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Replacing MCI with NMC: to what end?

By Vatsala Vedantam Feb 2 2018, 1:11 IST

"Whenever a doctor cannot do good, he must be kept from doing harm," quipped ancient Greek physician Hippocrates in whose name medical graduates take an oath before stepping into their new profession.

The father of modern medicine could not have put it more succinctly. His advice is still relevant today, especially in a country like India, where medical colleges of dubious standards churn out hundreds of still more dubious "professionals" and unleash them on an unsuspecting public without any qualms.

It is to overcome this hazard (which mostly affects poor patients in government hospitals and primary health care centres) that the Union government is said to have introduced the National Medical Commission (NMC) Bill in Parliament which hopes to set right all the ills in medical education and practice. But, like all well-intended reforms, this one may only aggravate matters unless it is carefully examined, corrected and implemented before it becomes an Act.

As its name indicates, the Bill hopes to replace the Medical Council of India (MCI) with a National Medical Commission. (NMC) It hopes to improve the quality of medical education, both at the undergraduate and postgraduate levels, in addition to monitoring the conduct of doctors and other healthcare professionals in the country.

A tall order indeed, which requires monitoring of all medical colleges, their admission policies at the UG and PG levels; their standards of teaching and research; their facilities to carry out these programmes, and, finally, their viability to impart medical education in teaching colleges that have proper infrastructure.

The existing medical council was supposed to take care of all these aspects which it failed to do. What makes the authors of the present Bill think that merely replacing one commission with another (perhaps with the same members) will correct all the problems and ills of medical colleges, hospitals and professionals in the country?

Of the many boards that have been visualised by this Bill is the Ethics and Medical Registration Board which will "promote medical ethics among its practitioners and professionals." If the aim of this Bill is to improve medical practice, would it not be better if students aspiring to become doctors are first taught ethics and professional conduct?

Medical education is not just cutting up cadavers, learning physiology and history of diseases. It has to teach its students to be responsible professionals and cultivate qualities like decency, integrity and humanity in their conduct with patients.

How can a board promote these values in doctors who were not exposed to them in their learning years? It can only frame rules to punish them if found guilty. In a country plagued by corruption, such moral policing has no relevance.

Unethical entity

The NMC will be just one more source of nepotism and bribery where medical practitioners could be favoured or hounded if found guilty. Then, the ethics committee itself becomes an unethical entity. We have seen how substandard medical colleges were allowed to flourish by the MCI while viable institutions were unnecessarily nitpicked and harassed. Where is the assurance that the new commission will be any different? This is nothing but pouring old wine into new bottles.

The fact that the commission will be set up "to recognise medical qualifications granted by universities in and outside India" makes the NMC Bill still more suspect. When countries like the USA and the UK do not allow doctors to practice unless they qualify through their own examinations like the USMLE or UKMLE, we may be unleashing fake doctors with spurious degrees if we appoint graduates from unknown foreign universities with no credentials.

Postgraduate examinations like the USMLE, which is a test conducted in three stages to judge a medical graduate's ability to apply his medical knowledge to practical patient care, is crucial to getting a license to practice in hospitals. How will the NMC test foreign graduates when we have not established proper licensing procedures for our own medical graduates?

It's a challenging responsibility to make a fair assessment of a medical graduate's potential to be a competent doctor. Can a newly formed commission be able to undertake this responsibility where years of experience failed hopelessly? This is not to suggest that foreign universities should be suspect. But, there is a potential problem of varying standards against which we have to guard.

Lastly, any commission by whatever name it is called loses its transparency when it is politicised and becomes a handmaiden of the government. The MCI failed miserably precisely for this reason. Unless the Centre makes sure that its successor will not be trapped in the same bureaucratic, political web which aimed to strangle its independent decision-making abilities, the proposed commission will go the way of many other similar regulatory bodies. Will the NMC Bill at least ensure total autonomy for its new brainchild?

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