More than half of the allopathic doctors in India lack medical qualification

More than half of the allopathic doctors in India lack medical qualification
IMA urges people to beware of quacks and have faith in qualified doctors

New Delhi, 18 December 2017: As per a study published by the WHO, only 58.4% of doctors have a medical qualification in urban India. The condition is worse in rural areas with only 18.8% having a proper medical qualification. India has lakhs of quacks and about 60,000 work out of Delhi alone. Additionally, the study also indicates that 57.3% allopathic doctors do not have a medical qualification and another 31.4% are educated only up to the secondary school level.

A quack or charlatan, as defined by the Supreme Court in 1996,is anyone practicing modern medicine without proper training in the discipline. The large number of quacks in both the rural and urban areas of India are a threat to the people and society at large. What exacerbates the situation is that if anything goes wrong, only few have the resources to file a complaint against them. Many just accept it as fate, particularly in the rural areas.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “In many parts of India, the sick are first taken to the ‘so-called’ faith healers offering treatment in the garb of doctors, before they are brought in to a hospital for actual treatment. It is a settled law that quacks are untrained and cannot diagnose or treat routine and emergency situations. They will invariably miss diagnosis of acute heart attack, paralysis, meningitis, early cancer, early rheumatoid arthritis, appendicitis, acute abdomen, acute pregnancy situations, dissection of aorta, pulmonary embolism etc. leading to a high mortality and morbidity. Their modus operandi is based on referral practice to corporate set ups with a desire of getting commissions.”

The IMA has taken a strong stand against quackery. This was also one of the issues raised by the association in a movement called Dilli Chalo conducted in June this year.

Adding further, Dr Aggarwal, said, “It takes over a decade for a modern medicine doctor to acquire sufficient knowledge to decide which antibiotic should be prescribed in a certain situation and which should be avoided. It’s not mathematics. One cannot learn medicine via Google or following the prescriptions of modern medicine doctors. Every case is different; hence, we say individualize treatment according to that particular patient. Most preventable deaths can be traced to ignoring warning signals or self-prescriptions or relying on medicines by quacks or chemists.”

IMA urges one and all to beware of quacks as they indulge in cuts and commissions, will never refer the patient in time, invariably give steroids in every case, and will over investigate the patient to appear genuine. On the other hand, people should have faith in registered and qualified doctors as they do not indulge in unethical practices, do not take or give commissions, work with the primary aim and dharma of healing and not financial gain, believe in Karma and not Kriya, and will always guide patients with the best of interest.

Why this disparity in standards for Allopathic and Ayush doctors?

Why this disparity in standards for Allopathic and Ayush doctors? Becoming a doctor and being a doctor is not easy. It requires lot of hard work, dedication and sacrifice. The medical profession demands long hours as the patient comes first. The road to becoming a doctor is long one and the journey begins from the premedical examination where an aspiring doctor tries to secure admission to a medical college amongst lakhs of aspiring doctors who appear for the entrance exams every year across the country. Five and half years of gruelling undergraduate MBBS studies then follow along with series of theory and practical exams interspersed with countless tutorials along the way including one year of compulsory internship. Today, a simple MBBS degree is not enough. To become a specialist and then a super specialist, an MBBS graduate is again required to undergo entrance exams to gain admission to the 3-year PG and 3-year DM courses. The road to becoming a doctor is about a decade long before a student acquires sufficient knowledge to become an expert in his/her chosen specialty. All of us have gone through this process and are familiar with it. Reiterating this long and tough process assumes importance in light of the government’s proposal of a ‘one-year Bridging Course’ allowing Ayush doctors to practice allopathic medicine at a primary health center (PHC). India’s new national health policy 2017 has made provisions for this, which states that “the national health policy it would continue mainstreaming of AYUSH with general health system but with the addition of a mandatory bridge course that gives competencies to mid-level care provider with respect to allopathic remedies.” An MBBS student after successfully clearing Pathology subject is not allowed to open a lab. While studying clinical subjects, the student is not allowed to practice clinical medicine or write prescriptions. An MBBS graduate, after 4.5 years of studying, is allowed to write prescription during internship training, but only under supervision. It’s only after completing the mandatory internship training that he/she gets his/her degree and is formally allowed to practice medicine independently. The volume of material to be studied during this process is tremendous and exhausting. For a doctor, studying does not stop with clearing the undergraduate or postgraduate exams. A doctor has to read constantly to be updated with the latest advances in medicine so that patients can benefit from these advances. Yet, the government seems to think that a one-year training is enough for Ayush practitioners to learn the nuances of modern medicine and practice the modern system of medicine safely. NEXT, an exit exam for all medical graduates to obtain license to practice is another proposal for modern medicine doctors, which the government wants to enforce. By proposing a one-year Bridging course, the govt. accepts that one year is enough for Ayush doctors to acquire adequate knowledge and competency to practice modern medicine and prescribe modern medicine drugs, including schedule drugs such as antibiotics, which an Allopathic doctor takes at least a decade to learn. Yet the govt. feels that an exit exam is necessary before an MBBS graduate is allowed to practice modern medicine, even at a PHC. Medicine is an art based on science. It’s not an exact science. And at times, years of clinical experience of an allopathic doctor come to the aid of critically ill patients. Will an Ayush doctor be able to recognize and accurately diagnose life threatening conditions such as acute heart attack, meningitis, early cancer, acute abdomen, pulmonary embolism, and give timely and appropriate first aid? Can they be expected to exercise discretion and judgement when prescribing drugs such as antibiotics? Outcomes may not benefit the patients, for whose benefit, this bridging course has been envisaged. Patient benefit and safety is first and foremost. All systems of medicine work towards this common end. It is the patient who will be at loss and by putting the lives of patients at risk, the very purpose of this course is defeated. How can the government allow Ayush doctors to practice modern medicine after just one year? MCI Code of Ethics Regulations do not allow doctors of other systems of medicine to practice modern medicine. Regulation 1.1.3 states “No person other than a doctor having qualification recognised by Medical Council of India and registered with Medical Council of India/State Medical Council (s) is allowed to practice Modern system of Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice Modern system of Medicine in any form.” Similarly, the MCI Code of Ethics do not allow modern medicine doctors to practice crosspathy. Regulation 6.5 Secret Remedies states, “The prescribing or dispensing by a physician of secret remedial agents of which he does not know the composition, or the manufacture or promotion of their use is unethical and as such prohibited. All the drugs prescribed by a physician should always carry a proprietary formula and clear name.” Who will own the responsibility in case of a mishap or medical negligence? How will the concept of informed consent be implemented? By allowing Ayush doctors to practice allopathy, does this mean that our ancient systems of medicine are not competent enough to treat common illnesses in their own pathy? We respect Ayush doctors and their pathies. They should be allowed to advance their own pathy and not indulge in crosspathy. If the objective of this bridging course is to realize the “unmet need” of healthcare delivery in rural areas, this is not the solution. The govt. needs to strategize to empower MBBS doctors, incentivise rural practice and increase the number of family medicine seats.

The Allopathic Modern Medicine Ramayana

The Allopathic Ramayana

Dr KK Aggarwal Navratras to Diwali is the season of revisiting the messages from Ramayana, the largest epic of our country once classified as one of the Puranas. One can understand the story of Ramayana as the story of mind, body and soul and the story of causation and prevention of a disease. In the mind, body, soul concept, the soul is represented as Rama and the physical body as Sita. Body is made up of five elements with earth being the predominant. Sita was the daughter of earth (prithvi). Soul and body can only unite in presence of a determined mind holding them together. Determination means “aim” and in Hindi it is called “lakshya”. The mind with a defined aim, therefore, represents “Lakshmana”. Rama, Lakshmana and Sita, therefore, represent the union of mind, body and soul. The three will stay together as long as one has his or her ten 10 senses (five motor and five sensory) under control. Senses are Chanchal like horses. Chariot of two horses is called Rath and chariot of ten (das) horses is called “Dasharatha”. Therefore, mind, body and soul will be together with the resultant health only if the body is ruled by “Dasharatha” by controlling all the ten senses. The next part of Ramayana talks about the causation of disease and worries. The causative factors are “kama, lobha and ahankaara”. In Ramayana kama is depicted by Kaikeyi, lobha by Mareech and ahankaara by Ravana. If any one of them was not there Ramayana would not have happened. The sum total of the three is responsible for any disease or miseries in life. When Kama (Kaikeyi) predominate senses (Dasharatha) has to die. When moha (Mareech) dominates the mind (Lakshman) gets diverted and when Ahankar (Ravana) takes over, it controls the body (Sita) and makes the mind (Lakshman) and soul (Rama) wander. The next part of Ramayana is how to win over ego or Ravana. The first step is to win over the mind by controlling the prana Vayu component of the body by indulging in Pranayama. In the context of Ramayana, this means winning over Hanumana, the son of Vayu. Once he is controlled, all the thoughts representing as the Vanar Sena (Chanchal natures) are controlled. The next step is to control the intellect (King Sugriva). He can only be influenced by killing lust (Bali), who is living with Sugriv’s wife. Lust cannot be killed from front and has to be killed from behind and that is what Rama does to Bali. Killing of the lust from behind is depicted as Pratyahara in Yoga and means living a disciplined satvik lifestyle. The next step is to follow “one point contemplation” or living in the present. In Ramayana context it represents one point determination or “the war over Lanka”. Once that happens firstly the tamas (Kumbhkaran), than the rajas (Meghnad) and finally the ego (Ravana) dies. Both tamas and ego die automatically by the consciousness (Rama) but to kill the rajas, one has to conquer it with the mind (Lakshmana). Once this happens, the Satwa or Vibhishana takes over and the mind, body and soul are reunited leading to inner happiness again. Lastly, when Rama, Lakshman and Sita go back to their journey of life, back to Ayodhya, Hanuman goes with them as in Ayodhya, Dasharatha is no more. If you cannot control your 10 senses by yourself, you need to continue Pranayama or carry Hanuman with you for life. These the spiritual messages from Ramayana.