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Documented by Goa Desc Documentation Service
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Doctors are now required to display their fees.
by Mayuresh Pawar.
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WHAT DO THE REGULATIONS SAY ?

 > a physican should announce his fees before rendering service
and not after an operation or treatment is under way. It is
unethical to enter into a contract of "no cure no payment".

 > A physican should clearly display his fees and other charges
on the board of his chamber and/or hospital he is visiting.

 > The question of withdrawing supporting devices to sustain
cardiopulmonary function even after brain death, should be
decided only by the team of doctors and not, merely
by the treating physician alone.

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Now... there could be a board on your doctor's door displaying his fee
that would radically redefine the doctor-patient relationship all over the 
country,
as the Medical Council of India (MCI) issued the new guidelines
that would make the life easier for users of health services.

Thanks to this revision  the first comprehensive one since 1970
doctors have been instructed to give patients the copies of their medical 
records
within 72 hours of being asked. The India Medical Council (IMC),
(Professional conduct, Etiquette and ethics) Regulations 2002
was notified by the MCI and that the regulations addresses a gamut of issues,
ranging from the ethics of the medical profession
to conduct of the physician while dealing with a patient.

This, according to highly placed sources in the State Directorate of Health 
Services
DHS), here at Campal, the Regulations 2002 is mostly a codification
of new law and court judgements.Sources informed Herald that,
the medical practitioners have also been asked to display
the registration numbers and fee charges in their clinics.

Doctors, the sources stated, are now permitted to inform the patient's 
family member
about the communicable diseases, which is a significant amendment
particularly in the situation of life-threatening diseases like AIDS.

The clause regarding confidentiality of a patient having a communicable 
disease
has drawn the fraternity into seeking more clear guidelines, sources stated
quoting the Supreme Court order, which says, "Right to confidentiality is 
not absolute
and cannot override, right to life. The guidelines should clearly specify 
as to whom
the wife, fiancee or which other family members should the information be 
given."

Also significant is the clause that states that no patient can be denied 
emergency care.
Continuing the medical education a subject under discussion in medical circles
has also been made compulsory for doctors  who will now have to devote 30 
hours
in every five years for upgrading their skills and knowledge.

Sources said that these guidelines could be implemented properly,
make the doctor-patient relationship more professional. However,
these guidelines came into force on April 6, 2002, and that,
very few doctors are aware of their existence.

Yet it's conclusions and instructions "any violation of the rules
would attract disciplinary action from the MCI which will include 
de-registration"
have drawn the medical fraternity into debating issues like the 
confidentiality
involved in a doctor-patient relationship as well as the philosophical 
dimensions
of concepts like mercy killing.

Refusing to be quoted, most of the doctors had ruled out strongly
against the display of fee structure. The doctors also felt that,
the time frame of 72 hours for providing medical records on request by 
patient,
set under the guidelines as unreasonable. "At least 7 days time should be 
given
to furnish records on request," says a Panjim-based private practitioner.

The clause regarding confidentiality of a patient having a communicable 
disease
has drawn the fraternity into seeking more clear guidelines.
Welcoming most of the regulations a Panjim-based physician opines that,
"the guidelines should be more specific in case of diseases like HIV
and tuberculosis and added, "Whom to inform can be a dilemma for a doctor
and be specified in the context of social responsibility."

Another private doctor while welcoming most of the guidelines set by the MCI,
argued that, the confidentiality be maintained and
discretion be left solely to the patient suffering from a communicable disease.

Citing instances this doctor said, "When HIV carriers have hidden the fact
from their fiancees forcing them into mental agony," and added that,
"I cannot give any specific incident but we have been coming across many 
such cases.
Mental agony and torture are finally taking its toll in some of these cases."

Similarly, the ban on foeticide sex-selection procedures
is derived from the Pre-Natal Sex Determination Test (PNDT) Act, 1994.
The clause on communicable diseases meanwhile, comes from the Supreme
Court judgement earlier this year. The issue is expected to set the debate 
rolling.

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HERALD   13/5/02  page 1
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