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Jan-Mar2003-11(1)
CONFERENCE REPORT
Everything but medicine
Sanjay Nagral
The seminar 'Everything but Medicine' was organised
as one of the annual programmes of the Salelkar Medical Foundation on August 24,
2002. The Foundation was established in the memory of Dr Salelkar, a popular
physician and leading internist from Goa. The focus of the meeting was ethical
and medico-legal issues in the practice of medicine, and it was well attended,
with representation from medical professionals of all specialities and from
various parts of Goa. I participated in the seminar on behalf of the Forum for
Medical Ethics Society.
The meeting started with a talk on 'How to avoid
consumer courts' by Dr Shah, an orthopaedic surgeon and medico-legal expert from
Gujarat. His talk was a typical enumeration of 'precautions' that doctors should
take so that they do not get involved in medico-legal tangles. The emphasis was
on protecting oneself with defensive practices rather than on rational and
standardised practice. Dr Shah was followed by Dr Keiki Mehta, a senior
ophthalmologist from Mumbai, who spoke on 'How to market yourself ethically'.
This lecture consisted of tips from this senior successful private practitioner
on how to enhance one's image in the market of medicine by the use of subtle
techniques which do not smack of 'advertising' and thus invite criticism. For
example, Dr Mehta suggested that getting favourable reports on one's work and
clinic in the lay press could be very useful. Or one could train one's clinic
staff to impart information on one's competence, in a matter-of-fact way, while
talking to waiting patients.
This was followed by a talk on 'Patients'
perceptions' by Dr Sugandha Johar, a management consultant, who spoke on how
patients find their doctors wanting in communication. She tried to make her
point by role playing and by quoting various published studies on the subject.
Her effort to point out the medical profession's poor emphasis on providing
information to patients was, however, met with hostility. The audience responded
with a barrage of questions rather than reflection. Many of them questioned the
right of Ms Johar, who they said was a 'non-medico', to bring up such issues.
The meeting ended with a panel discussion on the
Medical Council of India's revised Code of Ethics, 2002. The panel consisted of
a representative of the Goa Medical Council, a representative of the IMA, Goa,
and myself representing the Forum for Medical Ethics Society. I presented a
brief background to the MCI rules. I spoke on the historical evolution of
medical ethics. Society recognised medicine as a profession and expected in
return that the profession would regulate itself. The medical councils had a
central role in this self-regulation. In India the failure of self-regulation
had led to intervention by the state and the judiciary, and the promulgation of
various laws. Finally, I emphasised that the basic principles of the so-called
'new' provisions in the MCI's Code of Ethics were actually present in the
previous set of rules in a different form and all of us as practising doctors in
India were already signatory to these. Many of the new guidelines were necessary
to respond to new areas of concern - such as human rights, torture, euthanasia,
recognition of brain death, sex determination and sex selective abortion, IVF
and artificial insemination. Also, recommendations like compulsory CME and the
use of generic names of drugs for prescription would actually increase the
credibility of the profession in the public eye. Thus, if we recognise the
amendments are mainly responses to the changing pattern of medical practice, the
emergence of new technologies, and pressure from activists and from
international agencies, we would be in a much better position to respond to
them.
The representatives of the Goa Medical Council and
IMA were candid in their description of falling ethical values in the practice
of medicine in Goa. They lamented that all the 'unethical' practices which were
associated with big cities were now rampant in Goa. They largely supported the
idea of self regulation and in fact suggested that Goa should take the lead in
the process of introspection and reform in the profession.
In the last few years the health care system in Goa
is changing rapidly from a predominantly state-run system to a privatised one.
Overall it was a little disappointing to see the seminar follow the fairly
predictable pattern of meetings of medical professionals on 'ethics' in which
the emphasis invariably shifts to 'medico-legal' issues, especially the Consumer
Protection Act and its fallout.
It was obvious from the audience's response that
the defensive and hostile response of the medical profession in India, to
regulation over the last decade, is reflected in Goa as well. However, the fact
that a large number of doctors spent a good five hours discussing and debating
these issues may be a positive sign. Also, the rather frank admissions by the
representatives of the Goa Medical Council and the IMA, about the need to stem
the decline in ethical values, were encouraging.
In the true tradition of Goan hospitality, the
meeting ended with a variety of cocktails and a sumptuous meal. Also, in a
departure from meetings in big cities, many of the participants were seen
stridently and ferociously debating some of the issues well beyond midnight.
Whether this was a result of the stimulation of wine or the meeting's
deliberations, it was indeed promising.
Sanjay Nagral,
Consultant Surgeon, Jaslok Hospital, Mumbai 400 026. Email:nagral@vsnl.com