KERALA is considering a radical prescription: a ban on private practice by government doctors. This comes in the wake of the public outcry over the alleged assault of a patient by doctors at the Medical College Hospital (MCH) at Thiruvananthapuram recently.
Following the incident, the CPM'S youth and student wings mounted pressure on the Left Democratic Front (LDF) government to abolish private practice by doctors of the states medical colleges on the grounds that they accord preferential treatment to private patients who visit their homes.
The November 27 patient-doctor conflict at the MCH occurred when a patient clashed with the duty doctor over the non-availability of intravenous fluid. The next morning, a group of doctors stormed into the ward and, according to reports, attacked the patient. The doctors then went on a rampage, destroying hospital property. Around two dozen medicos were taken into police custody - which triggered an eight-day doctors strike that evoked little public sympathy. The stir was called off after the government promised to upgrade the working conditions of government doctors. The medicos in turn agreed to a police investigation into the violence unleashed by doctors at the hospital.
The medical fraternity was quick to close ranks. Challenging the basic premise of the debate, the Indian Medical Association insisted that private practice had little to do with the incidents at the MCH and advised the government to draw a distinction between private practice and malpractice. It favours a crackdown on corrupt doctors and steps to improve hospital facilities rather than a blanket ban on private practice.
But public sentiment appears to swing in the opposite direction. Doctors are perceived as rude and avaricious. Those who pay the doctors get the best treatment and facilities in government hospitals, complains a patient recuperating at the MCH. The charge is grudgingly acknowledged by members of the medical fraternity. "Senior doctors are forced to show consideration to their private patients in the allocation or beds, thus subjecting the junior doctors to the wrath of patients lying on the floor," wrote a doctor in a local newspaper.
Government doctors parry the public criticism by pointing to their long working hours and poor living conditions. Says Kerala Government Medical Officers Association (KGMOA) president Alex Franklin: "The government should not stop private practice before raising the salaries of government doctors. He claims only 15 per cent of government doctors pursue private practice, which in most cases yields less than Rs 500 per day. The KGMOA is currently on a work-to-rule agitation to press for a pay hike and fixed working hours.
The LDF is caught between the pressure tactics of the doctor lobby and a hostile public sentiment towards the medical fraternity. The proposal to prohibit private practice appears to be a short-term palliative intended to defuse the crisis. The government is aware that going ahead with the ban will not be easy.
It is relying on the recommendations of the T.N. Jayachandran Commission, which had studied the issue. In its report, submitted in 1996, it recommended a phased ban beginning with the MCHs, later extended to district and taluk hospitals and then to public health centres. The commission noted that private practice had indeed degenerated into malpractice with doctors accepting bribes from patients for special treatment in government hospitals and ignoring those patients who failed to pay. Banning private practice would restore professional integrity and encourage doctors to shift their focus to patient care and to expanding their medical knowledge through reading and study, the commission held.
However, it added a rider: any move to abolish private practice by government doctors should be preceded by measures to improve their service conditions and bring them on a par with autonomous institutions such as the Regional Cancer Centre (RCC). The RCC, which disallowed private practice recently, is being projected by the government as a test case that has worked. Says RCC director Dr Krishnan Nair: "We stopped private practice as a prerequisite to multidisciplinary management. Doctors working independently in a hospital, projecting themselves as the sole saviours, is not in the best interests of the patient."
But the government is cautious. State health minister A.C. Shanmugadas states the position: "Stopping private practice is on the LDF agenda. A subcommittee has been set up to examine the issue. We are awaiting its report." Clearly, no early decision is in the offing. Meeting the stipulations laid down by the Jayachandran Commission cannot happen overnight. The public sector healthcare system will need a major overhaul to come close to satisfying the commissions standards.
It will also cost the tax payer to redraw the priorities of government doctors: to turn their attention from the purse to the textbook and to ensure an even-handed treatment of the sick. But first the physicians will have to heal themselves of greed.