Search This Blog

Friday, December 11, 2015

Restoration of Private Practice

By Sanath P. Lamabadusuriya

In 1979, private consultation practice was given to the University staff. There was a very interesting story behind it.  When Professor Rajasuriya died, the logical successor should have been Dr. David Chanmugam. When Professor D.A. Ranasinghe retired, he should have been succeeded by Professor T.Visvanathan. However for reasons best known to the higher authorities (probably communal) Professor  Dharmadasa  and  Professor D.E. Gunatilleke (Gunti) were appointed to the Chairs of Medicine and  Gynaecology & Obstetrics respectively. Both were seconded from the Ministry of Health for two years. During this period private consultation practice was restored to the Ministry of Health Consultants. When the two years were over, both Professor Professor Dharmadasa and Professor Gunatilleke threatened to revert back to the Ministry of Health, if private practice was not given to them. To retain their services (and prevent the 2 logical successors from assuming duties) private practice was given to the University staff. 

I was one of the first beneficiaries and I did a little practice at the Sri Lanka Nursing Home, Wellawatte, Central Hospital, Horton Place and Glass House before I went to Galle. The channel fee was Rs.20.00/- only. Dr. Thavarasah used to refer newborns to me. I used to visit MacCarthy Hospital and Frazer Nursing Home to see newborn babies. MacCarthy Hospital was owned by my classmate Chandima de Silva’s family.

At that time Frazer Nursing Home only admitted expatriate whites. As the patients were dwindling they decided to admit other foreigners as well. When one of Mr. M. H. Mohamed’s (who was a Cabinet Minister) relatives wanted to be admitted, he was asked whether it was a “foreign” Mohamed or a “local” Mohamed and told that only foreigners are admitted. When it was brought to the notice of Mr. J.R . Jayewardene, who was the President of the country, he threatened to take over the Nursing Home unless their policies were changed. Then they decided to open the doors to all  Sri Lankan patients.



26 comments:

  1. Sanath
    Thank you for that honest account. I am saddened but not surprised that so called educated people behave in that way. Being a foreigner in the UK competing for jobs I know how much it hurts when I was overlooked for those reasons. Such behaviour cannot be justified and I hope these issues are now properly addressed as they have done in the UK.
    Sanath, as a professional you have always maintained your dignity and integrity.

    ReplyDelete
  2. Thank you very much ND.You last spoke to me over the phone when I was spending sabbatical leave in Worthing and living in Shoreham -by -Sea, from April 1996 to March 1998. You mistook me for Sanath Tissera if I can remember right.
    Sanath

    ReplyDelete
  3. That is correct. Initially I got my wires crossed but soon I realised. I cannot believe it is now nearly 20 years since that call. It is lovely to catch up with you on this Blog. Much has happened since we left those shores and it is wonderful to receive an update and how professional life has evolved.

    ReplyDelete
  4. Sanath
    If I may digress a wee bit but remain on the topic of Private Practice: PP in Sri Lanka seems to be a hot topic in the newspapers recently. The ability to work Privately while remaining in the Government Health Service is a quirky situation we have inherited from the British. No other Government servant or anyone working for the Private sector is allowed that privilege. This situation leads to conflicts of interest which we are all aware of. Are there rules in place to safeguard the care of the non-paying patients and are they adequately policed? From the news coverage a worrying aspect seems to be the lack of proper patient record keeping by Consultants in the private sector. Every time a patient is seen he/she is like a new patient. This must amount to medical negligence. What are the professional bodies including the Medical Council doing about it?

    ReplyDelete
  5. That was quite illuminating Sanath. I didn't know the history behind this and I am sorry that Prof Viswa and Prof Chanmu did not get what they deserved. On the matter of PP for University staff, I think it was just a matter of time anyway before it was allowed for University staff too as the disparity in earnings would have been glaring and and a big incentive to leave the Academic environment. What do you think?

    When I worked in Kandy for about 16 months, I would have starved to death if I didn't do any PP. My salary at the time would have been enough to survive about 10 days! But I did ethical PP and only sufficient to supplement my meagre income and certainly not at the expense of my hospital work and I am sure you observed the same principles. Money can be such a magnet and it has had bad effects on some while others have managed to keep their values without compromise.

    I hope that appointments are now made on ethical criteria without any ethnic or religious bias.

    ReplyDelete
  6. Dear ND and Mahen,
    Thank you for your comments. Doctors are not the only ones allowed private work. Nearly all other professionals are allowed to do it so as to supplement their income because the salaries are so meagre. My personal practice is to have a personalized card for each patient so that there is continuity of care. Not everyone does it. Doctors get a bad press from time to time and I have also participated in the debates. (Please see Business pages of Sunday Island of 6th December 2015 ,regarding Rev. Sobitha's death). Some doctors are unethical in their ways and all of us are lambasted for it. The public are partly to be blamed because they continue to patronize such "rotten eggs"
    Sanath

    ReplyDelete
  7. Sanath
    Thank you for that. I have followed the debate raging in the Island newspaper. Not living in SL it is hard to distinguish fact from fiction. I am saddened by the innuendo and accusations against my profession. But at the same time such debate brings out the weaknesses of the system out into the open. The public too have voiced their opinion forcefully. Rights must go hand in hand with responsibilities. Money corrupts. Worldwide, healthcare is too important an issue to be left to the profession to police and manage. Living this far away it is hard for me to imagine the situation in SL. These are merely my comments after reading the newspapers and are not to be read as accusations.

    ReplyDelete
  8. From my earlier postings you may recall my views of PP, so much so I reneged on a lucrative GP offer to be a DMO. I joined the Blood Bank to sort out my future as a 'stop-gap' measure. As the political and communal issues spotlighted above. I knew damn well that I will never be the 'Bank Manager'!!! Also due to one of our personal tragedies my wife and I decided to quit SL and seek our future else where. This decision had far reaching repercussions to our & our children's lives. This was where as ND says ' the awesome forces of my destiny' played its hand and dealt me a "good hand"!! Went from strength to more strength and I am where I am now. I was at the right place at the right time and the rest is history.
    I suppose I was pre-destined to join a 'no future' Blood Bank in SL, but it turned out to be for my benefit for it was my future from another angle---
    So fate and destiny do play its role!!!!!!!

    Razaque

    ReplyDelete
  9. As you know Raz and ND, I don't believe in destiny in so far as a "roadmap" laid for you when you are born. From every tree, leaves fall with the wind and which one falls and where it falls is just down to chance in my view. We journey through the road of life and come across pitfalls and diversions and we choose which one to follow and then reap the consequences. To me there is absolutely no mystery about it. What would have happened to you if you went to the USA or France or stayed in SL will never be known. What we know is what happened! One reason I like my attitude is because it does not stunt your growth and block your path. Of course I do recognise that this is my view and that others are fully entitled to have different views. One may look at good things that happened to you as the work of a Benevolent Super Power but this begs the question of HIs benevolence for poor people (good people by any yardstick you care to use) who reap such unfair harvests.

    ReplyDelete
  10. To me Destiny is synonymous with the forces of Karma. There is no one controlling the traffic and directing us. It just happens. I never try to convince anyone of its presence as it isn't like mathematics and proof is elusive. Mahen, your not believing in destiny is your destiny!!

    ReplyDelete
  11. Ah! The real question for you is this. Is your idea of destiny something you know only when you look back or are our lives mapped out already?

    ReplyDelete
  12. I speak of Destiny only when I look back. The forces of destiny influences one's life everyday. We cannot influence it in anyway. We get on with our lives and try to do our best. As for the future Que Sera Sera.

    ReplyDelete
  13. Here we go again... We start with an erudite discussion about Private Practice and end up with the etherial subject of human destiny. Those are the glorious uncertainties of comments. Facts are sacred but comment is free.

    ReplyDelete
  14. I am beginning to wonder if Fate, Karma, Luck, Destiny and Religion is the same face of the sane IMPOSTER in different formats???

    ReplyDelete
  15. The concept of Destiny is like Religion and Politics. Discussions become circular and pointless. Mostly when we reach our age we have made up our minds already. That doesn't mean we cannot talk about it.

    ReplyDelete
  16. True. I do know something though, I know that I don't know! Discussion is always useful to broaden your outlook and appreciate another's point of view. In my case, my objective is absolutely not to change the views of others on this type of topic as it is a futile exercise but one does learn.

    Returning to PP, I never felt comfortable doing PP. I wanted a job where I was paid a reasonable salary ("reasonable" is open to interpretation) and as an NHS Consultant I was more than happy with my remuneration although I know that colleagues who did PP earned several times what I did. I don't feel comfortable making money through people who are ill. It can consciously or unconsciously, deviate your focus from what is really important as a doctor to material gain and even those who start ethically, could start to rationalise. I regard our position as doctors a very special one and I honestly feel that those who regard the Profession as a route to being rich, are in the wrong profession. There were many factors which made me return to the UK but one was the fact that I could work as a Doctor for a salary without the need to do PP. I don't regard myself as a Saint or anything like that but it broke my heart to accept money from some poor people who saw me in Kandy and I often waived my fee and by the same token, I was very uncomfortable in dealing with some well off people who saw me for favours because they thought that money was "power". I am not saying that all the people are like that.Please don't get me wrong but I found it very comfortable to do my best for a patient just because he/she was a patient and being paid a reasonable salary for doing so.

    ReplyDelete
  17. I was happy to do Private Practice in the UK. I gave up a session of my NHS commitment to provide the service. I make no apology for it. I have never charged doctors and dentists which was my professional etiquette. Most Patients had Private Health Cover. I don't feel guilty about charging a fee for a job well done. There were times I waived my fee for a multitude of reasons.

    ReplyDelete
  18. We have to do our best for the patients whether they pay or not. That is the bottom line. The rest are soundbites for those who like that sort of thing.

    ReplyDelete
    Replies
    1. As for me I never did PP as a DMO full stop. I could have minted till 'thy kingdom come'. Saw not one patient in my bungalow. However the thing I accepted were sweetmeats at the time of 'Sinhala Aurrudhu' So much so I was once given a hind quarter of a wild pig as a gift -- you all know this story from my posts in the early days of the Blog.

      Delete
  19. As I was at pain to point out, these were my views and I am not implying that it is not possible to do PP ethically. Of course it is possible, just as a person may refrain from PP but be an absolute "arsehole" to his patients in Hospital. I think we must just read these comments as just individual opinions, don't you think so?

    ReplyDelete
  20. "I don't like doing PP" cannot be inferred as it then follows that "I don't like people who do PP". Absolutely no need ND even to mention an apology. We all know you well and I have no doubt that whatever you did, you did your best.

    ReplyDelete
  21. Mahendra
    I agree with you fully. It is a personal choice. In a comment one has to be brief and perhaps in the process I haven't explained myself fully and may be came across bit too harsh. It was never meant that way. I understand your point of view and respect it. For some all private practice is immoral. I disagree with it but respect that view too. I am happy I have provided the best service I could to all my patients throughout my career.

    ReplyDelete
  22. Sleep well, keep smiling (not in your sleep, but OK if you do) and don't forget to enjoy your daily spell in the toilet in the morning! It costs nothing and gets rid of everything (unwanted).

    ReplyDelete
  23. I will sleep with my specs on to see my dreams better.
    I am reminded of the squatting plate when you speak of the ablutions. I wonder if those are still in vogue.

    ReplyDelete
  24. Doing PP in Sri Lanka is a necessary evil because of the low salary. A young consultant starting his career has to have an additional source of income to lead a comfortable life. Otherwise the brain drain would have been definitely worse. There are other facets to it. Professor RA Navaratna who was an exceptional surgeon was hardly known outside the medical profession. Just compare him with Dr. PR Anthonis at the height of their careers. Also I used to see very interesting patients in the private sector whom I used to expose to students whenever opportunities arose for the latters benefit.
    Sanath

    ReplyDelete
  25. Private Practice is an emotive subject worldwide. It divides opinions amongst doctors and the public and will continue to do so. The Island newspaper seems to be full of it. Carlo Fonseka and Prof Illangasekera have joined in the fray. Now I reflect without regret which makes me BSS(2)

    ReplyDelete