Tired of waiting for the government to restore to a state of health the Medical Council of India (MCI), the regulator of medical education and practice, the Supreme Court has transferred its statutory functions to a three-member committee headed by former chief justice RM Lodha. The Centre now has a year to frame rules to restructure the organisation, whose legitimacy is at rock bottom because of accumulated inefficiencies and allegations of graft. An intervention is immediately required to correct an imbalance between the volume of MBBS and postgraduate seats.
The former traditionally predominated as the general practitioner used to be the first point of contact between the patient and the medical system, and was deemed capable of dealing with most illnesses. However, the volume of medical knowledge has grown dramatically over the last three decades and specialisation has become the norm. In recognition, the MCI should have encouraged teaching institutions to increase the ratio of seats in postgraduate specialisations.
However, the biggest challenges before a refurbished MCI could stem from shortfalls in medical ethics, rather than the lack of facilities in the system. For instance, the rampant use of expensive inducements by pharma companies to influence doctors’ prescriptions has only just been engaged with. Far better oversight will be required to dismantle this pernicious system, which imposes arbitrary costs — and sometimes arbitrary outcomes — on patients. Equally problematic is the rampant growth of the diagnostic laboratory, which has become an ancillary industry of the practice of medicine and flourishes because of kickbacks for referrals. Traditionally, doctors narrowed down their diagnoses by examining patients, and then prescribed confirmatory tests. However, prescribing a battery of lucrative tests before even setting eyes on the patient is the new norm. Indeed, the priorities of healthcare seem to have been overruled by the imperative to keep the production lines rolling. Sometimes medicine seems to have been reduced to a set of asset management challenges — how to keep hospital beds optimally filled, how to maintain a good turnover rate at operation theatres and clinics, and so on. Such are the Augean stables in the field of medical ethics which the MCI has failed to address, but will now have to face up to.
In the field of teaching, it is imperative to prevent a system of education from degenerating into a mere certification protocol. The new, improved MCI must consider factors like the entry of private capital in a not-for-profit teaching system, doctors’ reluctance to take rural postings versus capital’s enthusiasm for running poorly manned rural institutes, and so on. And in all matters, the restructured MCI will have to respect the principles of medicine rather than those of accounting, and serve the public good first and the profit motive afterwards.