Qs & As — Dr Baboo Servansingh, Former President MCM
A number of questions have been asked and continue being asked in public about the standard of training and the dispensing of medical care in Mauritius. Rightly so, not only because it should be normal for a country like Mauritius to encourage and support the highest quality of medical practice for the good of patients and the high standing of the profession.
There should also be a sound track record if Mauritius wants to play a role in providing medical care to an international market. We asked the outgoing Chairperson of the Medical Council of Mauritius, Dr Baboo Servansingh, the role played by different institutions in the medical sector, the Medical Council in particular, towards fostering the good image of the country in terms of the quality of medical practice, authorization and oversight of medical training institutions, scrutiny upon and responsibility for the standards of healthcare meted out, etc…
* It appears that it’s not only the lay public who would not be totally conversant with the raison d’être of the Medical Council of Mauritius (MCM); even quite a significant number of health professionals might also entertain misconceptions about its role and mission. What is the role of a Medical Council in a country’s system of health?
The Medical Council of Mauritius has a very important role, clearly defined in the Medical Council Act 1999. Its functions are to publish an annual list of registered medical practitioners, to exercise and maintain discipline in the practice of medicine, to advise the Minister on any matter governed by the Medical Council Act, to establish a code of practice on standard of professional conduct, medical ethics and finally to promote the education and training of medical practitioners. All these functions are being carried out pretty well by the Council.
* Do all countries have a Medical Council?
I cannot confirm that all countries have a Medical Council but the main countries where our Medical Doctors are qualified from, do have Medical Councils or a regulatory body. The Medical Council of Mauritius is a member of the Association of Medical Councils of Africa ( AMCOA) which has 20 affiliated members.
Last year, we had the opportunity to host the Annual conference of AMCOA in Mauritius. This kind of exchange among Medical Councils not only brings practitioners from different countries together. They also help share the specific experiences of Council members faced with situations that are not exactly similar to ours. We also have the opportunity to learn from each other about how to cope with distinct professional issues and to prepare a good and efficient platform for our own medical practice by reference to experience from outside.
* Do you feel that the MCM is fulfilling its role properly? Are there any obstacles or difficulties that prevent the MCM from functioning?
I can assure you that the Council is fulfilling its role to the best of its ability. Obviously, we do face many difficulties. Yet, despite these difficulties, we have been operating at a satisfactory level for the upkeep of the objectives of the Council and for sustaining a high standard of service and discipline among practitioners.
The members sitting on the Board of the Council are full-time professionals who participate in the Council’s work on a part-time basis. All the committees of the Council need the participation of all the Board members but we often face situations where members cannot free themselves from their professional obligations for scheduled meetings. We do our best in the circumstances.
* Does the MC have any part to play in overseeing the maintenance of standards of practice and of professional ethics?
In November 2013, the Medical Council Act was amended. Four amendments were made which will certainly bring a higher standard to the practice of medicine in Mauritius, namely (1) the introduction of a minimum qualification of at least 21 points at HSC exams in order to enroll in a medical school, (2) the introduction of an examination before registration as a general practitioner, (3) the introduction of the postgraduate medical board to assess all specialists before their registration, and (4) the introduction of a system of continuous professional development. All these amendments will, beyond any doubt, contribute to maintain a good standard of practice and help improve the standard of our medical practice.
The Medical Council obviously has a major role to play in the maintenance of the standard of practice and professional ethics in Mauritius. We have published a code of ethics meant for all doctors. Some doctors have been sanctioned for not abiding by the code of ethics. So, it should be clear that the Council will leave no stone unturned to ensure a continuously improving standard of medical practice in Mauritius.
* What about pre-registration training and the situation regarding the examination at the end of this training?
Pre-registration training is being done under the supervision of consultants-in-charge at the hospitals. The training is of 18 months’ duration. Those undergoing the training have to appear for oral examinations in five major specialities during their training. These examinations are held at the Mauritius Institute of Health.
After completion of their internship, trainees have to appear in a written examination held by the Medical Council of Mauritius. The paper is set by the National Examination Board of India and the examination is conducted by the Mauritius Examination Syndicate. The latter have the expertise to conduct such examinations. Once they pass this examination, the trainees become eligible to be registered as general practitioners.
* Where does the MCM come in as far as the local medical colleges are concerned, and what are the other stakeholders involved and their respective roles?
This is a very important question. It is so unfortunate that the Medical Council of Mauritius has no role in the supervision of medical studies in Mauritius. In fact, Mauritius is perhaps the only country where the Medical Council has no role in the supervision of medical studies.
This is why we have requested the Government to amend the Medical Council Act in order to give the Medical Council its due right to be the main body responsible for the supervision and control of medical studies in Mauritius. At present, it is the Tertiary Education Commission which is responsible for overseeing medical studies in Mauritius. We believe that the Medical Council should be directly involved in such matters.
* Does the MCM have any say as regards postgraduate medical education?
The Medical Council has no role concerning postgraduate medical education. The role of the Council is to advise the Minister of Health to list the medical instituitions which are conducting postgraduate studies in Mauritius so that their names can appear on our register of recognised medical institiutions. The Council carries no responsibility beyond what one might call a mere official responsibility in this regard, that of a registry. I believe this situation arises from the previous reply I gave, notably, that the Council has no role in the supervision of medical studies in Mauritius.
* Both the legitimate aspirations of parents to have a doctor in the family and the responsibility of the authorities to ensure that patients are in safe hands have come to the fore these last years. You have had to go public on different occasions to state the Council’s position regarding the credentials of training institutions, both locally- and foreign-based. Have things improved?
Unfortunately, things have not improved at all. We are very uncomfortable at the Medical Council concerning this issue. One the one hand, the Medical Council has no say concerning medical studies and the status of medical institutions in Mauritius. On the other hand, according to the Medical Council Act, we must advise the Minister to recognise the medical institution concerned in order to appear on the list of recognised medical institutions in our register.
As regards foreign medical institutions, we have no proper means to assess them. We can only rely on the documents that these institutions provide us. We have requested the Ministry to have a fixed list of recognised medical institutions from different countries so that we can advise our students to enroll in these institutions only. The Medical Council can help to establish that list by the sheer fact that we have information about their standards of practice and our own expectations in this regard.
* Allegations of medical negligence are heard of from time to time. Can you give an idea of what is the real situation from the perspective of MCM? And is it mandated to take sanctions in all cases, and has this happened?
We receive a lot of cases of complaints from the public concerning alleged cases of medical negligence. In fact, the bulk of our work at the Council consists in conducting investigations about alleged medical negligence.
Concerning medical doctors practising in the private sector, the Council conducts its own investigations and has the mandate to sanction the doctor if found to be at fault.
However when it comes to public sector doctors, the Council has to seek for delegation of power from the PSC through the Ministry of Health in order to investigate reported cases. Moreover the Council cannot sanction the concerned public sector doctor. The sanction is administered by the PSC.
The investigations are carried out in a very fair and independent manner. During my mandate as Chairperson, we have sent 8 doctors to the Medical Disciplinary Tribunal out of which our sanctions have been confirmed in 7 cases. Many other minor sanctions have been imposed on doctors, such as giving warning, severe warning, etc.
* Should it be the responsibility of the Medical Council ultimately to ensure that patients are indeed in safe hands? And should it be better empowered by way of legislation to assume that responsibility?
Yes. It should be the responsibility of the Council to ensure the safety of patients. I have always emphasized that the main role of the Council is to protect the public by ensuring the practice of a safe and high standard of medicine. We have requested the Minister to empower the Council effectively by bringing certain amendments to the Medical Council Act in this regard. The more we go in this direction, the better it will be for patients but also for the conscientious practice of their duty by practitioners.
* The over-supply of doctors has for some time now been a major public concern. What are your views on this issue?
It is indeed a matter of great concern for everybody – government, parents and society at large. As we say, what is done cannot be undone. It has been a big mistake to have given exemptions to all those doctors from taking part in the examination conducted by the Council before registration. What we need in this country is a supply of an adequate number of good quality doctors. What we have at present in the market is a mixture of sometimes poorly-trained and well-trained doctors. How to choose between the two? By conducting interviews. I don’t know exactly but the over-supply could have been dealt with effectively by restricting the numbers to only those who meet specified criteria.
* How do you see the MCM evolving in the future? Are any changes in the Medical Council Act needed to make it more efficient or responsive to the challenges of modern medicine?
The Medical Council has to evolve in the future. The present Medical Council Act was enacted in 1999. It is high time to have an updated Medical Council Act to be voted in Parliament. In 1999, nobody was talking about Medical hub, Education Hub, Medical Tourism. The Act has to be in line with all these targeted developments. I am confident that amendments will be made and I wish that new Council will move forward to bring a high standard of practice of medicine in Mauritius. What matters most is the safety of patients.
* Published in print edition on 22 January 2016