Editor's Choice India Editor’s Choice

Rx: A dose of ethics to revive trust in medical practice

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2987 (Published 09 May 2013) Cite this as: BMJ 2013;346:f2987

Re: Rx: A dose of ethics to revive trust in medical practice

Dr Jain’s editorial has drawn much needed and timely attention to the field of ethics and quality of health care in the unregulated settings of medical practice in India. The issue becomes more complex in a setting where the apex licensing authority for medical practice in India i.e the Medical Council of India (MCI) had to be recently dissolved by the Government of India due to corruption charges against the top office bearers of the institution including its chief. MCI was designated with the responsibility of ensuring basic standards of medical practice and health care in the country and not so long ago the Health Minister of India also had to resign on similar grounds apart from interfering and politicizing the functioning of the apex medical teaching and research institute of the country i. e All India Institute of Medical Sciences (AIIMS), at New Delhi.

The Indian Medical Association (IMA) which is the largest body of doctors in India is dominated by those who are successful commercially; success measured by the amount of money earned, period, no other criteria. It only comes into the forefront when some doctor gets implicated in a legal case of negligence to protect and support the doctor publicly against the legal and media hassles even if he or she is guilty. It has never ever given any statement for improving the quality of healthcare nor criticized any member ever for not following medical norms, or ethics. It protects them blindly.

Against this backdrop of crumbling institutions of medical care governance in India, and an increasingly capitalist society overall, advertised globally as “economic growth”, the issue of ethics remains a very individual level trait. There is of course a large section of clinicians who are strictly ethical based on personal and institutional values and perhaps a larger number who do what they feel is the “accepted norm” as they have seen their medical seniors, mentors and predecessors do without ever a thought on the ethical aspect of it. They are all driven by their personal aspirations of money, respect, a comfortable life and of course patient outcomes. The private sector is focussed on increasing the patient load than improve patient outcomes and the government doctors would love to lower their load as they are either overburdened with such huge numbers, that quantity of patients are often managed at the cost of quality or almost no patients at all due to low credibility.

Notably, ethics is not a part of the medical training at any level graduate, post graduate or super specialisation in India. There is no subject of ethics in medical school, not a single paper or even a question on ethics during the entire medical career. In fact, institutional research ethics committees are also a recent addition to medical institutions in India and still don’t exist in all institutions.

Therefore, if the global and Indian medical fraternity want to improve the ethical awareness, practice and conduct among medical practitioners in India, it will require a multi-pronged approach consisting of incorporating ethics as a mandatory paper in both undergraduate and post graduate medical teaching curriculum in India as a starting point. More importantly the medical fraternity and the government has to encourage and provide platforms for respecting and creating “role model clinicians” who follow ethical principles and values along with display of clinical knowledge and skills. The role models will only inspire younger doctors if the respect is not only in the form of a certificate or medal but also includes a substantive cash prize and promotion in their jobs because hardly anyone wants to emulate “poverty stricken idealists”. Moreover, there is an urgent need for India to build “model institutions” known for its technical soundness and ethical conduct like NICE in U.K.

Last but not the least, there is a need to do political advocacy for formulation of guidelines for private practice in India to ensure adequate quality of health care which promotes quality, equity, access and affordability based on ethics for the millions of patients in this country most of whom spend money from their own pockets to get healthcare and medical services.

bidyutk.sarkar@gmail.com

Competing interests: No competing interests

13 May 2013
BIDYUT K SARKAR
WT Research Scholar
Dr Sushil Dohare, Associate Prof, Sharda University, Noida
University College London
Department of Epidemiology and Public health,1- 19 Torrington Place, UCL,, London WC 1E 6BT, U.K