Wednesday, August 2, 2017

Why this disparity in standards for Allopathic and Ayush doctors?

Becoming a doctor and being a doctor is not easy. It requires lot of hard work, dedication and sacrifice. The medical profession demands long hours as the patient comes first.

The road to becoming a doctor is long one and the journey begins from the premedical examination where an aspiring doctor tries to secure admission to a medical college amongst lakhs of aspiring doctors who appear for the entrance exams every year across the country. Five and half years of gruelling undergraduate MBBS studies then follow along with series of theory and practical exams interspersed with countless tutorials along the way including one year of compulsory internship. Today, a simple MBBS degree is not enough. To become a specialist and then a super specialist, an MBBS graduate is again required to undergo entrance exams to gain admission to the 3-year PG and 3-year DM courses.

The road to becoming a doctor is about a decade long before a student acquires sufficient knowledge to become an expert in his/her chosen specialty.

All of us have gone through this process and are familiar with it.

Reiterating this long and tough process assumes importance in light of the government’s proposal of a ‘one-year Bridging Course’ allowing Ayush doctors to practice allopathic medicine at a primary health center (PHC).

India’s new national health policy 2017 has made provisions for this, which states that “the national health policy it would continue mainstreaming of AYUSH with general health system but with the addition of a mandatory bridge course that gives competencies to mid-level care provider with respect to allopathic remedies.”

An MBBS student after successfully clearing Pathology subject is not allowed to open a lab. While studying clinical subjects, the student is not allowed to practice clinical medicine or write prescriptions. An MBBS graduate, after 4.5 years of studying, is allowed to write prescription during internship training, but only under supervision.

It’s only after completing the mandatory internship training that he/she gets his/her degree and is formally allowed to practice medicine independently.

The volume of material to be studied during this process is tremendous and exhausting. For a doctor, studying does not stop with clearing the undergraduate or postgraduate exams. A doctor has to read constantly to be updated with the latest advances in medicine so that patients can benefit from these advances.

Yet, the government seems to think that a one-year training is enough for Ayush practitioners to learn the nuances of modern medicine and practice the modern system of medicine safely.

NEXT, an exit exam for all medical graduates to obtain license to practice is another proposal for modern medicine doctors, which the government wants to enforce.

By proposing a one-year Bridging course, the govt. accepts that one year is enough for Ayush doctors to acquire adequate knowledge and competency to practice modern medicine and prescribe modern medicine drugs, including schedule drugs such as antibiotics, which an Allopathic doctor takes at least a decade to learn.

Yet the govt. feels that an exit exam is necessary before an MBBS graduate is allowed to practice modern medicine, even at a PHC.

Medicine is an art based on science. It’s not an exact science. And at times, years of clinical experience of an allopathic doctor come to the aid of critically ill patients.

Will an Ayush doctor be able to recognize and accurately diagnose life threatening conditions such as acute heart attack, meningitis, early cancer, acute abdomen, pulmonary embolism, and give timely and appropriate first aid? Can they be expected to exercise discretion and judgement when prescribing drugs such as antibiotics?

Outcomes may not benefit the patients, for whose benefit, this bridging course has been envisaged. Patient benefit and safety is first and foremost. All systems of medicine work towards this common end. It is the patient who will be at loss and by putting the lives of patients at risk, the very purpose of this course is defeated. How can the government allow Ayush doctors to practice modern medicine after just one year?

MCI Code of Ethics Regulations do not allow doctors of other systems of medicine to practice modern medicine. Regulation 1.1.3 states “No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council (s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form.”

Similarly, the MCI Code of Ethics do not allow modern medicine doctors to practice crosspathy. Regulation 6.5 Secret Remedies states, “The prescribing or dispensing by a physician of secret remedial agents of which he does not know the composition, or the manufacture or promotion of their use is unethical and as such prohibited. All the drugs prescribed by a physician should always carry a proprietary formula and clear name.”

Who will own the responsibility in case of a mishap or medical negligence? How will the concept of informed consent be implemented?

By allowing Ayush doctors to practice allopathy, does this mean that our ancient systems of medicine are not competent enough to treat common illnesses in their own pathy?

We respect Ayush doctors and their pathies. They should be allowed to advance their own pathy and not indulge in crosspathy.

If the objective of this bridging course is to realize the “unmet need” of healthcare delivery in rural areas, this is not the solution. The govt. needs to strategize to empower MBBS doctors, incentivise rural practice and increase the number of family medicine seats.

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