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Self-governance – The failure of doctors

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A central factor at every ‘doctors meet’ is a massive disquiet and consternation based on the governmental interference in regulating us. It comes as no surprise that the THIRTEENTH set of amendments was submitted in the Parliament – The National Medical Council Bill (NMC, 2017). This proposal has doctors in the country flustered for several reasons, one of the most prominent being that the new professional body seeks to appoint members that aren’t doctors. This is only one amongst a litany of other draconian measures designed to shrink the influence of the medical community. For instance, one of the many innovative thoughts include appointing a non-clinical person with no medical background whatsoever at the district level to judge whether a case meets the standards of medical negligence!

How did things reach this stage? I believe some of the blame lies with us doctors.

Since doctors did not self-regulate and doctors’ professional bodies busied themselves with pointedly looking the other way, we have wound up in a situation wherein our practice is determined by fear. We are entirely exposed, unprotected, and unsupervised. We are scared of insurance companies, organisations looking to malign us, disgruntled patients on social media – I’m barely skimming the surface.

At the risk of sounding like one of those desis longing for the American dream, I look back at my time practicing in the US fondly, especially in light of the protections I was secure in. This held true even while practicing within the high risk and legally toxic practice of critical care medicine. My sole worry, at all times, was to ensure that I did not run afoul of the standards of professional and personal conduct mandated by my doctor-led professional organisation, not what my hospital CEO or government regulator thought. The American Medical Association (AMA) and the SCCM (Society of Critical Care Medicine) ensured that it consolidated the confidence and trust of doctors while upholding a work ethic that punished poor medical practices. It was the carrot and the stick. In fact, the fear amongst doctors was never whether the AMA would fairly hear us out or not, but whether government bodies and representations would fairly hear the AMA out.

Recently, I’ve come across an abundance of hearty, self-congratulatory posts about how India’s medical tourism is soaring as a result of our high quality care. Which governing and regulatory body are people in search of exemplary healthcare putting their faith in? I have looked and I don’t see any. We still don’t even have a platform to publish our real outcome data and neither have we come up with uniform quality standards that are easily understood by patients. Have no doubt that without this, it is impossible to enable them to take independent decisions on which doctors and hospitals suit their purpose.

Doctors’ professional bodies such as the Indian Medical Council’s (IMC) ineptitude would be laughable if the consequences were not so severe. At the apex of our national medical ecosystem lies this organisation, bestowed with the most important tasks of governing and protecting the profession responsible for saving lives. Some argue that it is famous (read infamous) for everything but honourably carrying out these duties. The truth remains however that our other professional bodies sat idle by while the MCI quite successfully gave us all a bad name and actually opened the doors for this kind of disempowerment of doctors.

Doctors are being edged out of decision-making processes, the policy debates, and all other conversations surrounding how healthcare will progress in our country. A lot of this is the result of doctors’ professional bodies dragging us all through the mud, making us all seem morally corruptible in the face of power and/or money. We need to keep this in mind as we try and reclaim our voices and reinstate our presence, not just to protect our profession and ourselves, but also to uphold the basic tenet of medicine- “above all do no harm”- this is for our patients!

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