Friday, April 29, 2011

Moonlighting Murderers

By a doctor who prefers to remain anonymous 

I work at a major Gauteng public hospital. During the course of the last three days, I have had the misfortune of witnessing two young adult patients suffer preventable deaths. 

Many South Africans will easily explain away these deaths with predictable explanations such as collapsing infrastructure, shoddy equipment, long waiting times and poor nursing care.

While this does certainly portray the public sector accurately, these two patients died because the DOCTORS employed to oversee their care were nowhere to be found. That is not entirely true. They were at their nearby private practices at major private hospitals in the city. They elected to discharge their responsibilities there first, before coming across to assist/supervise their much junior and desperate colleagues. 

Sadly, it was too late.

It is no secret that many SPECIALISTS in the private sector hold full-time positions in state hospitals. A fair estimate would be approximately 30% to 40% in Johannesburg. 

Occupation Specific Dispensation has considerably improved the salaries of these doctors at the pinnacle of their professions. This is obviously not enough to retain them or inspire them to fulfil their obligations. 

There are many different stakeholders in this complex issue. These include the state, department of health, the taxpayer, the patients (both public and private), the guilty doctors, the innocent doctors, civil society and the private hospital network.

The department of health is aware of the problem as recently acknowledged in Parliament. 

Dealing with it though is a different issue. Too aggressive an approach will result in a mass exodus of these mobile professionals. Throwing money at the problem has done little to satisfy the professionals. Their solution lies in the forthcoming National Health Insurance policy that most ethical doctors are eagerly anticipating.

The taxpayer should be livid with the situation. These doctors are being remunerated for working forty to sixty hours a week. They routinely claim overtime as well. On average, they work less than 20 state hours a week, with the most negligent, working less than 10 state hours a week. 

They occupy posts that cannot be filled by the willing and able.

The public-sector patient gets the worst deal. He/she largely gets ignored or seen too late. He/she is often seen primarily by inexperienced junior staff members who are able to make a basic assessment, if at all, without being able to institute appropriate therapy until they receive the advice of their absent seniors. The outpatients are left waiting ridiculously at outpatient clinics and appointments are tailored to suit the specialists’ other commitments.

The private-sector patient is almost never aware that their doctor is giving someone else a pathetic deal while smiling in their faces. The objective of this piece is hopefully to educate this group that they indeed have a choice. The ethical choice would obviously be to see the many specialists out there that have no commitment to state hospitals.

The innocent state doctors often are left picking up the slack. Among these are the junior doctors that are so reliant on their seniors to shape their careers. This explains why so many of our younger doctors are lacking not only in confidence but also fundamentally in expertise. The innocent senior doctors are a dying breed. They are the true heroes of the public sector. Sadly, the lure of easy money has shrunk this pool.

All of the three major private hospital groups have doctors working at their hospitals that are employed by the state. Some are even bold enough to publicly declare that some professors are major players at their facilities. It is important to admit that the department of health has a policy (remunerative work outside the public service) that allows these doctors to get away with it. 

Gross violations of the regulations contained within this policy go unpunished. The private hospital groups have only their interests at heart. I have yet to come across a hospital that takes the ethical route and only allows non-state employed doctors to man their facility. It is a good idea and will attract patients that are like-minded.

I hope that I have met my objective. I know that much of what has been written here will not bring back those two patients but I hope that it will prevent further tragedies. This is a complex issue and all too often the government or the ruling party is criticised for its failings with the public health sector. 

My feeling is that a considerable portion of the blame can be found within. 

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