Professional Conduct of Doctors in India
Key Takeaways
- Professional conduct of doctors in India is governed by statutory regulation, medical ethics and judicial principles concerning patient care, consent, confidentiality, negligence and professional responsibility.
- The National Medical Commission Act, 2019 establishes the present regulatory framework. The Ethics and Medical Registration Board regulates professional conduct, promotes medical ethics and exercises appellate functions in disciplinary matters.
- The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, as amended, continue to be an important ethical framework. The NMC’s Professional Conduct Regulations notified on 2 August 2023 were subsequently kept in abeyance on 23 August 2023.
- Doctors are expected to protect patient welfare, maintain professional competence, preserve medical records, respect confidentiality, obtain valid consent and provide assistance in medical emergencies.
- Unethical practices such as patient solicitation, improper advertising, fee splitting, referral commissions, false medical certificates and abuse of the doctor-patient relationship may result in disciplinary proceedings.
- The Supreme Court has laid down important principles governing informed consent, emergency medical care and the standard of care expected from medical practitioners.
- Breach of professional conduct does not automatically amount to medical negligence or criminal liability. Ethical misconduct, civil negligence and criminal negligence are separate legal concepts, although the same conduct may sometimes give rise to more than one form of liability.
What Is Professional Conduct of Doctors?
Professional conduct of doctors means the ethical, professional and legal standards that registered medical practitioners are expected to follow while practising medicine.
A doctor’s responsibilities are not limited to diagnosis and treatment. Medical professionals occupy a position of trust because patients disclose sensitive information, permit physical examination and treatment, and frequently depend upon medical judgment in situations involving health and life.
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Professional conduct therefore covers areas such as treatment of patients with dignity and reasonable care, maintenance of professional knowledge and competence, obtaining proper consent before treatment, preservation of confidentiality, maintenance of medical records, ethical prescription of medicines, responsible referrals and consultations, avoidance of improper commercial practices, appropriate interaction with other medical professionals and compliance with laws regulating medical practice.
The purpose of professional regulation is both to protect patients and to preserve public confidence in the medical profession.
Legal Framework Governing Professional Conduct of Doctors in India
The regulation of medical professionals in India has undergone an important institutional change.
National Medical Commission Act, 2019
The National Medical Commission Act, 2019 replaced the earlier Medical Council of India framework and established the National Medical Commission.
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One of the functions of the NMC is to lay down policies and codes for observance of professional ethics and promotion of ethical conduct in medical care. The Act also establishes autonomous boards, including the Ethics and Medical Registration Board (EMRB).
The EMRB performs important functions relating to maintaining registers of licensed medical practitioners, regulating professional conduct, promoting medical ethics, coordinating with State Medical Councils and exercising appellate jurisdiction over actions taken by State Medical Councils in appropriate cases.
Indian Medical Council Professional Conduct Regulations, 2002
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 contain detailed provisions concerning professional responsibilities, duties towards patients, duties towards other doctors, unethical conduct and professional misconduct.
Although these regulations originated under the earlier Medical Council of India framework, they remain particularly significant in the present regulatory structure.
What Happened to the NMC Professional Conduct Regulations, 2023?
The NMC notified the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 on 2 August 2023.
However, on 23 August 2023, an amendment notification kept those regulations in abeyance.
Therefore, the 2023 regulations should not simply be described as the currently operative comprehensive professional conduct code without acknowledging this position.
What Are the General Duties of a Doctor?
The Code of Medical Ethics places broad obligations on medical practitioners relating to professional character, knowledge, patient welfare and lawful medical practice.
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Upholding the Dignity of the Medical Profession
A physician is expected to uphold the dignity and honour of the profession.
The medical profession is fundamentally understood as a profession of service. Financial gain cannot override the interests of patients or the ethical duties attached to medical practice.
This principle becomes relevant whenever a doctor’s financial or commercial interests conflict with proper patient care.
Maintaining Professional Knowledge and Skills
Medical science changes continuously. Doctors therefore have a professional responsibility to maintain and improve their knowledge and skills.
The ethical framework emphasises scientifically founded methods of treatment and continuing improvement of professional competence. Professional competence is particularly important because treatment decisions may have serious consequences for patients.
Practising Within Professional Competence
Doctors should not undertake medical functions beyond their competence merely because a patient has approached them.
Where a patient’s condition requires specialised knowledge or treatment, an appropriate consultation or referral may become necessary.
Serious, doubtful or difficult medical conditions may require consultation, but such consultation should be justified by the patient’s interests rather than commercial considerations.
What Are the Duties of Doctors Towards Patients?
Duties towards patients form the core of professional medical conduct.
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Patient Welfare Must Come First
Medical judgment should primarily be guided by the patient’s medical interests.
A physician should give priority to the interests of patients, and personal financial interests should not conflict with medical interests.
This principle affects decisions concerning investigations, referrals, procedures, medicines and other forms of treatment.
Doctors Must Not Neglect Patients
Once a doctor has undertaken a patient’s case, the patient should not be neglected.
A doctor should not ordinarily withdraw from treatment without giving sufficient notice so that appropriate alternative medical care can be arranged.
The professional duty becomes especially important where discontinuation of treatment may expose the patient to serious harm.
Are Doctors Required to Provide Emergency Medical Treatment?
Emergency care occupies a special position in medical ethics and Indian law.
In Pt. Parmanand Katara v Union of India, the Supreme Court emphasised that every doctor, whether working in a government hospital or otherwise, has a professional obligation to extend medical services for protecting life.
The case arose in the context of an accident victim who was not immediately treated because the hospital considered another institution to be appropriate for medico-legal cases. The Supreme Court emphasised that preservation of human life is of paramount importance.
Procedural formalities should therefore not prevent immediate efforts to save an injured person. Police procedures, medico-legal formalities and similar administrative considerations should not become reasons for delaying urgently required medical assistance.
The ethical principle is straightforward: preservation of life must receive priority in a medical emergency.
What Is the Duty to Obtain Patient Consent?
Consent is one of the most important elements of lawful and ethical medical treatment.
A competent patient generally has the right to decide whether a medical procedure should be performed. Treatment without proper consent may raise questions of professional misconduct as well as medical negligence, depending on the circumstances.
What Makes Medical Consent Valid?
Valid medical consent should be real, voluntary and based on adequate information.
The Supreme Court in Samira Kohli v Dr. Prabha Manchanda laid down important principles concerning consent for medical treatment.
For consent to be valid, the patient should possess the capacity and competence to consent, the decision should be voluntary, and sufficient information regarding the proposed treatment should be provided.
Relevant information may include the nature and purpose of the procedure, expected benefits, substantial risks, reasonable alternatives and important consequences of refusing treatment.
Consent is therefore more than obtaining a signature on a hospital form. Its purpose is to enable the patient to make a meaningful decision regarding medical treatment.
Consent Must Relate to the Particular Procedure
Consent given for one procedure does not normally authorise a substantially different procedure.
In Samira Kohli v Dr. Prabha Manchanda, the Supreme Court clarified that consent for a diagnostic procedure cannot ordinarily be treated as consent for an additional therapeutic operation unless circumstances such as an immediate life-threatening emergency justify intervention.
This principle protects patient autonomy and prevents treatment from being extended beyond the scope of valid permission merely because the additional treatment appears medically beneficial.
What Is the Duty of Confidentiality?
Medical confidentiality is fundamental to the doctor-patient relationship.
During diagnosis and treatment, patients may disclose highly personal medical, psychological, family or social information. Doctors are generally expected not to reveal such information without lawful justification.
The professional ethics framework recognises that confidences concerning the individual or domestic life of patients should not ordinarily be disclosed. Disclosure may, however, be justified in limited circumstances recognised by law, such as a court order, serious and identified risk to another person or community, or certain notifiable diseases.
Confidentiality is therefore important but not absolute.
The issue also has a constitutional dimension. Medical information forms part of informational privacy, and the Supreme Court’s decision in Justice K.S. Puttaswamy (Retd.) v Union of India recognised the right to privacy as a fundamental right protected under the Constitution.
The operation of medical confidentiality may nevertheless be affected by statutory reporting duties, court orders, public-health requirements and other recognised legal exceptions.
What Are the Rules on Medical Records?
Proper medical records are essential for continuity of treatment as well as legal accountability.
Under the 2002 Regulations, physicians are required to preserve records relating to indoor patients for three years from commencement of treatment.
Where the patient, authorised attendant or competent legal authority requests medical records, the documents are required to be supplied within 72 hours.
Medical records commonly contain diagnosis, investigations, prescriptions, treatment administered, operative procedures, consent documentation and information concerning clinical progress.
Their importance is not limited to continuing healthcare. Medical records frequently become crucial evidence where allegations of medical negligence arise because they show what treatment was provided, what investigations were undertaken and how the patient’s condition was managed.
Failure to properly maintain or provide records may itself amount to professional misconduct under the ethical regulations.
What Are the Rules on Prescriptions and Registration Numbers?
Professional prescriptions should clearly identify the medical practitioner responsible for treatment.
The 2002 Regulations require doctors to display their registration number in their clinic and on prescriptions, certificates and specified professional documents.
They also provide that drugs should, as far as possible, be prescribed using generic names and that doctors should ensure rational prescription and use of medicines.
Doctors should also avoid allowing unqualified or unregistered persons to perform functions requiring medical skill and professional discretion.
Can Doctors Advertise Their Medical Practice?
Medical advertising is subject to ethical restrictions.
Under the 2002 Regulations, direct or indirect solicitation of patients by doctors, groups of doctors or medical institutions is regarded as unethical.
The rules traditionally restrict publicity designed primarily to promote a doctor’s skill, achievements, qualifications or professional status in a self-aggrandising manner.
Certain factual announcements are nevertheless permitted, including announcements concerning commencement of practice, change in the nature of practice, change of address, temporary absence, resumption of practice and public declaration of professional charges.
The distinction is therefore generally between legitimate professional information and promotional conduct intended to solicit patients.
Are Referral Commissions and Fee Splitting Allowed?
Referral commissions are treated as unethical conduct.
A doctor must not give, solicit or receive gifts, gratuities, commissions or bonuses in return for referring, recommending or procuring patients for medical or surgical treatment.
The prohibition also extends to arrangements involving diagnostic specimens and investigations.
Similarly, fee splitting, rebating or transferring portions of professional fees in consideration of referrals is prohibited.
The purpose is to ensure that referrals, diagnostic investigations and treatment recommendations are based on medical necessity rather than financial incentives.
What Duties Do Doctors Have Towards Other Doctors?
Professional ethics also regulate interactions among medical practitioners.
Doctors are expected to maintain professional courtesy and avoid rivalry or conduct that unnecessarily undermines colleagues.
During consultations, the welfare of the patient remains the primary consideration.
Where professional opinions differ significantly, disagreement should be handled responsibly. Differences between doctors do not automatically establish negligence because competent medical practitioners may reasonably adopt different recognised approaches to treatment.
This distinction is particularly relevant when considering whether a medical decision amounts to a genuine professional judgment or negligence. LawBhoomi’s discussion on whether a doctor is liable for an error of judgment explains this principle in greater detail.
When a patient is referred to a specialist, appropriate medical information and case details should also accompany the referral.
What Is Professional Misconduct by a Doctor?
Professional misconduct refers to conduct that violates recognised ethical or professional standards applicable to medical practitioners.
Chapter 7 of the 2002 Regulations identifies several acts or omissions capable of attracting disciplinary proceedings.
These include violation of professional conduct regulations, failure to properly maintain required medical records, refusal to provide records within the prescribed period, failure to display the medical registration number, improper conduct involving a patient, certain criminal convictions involving moral turpitude, prohibited sex-selection-related conduct, unethical advertising or solicitation and acceptance of commissions for patient referrals.
The specified examples should not be understood as reducing professional ethics to a narrow checklist. Medical disciplinary bodies may examine the nature and surrounding circumstances of particular conduct while applying the governing legal framework.
Professional Misconduct and Medical Negligence: Are They the Same?
Professional misconduct and medical negligence are related but distinct concepts.
Professional misconduct primarily concerns violation of ethical or professional standards and may result in disciplinary action by the competent medical regulatory authority.
Medical negligence generally concerns breach of a legal duty of care resulting in injury or damage to a patient. It is a specialised application of the broader principles of negligence under the law of torts.
A doctor may therefore breach an ethical rule without necessarily committing actionable negligence. Conversely, negligent treatment may also amount to professional misconduct where the circumstances justify disciplinary action.
Civil and criminal medical negligence must also be distinguished. Criminal negligence requires a considerably higher degree of negligence.
In Jacob Mathew v State of Punjab, the Supreme Court laid down important principles concerning criminal liability of medical professionals. The Court explained that negligence sufficient for civil liability may not necessarily be sufficient to impose criminal responsibility upon a doctor.
A mere error of judgment, accident or unsuccessful treatment outcome does not by itself establish criminal negligence. The degree of negligence must be sufficiently serious to attract criminal liability.
Thus, disciplinary liability, civil liability and criminal liability must be examined separately.
How Are Doctors Disciplined for Professional Misconduct?
Medical disciplinary proceedings generally operate through State Medical Councils and the national regulatory framework.
The Ethics and Medical Registration Board is responsible for regulating professional conduct and promoting observance of ethical standards. Where a State Medical Council has statutory disciplinary authority, complaints concerning professional misconduct may ordinarily be considered within that framework, subject to the applicable appellate mechanism.
A disciplinary proceeding must comply with principles of procedural fairness. The medical practitioner should ordinarily be informed of the allegations and given an opportunity to respond.
Where misconduct is established, disciplinary consequences may vary according to the governing law and seriousness of the conduct.
Possible consequences may include removal of the practitioner’s name from the medical register for a specified period or other disciplinary action recognised under the applicable legal framework.
Disciplinary proceedings are distinct from claims seeking compensation. Where negligent medical treatment causes harm, separate proceedings may sometimes arise through consumer, civil or criminal law. The different routes available in cases of alleged malpractice are discussed in LawBhoomi’s guide on where a patient can complain about medical negligence.
Why Is Professional Conduct Important in Medical Practice?
Professional regulation serves purposes broader than punishment for misconduct.
Medical treatment often involves unequal knowledge between the patient and doctor. Patients may be physically vulnerable, emotionally distressed or incapable of independently evaluating complex medical decisions.
Professional ethics therefore provide safeguards against misuse of medical authority.
Ethical conduct promotes patient autonomy, confidentiality and privacy, responsible medical decision-making, transparency in professional fees and referrals, competent and scientifically based treatment, proper medical documentation, accountability within the profession and public confidence in healthcare institutions.
Professional standards also protect responsible doctors by distinguishing genuine medical errors and reasonable professional judgment from unethical or negligent conduct.
Conclusion
Professional conduct of doctors in India is based on a combination of ethical obligations, statutory regulation and judicial principles. The National Medical Commission Act, 2019 places professional ethics within the present NMC framework, while the Ethics and Medical Registration Board performs important functions relating to professional conduct and disciplinary oversight.
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 continue to provide important standards regarding patient care, medical records, confidentiality, prescriptions, consultations, advertising, commissions and professional misconduct. The broader Professional Conduct Regulations notified by the NMC in August 2023 were subsequently kept in abeyance and should therefore be discussed with that qualification.
Indian courts have further strengthened medical ethics through principles concerning consent, emergency treatment and standards of professional care. Decisions such as Samira Kohli v Dr. Prabha Manchanda, Pt. Parmanand Katara v Union of India and Jacob Mathew v State of Punjab demonstrate that professional medical practice involves more than technical competence. It requires respect for patient autonomy, protection of life, responsible professional judgment and adherence to ethical standards.
Professional conduct ultimately forms the foundation of trust between doctors, patients and the healthcare system. Proper observance of these standards protects patient rights while preserving the integrity and credibility of the medical profession.
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