Friday, April 8, 2011

Private practice: Bane or boon?

Should a doctor employed by the government in a hospital to tend to the ill for a stipulated amount of time be allowed to practise at a clinic or not
Saima Farhad

A witch-hunt of sorts has been started against the doctors in Kashmir. The reason stated: private practice, wherein it is stated that doctors are too busy filling their own coffers and not tending to the ill in the hospitals. But does the argument stand.
First let us come to the basic question: should a doctor who is employed by the government in a hospital to tend to the ill for a stipulated amount of time, say 8 hours every day, be allowed to practise at a clinic or home, or not.

The people who say that he should not put his skill to use in tending to those in need beyond the stipulated 8 hours for which he is being paid should understand that by not allowing the doctor to practise they are depriving the society of quality healthcare. He is an asset to the society who can give more. And he has every right to charge for this service. Why should he see people, who can afford to pay, free of cost? It is not as if he is forcing anyone to come to the clinic. People who do not go to the hospital, and instead prefer to come to the clinic have their reasons and freedom to choose so.
And it is not at all the case that a doctor will be able to give full attention to a patient in a hospital OPD when 300 more patients are waiting outside. If a patient wants more attention than what is being given to him in a hospital then if he has no problem in a paying a fee, what is the problem of the government. The same OPD time of the doctor can be availed by a poorer patient. But if we are insisting that a doctor not see patients beyond the hospital hours we are, actually, putting more burden on the overburdened hospitals, and compounding the problems of poorer patients.
This leads us to another question: why do people not want to come to the hospital? This, in itself, is self explanatory. Why stand in long queues and fight over the turn, when you can afford to go to a private clinic. Many of those who visit private clinics do not have the time to come to the hospital as OPDs as a rule function in their work hours. Going to the clinic in the early morning or the late afternoon solves their problem. Why should a person lose a work day to visit a hospital?

Then there is one more thing which must be taken into account: the doctors have an option to earn more if they prefer to work outside of the state or the country, as has been the case in many instances. If they chose to do this, then this will accelerate the brain drain form our society and create a vacuum which will affect the healthcare of the state.

All the arguments of those who oppose private practice cannot be rejected outrightly; if a doctor, who is on government rolls, prefers his private practice even during the time he should be in the hospital, then he should be punished with the most severe penalty, which may even include firing him outright from the Job, and even imprisonment. The time in which he has to be in the hospital, should not be compromised anyhow. For this, the government can come up with a stringent monitoring policy to see whether the doctor is coming to the hospital on time, and doing his work efficiently.

Also number of people raises this point which is related to the ‘Doctoral pride.’ A lot of doctors are not ready to listen to patients at all. They present an image that they know everything and patients know nothing. Then again there is the question of the sincerity a doctor puts into his work at the hospital. He can not afford to give second class treatment to the patients who visit him in the hospital intentionally.
Coming back to the question of private practice, one thing is for sure that there has to have regulations. The fees charged should not be enormous, and only certified doctors should be allowed the same.

Then there is the most important issue of supplementing the healthcare infrastructure. In this debate that issue has somehow lost.

Author is Assistant Professor, Department of Sociology and Social work, University of Kashmir and can be mailed at