Doctors can refuse to treat Unruly patients, those patients who don't pay displayed fees - NMC notifies new code of conduct

New Delhi: Over a year after putting its draft code of conduct in the public domain, the National Medical Commission (NMC), finally, through a gazette notification, has notified the NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023. These regulations prescribe a code of ethics mandatorily to be adopted by every practitioner of modern medicine who is registered under the NMC Act and is practising in the country.

The National Medical Commission Registered Medical Practitioner RMP (Professional Conduct) Regulations, 2023 will replace the erstwhile Medical Council of India MCI’s Code of Medical Ethics 2002. These new regulations have been enforceable since August 2nd 2023, the date of its publication in the official gazette.

The gazette notification contains a comprehensive document laying down a self-regulatory set of guidelines on how an RMP should behave, their professional conduct as a doctor, their duties and responsibilities towards patients, other doctors and health professionals as well as society.

The regulations also specify the professional misconduct if committed by any doctor. The guidelines list the procedure for a complaint of professional misconduct, the manner of Inquiry as well as disposal of the complaint, penalty to the doctors and further a provision of appeal in case a doctor is aggrieved by the decision of the State Medical Councils.

These regulations further consist of a set of guidelines on the prescription of generic medicine, a code of ethics, penalties, levels of disciplinary actions, informed consent in clinical practice, the conduct of doctors on social media, Continuous Professional Development (CPD) Guidelines, and Telemedicine norms.

Laying down the norms for the professional conduct of doctors, the NMC specified the responsibilities of doctors practising modern medicine including the sale of drugs, maintaining medical records and consent. It stresses on the prohibition of soliciting patients, fee splitting/commissions and endorsements.

One of the salient features that stand out from the code of conduct for the first time is the right of refusal as per which the doctors can now refuse treatment to the unruly and violent patients. In such cases, the doctors have been told to follow a procedure of properly documenting and reporting the said violence, their refusal and referral of the patient to other health facilities.

“In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behavior and refuse to treat the patient. Such patients should be referred for further treatment elsewhere.”

The regulations also give the doctors the right to choose whom they will serve, except in case of a life-threatening emergency.

The ‘Patient Care’ section in the document clearly mentions:

“RMP is free to choose whom he will serve, except in case of a life-threatening emergency. Having accepted a case, the RMP should neither neglect the patient nor withdraw from the case without giving adequate notice to the patient and his family. If a change of RMP is needed (for example, the patient needs a procedure done by another RMP), consent should be obtained from the patient himself or the guardian. The RMP who attends to the patient will be fully accountable for his actions and entitled to the appropriate fees. In case of abusive, unruly, and violent patients or relatives, the RMP can document and report the behavior and refuse to treat the patient. Such patients should be referred for further treatment elsewhere.”

Moreover, the doctors can also refuse to treat patients if the agreed-upon fees are not paid by the patient in lieu of treatment. This said provision, however, will not be applicable to the government doctors or in case of emergencies.

‘Right to remuneration’ feature mentioned in the gazette entails:

“Consultation fees should be made known to the patient before examination or treatment of the patient. A reasonable estimation of the cost of surgery or treatment should be provided to the patient to enable an informed decision. RMP can refuse to treat or to continue to treat a patient if the fees, as indicated, are not paid. At the same time this does not apply to doctors in government service or emergencies but the doctor must ensure that the patient is not abandoned.”

Any violation of these regulations is bound to attract strict disciplinary action in the form of a suspension of the license to practice for a period ranging from 3 months to 3 years.

“At each of Levels 2, 3, and 4, the extent of action recommended may range from reformation alone to a maximum of suspension for the period indicated at the level, depending on the quantum of responsibility of the RMP for the harm/injury caused,” the regulations stated while prescribing the level of actions in case of violations.

To view the NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023, click here