 |
Al-Ahram Weekly 13 - 19 April 2000 Issue No. 477 
|
||
Published in Cairo by AL-AHRAM established in 1875 |
| ||
|
Al-Ahram Weekly 13 - 19 April 2000 Issue No. 477
|
||
| Published in Cairo by AL-AHRAM established in 1875 |
| ||
Egypt Region International Economy Opinion Culture Books Features Travel Living Sports Profile People Time Out Chronicles Cartoons Letters The money behind the medicine
By Mariz TadrosDr Alaa Shukrallah, a specialist in child disability, contends that the growing number of malpractice cases may be due to the increasing commercialisation of medical care in Egypt. Since its birth, argues Shukrallah, the medical profession has been beset by two basic dilemmas. The first is the inherent contradiction between providing health care and making money, "because if making more money is based on more people being ill, then doctors should want more ill people, because that means more money." The second problem is the monopoly of knowledge, which is worsened by the first. "When health care is private, obviously there is a vested interest in keeping decision-making power in the hands of the doctors," he explains. Developing countries like Egypt, Shukrallah believes, are still in a "transitional stage" characterised by deficiencies in supervision of medical practice, the auditing system, patients' awareness levels, etc.
"Patients usually have little awareness of their rights. They don't know where to go to when they have been victims of malpractice." Shukrallah also suggests the syndicate cannot deal adequately with patients' claims, since it is biased toward physicians by definition.
The poor get the worst deal, he argues: "They don't know where to go or what to do, and their awareness of the doctors' accountability is minimal." A common form of malpractice, he asserts, is the violation of patients' rights to confidentiality and treatment that respects their human dignity. "Poor patients are expected to give up certain rights in return for being examined by qualified staff at a low cost," he says.
Well-off patients are also vulnerable, however. "Take caesarean operations. The rationale is that a C-section is safer for the baby, better for the mother, and faster. But is that really the case? A surgeon gets a few thousand pounds for an operation that would take 10 minutes, whereas a natural birth can take hours, and certainly costs less," he reflects.
Nor does the situation seem set to improve with the government's commitment to cutting back on health expenditure. Shukrallah believes that the quality of health care has deteriorated with the growing role of private medical services. Physicians' salaries are very low; some are tempted to compensate by taking up private work on the hospital premises. In some hospitals, doctors in effect provide a dual service: little attention for the poor, and better care for fee-paying clients. But being a paying patient in that situation does not necessarily mean proper treatment, Shukrallah warns.
