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

Health Care Comments Off

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.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)