Friday, July 11, 2008

Medical doctors need to eat too


Publication Date: 7/9/2008

It is open season on doctors again! It is increasingly becoming fashionable to attack doctors for engaging in ‘‘private practice’’.

A recent media interest in the issue seems to have sparked a passionate commentary by one Mary Okello (DN, July 4), who seems to have a particular gripe with doctors providing radiation oncology services at Kenyatta National Hospital and has now generalised it to all doctors in public service who engage in private practice.

Several allegations made in the article cry out for immediate clarification to make the debate better informed. The writer asserts that all doctors in public hospitals engage in private practice, and that this is poorly regulated, resulting in patients without money dying ‘‘while waiting to access services, while their richer counterparts are fast-tracked into treatment’’.

Another serious allegation of an ethical (and even criminal nature) is that doctors refer patients requiring ‘‘specialised treatment… to their own clinics or to their colleagues’ private clinics’’.

The writer also suggests that private practice is inherently unethical since most doctors in public service ‘‘went through medical school courtesy of loans made possible by taxpayers’’.

She closes by asserting that the ‘‘current position is heavily skewed in favour of doctors’’, and is creating discontent among other health cadres who feel overburdened and underpaid.

Not all doctors engage in private practice. Issuance of private practice licences by the Medical Practitioners and Dentists’ Board is tightly regulated, and there are clear guidelines on who is entitled to engage in private practice and who is not.

Even highly-qualified specialists are required to work under supervision of senior colleagues.

Doctors do not see their private clients at the expense of hospital patients. Any doctor who does this flouts the terms of his or her employment.

The question of referal is vexed. Doctors are trained to deal with a host of common problems during their basic training.

However, some undergo further training in specialised areas to provide expertise in dealing with more serious and less common problems that would be difficult for a doctor with basic training alone.

In medical practice, it is expected that a doctor will only deal with conditions that he or she is competent in.

When a doctor comes into contact with a condition that requires more expertise, the practice is to refer to a specialist in that area, or to a colleague with more experience with the condition.

It should therefore not surprise anyone that they get referred from one doctor to another. Would it be prudent for the doctor to insist on treating conditions he or she is unqualified to handle? It would be unethical and even criminal for a doctor to do so.

Private practice is encouraged by hospitals since some clients demand to be seen privately by highly-skilled consultants who are few and sparsely distributed.

To serve such clients, many hospitals have private wings where their consultants can continue to offer private services within the hospital.

The doctors are offering an important service, and anyone who has problems with how this is organised needs to give suggestions about administrative measures instead of launching an attack on the service provider.

The Government appreciates that lack of appreciation of professionalism and commensurate remuneration is the major factor in brain-drain affecting the health sector.

Dr Atwoli is a consultant psychiatrist and lecturer, Moi University School of Medicine

Scam a test for the Grand Coalition


Publication Date: 7/7/2008

WHEN THE GRAND COALITION Government was sworn in a couple of months ago, they promised Kenyans that despite the bloated size of the Cabinet, they would do the right thing to bring the country back on its feet economically and in other spheres.

They promised to rein in corruption and improve the business environment to achieve huge levels of economic growth. Kenyans were promised that any public official on whom even the mere suspicion of corruption was directed would be relieved of his or her duties.

Given the nature of the recent scandals and the personalities involved, it must be reasonably expected that in the coming days we will have a new Finance minister, governor of the Central Bank and other senior civil servants at the Treasury.

This is the big test for the grand coalition. If it fails in this, all its members will lose legitimacy in the eyes of the common citizen, and all talk about vanquishing corruption will be rightfully dismissed for the hot air it is.

It is not enough, or even exculpatory, for a minister to purport to ‘‘blow the whistle’’ on a Cabinet colleague. It is worse than tragic for the fellow on whom the whistle has been blown to go to the press to ‘‘praise’’ the whistle-blower while in the same breath defending the illegal sale of public property.

It betrays a view of the common citizen as a blundering fool who will accept anything from those in Government despite the contrary evidence.

Why was it necessary to complete the Grand Regency deal with such haste and secrecy? Why the apparent lies about the buyers and the amount paid for it? Why the use of force and threats to public servants in order to register the sale and transfer of ownership?

FOR GOVERNMENT TO BE SEEN TO be working, these issues must be resolved at Cabinet level, the culprits identified and punished, and the entire Cabinet speak the same language about corruption and good governance.

That being the case, Mr Kimunya will find it increasingly difficult to explain away the sale of the Grand Regency.

The minister is still grappling with public discontent over the handling of the Safaricom IPO and the refund process, and another scandal concerning printing of currency lurks in the shadows. There is no way he can remain in Government while these issues remain unresolved.

Whether there are others involved in these scams or not, he must be the first casualty. If this does not happen, then any other minister who shares a Cabinet meeting with him must be deemed to be guilty by association. None of them will retain any moral authority with which to rant and rave about official corruption or poor governance.

An argument that is beginning to gain currency is that these scandals in the financial sector are all machinations aimed at burying the debate over taxation of MPs’ allowances by deflecting attention to other matters that will keep the minister busy.

That may well be the case, but we must, in the Prime Minister’s words, be able to chew gum and ascend a flight of stairs at the same time. We can keep an eye on the MPs to ensure they pay their taxes while at the same time ensuring those that insult the taxpayer by selling our property for a pittance are held responsible.

Dr Atwoli is a consultant psychiatrist and lecturer at Moi University School of Medicine.