Prefixing “Dr”: Taking the Shine Away

Reproduced from: http://www.indialegallive.com/viewpoint/prefixing-dr-taking-the-shine-away-66572, published June 6, 2019

With the pharmacy council allowing its degree holders to use the “Dr” prefix, practitioners of modern medicine are irked and patients are left confused as to whom to go to in an emergency   

By Dr KK Aggarwal

As per Medical Council of India (MCI) ethics regulation 2.1, every doctor has an obligation towards the sick: “Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission… A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient…”

Regulation 2.4 says: “The patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency….”

In an emergency situation, the only answer is a modern medicine doctor or one registered with the Medical Council of India.

But it is regulation 1.1.3 that is especially important and defines who is a physician: “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.” So, in an emergency, the public must find a doctor with an MBBS degree and the accepted way of doing it is to search for a person who has prefixed Dr before his name.

MCI ethics regulation 1.4.2 also says: “Physicians shall display as suffix to their names only recognised medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognises any exemplary qualification/achievements.” In the case of MBBS doctors, it will be modern medicine.

Article 18 of the Constitution talks about abolition of titles: “No title, not being a military or academic distinction, shall be conferred by the State. No states can officially issue titles.” When I got the Padma Shri by the president in 2010, I was cited a Supreme Court ruling as part of the briefing: I cannot use Padma Shri Dr KK Aggarwal under Article 18. But I can use Padma Shri awardee Dr KK Aggarwal or recipient of Padma Shri Dr KK Aggarwal.

The prefix Dr used by modern medicine doctors is not given by the Medical Council of India, a medical college or a state university, but by society to differentiate us from others and identify us as modern medicine doctors. However, today, even a person who has completed doctoral research and is awarded a PhD, prefixes Dr to his name. Practitioners of AYUSH systems of medicine also prefix their names with Dr even though they have their own appropriate terms such as Vaidya (Ayurveda), Hakim (Unani), Naturopath (Naturopathy), Yogacharya (Yoga) and Homoeopath (Homeopathy). One must remember that in an emergency, these systems of medicine are not effective. That’s not all. Universities also felicitate eminent individuals for their contribution in many fields such as literature, science, sports, music, cinema, social service, etc, with doctorate degrees. These individuals also prefix Dr to their names.

Now there is talk of the Pharmacy Council of India (PCI) authorising candidates receiving the Doctor of Pharmacy degree (Pharm D) from recognised universities to use the “Dr” prefix. This title reflects entitlement and identity and the Indian Medical Association (IMA) is against it being used by those trained in other streams of medicine as it confuses people during medical emergencies. In a letter issued to the director of Board of Examination and Evaluation of Sant Gadge Baba Amravati University, the registrar-cum-secretary of the PCI, Archana Mudgal, has informed that the University should use the “Dr” prefix before the names of candidates while awarding them degrees. But as universities in Maharashtra were not issuing degrees with “Dr” prefix, members of the Doctor of Pharmacy Association of Maharashtra approached the PCI for clarification. The PCI then issued a circular stating that Pharm D candidates can use Dr before their names. Legally, this is only an executive order and not a legally sanctioned clause.

Physiotherapists have also been asking for Dr as a prefix. Tomorrow, even nurses will start writing Dr as a prefix. Of course, quacks are also prefixing Dr before their names. And surprisingly, even health products are using Dr liberally such as Dr Morpen, Dr Fixit, etc.

The use of Dr as a prefix is widespread, be it dentists, veterinary doctors, acupressure and acupuncture specialists or occupational experts. The easiest solution to distinguish these branches of medicine would be to have specific degrees such as XYZ, Doctor of Pharmacy.

When I was the National President of the IMA, this matter was discussed on many occasions. We were getting many complaints from the public of being misguided and exploited by untrained doctors during emergencies.

Different variations of Dr were being used—DR, DR., Doc, Doc., Doctor, Dr (Modern Medicine), Dr (Homeopathy), Dr (Ayurveda), Dr (Naturopathy), Dr (Dental), Dr (Veterinary), Dr (Yoga), etc. I personally started carrying a stethoscope around my neck as a symbol of modern medicine and being available in any emergency.

While one can stop pharmacists or physiotherapists from using Dr before their names, one will never be able to stop AYUSH doctors from doing the same. So the IMA copyrighted an emblem for modern medicine which is to be used by all its doctors to differentiate themselves from those in other fields.

The government must come out with a regulation so that ordinary people can differentiate between doctors of different systems of medicine. The confusion can cause fatal errors and delay in treatments. Will the government listen or should we again look to the judiciary to intervene and take a decision?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

National Education Policy 2019: Pluralistic healthcare education with IMC Act still in place is premature

The government has released a draft National Education Policy 2019, which proposes to make changes in education including healthcare education.

The policy is in the public domain, with comments sought from all stakeholders till June 30.

A key recommendation of the new education policy as far as medical education is concerned is pluralistic healthcare education and delivery.

P16.8.2: Pluralistic healthcare education and delivery: “The first year or two of the MBBS course will be designed as a common period for all science graduates after which they can take up MBBS, BDS, Nursing or other specialisations. Common foundational courses based on medical pluralism will be followed by core courses focused on specific systems, and electives that encourage bridging across systems. Graduates from other medical disciplines such as nursing, dental etc., will also be allowed lateral entry into the MBBS course.  A medical education qualification framework to achieve this will be developed in conjunction with the NMC...”

This means that after class 12, students aspiring to become healthcare professionals will first take up a common 2 year (or 1 year) course of basic sciences after clearing a common entrance test and then they can choose a system of medicine be it MBBS, dentistry, nursing, Ayush, occupational health, physiotherapy, etc.

What is not clear is how students would be selected for their specific system of choice. Would it be through an entrance exam? Would each system hold its own separate exam or a common exam? Or there will be only one exam at this level and for basic course there will be no common exam.

  

The initial two-year course may enable a student to take up teaching as a vocation.

Also, the terms “bridging” and “lateral entry” have been used out of context here and have created ambiguity and are therefore open to misinterpretation.

There are debatable issues, which need to be discussed in stakeholders meeting and several challenges in their implementation should be anticipated and addressed. 

The above thinking is also premature as the IMC Act is still not abolished. The MCI ordinance is under challenge in the Supreme Court.

A debate cannot be started on an assumption that if IMC Act is replaced by NMC what should be the criteria for education?

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

The battle is still far from being won; the struggle must continue

Dr KK Aggarwal

Padma Shri Awardee

The Union Cabinet has cleared some amendments to the proposed National Medical Commission (NMC) Bill, which will now be debated in both Houses of the Parliament. Will they pass the amended Bill or will the Bill be passed by vote of voice remains to be seen. IMA and all doctor MPs should continue their efforts to get more amendments done before the Bill is passed.

·         Final MBBS Exam to be held as a common exam across the country as an exit test called the National Exit Test (NEXT): This is a victory of all. IMA had proposed last year. Now, the students would not have to appear in a separate exam after MBBS to get license to practice. NEXT would also serve as the screening test for doctors with foreign medical qualifications to practice in India. It will make more doctors available to practice. The next debate ….Who will conduct the exam?

·         Provision of Bridge course for AYUSH practitioners to practice limited modern medicine has been removed. But it has been left to the State Governments to take necessary measures for addressing and promoting primary health care in rural areas. This is a win for both Modern medicine and AYUSH systems of medicine. Ayush will now be able to continue research in their disciplines. If they had entered modern medicine, as had been earlier proposed, their very existence would have been at stake.

·         Fee (including all charges) regulation for 50% seats in private medical institutions and deemed universities. More details are needed, or the private institutions will increase the fee for 50% of seats in crores. A solution to this can be to increase number of government and district medical colleges.

·         Number of nominees from States and UTs in NMC increased marginally from 3 to 6. The NMC will comprise of 25 members of which at least 21 will be doctors. Not been able to increase the seats of registered medical practitioners is a major failure on our part.

·         Only 5 representatives from the registered doctors in states, as suggested to be 9 by the parliamentary committee, is too low a number. It seems that the government does not want IMA or professional representatives to be a part of it. It will be our collective failure if we are not being able to challenge it. Only one representative from each zone or all five from all India elections will make it interesting?

·         Monetary penalty for a medical college non-compliant with the norms has been replaced with a provision for different penalty options (warning, reasonable monetary penalty, reducing intake, stoppage of admission leading up to withdrawal of recognition etc). This needs to be studied in detail.

·         Stringent punishment for unqualified medical practitioners or quacks: The punishment for any unauthorized practice of medicine has been made severe by including a provision for imprisonment of up to one year along with a fine extending up to Rs. 5 lakhs. It’s good that it is ‘AND’ and not ‘OR’. Once convicted the imprisonment is a surety. We need to study the loop holes further.

Our struggle was not only against NMC…It was but one of our many demands.

The battle is still far from being won.

We were also fighting for suitable amendments in the Clinical Establishment Act (replacing police representative from DRA with a representative of the association; exempting single doctor establishment; doing away with NABH inspection, suggestion with respect to standard treatment guidelines to be provided by IMA and to define the change in the word ‘to stabilise’) and PCPNDT Act (graded punishments and non penal provisions for clerical errors).

A stringent central act against violence and capping of compensation (to be based on the lines of Drug and cosmetic rules in a clinical trial and not based on annual income of the patient) have been on the forefront of our agenda.

We also need to continue to voice our demands for increasing the health budgetary allocation to 5% of GDP; introduction of IMS on the lines of IAS and implementation of MCI Code of Ethics 8.6 to decide professional negligence and misconduct and MCI-IMA recommendations on police actions as recommended by the Hon’ble Supreme Court in any alleged criminal negligence.

Our demands of omission of penal provisions on doctors during practice, uniform pay scale for service doctors across the country and better service conditions for doctors and patients in government hospitals still remain unresolved.

Any government listens to pressure.

Events like IMA Dilli Chalo or IMA Mahapanchayat should be a part of our annual calendar of events and should become the extraordinary general body meeting of IMA and FOMA.

We should continue to fight for our rights as well as that of our patients till we achieve what we set out to do when we embarked on this journey. Even Rama, Krishna, Jesus had to fight for their principles.

What shape the NMC would ultimately take may well depend on how steadfast we are.

All resolutions must be adopted and fought for till they are achieved.

IMA will be taking further call on its plan of action on 2nd April after meeting with the Health Minister.