Overhauling the Indian Medical System
I recently tried to determine the qualifications of a not-to-be-named Indian dermatologist to the stars and came up with few-to-no hard facts about her medical background. If I’m ever going to consider letting somebody use a laser near my face, I’m going to want to know about their background.
This lack of transparency around many Indian physicians’ training backgrounds is particularly concerning in light of a recent Washington Post piece that questions the quality of India’s medical schools and a Reuter’s report of corrupt qualification practices that allow 700,000 unqualified doctors to practice at some of the country’s biggest hospitals. These articles illustrate that the problem is systemic.
But people – students, practitioners and, most importantly, patients – still have to navigate the murky Indian medical system. This topic is complicated and much-debated, and many good solutions have been offered to try to find a balance between physician accountability and patient advocacy. Most focus on regulation of some sort, which is necessary; I’d also, however, offer a different take.
At the Student Level
For students who are honourably interested in becoming doctors, a thorough and unique ranking system for medical schools is needed. Currently, the best insight around the quality of medical education a prospective student is likely to get seems to come from rankings by the Times of India and India Today.
India Today uses generic criteria for all schools, no matter what the focus; engineering colleges are judged by the same metric as medical colleges and fashion schools. The issue with the Times’ rankings is that they are drawn from job placement of graduates, tenure of faculty, and the perceptions of current students, aspiring students and their parents – all flash and no data. (India Today’s generic criteria are similar.)
Rankings instead should be based on the amount of research funding granted to institutions, which would provide students with an insight into which medical colleges are generating evidence-based research. Additionally, rankings could be based on a standardized metric that takes into account average student GPA, board exam pass rates, student-to-faculty ratio, and other metrics that might allow prospective students to qualitatively measure these schools against each other.
These types of criteria will help aspiring doctors as well as the general public better understand where these schools excel.
At the Practitioner Level
Physicians need to demand a national licensing exam as a point of professional pride. (I’m sure many already are.)
Such an exam has been under discussion as far back as 2010, when the Medical Council of India (while we’re at it, how about a better medical council … here’s hoping its restructuring brings actual change) first proposed it, but nothing has been approved or implemented. It’s a much better solution than NEET, which is the proposed pre-admission exam that the MCI is currently rallying for.
The good news is, a blueprint already exists: the Foreign Medical Graduate Examination (FMGE), which anyone with a medical degree obtained outside of India must take in order to practice domestically.
A nationalized exam may run into the same legal issues as NEET and also challenge states’ jurisdiction; these are not small issues, and I am not a lawyer who can parse them. They do not change the key point: With no standardized method to train physicians and no standardized way to test the disparate training, the quality of medical practice in the Indian medical system will always be questionable.
At the Patient Level
The Indian medical system tends to be highly paternalistic, with many patients blindly following their doctor sahib’s advice. Until India’s medical education system straightens itself out, patients must challenge this power structure and be their own healthcare advocates.
Despite how imperfect and cumbersome these databases are, you can at least look up your doctor on the Medical Council of India’s Medical Registry and check for his or her name on MCI’s list of blacklisted doctors.
Beyond that, stay proactive – ask for recommendations from trusted friends and associates. Ask questions of your doctor when you don’t understand something; a good doctor will explain and encourage you to be an active participant in the management of your health.
If you feel like you’re getting inappropriate treatment, then never hesitate to get a second (or even third) opinion. Because, in line with the age-old adage — “trust in God, but tie up your camel” — it is absolutely critical to trust your doctor, but be your own healthcare advocate.
India could have a premier medical education system. It has many excellent physicians, plenty of great institutions, and an abundance of knowledge. But India’s medical education system lacks accountability, and that’s what is holding it back, potentially harming patients in the process.