No faith in the medical councils
The medical profession has been traditionally considered a noble profession. In civil society, the profession gets respect, as doctors are usually revered. This is all the more true in the Indian context. Over the years, the medical profession has been deified and mystified. People have posed enormous faith in the profession and its members. Family physicians, an almost extinct species, have been traditionally considered family members.
This situation has changed in developed countries some decades ago. The increasing use of high technology medicine, and the commercialisation and corporatisation of medical care were some of the major reasons for this change. The doctor-patient relationship, traditionally based on faith, changed into one of a commercial or professional contract. The human touch in medical care reduced significantly, though new technology ensured that the quality of care improved enormously.
The profession has traditionally regulated itself, supported by appropriate legislative measures. This involved the setting up of councils which have been empowered to monitor and regulate ethical standards of the profession. The General Medical Council of the UK was considered a model of self regulation.
However, the recent case of a UK gynaecologist has raised doubts about the GMC’s role as a disciplinary body. Dr.Richard Neale was allowed to practice in the UK despite his license having been previously revoked in Canada. The GMC had been alerted of this fact as long ago in 1985 by Canadian authorities but took no action for 15 years. Sir Donald Irvine, president of the GMC, conceded that there was failure of mechanism in the GMC to prevent such an incident. Similarly in the USA, a physician was charged with serial murder. He is alleged to have killed many patients as he moved from post to post in the USA and other countries. The concerned physician was convicted in Ohio state for giving arsenic to five emergency patients. However, he could easily obtain jobs in other states.
This raises the issue of failure of coordination amongst various national regulatory authorities. In an era of high-tech medicine and information super highways, such a failure of basic coordination exposes serious lacunae in the modern medical profession. Failure of regulatory bodies in both instances led to totally avoidable deaths of patients. In developed countries, such issues will be settled in the courts. However, the larger ethical issues need to be widely debated.
For a long time, a section of Indian society in general and the medical profession in particular has been fascinated by high tech medicine and information technology in medicine. However, the basic ethical tenet: ‘Cause no harm if you can not heal’ seems to have been forgotten. The defunct medical councils in our country are not capable of any coordination. Though no data are available, there are numerous anecdotal reports of criminalisation of the medical profession. The medical councils in India have neither taken cognisance of these reports nor tried to systematically study the problem.
A recent report in a national news paper about the income tax raid and unaccounted wealth seized from the house of the president of the Medical Council of India shows the criminalisation has spread to the regulatory body itself. The current president of the MCI is also the national president of the Indian Medical Association, which claims to represent the interests of the profession. The deafening silence from the IMA and other professional bodies reveals a shocking decline in ethical standards in the profession. The IMA has been in the forefront of the campaign against the Consumer Protection Act. Its main demand has been to give extra powers to medical councils.
However the IMA’s silence on this issue shows its moral bankruptcy of its national leadership. (Some branches of the IMA are concerned about ethics, and are collaborating with us. However, this has still not found reflection in the national body.)
It also shows the hollowness of its campaign against the CPA. Does the IMA honestly believe that the common man should trust a medical council whose president’s credibility is under a cloud?
It is high time that organisations like the IMA do some introspection to realise why people have lost faith in the medical councils and bodies like the IMA. No technology can replace the bond of faith between a doctor and patient, a vital ingredient of patient care. This bond of faith is solely dependent on ethical values. The use of high tech medicine without ethical standards can be detrimental to patient care as well as to society at large.
- McCarthy M: US doctor pleads guilty to murdering patients. Lancet 2000; 356: 1010-1012
- Sharma D: Medical body chief under cloud of suspicion in India. Lancet 2000; 356: 573-576.