When Patient Safety and Disability Inclusion Pull in Different Directions

Why the NMC's New Guidelines Matter More Than They Appear To

For years, a candidate with a disability seeking an MBBS seat in India faced a strange kind of gatekeeping. It did not ask "can you become a competent doctor?" It asked "does your disability cross a fixed percentage on a chart?" Cross it and you were out - regardless of whether you could dissect a cadaver, read an X-ray or counsel a patient.

This week, the National Medical Commission moved away from that logic, replacing blanket percentage thresholds with functional assessments conducted by designated medical boards.

The Old Model's Real Cost

The earlier framework followed what disability scholars call the "medical model"

• treating disability as an inherent deficit to be measured and, past a certain point, disqualified. Under the Rights of Persons with Disabilities Act, 2016, this logic sits awkwardly with the law's own promise of equal opportunity. The Supreme Court, in the Omkar Ramchandra Gond case and others, held that a benchmark disability alone cannot be a disqualifying condition - what matters is whether the candidate can perform the essential functions of the course, with reasonable accommodation.

What Changes Now

Functional assessment asks a narrower, fairer question: with appropriate technology, training and institutional support, can this specific candidate acquire the competencies medicine requires? A candidate with a visual impairment who can operate assistive diagnostic tools or one with a locomotor disability who can adapt surgical technique, is no longer excluded on the basis of a chart alone.

This is the shift from a medical model of disability to a social and human-rights model - one that locates the barrier not only in the body, but in the absence of accommodation around it.

Why This Is Not a Simple Story

The genuine difficulty is this: medicine is a profession where competence failures carry irreversible consequences for patients. A functional-assessment regime is only as fair - or as safe - as the rigour and consistency of the boards applying it.

Without clear, standardised protocols, two equally capable candidates could receive opposite outcomes depending on which board evaluates them. That is not a hypothetical risk; it is the exact failure mode functional assessments are supposed to fix, reappearing in a new form if implementation is careless.

The Institutional Stakes This is

why the NMC's own follow-through matters as much as the guideline itself. The Supreme Court's suggestion that boards include doctors with disabilities is not a symbolic gesture - it directly addresses the credibility gap between an able-bodied evaluator's assumptions and a disabled candidate's actual working reality.

Without that safeguard, "functional assessment" risks becoming a more sophisticated language for the same old gatekeeping.

The Larger Point Inclusion in a

licensed, high-stakes profession cannot rest on litigation alone - it has to be built into ordinary administrative practice, revisited each year rather than reopened only when someone sues. The NMC's guidelines are a genuine improvement in principle. Whether they deliver in practice depends on decisions the Commission has not yet made public - and that is where scrutiny should now turn.