Medical professionals in the private sector are up in arms against the proposed Karnataka Private Medical Establishment (KPME) Bill. Sometime back, doctors took out a protest march against violent attacks by patients and their relatives. A few years ago, doctors took the nation by storm against their inclusion in the Consumer Protection Act. Not to be left behind, the legal fraternity, the other privileged section of society, went on strike throughout the country opposing certain amendments to the Advocates Act proposed by the Law Commission of India. Every time professionals are on strike, the response of the State has been weak and takes recourse to fire fighting. Similarly, the public blame the professionals on grounds of ethics, professional values, etc. It's time to initiate a dialogue and settle whether professionals have the moral and legal right to strike, and what mechanism needs to be in place to address the concerns of professionals.
Traditionally, it is only teachers, doctors and advocates who are considered as professionals. In good old days, the teacher herself was dispensing medicines and played the role of a doctor. Nevertheless, now we have a long list of professionals. A beautician, a carpenter, even a regular blood donor, consider themselves as professionals. Professionals are a special category of individuals who are given certain privileges by the state and society and are respected by the general public. Despite many allegations against doctors and legal practitioners, people still respect them and they are the only recourse. It is like our overloaded public transport buses. Commuters may criticise and abuse them, yet they depend on them and prefer them.
Professionals, whether legal or medical, have the exclusive right to practice. It is this exclusivity that gives them special status and power. No other person, who cannot fulfill those qualifications, can practice law or medicine. Secondly, professionals are regulated by an institutional mechanism. The Medical Council and the Bar Council have developed codes of ethics, which the members are required to adhere to. Any violation of the code may, at least in theory, lead to cancellation of their membership of the profession. Neither of the regulatory bodies gives its members the right to strike. Professionals striking work go against professional ethics. It is the failure of the regulatory institutions that needs serious consideration. One cannot ignore the fact that professionals are also human beings operating in the midst of people with diverse cultural and behavioral patterns. For one or two doctors who fail in their duties and are negligent, there are hundreds of doctors serving patients, sometimes even without monetary gain.
Coming to the present strike by doctors in Karnataka, a plain reading of the KPME Bill, particularly of provisions relating to the composition and powers of the Grievance Redressal Committee, imprisonment of the guilty, fixation of rates by the state, indicate that doctors have a case. The state should realise that overregulation is more dangerous than no regulation. As noted by David Osborne and Ted Gaebler in their book Reinventing the Government, the state should steer, not row; empower communities to solve their own problems rather than simply deliver services; encourage competition rather than monopolies; be driven by missions, rather than rules; be results-oriented by funding outcomes rather than inputs; meet the needs of the customer, not the bureaucracy; concentrate on earning money rather than spending it; invest in preventing problems rather than curing crises; decentralise authority; and, solve problems by influencing market forces rather than creating public programmes.
However, the doctors cannot hold patients and the state to ransom. Their primary concern should be patients and their health. They should immediately stop their agitation and take recourse to more sober methods.
Doctors, who claim to be transparent, should come forward to publish the rates they charge. Though the 2007 Act did contain this clause, it has not been implemented in all private hospitals. In some private institutions, the board is displayed when the District Health Officer is on inspection, and removed after her exit. Regarding fixation of fees for various services, doctors, private hospitals and the state should consider forming a committee and study the practice in vogue in other states, like Maharashtra, and reach an amicable settlement. Even the Patients' Charter in the Bill should be put to public debate. It appears that not a single consumer group in the state was consulted while drafting the charter, though it is they who fought for Citizens' Charters. In addition, the appeal against the order of the grievance redressal authority should be heard by an ombudsman, who could be a retired high court judge.
