Recent professional conduct regulations by the National Medical Commission NMC for registered medical practitioners RMPs are penned down in this article.

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The Ethics and Medical Registration Board (EMRB) of the National Medical Commission (NMC) has released draft rules entitled "National Medical Commission, Registered Medical Practitioner (Professional Conduct) Regulations 2022."

The proposed regulations include a broad variety of topics for RMPs, including registration, professional obligations, pay, prescription of generic vs branded pharmaceuticals, restriction on commission, self-promotion and publicity, the release of medical reports, and professional misconduct.

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The professional conduct of RMPs

1, Prefix, suffix and modern medicine:

Medical Doctor (Med Dr.) is a prefix that may only be used by RMPs only who are registered under the NMC Act of 2019. Every self-employed RMP must include the EMRB's unique registration ID on all prescriptions, certificates, and money receipts given to patients. Employed RMPs will receive a seal from their employer to display the RMP's unique registration number beneath their signatures.

Only NMC-authorised and certified medical degrees/diplomas as given in the nomenclature of the rules and available on the NMC website must be shown as a suffix to the RMP's name. (A list of such degrees and diplomas will be available on the website, which will be updated on a regular basis.) To give clarity to patients and the general public, RMPs who are certified outside of the United States and seeking registration to practise after passing FMGE/NEXT must use NMC-approved equivalent Medical prefixes and suffixes. 

To give clarity to patients and the public, RMPs who have completed their training overseas and are seeking registration to practise after passing the Foreign Medical Graduate Examination (FMGE)/National Exit Test (NEXT) must use NMC-approved comparable medical prefixes and suffixes.  An RMP cannot call himself or herself a clinical specialist unless he or she has received NMC-approved training and certification in that field of modern medicine.

An RMP cannot call himself or herself a clinical specialist unless he or she has received NMC-approved training and certification in that field of modern medicine. (The list of recognised post-graduation and super-specialisation degrees/diplomas will be available on the NMC website)

Every RMP must practise the system of medicine in which he or she has been educated and certified (referred to as modern medicine* or allopathic medicine for this purpose) and must not work with any untrained individual to execute any treatment, procedure, or surgery.

An RMP may not engage any healthcare practitioner in the course of his or her professional activity who is not registered or trained under the applicable Medical Acts in effect governing the practice of modern medicine. If any additional assistants are engaged in the practice, the ultimate duty falls to the self-employed RMP or the RMP in charge of administration and recruiting in the case of hospital practice.

A physician who is trained in more than one medical system should choose which one to practise. He may not practise another system of medicine concurrently once licenced to practise Modern medicine under the NMC Act. Short courses in other medical systems do not qualify a practitioner to practise and prescribe in that medical system.

2. Continuing professional development program:

Every five years, an RMP should enrol in continuing professional development programmes totalling at least 30 credit hours. Only recognised medical colleges and health institutions, as well as medical societies that have been accredited or authorised by the EMRB/State Medical Councils, can provide this type of training and credit hours. On the EMRBNMC website, credit hours awarded will be updated against the RMP's Unique Registration Number.

After submitting documentation of CPD credit hours, a licence to practise should be renewed every 5 years (from the date of publication of the Gazette notification). Updates to details such as specialisation, place of work, address, contact information, or any other detail specified by EMRB/NMC will be possible using the licence renewal form. RMPs who wish to practise in another state (due to a change in employment or residence) should notify that state's medical board and apply for a licence to practise there. Within seven days, the state must give a mandatory licence to practise for a reasonable cost.

3. Right to remuneration of an RMP:

Before the patient is examined or treated, the costs for consultation should be disclosed. The patient should be given a realistic estimate of the cost of surgery or therapy so that they may make an educated choice. If the payments are not paid, an RMP may refuse to continue treating the patient. This does not apply to physicians working for the government or in an emergency, although the doctor must guarantee that the patient is not left alone.

4. Prohibiting soliciting of patients:

An RMP shall not solicit patients directly or indirectly or as a part of the group of RMPs, institutions or organisations or hospitals or nursing homes, or corporate hospitals established, owned, controlled, or maintained by the appropriate Government, local authority, trust, whether private or public, corporation, co-operative society, organisation or any other entity or person.

5. Prescribing generic medicine:

Every RMP must prescribe prescriptions with legible generic names and in a rational manner, avoiding superfluous medications and irrational fixed-dose combo pills. (Generic Drugs and Prescription guidelines)

6. Prohibition of fee splitting/commissions:

An RMP shall not directly or indirectly participate in any act of division, transfer, assignment, subordination, rebating, splitting, or refunding of any fee for diagnostic, scanning, medical, surgical, or other treatment. These provisions shall apply with equal force to the referring, recommending, or procuring by an RMP of any patient, specimen, or material for diagnostic purposes or other studies/work. However, nothing in this section shall prohibit payment of salaries by a qualified RMP to another duly qualified person rendering medical care under his/her supervision. RMP shall not use online forums or agents for procuring patients.

7. Prohibition of endorsement of the product or a person:

1. An RMP individually or as part of an organisation/association/society shall not give to any person or to any companies or to any products or software/platforms, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report, or statement concerning any drug, medicine, nostrum remedy, surgical, or therapeutic article, apparatus or appliance or any commercial product or article with respect of any property, quality or use thereof or any test, demonstration or trial thereof, for use in connection with his name, signature, or photograph in any form or manner of advertising through any mode nor shall he boast of cases, operations, cures or remedies or permit the publication of report thereof through any mode.
2. An RMP shall not issue certificates of proficiency in modern medicine to unqualified or nonmedical persons. This does not restrict the proper training and instruction of bona fide students, midwives, dispensers, surgical attendants, or skilled mechanical and technical assistants & therapy assistants under the personal supervision of RMPs. Every certificate must contain the details regarding experience, skills and competency obtained, duration of the training, and kind of work done during training. The onus of the veracity of the certificates lies with the RMP.

8. Restriction on advertisment:

An RMP is permitted to make a formal announcement in any media (print, electronic or social) within 3 months regarding the following:

• On starting practice
• On change of type of practice
• On changing 6 addresses
• On temporary absence from duty
• On resumption of practice
• On succeeding in another practice
• Public declaration of charges

A RMP or any other person including corporate hospitals, running a maternity home, nursing home, private hospital, rehabilitation centre, or any type of medical training institution, etc. may place announcements in the lay press, but these should not contain anything more than the name of the institution, type of patients admitted, kind of training and other facilities offered and the fees. (Guidelines on social media conduct)

A RMP is allowed to do public education through media without soliciting patients for himself or the institution

9. Responsibility of RMP regarding the sale of drugs:

1.  An RMP shall not run an open shop to sell medicine prescribed by RMPs other than himself or for the sale of medical or surgical appliances. They are allowed to sell medication to his/her own patients.
2. RMP can prescribe or supply drugs, remedies, or appliances as long as there is no exploitation of the patients. Drugs prescribed by an RMP or bought from the pharmacy for a patient should explicitly state the generic name of the drug.
3. An RMP shall not dispense or prescribe secret remedial agents of which he does not know the composition or action in the body. The manufacture or promotion or use of these remedies is prohibited.

10. Responsibility of RMP regarding the medical records:

1. Every self-employed RMP shall maintain medical records of patients (outpatients or inpatients) for 3 years from the date of the last contact with the patient for treatment, in a standard proforma laid down by the NMC.
2. If any request is made for medical records to an RMP responsible for patient records in a hospital or healthcare institution either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be supplied within 5 working days.
3. In case of medical emergencies, the medical records should be made available on the same day.
4. Efforts shall be made to computerize patients' medical records for quick retrieval and 7 security. Within 3 years from the date of publication of these regulations, the RMP shall fully digitise records, abiding by the provisions of the IT Act, Data protection and privacy laws, or any other applicable laws, rules, and regulations notified from time to time for protecting the privacy of patient data.
5. RMPs are in certain cases bound by law to give or may from time to time be called upon to give certificates, notifications, reports, and other documents of similar character, signed by them in their professional capacity for subsequent use in the courts or administrative or other purposes. Such reports, certificates, or documents should not be untrue, misleading, or improper. A self-employed RMP shall maintain a Register giving full details of such certificates issued by him/her.

11. Cooperation in the investigation:

An RMP shall cooperate in the investigation against incompetent, corrupt or dishonest conduct of other members of the profession without fear or favour.

12. The RMP shall not aid or abet torture, nor shall he be a party to either infliction of mental or physical trauma or concealment of torture inflicted by another person or agency in clear violation of human rights.

13. Practicing euthanasia shall constitute unethical conduct:

However, in some instances, the question of withdrawing life-supporting devices or measures even after brain death shall be decided following the provisions of the Transplantation of Human Organ Act, 1994. (End of Life Guidelines)

14. Boundaries:

The RMP should respect the boundaries of the doctor-patient relationship and not exploit the patient for personal, social, and business reasons and in particular, avoid sexual boundary violations.

15. RMP shall not refuse on religious grounds alone to assist in or conduct sterility, birth control, circumcision, and medical termination of pregnancy when there is a medical indication.

16. Informed Consent:

1. Before performing any clinical procedure, diagnostic or therapeutic, or operation, the RMP should obtain the documented informed consent of the patient. In case the patient is unable to give consent, the consent of the legal guardian or 8 family members must be taken. The name of the operating surgeon must be mentioned in the medical records. In an operation that may result in sterility, the consent of both husband and wife is required.
2. In case of an emergency, the doctor should try to obtain consent, but if this is not possible, he must act in the best interest of the patient. The medical records should describe the basis of decisions taken in an emergency No act of in-vitro fertilisation or artificial insemination shall be undertaken without the informed written consent of the female patient and her spouse as well as the donor. (Consent Guidelines)
3. An RMP shall not publish photographs or case reports of patients without their permission in any medical or another journal in a manner by which their identity could be revealed.
4. Clinical drug trials or other research involving patients or volunteers must comply with ICMR guidelines and the New Drugs and Clinical Trials Rules, 2018. Consent taken from the patient or participants for the trial of a drug or therapy which is not as per the guidelines shall also be construed as misconduct. (Research Guidelines)

17. Conduct of RMP on Social/Electronic and Print Media shall follow the prescribed guidelines (Social media guidelines)

18. RMP should take due care in practice and exercise reasonable skills as expected, to preserve the life and health of the patient and follow the guidelines (Guidelines on Reasonable Care and Skill)

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Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.
About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.