think, he/she must inform the family...or at least refer for hospital admission if the doctor is not sure about the dx..

yes.. there are other causes.. the pregnancy at a young age (Jyotsana is 20 y/o) and the pregnancy being uneventful...

internal factors could be first age, jyotsana was only 20 years old. second, it was her FIRST pregnancy. those two classified her as a high-risk pregnancy.

well possible reasons why the doctor did not tell anything to the family will be:
1) he is not sure with the real diagnosis (I doubt but maybe such cases really happens)
2) poor assessment skills done, associating the condition with a simple premature contractions...
3) the doctor is too busy (???)
4) he thinks he can handle the case..

But whatever the reason is, i think the doctor have violated the right of the family to the full disclosure of information regarding the worsening condition of Jyotsana..

Follow up question.. Most of your answers are focused on the external factors (doctor's negligence, inaccessibility of the health facility..). What could be other factors that led to Jyotsana's death?

maybe the doctor was not expert on such cases OR maybe there weren't tests to support any diagnosis. BUT THE THING IS, the doctor SHOULD have at least REFER the patient if he cant examine well or instruments/tests were not possible.

Underlying cause of her death
The underlying causes of her death are the fever and abdominal pain which was not given proper medical management upon consulting with a doctor. She died due to the untreated infection which is manifested by the fever.

What should she have done differently?
She should have asked the doctor for the diagnosis of her condition. If she is not satisfied with the way the doctor examined her, she should have looked for another doctor who could really take care of her.

What should her family have done differently?
The family could help her by looking for another physician since her condition worsens.

What should the doctors have done differently?
The doctor should discuss to her the differential diagnosis so that the patient is informed about her condition. By that, the family can do something out of her condition. Since the family is capable to meeting her needs.
If the doctor happens to be really busy at the moment, the doctor should refer immediately the patient since her condition is serious.

Yes I agree with you girls.. I can see that most of you are blaming the doctor for his negligence. But what do you think is the reason why the doctor did not reveal his diagnosis for Jyotsana?

YEs thea and tina.. it is really on the delays in decision making of the doctor... and the full disclosure of the condition of the patient with the family is not made by the doctor.