Yesterday the Rajya Sabha passed the National Medical Council (NMC) Bill, 2019 paving the way sweeping reforms in the field of medical education in the country. The Bill has been the subject of protests from the medical community from its draft stages and doctors spearheaded by the Indian Medical Association (IMA) has rejected the Bill passed in the Lok Sabha in toto, thereby seeking to maintain status quo. Almost all medical Whatsapp groups have been inundated with memes and jokes mocking provisions in the Bill, particularly a proposed Bridge Course and measures to address the chronic shortage of doctors in India.
It is in this background that, Mirror Now, tweeted out a short video by Ms Faye Dsouza that purports to educate all stakeholders regarding the provisions of the Bill. However, as we shall see, her efforts seem intended to fan discontent among people about the Bill than to actually educate people. Ms DSouza’s video largely focuses on Chapter V Section 32 of the Bill which deals with the provision to introduce a new class of medical personnel called Community Health Providers (CHPs) and their roles. As is her wont, she starts her misinformation campaign (also read here and here) by bringing up the Bridge Course, which she says was part of the draft but fails to mention has been dropped in the version that was passed in both Houses. She says that “…people who practice Ayurveda or Homeopathy or Unani medicine or pharmacists or compounders can take a six month bridge course and start practicing some level of medicine.”
The bridge course even in its draft stage didn’t allow compounders to practice medicine. And Ayurvedic and Homeopathic doctors already legally practice “some level of medicine” after having acquired degrees that require five and half years of studying, the same as an MBBS graduate. Some more fear mongering follows; “…would you take your child or your family member to a person who has only studied for 6 months where it necessarily needs about 8 years of study before someone can prescribe medication, give you IV or decide what is the best course of treatment for you..” As has already been stated, an MBBS doctor can do all of those things with 5.5 yrs of study just like an Ayurvedic or Homeopathic doctor. She then moves on to the specific section 32 and begins to “quote” from the Bill in her effort to inform the viewer.
But whats interesting is how she leaves out important bits and whole subsections. At 1:24 secs she begins to discuss Sub-section 1 of Section 32, apparently reading off the bill “..the Committee can grant a limited license (we don’t know what a limited license is) to practise medicine at a mid-level (we don’t know what a mid-level is) as a Community Health Provider to people with modern scientific medical profession (we don’t know what that is either) and qualify such criteria as will be specified by regulations (now we don’t know what those regulations are.” Here is subsection 1 in its entirety. “The Commission may grant limited license to practice medicine at mid-level as Community Health Provider to such person connected with modern scientific medical profession who qualify such criteria as may be specified by the regulations Provided that the number of limited license to be granted under the sub-section shall not exceed one-third of the total number of licensed medical practisers registered under sub-section(1) of section 31.”
By leaving out the word “connected” Ms DSouza completely and deliberately changes the intent of this clause. Also the phrase “modern scientific medical profession” can only refer to persons involved with Modern medicine, ie, nurses, trained Physician Assistants etc, especially so in a Government that has clubbed non-Modern schools of medicine under a separate Ministry of AYUSH. She completely leaves out sub-section 2 which reads “ The Community Health Provider who are granted limited license under the sub-section (1), may practice medicine to such extent, in such circumstances and for such period, as maybe specified by the regulations”. This clause clearly indicates that CHPs aren’t at par with regular doctors and can be limited the extent, duration and circumstances under which they can practice medicine.
This explains the nature of the “limited license” being granted; something Ms DSouza indicated she couldn’t understand. She then moves on subsection 3 “…that they may independently prescribe medication without basically the supervision of a doctor in primary and preventive healthcare” Subsection (3) in its entirety reads” The Community Health Provider may prescribed specified medicine independently, only in primary and preventive healthcare, but in cases other than primary and preventive healthcare, he may prescribe medicine only under the supervision of medical practitioners registered under sub-section (1) of section 32.” Again Ms DSouza leaves out quite a bit (in this case everything in italics) to alter the meaning and intent of the clause. CHPs are only allowed to prescribe certain medications independently and that too only in the primary and preventive healthcare setting. In ALL other settings their work will have to be supervised by a doctor. After all this obfuscation she finally raises one relevant point, ie, how do we police these CHPs and the extent to which they practice medicine?
She acknowledges the reality of quacks but misses the woods for the trees. Quacks exist and thrive because there is a huge shortage of doctors in India and this shortage is most acutely felt in Rural India where, to be brutally honest, most of the protesting doctors will not go. By having trained and licensed CHPs, the Bill seeks to make up some of this shortfall. And as licensed medical personnel they will, likely, come under the same standards and checks and balances that other medical professionals come under. This scenario is infinitely better than leaving our rural patients at the mercy of quacks. And no Ms DSouza, the Bill does not give any CHP “the legal out… to call themselves doctors”.
All doctors are required to prominently display their qualifications and sign off all their prescriptions with their registration numbers thereby enabling the patient to check up on all such details with the State or National Medical Council. In the real world, doctors do prescribe Ayurvedic medicines and vice versa. As with so much else, the problems that plague medicine in India are a legacy issue of decades of uninspired policy making. This largely involved sending off fresh medical graduates to rural Primary Health Centres which are under-equipped and under-staffed via an enforced compulsory rotation or financial bonds that doctors have been protesting ever since they were first introduced.
The NMC Bill seeks to bring in some out of the box solutions to a chronic problem. It may well have teething problems. But at the very least, people like Ms DSouza should try to be accurate while informing citizens of its provisions and intent.