Doctors should avoid criticizing each other Dr KK Aggarwal National President IMA Every person, who has an MBBS degree, has obtained it only after he/she has secured at least 50% marks. He/she is qualified to practice medicine anywhere in India with reasonable degree of skill and knowledge required to treat all. A doctor who has scored higher, say 60% or 70%, does not mean that the one who has scored 50% has poor knowledge. A patient visits a doctor to get the best advice from that doctor, who takes a decision based on the findings of the case at that point of time. No one has the right to criticize the other professional to establish their superiority in case of a difference of opinion over the diagnosis or line of management. Everyone has a right to differ. General practitioners (GPs) or primary care physicians often refer their patients to specialists, when the situation demands it. The patient is referred to you because you are believed to be more knowledgeable and competent in that subject. But, having more knowledge of the subject or more competence does not mean that the doctor who referred his patient to you for specialist opinion was incompetent. Doctors are often called for an opinion as experts in cases of medical negligence. Always remember you are an expert and hence more knowledgeable and skilled than the doctor accused of medical negligence. But, never judge the other doctor with your level of knowledge and competence. Judge him based on his level of knowledge and/or competence. The opinion given should be in a manner that does not set out to present the accused doctor in a negative light. “I would not have taken this approach’ in a situation does not mean that the other’s stand is not correct. Difference of opinion or error of judgment cannot be termed negligence, as held by the Supreme Court in its judgment in Jacob Mathew v. State of Punjab SC/0457/2005:(2005)6 SCC 1. Whenever there is difference of opinion, the benefit goes to the doctor in question. Professional criticisms voiced to patients undermine the trust in the profession and give it a bad image in the public, which already is under siege. As I said in my speech on the occasion of the “Dilli Chalo” movement on 6th of June, “the medical profession is being strangulated from all directions.” Criticizing your colleagues is unprofessional and unethical as it violates the code of conduct as defined by the Medical Council of India (MCI) that should govern our behavior towards our professional colleagues. 1.1 Character of physician: A physician shall uphold the dignity and honour of his profession (1.1.1). 1.2 Maintaining good medical practice: The principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man… (1.2.1) 1.7 Exposure of unethical conduct: A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession. 4. Responsibilities of physicians to each other: A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependents. • 4.2 Conduct in consultation: In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed towards the physician in-charge of the case and no statement or remark be made, which would impair the confidence reposed in him. For this purpose no discussion should be carried on in the presence of the patient or his representatives. • 4.3 Consultant not to take charge of the case: When a physician has been called for consultation, the Consultant should normally not take charge of the case, especially on the solicitation of the patient or friends. The Consultant shall not criticize the referring physician. He / she shall discuss the diagnosis treatment plan with the referring physician. • 4.4 Appointment of substitute: Whenever a physician requests another physician to attend his patients during his temporary absence from his practice, professional courtesy requires the acceptance of such appointment only when he has the capacity to discharge the additional responsibility along with his / her other duties. The physician acting under such an appointment should give the utmost consideration to the interests and reputation of the absent physician and all such patients should be restored to the care of the latter upon his/her return. • 4.5 Visiting another physician’s case: When it becomes the duty of a physician occupying an official position to see and report upon an illness or injury, he should communicate to the physician in attendance so as to give him an option of being present. The medical officer / physician occupying an official position should avoid remarks upon the diagnosis or the treatment that has been adopted. Declaration • I will practice my profession with conscience and dignity. • I will respect the secrets which are confined in me. • I will give to my teachers the respect and gratitude which is their due. • I will maintain by all means in my power, the honour and noble traditions of medical profession. • I will treat my colleagues with all respect and dignity. Yes, a physician should expose, without fear or favor, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession. But, in doing so, Regulation 1.7 is often misconstrued. Any such criticism should only be done at appropriate platforms such as the IMA or the medical council or any appropriate academic fora or committee formed for the purpose and not the media. Reserve your comments for professional discussions. IMA has the right to call such individuals and take disciplinary action So, when a patient comes for a second opinion or specialist advice do not criticize your colleagues. Comments that are gratuitous and unsustainable and aim at undermining trust in a colleague’s knowledge or skill are unethical. Doctors are the “Brand Ambassadors of Health” and as role models, they have a responsibility to act in a manner befitting their position in the society and to “uphold the dignity and honor” of their profession. So, think before you act or speak.