The National Medical Council (NMC) is a flawed Regulator

The parliament of India recently passed the NMC bill and the President Ramnath Kovind swiftly gave his assent to make the bill the new law. The bill has been in the works for a while and one can’t really say that it has been passed in haste. Yet, some of the features of the bill seem to be completely detrimental to the effective regulation and administration of medical education in India.

The law now envisages the abolition of the erstwhile, Medical Council of India, which had so far governed and regulated medical education in India. It is no secret that MCI had over the years become a den of corruption and had fostered an opaque system of patronage, which has done a huge disservice to the medical education sector in the country. Thus, the demise of MCI should not be much lamented. However, the NMC Act too does some serious injury to the very sector it professes to reform.

The Regulator is not Independent

Members of the NMC will include the Chairperson, four Presidents of the Boards set up under the NMC, Director Generals of the Directorate General of Health Services and the Indian Council of Medical Research, five Directors of medical institutions including the AIIMS, Delhi, five members (part-time) to be elected by the registered medical practitioners, and three members appointed on rotational basis from among the nominees of the states in the Medical Advisory Council. Most of these members will essentially be drawn from the government and will be expected to toe the government’s line.

A search committee comprising of the Cabinet Secretary, Union Health Secretary, CEO of NITI Aayog, and four experts nominated by the central government (of which, two have experience in the medical field), will recommend the name of the chairperson of the NMC, which will be duly appointed by the government. While, the search committee is quite high-powered, its composition once again reflects the bias they will have, while selecting the NMC Chairperson.

To make matters more explicit section 46 of the act says ” “Central Government which will direct, as it may deem necessary, to a State Government for carrying out all or any of the provisions of the Act and the State Government shall comply with such directions.” This is in fact an assault on the rights of the states and clearly concentrates unnecessary powers in the hands of the federal government.

Quackery is In

NMC acknowledges the emerging shortage of doctors in India. However to combat this, the Act resorts to legitimizing quackery!!! It is a well known fact that all over the world, it takes several years of study and training for someone to qualify as a doctor. NMC through, what can only be called as a sleight of hand, proposes to offer a 6 month ”bridge course”to the practitioners of Ayush systems of medicines. This will qualify them as ”Community Health Practitioners” (CHP’s) and these CHP’s will be allowed to prescribe allopathic medicines. Essentially, the CHP’s, after a bridge course of 6 months, will be able to independently practice medicine. While, the act does mention about the possible supervision of the CHP’s by medical practitioners in a timely manner, it isn’t clear about will this work in a country the size of India. To say that this will help solve the shortage and uneven distribution of medical practitioners in the country is pure chicanery.

The Central Government is the final arbiter

It is strange that the appeal against an order of the NMC can only be to the government. Thus, if a doctor is aggrieved with any decision of the NMC he can appeal to the Government of India. With the NMC largely populated with government nominees, government servants and officials, this hardly looks like a fair recourse. It is not clear, why a judicial body is not an appellate authority against the decisions of the NMC.

India certainly needs a regulator for medical education. The regulator however has to be an independent body, comprising of eminent persons from the relevant fields and free to carry out their work in a transparent manner. Moreover, the regulator must be above any possible or likely political interference.

Unfortunately, NMC as envisaged in the present Act is just not that.


Ramrati and some Questions

I learnt about Ramrati from the pages of the Hindustan Times a few days ago. Apparently, the newspaper found her living in a urinal outside of the All India Institute of Medical Sciences (AIIMS), India’s most renowned medical facility located in the heart of the capital. Ramrati had a defective mitral valve and was seeking treatment for her medical condition.

Ramrati hails from a village in the Hamirpur district of UP. She is a mother of 5 and is 50. Needless to say that Ramrati, her husband Bhawani Din and their family lives in abject poverty and can hardly afford cardiac surgery, even at government-run hospitals, which are supposed to treat the poor free, but very often do not. Ramrati traveled to Jhansi for her treatment, from where she was asked to go to the Post Graduate Institute (PGI) of Medical Sciences in Lucknow the provincial capital. From there, she was sent to the AIIMS in Delhi, where she had been languishing in a men’s urinal for close to two and a half month hoping to have her surgery at India’s most premium medical institute.

Bhawani Din mortgaged all of his land to raise Rs. 100000 to fund his wife’s surgery. It would probably have been possible for Ramrati to undergo surgery at AIIMS, but then the hospital is over crowded and Ramrati has to wait her turn and since she has no place to live in Delhi, she found an unused men’s urinal, outside AIIMS and shared it with some other patients in a similar predicament.

Thanks to the story in the Hindustan Times, Ramrati found help. A local NGO found her room to board in a dharamshala and an eminent cardiac surgeon Dr. A. Sampath Kumar, formerly the Head of CTVS Surgery and now at a private hospital, Pushpanjali Crosslay Hospital in East Delhi agreed to operate on Ramrati free of cost.

The newspaper duly wrote about Ramrati’s good fortune also highlighting its own role in bringing succor to her. Pushpanjali Crosslay Hospital too did not miss the opportunity of grabbing headlines by positioning itself as a hospital with a heart. Dr. A. Sampath Kumar, who was part of the team of surgeons who had operated on the Prime Minister a few years ago got an opportunity to present himself as one of the ‘finest’ cardiac surgeon in the country.  Pushpanjali Crosslay Hospital, released pictures of a tired looking Ramrati being taken to the hospital for treatment and undergoing treatment at the hospital. AIIMS agreed to refund the Rs. 100000 deposit it had accepted from Bhawani Din.

Well, all this does sound like a fairy tale but it does raise disturbing questions. Why does Ramrati need to run from pillar to post to seek medical attention? Why does she need to travel to Delhi, via Jhansi and Lucknow, when the medical attention she needs can be provided to her in Lucknow? Why does Bhawani Din need to mortgage his land to raise money for his wife’s treatment? Why does Ramrati need to languish for two and half months in a men’s urinal outside India’s best hospital to get treated? What happens if she dies waiting for her turn? Who is accountable for all this? How many Ramrati’s are waiting outside AIIMS and other such facilities desperately seeking medical attention and why no one does anything about it? At the end of the day, who is accountable for Ramrati’s fate?

Now let us look at Dr. Sampath Kumar’s intervention. I would like to believe that he is a genuinely altruistic man and by responding to Ramrati’s predicament, he is only honouring the Hippocratic oath. But look at the way Pushpanjali Crosslay Hospital has gone about talking to the press about the free treatment that Ramrati has been offered by them. There are Ramrati’s photographs with the hospital ambulance serving as a nice backdrop and every mention of Dr. Kumar is followed by a statement that he is now with Pushpanjali Crosslay Hospital. It seems that the hospital wants the media spotlight firmly on itself, somehow the entire things looks way too opportunistic.

While the likes of Anna Hazare and the so-called members of the civil society prepare to commence a Gandhiji like fast, hoping to bring the government down to its knees, who is looking out for the Ramratis of the world. Why don’t we have the civil society empathizing with the poorest of our land and the callousness of our system, which does not care for them? Isn’t the right to reasonably good healthcare a fundamental right derived from the right to life? Isn’t  this something to agitate for? How can we have a shining India and a Ramrati’s India existing together and for how long?

And finally,  today as we have our netas shamelessly mouthing platitudes to our freedom from the British, we need to look inwards and ask ourselves if Ramrati is free today. Unless we get an answer in the affirmative, India will continue to struggle for real freedom.

PS: I believe Ramrati has since been successfully operated upon and is on the road to recovery

Doctors and Healthcare Advertising in India

Many years ago when I worked at a hospital chain, our advertising agency had come up with a campaign featuring happy patients. The hospital wanted to showcase their doctors. The objective of the advertising was to highlight the hospital’s expertise and superior services and position it on the ‘care’ platform.

The advertising agency and the hospital had been at loggerheads on this. The agency was dead certain that showing hospital doctors in ad visuals was a bad idea. They had come up with the images of happy people, who had had wonderful experiences at the hospital. The copy proceeded to narrate the experience in glowing terms, capturing the essence of the hospital and making a point about its medical and other services. I had liked the ads, though I found them a little run of the mill. Nothing very extraordinary but steady communication, which made its point. It however never saw the light of the day.

In those days (and I suspect in many hospitals even today) the brand manager had to run the ads past the medical folks. The prevalent thinking was that the medical people will be able to spot bloomers and also come up with great suggestions and those could be incorporated in the communication. However, I quickly learnt that the reality was usually very different. Most medical folks had very little understanding of consumer facing communication, and most wanted themselves featuring in the ads. Many also wanted images of them operating on patients and were keen to showcase all the gory details of their glorious profession.  Some even had suggestions on how ad copy headlines and even hospital logo was to be arranged. The advertising agencies hated this mutilation of their advertising and the brand manager had the task of balancing the demands of the doctor, the agency and the brand itself.

As I gained in experience, I realized that a lot of hospital advertising had very little to do with end consumers. Now, this may sound absurd, but let me explain. Often hospitals would hire high profile doctors committing huge marketing spends on promoting them and their specialities. This would be the understanding between the hospital bigwigs and the doctor concerned. Thus, a significant purpose of the advertising will be to keep the doctor in good humour and honour a commitment made to him.  Thus the doctor would legitimately expect to feature in the communication and try and showcase his skills.

Unfortunately, even now one rarely comes across real ‘brand’ advertising in healthcare in India.  Most hospitals still prefer to bet on individual doctors and shy away from investing in the hospital brand.  New hospitals do a little ‘launch’ related advertising, however there too quite often one encounters a well known doctor prominently featured in the communication.

Recently I came across advertising for Alchemist Hospital in Gurgaon, featuring the well known cardiac surgeon Dr. P Venugopal. He was till recently the director of the All India Institute of Medical Sciences and has now joined Alchemist Hospital in Gurgaon. Max Healthcare announced the commencement of their cancer services leading in with the doctors they have hired. They also ran ads featuring Dr. Pradeep Choubey, a well known laparoscopic surgeon who has joined them from Sir Gangaram Hospital.As a consumer, why do I need to know how Dr. Choubey looks to understand that he has now moved from Sir Gangaram Hospital to Max Hopsital. Yes, as a consumer I would like to know how Dr. Choubey’s expertise and services makes Max Healthcare a better hospital.

Seeing these ads recently reminded me of my struggles as a young brand manager. Even after so many years, it seems in healthcare communication nothing much has changed.

Here is wishing everyone a Merry Christmas!!!

Pic courtesy

The Power of a Compelling Story in the Marketing of a Hospital

cardiac-surgeryMany years ago, when I worked at Max Healthcare, I met an elderly man whose grand daughter had had a major cardiac surgery and was admitted in the hospital. The child was on her way to recovery and the old man was profoundly grateful to Dr. Anil Bhan, who had operated on the child. The old man narrated a very interesting tale.

The old man and his wife lived in Roorkee, a University town about 150 miles from Delhi. His son worked in a nationalised bank in Delhi and he had two grand children, twins as a matter of fact, a grand daughter and a grand son. The children now aged 11 years lived apart, the son in Delhi with his parents and the daughter with them in Roorkee.  The daughter from the time of her birth had been a sickly child and had required heart surgery, when she was 9 months old. Being a girl child and that too a sick one, her parents had entrusted her care to the old couple and they had brought her up. Clearly, the old man and his wife were extremely attached with this child and she was the apple of their eyes.

The child too enjoyed living with her grand parents and they clearly doted on her. They ensured that she received the best medical care and would regularly bring her over to AIIMS, the premier medical institute in Delhi for regular monitoring and check ups. About two years ago, when the child was 9, they had noticed that she would become breathless after a little exertion. Initially they did not worry too much, however things grew steadily worse and they became quite alarmed and brought her to Delhi.

The paediatric cardiologist at AIIMS, who has been taking care of the child in all these years told them that the child needed another surgery, an extremely rare and very risky procedure and she needed it fast. They were also told that without the surgery the prognosis was very poor. Dr. Anil Bhan, who was the paediatric surgeon who had operated on her as a eight month old infant had now moved to Max as their chief of cardiac surgery.

The old couple brought the child to Dr. Bhan, who examined her carefully and pronounced that while the surgery was extremely rare and very risky he was willing to do his best. The old couple let things in the hands of Dr. Bhan and prayed to the almighty to save their grand daughter. Dr. Bhan operated on the child and she was wheeled into the Paediatric ICU after the surgery. Soon post surgical complications set in and hopes of her survival dimmed. Dr. Bhan, however approached the old couple again and requested permission to try surgery once again. The old couple with nothing to lose, told him to go ahead.

The child was again wheeled into the OR and Dr. Bhan and his team once again made a heroic attempt to save her life. She survived the surgery and spent the next 9 days in the ICU under the watch of some very dedicated doctors. The child was than shifted to a ward and when I met the old man, he was preparing for her discharge from the hospital.

The gratitude this man had for Dr. Bhan and his team, the ICU staff and for the hospital was immense. He showed me a poem he had composed in Dr. Bhan’s honour. He could not help narrate the wonderful things that happened to him in the hospital, about the extraordinary skills of the doctors, their commitment and their indomitable spirit in not giving up on them even in the face of unbelievably daunting odds.

There can be no greater hospital marketing tool than a powerful and a compelling story narrated by the patient or a patient attendant about his experiences in the hospital.


PS: Dr. Bhan and his team has since moved to Batra Hospital in New Delhi


Pic courtesy


The Patient Prime Minister

dr-manmohan-singhThe Prime Minister of India, Dr. Manmohan Singh underwent a multiple bypass surgery at the All India Institute of Medical Sciences (AIIMS) a few days ago. Dr. Singh is a diabetic and has a history of heart ailments. He has had a bypass surgery almost 20 years ago and also had to undergo an angioplasty subsequently. Dr. Singh is 76. The surgery was performed by the eminent cardiac surgeon Dr. Ramakant Panda, who is considered to be the foremost expert in ‘redo’ bypass surgeries. Dr. Panda, who is presently the CEO of the Asian Heart Institute, Mumbai is also an alumni of the prestigious AIIMS.aiims

While the extremely challenging surgery went of well and the Prime Minister is recovering, I could not help but wonder at the Marketing opportunity celebrity patients present for the hospital and the doctors.

Dr. Ramakant Panda is a very well known surgeon but the kind of fame that operating on the Prime Minister will bring to him would do his already busy practice a world of good. It would also rub off on the Asian Heart Institute, which he heads. AIIMS of course is the premium medical institute in the country. That the Prime Minister chose it over any other hospital in the country is a great vote of confidence in the medical capabilities of the doctors and medical team at AIIMS.

Many years ago Atal Behari Vajpaye, the than Prime Minister of India had had a knee replacement surgery at the Breach Candy Hospital in Mumbai. Dr. Chitranjan Ranawat, a surgeon of Indian origin based in New York had operated on the Prime Minister. The hospital had remained in the limelight for many weeks, with the tremendous media coverage around the event. Though the Prime Minister recovered, his unseemly tottering  gait remained a poor advertisement for the surgery.     Continue reading