As doctor-patient mistrust grows, IMA announces self-regulation tips for doctors, hospitals

Indian Medical Association (IMA), the professional lobby group of allopathic medicine practitioners has just announced a set of self-regulation measures for hospitals and doctors. What triggered the decision, announced at a press conference on Monday in New Delhi, are the growing incidents of doctor-patient mistrust in the country.

The immediate provocation apparently was the action initiated by Haryana government against one of the hospitals of the leading private healthcare provider Fortis for allegedly failing to provide adequate treatment to a seven year old dengue patient. In a similar fashion, the Delhi government had decided to cancel the license of one of the units of Max Healthcare, another corporate healthcare chain, for wrongly declaring a premature baby as dead, both recent developments. A couple of months ago, while hearing a Public Interest Litigation against alleged overpricing of cardiac procedures by private hospitals, the Delhi High Court had the Union health ministry to come out with a policy to put a check on overcharging patients.

As IMA National President KK Aggarwal says, the doctor-patient trust in the country, which was already experiencing a downward spiral, has deteriorated further. Can self regulation help? Will there be voluntary compliance across the board?  "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. We are often blamed for prescribing costly drugs. 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. No service charges should be added to procure drugs from outside. MRP shall not be dictated by the purchaser."
 
The IMA recommendation is the following:

• IMA recommends that all doctors should prescribe preferably NLEM (National List of Essential Medicine) 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 doctors indulging in female feticide.
• 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.
• IMA LAMA policy: being a grey area is being made.
• 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. Acknowledge their 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 for us all are equal. BPL, APL, EWS, rich, or poor all should get the same attention and treatment.
• IMA policy: With no National Guidelines viability of fetus issue is being looked upon by IMA, FOGSI, IAP and NNF.
• 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.
• We must ensure that our establishment has a transgender policy.
• 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.