Weakening MBBS amid a super-specialist epidemic
India is in the throes of a super-specialist epidemic. Patients come armed with reports related only to gastroenterology when consulting a gastroenterologist, forgetting to mention that they are also diabetics under treatment with an endocrinologist, who is also not told that the stroke part is being managed by a neurologist. Patients research their ailments and decide that the atypical unstable angina symptoms are actually only gas and insist on getting upper gastrointestinal endoscopy done. Deliberately or otherwise, they will not mention the history of shortness of breath to the gastroenterologist. Even the neurologist treating a recent stroke during monthly visits does not keep a hand on the abdomen to notice the nodular firm to hard liver, which was an advanced hepatocellular carcinoma as happened recently with me.
This compartmentalisation of medicine as has happened in India is rapidly gaining ground and is not in the best interest of the nation.
Courts have emasculated the MBBS degree to an extent that except for routine fever and diarrhoea, the MBBS generalist has nothing to do professionally. He is used as a glorified clerk in glitzy hospitals and maybe does medical transcription on the side. Despite being a Bachelor of Medicine, Surgery and Obstetrics and Gynae, he can practice none of the above or gain proficiency in any one. There is no document which defines the complete scope of work that an MBBS doctor can do.
The problem is magnified in specialities, particularly MD (medicine). The internist is in a worse situation. An MBBS can at least conduct a delivery (in an emergency in a remote area), clear wax from the ear, remove a foreign body from the nose and do injection sclerotherapy for haemorrhoids. An MD (medicine), after studying for nine years, is a specialist of nothing. He is taught and grilled during the MD exam on diseases in cardiology, neurology, nephrology, gastroenterology, rheumatology and endocrinology besides infectious diseases. However, after qualification, he is a specialist of none.
During his training for MD (medicine) when his maximum qualification is MBBS, he is posted in the ICCU to treat critical heart patients. But after he qualifies and may have worked as senior resident in the department of cardiology, if he writes the word “cardiologist” on his board, it is negligence, according to the law. Is it not Bolam’s law which states that a doctor should have done what a responsible body of medical men would do? Any city will have more than 10 doctors who are MD (medicine) and practising for more than 10 years as “physician and cardiologist”, how can this then be negligence?
SKILLED IN SUBJECT
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, clause7.20 says, “A physician shall not claim to be a specialist unless he has a special qualification in that branch.” The MCI, in an RTI reply, also says that this provision does not debar a doctor having proper and adequate training/exposure, competency and experience to work in any particular discipline/branch, where he has got special interest.
Section 45 of the Indian Evidence Act says an expert is not defined by his qualification but if “he is skilled in the subject”. So an MD (medicine) trained in cardiology with experience can give evidence for or against a DM cardiologist in a court as an expert but can’t call himself an expert outside court. So who is a specialist; is it a person in or is it a person trained, competent and experienced in, that specialty?
Resolving this issue is important in a country where a quack, an ayurveda and homeopathy practitioner, an MBBS doctor and even physiotherapists are all qualified “physicians” and “registered medical practitioners”.
Given the substantial patient population that is uneducated and/or non-discerning, those with specialised training (MD, medicine) use terminologies such as heart specialist, cardiologist, gastroenterologist, endocrinologist, specialist in diabetes, neurologist in addition to the consultant physician on their letterheads and nameplates.
Unscrupulous businessmen and politicians today sell superspecialty degrees such as DM/ MCh in their private medical colleges for crores without training infrastructure. In such circumstances, is such a qualified specialist, who is not competent, better than a competent and experienced cardiologist who is MD (medicine)?
Impersonation needs to be punished but as long as an MD, medicine, who claims to be a cardiologist, does not write DM against his name, which he does not possess, there should be no illegality committed.
GOVT VS PRIVATE
It’s strange that in government hospitals, MD (medicine) and even MBBS are treating patients of heart attack as cardiologists. Under RTI, the Medicos Legal Action Group has information from civil hospitals and even large government general hospitals and it has revealed that no DM cardiology , DM gastroenterology, DM endocrinology or DM nephrology has been on their rolls over five years. What is acceptable in the government sector cannot become suddenly a crime in the private sector.
The army also has a system of graded specialists and qualified specialists. An MD medicine trained and experienced in a particular sub speciality is acknowledged and treated as a specialist.
On one side, the government laments the dearth of specialists, whereas on the other, it shackles qualified MD (medicine) degree holders with training in cardiology/nephrology/ gastroenterology from practising in the branch they are trained in.
UNSCRUPULOUS BIZMEN, POLITICIANS SELL SUPERSPECIALTY DEGREES IN PRIVATE MEDICAL COLLEGES FOR CRORES. IS SUCH A QUALIFIED BUT INCOMPETENT SPECIALIST BETTER THAN A COMPETENT AND EXPERIENCED CARDIOLOGIST, WHO IS AN MD IN MEDICINE?