Private practice in Kashmir: The various sides
The polemics have been raked up, often variable, regarding legality, moral conformity and social permissibility of private practice by doctors in Kashmir. But unfortunately most of the discursive has either been too abstruse or extremely expedient and over-simplifying. The ‘private practicing’ of the doctors needs to be understood by the civil lobbies and masses in a dialectic that helps to resolve these extreme, sometimes rhetorical points of view.
The importance of availability of private practitioners for general masses must be acknowledged for a region like Kashmir, where government hospitals are already stretched to the their fullest. Our healthcare delivery mostly depends on the three or four tertiary level hospitals in the valley. Everyday these hospitals cater to a colossal rush of regular patients and in addition to it Kashmiri hospitals have an extra burden of physical, psychological and emotional visitants owing to a very non-typical topography, both climatic and political. The huge lines of ailing and rumpled waiting outside the hospitals is a reality; waits which range from a few hours for a simple itch to waits for several months for a rather life endangering surgical condition. As such, the masses should have an alternative to this cumbersome practice, when they have a right over their health and life to choose for more convenient ways of its well being. The subjects must be allowed to see the physician and surgeons in private if they have avenues of paying the extra, but nominal and justifiable charges. If someone is suffering from a deadly infirmity and someone else from a minor discomfort, both have volition to ease their travail, without waiting in unease for days, or hours or even minutes. Right to good health is a basic human right that no corridor and no government can deny to the sick. Hence, the implacable monologues calling for an outright ban on private clinics mostly stem from ignorance and do not consider a larger issue of human rights and personal convenience. These must be outrightly rejected, as mawkish, since the language used in them engenders a sense of unnecessary disapproval of a very important professional class of our society.
Having said this, the privatisation of the medical profession should not be extolled in absoluteness. The expedient of privatisation should in no way be confused with commercialisation. The charging by the doctors should be uniform throughout the valley according to the qualification of the doctor and the nature of the medical procedure performed and thoroughly standardised by the bodies of doctors and analysts according to the economic conditions of the place where the doctor practises. There should be due considerations made in the favour of poor and socially weaker sections. The concessions in surgeries, tests, and visit fee should be made for the old and those below poverty line, the concessions suiting both the doctor and the patient.
The most important aspect of the issue, i.e the private practise of doctors already working and drawing incentives from government hospitals, needs to be talked about at length. Out of the four tertiary level hospitals only one has banned its employees from involvement in private practice, and justly so. The private practice of the doctors working in public sector has always been a major subterfuge responsible for a general insouciance and decline of the public institutions that approved of it. If a doctor is on public pay rolls, it becomes a moral incumbency on him to abide to his ascriptions to the public set-up by virtue of the salaries he draws from the public coffers. The recruitment into a public job sets a moral fetter on any ‘outside the job’ indulgences and if not in the subcontinent, any such practices outside southeast Asia are considered criminal and a major betray of trust of the employing bodies. There have been incidents all over India, Pakistan and Bangladesh where involvement in private practice by the government employed doctors have lead to their evasions, negligence and sordid discourses at work. Such incidents have brought bad name upon the whole institution of medicine and this exactly is the reason why the nimble critics have found it very convenient to label doctors as dishonest and ‘money hungry’. The fraternity is often castigated for delaying patients or not seeing patients in government hospitals and even demanding the patients to come for private visitations, the veracity of such claims can’t be verified, but the reason of such slurs simply lies in the fact that public doctors take to private clinics. Apart from this, the other major sufferers of such a practice are the students that in the academic hospitals. The general trend is that the academics of most of the institutes where private practise is banned are better as compared to the languid teaching practices in the hospitals which allow private practising of the doctors who are supposed to prepare, teach and take classes of medical students. Hence, the practise is a potential impasse to having better future doctors and calls for a complete legal dictation annulling it.
The least talked about issue but one of paramount importance pertaining to private practise by government employed doctors is that of inequitable employment distribution. It is a common scenario that a doctor who enjoys a good repute in the government hospital is the one who has a largest patient following in private setup. The person earns from the public treasure and at the same time creates an impediment for establishment of other young qualified unemployed doctors in private clinics. This is one of the reasons that many youngsters, after having spent decades of their lives in training leave the state for better options outside Kashmir. The rich and famous are getting richer while the young and qualified are suffering.
Hence my opinions, to which I am rightfully entitled, adduce to the exemplary steps that must be taken by policy makers, encouraging privatisation, discouraging commercialisation and criminalising the commodification of medical field by those who take an oath to public service.
The article was originally published on Daily GreaterKashmir
(Writer is a published author and medical doctor serving in SMHS hospital and can be reached out at https://twitter.com/khawar_achakzai
