A Pathological Anomaly

A Pathological Anomaly   

Herald Review, October 26, 2014

Cross practice has become rampant in the State with hospitals openly exploiting the system, endangering patients’ lives.

Lisa Ann Monteiro

The Maharashtra State cabinet recently gave its nod to a bill that allows homeopaths to practise allopathy after completing a one-year bridge course in pharmacology. The State government also amended the Maharashtra Medical Practitioner’s Act to allow ayurveda practitioners to practise allopathy. The medical fraternity was shocked and the India Medical Association said they would be taking legal recourse.

The State government’s move came in the wake of homeopaths going on hunger strikes, pressurising the government to allow them to prescribe allopathic drugs. It emerged then that of the 62,000 registered homeopaths in the State of Maharashtra a mere 10,000 were practising homeopathy. The rest were involved in mixed practice.

In Goa too a large number of homeopath and ayurvedic doctors are involved in mixed practice. These doctors are the first preference for hospitals and nursing homes who can employ them for a paltry Rs 10,000 a month. After struggling to obtain their medical degree no MBBS doctor is willing to work for one fourth the salary that government hospitals pay them. It is therefore common to find homeopath and ayurvedic doctors employed as RMOs (Resident Medical Officers), casualty medical officers and general duty medical officers in hospitals throughout the State. Some hospitals realizing they can get into trouble for this have begun calling them ‘clinical assistants’ instead of RMOs. Although they are employed to monitor patients, there are those who sign patients’ discharge letters and even prescribe allopathic drugs, using an allopath doctor’s prescription pad or a blank piece of paper.

Allopath doctors insist that these doctors who are qualified in one system of medicine aren’t legally permitted to practice another system. The systems of treatment are vastly different. “All allopath doctors study medical pharmacology from the first year till their last. The essence of medical treatment is pharmacology and all subjects in our course are taught in the context of each other. Pharmacology is not a standardized subject that one can study by doing a one year’s crash course,” one GMC doctor said.

Cross practice or cross pathy has become rampant with hospitals exploiting the system openly and taking things for granted. Many a times ICUs (Intensive Care Units) are left in the hands of these doctors with no MBBS doctors available round the clock. Hospitals however don’t fail to bill their patients the steep ICU charges. The safety of patients are being compromised and it is only time before a patient goes to court and sues for medical negligence. “Why should patients pay Rs 10,000 as ICU charges unless there is an anesthetist, an intensivist and one specialised in internal medicine present? It’s ultimately all about the profits,” one doctor said. He pointed out that reputed educational institutions conduct short intensive care courses open to homeopaths and ayurvedic doctors too.

It is mandatory for allopath doctors to register with the Goa Medical Council before giving their first prescription. MBBS doctors have to obtain credits and every five years these credits are renewed. “When it is so mandatory for MBBS doctors how are these homeopathic doctors able to prescribe medicines. How does their council allow it? The Health services should take action as they are the ones giving licenses as per the Goa Medical Practitioner’s Act,” one doctor said.

Recently the Delhi Medical Council issued an order warning doctors registered under its council against cross practice. It stated that no cross pathy practice is allowed by any medical practitioner unless such person is also registered in that system in which he is practising. The order states that drugs commonly prescribed include LIV52, Amlycure DS, Cystone, Septilin, M2 Tone, Neeri and Amycordial. Cross pathy the order said can be punishable by rigorous imprisonment up to three years and a fine of up to Rs 50,000 under the Delhi Bhartiya Chikitsa Parishad Act of 1998.

President of the Goa Medical Council Dr Shekhar Salkar says the council hasn’t received any complaints in the past three years of cross practice. He explains that the council has jurisdiction over only allopath doctors and cannot pull up or act against homeopath or ayurvedic doctors. Aggrieved patients needn’t come to the council and can complain directly to the police he says. Hospitals employ a large number of homeopath and allopath doctors because there are a shortage of MBBS doctors he says. “There are hardly any MBBS doctors available. They are either absorbed by government hospitals or pursue higher studies. Hospitals have no choice. These doctors can’t write prescriptions but they can monitor patients in wards. Many homeopathy and ayurvedic doctors rate higher than MBBS doctors. Around 60 percent of medicine is common sense and they learn the required skills when practising in hospitals,” he says.

Registrar and secretary of the Council for Indian System of Medicine and homeopathy Dr Dilip Vernekar says homeopaths don’t have well equipped, full fledged hospitals where they can train. They need clinical exposure and experience in general hospitals. Further, when they graduate they have no job opportunities. Many enter the marketing field, do their MBA while others join hospitals. Majority of homeopathy and ayurvedic colleges in the country are run by politicians. They receive grants and many aren’t able to fill up even half their seats.

Pediatrician and vice president Goa Medical Council, Dr Dyanesh Volvoikar says a need based assessment needs to be carried out as there are a large number of homeopaths and ayurvedic doctors unnecessarily being thrown into the system with no jobs available for them. He suggests that the government employ them as health educators and that their services be used for health programs. The solution to the problem of health care not reaching rural India, he says is to have more allopath doctors. He suggests that district hospitals be converted into medical colleges since they are already equipped. Doctors can be employed part time on honorary system as their lecturers. Dr Volvoikar points out, “Can an accountant who is not a CA sign a company statement? Can a notary ship be awarded to a non advocate? Why the different standards then for medical practice? Review Bureau 

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