06 April 2012
In our hurry to import overseas Indian medical practitioners, let us not make compromises on licensing and patient care.
In recent years, there has been much brouhaha over medical tourism and the use of telemedicine to get opinions from doctors far away. While these concepts are beneficial in certain specific situations, they can be dangerous if not applied prudently. Globalisation of medicine is not as straightforward as setting up a call centre in a country where the cost is lower or employing a software engineer in a developing country to make a product for the first world. Plus, patients as well as their doctors are less portable across the globe than say an iPad or its maker.
Aspects of patient care
The Indian government is in the process of enacting laws to allow doctors who hold the Overseas Citizens of India status to practise in India and even become faculty members in medical colleges. In a country where allopathic doctors are in short supply, even though this may seem like a good move, it is not necessarily so, unless adequate measures are put in place. Most countries allow doctors trained elsewhere to practise only after going through rigorous requirements including passing their licensing examination and training in their country.
These processes are absolutely necessary to make sure that the practitioner is aware of local diseases as well as social, cultural, and ethical aspects of patient care that are unique to the region.
Imagine an overseas citizen of India who could be born, raised and trained as a doctor in the United States going to rural India to work for a few months with little understanding or experience of treating infectious diseases like tuberculosis and malaria or inherited diseases like thalassaemia. All of these are much more prevalent in India and someone trained locally would be better qualified to treat them. Even for those who were born and trained in India, it would not be easy after practising abroad for years. This move by the Indian government is obviously to woo the large number of non-resident Indian doctors in the U.S. and the United Kingdom. It seems ill conceived if we are to believe recent media reports of the possibility of allowing them to work in district hospitals for short periods without registration and necessary clearance. India needs good general practitioners more than super specialists, who seem to be in abundance nowadays in the urban areas. It needs doctors for the poor and the rural population and not necessarily for corporate hospital patients who can afford such facilities. These are the circumstances where the “foreign” doctor is likely to be all at sea while trying to treat diseases which are not commonly encountered in the western world. This is also likely to be the scenario for faculty positions, which are most often in medical colleges affiliated with government hospitals. The Indian diaspora is pushing for new rules in the hope of satisfying the inner yearning to give something back to the homeland. This ambition of brief stints by a handful does not warrant a major policy change that may result in the creation of loopholes in the system or even adverse patient outcomes.
The western world is coming up with stricter requirements for doctors to maintain certification like ongoing periodic examinations, continuing medical education and documentation of satisfactory patient care in local conditions. To allow a doctor to practise in India without satisfying necessary prerequisites would be regressive. Instead, the government should look to alternative strategies like establishing programmes to train rural general practitioners or physician assistants to address the shortage of health–care providers.
(The author is a neurologist at Children’s Hospital Los Angeles and faculty member at Keck School of Medicine of the University of Southern California.)