Price of compassion

  • Business
  • Saturday, 20 Dec 2008

The kidney-shaped bed pan costs RM16 while a pack of sanitary pads costs RM15.50. These were among the items that were struck off the bill after the insurance company went through the charges one by one. The doctor gave the go-ahead to check out at 10am but we left the hospital only five hours later.

The conversation going on in the waiting room revolved around how careful the bills were being checked. Someone asked if this was indicative of the lack of trust between hospitals and insurance companies. The process is much faster if one has a company guarantee letter. If you pay by credit card or cash, it is a breeze.

My wife had an appendectomy recently. Despite the trauma of having to drive to the hospital at 4 in the morning, the operation was routine and professionally done. And I am thankful that the insurance covered the bulk of the bill.

I visit patients in various hospitals on a regular basis. Having been through two cancer journeys myself, the oncology wards offer an interesting view of how the Big C can affect anyone regardless of position, race or religion.

I have rushed people to emergency and trauma centres, once travelling in an ambulance with a friend. I have been to cardiology wards. I have seen eight patients cramped into one room and also seen patients having the luxury of fully-carpeted rooms all to themselves.

This is the reality of healthcare in Malaysia today. Public and private facilities exist side-by-side and there is always a tension with regard to facilities and the availability of doctors.

It is not unusual for patients to be transferred from one facility to another, sometimes for reasons that are not necessarily medical-related.

And doctors moving to better-paying positions is not uncommon either.

Way before the advent of private healthcare, Malaysia was the model of public healthcare worldwide.

Despite limited resources, our network of public clinics, district health centres, and the general hospitals ensured that every citizen had access to basic healthcare facilities.

When private hospitals started to appear, they were seen as necessary and a welcome addition as our society progressed and more people were able to afford the generally higher rates that these facilities charged.

In my opinion, it is not about private versus public. I believe all doctors do have a genuine desire to live up to the Hippocratic Oath. It is a simplistic view to say that government doctors are working for the public good while private doctors only want to get rich.

But what is clear is that unlike shopping in a mall, when one is generally in a good mood and making choices is not really traumatic, being in a hospital is quite a different experience altogether.

Patients are not often in the best frame of mind to make informed choices. Family members and caregivers also falter at moments like this.

It is not easy to take news like, “Sorry, you have cancer and you have to undergo chemotherapy,” or “You need a bypass.” Often, the process is a daze. Some may opt for a second opinion. Some, like journalists, will ask all sorts of questions. But the majority will just take whatever is told to them.

Dr Albert Lim, a regular columnist in Fit for Life, The Star’s health section published on Sunday, wrote that under guidelines updated recently by the American Society of Clinical Oncology, a breast cancer survivor who is well and without any complaint (asymptomatic in medical terminology) is not required to undergo blood tests, tumour marker tests, a chest x-ray, a radioisotope bone scan, a liver ultrasound scan, a whole body CT scan and a PET/CT scan.

Basically, he argued, this is everything an oncologist is pestered to do at each follow-up visit of many such patients.

In my own journeys, I have been blessed by good doctors who do not carry out unnecessary tests on me. People are generally surprised when they ask about my tumour marker readings and scan results, and I have none to share with them.

Having been with many different patients in different hospitals, I can say that for many patients, such tests have indeed become routine.

And why so? One of the reasons could be with regard investment in such equipment and the need to recover costs in as short a time as possible. In government hospitals, such investments do not come with similar concerns because it is part of the government’s social agenda.

Assurances, be it by the business operators or by the government, carry only so much weight. Once the public focus is shifted away from the issue, the reality of running a hospital will set in.

Whose case is more important when there is a waiting list?

Would those with powerful purse strings and connections be able to jump the queue?

Will patients in a sister hospital get priority over the surgeons and support staff?

Will one be charged for extras that never were part of the culture of one hospital now that it has to embrace the culture of the other?

These, I believe are real questions that need to be asked.

These are the questions of the ordinary people. Let us listen to them.

  • Deputy executive editor Soo Ewe Jin believes one cannot put a cost on intangibles such as compassion and the ability to be sensitive to circumstances when it is people and not a production line that one has to deal with.

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