Five to ten minutes to each patient and him or her walks out clueless!

By Dr Harold Gunatillake - Health Writer

These are shocking stories I selected from the series of comments received as a sequel to writing an article titled,” Do Doctors talk to their patients long enough?”

Sri Lankan specialists have no time to spend sufficient time to listen to patient’s symptoms, examine and give an opinion, within the brief time they spend unlike in practices in most developed countries. In Australia, the Medicare system rewards a nominal consultation fee for a 20 minutes consultation and a half an hour with a specialist, and more if required.
In Sri Lanka, you pay from your own pocket over 2,000 rupees for a consultation of 5-10 minutes after hours of waiting.

A good example of that, I quoted in my article was that there was an eye surgeon in Kandy who would see 60 patients in the morning before visiting the hospital to see his warded patients. This sought of practice is unheard in most other countries.

In Colombo, I am aware of situations where the first patient who makes the appointment at 5 pm would see the specialist at 6pm or even after, frustratingly waiting, and the specialist would see an easy 30 patients before dinner time. Most specialists travel to a few private clinics in hospitals after hours to see the booked appointments.

Driving in Colombo during that time of the evening is not easy, takes hours to get from one destination to the next.

As for a solution, I did mention that GPs’ should participate in the consultative practice, and see their respective patients registered under their lists, as required, and take responsibility and decision making in referring patients to the various specialists. In such a system the specialists see fewer numbers and could spend more time with each patient, and even charge more.

Expatriates and others visiting Sri Lanka should get adequate medical insurance cover, as medical care privately could be exorbitantly expensive.
May I quote an example that happened to a friend of mine staying at Cinnamon Grand a few years back? I vividly remember that we went to dinner to ‘Raja Bojun’ opposite the hotel, and our guest had lot of local treats like hoppers and pittus with lot of spicy curries, including ‘Lunu Miris’

After dinner, I left to Kandy and a few hours later my friend had a severe attack of gastro-enteritis. The hotel doctor was summoned and he said that he was thoroughly dehydrated and needs immediate hospitalization.

He did get admitted to one of the local private hospitals of doctor’s choice. A specialist had seen him and ordered intravenous fluids.

For the next two days the specialist peeped through the door and asked how he was and went off.

The tax invoice at the end of three days was as follows:
GP’s visit to hotel               Rs 10,000:
Specialist visits for two days Rs 20,000.
Hospital stay                     Rs 20,000
He paid a bill of rupees Rs.50,000.

Ever since, when he visited Colombo, he ordered a couple of king coconuts on my advice, and the coconut water was kept in the fridge in case he repeated his episodes.

All readers of this article should remember this story and please get adequate medical cover when you visit ‘Paradise’

1. Dear Doctor
Let me congratulate you for being able to take a bold stand and comment on this serious problem which is a blotch on the medical profession in Sri Lanka. My husband and I in our eighties have returned to SL after almost forty odd years abroad. We were lucky to get the best of medical treatment abroad in the countries we lived in. My two children were born in London and Tokyo five years apart and I had the best treatment a mother could have expected.

During our twenty years in the US and the next twenty-two years in Melbourne, a visit to the doctor was a long session where he checked past records. Listened to present problems, gave physical and made records for his future guidance. The cardiologist would do an ECG /EKG and recommend what had to be done next. But since our return to SL a year ago everything is in turmoil. I was shocked by the brevity of the doctor’s consultation and the disinterest of the doctor. Apart from ordering a few more tests, we returned from the visit none the wiser.

The doctors did not even touch us during some visits and the Vascular Cconsultant never even looked at my legs. I had done some research when selecting him and found he did transplants and had presented several papers on the subject. I was so exasperated at his treatment of me spent perhaps eight minutes with me but never looked at my varicose problems but recommended Glucosamine which I was already taking. When I tried to show my foot he told me that this was nothing compared to others he had seen.

I wanted to tell him that I had not come to him for a comparative study of feet but because I was having problems with my feet-swelling pain etc. He was in a hurry and was off after perhaps the whole long eight minutes he gave me. The result was that we stopped seeing doctors after this disastrous one. All the hassle of making the appointment .paying beforehand and then hanging around in the hospital for an appointment that never was made me want to fly back to Melbourne.

This kept us away from the doctors and hospitals for more than a year getting repeats of our prescriptions and lot of self-medication. However, in the past few weeks, our problems made it necessary to see a doctor and we have joined the rat race. Fortunately, there is an unusual doctor we have latched on to who does not care about the money but believes in service to humanity and he is guiding us. Through our current crisis -need to see an ophthalmologist.

I was shocked beyond measure when I was told the appointment would be for only SIX MINUTES. I could not believe my ears and when I queried it they said they were only fulfilling the doctor’s order about the six minutes only. We wanted a complete eye check including a test for glaucoma and I was worried sick. I called up many doctors but all had this time frame. Eventually, an angel called Aloka suggested I come to the OPD where a thorough check was possible and all tests were done. She saved me from a stroke-I was that worried.

I think there should be some legislative enactment making it obligatory for doctors to give compulsory minimal time to each patient. I am all for doctors making money and flying to UK/USA every few months but they should have a heart in dealing with poor old confused patients like us.

So thank you, doctor, for taking this bold stand and hope it inspires a few doctors to spend at least twenty minutes with each patient.
Your letter appeared some time ago but poor health delayed this response. Since writing this I have seen the Ophthalmologist and had a satisfactory comprehensive test and am grateful to the technician who guided me towards this.

Once again thank you for this bold step you have taken which would make the Sri Lankan doctors remember their Hippocratic Oath.
Mrs S

2. Another expat patient writes: Being pretty sick since arriving visiting one specialist and GP'after another. A medical system as far as I can see is a big, big business in Sri Lanka. Very sad indeed but frightening as well. Went to see a chest specialist - I was No 31 with 10 more to follow and this for just one session!!!! How does he justify giving time to each and
Every one of his patients. Rotten to the core!
Mrs Z

These are the stories you hear especially from expat Sri Lankans who visit or settle down in the island, and the local people have accepted the system with no grumbles, as for them there is no alternative.

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