While medicos air their grievances, one hopes that they introspect on the issues exposed once again by the opposition to the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023
The deep criticism of the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, now held in abeyance, has yielded one positive: the government has started a weekly redressal/ public hearing session for grievances/suggestions/query resolution, each Thursday, from 11 am – 1 pm.
As per a public notice from Joint Secretary (Medical Education) Dr Vipul Agarwal, who also officiates as Secretary, National Medical Commission (NMC), the first session would be on September 7, with an aim to ‘’to promptly resolve the grievances of students and other stakeholders.” The notice goes on to state that while efforts will be made to resolve the issue on site, NMC will try to ensure the written response is sent within a maximum seven days. The request needs to be emailed at least two days in advance and once they receive confirmation of the date, two representatives per request can schedule a visit.
Building trust between various stakeholders is a good idea and public hearings are a good way to encourage a healthy transparent discourse. However, it remains to be seen if two hours per week will suffice.
Response to Dr Agarwal’s LinkedIn post indicates the plethora of sore points. Several students of the 1000-odd 2021 batch of medical students from medical colleges in Ukraine are caught in limbo, with the Russia-Ukraine war on one side and NMC regulations on the other. They have been pleading for transfer to other NMC-recognised countries/institutes like their peers of other batches.
Similarly, the decision of the NMC to drop three departments (respiratory medicine, physical medicine and rehabilitation, and emergency medicine) from the Minimum Standard Requirements for UG medical education is worrisome. Experts point out that post-COVID, training medical students to recognise and treat respiratory infections is even more crucial. Given that Prime Minister Modi himself is closely involved in the End TB campaign, this was a surprising move.
While the NMC’s move to drop emergency medicine was reportedly triggered by medical colleges finding it difficult to recruit faculty for this department, experts point out that expecting different departments to handle emergency medicine in rotation 24×7 is not optimal for patients or medical students. The physical medicine and rehabilitation department is important to treat the physically handicapped as well as other cases needing rehab care. All in all, these are critical departments and leaving it to medical colleges to include them or not, will deprive future generations of doctors of these vital skills.
But while medicos air their grievances, one hopes that they introspect on the issues exposed once again by the opposition to the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023. While the rules and fines governing might be diluted in the final rules, there is no doubt that the doctor-pharma company relationship will be continue to come under even sharper scrutiny. The debate throws up important issues, which have become flashpoints in the past. While doctors (represented by the IMA) are comparing the NMC’s push towards promotion of generics as “running trains without tracks’’, they point out that prescribing generics gives chemists/pharmacists the power to fill/substitute their prescription with whichever pharma companies/distributors /brands give them better margins. Moreover, they reason that it is the doctors and not pharmacists who know a particular patient’s medical history so this will impact health outcomes. This is clearly a tug of war, motivated by patient mindshare as well as monetary considerations.
There are divisions within the ranks of medicos too. The Alliance of Doctors for Ethical Healthcare (ADEH) urged the NMC to bring back the directive, with modifications, suggesting a “fresh, improved directive mandating doctors to write prescriptions in generic name only with the company name in brackets if any RMP desires to”. Once the government can guarantee the quality of all medicines, ADEH advocates dropping all brand names. It has also urged the government to ban irrational fixed dose combinations, another long standing demand.
Thus, it is clear that doctors are not immune to conflict of interests. Some of the NMC’s regulations seek to prohibit doctors and their families from accepting gifts, fully-paid trips to medical conferences, etc. While the Uniform Code for Pharmaceuticals Marketing Practices (UCPMP) is supposed to be followed by all pharma companies, it is very evident that there are many loopholes.
For instance, while some medical conferences were postponed till clarity was received on the NMC diktat, doctor associations have interpreted the proposed regulations to suit their means. For example, pharma/diagnostic/medical device companies can route their sponsorships to associations as this would not be directly influencing individual doctors.
No one doubts that the intent behind the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 is sound: unbiased professional conduct of doctors. But who will maintain this across the rest of the patient’s wellness journey: chemists/pharmacists and pharma companies, hospitals and beyond?
Every regulation is only as strong as its implementation. Thus, the government will have to carefully plan the roll out any policies, and the impact on the various stakeholders like doctors, chemists, pharma companies and patients. That is Utopia. Until we reach there, patients have to stay alert, become more aware, and educate themselves on their choices.
VIVEKA ROYCHOWDHURY Editor