Doctors on the warpath

"The extreme unionization of state sector doctors and their quick resort to strike action also refer to the deteriorating standards of the education they are receiving from our universities. It seems that these institutions and their teachers are merely producing technicians rather than professionals who have a good grasp of the philosophical and ethical foundations of their profession."
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by Sasanka Perera

(February 02, Colombo, Sri Lanka Guardian) In Plato’s (427-347 BC) political and philosophical treatise, the ‘Republic’, the following observation about ideal physicians is made: ‘It is true enough of physicians that the ablest might prove to be men who, from childhood up, besides mastering their profession, had been in contact with the largest number of the worst cases, and moreover were not of a robust constitution and had themselves suffered from every malady.’ The wider implication of this observation is that in addition to their professional training, physicians must be sensitive enough to understand not only the medical contexts of the conditions they are treating, but also be able to understand the pain of the patients. By extension, this also means that they have to sense the pulse of the society in which they work. Many commentators have noted that what is described today as western medicine is based on the Greek model that thinkers such as Plato and Hippocrates have commented upon. In fact, Hippocrates (460-377 BC) is considered the ‘father’ of western medicine and the author of at least some of the books of the ‘Hippocratic Collection’ consisting of 60 to 70 volumes detailing numerous aspects of medicine in the ancient world. On the other hand, the well known Hippocratic Oath which all doctors of the western tradition are supposed to take also originates from the ideas generated by Hippocrates, and has been traditionally considered to be the most significant statement on medical ethics and good practice. It is this system of medicine with its Greek philosophical foundation that was established in countries such as Sri Lanka as yet another implantation of colonialism. But if Hippocrates, Plato or the colonial founders of western medicine were alive today, they would have been utterly horrified to see the extreme deterioration in some aspects of western medicine in our country over the last decade or so. This is most clearly visible in the state sector medical establishment when it comes to industrial action by doctors.

These thoughts came to my mind while trying to comprehend the news coverage of the doctors’ strike that began at the Accident Service of the Colombo National Hospital (CNH). The strike began after a physician was assaulted by a group of organized and politically connected hooligans who had the freedom to operate as they wished within and outside hospital premises. The incident that led to the strike by doctors as well as the strike itself clearly places in context today’s wider socio-political realities. It is in this context that we might understand how it is possible for group of individuals under the influence of alcohol and political power to go into a site of healing and assault a doctor whose duty is to heal. It is in that same context we could also understand how a group of individuals vested with the primary duty of healing can go on strike inconveniencing a large number of not very affluent people whose only option is the public sector health service.

The doctors’ strike at the Colombo General Hospital is not an isolated incident. As we know quite well, over the last decade, the strike or the threat of striking have become the most commonly used weapon by local doctors in the state sector health services to make and usually get their demands. And consistently, regimes have given in under these circumstances. This has made strike action almost the first resort of this professional group in industrial action rather than the last. One does not hear of any country in the world where doctors vested with the duty of healing, resort to such violent industrial action essentially depriving people of medical attention thereby completely negating the ideals of the philosophical tradition of their own profession. On the other hand, this has become possible because as a society we have never publicly questioned this practice even though in private many opinions have been generated with no affect. We have also not initiated a public debate on it, attempt to find more civilized means of conflict resolution in the state medical services and investigate ways to censure powerful professional groups playing with people’s lives for whatever purpose.

How is this possible? Much of the answer to this has to do with the general socio-political deterioration we have experienced since the 1970s. This includes the drop in education standards, extreme politicization of service providers and their professional bodies, the drop in professional ethics, the violent politics and the overall destabilization of society. The latest strike that began on 15th of April and lasted for four days can be a case study to place some of these issues in context.

As any average citizen would accept, the assault on the doctor and the ability for the assailants to operate so freely within hospital premises is completely unacceptable. But it was possible for this incident to happen in the first place because hospital administrators and the medical and non-medical staff who worked there allowed this situation to grow rather than eliminating it when it first emerged. Thugs should never have been allowed to roam within hospital premises and they should never have been allowed to operate kiosks within hospital premises or dictate terms to hospital staff. But all this was allowed to take root, because of the nature of political interference in our society. The thugs were not free roaming agents; they had political clout very much like the taxi operators at the Colombo International Airport. So like most of us, the doctors and other hospital employees allowed the situation to get out of hand before seeking solutions. For one thing, the demands of the doctors were perfectly reasonable: safety for themselves, additional police security at the hospital, punishment for the culprits and the removal of the illegal structures that the culprits and their supporters have set up within hospital premises.

The question is whether there were no other ways to ensure these outcomes rather than by taking a large segment of the population hostage depriving them of their right to health care for four days? Of course hospital authorities claimed that ‘arrangements had been made to send patients arriving at the Colombo National Hospital to other hospitals’ such as the Colombo South and Colombo North Hospitals. This statement would seem as the Government Medical Officers Association and hospital administrators had made transport arrangements for these greatly inconvenienced people to go to alternate hospitals. But in reality, this simply meant that they were told to go to another hospital after they had already arrived at the CNH.

Other than resorting to this strike, could not the authorities responsible for not providing a safe working environment for the doctors and other staff be taken to courts? Could the hospital administrators, the Municipality, the Ministry of the Interior, the Ministry of Health and the Police Department who had certain responsibilities in this matter be sued? Such a civilized and acceptable means of action would also have re-established a sense of process that seem to have disappeared from most sectors of life in contemporary society over the last two decades. But as one doctor not involved in the strike but very sympathetic to the cause told me, there were reasons for not taking this kind of action: ‘It takes too long and it is too expensive. We need instant action. And this is the only way the government will listen and do something.’ Unfortunately, in the messy society we have created for ourselves, this observation also makes some sense. But rather than helping-reestablish civilized ways of addressing issues that we once admired, the doctors are helping entrench the ad hoc and often unethical ways of resolving conflict that had been introduced by such vulgar elements as politicians.

The extreme unionization of state sector doctors and their quick resort to strike action also refer to the deteriorating standards of the education they are receiving from our universities. It seems that these institutions and their teachers are merely producing technicians rather than professionals who have a good grasp of the philosophical and ethical foundations of their profession.

On the other hand, while the strike was initiated by one set of doctors in one hospital there were no opposing views from any sector of local medical practitioners in the private sector or from university academics who teach these individuals. It would then appear that in the local tradition of medicine that has now emerged, the logic of the Hippocratic Oath no longer applies. Against all odds, one hopes that in the future the state sector medical practitioners would be able to help civilize this society rather than become part of the problem where they can actually be doctors rather than mercenaries.