IMA moots self-regulation to boost doctors-patients trust

Jolted by shocking incidents involving twins and a 7-year-old dengue patient in two different corporate hospitals, Indian Medical Association has listed out a host of self-regulation techniques both at the state and the national level so as to arrest further deterioration of doctor-patient trust in the country.

The move was necessitated as IMA leadership said that doctor-patient trust was experiencing a downward spiral with all stakeholders including doctors, hospitals, the health industry, patients, media and politicians are said to be unhappy.

While doctors do not have the intent to be the cause for public unrest or loss of public trust, there is need for patients to understand that to err is human and one incident does not mean that there will be more such cases in future as well.

"What happened was most unfortunate. However, not all doctors are wrong, and the public must have faith in them. Such errors happen by accident and not intentionally. Having said this, it is also time for the medical profession to introspect and come out with self-regulation procedures," said Dr Agarwal.

The foundation of Trust

Trust is the foundation of a doctor and patient relationship. The medical profession is undergoing certain changes. While violence against doctors is on the rise and they are being held accountable for deeds not committed, it is also true that there is some introspection needed on the part of doctors and hospitals, failing which this trust may take a long time to reestablish.

Today, the private sector looks after 80% of the patients that too with highest quality. In the absence of state subsidy private sector providing quality care will invariable will come at a cost which is still at fraction of a cost compared to that in advanced countries.

Speaking about this, Dr K K Aggarwal, National President Indian Medical Association (IMA) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "It is disheartening to see the erosion in trust and we want to make it more transparent. IMA is and will continue to work towards improving doctor-patient relationship."

Linking such incidents to skewed doctor to patient ratio in India, the top IMA leadership said that doctors are also human beings and not healing angels. "Once treatment is administered, the recuperation of a patient depends upon physical and organic factors. It is unacceptable and absurd to victimize the medical practitioner if the patient does not respond to treatment,” they said.

Self-Regulation

All doctors shall practice with compassion and follow IMA ALERT policy (Acknowledge, Listen in detail, Explain, Review and Thank you). The IMA has also announced formation of an IMA Medical Redressal Commission at the state level (in each state) to engage in social, financial, and quality audits of health care (Suo moto or on demand). 

The commission will have a public man, an IMA office bearer, one former state medical council representative, and two subject experts. 

The commission shall consider every grievance in a time bound manner. An appeal from the state commission will be heard by the "Head-quarters IMA Medical Redressal Commission" which will have the powers to take suo moto cases also. The headquarters shall also suggest reforms in healthcare on periodic basis.

From today onwards, all doctors in the country shall choose affordable drugs. We also appeal to the government to come out with an urgent ordinance for one drug-one company-one price policy. Doctors should actively participate in ensuring that no hospital sells any item priced higher than the MRP. 

The other points announced by IMA are as follows.

·             IMA recommends that all doctors should prescribe preferably National List of Essential Medicines (NLEM) drugs.

·             All doctors shall promote Janaushidhi Kendras.

·             We appeal to the government to classify all disposables under both NLEM and non-NLEM categories and cap the price of essential ones. Till then all medical establishments should sell the disposables at procurement prize after adding a predefined fixed margin.

·             Hospitals and doctors are often blamed of overcharging and over investigations. Billing should be transparent, and all special investigations should be well informed.

·             Every doctor should ensure that it becomes mandatory on the part of the hospital administrator to give options at the time of admission to choose cost-effective treatment room and treatment (single room, sharing room, and general-ward) and explain the difference in total bill estimates.

·             All doctors should ensure that hospital estimates at the time of admission are near to actual.

·             The treating doctor must explain the chances of death and unexpected complications and resultant financial implications.

·             Once doctors take charge of a patient, the patient should not be neglected. They should look after the patient till discharge.

·             Emergency care is the responsibility of the state government and the government should subsidize the costs of all emergencies in private sector.

·             Every medical prescription must include counseling on the cost of drugs and investigations.

·             IMA has zero tolerance to cuts and commissions. Medical establishment should revisit their referral fee system. Billing paid to doctors should be transparent and reflected in the bill.

·             No hospital can force their consultants to work on targets. Contractual agreements should be in such way in which interested of both parties that is consultant and the hospital is equally protected. All hospitals should consider not charging service charges from the consultants.

·             Choice of drugs and devices rests with the doctors based on the affordability of the patient and not on the profitability.

·             All hospitals must comply to the commitment towards EWS, BPL, and poor patients without any discrimination.

·             All patient complaints should be addressed in a timely manner through an internal redressal mechanism with a chairman from outside the hospital.

·             All medical establishments must ensure that their business ethics comply with the MCI ETHICS.

·             Every dead body needs to be treated with respect and dignity.

·             All charitable hospitals should do their free work as assigned.

·             All needy patients must be routed through the social worker of the establishment and guided and directed to the appropriate place.

·             At least one more equally experienced but unrelated surgeon should be involved in the consent form during elective LSCS.

·             The patient has a right to get medical records within 72 hours of request. 

·             The patient has the right to go for a second opinion from an appropriately qualified medical doctor. The primary doctors have no right to get offended.

·             A hospital has no right to stop life-saving investigations or treatment for non-payment of bills if the patient is still admitted in the hospital. The government should make a mechanism for the reimbursement for the above for poor patients.

·             Ensure all patients are treated equally. BPL, APL, EWS, rich, or poor all should get the same attention and treatment.

·             We are not against any regulations and accountability, but we should all ask for a single window accountability at the state level. The state medical council should be proactive and take timely decisions. We should also ensure a single window registration.

·             All government hospitals should be upgraded and have facilities like those in the private hospitals. All public, private or charitable hospitals should have quality accreditation.

·             No doctors should issue false certificates.

“All the above will should be implemented with immediate effect”, said Dr Ravi Wankhedkar, National President Elect IMA.