Physicians, heal thyselves

The promulgation of the ordinance sending all office bearers of the MCI home has not come a day too soon. But some urgent concerns need to be addressed even as a bill is readied for Parliament’s monsoon session.

Public confidence has been temporarily bolstered by positioning seven medical professionals of calibre and proven integrity to run MCI’s affairs. The new governing body meets today; but precisely because its chairman represents the acme of liver and biliary science, another member is a top-ranking cardiologist, and a third the full-time dean of a private medical college (in Sikkim), there is a lurking fear that both patient care and critical decision-making may falter as these medical giants scramble to grasp additional responsibilities.

The foremost priority for the seven-member governing body is tackling the council’s contending priorities, some statutory, some time-bound — approving new colleges in the pipeline, recommending additional seats and new courses, inspecting the infrastructure of medical colleges, approving modifications to the curriculum, to name just a few. They are dependent on their secretariat, which has long owed allegiance to MCI’s departed office-bearers, raising doubts about where the loyalties of the former may lie. Whether this seven-member combination can perform the monumental Flexnor type clean-up that purged the medical system of the US and Canada in 1910 is yet to be seen.

Having said that, admittedly the governing body’s role is small compared to the impending challenges that lie ahead. The elimination of the old office-bearers is now history. But the MCI Act remains alive; and only its remodeling will decide the track medical education now follows. Health is a state subject under the Constitution and medical education is on the concurrent list. The bulk of the MCI’s members are elected from the medical faculties of state universities and from among practitioners. Another 40 representatives are nominated both by the states and the Centre, several of whom are products of “intense manipulation” says Dr Chaperwal, a former vice-president of the MCI who recently, reportedly, spoke of the Medical Council’s “loot” in a complaint to the prime minister. “The stakes are too high to prevent a repetition of the past,” he says. “We need an independent regulator because even in the future, elections and nominations can be stage-managed.” In the UK, the General Medical Council (GMC) is answerable to the Council for Healthcare Regulatory Excellence which oversees and can even overturn the GMC’s decisions. The proposed National Council for Human Resources and Health can hopefully play that role.

The second important aspect which needs to be addressed by the bill is whether lay people should be inducted on the Council. The Lancet, recently discussing “Trouble at the Medical Council of India” referred to the regulatory systems in the West where medical councils include non-doctors. The MCI has none; the UK Council has half its members from the lay public. “It is time to include non-doctors who can speak for patients’ concerns without creating a forum for activism and doctor-bashing” says Dr S. Dagaonker, member of the senate of Maharashtra’s University of Health Sciences.

The third important addition the bill needs to introduce: make the protection and maintenance of public health and safety the aim of the legislation, by emphasising the observance of proper standards in the practice, not just the teaching of medicine. The Medical Council Act 1956, unlike GMC, does not make this a direct responsibility. The new bill should specifically provide for this, around which cases of medical malpractice and negligence should be built. The law should also bind the council to declare professional standards it sets out for doctors, and the principles that underpin fitness to stay on the medical register. These are mandatory in other countries. It’s time the law enjoined MCI to follow suit.

Fourthly there is the issue of medical curriculum. The erstwhile Medical Council followed a caste system in which public health concerns normally elicited scorn from the overwhelming majority of specialists that saturated the Council’s bodies. Giving primacy to the containment of preventable communicable diseases is a fundamental tenet of the country’s health policy and, in the next MCI, should not be permitted to be dismissed.

Recently an opportunity has emerged to reach out to millions of Indians who live at an insurmountable distance from a health facility, by using mobile phones and remote-controlled diagnostics. We need to introduce a medical specialisation based on such technological solutions. That alone can bridge the disparities that confront more than half the districts. MCI will parry all such ideas unless the law provides for compliance.

Until now concern for profitable health care has driven medical education. Contemporary thinking and a few harsh decisions can inject equal concern for quality patient care into the Council’s ethos.