The National Medical Commission (NMC) has published a draft of the regulations it proposes for the professional conduct of doctors and invited comments by June 22. Chapters 2 to 6 deal with the professional conduct of doctors, the duties of registered medical practitioners towards their patients, the responsibilities of doctors to each other, the responsibilities of doctors to the public and allied health professionals, and professional misconduct, respectively.
Areas that need reworking
Much in these chapters is similar to the existing regulations of the erstwhile Medical Council of India. The requirement for every registered medical practitioner to maintain patient records for three years from the last consultation will be difficult to implement for most general practitioners who provide high-quality services at low prices and depend on high volumes of patients to earn a decent income. It will reduce the number of patients who can be attended to, add considerably to costs, and delay treatment. This measure is unwise and should be withdrawn. In the section on informed consent, the statement that “in an operation that may result in sterility, the consent of both husband and wife is required” is poorly thought out and must be redrafted. It is possible that the person requiring such surgery may be single. Even if the individual is married, this regulation is contrary to the principle of individual autonomy.
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Following the chapters detailed above, there are 11 guidelines. These guidelines are a curious mix of templates for certificates and extensive instructions. It is interesting that guideline 3, the NMC code of medical ethics, has dropped the controversial Charak Shapath and returned to the Declaration of Geneva. This is a wise move. India is a founder member of the World Medical Association and contributed to the drafting of the declaration. The guidelines on continuous professional development resemble an edict. All practitioners of medicine need to keep abreast of evolving knowledge in medicine to provide competent care to patients. Such continuing education must be sensitive to the needs of the practising doctor. It cannot be a repetition of college education. The rules suggested demonstrate a schoolteacher’s approach with excessive regulation and control. Renaming continuing medical education as continuing professional development is symptomatic of this bureaucratic approach. Typically, medical practitioners utilise a variety of media to enhance knowledge. The easy availability of high-quality content on the Internet has greatly enhanced accessibility. Medical practitioners are mature learners and do not need the stick to be forced to learn.
A committee, the draft says, will decide who can impart continuing education and what the content of such education should be. This lays the foundation for the creation of a new set of rent-seekers who will create such content, get it approved by the committee and sell it to the medical professional who has no option but to undergo these courses. Recertification has been required in the U.S. since 2000. Studies have shown that the major beneficiaries have been corporate programmes licensed by the American Board of Medical Specialties called Maintenance of Certification. The experience in the U.S. demonstrates that there is no value in recertification. It is unclear why India should follow a path known to be useless. This guideline should be removed if not extensively reworked.
Lack of harmony
The blanket prohibition on medical practitioners participating in educational activities sponsored directly or indirectly by pharmaceutical companies and the allied health sector will severely restrict access to the latest developments. It is true that there is much literature on the malign influence of pharmaceutical companies and medical device makers on medical decision-making but prohibiting information flow is unlikely to counter this influence. It is wiser to provide guidelines on such education. In the guidelines on social media, the prohibition of sending scan images on social media will considerably impair communication and needs rethinking.
The guidelines on telemedicine read more like a briefing paper than a guideline. It is one of the most elaborate sections and there is some repetition, but it provides a good framework in a type of medical consultation that became somewhat common during the COVID-19 pandemic.
There is a lack of harmony in the draft. The first part, the regulations, read like typical bureaucratese. The guidelines on comprehensive professional development have a schoolmarm air, and the one on telemedicine reads like a chapter from a textbook. In summary, the draft needs extensive reworking.
Dr. George Thomas is an orthopaedic surgeon at St. Isabel's Hospital, Chennai
