Doctors and hospitals should be governed by a common code of conduct

Doctors and hospitals should be governed by a common code of conduct Recently, hoardings “Honest Opinion, No Commission to Doctors” put up by the Asian Heart Institute in Mumbai generated a lot of controversy, with many criticising it as casting a negative shadow over the entire profession. Giving and accepting Rebates and Commission are unethical in the medical profession as laid down in the MCI Code of Ethics under Regulations 1.7, 6.1.1, 6.4 and 7.19,. “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. 6.1 Advertising: Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or organizations is unethical (6.1.1). 6.4 Rebates and Commission 6.4.1 A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive, any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment. A physician shall not directly or indirectly, participate in or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding of any fee for medical, surgical or other treatment. 6.4.2 Provisions of para 6.4.1 shall apply with equal force to the referring, recommending or procuring by a physician or any person, specimen or material for diagnostic purposes or other study / work. Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly qualified person rendering medical care under his supervision.” 7.19 A Physician shall not use touts or agents for procuring patients.” Where do doctors stand vis-à-vis the culture of corporate hospitals today? The MCI Code of Ethics are binding on doctors. However, the corporate hospitals are out of the purview of the MCI. Doctors cannot advertise. Hiring agents or touts to solicit is an unethical act on the part of a doctor, but all corporate hospitals have a marketing dept. It is also unethical for a doctor to give rebates and commissions but for a corporate medical establishment, there is no such bar. It is very unfortunate that doctors working in the corporate hospitals and who are bound by a code of conduct, work and report to corporate hospitals, who do not have to abide by a similar code of conduct. Doctors are under pressure to reach the “targets” given to them by the corporate hospitals. There should be a common code of conduct for doctors and hospitals and both should abide by it. Alternatively, hospitals should be owned only by doctors. According to me, there should not have been any controversy on this issue. The hoarding put up by the Asian Heart Institute very daringly showed that the hospital does not indulge in the unethical practice of cuts and commissions. In my opinion, all hospitals in the country should follow suit and declare that they respect the MCI Code of Ethics and will not allow the unethical “cuts and commissions” practice in their premises. Doing so will make their interactions with doctors transparent to the public. This will generate trust resulting in an effective doctor-patient relationship, which is in the interests of both the doctor and the patient. IMA is for “one code of ethics” for doctors and hospitals and had attempted to develop a common code of ethics in collaboration with the Association of Healthcare Providers India (AHPI) and Healthcare Federation of India (NATHEALTH). We undertook this initiative two years back and developed basic documents on code of ethics (as below) as guidelines for members as how to conduct themselves ethically and in a transparent manner in all their interactions with the patients and all others involved in healthcare. IMA & AHPI Code of Ethics for Healthcare Providers • “We comply with all the Regulatory and Statutory requirements. • We respect and uphold the Rights of Patients. • All our doctors abide by MCI code of ethics. • We do not accept expensive gifts, cash benefits or gratification from the drug & equipment suppliers, diagnostic centers or similar agencies. • We do not indulge in any activities that are unethical or illegal such as: o Unjustified admissions o Un-justified reporting or billing to the patient o Sheltering any criminal from the law o Pre natal sex determination o Improper entries in insurance forms o Giving cuts and commissions to any one for soliciting patients o Overbilling in claim cases” IMA & NATHEALTH Code of Ethics for Healthcare “We, the members of IMA and NATHEALTH and signatories to the Code of Ethics for Healthcare, do hereby solemnly declare that we have read and understood the Code of Ethics and shall abide by it to maintain ethical and transparent professional conduct and practices to ensure improved access to and better quality of the healthcare ecosystem in India. • A voluntary and collective commitment to follow ethical practices to ensure that patients are provided access to high quality, cost effective, safe and efficient technologies, products and services. . Comply with all applicable laws and members’ internal policies on the subject and create a mechanism to address violations appropriately. • Recognize and champion the sanctity of patient confidentiality. • Maintain accurate and complete records and ensure their safety and access. • Refrain from offering or accepting any payments/gifts with the objective of influencing a decision making process within the healthcare community. • Desist from engaging in any activity, practice or act which conflicts with, or appears to conflict with the interests of the healthcare community, end users or patients. • Maintain a safe and healthy work environment. • Provide donations only for charitable purposes and not with the intent to influence the healthcare community to purchase, lease or recommend the use of specific products and services or treatment modalities. • Meet all applicable quality standards and accreditations as may be required to provide the appropriate delivery of healthcare services. • Undertake appropriate dissemination of the Code for full applicability and accountability.” But, these apply only to those who are members or signatories as these are voluntary Code of Ethics. There should be a debate on this issue. The same can be adopted by the Govt. The Ministry of Health should discuss with all stakeholders and come out with an Advisory in this regard.

Shh Shh Shh ... Baat Nahi Karo: Hospitals should be Silence Zones

Shh Shh Shh ... Baat Nahi Karo: Hospitals should be Silence Zones Noise is a well-recognized problem in hospitals. Air-conditioning systems, medical devices, phones, pagers, alarms, people movement, conversations etc. all constitute background noise in hospitals. Adding to this is the traffic-related noise, as many hospitals may be located in congested areas. Noise has been recognized as an environmental stressor, which has both physiological and psychological effects. A growing body of literature has demonstrated the potential negative impact of noise pollution in hospitals on patients as well as doctors. Noise disrupts sleep, both quantity and quality of sleep. Sleeping is one way that the body recuperates and recovers from damage. A well-rested body is up to meeting the challenges and stress of daily life. Hence, sleep is very important for patient recovery. A noisy environment also weakens the immune system, increases BP and heart rate and adversely affects wound healing, pain management. Being exposed to constant noise may cause anxiety, stress and increase blood pressure. All these can delay patient recovery and increase hospital stay. Not only patients, doctors too are not left untouched by the negative impact of noise. Reduced concentration, headache, anxiety, annoyance/irritability resulting in reduced work efficiency are some of the outcomes of noise pollution. Perhaps most importantly, hospital noise interferes with oral communication, causing medical errors; at times with disastrous consequences for patient safety. Sound-alike drugs can cause confusion e.g. Isoprin/Isoptin, Amlopress AT/80mg. Controlling noise pollution is the need of the hour, particularly in relation to hospitals. Hospitals need to be silence zones as also areas up to 100 m around them Permissible noise limits in Silence zone are 50 dB in daytime (6am to 10 pm) and 40 dB in night time (10 pm to 6am). Public awareness is also very important to prevent and control noise pollution in hospitals. The general public needs to be sensitized to the adverse health impact of noise pollution. In an effort to control noise pollution within the hospitals, IMA will launch ‘Silent Hour’ in medical establishments. We will observe silence from 2 pm to 4 pm every day, when everyone should not talk or speak very softly to minimize noise. Shh Shh Shh ... Baat Nahi Karo … Dr KK Aggarwal National President IMA & HCFI