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Regulating doctors

Officially rapping doctors on their knuckles for minor transgressions makes them feel they never transitioned from school to responsible adulthood.

ANJALI MEHTA | New Delhi |

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 are 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 must 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 individuals then have 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! With 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.