February 10, 2014 12:01:31 am
At an Idea Exchange moderated by Tabassum Barnagarwala, Maharashtra Medical Council (MMC) president Dr Kishor Taori speaks on the move to allow homoeopathic doctors to practise allopathy and the challenges faced in providing quality healthcare in rural areas.
SAGNIK CHOWDHURY: What is your opinion on the move to allow homoeopathic doctors to practise allopathy after a one-year course?
The MMC has unanimously come out with the proposition to the government. We have suggested that this cross-pathy should not be allowed. Whatever medicos have learnt, they should be allowed to practise only that. Many eminent homoeopathic doctors have said, ‘Do not kill our science by allowing cross-pathy’. Homoeopathy is a great and old science and it is valued in India. But there were a few people, in political groups, running homoeopathic institutes. They wanted to bring the one-year condensed course for their profit. We have decided not to register these doctors in MMC.
SAGNIK CHOWDHURY: But do you think enough has been done in rural areas to allow homoeopaths to practice homoeopathy in state hospitals?
Sadly, this is one aspect of the rural population not being provided proper healthcare. With primary health centres, health services are slowly improving. It is true that there are not enough doctors to serve the people. It is also true that there is a bond that doctors must serve in rural areas because they are provided subsidised education. But doctors, when they pursue post-graduation, think that they can do what they want. Proper infrastructure and a conducive environment should be provided. The World Health Organisation’s help has made the public health department raise its standards. Now rural hospitals have X-ray machines and ultrasound machines. So, doctors will start going there. Under National Rural Health Mission, they will also get doctors on contract basis.
SANDEEP ASHAR: What is the MMC’s opinion on the making the bond-term mandatory, as suggested by the health minister?
The minister is right. Bond term should be made mandatory. One of my students, after graduating, paid a cheque of Rs 15 lakh (in lieu of not fulfilling the bond) and moved to Kerala. I do not think this is in the right direction. If a doctor does not abide by this bond, the government can take action and refer his or her case to the MMC for misconduct, which might happen in the future. We will take the necessary action.
TABASSUM BARNAGARWALA: There were also suggestions that instead of making the bond a part of PG course, it should be made compulsory before appearing for PG entrance test. Will that help?
Rather than having theory for all years, right from first year, medical students should come in contact with the patients. The country’s medical education needs a revamp. In four years, rather than five-and a-half years, the graduation will be completed and the post graduation will be done in another four years instead of the current three years. We will do away with internships because nobody follows that. As soon as a person passes MBBS, he or she starts preparing for PG exam instead of an internship.
P VAIDYANATHAN IYER: Is it not the state’s fault that it is not appointing homoeopathic doctors where allopathic doctors are not available?
It is not a straight equation. It might play with the lives of people. Why study homoeopathy then? Study allopathy in order to practise it. Homoeopathy is a good science but the government has failed to nurture it. There are no takers for homoeopathy. Slowly, homoeopaths have switched to allopathic practise.
SANDEEP ASHAR: How many doctors have faced action from MMC in the past year?
We have suspended more than 50 doctors under Pre-conception and pre-natal diagnostic techniques (PCPNDT) Act (for sex-determination of unborn children). This is the highest figure in the country. In other states, not even a single doctor has been suspended. The medical council has come up with the idea of graded punishment. For clerical mistakes, there may be different punishments but for breaching the PCPNDT Act, the doctor may face suspension.
TABASSUM BARNAGARWALA: How many complaints are received in a month and usually how long does it take for a case to conclude?
When we took over in 2011, nearly 600 cases were pending. Around 150 cases are still pending. New cases have also started coming to us.
MAYURA JANWALKAR: What is the percentage of cases where doctors have been held guilty?
I think maybe three-four per cent. Because we do not have a system where a patient coming from Nagpur to Mumbai gets all the necessary mechanisms. He needs a lawyer and support. We are trying to overcome the situation.
ZEESHAN SHAIKH: There are many grey areas in the medical field such as fees and commissions charged by doctors or hospitals. Why does the Medical Council of India not address them?
In the new Clinical Establishments Act, we will insert a clause on charging patients. The government wanted charges for all hospitals to be the same but that is not practical. Charges should be transparent. When there is consent for operation, information about all charges must be there. Doctors will have to explain the procedure, complications and charges. For charging commissions, doctors have been punished for doctor-pharmaceutical relations.
ZEESHAN SHAIKH: Is the fact that expensive drugs are prescribed when there are less costly drugs in the market being examined?
When drugs enter this country, they are controlled by the central government. If they force multinationals to come with only generic drugs and if government opens credible shops everywhere, something can be done. The cost of generic drugs is also less. But the government is not taking such initiatives.
MAYURA JANWALKAR: The IVF industry has no checks except for the ICMR guidelines. What is the council doing to monitor this?
Newer techniques are coming up and regulations cannot be formed overnight. We will come up with guidelines. Taking ovum from another person is a new concept and has to be regulated. There are no defined rules at times. There are many grey areas as science is progressing in leaps and bounds. But a committee will be formed. I think certain policies will come out soon.
TABASSUM BARNAGARWALA: Does the MMC have power beyond cancelling the licence of a doctor guilty of malpractice?
We can register doctors and we can de-register them. Criminal prosecution can be done by police so parallel action can be taken by the government. Compensation will not be given by us, it will be given by a consumer court. It is a triangle between the government, the council and the consumer court. Our decisions have an impact. Compensations have been given based on our decisions.
SHUBHANGI KHAPRE: What is the total number of unregistered doctors? Are more doctors going out of the state?
When we fought elections, there were 60,000 doctors. Now, there are 73,000. So registrations are increasing. But there is no record of those not registered.
SHUBHANGI KHAPRE: Is there a decline in attacks on doctors by patients?
Lack of communication is the reason for a majority of such attacks. If doctors communicate properly, violence can be avoided. Andhra Pradesh was the first state to make attacks on doctors a non-bailable offence. In the Clinical Establishments charter, we will enlist the rights and duties of patients.
MAYURA JANWALKAR: Is an indefinite strike by doctors, after such an attack, justified?
Strikes are never a solution. In the Solapur incident, the government did not take any action against the police. Finally, the court had to direct the government to arrest the police officers who assaulted the doctor. Such blatant violation should not be committed. Although strikes are not justified, the government should know that this is an offence.
TABASSUM BARNAGARWALA: Do you think there should be a focus on communication skills of doctors like in the US and UK?
We have decided in the management council to include this aspect in the curriculum. Say if a patient dies, a doctor should be able to communicate this news. Just saying that the patient is dead will not help. He or she needs to
explain what the complications were. Final-year students will be taught about “recitation” of how to communicate with the patients’ families.
(TRANSCRIBED BY TABASSSUM BARNAGARWALA)
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