Last week’s column on the need for a patients’ Bill of Rights in the face of exploitative private practitioners and institutions generated very revealing responses.

There were the ongoing horror stories (some of which I will relate next week), but overwhelmingly, the patient response was that of fear:

 “You have a husband, two small children and parents. If those doctors don’t like what you wrote, they could make mincemeat of you if they ever get you on the operating table.” 

Or: “You have antagonised many doctors by advertising the virtues of a few.” 

The mind boggles. So now my life could be in danger because I praised a few doctors? I’ve heard of libel, but this is ridiculous! Do doctors’ antagonism toward colleagues, and egotism, run that deep? Surely, they are far bigger-hearted than that?

Confirming Suspicions

The responses confirmed several suspicions about the medical profession.

·     “Patients in this country are being held hostage with the most precious commodity of all from money-grabbing doctors - people’s lives.”

·     “The patient is invisible in this emerging portrait of a private medical practitioner, brushed as it is with colours of greed, prestige, envy for those who make more money, and contempt for those making less.”

Both as a consumer of medical services and journalist, I feel as if I’ve opened a can of worms that are reproducing themselves rapidly. But I want to stay in the realm of private practice for the time being. There were two substantive responses from doctors.

Doctor 1

·     Private and public care co-exist. This is complicated by the fact that the same key players are operating on both sides of the fence. The same doctors working in hospitals are working in nursing homes and create artificial waiting lists.

·     The very doctor who puts off your surgery in the hospital will walk across the road to his private practice, and if you greet him with a brown paper bag full of money, operate on you right away.

·     The patient sits on one side of the table wondering if he can afford your care, and the doctor on the other side, wondering how much you can afford to pay. They coldly sum up their patients. One doctor actually told me the little old lady is the best kind of patient to have, because she will sell her cow, her jewels, draw out every bit of savings and tie the money to the end of her orhni within easy access of any doctor. And she won’t ask any questions.

·     Doctors get away with all this because there is no policing. There is a Private Hospital Act, which requires that an independent Board chaired by the Chief Medical Officer regulate and inspect the standards of private hospitals and nursing homes, and ensures there is no patient exploitation.

·     The Board is meant to be made up of members of the fraternity who are neutral and operate without conflict of interest. But not only is the Act outdated, it is unenforced up to the point that it doesn’t exist. This is because several Board members have a personal financial interest in the very private institutions they are meant to police. There is no regulation both due to negligence and a clear conflict of interest. The governing body is uncaring to the point of being immoral.

Doctor 2

·     There are many studies which prove the single most important motivation for a physician is his pocket. He may want a new car or house. His child may be in university.

·     Our health care system has collapsed. It’s as old as the 19th Century and we need to skip a century to even begin to catch up with the rest of the world. The model of treating rather than preventing disease hasn’t worked. The physician as father figure has failed miserably. He does a lousy job of it.

·     Patients here live with the fear of antagonising physicians because this is a small society and there is a small pool of talent. Doctors here abuse that tremendously. If you ask questions they just hope you go away. Patients feel if they don’t ask questions or risk antagonising the doctor, they will get better service. The irony is they have been dying because they don’t ask questions.

·     People spend more time shopping for a fridge than a doctor. But they go to a doctor because a friend said so or he was nice to them, and that’s a cop-out on the part of the patient. In America patients walk into doctors’ offices with information off the Internet or libraries. They ask doctors questions related to their illnesses - like how many patients they treated in their lives and with how much success. They ask questions about drugs and side effects. At the end of the visit, they rate their doctors on a chart. Once the customer, or patient demands his rights, everything falls into place.

·     Ninety-five per cent of your medical bills are spent with a stroke of the doctor’s pen. It is ridiculous the way doctors send patients to labs and institutions in which they have shares. It is unethical to refer to a facility in which you have shares.

·     Our public health care system is better than our private care. All the nursing homes play the game of keeping patients in hospital, bouncing consultants among one another, with no accountability.

·     It is an insult to wait for hours for a doctor. In the US, self-regulating medical bodies say any waiting room time exceeding half-hour is not quality medicine. Educated consumers and patients ensure doctors do what is right.

·     Specialists here are contemptuous of the General Practitioner (GP). But a good GP can do 95 per cent of the work and puts the focus back on primary care. Diabetes, for instance, is such an expensive disease to treat because it is not controlled at the primary level and is treated only when it spirals into renal disease or when the patient requires surgery that puts the focus back on the specialist. But a specialist treats only a specific problem, not the patient. On the whole, specialists don’t understand the concept of whole body care. A good GP is worth his weight in gold.

·     Unfortunately, many GPs are sub-standard because there is no system of continuing compulsory medical education for them. They are not kept up to date with the latest drugs and medical information. In the US, doctors have 50 hours of continuing medical education every year, and have to be Board-certified every seven years, or else they can’t get their licence renewed.

·     We need a new system. We are operating without a Bill of Rights for the patient, which is why there is so much exploitation of the patient by the medical fraternity.

Next week: A Bill of Rights for patients.