Having recently had experience of the health system myself, I was interested to see a conversation on social media in which an articulate commenter responded to complaints about long delays in patient waiting time and frustrations regarding channelling, with some realism:
‘Man everyone hates our doctors. All your arguments are very superficial. It’s not the doctors’ fault - it’s the system. We have a ratio of 1800 patients to 1 doctor in this country. While in developed countries it’s about 400 patients for 1 doctor and in those countries the wait is still about 30 minutes. [By that reckoning] the ratios and the wait time here should be 2.25 hrs per patient.
So if a patient needs to see a doctor, our doctors need to see more patients per day than in the more 'developed' countries.
Simple maths here. The doctors' time is more valuable than the patients’ time. Hence you have no option but to wait. If you don't want to wait, go to Cuba: 166 patients per doctor.
Our doctors and nurses are working in a broken system, in which our healthcare system only works because of their dedication.
Therefore I think you should practise some patience next time’.
The commenter here makes a pun on the quality of ‘patience’ being a requirement of ‘patients’ in the health care system, in this country. It is also clear that, in the context of the current Corona Virus scare, with countries shutting down to protect themselves from immigrants who might place their own citizens at risk, and the stronger enforcement of visa restrictions generally, in the past 18 months, it is simply not realistic for most people to ‘move to Cuba’ or any other country where the odds are more greatly in their own favour.
We can’t move, so we have to fix it. Are we in fact dealing with a totally broken system?
I checked these statements with some practising doctors and was told:
‘It’s true [so-called developed countries] have lots of facilities.
But the crowd clearance done by our team here is unimaginable to western doctors.’
To this statement was added:
‘This comes with a lack of some quality of care and pleasantries.’
One of the striking contrasts between an experience of seeking medical assistance in this country and others is that there are no regulations on how many patients a doctor can see within each day. Doctors can see hundreds of people during long consulting sessions, and sometimes do not end their working days till 3 in the morning.
They also work simultaneously in several hospitals, so they go from one set of consulting rooms to another each day, offering their skills to a wide range of patients. This is the dedication the initial commenting friend referred to. But the high volume of patient processing is often seen by the frustrated, unwell public as being monetarily motivated.
Doctors study for years to qualify, and specialize, and from their point of view they get paid at a relatively low rate in the public health system. They are also human beings, who need sleep and food to perform their tasks at optimal levels of functionality. Doctors here sometimes get served sandwich meals during consultation hours, while patients are consulting them, because they cannot take time off for lunch or a break in a 15 or 17 hour working day.
These hours are standard in the corporate world, but in the health care profession the clients’ lives are on the line, and at risk.
The long hours of work performed by doctors also inevitably come at times with a lack of attention and care which can cost a patient their life. Doctors who are overworked and focused on ‘crowd clearing’ don’t often pursue further tests if the patient does not ask for them, for example. They simply do not have the time or the energy to persist in further diagnosis when there are further patients to see and clear.
And sometimes, in this risk-prone scenario, patients get misdiagnosed, increasing their suffering and leading to their untimely death. Then the grieving families are told ‘It is fate. His/her time was up’.
‘That happens in both settings’, say the doctors with whom I checked these facts. But it would be more likely to happen here, I suggest, given the ratios discussed in Sri Lanka.
In other countries, the duty of care is more clearly mandated, because doctors are limited by legislation in the number of patients they are permitted to see each day, and they are required to spend a certain amount of time in each consulting session with each patient. This enables the taking of a proper detailed medical history and more than just a superficial diagnosis of each patient’s condition.
Human beings in the caring professions are not robots. Quality control in a mass production scenario in a factory for example only works when dealing with material goods. Wellness encompasses not just biology but emotional and subjective factors as well, including the vulnerable patient’s trust and faith in their professional health practitioners and their country’s overall support system. The sheer weight of numbers as outlined above, in doctor/patient ratios in this country means that the odds are stacked against a patient getting excellent and supportive, humane care in what is described as ‘a broken system’.
In this scenario, survivalism necessitates that word of mouth recommendation regarding the best doctors is essential for patients, and we see this happening on chat groups in social media every day. We also see people being warned not to go to some doctors with whom patients have had negative experiences. Some of these conversations are quite damaging to the professional reputation of the practitioners concerned.
Attitudes towards doctors are often polarized, because their influence in our lives is so significant. Many people revere the excellent physicians they have encountered - almost to the point of idolatry. But there is also a tendency for doctors to be reviled, when things go wrong. Professionalism is not easy to maintain in a system which is so challenging for both overworked health practitioners and numerous unwell patients.
This is not a litigious culture yet, as the processes of the legal system are so tortuous and expensive that many potential plaintiffs are discouraged from charging doctors with negligence or malpractice. Frustrated in that path of remedy, people’s discontent and envy of doctors’ personal wealth is easily spiked - nothing makes people so likely to make venomous assumptions about people as a feeling of personal helplessness and powerlessness in relation to themselves.
What is the solution? We see those who can afford to prioritize their health care getting their surgical procedures done in other countries. For the vast majority, not only ‘patience’ is needed to navigate this system, but persistence, and a determination not to be resigned or mindlessly accepting of what any doctor says, given awareness of the system in which they are operating.
We must have a vigilant degree of awareness of our own condition, and our family and genetic history. Research it, with all the resources available to us. Question what the doctor says, if it does not make sense. My own advice is: If you are still in pain or distress even if you have been ‘treated’, ask for further tests. You have a duty of care towards yourself. Your life is important, and your quality of life is in your own hands.
The best health care is one in which the patient collaborates with the medical practitioner, and does not just passively accept what they are told. Developing that awareness and exercising our rights - and by doing so fulfilling our personal duty of care - is the best investment in ourselves that we can make.
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