'Doctor' title not exclusive to medical professionals! Kerala HC allows physiotherapists to use Dr prefix

Ernakulam: The Kerala High Court recently dismissed the pleas seeking a ban on Physiotherapists and Occupational Therapy Professionals to proclaim themselves as the first health care provider and use 'Dr' prefix.

"As rightly contended by the respondents, the NMC Act does not contain any provision for conferring the title Doctor on qualified medical professionals," the bench noted.

Even though in an earlier interim order, the HC bench had clarified that such professionals cannot use the concerned prefix 'Doctor' without a recognised medical qualification, now the High Court bench comprising Justice VG Arun has observed that the contention that the title 'Doctor' exclusively belongs to medical professionals is a misconception since even now, like in the olden times, persons with higher educational qualifications like PhD are entitled to use the title 'Doctor'.

Further, the Court agreed with the contention by the respondent authorities that the NMC Act does not contain any provision for conferring the title Doctor on qualified medical professionals.

"The expression title used in Section 40 of the Kerala State Medical Practitioners Act cannot therefore be understood as statutorily entitling the qualified medical professionals to prefix 'Dr' to their names. In the absence of such provision, the petitioners cannot claim exclusive right to use the prefix 'Dr'. The decisions relied on by the Senior Counsel for the petitioners are all rendered prior to or without reference to the NCAHP Act and are therefore not applicable to the cases under consideration," the Court held.

Background:

The issue arose when, earlier last year, the National Commission for Allied and Healthcare Professions (NCAHP) had recommended the use of 'Dr' prefix for physiotherapists.

Pleas before Kerala HC:

Several pleas were filed before the Kerala High Court seeking an order to nullify, rather read down, the wide scope of the connotation "Physiotherapy Professional" as enlisted vide Sl. No. 3 as well as Serial No. 6- Occupational Therapy Professional of the Schedule appended to the National Commission for Allied and Health Care Professions Act, 2021 so as to make and confine the scope of discharge of such professional services of Physiotherapists and Occupational Therapy Professionals only as a supporting group for the qualified Medical Professionals under the provisions of the National Medical Commission Act, 2019 and Indian Medical Degrees Act, 1916.

Further, the petitions prayed for quashing certain provisions in the Competency Based Curriculum for Occupational Therapy, to the extent to which they purported to place Physiotherapists and Occupational Therapy Professionals in a high pedestal as a First Health Care provider and in allowing them to use prefix 'Dr' in their names.

Another prayer was for a writ of mandamus or other appropriate order directing the authorities and their officers to issue necessary orders interdicting Physiotherapists and Occupational Therapy Professionals in proclaiming themselves as First Health Care provider and in using the prefix 'Dr' in their names and to ensure that their professional services should be confined only as a supporting group for the medical profession.

These pleas were filed by the Kerala State Branch of the Indian Medical Association, the Indian Association of Physical Medicine and Rehabilitation (IAPMR), and several other medical professionals.

Interim Order:

Last year in November, the HC bench, in an interim order, barred Physiotherapists and Occupational Therapists without recognised medical qualifications from using the prefix 'Dr'.

"Hence, there shall be a direction to the competent authorities to ensure that the prefix “Dr.” mentioned in Exts.P1 and P1(a) is not used by Physiotherapists and Occupational Therapists without recognised medical qualification," the Court had ordered.

Judgment by Kerala HC:

However, in its final judgment, the Kerala HC bench has upheld the right of Physiotherapists and Occupational Therapists to use the prefix 'Doctor'.

While deciding the matter, the HC bench endeavoured to understand the circumstances leading to the enactment of the NCAHP Act and the formulation of the Competence-Based Curriculum for Physiotherapists and Occupational Therapists.

It noted that till recently, the health force in the Indian scenario focused mainly on a few cadres such as qualified modern medicine practitioners, nurses, and front-line workers, while the professionals belonging to the healthcare sector were generally termed as para-medical professionals.

The Court observed, "The advancement in the health sector and the changing preferences of consumers and service providers warranted a fresh vision of healthcare delivery with a patient-centric approach and focus on moving to a multi-disciplinary team based care. Accordingly, the Allied and Healthcare Professions Bill, 2018 was introduced in the Rajya Sabha and referred to the Department Related Parliamentary Standing Committee of the Ministry of Health and Family Welfare for its examination and report. Based on the recommendations of the Committee, the earlier Bill was withdrawn and a new Bill, namely, the National Commission for Allied and Healthcare Professions Bill, 2020 introduced. Later, after due deliberations, the National Commission for Allied and Healthcare Professions Act, 2021 was brought into force. The Act is intended to provide for regulation and maintenance of standards of education and services by allied and healthcare professionals, assessment of institutions, maintenance of a Central Register and State Register, creation of a system to improve access, research and development, adoption of latest scientific advancement and for matters connected therewith or incidental thereto."

Referring to the NCAHP Act, 2021, the HC bench perused the definitions of 'allied and health professional' under Section 2(d) of the Act and the definition of 'healthcare professional' under Section 2(j) of the Act. "Thus, going by the definition itself, a healthcare professional is entitled to provide preventive, curative, rehabilitative, therapeutic and promotional health services," the Commission noted at this outset.

It also observed that there was no direct challenge to the said provision and the prayer was only to read down certain provisions, that too, of the Schedule to the Act and the Competency Based Curriculum.

"As rightly contended by the respondents, the prayer seeking the reading down of the provisions of an enactment passed by the Parliament will normally not be entertained, though, in appropriate cases the writ courts can resort to such procedure. In the cases under consideration, this Court is unable to find any compelling reason to read down the provisions of the NCAHP Act, so as to confine the scope of discharge of professional services by Physiotherapists and Occupational Therapists as a supporting group for the qualified medical professionals registered under the NMC Act," the Court observed.

It also noted that the healthcare professionals are conferred the qualification of degree under the NCAHP Act after undergoing extensive study of not less than three thousand six hundred hours spread over a period of three years to six years, divided into specific semesters.

"Even though healthcare professionals can provide preventive, curative, rehabilitative, therapeutic and promotional health services, they cannot prescribe medicines or provide allopathic treatment. Therefore, the services provided by a healthcare professional and a medical professional are distinct, though, at times, a healthcare professional will also be playing a supporting role during allopathic treatment of patients. While considering whether the prayers in the writ petition can be granted, the overriding effect provided by Section 64 of the NCAHP Act cannot be overlooked," noted the Court.

"Yet another aspect of importance is that the Parliamentary Committee had made its recommendations, after hearing the National Medical Commission also. The fact that the representative of the National Medical Commission is a member of the National Commission for Allied and Healthcare Professions, also assumes relevance. In such circumstances, it will be inappropriate for this Court to tinker with the policy of the Government or read down the provisions of the Act or the Curriculum at the instance of a few medical professionals," it further observed.

According to the HC bench, the challenge against the use of prefix 'Dr' by Physiotherapists will not also hold good since the NMC or the allied statutes do not provide for the use of the prefix 'Dr' by qualified medical professionals.

"Here it will be interesting to note that the term 'Doctor' originated from the latin word 'Doctor', which means teacher or instructor. Research reveals that, around the thirteenth century, the term Doctor has evolved into an academic title in European Universities and was used for referring to someone who had achieved the highest level of learning and had received licence to teach in fields like theology, law and philosophy. Thus, the term Doctor originally meant a learned person qualified to teach. Gradually, with the advancement of medical science, University trained Physicians (holders of degrees in medicine) began to be called Doctors. The usage became much more common for physicians by the nineteenth century, as medical education formalised and the public increasingly associated the title with healers. Therefore the contention that the title 'Doctor' exclusively belongs to medical professionals is a misconception since even now, like in the olden times, persons with higher educational qualifications like PhD are entitled to use the title 'Doctor'," the Court observed.

With these observations, the HC bench dismissed the petitions.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kerala-hc-physiotherapist-323440.pdf

Also Read: NO 'Dr' prefix for Physiotherapists, occupational therapists, Rules Kerala HC