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

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