PUBLIC-PRIVATE MEDICAL PRACTICE: Is it really the greedy preying on the needy?

The Ministry of Health has launched the debate on private practice by doctors working in public hospitals…once more. The public perception is being shaped around the supposition that doctors are the culprits of some wrongdoing and need to be brought back in line. By the looks of it, the public workshop planned for the 16th of January sounds more like a reproachfest than a consultative exercise, given that it will also be open to members of the public. There are perhaps certain points that the minister, people working in his ministry and those who remain in offices deciding the sanctions to be dealt to doctors from the comfort of their ivory towers, are not aware of. The aim of this article is to bring same to their attention.
First of all, the perspective should be moved from the doctors to patients. Why do patients go for private care with doctors working in public hospitals while undergoing a treatment there? Because there is a general perception that whatever is paid for will be better than what is obtained for free. Healthcare is no different. As a doctor, working in a public hospital, I have received countless requests of patients wishing to attend my private practice. Patients who are regularly seen by a doctor in public, will want a private care from the same doctor because (s)he believes that in private, the doctor will have more time to allocate to the patient; which is not far from the truth.
Doctors routinely have to see 70-80 patients in less than 4 hours during an outpatient consultation, which means less than five minutes per patient. Given this tight timeframe, doctors often have to call in the next patient to be prepped for examination, while taking care of a patient already, to gain time, which compromises both patients’ privacy. Let’s not forget, this is the public hospital, where people feel entitled to raise their voices, and occasionally their hands on doctors when they get tired of waiting… for doctors who are trying their best to do their jobs in not-so-favourable conditions. The same patient, in the waiting room of a private consultation room, will bide his time because he thinks that since he is paying good money, he needs to show some manners. This brings us to the next point.
Doctors, working in public, wishing to engage into private practice, respond to a demand that is highly present. When a patient asks a public doctor for private care, it means that a relation of trust has already been established between the two, which discredits the perception that public doctors are not competent. In private practice, the doctor gets to control many variables which leads to a better service, thus benefitting both the doctor and the patient. The doctor gets to choose the number of patients he can accommodate in order to give enough time to all patients indiscriminately. Moreover, without having to go through red-tape hospital procedures, tests can be carried out and results can obtained more quickly. The doctor is also not limited to giving patients only medicines that are available in the hospital pharmacy, but better performing ones.
Patients are also astute when it comes to surgeries. Many patients commit to long-term treatments privately with doctors working in public hospitals to get preferential treatment when it comes to surgeries; where they do not have to wait their turn on the public list. The competition for a privileged turn on the hospital surgery list is not limited to patients of doctors practising both in private and public. It is a very common practice among hospital staff as well. Several members of the paramedical staff of a large public hospital often bring in their family members who do not live in the catchment area of the hospital for treatment with a doctor who they like. Such internal pressure from staff means that doctors find themselves in a delicate situation where it is diffcult for them to refuse. If a doctor is pressured by internal staff, why cannot he do the same for a patient who is paying him?
Patients do not come to us out of pity because they think we are underpaid, and wish to contribute to our well-being. Patients come to us because they trust that we can give them better care in private. We public doctors are not here to give solutions to the minister on a silver platter, since he is not ready to engage with us objectively. We put forward our day-to-day experiences. We are after all, public servants, whom the public and ministry alike think are not worthy of a thank you, despite keeping the free health system of this country running. Unlike the minister and his appointees, we are here for more than five years, out of commitment for our jobs and dedication for helping others. Unless and until he decides to match conditions that a private practice offers, he might as well let doctors do their jobs to the best of their abilities in public and private, so that a maximum of people can be reached. I conclude on this note: if there is to be a regulation for the health sector regarding private/public practice, it is only fair that the same is extended to all sectors. I think of the education sector for instance.