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October 5, 2018

Who does the PMDC serve?


October 5, 2018

Newspapers and other mainstream media report stories of medical negligence or malpractice on an almost daily basis. However, there are rare, if any, reports of investigations or disciplinary actions by the Pakistan Medical & Dental Council (PMDC).

Improper commercial relationships between doctors and the pharmaceutical industry are rampant, substandard medical colleges have been allowed to proliferate, stories of corruption within are everywhere, doctors are not facilitated in getting their paperwork in order. In short, few will disagree that the PMDC is an abject failure as a regulator.

The PMDC is the body responsible for regulating medical and dental education and practice in Pakistan. It was formed via an ordinance in 1962. The law has since lagged far behind the times.

Early this year, the Supreme Court, while ruling on a civil appeal, declared the council’s composition null and void. It formed an ad-hoc committee to run its affairs. The court also entrusted the committee with suggesting a new law.

It was expected that the committee would recommend radical changes to bring the law in conformity with the realities and requirements of modern times. Unfortunately, reports regarding this are not encouraging. It seems that the new law will be more of the same. Reportedly, only the composition of the council has been changed in the new recommendations.

Revision of the PMDC law should start with a philosophical question: Is the PMDC there merely to protect the privileges of the doctors or is its primary function protecting the health and safety of the public?

In the United Kingdom, the main objective of the General Medical Council (GMC) is enshrined in law as ‘exercising their function to protect, promote and maintain the health and safety of the public’.

The PMDC law should borrow from the UK and state unequivocally in its statement of functions that its foremost responsibility is the protection, promotion and maintenance of the health and safety of the public.

Adoption of public health and safety as the main objective of the PMDC aligns perfectly with its regulatory functions vis-a-vis medical education, licensing and enforcement. The basic objective of ensuring quality medical education, licensing requirements and enforcement is providing the public with quality and safe healthcare.

The council itself should not be composed only of those belonging to the medical profession; ‘lay’ members should also be included. In the UK, the GMC – by law – has equal representation of lay and medical members. A similar setup should be adopted for the PMDC.

It must be made imperative for members of the council to declare at the start of their term, and annually thereafter, any conflict of interest with the duties and responsibilities of the council. The members should declare any honorary or material stake in any healthcare facility. They should also declare any benefits that have been paid for by any healthcare-related company or facility. The council’s officers and inspectors should also be required to submit similar declarations, which should be published on the council’s website and updated regularly. There should be zero tolerance for conflicts of interest.

Maintaining registers of medical and dental practitioners is one of the core responsibilities of the PMDC. The council should be most proactive in providing relevant information about medical and dental practitioners to the public. At the moment, it is not so. The PMDC website today provides bare minimum information about registered practitioners. A search for a doctor results in only the registration number, and the name and dates of registration.

The PMDC must do a better job with providing information about registered doctors. It should mention any disciplinary action ever taken against the doctor by the council. It should also clearly state whether the doctors’ registration is current or expired or if a doctor has been suspended temporarily or permanently struck off the register for disciplinary reasons.

The PMDC should facilitate doctors as they generate revenue for it from various fees. Doctors should be able to electronically update their details such as addresses. They should also be able to request copies of certificates or document verification through the online portal rather than the antiquated process of snail mail. Doctors should also be able to renew their registration online.

Most are familiar with the practice of pharmaceutical and medical device companies spending money to curry favour with doctors. This may be for legitimate reasons, such as sponsorship for educational conferences. In other cases, it may involve outright bribery with cash, leisure trips or other benefits.

Doctors should be bound by law to disclose annually any honorarium, gifts or other benefits they receive from pharmaceutical or medical device companies. They should also disclose any sponsorship for travel for education or leisure within or outside Pakistan. Failure to submit annual disclosures should be grounds for suspension of the doctor’s licence.

Pharmaceutical and medical device companies should also be mandated by law to provide the PMDC every year with the names and registration numbers of doctors along with the amount in rupees they spent on them as honoraria, sponsorship or in any other form. Failure to provide this data should result in criminal charges against the companies. The defaulting companies should face hefty fines plus jail terms for the owners and/or responsible officers.

The information from the pharmaceutical companies should be displayed with the name of the doctor at the PMDC’s website. The public should be able to see their doctor’s financial relationship with pharmaceutical or device companies.

The PMDC has been very casual if not negligent, with enforcement and disciplinary actions. One only needs to compare the number of disciplinary hearings held by the council to those by the UK GMC for any period of time to realise its failure on this account.

PMDC law should make it easy for the public to lodge complaints of negligence, malpractice or other improprieties against doctors. The present requirements of lodging complaints with the PMDC are nothing but red tape. According to the PMDC website, a complaint to the council needs to be written on a judicial stamp paper and attested by a magistrate. In this day and age, this is beyond ridiculous and amounts to discouraging the public from lodging their grievances.

People should be able to lodge complaints electronically through the PMDC’s website. Complaints through regular letters should also be entertained rather than requiring the cumbersome process of stamp paper and magisterial attestation. Newspapers reports of alleged medical negligence and malpractice should be paid attention to. The council law should require it to investigate these suo motu.

Hospitals and other healthcare facilities should be required under penalty of law to report to the PMDC any institutional action taken against a doctor for negligence, malpractice or moral turpitude.

Frivolous complaints can be dismissed by a committee of the council, with reasons recorded for summary dismissal. Any complaints meriting investigation and/or disciplinary hearings should be taken up in a timely manner to restore public confidence. Disciplinary proceedings should be open to the public, and decisions reported on the PMDC website.

The recognition of private medical colleges is a separate story in itself!

The writer is a former president of the Association of Pakistani

Cardiologists of North America (APCNA).

He tweets @spaelaney