By

Vinoth Ramachandra

Imagine walking into a bakery in order to buy a cake and being told that the price will only be revealed after the cake has been consumed, and no receipts will be issued.

This bizarre state of affairs is what prevails in our private hospitals. Doctors’ fees for treatment and surgery are arbitrary, undisclosed till the time of the patient’s discharge, un-receipted, and largely untaxed. The crass commercialization of medicine is bad enough; far worse is the non-applicability of norms assumed in normal commercial practice to the medical profession.

How has this situation come about? The middle-classes are largely to blame for their silent complicity in such a ludicrous system. We haggle over labour prices with our plumbers, carpenters or builders. But when it comes to doctors and lawyers, we meekly submit.

There is a simple remedy for this anomaly. The government should create a market for in-patient services in private hospitals. Doctors should state upfront what their fees are for patient visits, surgery, etc. An informed public can then make appropriate choices as to where and to whom to go with their medical needs. Having created such a market, the government should then regulate it like all other markets, ensuring truthful information and fair competition.

Some private hospitals boast of being global “centres of medical excellence”. This, of course, is sheer hype. The nursing care at such hospitals is well below the level in state hospitals. No decisions, however minor, are made without the word of the local deity called a consultant. And a steady stream of white-coated strangers strut into a patient’s room, rarely introducing themselves, and charging exorbitant fees for a few minutes spent taking the patient’s blood pressure or dispensing prescriptions to the nurses.

Sri Lanka is one of the few countries in the world which allows doctors practicing in state hospitals to work also in private institutions. This leads to all sorts of anomalies (as, for instance, some doctors requesting patients to come to their private hospitals rather than the state hospital). Perhaps it is time to review this practice. If tax collection can be enforced effectively among all the professions, there is no reason why doctors and nurses working in government hospitals cannot be paid reasonable wages.

Meanwhile, student unions and the GMOA hypocritically condemn the establishment of private medical colleges, and demand that the Sri Lankan taxpayer continue to subsidize their lifestyle, with everything from duty-free vehicles and (the latest lunacy) reserved seats for their children in privileged schools.

Clearly there is a moral vacuum at the heart of our medical profession. The training of doctors in our medical schools is woefully narrow. That medicine is an art, as well as a science, and requires moral virtues as well as skills of personal communication, seems to have been forgotten.

Surely the first class that students take should be about how much it costs a poor country like ours to educate them free of charge for five years. And before they graduate, they should be taught about how much medicine owes to other professional disciplines, and why and how it has become a source of health inequalities and income disparities in Sri Lanka.

Courtesy:The Island