Striking a deal with private practice | Daily News


Striking a deal with private practice

As this article is being penned, the Government Medical Officers Association (GMOA), the trade union of the government service doctors, have given notice of their decision to launch an indefinite strike from 5th July 2017 onwards, until their demand that the South Asia Institute of Technology and Medicine (SAITM) be taken over by the state.

Following calls by religious and society leaders, the GMOA claims that it has postponed it strike by one week.

The GMOA’s ostensible reason for striking, is because they believe, based on a report of the Sri Lanka Medical Council, that the SAITM, falls short in some areas for a medical educational institution. So, the ostensible reason is all about ensuring quality standards in medical services for the Sri Lankan public. To provide the Sri Lankan public with quality medical care the GMOA intend to deny the public medical care, all in the name of ensuring that subsequent care they receive after the strike would be of an assured standard, we presume. Surely a simpler solution would be for the SAITM to engage in a supervised process of remedying its deficiencies. Given the crucial role that medical services play in the life of the community, literally and the wellbeing of the public, the conduct of the GMOA, requires some public scrutiny.

Hippocratic Oath

The high hurdle of course with a doctor’s strike is should doctors strike at all. Unlike any other profession, doctors are engaged in an essential humanitarian service in which human life is at stake. The preservation of human life is the highest and most basic of societal and hence the state’s interest. Further, for thousands of years going back to ancient Greek civilisation, doctors have taken or are believed to have subscribed to the Hippocratic Oath.

The Hippocratic Oath among other things has doctors pledging to preserve life and to always act in the interest of the patient. Clearly, the action of striking or refusing to perform their medical service flies in the face of and is in violation of the medical oath and ethics.

Why not strike private practice?

Sri Lankan doctors are a privileged lot, receiving as they do, free education from primary school through medical college. As beneficiaries of this public funded largess, their only responsibility is to serve the public as government doctors, entitled to privileges such as duty-free vehicle permits and the right to lucrative private practice after hours. The public or government health service is accessed by Sri Lanka’s lower income section of society. All those who can afford private health care or have medical insurance opt for private hospitals. Accordingly, the GMOA action of striking only and exclusively their public service just comes across as knavish.

After all, the better option for doctors, who have qualified through the public purse would be to strike their private practice and do their public service of serving poorer sections of society or at least strike both public as well as private practice so that their action is principled and not cynical and opportunistic. Now the GMOA will argue that their employer is the government or rather the state, with whom they have a dispute. However, the standards at SAITM are not directly or even indirectly related to the Government doctors pay, work conditions or any other direct impact on their terms or conditions of work. It is only in relation to a single institution’s training standard, which matter is before the Courts, a matter of higher education policy on which several governments past and present have progressively and systematically taken decisions, going back to the early days of the North Colombo Medical College (NCMC).

Dengue epidemic

Sri Lanka is currently in the midst of a dengue and viral fever epidemic with hospitals and health care institutions overloaded and unable to cope with the situation. In such a situation to persist with a strike is to sentence many patients to a certain death, all in the name of ensuring standards of medical higher education. Really!!! There are certain categories of public servants who are not entitled to strike and the security services are the best example. There are internal grievance redress mechanisms but it is not possible to refuse to work. It is clear that at the grassroots level, that doctors are losing the public’s respect. Already social media is awash with messages to boycott the private practice of the GMOA executive committee members. The GMOA understands this and hence their regular press conferences and other attempts at winning over the public regarding their demands. But it is impossible to defend a really bad brief and the GMOA is not making any headway in their public relations campaign to secure public support for their strikes. Now the GMOA may argue that they continue essential services and it is primarily nonlife-threatening treatment and services which they strike. But failure to treat at early stages would only aggravate illnesses.

Private higher education

The Federation of University Teachers Association (FUTA) has long argued for a significant higher budgetary allocation for higher education, contending correctly that Sri Lanka’s higher education is under-resourced. Accordingly insisting on Sri Lanka’s medical higher education being a state monopoly is ridiculous. Due to Sri Lanka’s district quota system of university admissions, very well qualified candidates say from the Colombo, Gampaha and Jaffna districts will fail to get into medical school, although those with lesser qualifications from other “less privileged” districts will get admission. Now, this affirmative action has merit for equitability. However, we must have a method to enable these students to then even pay and get their desired and required medical education. Sri Lanka has a low ratio of doctors on a per capita basis, so there is a need to increase our number of doctors. All the doctors, GMOA members included going abroad for their specialisation or higher studies.

The way forward for Sri Lanka is to have private higher education, which we already do in fields such as computer science, law and management and business studies. Nationalising and kicking around the first private medical college is not the way to attract new investment into private higher education in Sri Lanka. The GMOA opposed the Indian ambulance service, the ETCA with India and now the SAITM. Where will they end? 


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These "tax-payer" educated Doctors are like Mudalalis safeguarding their turf from other competitors. So selfish.

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