Semi-skilled doctors are bringing patients to the hospital on commission

After completing his four-year tenure, Prof. Dr. Lord Koirala has taken leave.Citizens have to wait years to get justice from the council, which is responsible for regulating doctors. There is a situation in which the council has not made a judicial decision even though the doctor’s negligence has been seen in some treatments. The Medical Council has not won the trust of the citizens. The first reason for this is the appointment of the chairman of the Medical Council. The party or coalition that is the government, except for the exception, that the person preferred by them is made the president. There is a rule that the members, including the vice-president, come from the election, but even in that, the political party-affiliated organizations operate.Current outgoing president Dr. Koirala says that the environment will be difficult to make the right decision because of the officials who came from the election competition. He says, “Officials from the electoral system also play a role in protecting doctors.”Dr. on how to handle the four-year tenure in the council, what problems are seen in the medical field, and how they can be eliminated.Online Khabar’s Pushparaj Choulagai and Basant Basnet had a conversation with Koirala: How do you review the four years of the Nepal Medical Council?First of all, I did not go to the council with the expectation that I would be able to make a big change. I wanted to complete three or four agendas there. It also has a special background. I did not want to go to national responsibility. On the one hand, it was my conclusion that after resigning as the director of Tribhuvan University Teaching Hospital, it is not suitable for me to take any executive position. However, he was half-heartedly saying that if he could contribute something at the policy level, it would be fine to do so.He did not want to go to Tribhuvan University at that time. There was also a desire from within to build a children’s hospital. Last time I decided not to run for vice president of the Medical Education Commission. I was under more pressure then than now. At that time, he also scolded me a lot about why he did not go to the position of vice president. It came to my mind that I would rather do something in that regard. The council must have done it. However, I went to the council to be able to spend time in the children’s hospital for matters such as time management and policy issues.Another main reason was that the Medical Education Act had just been enacted at that time. Although I did not go to the commission, I agreed with its purpose. At that time, if the council disagreed with the concept of the commission, the commission would not have been able to move forward so quickly! We had to do all the work of the commission for the first year. The meeting chaired by the then Prime Minister KP Sharma Oli decided to request the Council to work until the capacity of the Commission is increased.There were many distortions in medical education at that time. A new model was needed to control it. India also revised behind us. There was no mechanism to carefully look at medical education at the policy level. It was not even at the professional level. Dr. Gobind KC’s movement established the issue that medical education should be looked at carefully. Looking back now, it was a shameful situation!A matter of thought before going to council there were two or three. First, to reduce negligence in health care. Doctors are not the only team that treats patients. There are nurses, radiographers, public health workers. In that, the doctor is a component, who leads the team. It was known that it could not be fixed without the leadership of all doctors. Muddy water is not so easy. However, the idea was not to allow gross negligence, to punish those who make mistakes, to warn them not to repeat it, and to punish those who are negligent. Moreover, no one should be deprived of emergency treatment. If this is found to be the case, strict action should be taken. Similarly, I went with the concept that the referral fee (bribe) game could be well discouraged and some other protocols like the World Health Organization (WHO) surgical checklist could be implemented everywhere. I had no idea that murky water would be edible. However, that is not even possible in the present situation.Similarly, within the Council’s main work areaFrom the beginning, there was a system of maintaining quality and ethical practice, continuous professional upgrading of doctors (establishing the obligation to retrain), and not giving treatment to the public until a good skill test was given. However, the main task of the council was to strengthen the examination system and register them with licenses based on it. These four subjects were the responsibility given to the council by law. The obligations given by the law have been improved.Similarly, we had to spend a year and a half in the coronavirus epidemic. At that time, we worked on making treatment guidelines, facilitating oxygen supply, etc. Similarly, we made a treatment protocol together with various societies. Based on that, the society and the doctors followed it.Looking at recent days, more than half of the doctors have been failing the license exam conducted by the council. Is our education system weakening?Now the council has to bear the blame because many failed the license examination. It is a sin to make the MBBS level fail by asking postgraduate (PG) level questions. minimum we say that we should be able to treat patients without knowing what we should know. We made it a practical knowledge-based examination system based on a computer system. The examination system has been developed by creating a question bank brainstormed by not only one doctor, but by 50 doctors and experts, and storing them in computer steam. Even the president does not have access to that question. The examinees are happy. Because they have less difficulty. It is possible to apply online, get registered, and so on.After that, there has been a radical change in the examination system. Similarly, the date of implementation of another subject in the examination system has been fixed. Doctors should know the minimum skills, not just book knowledge. A person who acquires knowledge by memorizing a book without taking a patient’s pulse, checking the blood pressure, or taking the heart cannot be a doctor. We have taken a stand that no matter how much bookish knowledge you come with, you cannot get a doctor’s license until you touch a patient until you know some minimum skills. After that, it was decided to start the exam. Very much in the case of exams good job has been done.In the same way, once registered, you don’t have to study for a doctor for the rest of your life! The intellect keeps getting corrupted. However, they still get licenses. There is no age restriction in Nepal. We changed the rules and made it legal to take Continuous Professional Development (CPD) training within five years. Now no facilities will be given to doctors who have not received 100 points training for five years. In the proposal to change the law, there is a proposal to cancel the license registration of doctors. This is a big leap. However, it has no meaning in the market. Citizens do not know how much the doctor has studied, or how well the treatment has been done.In the same way, good standards will not be made by the Council on Ethical Standards or Scientific Practice Standards in doctors. It has to be taught while teaching right from the university. In terms of medical skills, Nepal’s universities, institutes, and educational institutions from outside Nepal are very poor. Can’t even reach the throat by putting a pipe through the nose, even line they are unable to live well. That’s why we are determined to test the skills in any way. This means that studies have deteriorated in the meantime. In Nepal, students have not received education with skills. It has been tightened by the council to a large extent and has been prevented from going to practice through the examination. Many people have failed because they do not know the minimum medical skills.Currently, it seems that the medical education system does not have as much practical and theoretical knowledge as the doctors need. It may be better in our own country to some extent, but the situation is even worse for those who come from other countries to study.There is a tendency to go to parliament and scold the council for failing the license. However, MPs could not understand that even a little security was added to the people’s affairs.How did you see the need for improvement in the council? What are the things that have not yet been improved?There are two or three things that need to be improved. It is not only the case of complaint in the council but arrangements should be made to go to pro-active action. However, it is not provided by the Act of the Council. Also, other healthcare workers should change their right to see the law. Similarly, the structure (composition) of the council should be revised.We have submitted the unanimous proposal of the council officials to the government of Nepal. The process of that amendment has not progressed. It will be difficult to make a better team until that formation process is revised. They did not bring a person carrying the bag of a political party to the council team. It cannot be said that the decision will be 100 percent better as soon as a person involved in politics is brought to the regulatory body.Fake doctors are caught from time to time. There are still thousands of fake doctors’ files in the medical council. Why you could not open those files for four years?No matter how many cases of fake doctors have been raised, it has not yet reached its logical end. After the court case, it got out of our control. After going to the court, all but 5-6 people were cleared. Before I left, there was already a case filed in the court. The investigating agency does not know on what basis to file a case. Or we went to one kind of preacher and the rest went for what would happen. Evidence bases were not collected much. Now even the famous doctors in the market are concerned about fake doctors. All of them got a ‘clean chit’ from the court. At that time, only 5-6 government employees were arrested because of the authorities. Therefore, the council did not proceed with the investigation process in the matter of the SLC, graduate-level certificate by opening the old files. Because at that time everything was looked at and sent! It would not be appropriate for me to go and dig into a topic that I have seen once. There is a file of 1,600 in the council!People have to wait for years to get justice. It has also been accused that the Nepal Medical Council has failed to make a fair decision. Do you accept this topic?Our people are also hoping that it will be played at the same time. Law, and justice are like this! When a person dies, the family feels sad. They say that the patient died due to their negligence, and the doctor says it was suicide. That can be seen only after investigation. With expert opinion the wrong intention of the doctor is seen, the council has taken strict action. If there is an error, we have given a warning and left it. That is justice. People don’t just like it! The understanding and perception of the people is fierce. We aim to protect the people. However, the aspiration and desire of the people is that we will pay compensation in our case. I will give an example.A relative of a DIG of police died during treatment in a certain hospital. He met me. We took proper action against the treating doctor there. We decided not to practice that subject for a year. We felt fine. Complications occurred in the patient. A little ‘careful’ should have been used in the treatment of the patient. That would be a complication. Now that the person has died, your license should not be revoked, he asked. If the license is to be revoked if the person dies, how will the treatment be provided? Was the treatment done properly or not? This is a warning to take away the license or not to do it from now on. Or, what was the doctor’s intention you want to see? Even a slight up-and-down error during the treatment by the doctor is viewed with a great criminal eye.Where were the people who demanded health services like now? How much has the leader been insulted now? Doctors are not scolded every day! However, I believe that the doctor also lacks sensitivity.The work of Ethical Standards Reactive is done. As many complaints came to the council, they were acted upon. However, what is needed is proactive action. The council structure, sitting within the scope of legal rights, was not practical today. For example, we had to go and raid the hospital through a sample survey. Our structural situation does not allow this. We have a small structure. To increase it, it is necessary to move the council to a provincial structure from amending the law. In the Act, there is no right to look at other professions. How to catch the doctor if the mistake is due to the nurse? How to take action against the doctor if the patient dies due to the oxygen supply being stopped?Right of Medical Council Only doctors have the right to take action. However, from the treatment team it It is difficult to reduce this legal complexity to the issue of medical negligence as a whole. There is no mechanism to monitor the quality of medicines in Nepal. Sitting in the middle of this, there is also the limitation of the doctor’s positive work and not being able to bring good results. However, despite that, we have “fearlessly” investigated the case where the complaint was filed. Most of the complaints are that the council did not take the doctor’s job or canceled the registration. Doctors are arguing that they are saving doctors. We have not let ‘justice’ die without speaking. We have reviewed hundreds of complaints annually. However, we have conducted a complete investigation in some cases. The council reserves the right to cancel registration, from suspension to final warning. We have been following the law, from warning to those who commit minor errors, from suspension to cancellation of license registration to those who are grossly negligent, depending on the nature of the case.However, the point is whether the punishment is greater or the correction is greater. Revoking the license and reducing the number of doctors alone will not solve the problem. That is, to the physician as well offense of negligence should be looked into and given a chance to improve.Do you understand that today’s doctors are less dedicated to the people than the doctors of the past?I have mixed thoughts on this. Emotionally, it can be said that it is professional, and less emotional. I have seen thousands of doctors and nurses working with complete dedication. I have seen a doctor who treats me better now than the doctor I saw when I was a child. However, there is no habit of giving more time during the treatment. In terms of technology, more people would know now than before. Where were the people who demanded health services like now? How much has the leader been insulted now? Doctors are not scolded every day!However, I believe that the doctor also lacks sensitivity. It should also be washed. That too should be taught in universities and institutes. Now there is a big controversy. The University of Nepal Act has been registered in the Parliament after the debate that humanitarian science should not be taught before attending medical school. To do everything on the foundation of humanitarian sciences should be given Otherwise, the argument is that people do not become like people! From their own experience of 30-35 years, people have become very skilled in terms of technology. Although the knowledge of the earlier doctors was a little weak, they were more sensitive. Today’s doctors have a lot of knowledge and skills.In the meantime, how cordial were the Medical Education Commission and the council?I am trying to make sure that the concept of the Medical Education Commission is correct as much as possible. Later we also had disagreements on some issues. In particular, we had a strong discussion about the safety, security, and hygiene of the exam. Basically, I was also supporting. However, it would have been tough if the council had not cooperated during the fight between CTEVT and the Commission. Other councils refused. However, if the Medical Council also said that the Commission did not believe that the Commission did too much, it would have been very loud!We said that it is not possible to do it around the commission, it should be done together. Biometrics has been implemented in the integrated entrance examination conducted by the Medical Education Commission. June, with the help of the Medical Council.The commission did not agree to implement biometrics. 40 thousand they argued that it is not possible to do biometrics of students. In recent years, there have been rumors of fake exam candidates. Some such fake examinees were also caught. The only way to stop it was to implement biometrics. This means that the person who came to take the exam and the person who studied can be cross-verified. In that case, the person is caught after enrollment or registration. The council took the entire responsibility of implementing biometrics in the commission’s entrance examination. The next challenge is that there should be physical verification of the passed candidates on the biometric data.Why can’t the full meeting of the council take action against the doctor even if the ethical committee has found him guilty after investigating the complaint that he was negligent during the treatment?This question keeps coming up. Several times the proposals recommended by the ethical committee have been reversed by the full council meeting. In many cases, the amount of action has decreased. The reason behind that is the opinion of the Ethical Committee based on the opinions of three or four people including the opinion of experts. But, complete while going to the meeting, the amount of punishment is changed with reasoning or due to speculation. The full house will have the final say.The leadership should also take the initiative to make the right decision. If it’s wrong, say it’s wrong, and if you want to save it, you have to save it. We have also given a clean chit to the doctor in many cases where complaints have been made. What the world demands is not to go after it! The eyes of experts and the public are different.There is also an environment where decisions are hindered in the full meeting of the council. Officials who come from the election process also play the role of protecting doctors. However, because of that, we have not overturned or reduced the doctor’s sentence. In no case has the error been corrected. They have won and received compensation from the court due to the misbehavior (full text) of the investigation done by us. It has been a long process. However, there was no injustice. In my opinion, the council has helped in giving justice to the people. However, no action has been taken to show that we have paid compensation and registered the license. Even the council did not want it. Public opinion against physicians even if it is made, it is not good for the country. The strike is happening day by day. The first thing is to encourage them, to teach them, to teach them lessons. However, there are 18 criminal cases for filing criminal cases. The coordinator appointed by the council is looking into 18 cases. One or two have been registered.Why didn’t we publicize this matter in the market, and we didn’t let the public’s view of doctors sway too much?The Ethical Committee has never changed any part of the evidence and research found during the treatment by the full meeting. There may have been some changes in the amount of the decision. For example, suspension of those who canceled the registration, giving a final warning to those who were suspended, and giving another chance. However, the evidence about the error committed by the ethical committee has never been raised.When the doctor’s sensitivity decreases, the patient or the patient’s relatives get angry. If the doctor spends three minutes with the patient after the treatment, most of the cases will not occur.Why is the distance between the doctor and the patient increasing?Mainly four ‘factors’ have worked in this. The first thing is weakness from the doctor begins. Even when there is a lack of continuous communication or counseling between the patient, the patient’s relatives, and the doctor about the treatment, mistrust and suspicion are created towards the health workers. Similarly, the patient or the patient’s relatives get angry when the doctor’s sensitivity decreases. If the doctor spends three minutes with the patient after the treatment, most of the cases will not occur.Now the incident at Patan Hospital seems to be emotional. There was an error somewhere! Since both people died at the same place at the same time, the patient’s relatives suspected that there was a mistake. However, the relative of the patient gets emotional at that time! The doctor should be able to ‘deal’ with it. Love the patient. When making a decision, it should be done properly. This is all medical responsibility. The doctor cannot escape from this.The most common cause of death is a neuro-heart attack. Occurs in large-scale cancer operations. In neuro hospitals or heart hospitals, there is almost zero violence against doctors, beatings, or hospital riots. After that, people accept death. But, correctly had to go and teach the patient’s relatives.Similarly, the chaos of the people. “Brokers” who collect money have been added. Even after citizens have to withdraw money from their pockets, there are more riots in the hospital. Citizens can’t bear it even when people die and pocket money runs out. If the health insurance system and pocket money were not available, the emotion would be less. Even then, mistakes remain.You said to end bribery in the patient referral system after going to the council. However, why was this issue not raised during your tenure?I could not finish this topic. I agree with this. Commissioning should be stopped. Bribery for patient referral is illegal. It reduces the quality of health care. Good doctors are suffering. Unscrupulous and uneducated doctors are bringing patients on commission. 10-15 years ago, there was no business of giving money when referring. But now bribery is on the rise. It is a subject learned in India. In India, they do it openly. However, they are doing it secretly in Nepal. Now the coming officials should see. The commission should be closed. It does not end at once. Because this bribery has become widespread.Recently, the trend of doctors going abroad has also increased. According to the data of the council, it seems that the number is increasing by doubling every year. Why could not the doctor be convinced to stay in the country?The economic, political, and social environment in the country is chaotic. This situation has come about especially because of depression among doctors. If you believe that you can do it in Nepal, there is peace here. Working in America is not easy. The atmosphere of eating and living in Nepal has deteriorated. Bribery increased. The financial aspect is one aspect. However, doctors are coming from America who want to do something in the country even if there is no money to improve other conditions in Nepal. Similarly, if security is guaranteed, the process of going out of the doctor will also be stopped.Let’s change the context, how much potential do you see for a medical hub in Nepal?Theoretically, it is ridiculous. The ability and structure of our current teachers are not enough. Chances are good. The current thing is to increase the number of seats. However, two to four model educational institutions will be created by making it more difficult to bring two to four hundred students from outside. However, the current quality is not satisfactory.What is the next plan?I will spend two days a week at the National Academy of Medical Sciences (NAMS). The program of the heart has been closed after the first run. I will help you to improve it. I also do patient examinations and surgery. My dream is to build a multi-specialty children’s hospital in Kathmandu with seven satellite centers in seven provinces. Which I have moved forward by establishing the Kathmandu Institute of Child Health (KIOCH). I spent the whole afternoon on it. A hospital is already operational in Damak municipality of Koshi.A building is being constructed in Kathmandu. The fund is facing difficulties due to economic recession. However, it did not stop. A positive message is also coming from the market. The active participation of the government was not possible.

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