The Statesman (8 July 2022)
A comprehensive bill by the National Medical
Commission that provides renewed guidelines for the expected professional
conduct of medical practitioners and some standardization of healthcare is
under consideration now. Suggestions have been invited on the draft of recommendations.
Previously, what has been followed are the medical
conduct and ethics guidelines notified by the Medical Council of India in 2002.
For dissatisfied patients there are robust grievance redressal mechanisms. Perceived
gross negligence by medical practitioners attracts criminal lawsuits. Lesser medical
malpractices by doctors attract fines in civil consumer courts. Quacks, i.e.,
conmen masquerading as doctors, are dealt with strongly and have no connection
with the medical world.
The new bill draft suggests five levels of
disciplinary action which can be taken by state and central medical commissions
against erring doctors. The first level termed ‘reformation’ includes
counselling for minor administrative or procedural lapses and advisories can be
issued to doctors to attend generalized or specialized workshops on medicine/ethics/other.
The second level of punitive action allows suspension of a medical practitioner
up to one month. It is to be employed in those instances where there is no
evidence of direct harm by the doctor.
To my mind level one and two are completely superfluous
and should be done away with. They vitiate the enabling atmosphere and peace of
mind doctors need in order to give their very best to the patient. Officially
rapping doctors on their knuckles for minor transgressions makes them feel they
never transitioned from school to responsible adulthood. It would also
unnecessarily add to the work of the officials of various medical commissions,
distracting them from bigger issues.
There is much self-correction built into the medical profession.
Teachers and mentors keep tabs on those working with them and regularly point
out the finer aspects of the profession to their junior colleagues. Almost all
doctors belong to professional bodies or work at hospitals/registered clinics
that follow prescribed norms (without which they don’t get a licence) so there
are regular audits, reminders and well-worn guidelines.
As far as level two is concerned, even the country’s
judicial system at large finds a person innocent until proven guilty. It is
worrisome that even when the examining officials are sloppy or unsure about the
doctor’s attributability, they will still be able to penalize this cohort of
sought - after professionals.
Level three and four prescribe longer suspensions from
work -up to 3 months and 3 years respectively. In this case there has to be
evidence of direct harm caused by the doctor’s actions. Level 5 seeks to debar
medical professionals permanently for grave negligence. The last three
categories make sense. For actions of the doctor that result in direct grave harm
to the patient there should definitely be thorough investigations and full accountability.
This is already being ensured through judicial recourse.
Overall, there plenty of reassuring checks and
balances in the medical profession. Difficult entrance exams cull out people
with fine brains and the ability to work hard. Long arduous years of study,
tough competitive exams for getting into a speciality and doctors’ inherent
desire to be cutting-edge ensures they remain abreast of developments in their
field. Many institutions have doctors working in units or teams and hence collective
decisions are made after thorough discussions. A doctor’s reputation is closely
linked to the patient getting healed successfully and there is heavy
competition in the private sector.
No doubt, medicine is a vocation where quality of life
and prevention of death are at stake, so it is always under scrutiny. However,
the actions of many other professionals have a deep impact on our lives and
therefore this umbrella of accountability has to be widened to include them.
Doing this would ensure standardization of care in a holistic manner across
professions and not just single out the medical community for having to labour
under a plethora of rules.
For example, wrong conclusions arrived at in courts of
law have sent many an innocent person to jail. We read about influential rapists
who are given bail and then hurt and threaten their victims. Many illiterate
people are not able to understand the court proceedings but this doesn’t
translate into a reprimand for their lawyer. The court enjoys many honorific
titles and can penalize someone who is deemed to have held the court in
contempt. Judges have the freedom to ‘interpret’ the laws according to their
own understanding. Their judgements cannot be scrutinized on merits per se. There
is no judicial ombudsman or grievance cell where the public can ask for review
by senior judiciary/ legal peers when an occasional judgement seems illogical
or absurd. Citizens can certainly appeal a lower courts’ judgement in a higher
court. However even if a judgement is overturned the lower court is not held
accountable. Despite laws being well defined, their interpretation is rather
‘fluid’. Imagine the outcomes if doctors were allowed their own ‘interpretations’
of medical textbooks!
Similarly, police reforms are long overdue. A recent report
in the paper described how eight people were wrongly arrested by the police for
fomenting trouble in a crowd. They were released after their families submitted
categorical video evidence of their absence from the scene. It is sobering to
think that the police can round up anyone they suspect without due process or
accountability and the individual then has to run from pillar to post to free
themselves. Of late the police seem to have become a weapon for politicians to
bully the public with. Policemen deviate further day by day from their friendly
ideal of ‘with the public, for the public always’. The tragic death a few years
ago of a dentist’s daughter in Noida, made headlines for long. Despite police
thronging the house that day for the express purpose of discovering clues, they
failed to pick up an enormous clue – another lifeless human body in the same
house! The body being discovered only the next day -the blundering nature of
the investigation became equally sensational. Citizens have to live with the
spectre of tardy arrests, delayed FIRs, poorly written chargesheets and faulty evidence
collection. However, there are no well laid out procedures for police officers
to be held directly accountable to the public for poor quality of services
rendered.
Politicians imagine they are special and above
reproach. From broken manifesto promises, horse trading and jumping parties
after elections to hogging all the resources and security, the list of
misdemeanours is endless. Political decisions that decimate the environment (for
short term ‘development’ gains for a few businessmen) are contributing to
global warming and sending our planet hurtling towards a collapse. Poverty,
prices and unemployment are surging everywhere. Yet there is no provision to
change the representative for non- performance and even the most unpopular ones
are allowed to complete their full term.
Doctors are probably the only professionals today that
agree to double work shifts - OPD during the day and emergency night duty – in
rotation with colleagues. The fact that the world has been through a pandemic
where doctors have worked overtime, suffered great emotional and physical
burnout and risked their lives for others must never be forgotten. The population
is still reeling from ill-health, emotional, financial and mental stress
brought on by this pandemic. Patients do need the strong reassurance that
doctors provide.
However, doctors can function well as pillars of
support if their worth is well recognised and they get appreciation rather than
overzealous regulation. Also, rather than the national focus being selectively
sustained on doctors’ conduct, it should be holistically broadened to include
accountability from all professions. This is the most sustainable way forward.
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