Hippocrates oath, wallet fattening and accountability

Far from practising the Hippocrates oath many specialist physicians are into wallet fattening endeavour falling short of accountability. Here Sunday Observer staffer Afreeha Jawad peruses prevailing inadequacies among those that are believed to be 'healing' hands."

Looks like the Hippocrates oath taking clan - a good majority of them, have completely thrown overboard all the sublime ideals and noble messages contained therein. Following an interestingly tedious tour of many five star hospitals in Colombo as a prelude to this, my weekly rendition, my observations confirmed their gradually eroding image in the public eye.

Having perched not so comfortably in one of those steel chairs not meant for long time sitting, I cast my lenses from one end to the other in that near freezing enclave.

There was absolutely no difference between the 'goings on' in a central railway station and what I saw over here. The long line of patiently seated patients - some waiting for the doctor well passed his appointed hour and others so restless over appointment turn and to top it all a female snuffling through the mike, informing patients of specialists' arrival and their roosting rooms reminded me of how much a sick patient had in common with a weary traveller.

Traveller and patient

I saw no difference in waiting to board a train and meeting one's consultant physician except that the train tolerates you on board for at least fifteen minutes but not so your supposedly 'healing hand'. Before you could even say Jach Johnson be sure to be dismissed in style and mind you within a couple of seconds. One stern look followed by, 'yes, what's your problem' and after some scribbling you are sure to be shown the door. Accommodating the 'next Rs. 500' is uppermost in his mind.

Interestingly, a colleague and friend of mine had this to say of the grotesque and bizarre side of 'hands that heal'. Having sent off a patient and while waiting for some other this guy had even noticed how the doctor concerned had even started to count the channelling chits to assess his financial collection at day's end.

This boy also laughingly informed how kindness was meted out only within the limits of patient's insurance claim. All that type of exuding love of 'Hello Putha ! How are you young man' followed by a pat on the shoulder wanes as this claim snuffs out.

Value free skills

With no restrictions on patient intake, these guys remind me of an apparel departmental store's recent name change. Better suited for them is 'Mr. No limit' than the acquired title following whatever 'skills' they've managed to get hold of at medical school. Incidentally, talking of skills I seek reader apology for the repetition of past delivery. A school teacher over a radio broadcast asked, "Of what use are skills without values'?". She then was not far from the truth. Today's robot like behaviour coming off so-called professionals is a result of greater emphasis on the part of policy-makers on skills and skills alone and not a combination of skills and values.

No wonder then the loss of accountability. Even the medical community is no exception to whatever Sri Lanka has missed out on accountability. This then is not to talk of exceptions within that community. For instance in times of disaster natural or otherwise their yeoman services are not to be overlooked.

Yet my topic under scrutiny right now is the accountability of many specialists. It's with much difficulty that any low middle class patient forfeits Rs. 500. The specialist doctor is thus morally bound to spend some time with his patient. However, accountability ceases to be when the wallet takes precedence and patient commodification becomes the accepted norm.

No one denied their hard and arduous entry into the profession. Yet a display of magnanimity if not generosity warrants patient handling. Restricting patient intake would lead to more attention per patient which is when effectiveness sets in.

Discussing all about this ghastly state of affairs with a friend led him into a hilarious expression, "Leday Kiyannath Issara Behetha Liyala Ivarai" ("Even before we could describe our ailment, the prescription has been written.")

Lamenting on the long hours of waiting patients he also said, "Waylaavata Enney Nahe. Athana Visipahak Balala Enakota, Methana Thava panahak leddu". ("They don't come on time. Should they finish examining twenty five in one hospital, another fifty patients keep waiting in some other").

Accountability

What's still worse is during Sinhala new year you wouldn't find even one single specialist in town. If among them a mutually agreeable roster is arrived at - this according to popular opinion would be far better and more in line with accountability instead of keeping even seriously ill patients on the hook. Exercising one's own right, seemingly a conflict with moral entailment warrants much thought. Giving of one's best for someone fighting between life and death and one's own right to go on leave comes within accountability's purview.

Considering the delay in timely treatment due to the non-availability of specialists on duty round the clock, it is incumbent on all hospital management to make available such service instantly. I'm sure in such instances the extra payment though heavy will certainly be ungrudgingly given by the patients' family.

Greenhorns

All this aside, even private hospital standards are fast deteriorating. Given the green horns into the nursing profession, patient safety cannot be guaranteed.

Many have been instances of nurses having given drugs to patients not even prescribed by the physician. Faulty X-ray and medical reports make even para medical staff knowledge highly questionable.

In the Sri Lankan context special, specialised and specialist are increasingly becoming fad words. Should you think there are only special attendants and specialist doctors, you are well behind time. Now we even hear of special nurses. So next time you want one (pray that you don't face the tragedy of hospital entry) all you've got to do is to hire a special nurse. Someone asked me, 'Why special nurses'? What of the ward's nursing team?' In-as-much as bribery has been overlooked over the years due to rising cost of living, hospital owners' tight fistedness into wholesome remuneration leads to such innovative measures.

Well anyway nothing like having a costly nightingale singing sweet melodies lulling you to sleep as you recuperate in what was once but no longer perceived as a home away from home.