Don’t carry on, doctor

M unna Bhai MBBS did not become a blockbuster film for nothing. Making us both laugh and cry, it held up a mirror to our lives.

Even if you are an emergency case, for instance, you still need to fill a form to be admitted, a scene in the film showed. The film took the light-hearted route to treat some serious problems in medical practice.

One size doesn’t fit all

India does not have a universal emergency services number or support network like the US’ 911 or the UK’s 999. And patients here are pretty much at the mercy of government- or privately run hospital emergency services that could turn out to be good, bad or downright ugly.

The recently notified Clinical Establishments Act (to regulate medical centres) sought to address this concern over emergency care. And a key feature in the Act is that no patient can be refused emergency treatment.

The well-intended effort, though, is getting the wrong end of the scalpel, as it lays more responsibility on the neighbourhood doctor than he or she is probably equipped to handle. So while it seeks to protect the patient, the Act’s one-size-fits-all approach could end up doing quite the opposite — affecting patients and putting the small, single doctor in the dock.

Doctors under the Indian Medical Association’s (IMA) banner have approached the Delhi High Court to stay the implementation of the Act. This, even as they protest a couple of other Government proposals on regulating the medical profession and addressing the rural requirement for doctors.

The doctors make a serious point when they seek discussion and clarity on norms that govern them. Contrary to popular perception, the medical fraternity is not averse to regulation, they say in their defence. Dissecting the Act, they say, a doctor is required to “stabilise” a patient before sending her across to the nearest referral hospital, failing which he or she could face a non-bailable warrant.

Who pays?

On the face of it, it is a much needed, pro-patient move by the Government. Scratch the surface, and complexities emerge. The definition of “stabilise” is unclear.

Besides, it is not realistic to expect a regular family physician to be equipped with ventilators and so on. The equipment is expensive, and if individual doctors were to invest in such equipment, who shares their cost, they ask. And while the Act’s efforts to regulate all clinical establishments is a good move, to expect all clinics to be at least 500 sq.-ft, for instance, is practically impossible in expensive cities such as Mumbai, where real-estate costs are prohibitive.

If a doctor has that kind of money, he wouldn’t need to practice, quips a general practitioner in South Mumbai. He asks, who pays for this? Having invested in a large room, a ventilator and so on, a doctor will be under pressure to recover his cost and the most likely victim will be the patient, he observes.

The Act’s stiff requirements and penalties will encourage corporatisation of healthcare, as only the big corporates have deep pockets. It also opens the door to abuse of power, as authorities can penalise or shut down the clinic of a good doctor for reasons not connected with his medical expertise. The small, neighbourhood doctor will be virtually forced to shut down.

Such “draconian” measures will also keep young people away from becoming doctors, says a local family physician, adding that his own children have chosen to pursue engineering, rather than follow in their father’s footsteps!

Objectionable Bill

Doctors are also protesting the National Council for Human Resources for Health Bill that seeks to supersede the Medical Council of India (MCI). The proposed Council will have Government nominees.

It is true that the MCI has not cloaked itself in glory, with its former head honcho being arrested for corrupt practices, even as he turned the heat on the gift culture prevalent between drug companies and doctors.

Doctors argue that the Government has seen one scam too many at the Centre, but does that result in dissolving the Government? Similarly, despite its ills, the MCI is more democratic, with members being drawn from across States and universities, they point out.

Just as sports bodies should be run by sporting greats, the medical body too should be left to well-reputed doctors, with counter-checks being provided by independent nominees from Government, and by people other walks of life, even advocacy groups, to prevent the MCI from functioning like an old boys’ club.

Especially so, since medical education also comes under its purview and with corporates now encouraged to get into medical education, a stringent body is required to ensure that medical colleges have all to do with education and little with becoming money-spinners for their patrons.

Doctors also bristle at a proposal in the Bill disallowing them from pursuing any other profession.

So a doctor as Government advisor or author could be on the wrong side of the law! And worse, they say, there appears to be no avenue for redressal.

The medical fraternity further cautions that the Government’s proposal to have a short-term modern medicine course (ostensibly to target the rural need for doctors) could dilute standards, and put patient safety at risk.

Doctor absenteeism in villages is a governance issue, doctors say, suggesting measures, including a year’s compulsory rural service for all MBBS graduates — a move that will create a ready pool of 30,000 doctors. Rural medical colleges, or an All India Rural Health Services with a short and permanent commission like the Armed Forces (suggested by the IMA), are ideas worth exploring to get doctors to rural areas.

Introspection

From the stinging report by a Parliamentary committee that flagged the doctor-drug-company-regulator nexus to Aamir Khan’s well-researched television programme that raised similar issues, there is a general consensus that doctors should introspect on why their noble profession seems to be falling from grace. While the Government could do well to take doctors along in its efforts to protect patients and ensure affordable healthcare, doctors too need to work to cleanse their fraternity.

Not to tar all doctors with the same brush, but the good and reputed doctors need to step up and help bridge the trust deficit that has crept in between the medical fraternity and ordinary people.

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