Medical services is not rosy in fancy areas

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What I enjoy about solus family practice most is that l have the freedom to devote as much time as is required with patients and do what is required and not judt what is necessary. Yesterday made me realise how important it is for a doctor to focus on his/her patients without being under pressure by a businessman boss or the clock.

A retired couple, who live far out in the leafy suburbs came to see me and they have been coming to me for the  past year so they have become quite regular patients. Both of them have multiple problems that require time, which l give to them as I would with any other patient with serious medical conditions.

During the consultation and in conversation with the husband, I was saddened to hear him mention to me that in the area from where he comes from, the doctors are under pressure by the practice managers to dispense with patients within fifteen minutes otherwise they would be in trouble for “wasting” too much time and run the risk of losing their jobs or taking drastic cuts in their incomes.

In addition to this, patients, even pensioners, have to pay an additional upfront fee each time they visit their doctor. Not an easy situation for pensioners, struggling on their limited budgets. This type of medicine has its roots from America, where big business conglomerates, like managed care businesses, dictate how medical care is delivered in that country.

For doctors, who enjoy practicing the art of medicine the way they were taught by their professors and the doyens of medicine from the past, working under such external pressures must be a most unpleasant experience every day of their lives. The patient said to me that he always left those rooms unsatisfied because he couldn’t ask  questions too freely due to time constraints. Not surprising, his asthma was not diagnosed till he saw me at age, 64, by which age he had taken early retirement due to ill  health.

He developed severe cardiac  failure last year and was successfully treated without being referred to a specialist for admission to an expensive tertiary institution. Fortunately, he has done very well because he was also counselled about his weight and the need to stop his drinking.

Yesterday, he looked a good five years younger, not so much because of his medications but because of a drastic change in life style. This change in life style did not happen overnight. It required a number of long painstaking motivations to stress the need for him to change. Such results can never be achieved by a medical practitioner if he/she is under pressure by a practice manager about getting done with a patient in a limited allotted time.

After listening to the gentleman’s past experience, I felt extremely vindicated about my total abhorrence to managed care and its constant invasion of a doctor’s right to deliver the highest standard of medicine to his/her patients. Our minister of health, sad to say, has been a great proponent of group practices, with multiple service providers under one roof instead of the cost effective solus family doctors, who have been rendering a sterling service to the poorest communities in this country, in an effort to bridge the gap between the rich and the poor for well over a century.

As part of apartheid’s appalling legacy, doctors of colour have always had to offer their services to their patients in the townships at highly subsidised rates compared to their colleagues working in the more affluent suburbs without compromising the standard of their service. Twenty five years into our freedom, the status quo has not changed one bit.

The academics in the departments of family medicine   in medical schools have an extremely poor understanding of the dynamics of practicing medicine amongst the poor with little or no resources. Doctors working in the lower socio-economic areas are compelled to think on their feet and make major decisions just by relying on their clinical acumen. The pressure of limited resources has played a crucial role in teaching doctors  to become better and cost effective service providers. This hard earned clinical acumen, which is a huge cost saver is sadly rarely ever recognised both by government or the funders of medical schemes.

One of the greatest tools in the making of great doctors is knowledge of the subject matter and experience. The free availability of the latest in medicine via the internet and high quality journals has made it possible for every doctor in this country to gain access to this knowledge with minimal cost and effort, so there is little excuse for a doctor not to practice a high standard of medicine regardless of where he/she practices.

It is indeed sad, when patients, with a little bit of moola or top end medical aid, think less of their doctors in the townships and run to fancy medical centres with the misguided notion that the extra money is going to buy them more or better than what is offered in the township. This, too, is due, to a large extent, the result of apartheid’s painful legacy that services are better in the leafy suburbs than in the townships.

It is not where doctors practices that determines their standards of service but how they practice the art and science of medicine Finally, I do hope that my thoughts and views will filter down to the Minister of health in his noble quest to set up an NHI to bring about equity in healthcare in this country. A goal that I strongly support but with a format that recognises the crucial role that GPs can play to make this goal a reality. Unfortunately our minister does not seem too keen to speak to the GPs, who would and should be the back bone of the NHI with their multifaceted approach to medical care.


Ellapen Rapiti is a family physician working in Mitchells Plain for over 36 years. He is also the author of a book called, ‘4  Steps to healing’, a self help book on addiction for users and their families as well a motivational speaker.