Medical Practice - Yesterday, today & tomorrow
Medical Practice – yesterday, today and tomorrow
The present generation of senior doctors in India, are witness to a dramatic transformation of the society in general and medical practice in particular. The changes are positive as well as negative. The changes have been witnessed in the attitudes, facilities, knowledge, skills & results.
Medical science has progressed with leaps & bounds. The fantasies of yesterday have become realities of today. Laparoscopic surgery & Robotic surgery are only 2 to 3 decades old and have made complicated surgeries so easy. The support systems in the operation theaters & ICUs, with specialists & super specialists have enabled good outcomes even in very complex cases. Artificial Intelligence and Machine Learning tools are going to further enhance diagnosis & treatment of complicated diseases in future. Pharmaceutical industry as well as instrumentation and devices have revolutionized medical practice. Specialities like cardiothoracic surgery, Neurosurgery, Spine surgery, Bariatric surgery, ART, Fetal surgery, congenital diseases, genetic disorders, Oncology and so on are now in the realm of effective treatment though they could only be imagined a few decades ago.
With progress in medical science, the awareness levels of the public have also improved immensely. The internet and the social media virtually provide information on all aspects of medicine. This does educate the laypersons but can be a double edged weapon, as little knowledge sometimes proves to be dangerous. The high awareness level coupled with consumer activism has brought in a never imagined burden of litigations on the medical practitioners. The Consumer Protection Act, being a beneficial legislation to protect the interests of the consumers, has been lopsided and heavily prejudiced in favor of the consumers. With each amendment, the provisions have become more & more unfavorable for the medical practitioners.
All adverse events during the course of medical treatment & care started being treated as medical negligence & deficiency of service. With the consumer court judges having little or no experience of clinical medical practice, it often presents a very peculiar situation in the courts. Advocates from both sides and the judges required to adjudicate on highly technical issues of medicine, are devoid of the necessary knowledge & experience on contentious issues. Bookish knowledge may not suffice for deciding on what the doctors did or did not do in a given case under circumstances specific to the case. Some of the changes witnessed during the last few decades and what could be expected in the next few decades, in the field of law, are summed up as below :
1. Doctor patient relationship : The relationship between doctors & patients, earlier had been fiduciary in nature, based on trust. The doctor trusted his patients and the patient trusted his doctor. For the good outcome, doctor was given the credit and for adverse outcome, it was taken as God’s will. Doctors were actually & genuinely given the status of second Gods. People felt privileged in standing up and giving their seat if they came across a doctor, in a bus or train. Doctors also treated their patients as their own family members. Money was never an issue between them. Doctors very often used to help poor patients with monetary help to purchase food & medicines. There was never a dispute between them and litigation was out of question. Gradually however, as the society transformed with materialism & commercialism gaining more & more importance, this trickled into healthcare as well. The doctor patient relationship now became contractual and the trust deficit kept on increasing between the two.
Medical treatment became more & more costly as the diagnostic and therapeutic modalities developed exponentially. With better knowledge, experience & skills, just as the outcomes improved, the healthcare cost kept on increasing. Dis-regarding all this, the patients expected their ‘second Gods’ to stay unchanged. The introduction of large corporate hospitals was welcome in improving the quality of treatment & care of patients but obviously, everything has a cost. The cost of medical treatment went on increasing. The small community hospitals began to be neglected and only poor patients without the third party payor facility, looked towards them for medical help. The expectations from doctors became more & more unrealistic. Services similar to a large corporate hospital with charges of a small nursing home, created an imbalance between expectations & reality. This essentially resulted in growing mistrust between doctors and patients. This led to exploitation of each other though by miniscule minority, on each side. The consumer activism, in 1980s & 1990s resulted in enactment of the Consumer Protection Act in 1986. In 1995, the Hon’ble Supreme Court, considered it appropriate to include Medical Practice also under the purview of this Act (VP Shantha v IMA). This was the first major milestone shattering the doctor patient relationship in India. There have been flood of cases against doctors and hospitals in consumer courts, growing since then.
Doctors were at the receiving end, with lot of cases filed against them, even for frivolous reasons. This obviously caused harassment, defamation and financial losses. The non medico judges in the consumer courts and the lawyers with their inherent limitations, compounded the problems further. The medical practice became more & more defensive in nature. In fact this started a vicious cycle of exploitation from both sides – to a smaller or larger extent, worsening the doctor patient relationship. The plight of doctors was never really understood by the law makers.
A significant decline in this declining doctor patient relationship came when corporate hospitals came to the scene & grew rapidly in metropolitan cities & gradually in Tier 2 & Tier 3 cities. These hospitals actually have brought in world class infrastructure, equipment and systems. They also brought in the culture of mediclaim insurance in view of the exorbitant cost of treatment in these hospitals. So the public had easy access to world class treatment but were not prepared for the high costs. Those without mediclaim insurance found it hard to pay the costs of the corporate hospitals. They began to harbour similar expectations from smaller hospitals. The smaller hospitals are essentially neighborhood community hospitals and thrive on low charges and personalized services. Now it has become difficult for these hospitals to match the rising expectations of the patients. The adverse events in smaller hospitals, now tends to bring the doctors on the defensive as the patients suspect negligence & deficiency of service in all such cases. The doctor patient relationship dipped further and the litigations increased further. This also brought in the element of hospital violence.
Another milestone in the doctor patient relationship is the recent enactment of the new CPA in 2019, notified on August 9, 2019. The Rules for implementation of the CPA 2019, termed as Consumer Protection Rules 2020 have been notified on July 15, 2020 and the Act has come into force for implementation, from July 20, 2020. Some of its features which have caused a further deterioration in the doctor patient relationship are :
i. Some allegations related to bills, cash memo, receipts, excessive advance deposits, refunds have been included as unfair trade practice, with penalties including imprisonment and fines
ii. Central Consumer Protection Authority (CCPA) formed to regulate matters relating to violation of rights of consumers, unfair trade practices and false or misleading advertisements which are prejudicial to the interests of public and consumers and to promote, protect and enforce the rights of consumers as a class. CCPA shall have an Investigation Wing for the purpose of conducting inquiry or investigation, under this Act, as may be directed by the Central Authority. Failure to comply with orders of CCPA : imprisonment upto 6m or fine upto 20 L or both
iii. Pecuniary jurisdiction has been increased as
· District : where value of goods or services is < 50 L
· State : where value of goods or services is 50 L to 2 cr
· National : where value of goods or services is > 2 cr
This obviously encourages the consumers to claim heavy amounts even in frivolous complaints. There being no significant court fee and no need to visit State Capital or the National capital, the quantum of potential extortion / blackmail by filing such complaints, has increased many folds. In addition the District Commission also gets the liberty to award heavy compensation against doctors & hospitals, with potential for encouraging corrupt practices.
iv. At the same time, the request for increasing the trivial capping of Rs.10,000/- on penalty for frivolous complaints, or capping it to a proportion of the amount claimed, the new Act has removed the provision for penalty in frivolous complaints, altogether. This is a huge invitation for false & frivolous complaints.
v. Territorial jurisdiction has been enlarged in favour of the complainant, to include place of cause of action or place of residence or branch office or work for gain of respondent or place of residence or work for gain of the complainant
vi. Statutory court deposit for appeal has been increased to 50 % of the awarded amount. This will be a big discouragement to file an appeal against an erroneous District Commission order.
The doctor patient relationship yesterday was fiduciary in nature, today it has evolved into a contractual relationship and we seem to be heading for exploitational relationship in future.
2. Materialism & commercialization in the society : Social dynamics impact all segments of the society. Medical professionals are no exception. Expecting them to be static and unaffected by the changing social environment, is not correct. After spending lot of time and effort as also huge sums of money on their education & on their hospital, equipment and staff, expecting them to depend only on charity for their own survival, is too unrealistic. Doctors not only spend lot of money to be able to provide good healthcare services but also need money to live a good life for themselves & their families. Yes, there are some black sheep amongst them, who exploit the situation, like there are black sheep among advocates, judges, architects, engineers, chartered accountants, bureaucrats, politicians & so on. The whole profession cannot be demonized because of such black sheep. It is very unfair to make laws with prejudice against them and with every incident of hospital violence, the powers that be remain indifferent. As a matter of fact, a large percentage of frivolous litigations and violence is faced by the law abiding, genuine, dedicated & hard working medical professionals, as they are the soft targets. The black sheep, expecting a back lash, are clever enough to manage such events through their under hand tactics and contacts with influential people.
3. Impact of digital technology, robotics, Artificial Intelligence & Machine learning. In the good old days, the doctor provided personalized treatment to his patients. He had lot of limitations but much of that was compensated by a detailed history taking, a good physical examination and analysis of diagnosis & differential diagnosis followed by treatment & detailed counseling. There used to be a good level of trust between them which also helped. The spectrum of healthcare has expanded a great deal in the last few decades, with outcomes improving even in hitherto incurable conditions. Part of this has been achieved because of extensive medical research and availability of high tech support. Robotics, Artificial Intelligence and Machine learning are being used in the medical diagnostics & therapeutics, more & more, with encouraging results. As we move along, technology in general and technology in healthcare will become even more important. Digitization of patient’s health data and its access to the doctor on consultation will facilitate medical practice a great deal. The investigation reports & images will also be available by the click of a button. There will also be a time when the patient’s allergies to food products & medicines as also drug to drug interactions, will automatically alert the doctor while prescribing medicines. The doctor’s function will mainly be to counsel the patient and address his queries. Robotics & AI will evaluate the patient’s body systems for the minutest details to facilitate the treatment & care. Surgical procedures will become more precise, targeting tissues & cells to rectify the ailments. Robotic surgery might become the routine. The surgical training will also be facilitated by endo trainers and surgical simulators.
4. Internet & Social media in medical practice. This has truly revolutionized the communication and information system. One can get information by the click of a button, as they say and the information can be spread to one or more persons very fast. This helps the doctors if their patient has gained some basic knowledge about his disease and the options of treating it. It helps if he is aware of the fact that there is always a chance of his body not responding adequately to the treatment. It helps if he is aware from his google search that the outcome depends on several known & unknown factors, many of which are not in the hands of the doctors.
Factors causing adverse events during treatment
Doctors try to counsel their patients on these factors. It will help them if the patients either accept what their doctor tells them or understand the dynamics of the body response to disease & treatment from their google search. However, many times the patients or their relatives & friends do a sketchy search and specifically search for the negative aspects to match with their fears and apprehensions, which may actually not at all be relevant in the given case. This tends to spoil the doctor patient relationship, bringing distrust between them. Doctors were never taught in their undergraduate & postgraduate curriculum, the art of dealing with such situations. The National Medical Commission has done well to give lot of attention to the soft skills in the curriculum of doctors. Internet & social media has lot of other positive impacts. It has facilitated communication between the medical team members, sharing pictures of lesions, monitor screen, images, reports etc to speed up the decisions. It has markedly improved tele-education programs for updating of knowledge & skills. Culture of webinars has brought in a good alternative to offline seminars.
In the future, it appears that the technology will bring some ease in the doctor patient relationship. Uploading & updating of patient’s digitized health data & current symptoms into a robotic system, will get his diagnosis & proper line of treatment. He will visit the doctor only for confirmation or a second opinion. The treatment and care in the hospital will also become mechanized with the help of nurses using gadgetry for almost every thing. Surgeons in the operation theater will get the well prepared patient, for surgery by robots supervised by the surgeons. All details will be captured in the form of dynamic images and data. The patient goes back to the ward for monitoring and supervision by monitors and machines. The actual role of the doctors will become very much limited. That will also be a blessing in disguise because in the period before the highly mechanized healthcare management era, the medical litigations and hospital violence will have discouraged many bright boys & girls from joining medical profession or going for post graduation & post-post-graduation. The Robots will be able to fill that resource gap to a large extent. Moreover, the government is encouraging half baked doctors from Ayush stream & nursing cadre in doing much of the primary healthcare & wellness work. This will also take off much of the load from qualified medical practitioners & specialists. The future will surely see lot of changes in which healthcare is delivered.
5. Impact of consumer activists. Consumer activism, in the society, in the government and in the judiciary, has already tilted the balance of doctor patient relationship, highly against the medical practitioners. Medical practitioners have adopted a defensive approach and this is likely to grow in future. Bright boys & girls in the society are discouraged from taking this stream as a career. Those who do take up medicine as a career prefer the softer specialities (eg dermatology, psychiatry, radiology, pathology) and shun vulnerable clinical specialities like surgery, anesthesia, obstetrics, cardiology, critical care medicine. Primary healthcare and wellness will be dealt with by Ayush doctors and nurse practitioners. It also appears that the dominance of the corporate hospitals in healthcare delivery esp in secondary & tertiary care, will be almost complete. The small nursing homes in small towns will either perish or be restricted to primary healthcare and wellness. The level of public awareness, high standards of hard & soft infrastructure and standards of quality & patient safety and the high expectations of patients from doctors & hospitals, will make it difficult for the small nursing homes to serve comfortably. There may be a trend for small hospitals of a city to collaborate to pool their resources to undertake their services with some degree of safety for themselves & for their patients. Hopefully, public private partnerships in healthcare might be devised on more realistic terms so that they become attractive for both parties. Perhaps failure of the PPP models in healthcare because of one sided stringent terms, may educate us on more equitable terms. There is another potential which has not yet been tapped adequately and may be seen in times to come. Large corporate houses should be encouraged to adopt villages for developing their infrastructure to an optimum level. The government should provide the support and facilitate their functioning as best as possible. In addition, all medical colleges should mandatorily adopt 5-10 PHCs and 2-3 CHCs and run them as their satellite units. Again the government should provide optimum support to them in the process. The fee structure for the services provided may be capped at 50 % (or so) of their regular schedule of charges, in a transparent manner. This will enable them to maintain the services, with minimum of strain. Government can support these medical colleges by way of easy loans or grants, if required and ensure adequate security to those doctors & HCWs working & living in the premises. One expects lot of activity in this direction in the future because Covid 19 has given us a wake up call in terms of the importance of primary healthcare & wellness and the importance of community & personal hygiene and health education of the public. Mediclaim insurance will become almost obligatory. The scope, scale & spectrum of Ayushman Bharat will also be enlarged to cover most illnesses & most procedures also for middle class families.
6. Changes in consumer protection laws. The CPA 19 has tilted the balance heavily against the service providers in general and medical practitioners in particular. We may get a time when the judiciary & the law makers might see some serious lacunae in this enactment which may well be exploited to frightening extent. Some of these are
a. There is no provision for medical screening of cases before the complaint is admitted
b. The pecuniary jurisdiction of the District Commission has been increased to upto 50 Lakh, from 20 Lakh earlier and for pecuniary jurisdiction, the Act looks at the consideration paid and not the compensation claimed. This not only encourages the complainant to claim unrealistic high amounts for any perceived deficiency. He faces no difficulties in the absence of proportionate court fee or need to go to the State HQ or National capital to file the complaint of such a huge claim.
c. Territorial jurisdiction has been enlarged to heavily increase the difficulties for the doctors. The complainant can now select his place of residence or place of work (anywhere in India) to file the complaint. In most hospitals patients come from different cities & different States of the country to get the specialized treatment. So now the doctors & hospitals will need to move from city to city in different States of the country to fight these cases.
d. The penalty for frivolous complaint (which was unrealistically capped to Rs.10,000/-) has been removed altogether
Consumer laws as also the alternate disputes redressal mechanisms are likely to grow much faster than the conventional litigation process
7. Hospital violence. Hospital violence has been bothering the doctors / hospitals for the last about 2 decades. Initially it used to be occasional, sporadic incident but over the years it has grown into a pattern. Violence of some type & severity has been faced by about 80 % of the doctors. It is a strange phenomenon. Doctors are not the adversaries of their patients. In fact both the parties are jointly fighting the disease. Two major factors, which generally initiate violence, are related to adverse events during treatment and the billing issues. Doctors & hospitals, anywhere in the world, cannot get a 100 % positive outcome, in all cases. This fact is made clear to the patients before admitting them. In fact the patients & their family members, at the time of admission, have a very cooperative attitude (‘second God’ label). They accept all the risks associated with treatment & care related to the disease. They accept the risks & complications that may occur. If an adverse event, unfortunately does happen, their attitude changes (negligence, deficiency). Some relatives & friends of the patient show their presence by showing an aggressive response, vitiating the environment in the hospital. The problem then peaks at the time of billing, esp if the billing staff is not very tactful. They start abusing the billing staff & others who come to their rescue, followed by shouting, assaulting and breaking the hospital property.
8. Changes in Medical Education scenario. Medical education has deteriorated over the years. This has been largely due to the mushrooming of private medical colleges, paucity of good teachers, failure to update the curriculum as per the current requirements and overall social degradation. Some changes are being brought in after the enactment of NMC 2019 where provision for soft skills training of undergraduate & postgraduate students and training of the faculty is there. Emphasis on preventive public health and wellness is also welcome. The same needs to be smartly ingrained in medical education. With the passage of time the eligibility requirements of medical colleges will shift from horizontal dimensions to vertical dimensions and from number of rooms and number of faculty members to quality of faculty members and their ability to train a larger number of students. Emphasis on apprenticeship during training is also to be considered. We do visualize lot of changes in medical education and skilling of doctors, nurses and other healthcare workers.
9. ESMA and its impact. Essential Services Maintenance Act is a laudable legislation because the essential services need to be given top priority. In healthcare, we have often seen & read about ESMA being invoked when the doctors are compelled to go on strike when the authorities ignore their legitimate demands. Invoking ESMA under these circumstances is like a threat to crush a protest. Hopefully, in future, the society might realize that the government, district administration and the judiciary also have a responsibility towards the ‘essential’ services. Why should the people manning essential services face difficulties during their duties. Why the grievances of the people manning essential services, be ignored & not addressed promptly and properly, even though they deal with essential services. Why should they be compelled to come on the roads and resort to strike. Time may come when the authorities realize this aspect of their responsibilities towards those who man essential services and do not give them any chance to feel aggrieved.
10. Hippocratic Oath. This is meant to be a sacrosanct document to be publicly recited & signed on getting the medical graduation degree but has been reduced to be only a routine ritual. In the changing social dynamics some aspects of that original oath has become irrelevant. The Hippocratic oath is often used to demonize the medical practitioners, when they happen to go on strike or when some adverse events happen in the hospitals. Some efforts have been made to modify the oath but none has been able to actually replace the original oath. Let us discuss this in some details.
a. Historical aspects. Who designed the original oath is not exactly known but it is generally believed that it was composed in 4th century BC, by the Greek physician Hippocrates, often referred to as ‘father of western medicine’. It is not clear as to what weight it carried in its own time or how widely it was used and what were the consequences of not adhering to it. Were there other oaths also prevalent and this was the only one survives, is also not known. After several centuries, this oath was re-discovered by church scholars and the first recorded mention of this oath outside of Greece was at the University of Wittenberg, Germany in 1508. It was translated into English in the 18th century and its different versions began to be used in medical schools in Europe & USA, as oath in the graduation ceremonies. There have been versions after that. After World war II, as a reaction to the Nazi atrocities, the oath of Geneva was written. The Declaration of Geneva was adopted by the General Assembly of the World Medical Association at Geneva in 1948 and amended in 1968, 1984, 1994, 2005 and 2006. Different Universities & Medical Schools used these versions of the oath with or without modifications. Whatever version is used at graduation ceremony of medical colleges in India, they are generally addressed as Hippocratic oath.
b. The original Hippocratic oath is as under
“I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation”
“to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and Oath according to the law of medicine, but to none others.”
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel.”
“in like manner I will not give to a woman a pessary to produce abortion”
“With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.”
“Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.”
“Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.”
“While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!”
c. The oath is laudable & a well conceived concept. However, its importance is reduced because of some lacunae like
i. The contents of this oath do not match today’s requirements in the current social environment.
ii. The oath needs to be recited not only in graduation ceremony but periodically all along the professional career of the medical practitioner
iii. The oath is not worded in simple flow for the medical practitioner to understand
iv. The oath is only a moral binding and has no legal binding
d. The lawmakers in India have done well to enact an ethical code for the medical practitioners in India. This is called the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002. This has a legal binding and covers several ethical & moral aspects. The National Medical Commission has also brought out the ethical code for medical practitioners. These legislations tend to objectively look at the aberrations and penalize the violators
e. It may also be worthwhile to have a new Hippocratic oath which is commensurate with the current needs of social environment. It should be such that it is amenable to easy understanding, practically comfortable to recite it periodically and taken as a moral binding by the medical practitioners. It will be more meaningful & effective if the new medical graduates & post graduates are able to see their seniors adhering to its contents, in letter & in spirit, in their practice.
f. Such an oath is being suggested as under :
I, ________, on this day, swear in the name of God that:
a. I will give to my teachers the utmost respect and gratitude that is their due and uphold the rich heritage of the skills & ethics that we have inherited from them in the past. It will be my privilege & honour to provide my professional services to my teachers & their family members, if they so need & desire.
b. I will use my knowledge, experience & skills for the benefit of my patients. I will try my best to ensure that no harm is caused to them because of my treatment and / or care.
c. I will counsel my patients about the inherent possibility of adverse events due to known & unknown causes, inspite of the best efforts of the treating team. In such a situation, I will do my best to take care of such events with due diligence and in a compassionate manner.
d. I will not permit considerations of caste, creed, nationality, disease or disability, social or political standing or any other factor to intervene with my professional duties & responsibilities.
e. I understand my patients’ right to privacy & confidentiality. I will respect and maintain the same.
f. I will provide the relevant information to my patients before asking for their consent for any procedure. I will counsel them & their family members and give them enough opportunity to seek clarifications, so that they can make an informed choice while giving or refusing consent
g. I will continue to keep myself abreast of advances in medicine and will understand & admit my limitations. I will not hesitate in seeking advice from experts of the same or different speciality, where indicated, for the benefit of my patients.
h. I will not allow my ethics and medical practice to be influenced by cash or other incentives offered by drug, appliances, devices or other companies or any other agency.
i. I will not hesitate in providing first aid and supportive care in emergency / life threatening cases, without wasting time in formalities, which can be completed later.
j. In emergency cases, if I need to refer the patient to another hospital, I will guide and help them to the best of my knowledge & capabilities.
k. I will abide by the rules & regulations of the place of my practice and cooperate with the authorities, whenever required
I shall repeat this oath frequently lest I should forget that I am in a divine profession to heal my fellow human beings. So help me God
11. Indian Medical Association (IMA), Being the biggest association of medical practitioners in India, IMA was expected to discharge a huge responsibility in safeguarding the interests of the members as also to act as a professional bridge between the members & the government and between members & the general public. It has unfortunately not done any thing substantial to prevent unjust regulations, atleast since 1995, when the medical practice was included under the purview of the Consumer Protection Act, by the Supreme Court. IMA was a party to the case. It remained casual & complacent and could not provide proper arguments against inclusion of the medical practice under this Act. If the inclusion was inevitable, it should have convinced the court to provide safeguards against false & frivolous complaints. If we slipped during that petition, IMA could have planned representations to the government / law makers for introducing the safeguards. For example, mandatory screening by a credible medical expert before the complaint is admitted and a penalty for false & frivolous complaint, amounting to a proportion of the claim amount, were very genuine & effective amendments which should have been requested for by the IMA. Nothing has been done by IMA against the multiple taxes like professional tax, commercial tax, Pollution fee, PNDT registration fee etc being levied on healthcare establishments. Such taxes for small hospitals in tier 2 & tier 3 cities or in rural areas, is an avoidable source of financial & administrative burden, which deserved effective action from IMA. Hospital violence is another area which has largely been neglected by the IMA. Apart from lip service in the form of some press releases or protest marches or dharanas after some grave instances, nothing substantial has been done. The violence continues unabated and the IMA sits helplessly waiting for some miracle to happen. The new CPA of 2019 is even more lop sided & prejudiced against the doctors. IMA has no plan or strategy to protect its members from such absurd provisions against those who are labeled as second Gods or Angels, whenever it suits the public. Similarly some of the provisions in NMC 2019 have been included ignoring the feeble protests by the IMA.
It appears that the IMA has lost track of its own objectives. Their agenda & priorities have become more individualistic & self centered rather than for the best interests of the fraternity. If that were not so, we would not have seen them wasting energy on superfluous things like sponsoring & endorsing products like PepsiCo’s Tropicana fruit juices and its breakfast cereal Quaker Oats, Crompton Greaves LED bulb, Dettol, Kent water purifiers, Asian Paints etc. Many of the National & State office bearers of IMA are committed & vocal proponents of political parties. Their commitment to their fraternity cannot be as strong, because of their political affiliation with one party or the other. Their opinions & actions reflect their political agenda and the important IMA meetings remind one of the fights that we often see between different political parties. There is no proactive program to correct the public perception about doctors & medical profession. There was a suggestion to start a newspaper or a magazine or even a TV channel of our own, to project the correct image of doctors & hospitals and to show to the public the good work being done by them contrary to the negativity projected by the existing modes. Nothing has been done in that direction. There is no program to identify black sheep among its members and to take corrective measures against them. IMA should have been a professional body with highest credibility, with no place for bad elements. The IMA has the major responsibility to serve the best interests of the members, in discharge of their professional duties. The focus on academics, conferences & seminars is misplaced. There are specialist professional bodies good enough for that. IMA has got into these projects because there is lot of money in this. The IMA has got derailed because of these direction-less paths. Unfortunately, the IMA hierarchy is managed by the IMA mafia which remote controls who will be the next President & his team of ‘ministers’. How then can such an organization remain on track even if it is composed of doctors, the so-called cream of the society. The fact of the matter is that the real issues of importance for the members do not attract due attention of the IMA ‘sarkar’. They pay only a lip service to the real issues which trouble the members. Whenever violent incident happens, IMA just gives a media byte here & there or writes some letters and get silenced till the next incident occurs.
It is hoped that IMA or an alternate association of doctors will rise in future and work to dedicatedly and effectively safeguard the interests of the members so that the members, in turn are able to serve the public with their un-divided attention.
12. Learnings from Covid 19 Pandemic. This pandemic was the biggest global tragedy of our times. However, it was also an opportunity for us to learn, un-learn & re-learn several things. In the field of health, importance of personal & community hygiene, importance of Social & Preventive Health, diet & nutrition are some of the most important things that came our way. Importance of masks, physical distancing and avoiding crowds as much as possible are other things we learnt. Telemedicine, virtual meetings & webinars have provided a good alternative to physical consultations & meetings. It is hoped that the learnings from this pandemic will be taken forward as the new normal.
As we move forward, the society in general and the law makers & opinion makers in particular would do well to learn from the past experiences and evolve a healthcare system in our country which is useful, effective and equitable for all stakeholders.