INSUBCONTINENT EXCLUSIVE:
Dr Bhagwan Koirala, a senior cardiothoracic and vascular surgeon, was recently appointed as the chair of Nepal Medical Council, a body that
regulates the medical sector and provides licence to doctors to practice medicine in Nepal
He pioneered open heart surgery in Nepal and played a crucial role in establishment of Shahid Gangalal National Heart Centre and Manmohan
Cardiothoracic Vascular and Transplant Centre
Sabitri Dhakal of The Himalayan Times met Dr Koirala to discuss the changing roles and responsibilities of the medical council, its future
plans, anomalies in the medical sector and reforms required to provide quality healthcare services
Excerpts:
Roles and responsibilities of Nepal Medical Council have changed since the introduction of a new law, haven&t they?
With
change in the Health Professional and Education Act, the terms of reference for Nepal Medical Council have changed
The council will no longer look into medical education sector as it falls under the domain of Medical Education Commission
The council work is currently divided into three areas: overseeing whether or not doctors are upholding medical ethics; making sure doctors
are updated with medical practices; and monitoring safety-related issues in healthcare sector
The council will also conduct licensing examination for medical practitioners
I want to clarify that the council has its limitations and will not regulate works of nurses and technicians working in the healthcare
We only monitor works of registered doctors.
How are you planning to steer the council?
One of our main tasks is to provide licence to
doctors so that they can practice medicine
We provide licence only to the competent ones
The licensing examination is currently manual and basically tests theoretical knowledge of applicants
We need to introduce competency-based examination
We are also planning to conduct computer-based tests for which we need to strengthen our IT system
Though it will create difficulties, it is necessary for patients& safety as there are medical colleges where students haven&t got enough
practical education.
We are working to enhance skills of doctors so that they can offer healthcare services of international standard
Doctors should be aware about changes in medical theories and new researches being carried out in the field
So, they should study continuously
In this regard, we are trying to implement Continuous Professional Development programme for all registered doctors
If doctors fail to secure required points in CPD programme, their licences will not be renewed
The primary responsibility of producing competent medical practitioners lies with universities and academies
But we are authorised to cross examine their quality, and it our duty to make sure they are competent
We will use the principles of educate, empower and enforce to enhance quality of doctors
Doctors should not rest on their laurels after obtaining a degree from a college or a university
They need to keep themselves updated
We also intend to focus more on doctor works, mistakes made by them, and patients& complaints
The grievances of the public will be seriously investigated.
Some of the doctors are rejecting the concept of CPD
What is your take?
Doctors should ask whether the programme is beneficial for them, patients and the country
If the answer is yes, we all should support this cause
Many doctors are not happy with this programme because it forces them to attend conferences and meetings to score points
We should make sure that all the doctors, specially those working in remote areas, gain access to these conferences and meetings
So I don&t think this is a big issue
The council is training the trainers for CPD programme in all provinces.
How challenging is it to make Nepal Medical Council credible?
It is
challenging to meet all expectations of the public
As I told you earlier, we have limitations
But we would like to work with other stakeholders to bring about changes
These changes may not be visible immediately because reform is a continuous process
We will set certain performance indicators which will look into complaints that have been handled, decision-making process, delivery of
justice to people, and implementation of CPD programme
We are trying to improve the quality of doctors, which is something that can&t be assessed on a daily basis
We will lend our ears to those who complain about quality of doctors
We are not fully authorised to deal with a host of issues related to medical treatment of patients, but we will do whatever we are allowed
to do to deliver justice to the ones who have been unfairly treated.
Have cases of violence against doctors and acts of vandalism at
hospitals gone up, of late?
I think they have increased, but not in an exponential manner
Hospitals are providing compensation to the families of patients
This quick fix is damaging the reputation of the sector
If you really think a medical team has committed mistake, then the investigation team will obviously point out those shortcomings
So, one needs to have trust in the system
We would like to educate the public not to resort to violence if they are dissatisfied with the treatment
We would like to request the public to pursue legal action rather than resorting to violence because violent activities will eventually
cause damage to the healthcare sector
Violence may immediately provide some respite to people who are unhappy with the medical treatment, but it also deters good doctors from
Also, the service may differ depending upon the standard of hospitals
People should consider these aspects as well
We know there are lots of deficiencies in the healthcare sector, but we must work together to bring about changes.
What is the situation of
medical ethics in the country?
Medical ethics is a vast area
It ranges from being available to treat patients on time and giving 100 per cent of what you can, to being honest with patients and making
yourself competent enough to treat patients
If you are not competent, it is not your fault that you couldn&t cure the patients
Someone who is diligent and puts in lots of efforts to learn new things may be competent, but doctors can also become competent if they
So, we need to build a foolproof system
We do hear reports about doctors falling prey to pharmaceutical companies that offer them money and junkets to push their drugs
There are also doctors who do not clearly explain to patients what can be done and what cannot
It is not ethical to take undue benefit of your position
But various factors are promoting these malpractices, which can obviously be controlled.
How can doctors maintain high ethical standard?
We
need to educate, empower, enforce and enable
We know how to educate; universities know this
We are also learning how to educate people before they go to practice or before they become specialists
We can also educate them on ethics
Right now CPD programme has a threshold of 30 points
This programme will make doctors competent, but medical practitioners should also maintain high ethical standard
Our medical sector is mostly dysfunctional except in some of the urban centres
And many times doctors are held accountable for something they are not responsible for
So, we need to educate people and improve the healthcare system.
How does your appointment as chair of the council affect the
multi-speciality comprehensive hospital project?
I didn&t take up other challenging jobs partly because of the need to work on the children
That project is absolutely necessary for the country
My appointment as chair of the medical council will probably divert some of my attention from the project, but I am totally committed to
it.
Why did you feel the need for a speciality hospital?
I am a heart surgeon, but I was also trained as a paediatric heart surgeon
I was in the best paediatric cardiac centre for significant period of time
Earlier, when we started Shahid Gangalal Hospital, I was looking into a lot of paediatric cases
We also came up with lots of schemes because we were committed to handling paediatric cases
But we quickly realised that we couldn&t change much
We also noticed that fixing one organ in a child or an adult will not solve the whole problem
We need to have a systematic and comprehensive approach to child healthcare
In Nepal, all childcare services are not available under a single roof
And we only have around 1,000 or even lesser number of hospital beds for children
The number of hospital beds for children should be at least four to five times more than what is available at present
Generally, when children fall sick, they visit regional hospitals and if proper services are not available they have to come to Kathmandu
Even in Kathmandu child healthcare services are fragmented
Nepal, so far, has only concentrated on preventing infections in children by focusing on immunisation, hygiene and sanitation
We need to do more in the area of child healthcare.
How can we control anomalies in medical education sector?
The laws are becoming
ineffective and the rule of law is under threat
It is a sign of systemic failure
This is why many are now retaliating
Earlier, students used to complain about exorbitant fees charged by medical institutions
So, the first thing we need to do is to strengthen our system and ensure rule of law
The state needs to work proactively to fix these problems.
How can medical treatment be made cheaper?
We need to understand that everything
But we can devise a right financing model, backed by insurance or government schemes, to keep the healthcare costs low for the public
We also should not be extravagant
There is room for improving the quality of healthcare service and reducing its cost as well.
The post Doctors should not rest on their
laurels after obtaining degree appeared first on The Himalayan Times.
