22 November 2021

Physicians heal (and how!)

doctor-patient ratio: With 1:921, India has healthy doctor-patient ratio |  Bengaluru News - Times of India

Years ago I wrote an article titled ‘I will die in the General Hospital.’ I was convinced that the best treatment possible in the country is obtainable from the public hospitals and not private ones. Overworked, understaffed and overcrowded simply on account of free healthcare, these institutions are a testimony to the dedication of the public service.

Obviously they don’t look as pretty as private hospitals but then again the sick are not exactly looking for holiday resorts. There’s 24-7 surveillance and the hospital staff are alert to changes of condition that warrant immediate attention. They may not be at your beck and call simply because they cannot, given workload, and because they are forced to prioritise.

Are they error-free? No they are not. However, we do live in a world where some people love to vilify the public sector and bend over backwards to ensure that the corporate sector is spared embarrassment. Public institutions are named and shamed in the media whereas private companies are not.

Not all doctors are writers and the best among them, typically, let their work speak for itself. They don’t brag. They don’t even write memoirs. If they did, perceptions about doctors and government hospitals would change dramatically. Instead we hear of the sporadic mishap inflated to the point that the excellent services offered and the remarkable achievements are all but blotched.

It’s not that all doctors are paupers, but it does take years for them to actually start earning money. Five years of university with one or more years added on account of political turmoil, followed by internships and further training means that they are usually in the mid thirties when they can really say they are on their feet. They, like anyone else, have lives, they consume and dream. They have aspirations for their children. Most of these things require money.

Dr Mark Amarasinghe once said that he has seen thousands of idealistic freshers who’ve spoken about wanting to serve their fellow human beings and their country who towards the end of their university days talk of securing a remunerative private practice. Life gets in the way of ideals. Reality kicks in. For one and all. Doctors not exempted.

One day, the GMOA will do a survey and tell the country, ‘We have X members of whom Y have a private practice.’ We should not begrudge anyone for wanting to make use of available opportunities to earn money. Indeed, it could even be the case that the doctors with the best private practice also happen to be among those who work tirelessly at their respective ‘day jobs’ and with utmost integrity.

All this is true. The issue is that anything that’s not not voluntarily is, by definition, coloured by self-interest.  Where ‘self-interest’ involves earning oodles of money, reference to the lofty ideals of the vocation and oaths taken therein do sound hollow.

This is not to say that everything said by a doctor or a health official should be taken with a pinch of salt, but as they say it could pay to be cautious when anyone, physician or otherwise, advocates on matters that are not strictly within the ambit defined by training and qualification or on behalf of collectives. The history and agenda of such collectives must be taken into account.

We had doctors (not all) who ridiculed those who spoke of the vaccine. ‘We will never get a single vaccine! so thundered some ‘experts.’ Later, some of these very people were so peeved that they couldn’t be in the forefront of the ‘vaccine drive’ that they bad-mouthed the security forces who were in the thick of things but in a manner way more orderly than the experts could come up with.

We had ‘experts’ making dire predictions. Some, quoting the daily deaths or infections, would state the obvious in somber tones ‘this is the worst period.’ One doesn’t need to be a doctor to read numbers. Some came out with interesting projections: ‘the x stage of the nth wave is nigh’ or something to that effect. No mention of what demarcates x from x-1.

This is known. Some doctors thrived on lockdowns. The GMOA would be able to tell us how many of those who called for lockdowns or their continuations had shifted to online consulting. And let’s not even start about the general ‘practice’ of operating like sales agents of the pharmaceutical industry!

All this said, I am still convinced that we have one of the best health services in the world. It is under-appreciated in the main. It is simply because the health sector is so amazing that some health ‘professionals’ can talk as though they are deities of some sort, pontificating, passing judgment, offering wild extrapolation and such. It works. Politically. It probably works in terms of enhancing economies.

In the long-run though, these things tarnish the vocation. The GMOA is a trade union. Nothing wrong with that. There are rights that need to be secured. There are gains that must be fought for. If it’s alright for others, then it should be so for doctors as well. The GMOA can, I believe, obtain higher moral ground if it turned stethoscope on its own chest (and back) and deployed analytical and enumerative skills its membership so obviously possess to give us a clearer profile of itself. It can say ‘yes, we are not perfect; yes, some of our members do not have integrity; yes, some of them clothe self-interest as public necessity.’

If you are wondering, yes, I still want to die in a ‘general hospital’ treated by doctors and specialists paid by the tax-payers. They are the best when it comes to treating patients. Outside of this noble vocation, I do question intent and of course integrity.

[Malinda Seneviratne is the Director/CEO of the Hector Kobbekaduwa Agrarian Research and Training Institute. These are his personal views.]