Photo courtesy of Medium

Eyes closed, imagine a space where, interspersed among us mere mortals, Demi-Gods (DGs) roam. Each one of us has our own imagination about who or what a DG would look like or be like. Most probably imagine lightness and goodness, a sense of wonder permeating the air and an all pervading sense of well-being.

Wake up to the DGs  –  the doctors and health care service providers and the private hospitals; the money making machines for whom the Mere Mortal (MMs) wait and wait for hours on end. As the clock ticks, the MMs become more harried, some after long journeys, feeling unwell and with mounting anxiety. Count the anxious relatives in too. Mind you, let me qualify, there must be genuine DGs amongst the multitudes of them, so let’s grant them the respect of service and dedication they deserve. Do not exclude the private hospitals whom they serve. Again, no doubt, some are better than others. If some of these institutions are par excellence, there has been no loud public shout. One hospital in particular, of which a lot is heard, has a stinking reputation for being a money sucking vacuum. There are others.

These DGs, the titans of the money machine, toil for hours first in government hospitals, starting their day at dawn and labouring until late at night, and the greasy wheel turns on. No doubt some of these DGs are highly skilled. But for many DGs it is the sheer indifference to the client/patient, the absence of regulation and the overriding greed for money that is of concern here. Throw in the absence of humility and humbleness for good measure.

As we know, most doctors still take the Hippocratic oath to value patient interests and to protect their privacy. Hippocrates, the pioneering early Greek physician, used this oath to guide the work of physicians. To remind ourselves and the DGs who don’t know or have never heard of Hippocrates, here are the key principles of the Hippocratic oath:

The oath dictates the obligations of the physician to students of medicine and the duties of pupil to teacher. In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.”

DGs amongst us are well advised to read if not the whole, at least the five lines quoted above, in the hope it presses some value buttons.

So why write this article? The stories of people’s harrowing experiences in hospitals, exorbitant charges and waiting around for DGs is endless; there seems to be no change in sight.  Sound client service systems, standards, transparency, values and state regulation are all absent. If one were speaking of accountants or lawyers, the depth of callousness and arrogance would matter less since they do not serve sick, anxious people propped up by equally anxious kith and kin.

Experiential quotes from those “served” by DGs:

“Haven’t you heard of the doctor ‘mudalalis’. The doctors’ mafioso?”

“They charged for 20 toilet rolls when the patient didn’t even have diarrhea.”

“Patients still come even though that wing has no hot water.”

“Patient must bring a bystander; go and check the dictionary for the definition of bystander. Fees are paid for nursing care not for family bystander care. The hospital is responsible for the patient while under its care.”

“Please explain to me why the hospital needs to know if a patient is insured? Oh, that must be so they can jack up the charges.”

“We don’t give itemised bills, we don’t have a system for that.”

“You want me to keep patient records, you think this is the UK to get that sort of service for the fees you pay?”

“I went for day surgery scheduled for noon. The hospital said the doctor came in the morning and went for an emergency surgery. I called the doctor who said he was at a funeral out of town, no apology, no shame. I didn’t know then that he was also the spouse of the doctor who had recommended the surgery. The surgery eventually took place by a doctor of my choice. It took one and a half hours to get the bill, longer than the procedure.”

“I took my 93 year-old mother for a 8 pm appointment. The doctor came at 10 pm, he didn’t apologise and simply shrugged his shoulders, showing profound arrogance. They don’t care.”

“We selected the doctor from a list at the hospital because it was an emergency. The nurse got blasted for not recommending doctor x. Everybody gets a cut.”

“Everybody is getting a cut along the way – doctors hospitals and their staff are all involved in this heinous system of bribery and corruption. Caught in the middle: the hapless fee paying public”.

Some DGs are akin to mercenaries. They move from hospital to hospital, hours late, no shame, keep no patient records and retain no patient information. Look at the faces of patients in waiting rooms; they have the same obsequious look and body language the masses display towards politicians. The hospitals, desperate to get both the punters and the DGs into their facilities, can only resort to advertising their services but not actually delivering on them. Do they measure quality of care through patient surveys or independent reviews of performance against stated mission, vision and value statements? Big business and politicians form part of the nexus that works on the basis of mutual support. Politicians have one thing in common with the MMs, they also fall sick. There the commonalities end and the commonalities between doctors and politicians begin as they seek obeisance on the basis of status.

A scarce recognised fact by the DGs is that they were once MMs, medical students supported through an entire medical training programme, including overseas training, by the very public on whom they pour scorn and among whom they prance around like peacocks adorned with dreary, weary feathers. Theirs is not a bedside manner but a sometimes abrasive speak. How many ever apologise for being late? Let us all be reminded that humanism is essential when delivering humanitarian services. How will the DGs teach bedside manners to their students, were they even taught? It would be interesting to know how the DGs treat nurses and minor staff. There must be a great sense of power to walk through a throng of waiting patients. Once the conveyor belt is switched on, a few short minutes of consultation follows.

The MMs may know when the doctor is late from the messaging systems on mobile phones. For patients travelling from afar, it is often it is too late to change course or not worth risking losing the fee already paid. What have the hospitals done to change the behaviour of these walking egos?

Politicians, another kind of DG themselves or more suitably self-anointed gods, receive VIP treatment from the DGs and the hospitals. Given the recent Brandix debacle and COVID-19 transmission, one doesn’t need to elaborate the “you rub my back, I rub your back” principle or the shameless use of money and power that wrings the neck of the MMs. No doubt we have all heard of the self-anointed VVIPs. I was at a hospital where a matron was advising staff that VIP should be written on the ticket, and the next moment, I observed an irate DG bursting out of the consultation area screaming that there were no nurses, while the hospital complains of declining numbers and that there are not enough punters being brought in. All this in full display for MMs to hear and watch. Anyway, it was a bit of unexpected light entertainment, free of charge, for those who sat and waited. Hippocrates must surely be turning in his grave.

Here’s the DG self-diagnosis test. Check one consider yourself a DG:

  • Consistently more than 15 minutes late
  • Never apologising or explaining for being late
  • Spending less than 10 minutes with a patient
  • No bedside manner, being abrasive
  • Not practicing patient confidentiality or privacy
  • Forgetting that the patient is a fee paying client who paid for the DG’s entire education and training
  • Recommending unnecessary tests, drugs, unnecessary surgery and longer stays in hospitals
  • Delaying discharge
  • Taking money for a range of corrupt practices, prescribing drugs, referring patients to friends and family, overcharging for the time spent
  • Not questioning a corrupt system
  • Working from 6 am until late at night

Who is going to act to change this system that is so antithetical to our needs? In a highly unequal system, coupled with a weak civil society, patient woes are likely to remain just that – woes. The state has no interest in regulation, whether independent or otherwise. The hospitals present no patient charter and even if they do, who will ensure adherence to quality standards of service and duty of care principles? A state like Sri Lanka that operates without a moral compass, in decline in since independence, is hardly likely to rise to the occasion.

Competition may provide a longer term shakedown. It is, however, social media and civic action that will immediately erode the power base and question the ugly head of pervasive greed. There comes a time when it is clear that the citizenry must answer the call. We citizens must stand tall. The rule by snollygosters has never boded well for the public. The time has come.