Letter from Chennai
RECENT ADVANCES IN MEDICAL ETHICS
Let no one say that we of Tamil Nadu have no concern with medical
ethics. We update our codes regularly. We had a code of ethics
published in 1998, but we move with the times, and now we have
a fresh code published in 2003. I did not see the need for a
new code at first, but after reading it I must admit that the
new code is a document well worth possessing. It does not have
great literary merit, but it certainly brings us up to date.
The new code begins (Chapter 1.1. A) with the declaration: ‘Each
applicant at the time of making an application for registration
shall also certify that he/she had read and agreed to abide by
the same.’ This puts the responsibility clearly on the
doctors. We cannot now claim ignorance of the code in any of
our actions.
An important new exhortation is that ‘Physicians should
try continuously to improve medical knowledge and skills’ (1.2.1)
and ‘should participate in professional meetings as part
of Continuing Medical Education Programmes, for at least 30 hours
every five years. The compliance of this requirement shall be
informed regularly to Tamil Nadu Medical Council’ (1.2.3).
Another new injunction is ‘Every physician shall maintain
the medical records pertaining to his/her indoor patients for
a period of 3 years from the date of commencement of the treatment
in a standard proforma laid down by the Tamil Nadu Medical Council
and attached as Appendix 3’ (1.3.1).
We also need to maintain a register
giving full details of all certificates issued. We should always enter the identification
marks of the patient, and enter the signature of the patient
on the certificate. Our medical registration number must be entered
on the certificate. A form is provided in Appendix 2. We should
prescribe drugs by generic name. Helpful advice is given telling
us that we should be familiar with the various Acts, Rules and
Regulations that are in force, and we are cautioned that legislation
and court decisions may also influence medical ethics. We are
reminded that termination of pregnancy in case of a normal female
foetus
is professional misconduct, and that it renders us liable to
criminal proceedings.
We are now told that we should ‘expose, to the appropriate
authority without fear or favour, incompetent or corrupt, unprofessional,
dishonest or unethical conduct on the part of members of the
profession’ (1.7). We have tended to stick together in
the past, and rarely does a doctor let down a member of his profession.
However, now that we have entered a rat race, will this give
us an opportunity to harass rivals? Or will we hesitate to cast
aspersions? As Jesus said, ‘He that is without sin among
you, let him first cast a stone at her.’
These and other recent advances
apart, most of the provisions from the past codes remain. We had them before,
but what good
did it do us? We advertise, take cutbacks and commissions, give
false certificates, cosy-up to the pharmaceutical industry, and
no action has ever been taken against any of us. Will not this
code also atrophy with disuse?
Perhaps I am wrong. Item 1.1.2 tells us ‘The
prime object of the medical profession is to render service to humanity; reward
or financial gain is a subordinate consideration.’
The Gemini Film Circuit, we are
informed by the Tamil Nadu
Indian Medical Association (IMA) Newsletter, is producing a film called
Vasoolraja, MBBS. Having sworn to follow item 1.1.2,
it is clear that we are honourable and noble persons, and would
never do
anything mean of the sort implied by the title of this film.
Item 1.1.1 inspires us: ‘A physician shall uphold the dignity
and honour of his profession.’ The President of the state
IMA engaged a lawyer who sent a notice to the producer and director
to change the title of the film and delete the screening of scenes
that affect the ‘profession of doctors and their dignity
in a court of law, in such event, you will be jointly and severally
held liable for all costs and expenses incidental thereto [sic].’ Undeterred,
the producers have held a preview and plan an August release.
Perhaps we need to retain a sense of humour.
THE ODYSSEY OF THE ASPIRANT FOR A MEDICAL COLLEGE SEAT
I am glad I entered medical college in less complicated times.
Hardly a day has passed in recent weeks without medical admissions
being in the front pages of the newspapers. I am not sure I understand
just what is going on or what is likely to happen, but let me
try to give you a gist of my impressions.
Some years ago, the Government of Tamil Nadu decreed that a candidate
who had passed the Higher Secondary School Certificate (HSC)
examination but had poor marks could make a second attempt at
the examination in the hope of doing better. One notification
about medical entrance reads: ‘In the case of candidates
who have successfully completed all the subjects of the HSC (Academic)
or any other equivalent examination, the marks in the first regular
appearance or the marks obtained by them in the first improvement,
whichever is higher, shall be considered.’ Further, in
the prospectus for admission to the MB,BS, it was stated that,
when all other qualifications are equal, preference would be
given to the person who is older. One concerned candidate approached
the High Court saying that this automatically gave an advantage
to improvement candidates who would necessarily be a year older
than the regular candidates, and was therefore discriminatory.
No less than 23% of the applicants this year are improvement
candidates. A single judge decreed that students who had taken
improvement examinations should not be allocated seats as it
would delay the admission procedure of students who had passed
the qualifying examination held in March 2004. The Director of
Medical Education proceeded to hold what is called ‘counselling’ for
the regular candidates, which is actually the allotment of available
seats in the different colleges to candidates who are called
in the order of merit. A group of improvement candidates staged
a rasta roko outside the office of the Director of Medical Education,
apparently with some success. They stopped the traffic for nearly
an hour. Two students, who had taken the improvement examination,
filed a petition with the Division Bench, urging it to reconsider
the issue. The judges who heard their plea suspended the single
judge order and posted the case for further hearing. The selection
committee interviewed (counselled) the improvement candidates
according to their standing in the order of merit, noted their
choices, but did not allot the seats, as they had to wait for
the court to take a decision.
Is your head spinning? The Advocate
General, appearing on behalf of the government, said that of 945 medical seats,
493 were allotted
to regular candidates and 452 to improvement candidates. Consider
the odds. Just under a quarter of the candidates have nearly
half the seats reserved for them. If I were a regular candidate
this year, I would feel aggrieved too. That is where we stand
now. The ball is in the High Court. What will the learned judges
say? This is one occasion when I would not like to be in their
shoes. I cannot wait for the final decision as I have a deadline
to meet, and the editor is breathing down my neck. You must watch
this space for the verdict in my next letter.
That is not all. Writs and appeals
are still pending against some ambiguous questions in the common entrance test,
and against
a government order permitting the managements of private colleges
to retain 50% of the seats under their control, whereas Karnataka
permits only 25%. Spare a thought for the thousands of candidates
who are in limbo, unaware of whether they will get their seats
or not. I have a word of advice for them. Redirect your application
to law colleges. Lawyers have a bright future.
A LEVEL PLAYING FIELD?
There is much, much more going on with medical colleges. I cannot
cover it all, but there is one thing I must tell you about. What
I have pointed out earlier is common knowledge. Government-run
medical colleges do not have adequate staff. Whenever the Medical
Council of India (MCI) comes calling, the government transfers
teachers in hundreds to man the posts for the inspection and
they go back home the day after. I wondered whether the MCI inspectors
would read the newspapers or not. Apparently they do. This time
they asked each teacher to show proof of residence in the city
in which the college was located and hardly any of them could.
Further, the MCI made a surprise inspection of the Coimbatore
Medical College, not giving the government a fair chance to transfer
teachers there in time. ‘The MCI has been detestable,’ an
unnamed senior government official is quoted to have said. Anyway,
the MCI refused to recognize 3 medical colleges, and 53 postgraduate
degree and diploma courses in a number of institutions, though
the government has been conducting these for some years.
What is to be done? The Central
Health Minister is from Tamil Nadu, so everyone expects him to do something about
it. Our former
Chief Minister said the government should be taken to task, but
the students should not be penalized for the sins of the administrators.
It is good of him to say so. However, the situation was just
the same when he ran the government. The answer is simple, but
no one in the government seems to think so. The MCI has been
entrusted with the task of ensuring that every Indian medical
graduate is well educated. It is sad that, for reasons other
than medicine, there have been instances of it failing in its
duty. Right now, it is making amends for all those past failings
and the government should cooperate and correct its own faults,
not ask for exemptions.
ANNUAL CONVOCATION OF THE TAMIL NADU
DR M.G.R. MEDICAL UNIVERSITY
The last convocation I attended in Chennai (formerly Madras)
was in 1962, when I took my MD degree from the University of
Madras. A couple of thousand youngsters had gathered to take
their degrees and the atmosphere was riotous. The convocation
address has necessarily to be of some gravity, offering sage
advice to people as they leave the cloisters of academe and enter
the real world. Great orators are not easy to come by and hardly
anyone was interested. A buzz of conversation ran round the hall,
growing louder every minute and by the time the Chancellor declared
the convocation closed, the noise resembled that in the Chennai
Central Station.
A few days ago, I had occasion to attend a convocation in Chennai
again, after a gap of 42 years. Most of the time we old fogies
speak of the good old days and how things have deter-iorated.
This was one occasion on which we could not say that. There were
close to 2000 people packed in the hall, but they were dignified
and silent and heard Dr G. Lakshmipathy deliver his convocation
address with attention and respect. Kudos to the authorities!
The proceedings were punctual to the minute, not just starting
on time but ending on the dot too. University faculty and staff
went through a dress rehearsal the night before the meeting.
College students, known to be a bit boisterous, were seated in
the front rows. It is always easier to make mischief from the
back benches. One major improvement in the academic robes was
that the headgear has been abandoned. It was always difficult
to keep the mortar board on, and an occasional loss of a high
academic’s top gear raised mirth among the bored graduates
of years gone by. The robes themselves add dignity to the occasion
and have been retained. The university has indeed improved on
tradition.
WOULD YOU BELIEVE IT?
The day after I despatched this letter, the High Court of Madras
passed an interim order restraining the Censor Board from granting
certification to Vasoolraja, MBBS. The plea was made by Dr K.
R. Balasubramaniam, President of the Tamil Nadu Medical Council.
Has he no more momentous matters to attend to? I await the final
order with interest, but whatever happened to freedom of speech?
How can there be any objection to anyone poking fun at a fictitious
doctor? I for one would be most disappointed if the Court rules
in favour of the Tamil Nadu Medical Council.
Postscript from the High Court
The judges have spoken. On Monday, 2 August 2004, they ordered
revaluation of 5 out of the 22 disputed questions, and asked
the admission authorities to work out a fresh marks list. They
accepted the principle of improvement, so improvement candidates
can still use their best marks, but they are not given any weightage
for greater age against the first attempt candidates. If two
first attempt people obtain equal marks, or if two improvement
candidates score the same, the elder will get the seat (respect
the aged, says the Court), However, if the tie is between an
improvement candidate and a regular candidate, age will not apply
(respect the aged, but with reservations).
So now the admissions committee can get back to work. However,
there is always the Supreme Court for disgruntled candidates.
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