Insult And Injury

You and the Health Care Industry - A Survivor’s Guide

Image credit: emedprimarycare.com

Sri Lanka is very proud of its universal health care system, which provides free medical care for over 22 million people, from generally excellent medical practitioners. In fact, Sri Lankan doctors are known all over the world in the countries to which they have emigrated for their high level of skill, thorough professional training, and dedication. 

However, in Sri Lanka, the actual experience of seeking expert and timely medical care in the public system is often a less than smooth process, and can be an ordeal for the patients and their families. 

Last year, a close family member of mine died, and I believe if he had received care in another country, under a more accountable medical health care system, he would not have died. We can never see his beloved face again, in this life. I am writing this article in the hope that those who read it will take extra precautions when booking their own loved ones into hospital, to spare themselves what our family has gone through. 

In other countries, it is possible to book your loved one into a hospital and leave them in the care of the dedicated professional staff, confident that they will emerge well, and supported in their recovery. In this country, we have found this, unfortunately, not to be the case. 

I am not going to name the particular hospitals or medical personnel involved, not only for legal reasons, but because I have heard accounts from multiple people who have had similar experiences to ours, with hospitals and doctors all over the country. Because of the overriding positive national narrative of universal health care being such a gift and an asset to the people, these individual cases are treated as one-offs, yet they add up alarmingly when you hear and read them. Each lived experience is not just a statistic, but represents a family: all the loved ones the patients have left behind, or who continue to suffer from mismanaged procedures. 

1. The reality experienced by patients is that, however renowned and dedicated their doctor is, there is no limit on how many patients a doctor can see for a clinical appointment and diagnosis/ treatment each day. Many doctors see patients in multiple hospitals, and see more than 200 patients a day. There is also no designated minimum limit on the time period allocated for a patient visit, of 15 minutes per patient, for example, as in other countries. Many people say that the doctor does not even look at them or speak to them - they simply look at their charts or test results, and sign a form to authorize a script for medication. This is not humane medical treatment. It is conveyor belt medicine. 

Suggested remedy: Find a doctor who is willing to give you a proper consultation, and is able to verbally interact with you and your family members. You have pre-paid your appointment fee, via channelling, cancelled your work commitments and waited for a long time - up to 3 hours at times - for your time with them, to have your complaint and condition diagnosed. The least you deserve is for your consultation to be an adequate and thorough one. 

This level of professional dedication simply cannot be taken for granted in a system like this. While many doctors and medical personnel are genuinely wishing to care for patients, which is why they see so many patients each day, many others are wholly or largely motivated by the desire for personal enrichment. They justify it by pointing to the years of competitive exams and study required before they can qualify to practise, and that they wish to be rewarded for their efforts, which is of course understandable. Just ensure that they do not do so at your expense. Medical errors are unrecoverable errors. 

2. You should do your own research into your symptoms and ailments. Look into your family medical history, identify any risk factors, and keep a diary of your case, yourself, for your records. This will help explain your situation to the doctor, and also help you assess if the treatment you are receiving is correct. Given the heavy workload of the doctors, this is essential effort required from you. Do not go to your friends or social media. Look up reliable sources on the Internet, and medical text books. Ask doctors who you know for advice on where to do your due diligence. 

3. The doctors and nursing staff in the hospitals are under stress, and are often rude, dismissive or even bullying to patients. This is unprofessional conduct. Because it happens so often, and without witnesses, it has become normalized. Often stressed medical staff vent their own frustrations on those in their care. Suggested remedy: Be prepared for this. I have heard that some doctors even laugh at or mock patients who ask for information about what could make their hospital stay better for them, and that nursing staff are negligent or deliberately withholding of attention if the patient is seen as ‘difficult’ for knowing their rights. Keep a record of what is said and done, in the interactions you have with medical staff, with dates and times, in a notebook. Take video or audio recording if necessary. Show from the start that you expect a high standard of care, to prompt them to give it to you. 

4. There is very little chance that any valid complaint of negligence or malpractice against a doctor will be upheld in the current system. Unlike in other countries, where doctors are routinely held accountable, and have to prove that their conduct in any medical case in which they are involved was responsible, and beyond question, doctors in Sri Lanka have disproportionate power in the doctor-patient relationship. They will band together and support each other against patient complaints. The legal system in addition is slow-moving and tortuous, and the outcome is not guaranteed. The insult of the legal fees and the time and stress required for the patient to ensure that their concerns are represented  will be added to the injury the patient has suffered. 

        When you enter a hospital as a patient, and especially for surgery, you are in a vulnerable situation. Strangers will be designated to care for you, before, during and after your procedure. Their level of skill and dedication cannot be assumed. You need to know that the proper tests are being authorized and carried out, and that you are being cared for properly. From our experience, my family can say that the only way to ensure this is to accompany your loved one into the hospital, not only at admission, but during their hospital stay. 

You may have to argue with the doctors and nursing staff to insist on the rights of your loved one, who may be too weak physically to do so themselves. You may have to question what is being done, or not done, and face outraged or annoyed accusations of interference or even disrespect for doing so. 

Suggested remedy: Don’t assume everything will be ok, don’t submit to bullying or intimidation. Insist on the appropriate care being given, at every stage. The only way to do this is to be physically there in the same room when medical personnel are in attendance at all times, except of course in the operating theatre. Be vigilant. Don’t even ask a staff member to stay with your loved one. Do it yourself. 

Most hospitals allow an extra bed to be placed in a patient’s room. I have been told that the availability of this has to be checked by the patient themself before admission. Some doctors don’t honour the patient’s right to request this basic support. From the beginning, know your rights. Show that you know them, or they will not be recognized or upheld. 

Recently, a friend of mine was immensely supported in her cancer surgery ordeal by a mutual doctor friend, previously unknown to her, who generously made herself available (amidst her own busy schedule)  to speak with my friend, be present with her during her admission, answered her questions, addressed her anxieties and concerns, and visited her in her hospital room to ensure the aftercare was being given properly. This level of attention, support and care, which materially helped my friend in her major surgical procedure, and ongoing recovery, was not provided to her by the hospital staff who were officially responsible for her care. It was even said to my friend directly by her surgeon prior to surgery that her request for a support person was a ridiculous request to make. 

5. The nursing staff may be ignorant or uncaring, or unskilled. They often lack sensitivity training. You know your own thresholds of pain and anxiety best. Make sure you have whatever you need with you to help you during the days of recovery, and don’t rely on them to administer it. They will not move to assist you without the head doctor’s authorization. And the head doctor is often not there to give the authorization when it is needed by you, because of their own busy schedule. The protocol and the hierarchal structure of externally-imposed responsibility within the health care system is more important to most doctors and medical staff than their personal accountability. In fact, the punitive and blaming aspects fostered by the current system are responsible in large part, in my opinion, for the lack of personal accountability on the part of many personnel. When anything goes wrong, people often engage in blaming and scapegoating rather than directly and honestly addressing the problem. They will never admit error or negligence on their own part, for fear of losing their job and their income. The patient therefore has no pathway of redress. 

It should also be noted that the private health care system is prohibitively expensive for ordinary wage-earners in this country, so it is not a viable alternative, and in effect the patients have no choice but to trust the care offered in the public system. It speaks volumes in this situation that those who can afford it, including many politicians and those in the corporate sector, opt to have their personal surgical procedures performed in India or Singapore instead of locally. 

In conclusion, take care when dealing with the hospital system in Sri Lanka. Try to pre-empt the challenges and difficulties you will face, as you seek professional care from often overworked and sometimes uncaring individuals, whose capacity to empathize and be compassionate to the vulnerable people in their care is blunted, eroded and overwhelmed by the sheer numbers of people they treat each day. Develop self reliance. Take responsibility for your own safety as much as you can - both in sickness and in health.