In 1996, Gujarat resident Poonam Patel approached the Supreme Court of India, alleging medical negligence by Ashwin Patel that led to the death of her husband, Pramod Verma. Trained in homoeopathy, Ashwin Patel administered allopathic treatment to Verma. Despite repeated complaints of worsening health, he continued treatment without conducting proper physiological investigations.

In his defense, Patel claimed that he had acquired knowledge of allopathic medicine while working at a private nursing home in Bombay between 1983 and 1989, after which he opened his own clinic. The Supreme Court rejected this argument, observing that anyone practicing a system of medicine without proper knowledge is “a quack and a mere pretender to medical skill — a charlatan.”

India’s public health system continues to grapple with deep structural challenges: a severely skewed doctor-patient ratio, the rapid expansion of expensive private hospitals and nursing homes and limited access to affordable healthcare for the majority.

Alongside allopathic medicine, postcolonial governments have sought to revive traditional systems such as Ayurveda, Unani, Siddha, and homoeopathy. While this has improved access to healthcare, it has also raised concerns about malpractice — especially in cases where practitioners lack clearly defined qualifications or titles. As a result, debates around medical education and professional recognition remain unresolved.

Recently, in a significant judgement, the Kerala High Court ruled that physiotherapists and occupational therapists may use the title “doctor,” provided they add the suffix “PT.” The court reasoned that the title is not the exclusive preserve of any single profession.

However, in a country still striving to ensure institutional childbirth, eliminate open defecation, and curb the spread of unqualified practitioners, this ruling raises concerns about potential risks to public health. Healthcare in postcolonial India has long been a contested domain, where medical professionals and allied health providers compete for recognition, standardization, and legitimacy under evolving legal frameworks.

The recommendation allowing physiotherapists to use the prefix “Dr.” and the suffix “PT” was formalized in the Competency-Based Curriculum for Physiotherapy-Approved Syllabus 2025, issued by the National Commission for Allied and Healthcare Professions under the Ministry of Health and Family Welfare.

This move, however, triggered strong opposition from sections of the medical community. The Indian Medical Association (IMA), the country’s largest voluntary organization of medical professionals, filed a petition seeking to restrict the use of the title “doctor” to formally trained medical practitioners. In its white papers, the IMA argued that physiotherapists are rehabilitation professionals governed by the Rehabilitation Council of India Act, 1994, rather than the Indian Medical Council Act, 1956.

Allopathic (Western) medicine, though a colonial legacy, remains the dominant system in India. Yet issues of affordability and accessibility continue to exclude large segments of the population, who often turn to traditional systems such as Ayurveda, Unani, and Siddha.

To address similar concerns in the post-independence period, the Indian Medical Council Act, 1956 defined “recognized” medical qualifications for allopathic practitioners and mandated their registration with central or state medical councils. Parallel provisions for practitioners of Ayurveda, Unani, and Siddha were introduced through the Indian Medicine Central Council Act, 1970.

Disputes over professional titles, however, are not new. During the colonial period, efforts were made to institutionalize and regulate medical education while establishing Western medicine as the sole legitimate system. A key step in this direction was the Indian Medical (Bogus Degrees) Bill of 1915, introduced by Sir Pardey Lukis, which sought to criminalize the unauthorized grant or use of medical titles.

At the time, government and private medical colleges awarded degrees, while medical schools trained licentiates and sub-assistant surgeons. The colonial administration often labeled unregistered practitioners and diploma holders as “quacks,” particularly targeting Indigenous practitioners of Ayurveda and Unani as unqualified.

This regulatory framework was further strengthened by the Indian Medical Council Act, 1933, which aimed to centralize and standardize medical education in British India. The Act emphasized uniformity and representation to protect the public from unqualified practitioners. The Medical Council of India (MCI) was established to enforce these standards and curb the proliferation of underqualified practitioners posing as degree holders.

In 2012, the MCI approved the introduction of the Bachelor of Rural Medicine and Surgery to expand the rural healthcare workforce. However, graduates of this program were not permitted to use the prefix “Dr.”

The National Medical Commission (NMC), which replaced the MCI in 2019, proposed further reforms, including a bridge course for AYUSH practitioners to strengthen healthcare delivery. The IMA opposed this initiative, warning that it could legitimize unqualified practice.

Despite regulatory efforts, the proliferation of private institutions and the gradual loosening of central oversight have allowed quackery to persist. In 2022, N. V. Ramana, speaking at the National Academy of Medical Sciences on Law and Medicine, described quackery as one of the most serious challenges facing India’s healthcare system.

Such practices often result in medical negligence, undermining public health and making it essential to clearly identify qualified practitioners. Against this backdrop, the Kerala High Court’s ruling has intensified public concern over the potential for confusion and misuse of professional titles.

The debate over the title “doctor” is not merely semantic but central to public trust and patient safety. In an already strained healthcare system, clarity in qualifications and roles is essential to prevent confusion, ensure accountability, and protect patients.

Strengthening public health requires balancing accessibility with standardization. Expanding healthcare access must align with clear regulations and rigorous standards, ensuring patient welfare remains paramount while preventing negligence, misinformation, and the continued spread of unqualified medical practice.

Originally published under Creative Commons by 360info™.