Sunday, March 1, 2009

Doctors aren’t Saints


By Dr. Faisal Saeed

A man goes to the doctor with an ailment. The doctor cures this ailment and asks to be paid. The man refuses to pay, saying that by virtue of having become a doctor, doctors have special moral obligations to patients and the society and asking for payment for his services brings into question his humanity, his morals and the oath to honor the profession. He goes on to caution that such demands would ruin the faith of the public in the profession and portray doctors as being inconsiderate and materialistic.

It is unfortunate that the current strike by doctors is viewed in such a perspective that a strike is incompatible with the medical profession. It is disappointing that the Human Rights Commission denounced the strike by suggesting that doctors were trying to hold to ransom the rights of patients for material gain, when it wasn't so. The strike was limited in that doctors attended emergencies and care was provided for inpatients. As advocates of human rights the commission should rather question why policy makers allow unnecessary suffering of patients by improper allocation of healthcare resources.

While it is true that doctors have special obligations to his patients and society, a person who chooses to become a doctor does not make any declaration, implicit or explicit, that he/she will abstain from trying to make his/her life as fulfilling as possible and like any other individual they too have the right to pursue happiness. The actions of doctors should be judged by the same standards as those used for other professionals. When the Civil Service Commission fails to provide a just payment for their services, it is unfair to suggest that doctors should work under any circumstance. Several doctors, while employed full time as professionals, have been denied the professional allowance and exploited due to the Commission's refusal to review its rules.

If doctors have special obligations, they can demand special benefits and go on strike, as long as the demands are reasonable and it does not undermine patient care. The provision of healthcare is a joint responsibility of the government, hospitals and doctors and each element should support the other.

21 comments:

Anonymous said...

How can doctors claim high salaries similar to atoll councillors and civil service commission members? Ministry directors are the bosses of doctors. so they should get less than directors.

Anonymous said...

Maldivian doctors are quacks. They got there on their path to prestige and easy wealth. I was visiting a doctor at IGMH the other day. What a display of pomposity. The doctor appeared sicker than the patient. I spit on doctors. They don't deserve a penny sitting on their high seats. Get down and try to earn a good living and while at that try to consider patients as humans.

Anonymous said...

At this time of natinal crisis doctors must see patients for free. They must volunatarily agree to cut salary

Anonymous said...

at this time of national crisis everybody except doctors and nursese are entitled to raises in salary? what hypocrisy.already doctors have sacrificed a lot of their life just to become doctors.they have spent 10 to 15 years of their life studying . and the struggle they undergoe and the sacrifices they have to make during this time is not comparable to anyone else and beyond comprehension of most people.but everywhere else in the world, this truth accepted.
yes. doctors and nurses do humanitarian work. but they do not do voluntary work (e ee hiley saabahah masah kah kuraa baeh noon.) and is it only doctors and nurses who do humanitarian work? what about the police, the MNDF? what about the MPs who have taken an oath to serve the people of this nation? and what do they do after taking a fat salary of 62000, other than taking up nizamee nukutha and boycotting the majilis. Afeef and reeko moosa go to hell and if you can bring nurses and more doctors to replace the existing maldivians then do so. you are a bunch of real hypocrites.

Anonymous said...

what a pitty world we live in!? Wish i had the oppotunity to stuff with other drs.. i will offer free service and n will ask food n clothes from my patients if necessary!

Anonymous said...

Time is precious. Doctors must be willing to see patients at home. It's sad that Doctors think they're a special kind of people whom others should worship and make offerings.

fizan said...

I think the doctors handled this whole thing like a bunch of lily-livered dimwits. (behaving like this almost seems like a prerequisite of being Maldivian, disregarding academic or professional standing)

Instead of making up asinine excuses, they should have called for a press conference, made clear their intentions (of striking) and the reasons compelling them, acknowledge their special obligation to society, and finally, assert that they will not neglect their lifesaving duties. That should have preceded their strike. Had they done this, the public would've, no doubt, been much more sympathetic to their cause. Now we have this animosity and deep resentment for you white coats, nice going, doc!

As for Dr. Saeed's post, I wholeheartedly agree. It is ridiculous to demand just pro bono work from doctors just like it is to demand the same from a paramedic, a lawyer, a law enforcer or even a municipal worker. Sheesh, grow up people.

Anonymous said...

Doctor’s dissatisfaction with their pay package
The other night Maldivian Medical Association in their televised news conference voiced dissatisfaction with their pay package as set by the Civil Service Commission laid the blame for their grievances squarely on the Civil Service Commission and the permanent secretary of Ministry of Health Dr Sheena.
But as it unfolded it increasingly looked like a damage limitation exercise to stop increasing the public anger over their ‘simultaneous sick leave’. The panelists of MMA (which can be aptly named Maldives Monetary-benefit Association hereafter) repeatedly said it is not about the money and sadly contradicted themselves with in minutes by talking about their meager increments or even losses in take home pay. Some bits I found interesting are when Dr Niyasa only talked about the total number of patients seen without mentioning that she or other specialists would see 15 patients on average daily. Dr Ubaidh also blamed the un-repaired equipment of IGMH for medical mishaps. This is news because in many of the publicized cases of medical mishaps in IGMH the public have yet to hear of faulty machines as contributing to medical mishap; often it is about an on call doctor not attending to the patient.
Unfortunately this view that doctors must come first what ever the case is the unfortunate circumstance of our doctors being trained in India and Pakistan where they have a demigod status over the public. Their disdain for their colleagues in other fields is shown when they say a person could do a PhD during the time it takes for them to finish MBBS in effect implying any non-doctor who does a PhD is worth an MBBS. For their information it takes hard work and sacrifice to get a PhD so they must not belittle the achievement of many Maldivians who are their ministers including their health minister.
I have been told all panelists except for two studied their MBBS as well as specializations with government funded opportunities. I have also been told that it is possible to train several nurses or engineers at the cost of one MBBS and one wonder the return in loyalty. It is also this government funded opportunity that opens the door for these doctors to operate in their private clinics earning incomes several fold to their salaries.
Doctors basic training is 6 years for MBBS as compared to say a graduate nurses 4 year training. Considering this difference of two years and adjusting for the ‘fact’ that doctors represent the intelligent ‘cream’ as said in the news conference plus the course is hard, but does it merit a three fold difference in salary.
Our doctors must know that role and valuation of different professions are changing in rest of the world. It is also not on singular criteria but take into consideration many factors. The pay scales take into account responsibilities, time spent, nature of work, work environment, risks etc. For example with respect to job roles and qualification increasingly in many countries there are advanced specialized practice nurses who can prescribe. If these specializations come how much do doctors feel they be paid? In Thailand nurses specialize in giving anesthesia saving the cost of employing an anesthetist.
Changes are also occurring inside our country with independent commissions. Doctors cannot not take for granted that any disproportionate privileges they have enjoyed so far will continue. Although the panelist in the news conference talked about losses in take home pay they did not discuss publicly in relation to how much they are earning now. If the public new they were talking about a loss of 500 from a take home pay of 25-35,000 I am sure many would have switched channels. I call upon the Civil Service to publish the former and revised salary scales of doctors in local newspaper. It is quite misleading for the panelist to discuss percentages or allowances without talking about actual figures.
Both doctors and nurses deal directly with patients. A patient may see the doctor for 10-minute intervals once a day, once every few days or once a week, depending on the nature of the case. A patient may not even see the doctor at all, if the case isn't serious enough to warrant a visit. However, nurses care for the patient 24 hours a day. Although doctors assume final responsibility for their patients' well-being, nurses still spend more time with patients than doctors, qualitatively and quantitatively.
In the news conference doctors bemoan that their new pay scales will stop people choosing medicine as a career pathway. If doctors are implying what drives majority of young people to choose medicine is all about selfless human service to the nation it is hard to believe. What drives them in hoards with or without O Levels (intelligent or not) to former Soviet republics is the amount money they see you specialists are making. 100 rufiyaa for a 5 minute consultation in your clinic. [20 rufiyaa per minute]
Doctors forget when it comes to disparity in incomes between doctors and nurses it is also about gender non-discrimination. Are we to believe nurses should be paid less because their role should be subordinate and they are women however qualified they become? Who will give break to the nurse to attend to her children because her pay isn’t enough to employ baby sitter while a doctor can. It is the PS of Ministry of Health and Family should take up this issue as Maldives has signed the CEDAW convention to work towards gender equity in Maldives.
As the president rightly stated on this subject this is the best that can be given with in the limits of public money. Quite an important point! Firstly doctors forget that their salaries have been traditionally set higher for years by sacrificing the salaries of other civil servants. As it comes from the same pot, if doctors salary has to be increased even further it will impact the salaries of other civil servants.

Anonymous said...

to.the comment of anonymous at 11.07
looks like you are a dissatisfied nurses trying to put doctors down. this has been going on always but so far doctors have tolerated you lot for various reasons.but if your attitude continues in this manner in public , even doctors will not keep quite. there are many answers that i could give to your long comment and many truths that i could bare to the public including the kind of service that maldivian nurses are giving. but im not going to do so at the moment. instead i will ask you just one question. a doctor who has done specialization will earn a salary of 5000 to 8000 Us dollars per month along with many other benefits in any country of this world except maldives( this does not include any private practice earnings). but i dont think any specialized nurse in any country will get a basic salary of this much. why? other countries around the world are offering doctors that much salary because they are fools or what?

aai said...

Its interesting to see this common delusion that one has the 'real' solution and so can tell others what 'should' have been done. If someone really is looking for reasons why a certain profession should be paid (or IS paid) a certain way (boss/director nonwithstanding) then why not look around and see how things are in other countries. That is the least one can expect from an "elite" looking down on anything Maldivian, why pretend to use your Maldivian brain? After all, these Maldivians are proud self-proclaimed-dimwits?right? If being a Maldivian is the reason professional training makes Maldivian Docs quacks then there is all the more reason for other Maldivians to not offer advice/comments (with or without publicly spitting, an ailment in itself) Or are they somehow a different breed of Maldivians? I suppose its painful to listen to Maldivians from Medical profession. (why are they not in OPDs seeing patients 24-7, why are they addressing us, busying themselves with other aspects of life? Beats me.) I suppose Civil Service Commission is showing the way out. "Dont study, dont go for your degrees and diplomas. Dont bother, you are Maldivian. Stick around, join politics or start a business. In any case dont join the Civil Service." Not bad advice i should say looking at how things are proceeding.

Anonymous said...

Doctors who earn 8000 dollars in other countries there are over millions of people, they have income tax. Your are in Maldives its only three hundred thousand people, and you guys are in Male' serving only may be 50 thousand people. So how can you get 8000 dollars for this service.

How many of you are really qualified to go abroad and serve west to get that 8000 dollar, I bet not even 10 people, Those whom among you who has that opportunity they are in USA or UK even now. So don't try to fool us,

Anonymous said...

I would like to note that worthless medical degrees conferred in Pakistani maddrassas have no value in the west. Holders of such ill-gotten pieces of paper have no idea what the medical profession is.. and the west has now realised this, unfortunately after several incidents of negligence and malpractice. Which is exactly what we have happening here in Maldives.

The only option for Maldivian doctors with such lowly credentials will be to open a clinic and write Panadol prescriptions for third-world citizens.

Over here, an MBBS is a money-printing, magical piece of paper. I need to vomit.

Anonymous said...

To the comment at 9.46 pm.
doctors here are not demanding a salary of 8000 dollars. that was an example to show to people what a doctors worth is. doctors understand that maldivian government cannot afford to give doctors such a huge salary. in fact doctors were happy with the salary they were getting till the current change in civil service salary scale came. in that, initially doctors salaries were reduced by a large amount and then due to some pressure, some allowances were introduced to make the salary just equal to the previous one(which means there is no increase at all in the take away home salary of doctors
), when there is increase in salary for other civil servants in the range of 40 to 100 %. so what the doctors are demanding is to increase their salary also at least by 40% so that those who are joining the profession newly will also have a reasonable salary(as they will not get the allowance recently introduced to the doctors who are currently practicing here. they will get just the basic salary which is very small in comparison to many other civil servants too). this is the fact. don't write misleading comments.doctors knows who all are writing this type of comments to demean them.
and regarding the comment you made about the current doctors working here not being qualified to go abroad, how do you assume that? all doctors here are qualified. they just have to clear a licensing exam from any country , then they can go and work there. all the doctors here have the capability to do that. but they did not do it in the first place because they wanted to work here. to serve this nation and to be with their families and friends.those who have gone abroad did not go because they were better qualified or intellectually better.they have gone because they had ambitions to go abroad from the very beginning. so they wrote exams and they went.in fact many of the doctors here are now wishing that they have done the same thing. they are regretting that they have stayed behind to serve people like you.

Anonymous said...

Let the doctors strike. Let them become truly sick. Not falsely sick(salaamu ga).Our beloved President already has solved the problem. Indian Government is now rushing 30 doctors and several nurses next week to Male'.So there!

Anonymous said...

The venomous hatred spitted on the Maldivian doctors by their countrymen does not come as a surprise.Both the previous and the present government have systemetically tried to bring down the morale of those who chose to stay back and serve their nation.They have driven a wedge between the public and this profession.They have always worked to develop mistrust for the docs so that the common man have to beg them to go abroad.
I wonder where was this moral public when people were slaughtered on the streets of Male.To date thers no investigation and no Maldivian had spewn venomous comments over that.Where were these guys when certain people go on defending hardore criminals in this society as saints?You guys only wake up when someone goes on strike that for reasons and a very peaceful token strike.
All this speak of hypocrisy and selected vendetta toward this noble profession.
This worsened by the present govenments irresponsible comments and strategy to tackle this issue.Immature they are even to lead a group.
And my message for the public.If you hate Maldivian docs well ask your government to bring in docs from India,US,Australia etc.Wasnt that what they promised and you gullible peole chose to vote for them.They have mislead the people to grab power and they have ushered in an era of barbarism to this Nation.
However those who chose to stay in this country love their Nation and no matter what the public or the government thinks we will stay back and fight to lead our country forward.Allah will take care of food,clothing,housing and education for docs families.
May Allah bless Maldivian docs in their determination to bring in modern day healthcare to their Nation.
May Allah fail the plans of the barbarism loving democratic followers agenda to make this country a secular one and unite all Maldivians.

Anonymous said...

greedy docs, how much do u get by working at the hospitals and giving consultancy at clinics? for a moment all of you should think, the view of the public have changed they no longer consider docs as the nice ppl.. you all should have tried another way than this. just because there is a new trend in Maldives, that does not mean you have to follow it, u all are like kids. grow up think for a while the government dont have that much to pay all of you

James said...

Maldivians have lost trust in our healthcare system because of the poor quality of service these doctors provide. The education they get and the certificates they bring from Nepal, Pakistan and some parts of India are NOT recognised in the west or any developed country. The civil service is still paying the docs the same amount they were paid before. In fact they have a small pay increase. But these people decided to strike and use their patients as weapons. How ethical is this? We all know how much Dr's earn in their private practice. They earn so much only because the tax payer educated them!!! These guys are just too selfish. They want everyone to bow to them. They want a huge pay and dont give a damn on the state of our economy. These doctors are a disgrace.

Hamid said...

Hi,
The most funny thing I heard from doctors was that they are not demanding a pay hike. But they are just worried that doctors pay was not increased! What the hell does that mean? How stupid does this sound?
Becoming a doctor must not only be a choice; it has to be a calling. This has to be a decision not only of your mind, but of your heart. You must be inclined to go through this path, for altruism, for service, for saving lives. Whatever benefits you may derive from it are simply perks and icing on the cake. Its not a business! Like any adventure, accidents and hardships lurk along the way, like failures and mistakes, unappreciative patients. So whatever the going is, be it nice and profitable or a constant struggle with blood, sweat and tears, being a doctor is a lifestyle and a way of life. God's scalpel is lent to your hands. If this not how you feel, resign and work elsewhere.

Anonymous said...

Truly astonishing.All these comments by so called wise guys on the merits and demerits of being a doctor.This is simply a propaganda to intimidate and dishearten the few Maldivian doctors who managed to study and come back to their country sometimes against all odds and with great personal sacrifice.Some of those who commented here have doubted the medical education given in India, Pakistan and Nepal etcc. Are they aware that most of the very well known doctors in those western countries areIndians Pakistanis, Nepalis and have infact got the basic medical degrees at home and later gone abroad obviously in search of better working conditions and perhaps to avoid ungrateful and uneducated general pulic like most of those who commented here?
It is a well known fact that many of the so called other professions have a chronic inferiority complex and hatred against doctors and this includes the loud mouthed nurses of the Maldives many of whom claiming to have received a Masters Degree when infact they were people who got all U s in their O level examinations.
If the Maldivian doctors are so bad why does most of the locals prefer to show them when we have more Indian doctors working in the Hospitals?
Why the general public is just silent when the Majlis members hike their salaries at random and without any consideration to the plights of the common men?So much hypocrisy.
As for working abroad dont be fooled into thinking thatthe Maldivian doctors cannot work abroad, Most of the Maldivian doctors are more than capable of getting through any licensing examination and fit into the Health systems of most of these countries.
Perhaps this country is going to witness a brain drain and you pathetic loosers and the government will have to bring doctors at astronomical prices to fill any gap left by the local doctors.
Most of the expatriate doctors are recruited from the neighbouring India and many of you fools just do not know that India has revised the salary scales of doctors and it will not be possible to bring any good doctor from India with just '' pea nuts''
There was even a talk of emergency airlifting of 30 Navy doctors in 3 days and I wonder how many days have passed after that.
Just remember one thing and wake up to the real world.Professionals will demand what is rightfully theirs.If the government coffers have no money to pay a decent salary to doctors but plenty to offer pathetic activists and bunch of other good for nothing loosers then it may just be the biggest joke of all times.Who will believe this anyway.Already the people are fed up with all the flowery talk and empty rhetoric of this government.

Anonymous said...

Nurses giving anesthesia in thailand.I wonder how many of our nurses can be trained for such a sensitive and risky job when they dont have the necessary technical and academic backgrounds.You can risk and go ahead with this provided offcoarse you accept that many will probably not wake up from the anaesthesia and how will the ever grumbling and demanding public will react when they know their child will undergo circumscision and the anesthesia will be given by a nurse.Big ideas but will there be any takers?

Anonymous said...

Does some honourable members of the public realize that some of the services in the health sector were deliberately not developed so that the ruling governments can go on sending people abroad for treatment.This is when we have capable Maldivian doctors who can give these services provided offcoarse with the necessary equipment and infrastructure.The bottom line is inspite of all the talk poor public will always have to beg from government agencies if they have to undergo certain types of treatment.Now whom to blame for this .The doctors?corrupt polititians or the noisy public who elected those people to office in the first place.?