Aesculapius in the dock: Revitalising the new medical council

Doctors can only cringe with shame as reports of corruption, hegemony and slander within the MCI are splashed all over the media. The dubious reputation of the leadership was known and the ministry of health must own some responsibility for reinstating the president even while there were legal cases of misconduct pending against him. It is hard to see how members of the profession are expected to adhere to the highest norms of ethics when the regulatory body lies in disrepute. The attempt by the MCI and the government to legislate ethics by passing the IMC (Professional Conduct, Etiquette and Ethics) Regulations, 2002, can have very little impact under such disgraceful circumstances.

The interim board of governors appointed by the Centre to conduct the affairs of the superseded council, has called for detailed information from all registered medical colleges as the first step in assessing the extent of the crisis in medical education. They will function until there is clarity on whether medical professionals and colleges will be governed by the National Council for Human Resource and Health under the ministry of health or by the National Council for Higher Education and Resource that comes under the ministry of human resource development.

Rebuilding the apical body and the reputation of the profession will be a complex and challenging task. To prevent a relapse into old practices, it would be critical to stress on transparency in appointment of members to the new medical council. Members’ credentials and track record of service or experience should be available on the website. There is no dearth of good leaders in this field and elections would have to be democratic and supervised. Only persons of integrity, with a vision, can help get this vital sector back on its feet again.

Concerns and challenges
Health and healthcare services, which affects every citizen so critically, receives only around 5 per cent of the budget outlay and there is need to lobby for more resources to ensure healthcare for all.

Financial debt due to medical costs is the most common reason that drives a family into poverty in India. Our state of the art corporate hospitals in cities serve only the economically privileged and the vast numbers in semi-urban and rural areas have very little access to quality care. There is urgent need to upgrade and staff all district hospitals and primary health centres (PHC), ensuring better emoluments in order to attract and retain personnel in rural areas.

At present, according to government reports, PHCs serve only 60 per cent of the rural population. Although terrain and access may be difficult in certain areas, health services have to reach all citizens if we are to make any positive change in our health indices — especially infant and maternal mortality rates. Only when infrastructure in the form of roads, schools and electricity and medical care reach this disenfranchised population can we hope to see a measurable change in the healthcare scenario in India.
The fallout of registering substandard private medical colleges is already being felt. There is a shocking inadequacy in training of doctors passing through such colleges leading to a fall in the standards of care. As products of a compromised system, how can they then be faulted for seeking short cuts and monetary gain in their professional life? Most countries are aware of this disparity in the Indian medical colleges and therefore require all Indian medical graduates to re-train and re-qualify before they are allowed to practice abroad. It will be the mandate of the newly constituted council or National Council for Resource to ensure rigorous standards for accreditation of medical colleges with heavy penalties for default.

Increasing the numbers of undergraduate and postgraduate seats is not the only answer to our health personnel needs and new medical colleges cannot be allowed to compromise the standard of education in their haste to augment healthcare personnel. The curriculum must commit more hours to the understanding of ethical and socially conscious practice in order to sensitise young doctors to serve local needs. The ministry would then need to incentivise new graduates to work in family medicine, general practice and rural hospitals to propagate a grassroots level healthcare that is vitally needed in our national context. Our country has a strong tradition of excellence in medical care and exemplary institutes like Christian Medical College, Vellore, where state of the art medical expertise and cutting edge research coexists with affordable, socially conscious healthcare. These can serve as a benchmark for newer institutions.
The medical fraternity is looking to the new medical council to advocate for change in this sector and lead by example, inspiring a return to the desired standards of medical ethics and focusing on the need for health personnel in under served and rural populations to ensure a more equitable distribution of available resource in healthcare.