Padma Shri Professor (Dr) Ranjit Roy Chaudhury is a leading clinical pharmacologist, medical educationist and a researcher of repute in India. He graduated from the Prince of Wales Medical College, Patna in 1954 and proceeded to Oxford to be awarded the D. Phil degree In 1958. He was the first Indian doctor to be awarded the Rhodes scholarship
He is the National Professor of Pharmacology of the National Academy of Medical Sciences. Presently, the Chairman – Task Force for Research of Apollo Hospitals Educational and Research Foundation (AHERF). he has been appointed as an Advisor to the Department of Health and Family Welfare, Government of National Capital Territory of Delhi. He was a member of the Board of Governors of the Medical Council of India from 2010 to 2011.
LifeScienceWorld’s Editor, Sankar Iyer, interviewed Dr. Roy Chaudhury on the current ethics and norms of medical practicing. Read below Dr. Roy Choudhury’s outspoken views.
LifeScienceWorld: Having graduated way back in 1954, you have seen the growth of medical practicing and the ethics being followed. From the days when doctors who were following the norms, ethics and their conscience to the core, to this day, where the medical profession has just turned out be a business venture. The very first line of the Medical Oath “ I solemnly pledge myself to consecrate my life to service of humanity” Do you think that the current medical professionals (Doctors) truly abide by the Oath?
Ranjit Roy Choudhury: I believe that it would be fair to say that overall there has been a deterioration in the ethical conduct of doctors compared to 1954 when I graduated. There are many reasons for this and there are several ways to arrest this deterioration – some of these are to provide Ethics as a training module in the medical curriculum, to control the capitation fees in the private medical colleges and to revitalize the Medical Council of India and the State Councils. All these can be done.
LSW:. The practice of a general physician or commonly referred as Family doctor when he or she used to give in-clinic medicines (generic) assisted by the compounder has almost faded. Today, majority of the doctors have the tendency to prescribe branded drugs. Your comments
Ranjit Roy Choudhury: There are some reasons why doctors prefer to prescribe brand name drugs –
i) They remember the names of brand names but do not remember the long generic names., ii) The doctors trust the quality of branded drugs. Rightly or wrongly they believe that some or many of the generic drugs be of sub-standard quality.
iii) Representatives of pharmaceutical houses urge the doctors to prescribe the brand name drugs of their company.
I believe all this can be remedied by the following measures –
a) Inclusion about generic prescribing in the undergraduate medical curriculum., b) Providing evidence based assurance to the doctors that the generic drugs are of good quality and ensuring that this is indeed correct., c) Relationships between pharmaceutical houses and doctors to be regulated by a Code of Ethics which is part of the legal framework in the country. UNRHM is going to provide drugs only with their generic names. They must be in a position to say that these drugs are of the requisite standard for the programme to succeed.
LSW: All medical professionals are not the same. Even today, we have many practitioners who go by their conscience and ethics of their profession but their survival relies upon their patients’ loyalty and trust. Your views on this
Ranjit Roy Choudhury: Of course, there are indeed a majority of physicians who work according to their conscience No doctor wants to do unethical things. In many instances circumstances lead him to this sort of unethical conduct. If a doctor pays to get a seat and then pays again, up to Rs 1 cr. sometimes to get a postgraduate seat and this he or his family do on loans he has to resort to unethical practices to return the loan. The answer lies in carrying out the reforms in medical education we suggested as Board of Governors of the Medical Council of India in our one year term. There would be enough postgraduate seats and no buying and selling of seats. Unfortunately, these suggested reforms still have to be implemented.
LSW: Medical profession today is losing the respect due to commercialization. The growth and expansion in the medical studies, has paved way for specialization in various areas. This has created specialized practitioners in the areas like cardiology, oncology, Orthopeudic etc. which is a boon for the patients. But this has led to bitter competition among the practitioners. This obviously has led to and leading to unethical practices. What is going to be the future.
Ranjit Roy Choudhury: Competition between doctors and between specialists has always been there even in the fifties. There is nothing wrong in healthy competition. If unhealthy and unethical competition occurs the Medical Association and the Medical Council and State Councils must step in. They could, for example, work out Standard Charges for Procedures and Consultations. I do not know enough about private practice but during the six years I was President of the Delhi Medical Council we received a few complaints of doctors complaining against unethical behaviour of other doctors. We sorted out each of these complaints.
LSW: With the mushrooming specialty and multi-specialty hospitals, patients are lured towards package medical check-ups and treatments. The motto behind this is mere business and not service to humanity. Your comments:
Ranjit Roy Choudhury: Package medical treatments and check-ups have grown. Several companies are insisting that their employees take this check-up every year. The final decision whether to undergo such check-ups depend on the person himself. I feel we need more data before making strong judgments. Again all check-ups are not of the same quality. Some may be very useful while others could be avoided.
LSW: The, pharmaceutical industry plays a major role in the transformation of the medical professionals. Promotion of branded drugs is the practice. For the sake of promoting their brands, the companies tie-up with the medical fraternity, the medical practitioners and hospitals almost making them their partners in business. The doctors favor the pharma companies by prescribing their brands not bothering to know the patients’ case history.
Ranjit Roy Choudhury: Several countries in our own region like Sri Lanka and Thailand have resolved this issue by having a Code of Conduct and enforcing it. We also have Codes of Conduct governing relationship between the pharmaceutical houses and the medical profession but this is not enforced. I am not sure how widespread this unethical relationship is but the public perception is that it is fairly widespread. We need to make the relationship a healthy one by –, i) having a module on this in the undergraduate medical curriculum – Relationships with, Industry, ii) Enforcing the Code of Ethics, iii) Enforcing that the pharmaceutical industry clearly indicate what they have spent on, doctors in their Income Tax Returns – gifts, travel etc., iv) Doctors also list incentives they have received from the pharmaceuticals (by name) throughout the financial year., Prescribing brand name drugs without screening the case-history or examining the doctor is medical malpractice and the patient should complain to the Medical Council. Unfortunately the credibility of the Council itself is so low and that the public do not, by and large believe, they will get immediate justice.
LSW: It was a time when we had few medical colleges but most prestigious ones. They functioned with utmost principles, code and conduct. But today some of the same colleges or institutions have become corrupted business establishments. Your say on this.
Ranjit Roy Choudhury: In the earlier days the prestigious colleges you refer to were all government colleges except for the Christian Medical College, Vellore. Today we continue to have centres of excellence and it is not fair to say that these colleges have become corrupted business establishments. One only has to go to the Out Patients Departments of the All India Institute of Medical Sciences or the PGIMER Chandigarh or the Maulana Azad Medical College, Delhi or the G. S. Medical College, Mumbai to find hard working doctors working in difficult conditions with dedication. By and large the government medical colleges are doing a very good job in providing care and medical teaching. I wish I could say the same for the private colleges.
LSW: Private medical colleges are mushrooming mainly for the purpose a lucrative business proposition. Some of them are promoted by people with no moral or service mentality. They hire some leading doctors make them faculties or directors to fulfill their personal interest. In the process, due to the unethical practices implemented by the promoters or management, the doctors land up in big troubles. We have seen cases. Is there any government body or agencies to monitor such activities?
Ranjit Roy Choudhury::The Medical Council of India is the body that has the mandate to monitor and regulate the functioning of the private medical colleges. It has the authority to close down medical colleges if there is gross malpractice. Of course if the MCI itself is not above board then the government has the final authority to take action. They did so when in May 2010 they dissolved, the Medical Council of India and set up a nominated Board of Governors of the MCI for one year to run the activities of the MCI. I was one of the members of the Board of Governors for one year.
LSW: MCI is the watch dog of the medical fraternity in India. You had been associated with this-what are the steps taken by MCI in such practices.
Ranjit Roy Choudhury::During the one year I was a member of the Board of Governors of the MCI the following things were done –,
i) We demonstrated that a totally fair system of assessment of medical colleges is possible with randomized selection of assessors, surprise visits of the assessors to the colleges and assessment following well worked out parameters. In this system the whole scandal of borrowed faculty, fake patients, floating libraries and borrowed equipment which had made our assessment a farce, was not just possible.
ii) The whole concept and practice of setting up a Single Entry examination for medical colleges was worked out by us. This will be a great thing and will come into operation both for undergraduate and postgraduate medical entrance examinations from July 2013.
iii) Our Board had worked out a detailed Reform programme for Undergraduate and Postgraduate Medical Education in the country. The undergraduate reforms are being implemented. We plan to create a caring competent doctor with skills.
iv) The age limit for teachers were raised to 70.
v) The DNB qualification was given equal recognition as the M.D. for teaching purposes.
vi) The backlog of cases of medical malpractice was cleared and action taken on each case as appropriate.
vii) A Code of Ethics was prepared for the doctors.
LSW: Despite all the ongoing activities, some of our doctors in India and some of the Indian hospitals are the best in the world. Many patients from abroad come to India for treatment and go back cured. Is not this encouraging?
Ranjit Roy Choudhury: There are some hospitals in India providing the same level of care as the best centers abroad at 1/6th the cost. Naturally patients come to take advantage of this. There is nothing wrong in this. We need to encourage this and provide the standard of care the patients come for in addition to the human side of medicine which Indian doctors provide. Provided, of course, that we do not provide this at the expense of not providing this benefit to the Indian patient.
LSW: What are your views on the fast growing Medical Tourism ((being referred as an industry). Do you think this will be promoting the medical fraternity comprising the Indian doctors and Indian hospitals in a genuine way?
Ranjit Roy Choudhury: Medical tourism if you want to call it that is a way of offering our facilities to patients abroad. If we offer such facilities transparently and ethically it is very good. If we use this opportunity to make profits at the expense of quality health care it is bad. I believe it will be a great day if India is recognized as a country known for providing quality health care to the population of different countries. This will be possible provided we do an honest job., General Comments, Reforms in Medical Education in India need to undergo immediately – not cosmetic changes but drastic steps. Corruption needs to be replaced by transparency. We cannot continue as we are doing.