When Patients Have No Voice: The Silence of NMC and the Forgotten Side of Medical Regulation

Five years ago, the National Medical Commission was created with the promise of transforming the way India regulated its medical profession. It was meant to be the watchdog of ethics, the guardian of patient rights, and the bridge between society and the medical fraternity. September 25, 2020, marked the birth of this new regulator, replacing the century-old Medical Council of India that had collapsed under allegations of corruption and inefficiency. The NMC was supposed to be different, modern, transparent, and accountable. Yet as it completes half a decade, a troubling reality emerges: not a single complaint from a patient has been entertained. Hundreds of grievances, filed with hope by families who felt wronged, have been brushed aside, dismissed on technical grounds, or simply rejected without hearing. For a body entrusted with the noble task of regulating healthcare in public interest, the silence towards patient voices raises uncomfortable questions.

At the centre of medical regulation lies the principle that medicine is not just a profession but a contract of trust between doctors and society. When this trust is shaken, the patient must have the right to seek redressal. That is why the original Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations of 2002 explicitly allowed patients to file appeals against decisions of state medical councils. Those provisions were not erased when NMC came into being. In fact, the NMC Act itself stated that rules and regulations of the old council would remain valid until replaced. Yet, in practice, the NMC has systematically denied patients this right. In October 2021, during one of its internal meetings, the commission decided that appeals would be restricted only to registered medical practitioners. The word “only” was inserted by NMC into Section 30(3) of the Act, an insertion that did not exist in the law itself. This interpretation, unsupported by any legal opinion, effectively shut the door on every patient or caregiver seeking justice.

The consequence has been devastating. Imagine a family that loses a loved one due to suspected negligence. They approach the state medical council, only to find their complaint dismissed. Under the law, they should be able to appeal to the national body, the NMC’s Ethics and Medical Registration Board. Instead, they are told their appeal cannot even be registered, because they are not doctors. Their grief, their suffering, and their demand for accountability are reduced to irrelevance by a technicality that was never meant to exist. This is not just a legal failure but an ethical one. A regulatory body meant to stand for public interest has chosen to protect itself behind closed interpretations, leaving patients in the cold.

What makes the situation more concerning is the timeline of decisions. In December 2022, the health ministry placed a draft amendment to the NMC Act in the public domain. This draft clearly recognized the need for patients to be able to appeal to the Ethics and Medical Registration Board against state medical council decisions. By 2023, internal file notings confirmed the amendment had been approved. And yet, no movement has happened since. The amendment lies stagnant, gathering dust in the corridors of bureaucracy, while patients continue to face rejection after rejection.

The ministry, when asked in Parliament in August 2024 whether the NMC was biased in favor of doctors, responded by citing Clause 8.8 of the 2002 ethics regulations. On paper, this was an acknowledgment that patients indeed had a right to appeal. But what Parliament was not told is that the EMRB which is the very division responsible for handling these appeals had taken a contradictory stand. In every single case, the EMRB insisted that appeals from non-doctors could not be entertained. The contradiction is glaring. On one side, regulations recognize the patient’s right; on the other, the regulator blocks it with its own unilateral decision.

A regulator that was meant to rebuild trust between patients and doctors has instead reinforced the perception of bias. By placing the rights of medical professionals above those of patients, the NMC risks eroding the very credibility it was created to restore. It is no surprise that activists like Dr KV Babu, who has relentlessly used the Right to Information Act to uncover these decisions, have called out this practice as arbitrary and unfair. His findings show that NMC took these decisions without seeking any legal advice, without consulting stakeholders, and without considering the spirit of the law.

The contradiction reached another turning point in 2024. In its 14th meeting in May, the NMC decided to finally allow patient appeals. By December, during its 16th meeting, the commission formally approved the change. The minutes of the meeting were clear: all appeals received by the EMRB would be entertained. On paper, this was a long-overdue correction, a recognition that patients could not be silenced any longer. Yet in reality, little changed. The EMRB continued to reject appeals from non-doctors, holding on to the outdated interpretation that only registered practitioners could appeal. In effect, the regulator’s own division defied the regulator’s decision. Patients remained voiceless, their letters returning unanswered, their hope crushed again.

This raises troubling questions about accountability within the regulator itself. If the commission as a whole takes a decision, how can a division ignore it and continue its old practice? Who is watching the watchdog? What mechanisms exist to ensure that the NMC acts in good faith and in alignment with its own resolutions? These are not abstract concerns. They directly affect families across the country who find themselves caught in the labyrinth of medical bureaucracy, seeking justice where none seems available.

The larger issue is not just about rules and appeals but about the culture of medical regulation in India. Healthcare is one of the most sensitive areas of governance. Doctors hold lives in their hands, and mistakes whether accidental or due to negligence can cause irreversible harm. When such harm occurs, patients deserve not just sympathy but a fair and transparent system of accountability. A regulator that turns its back on patients sends the wrong message: that doctors will always be protected, that patients voices do not matter, and that justice in healthcare is not for the ordinary citizen. This perception, whether accurate or exaggerated, weakens the fragile bond of trust between doctors and society.

The irony is that doctors themselves stand to lose if patients cannot find justice. When a small number of negligent cases go unaddressed, the entire profession comes under suspicion. The vast majority of doctors, who work tirelessly under difficult conditions, deserve a regulator that upholds integrity and fairness. Shielding misconduct does not protect the medical profession; it damages it. That is why the right to appeal for patients is not an act of hostility against doctors but a safeguard for the credibility of medicine itself.

As the NMC enters its sixth year, the road ahead demands clarity and courage. The amendment to the Act must move forward, ensuring once and for all that patients have the right to appeal to the Ethics and Medical Registration Board. The regulator must align its practices with its own decisions, ensuring that divisions like the EMRB do not operate in contradiction to the commission’s resolutions. Above all, the culture of silence must end. Patients are not outsiders to the medical system; they are its very purpose.

This episode also highlights the need for transparency. Every complaint, every appeal, and every decision should be placed in the public domain. Patients must know whether their appeals were rejected and why. Doctors must know that the system will protect them if they act ethically but hold them accountable if they falter. The regulator must not function as a fortress but as a bridge, open to scrutiny, responsive to feedback, and committed to fairness.

The story of the NMC’s silence towards patients is a cautionary tale of how well-meaning reforms can falter in execution. A new law, a new regulator, and promises of accountability mean little if the lived reality remains unchanged. For patients who have knocked on the NMC’s door only to find it closed, the promise of reform feels hollow. For doctors who continue to serve with dedication, the lack of a fair system damages the dignity of their work. For the country as a whole, the credibility of medical regulation cannot be allowed to collapse again.

As healthcare in India grows more complex with new technologies, expanding institutions, and rising patient expectations, the role of a strong, fair, and transparent regulator becomes even more vital. The NMC cannot afford to repeat the mistakes of its predecessor. It must rise above bureaucratic inertia, internal contradictions, and narrow interpretations to truly serve the public interest. The silence towards patient complaints must end, replaced by a culture of listening, accountability, and justice.

In the end, medical regulation is not just about protecting doctors or disciplining misconduct. It is about honoring the sacred trust that binds doctor and patient. Every appeal rejected without hearing is not just a legal matter, it is a human story of pain left unacknowledged. For every family that feels abandoned, the system loses a little more of its legitimacy. For every patient who finds no voice, the promise of healthcare as a public good becomes a little weaker.

The NMC stands at a junction. It can continue down the path of silence, protecting itself with technicalities and internal contradictions. Or it can choose to rebuild trust, to open its doors to patients, and to embrace its true mandate as a regulator in service of society. The choice will define not just the future of the commission but the future of healthcare accountability in India.

For a nation that takes pride in its doctors, that sends healthcare professionals to every corner of the globe, the standard of justice it offers its own patients must not remain so low. If medicine is to remain a noble profession, its regulator must act nobly too. The silence of NMC cannot be the last word. Patients must have a voice, and that voice must be heard.

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