1,700 doctors who did PG Diploma from IGNOU can’t practise cardiology as MCI refuses to recognise their degrees

Opinion

1,700 doctors who did PG Diploma from IGNOU can’t practise cardiology as MCI refuses to recognise their degrees

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

The two-year course was started in 2006 to train doctors as cardiologists in 70 hospitals across the country. Between 2006 and 2012, about 1,700 doctors opted for the course. The university, however, stopped fresh enrolment in 2013 after the Medical Council of India (MCI) refused to grant a license to students pursuing it.

A group of doctors who had earlier taken the course then approached the Delhi High Court. In September last year, the court asked the Union Health Ministry to take a view in the matter.

The MCI-Board of Governors too concluded that those doctors cannot be allowed to work as cardiologists.

Reason Given: Evaluation of the training programme was not done within one year of starting it as per the Indian Medical Act, 1956 rules.

My Comments

MCI Ethics Regulation: 1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.

Under clause 1.4.2 there should be no reason not to write about their diploma on their letterhead along with then name of IGNOU. It will still be IGNOU certified and not MCI certified.

The clause 1.4.2 does not stop people for doing non-MCI diploma or take certificates. It give options of both only recognized medical degrees or such certificates/diplomas. MCI itself has no Diploma or a certificate course in cardiology, so other certificate and diplomas courses will invariably be started by institutions.  The MCI clause 7,20 should not be read in isolation but read with 1.4.2

7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch.

Also, the reason given by MCI is technical and not on merit.

With NMC taking over it may be time to revise MCI Code of Ethics (Part 3)

Dr KK Aggarwal

The MCI Code of Ethics Regulations requires a Declaration (Appendix 1) to be signed and submitted at the time of registration.

A. DECLARATION

1)    I solemnly pledge myself to consecrate my life to service of humanity.

2)    Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.

3)    I will maintain the utmost respect for human life from the time of conception.

4)    I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.

5)    I will practice my profession with conscience and dignity.

6)    The health of my patient will be my first consideration.

7)    I will respect the secrets which are confined in me.

8)    I will give to my teachers the respect and gratitude which is their due.

9)    I will maintain by all means in my power, the honour and noble traditions of medical profession.

10)  I will treat my colleagues with all respect and dignity.

11)  I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. I make these promises solemnly, freely and upon my honour.

Here is what the American Medical Association (AMA) has to say about professional responsibility and the Declaration.

Appendix D Declaration of Professional Responsibility 

Preamble:

Never in the history of human civilization has the well-being of each individual been so inextricably linked to that of every other. Plagues and pandemics respect no national borders in a world of global commerce and travel. Wars and acts of terrorism enlist innocents as combatants and mark civilians as targets. Advances in medical science and genetics, while promising great good, may also be harnessed as agents of evil. The unprecedented scope and immediacy of these universal challenges demand concerted action and response by all. As physicians, we are bound in our response by a common heritage of caring for the sick and the suffering. Through the centuries, individual physicians have fulfilled this obligation by applying their skills and knowledge competently, selflessly, and at times heroically. Today, our profession must reaffirm its historical commitment to combat natural and man-made assaults on the health and well-being of humankind. Only by acting together across geographic and ideological divides can we overcome such powerful threats. Humanity is our patient.

Declaration

We, the members of the world community of physicians, solemnly commit ourselves to:

1.     Respect human life and the dignity of every individual.

2.     Refrain from supporting or committing crimes against humanity and condemn all such acts.

3.     Treat the sick and injured with competence and compassion and without prejudice.

4.     Apply our knowledge and skills when needed, though doing so may put us at risk.

5.     Protect the privacy and confidentiality of those for whom we care and breach that confidence only when keeping it would seriously threaten their health and safety or that of others.

6.     Work freely with colleagues to discover, develop, and promote advances in medicine and public health that ameliorate suffering and contribute to human well-being.

7.     Educate the public polity about present and future threats to the health of humanity.

8.     Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.

9.     Teach and mentor those who follow us for they are the future of our caring profession.

We make these promises solemnly, freely, and upon our personal and professional honor.

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

With NMC taking over it may be time to revise MCI Code of Ethics (Part 2)

Dr KK Aggarwal

Here is how the American Medical Association Principles of Medical Ethics changed from that issued in 1980 to that adopted in 2001.

Appendix B American Medical Association Principles of Medical Ethics (1980) 

Preamble

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.
2. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law.
5. A physician shall continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical services.
7. A physician shall recognize a responsibility to participate in activities contributing to an improved community.

Appendix C American Medical Association Principles of Medical Ethics (2001) 

Preamble:

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
2. A physician shall uphold standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
4. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
5. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
6. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
7. A physician shall, recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX.A physician shall support access to medical care for all people.

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

FAQs on National Medical Commission (NMC) Bill 2019 (Part 3)

NMC to ensure due weightage to theoretical and clinical skill sets

Dr KK Aggarwal

“Clause 15: NEXT Exam

Medical Education (ME) is a specialized area with high focus on technical skill sets. A common final year undergraduate examination (NEXT) with common standards of knowledge and skills for Doctors on a Nation-wide basis.

An enabling provision has been made to ensure common standards. Regulations for operationalizing the NEXT would be made in due course keeping in mind importance of both theoretical as well as clinical skill sets required at the level of UG.

Composition of NMC includes 75% doctors representing Central and States Institutions/Councils and health universities. Such a composition of NMC will ensure that due weightage to theoretical as well as clinical skill sets is adhered to. There is a 3 year window before NEXT becomes operational, leaving ample scope for detailed negotiations on the contours of the exam.”

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

With NMC taking over it may be time to revise MCI Code of Ethics (Part 1)

Dr KK Aggarwal

The President has given his assent to the NMC Bill and with this the stage is set for formation of a National Medical Commission (NMC) to replace the Medical Council of India (MCI).

With NMC now taking over, it may be time to revise the MCI Code of Ethics Regulations.

Here are American Medical Association Principles of Medical Ethics (1957) .

These principles are intended to aid physicians individually and collectively in maintaining a high level of ethical conduct. They are not laws but standards by which a physician may determine the propriety of his conduct in his relationship with patients, with colleagues, with members of allied professions, and with the public.

·         Section 1. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.

·         Section 2. Physicians should strive continually to improve medical knowledge and skill, and should make available to their patients and colleagues the benefits of their professional attainments.

·         Section 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle.

·         Section 4.The medical professional should safeguard the public and itself against physicians deficient in moral character or professional competence. Physicians should observe all laws, uphold the dignity and honor of the profession and accept its self-imposed disciplines. They should expose, without hesitation, illegal or unethical conduct of fellow members of the profession.

·         Section 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having undertaken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients.

·         Section 6. A physician should not dispose of his services under terms of conditions which tend to interfere with or impair the free and complete exercise of his medical judgment and skill or tend to cause deterioration of the quality of medical care.

·         Section 7. In the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients. His fee should be commensurate with services rendered and the patient's ability to pay. He should neither pay nor receive a commission for referral of patients. Drugs, remedies or appliances may be dispensed or supplied by the physician provided it is in the best interests of the patients.

·         Section 8. A physician should seek consultation upon request; in doubtful or difficult cases; or whenever it appears that the quality of medical service may be enhanced thereby.

·         Section 9. A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the community.

·         Section 10. The honored ideals of the medical profession imply that the responsibilities of the physician extend not only to the individual, but also to society where these responsibilities deserve his interest and participation in activities which have the purpose of improving both the health and the well-being of the individual and the community.

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

FAQs on National Medical Commission (NMC) Bill 2019 (Part 2)

Almost 75% of total seats in the country would be available at reasonable fees 

Dr KK Aggarwal

There is a concern that medical education will become expensive with the formation of NMC. Here, the government has tried to allay this concern as below. According to the government, almost 75% of total seats in the country would be available at reasonable fees.  

“Clause 10(1) (i): Fee regulation

“IMC Act, 1956 has no provision for regulation of fees. As a result, some states regulate the fees of some seats in private colleges through MoUs signed with college managements. In addition, the Supreme Court has set up committees chaired by retired High Court Judges to fix fees in private colleges as an interim measure. Deemed to be Universities claim that they are not covered by these committees.

Nearly 50% of the total MBBS seats in the country are in government colleges, which have nominal fees. Of the remaining seats, 50% would be regulated by NMC. This means that almost 75% of total seats in the country would be available at reasonable fees.  In the spirit of federalism, the State governments would still have the liberty to decide fees for remaining seats in private medical colleges on the basis of individual MOUs signed with colleges on the basis of mutual agreement.

States also have been providing scholarships on the basis of merit cum means and would normally continue to do so in order to make medical education affordable to all students. We need to balance the interests of the poor but meritorious students and the promoters of the private medical colleges in order to expand the number of seats on offer. It is not correct to assume that colleges would be free to arbitrarily raise the fees for unregulated seats. The transparency provided by NEXT results would lead to regulation of fees through market forces. Colleges would have to provide quality of education commensurate to the fees charged by them, otherwise there would be no takers for their management quota seats.

Rating would be provided by MARB for medical institutions based on the standard of education/training.  This will serve to regulate fee through market forces.

Any affirmative action has to meet the test of reasonability. India has a large middle class population. The government of the day is duty bound to create infrastructure for all segments of society.

While we solicit private investment in the medical education sector and want private medical colleges to be financially viable, this government has not shied away from its responsibility to create more seats in the government sector. We have invested more than Rs 10,000 crores in creating government seats in the past five years, and are also setting up 21 new AIIMS at a cost of over Rs 30,000 crores to boost the medical education sector. This trend of creating government seats will continue in future.

There is no question of NMC Bill making medical education a preserve of the rich. On the contrary, it is common knowledge that before the reforms of NEET and common counseling were introduced by our government, rich students who could afford to pay huge and unrecorded capitation fees were able to secure admission to private medical colleges. Our reforms have eliminated the role of black money in medical education and the NMC Bill will provide statutory force to the reforms which have been carried out.

Another bogey which is being raised is that merit will be given a go by in the proposed dispensation. Nothing could be further from the truth. The earlier provision was that any student who obtains 50% marks at class 12 level could gain admission to MBBS courses. Colleges negotiated with students and conducted their own admission tests in a totally non-transparent manner. As a result, many undeserving students got admission. Now only NEET qualified students can get admission, which ensures that merit prevails in admissions.”

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