“We have not lost faith, but we have transferred it from God to the General Medical Council.”
“Every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquette by giving him away.”
— George Bernard Shaw
We have indeed come a long way since the great Irish playwright/humourist made this observation. Sadly to the extent where Liam Donaldson, the former Chief Medical Officer of the United Kingdom was constrained to remark in 2006:
“GMC has totally lost public’s confidence in its ability to protect public interest from the bad doctors.”
To adumbrate an instance, there have been no fewer than three high powered committees that have been set up since 1996 which have concluded quite conclusively that the Council has displayed racial bias which goes against every grain of the ethical principles the medical profession is meant to uphold.
Delving into history, the General Medical Council or the GMC came into being in 1858 supposedly to keep ‘quacks, crooks and charlatans’ out of the medical profession. John Allinson, a medical practitioner in those days was struck off the Medical Register having been declared a ‘charlatan’ for claiming that ‘smoking was injurious to health.’
Before we go up in arms, we have to remember that in those days a link between smoking and cancer had not been established and Dr Allinson, although observant and astute, was relying on conclusions unsupported by hard body of scientific evidence.
In the following years, the GMC did make a sincere effort to clean up its act and enjoyed a degree of public confidence which is what must have prompted Shaw to make that acerbic observation. Its fundamental functions were broadly defined as regulation of medical education, maintenance of a medical register and ensuring observance of the ethical principles through punitive sanctions mandated by statute.
The GMC also served as a model for medical regulation in the US, Ireland and the British Commonwealth and is still looked upon with a degree of veneration by these bodies although the prestige it previously enjoyed has steadily waned largely because of its own actions which is reflected in Sir Liam Donaldson’s despair.
In fairness though it has to be stated that the GMC is not the only medical regulator that has been known to act arbitrarily and ignore the most basic principles of medical ethics when expedient.
The author has personal knowledge of several medical regulators who have fallen way short of the minimal standards that the world population at large should expect from them.
Sadly, the Medical Council of India (MCI) also fell victim to this malaise. For at least the last four decades, its performance has been constantly under scanner but for most part there has been no motivation either professional or political to clean up the stables.
I would stand corrected but from what I can make out, the rot seems to have commenced when a thoroughly undeserving person, a very senior orthopaedic surgeon whose observance of medical ethics was minimal if not non-existent, was elected to head this august body. While his commitment to ethics was minimal, his personal ego was always in a state of super-inflation in need of a massage. He acted in the most whimsical manner on several counts which included derecognition of the UK qualifications because that ensured that his speech was broadcast in the BBC bulletins. This was his priority instead of ensuring the maintenance of a Medical Register in all the provinces, one of the primary functions of the medical regulator.
My medical colleagues would hopefully concur with me when I state that even today, the Medical Register in different provinces of India is most unsatisfactorily maintained which makes it very difficult if not impossible for a layman to gain information about a supposed physician – whether he/she is on the active register and whether there have been any sanctions against him/her.
Sadly, there was a steady decline in the standards of functioning of the MCI since then and it is only recently following the Supreme Court rulings and an active interest by a few committed public servants like the former Health Minister Harsh Vardhan that we have accorded the manner the level of cognizance that is due. Hopefully, this signals a move towards rectification and I look forward to the day when the MCI would enjoy the same veneration that the GMC did in Shaw’s times.
But it would be completely erroneous to infer that the MCI or for that matter the GMC are the only two bodies whose conduct is open to serious questions. The author of this column has had the good fortune of having worked in 14 different countries across the globe, both developing and developed. Three of them did not have recognized medical regulators, the health ministry being the institution responsible for providing the permits. But it was not the developing countries that demonstrated the most shocking absence of commitment to medical ethics but supposedly the developed ones.
The author has personally observed that the College of Physicians and Surgeons of British Columbia in Vancouver has lost every grain of credibility to any objective and informed observer. It had on its roll a Registrar / Deputy Registrar duo of Thomas Handley and John Harrigan who in a very blatant and egregious fashion had declared that they were entitled to remove any physician WITHOUT even giving him the most preliminary opportunity of getting to know the charges against him/her and to them this was consonant with the principles of natural justice. The victim in the saga was a coloured doctor – and while Harrigan refuted the claim, it was stated that he had addressed him with a racial epithet which included an adjective that defined the excessive melanin in his dermis and a noun which questioned his paternity. The most shocking aspect of this saga was when the shenanigans of the College was exposed, Handley and Harrigan engaged the services of a proven shyster named David Martin who claimed statutory immunity for any acts committed by them as office bearers of the College. Even the Provincial Government when made aware of this injustice refused to act. The Federal Government expressed its inability as medical licensing is a provincial issue.
Not content with this, Handley’s successor Van Andel took it upon himself to malign this physician by disseminating false information which was admitted by his successor Heidi Oetter. But even she refused to recognize Van Andel’s actions as tantamount to professional misconduct as they did not constitute a part of his medical practice.
I might add here that Canada has ratified the UN Charter of Human Rights. I shall reproduce certain sections of this very important document:
All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.
Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted to him by the constitution or by law.
Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any charge against him.
Clearly the Canadian commitment to these principles is skin deep.
The author was also aware of some equally shocking instances of outrageous injustices emerging from the Medical Board of Victoria in Australia which now thankfully has been dissolved. The jury is out on the Australian Medical Council’s commitment to upholding the principles of medical ethics.
The other factor which is very commonly overlooked is the unwritten understanding that the medical regulators have among themselves i.e. exchange of information. In order to obtain a permit from one regulator, one has to provide a supposed ‘Certificate of Good Standing’ from the previous regulator. In the absence of this document, one is unlikely to obtain a permit to practice. If any regulator provides some negative information, it can have catastrophic effect on the career of the physician concerned.
On the face of it, it seems fair but it does not take into account the commitment of the other regulator to the principles of medical ethics. Should a regulator display a callous disregard for observance of ethics as the College of Physicians and Surgeons in Vancouver or Keery Breen of the Medical Board of Victoria then an unacceptable injustice is likely to take place — and I am sure it must have.
I therefore wrote to different regulators around the world asking them to consider instituting a mechanism by which a determination of the regulator’s commitment to ethical principles and its conformity to natural justice can be made. Six weeks have elapsed but I am yet to receive a response.
I have also been able to get a response from Anthony Egerton of the GMC in which he has claimed that the GMC regards the College in Vancouver and the Medical Board of Victoria in Australia (now defunct) as ‘reliable sources’ of information, which is truly shocking! While there was no comment on how they regarded the MCI, I am troubled by an act of the GMC — they derecognized the Indian medical degrees in 1974 but maintained their recognition of the West Indian and Malaysian degrees! And by no stretch of imagination could those be regarded as superior to the Indian degrees.
I am all for exchange of information between the different regulators. But in order to minimize the possibility of a grave injustice, I suggest that while communicating information to another regulator, the communicating regulator must be made to declare under the penalty of perjury that:
— the information was obtained after observance of every principle of natural justice prescribed under the Human Rights Charter of the United Nations
— the communicating regulator is prepared to accept responsibility for any violation of the principles of medical ethics as enunciated and compensate accordingly.
That to me seems to be the best way of reining in the rogue regulators who have propped up recently and are bent of creating havoc.
by Dr Ashok Jahnavi Prasad