If there is an imbalance between the rights of medical practitioners and the rights of patients, it could be sorted out by adopting some healthy and practical measures rather than the confrontation course that we see today between Health Minister A. H. M. Fowzie and the GMOA. Our public health service is widely seen as a sick giant and the ailment will only get worse if both sides do not change their attitudes.
Mr. Fowzie, apparently piqued by the snub he got over the Cuban scholarships issue, is in the opinion of the GMOA taking sweet revenge by threatening to restrict private practice only to specialists or consultants in public service. It seems to be another prestige battle for Mr. Fowzie and the GMOA so soon after the earlier confrontation which crippled hospitals and caused immense suffering to thousands of people.
In recent statements Mr. Fowzie has been stressing that the proposed ban on private practice will not apply to medical specialists. It will thus affect mainly the middle level medical officers. Let us look at some basic realities to judge whether such a move is fair.
An intern gets an initial salary of Rs.7,000 a month after toiling for five years, or sometimes seven or eight years, in medical school often the term being lengthened for no fault of his own. As doctors they get Rs.13,000 a month. That is less than a drug sales representative would get in a mercantile firm.
A specialist would get about Rs. 21,000 a month and by that time he or she would be nearing the age of 40. We cannot expect them to continue to work in Sri Lanka for such salaries. They like most other professionals would like to have a modest house of their own, some transport facility and provide for a good education for their children. If they can't do it here they will go abroad. Only a precious few will stay back to serve the poor people of this country whatever the personal sacrifice.
Mr. Fowzie's chest beating will only drive more doctors out of this country. We may see another brain drain as we did in the 1970s. When the then government clamped a ceiling on income, doctors flew in droves to work in hospitals abroad. The rich and the influential were able to go for treatment abroad leaving the less fortunate here largely at the mercy of quacks. Today also the GMOA says we have some 35,000 quacks among us while Mr. Fowzie is gunning for qualified doctors. Just a few days ago there was a case of a quack in Tangalle who ran a medical centre treating patients and prescribing drugs though he had hardly any qualifications.
Now let us look at the other side of this story. Much as they may protest and pontificate, the physicians also need to be healed themselves. Medicine began as a noble vocation of healing the sick without counting the cost. Then it became a profession. Now tragically it has become a big business for many of the doctors. Just go to a medical centre and see what is happening. It is like a railway station. Some specialists see more than 50 patients a day, giving less than three minutes to some of them. There is little or no doctor patient relationship. The Hippocratic Oath calls for three great Cs competence, care and compassion. We see a lot of the first C, but little care and even less compassion.
Mr. Fowzie says many doctors have only one foot or even less in public hospitals while the other foot and the mind is on private practice. He may not be wrong. Some doctors give step-motherly treatment to poor patients in public hospitals while having a hawklike eye on the channelled patient.
There is yet another side to this unhealthy drama. Many people today have developed a misconception that they should see a specialist for anything. Patients with a worst case scenario are known to go to a neurologist for a headache. The time-honoured concept of having a GP nearby as a family doctor is dying.
Hospitals need to be improved and expanded so that we could accommodate all the doctors passing out of the eight medical faculties and tap their full potential.
While we believe that the GMOA has not done enough to bring about more care and compassion in medical services, it is also clear that curbing private practice is not the answer to the ailment.
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