Rather than commission of various regulations for qualified doctors, i am concerned more about so many issues that are omitted by the NMC!
Why did NMC omit the serious issues like prohibition of quackery,crosspathy&mixopathy and bridge courses?
Why did NMC omit the rights of doctors?
Why did NMC omit addressing the issues of rampant violence?
When NMC is quasi-judicial & LEARNED MEDICAL BODY, why is there a need for CPA and civil litigations?
Why did NMC omit the addressing of prolonged working hours that could affect the clinical judgment of the doctors?
Why did NMC omit the addressing of insecure working places & disparity in stipend?
Why did NMC omit the addressing of deficit infrastructure that has been crippling the right treatment at right time?
When responsibilities are prescribed, it's natural justice to highlight and assure the rights also!
------------------------ the above questions raised in my mind after going through the draft code.
The National Medical Commission on 23rd May 2022, has notified the Draft National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022 and has invited comments from the public, which shall be addressed to the email at emrb.ethics@nmc.org.in within one month i.e by 22nd June 2022.
According to the NMC draft regulations, The Ethics and Medical Registration Board (EMRB) and NMC will generate a unique ID No. and thereby accord license to practice medicine to the practitioner in the respective state or union territory.
The National Medical Commission proposes the Code of Medical Ethics, which will serve as the set of commitments of the registered medical practitioner towards patients, society, professional colleagues, and self.
code of ethics include beneficence,
empathy, non-maleficence, respect for patient autonomy and confidentiality,
integrity, honesty, and justice. Medical practitioners are expected to uphold
these principles for their inherent value in medical practise.
not intended to establish legal or
clinical standards in practice but to provide a set of ethical guidelines .
The code of ethics carefully makes
use of the English language to stress of the significance of certain
points. The words 'must', 'shall / should 'and 'may 'are used purposefully
in these guidelines and indicate the degree of obligation that the doctor has
to follow the guidelines. The word 'must 'indicates a higher level of
commitment and obligation required of the doctor, while in the case of
'shall/should 'the level of obligation is less and there could be room for
individual judgment.
Ten important guidelines of NMC draft regulations
1. Modern doctors practice what they study and get qualified.
2. Modern doctors shall not employ or get associated with any healthcare professional who is neither registered nor trained.
3.. private doctors can refuse to continue to treat a patient if the fees are not paid.
4.Every doctor may prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets
5.. Doctors shall not dispense or prescribe or promote secret remedial agents.
6.Every private doctor shall maintain medical records of patients (outpatients or inpatients) for 3 years from the date of the last contact with the patient for treatment, in a standard proforma laid down by the NMC.
7.The doctor shall not exploit the patient for personal, social, and business reasons and in particular, avoid sexual boundary violations.
8. doctor shall not refuse on religious grounds alone to assist in or conduct of sterility, birth control, circumcision, and medical termination of Pregnancy when there is a medical indication. . In case of emergency (life and limb saving procedure) an RMP shall provide first aid and other services to the patient according to his expertise and the available resources before referral.
9. Doctors should keep in time with appointments or visiting/consultation hours. If there is a delay for a valid reason, the patient should be informed.
10. Consultation through Telemedicine by the doctors shall be permissible following the Telemedicine Practice Guidelines.
1. Must provide care for the
patient with compassion and respect, keeping the best interest of the patient
in mind at all times.
2. Must protect patient
confidentiality and privacy, and treat every patient equally, without
discrimination.
3. Must not refuse to treat a
patient in case of medical emergency, nor discriminate between patients based
on gender, race, religion, caste, social, economic or cultural grounds. No
patient should be abandoned.
As per the Code of Ethics, the
following are "Shall/Should" for Medical Practitioners
1. Shall ensure one's competency
and fitness to practice, and keep up to date with advancements in medical
practice. They shall consult with other health professionals, as and when
required for the benefit of the patient.
2. Should be respectful of the
patient's rights and opinion, communicate clearly with the patient, and be
honest and transparent in all professional interactions.
3. Should function in accordance
with the laws of the land. When there is a conflict between ethics and law, the
doctor is expected to advocate for changes in the law, in the interest of
patient care.
4. Shall be responsive to
individual and community health needs, and advocate for patients and the wider
community they serve in matters of health and welfare.
5. Should practice according to his
conscience and ethical guidelines, free from external pressures. They should
not provide treatments that are not medically indicated, and must not
participate in any act of torture.
6. Should promote and model the
ethical standards of the profession in the work place, mindful of the moral and
professional obligation owed to the patient and society who have reposed trust
in the profession.
7. Should not hesitate to report
unethical acts, fraud, incompetence, dishonesty, exploitation or misconduct on
part of other health care professionals that could result in harm to the
patient.
8. Should recognize conflict of
interest situations that may arise in practice as they are detrimental to the
patient and should avoid or minimize them. In such situations, the patient's
interest should take precedent over any other consideration.
9. Should not engage in endorsement
or promotion of any drug or medical product for commercial purposes or for
personal gains. In sharing findings of research with peers and scientific
societies, the practitioner is expected to be neutral and unbiased in the
interest of science and patient care.
10. Should protect and minimize
risk of patients who participate in medical research, conscious that the dual
role as researcher-practitioner would require disclosure to patients and
additional regulatory and ethical compliance.
11. Should ensure that professional
boundaries of the doctor patient relationship are respected and not violated.
Doctors to declare their earnings
from pharma in affidavit, violations to bring 3-month suspension:prohibiting
doctors AND THEIR FAMILIES from taking any kinds of gifts or money from pharma
and medical device companies, linking the same to a penalty that can go upto 3
months suspension.
The guidelines also state that
doctors may have to file an affidavit declaring their financial earnings and or
benefits received in the past 5 past years from any pharmaceutical companies or
allied health sector.
CONDUCT OF RMPs ON SOCIAL MEDIA
Doctors should not directly or
indirectly indulge in the practice of purchasing "likes",
"followers", or paying money so that search algorithms lead to their
name being listed at the top or registering on software programs (apps) that
charge fees for higher ratings or soliciting patients," the guidelines
clearly spell out. The draft guidelines, however, currently do not define what
comes under the ambit of social media.
The draft currently, however, does
not clearly specify what all falls under the domain of Social Media.
The guidelines do not stop any
doctor from having their own websites or social media profiles but specify that
the information should be factual and can be verified. The information should
not be misleading or deceptive, nor should it exploit the patient's
vulnerability or lack of knowledge.
1. RMPs can provide information and
announcement on social media. However, the information should be factual and
can be verified. The information should not be misleading or deceptive, nor
should it exploit the patient's vulnerability or lack of knowledge
2. RMPs should avoid discussing the
treatment of patients on public social media or prescribing medicine to
patients on the public social media platform. If a patient approaches doctors
through public social media, the doctor should guide the patient toward a
telemedicine consultation or inperson consultation as the situation warrants.
3. RMPs should not post patients'
photographs or scan images (ct/pet scans) on social media. Once an image is
posted in social media, it becomes data that is owned by the social media
company or the general public.
4. RMPs behavior on social media
towards his colleagues should be guided by general principles of medical ethics
on professional behaviour.
5. RMPs should not directly or
indirectly indulge in the practice of purchasing "likes" ,
"followers" , or paying money so that search algorithms lead to their
name being listed at the top or registering on software programs (apps) that
charge fees for higher ratings or soliciting patients.
6. RMPs should not request or share
patients 'testimonials or recommendations or endorsements or reviews in social
media.
7. RMPs should refrain from sharing
images of healed/cured patients, or surgery/procedure videos or images
displaying impressive results under any circumstances.
8. RMP is allowed to share
educative material for the information of the general public. However,
communication should be limited to the expertise of the RMP.
9. RMP's webpage should also follow
the same guidelines as above.
10. On social media, RMPs should
refrain from boundary crossings or violations and conduct themselves with
dignity and decorum.
11. Soliciting of patients directly
or indirectly through social media is unethical
The draft regulations, released by
the National Medical Commission's Ethics and Medical Registration Board (NMC
EMRB) for public comments, are intended to replace the current code of ethics
set by the Medical Council of India two decades ago. The last date to send the
comments to the NMC is June 22, 2022.
These new regulations have
addressed the issue of Professional Conduct of Registered Medical Practitioners
(RMPs) including their duties and responsibilities, continuing professional
development program, remuneration, prescribing generic medicine, prohibition of
commission, responsibilities regarding sale of drugs, medical reports, etc.
Apart from these, the regulations
have also specified about the duties of RMPs towards their patients,
responsibilities of RMPs towards each other, their duties towards the public
and allied healthcare professionals. The issue of Professional Misconduct has
also been addressed in these regulations. It describes the procedure for a
complaint of professional misconduct, manner of inquiry into the complaint,
manner of inquiry into the complaint, prohibition of review of the order, power
of the SMC/EMRB, delay in decision, etc.
Further, the guidelines for
prescribing generic medicine, the template for writing prescriptions, NMC code
of medical ethics, guidelines on penalties, levels of disciplinary action as
per breach of conduct, guidelines on informed consent in clinical practice,
conduct of RMPs on social media, format for medical record, form of certificate
recommended for leave or extension or communication of leave and for fitness,
continuous professional development guidelines, creation of CPD Committee under
EMRB, application for obtaining eligibility for conducting CPD from EMRB,
format of certificate for delegates among others.
Key Highlights from the draft regulation.
- As per the draft regulation, the registered medical practitioner (RMP) should attend continuing professional development programs regularly each year, totaling at least 30 credit hours every five years. Only recognized medical colleges and health institutions or medical societies accredited or authorized by EMRB/State medical Councils can offer training and credit hours for this purpose.
- The Consultation fees charged by the RMP should be made known to the patient before examination or treatment of the patient. A reasonable estimation of the cost of surgery or treatment should be provided to the patient to enable an informed decision. A RMP can refuse to continue to treat a patient if the fees, as indicated, are not paid. This does not apply to doctors in Government service or emergencies and the doctor must ensure that the patient is not abandoned.
- A RMP shall not solicit patients directly or indirectly or as a part of the group of RMPs, or institutions or organizations or hospitals or nursing homes, or corporate hospitals established, owned, controlled, or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organization or any other entity or person.
- Every RMP is expected to prescribe drugs using generic names written legibly and prescribe drugs rationally, avoiding unnecessary medications and irrational fixed-dose combination tablets.
- Every self-employed RMP shall maintain medical records of patients (outpatients or inpatients) for 3 years from the date of the last contact with the patient for treatment, in a standard proforma laid down by the NMC.
- A RMP shall not run an open shop to sell medicine prescribed by RMPs other than himself or for the sale of medical or surgical appliances. They are allowed to sell medication to his/her own patients.
- All signatures in the notes, prescriptions, certificates, orders, referral summaries etc, should carry the RMP’s Name and NMC Registration number. Electronic generation of orders/prescriptions may help automation of this information.
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