Doctor’s Day 2022: Let's Decode the New NMC Draft Guidelines for Doctors

On National Doctor's Day 2022, let's talk about the new NMC guidelines proposed for doctors.

The National Medical Commission (NMC) has started a serious debate among doctors by releasing its new draft guidelines.

While some proposals in the guidelines are being welcomed, some questions are also being raised about some of the proposed guidelines.

According to the authorities, though, the new guidelines have been prepared to keep in mind the convenience of both the doctor and the patient.

Today, on National Doctors Day, let's unpack these new proposed guidelines for doctors.

A Doctor Specializing in Two Disciplines/Departments Will Have to Surrender the Registration of One of His Disciplines.

Dr Praveen Gupta, Principal Director and HOD, Department of Neurology, Fortis Memorial Research Institute, says, "What we have here has created confusion. The reason for the confusion is the existence of so many systems of medicine—cross practice."

"To bring transparency and clarify to the patient which method they are getting treatment and what medicine they are taking, this proposal has come."

Dr Praveen Gupta, Principal Director and HOD, Department of Neurology, Fortis Memorial Research Institute

Dr Gupta also says,"But we are ignoring the most important thing here: the patient's recovery- whether allopathy or Ayurveda is used for the treatment."

"Many doctor members of the association have objected to this and suggested not to make this rule. It is against the fundamental rights of our constitution."

Dr Ashwini Setya, Medical-Legal Expert and Gastroenterologist

“If a doctor is qualified in 2 disciplines, then he would not be doing anything wrong by practising in both. Why is this restriction being enforced? The only time it would be wrong is if the doctor prescribes medicines from more than one discipline to the same patient.”, adds Dr Setya

"It is not right to do this. But the same doctor can treat the patient, if need be, through his other specialized practice. That is allowed," he says.

A provision has been made in which doctors, irrespective of their discipline or qualifications, i.e. whether they are of modern medicine, allopathy, homoeopathy or Ayurveda, will practice only one domain, despite being qualified in two disciplines.

The second registration will have to be surrendered by the doctor.

Changes in the Licensing Process Given to Doctors

Some changes have been brought in the new draft guidelines. In India, MBBS graduates will have to take an exam called NExT for a license after their internship, based on which they will be registered.

Those coming from abroad after graduation will have to do a one-year internship in India even after doing training in their country. After that, they will have to take the NExT exam and also screening.

NExT is a test that will ensure a minimum standard for doctoral study students. Like in the US, USMLE is a test all medical graduates must give to study and practice post-graduate.

Similarly, it has been said to start this to check the minimum level of medical education in our country so that every person practising medicine has the same basic competence and is above a minimum level.

"Earlier, any person could get a license by doing an internship from anywhere, and he would be registered as a doctor. But now, before registration, he has to take an exam called NExT. With the help of this, the minimum level of the candidates will be checked," says Drima Anand, 2018 batch, Hind Institute of Medical Sciences, Lucknow.

It will be seen whether the person possesses at least the prescribed minimum level of knowledge and educational qualification and can practice medicine above a specified minimum level or not?

"NExT is a good effort. One of the advantages of this is that students will prepare for PG and give equal opportunity to all to showcase their potential. This will increase the overall level of medical practice."

Drima Anand, 2018 batch, Hind Institute of Medical Sciences, Lucknow

"Due to this, the level of practice will increase overall. It is not that someone took a medical degree from anywhere or any private college and got a license to practice," adds Dr Praveen Gupta.

Doctors Cannot Prescribe the ‘Brand Name’ of the Drug on the Prescription

It is proposed not to write 'brand name' in the guideline on generic medications. The doctor will only prescribe generic medicines. Strict punishment has been said for violation of this rule.

Generic medicine means, if the name is the drug of the salt from which it is made, it is called generic medicine.

For example, if a company sells paracetamol salt used in pain and fever under the same name, it will be called generic medicine.

At the same time, when it is sold under the name of a brand such as Crocin, it is called a branded drug of that company.

Suppose this guideline has been implemented, and now doctors prescribe only generic medicine. Some of the problems that I can see are:

In such a situation, when the patient goes to the drugstore to get generic medicine, two types of cases can come up, and both positions are not ideal.

Let us remind you that many pharmaceutical companies in our country make and sell generic medicines under different names.

The shopkeeper means that the chemist can show the patient 4-5 options of the prescribed generic medicine.

In such a situation, the patient is in a dilemma and will either contact the doctor again or buy the medicine with the chemist's advice.

Following the advice of a chemist can be harmful because, often, even chemists do not have complete information.

The chemist will sell the medicine in which he gets the most profit. Due to this, the pocket of the patient will become lighten.

It will also become a problem for the doctors.

For example, one tablet of multivitamin or one teaspoon of syrup contains 15 different salts.

Under this guideline, doctors must write the names of 15 medicines for one multivitamin, which can increase many other complications.

"There will be no benefit from this. We have tried this earlier also. While buying medicine, patients get into the dilemma of which medicine to take? This would have been true if only two companies in the country had the right to manufacture the medicine. Then anyone could understand."

Dr Praveen Gupta

"This would increase the problem rather than reduce it. This would allow chemists to decide which brand of medicine to take. Which is wrong because chemists are incompetent in this matter and secondly their selfishness," he adds.

There is also a problem here: when the matter is taken out of the hands of the doctor, who has more knowledge than the chemist in medicine, questions will arise about the quality of the drug. We are all well aware of the country's counterfeit medicines market.

One way to avoid this is to set criteria for quality check of the drug, and only then is the drug sold in the market for patients' use.

Refusal to give 'fixed-dose combination' to patients.

"Some medicines are such that due to their compliance, they are made into 'fixed-dose combination,' i.e. combining two-three medicines in a single capsule. This has its disadvantages and benefits. Most of the patients who need such medicines needs, are satisfied with it." Dr Ashwini Setya tells FIT.

Let us understand what the benefits of a fixed-dose combination are.

Suppose a patient has two-three diseases simultaneously, such as high blood pressure, diabetes, and thyroid. He will have to take nine medicines in a day for their treatment.

On the other hand, if he takes medication with a fixed-dose combination, then only three pills will have to be taken in a day.

Naturally, the patient would like to have at least one pill.

What Is the Reason Behind the Prohibition of Fixed-Dose Combinations?

Our experts say, nowadays many companies mix any two-three medicines to make one medicine.

After that, the doctor prescribes him. Due to this, new combinations and over-medication are increasing.

The government is taking this step to stop this, which is correct, but not all combinations are inadequate or useless. In such a situation, the mix should be approved or rejected at the level of the regulator itself.

Dr Gupta tells FIT, "Patients will have to face the dilemma and the impact of increasing the number of medicines. This will also result in spending more money on medications. It would be better to restrict the number of combinations. "

"Nowadays, anyone makes and sells any combination. Some standard-approved varieties should be kept in their place, and any other combination should be stopped from approving," says Dr Setya.

This will also eliminate unnecessary, unwanted drug combinations offered. This is not to destroy the varieties that have become prevalent, due to which people have to take fewer medicines," he adds.

"The 104-page document contained so many things, for debate and analysis, that we had sought extension of the last date for expressing suggestions, but they ignored it; the date has passed."

Dr Ashwini Setya

Doctor of Allopathy: How to Use Dr Prefix or Prefix

Many people are using the doctor prefix. For example, if there is a PhD, there is a physiotherapist, a doctor of Ayurveda and many more.

According to NMC, to end this dilemma, Modern Medicine, i.e. Allopathic doctors, have been asked to apply MED before Dr.

According to Dr Gupta, this proposal is a bit complicated, but at least those who are allopathy doctors will differentiate from others. This will help patients identify the Modern System of Medicine doctor.

"Since immemorial, doctors of allopathy have been writing Dr in front of their name. So we suggested that it would be better to do this if others, such as those who are Vaidyas or Ayurvedacharyas, use their own adjective/prefix, Unani. As Hakeem used to write, the doctors of homoeopathy should write homoeopaths. Those experts or specialists in the discipline put that discipline in front of their name, and then the dilemma will end."

Dr Ashwini Setia

FIT asked Dr Gupta, 'will using the prefix Dr for allopathy doctor and another prefix for other doctors reduce the complexity?'

He answered, "This would have been an ideal thing. Maybe we do not dare to take this step yet. We have provided this facility to everyone else, and now we do not want it back from them because they may not like it. Let me remind the importance of the doctor prefix is ​​more than any other prefix of this profession."

Many doctors put different letters in front of their names, like degrees. I'm afraid that's not right. So doctors can prescribe only those degrees which the NMC recognizes. Like many doctors write MIMA, i.e. Member of Indian Medical Association with their name like degree. This spreads confusion.

On this, the members of the Doctor's Association have suggested that those who are recognized for fellowships should be given the facility to write their prefixes.

How Will NMR (National Medical Register) Help?

Currently, there is no perfect platform or platform where accurate and complete information about doctors is available in one place.

A National Medical Register will be created within which the qualifications of people (doctors) will be updated and updated on a dynamic basis so that a continuous information flow can be made.

There will be a dynamic updation of doctors' exact number, capacity and educational qualifications across the country.

Due to this, the educational qualification and registration of doctors across the country can be seen equally.

It will be easy for doctors to practice from one state to another.

Doctors suggest that a unique number the NMC will give should be linked to the State Medical Register so that if any authorized person wants information related to a doctor, they can get it all in one place.

Digitizing all the information will prove to be very helpful.

"Guidelines are made to improve the situation. This new guideline is also a step toward improvement, but it also needs to be seen whether the guidelines are practical? Make it."

Dr Praveen Gupta

Doctors With Knowledge of Medicine Are Not Allowed to Open ‘Open Chemist Shop’, but Businesses Are.

A doctor can sell medicine to his patient from the drugstore in the clinic, but he cannot sell that medicine to another doctor's patient.

No matter how much they know about treatment. Because it is against the law to do so.

On this subject also, doctors have suggested that just like any other professional chemist, be given a license to sell medicine to all; similarly, doctors, who have more knowledge of drugs than any chemist, should be given a license to selling medicine.

Doctors Are Alone in the Matter of Medical Negligence.

Medical negligence cases are heard in the National Medical Council or State Medical Council.

One problem for doctors here is that the doctor has to advocate his case or case himself. They cannot take the help of any lawyer or any other person in this.

In such a situation, a question also arises- can all innocent doctors speak effectively enough to prove their innocence to the court?