Do you treat your doctors as well as they treat you?

There’s an aspect of medicine called family medicine. It’s the part medical students love to hate. It’s the touchy feely bit where we care (or at least pretend to) about the things that can’t really be treated with a pill. We’re concerned about the impact your job is having on your life, we wonder how many cigarettes you’re smoking a day or if you’re drinking a bit more than is considered healthy. We draw elaborate genograms and ecomaps and try to understand your illness in the context of your life. We try to look at you and see more than a disease profile. Sounds attractive, doesn’t it?

If I really did this for every patient I saw, consultations would take an hour (with the infamous language barrier, maybe a few more). The queue outside my door would be a grumpy festering mass of sickness with a disgruntled expression. So, I don’t do hour-long consultations. I stick to the medicine. I use pills as my allies and treat what I can. This is not to say that I don’t care about the holistic management of the patients I see. Holistic care, but in moderation. So, if you come to me with the flu, I’m really not going to draw you a family tree and try to figure out how your controlling boss/ evil stepsister/ neighbour’s dog is the real root of the problem.

What I mean to say is that while holistic health care is the ideal, it is by no means practical in the public health system in South Africa. The clinics and hospitals I have worked at are overburdened and understaffed: a cruel combination. Add to this the increasing incidence of HIV and a continuing prevalence of tuberculosis and drug resistance, the public health system is, quite frankly, the unhealthiest place to be right now.

Family medicine also stresses the importance of a doctor-patient relationship.

Now, I have learned many lessons from working in the medical profession, not the least important of which is that people can be terribly mean when they’re sick. Case in point, the patient who recently barked at me at the medical out-patient clinic insisting that she be started on insulin for her uncontrolled diabetes. Headstrong, she refused to listen to other modalities of treatment and proceeded to direct all her complaints regarding the public health system (there were many) at me. On hearing that we would in fact, not be starting her on insulin that day, the woman snatched her file from my hands, shouted a range of insults, displayed a disgusted expression and boldly announced that she would henceforth be seeing a private doctor.

It is a real test of one’s patience to smile and calmly explain treatment rationale to a patient who is glaring down at you, hurling a string of criticisms at your face. It is also extremely unreasonable for a patient who neglected to adhere to both dietary and lifestyle modification as an aspect of therapy to demand insulin therapy when they haven’t held up their end of the deal. People often forget that while doctors are there to direct you towards good health, you have to take a few steps on your own.

In public hospitals a therapeutic doctor-patient relationship is largely fictional. More especially, in out-patient clinics, patients rarely see the same doctor twice, a situation that sometimes has adverse effects on the success of therapy.

Patients that visit public hospitals pay per earnings at a fraction of the cost they would pay at a private practitioner. Why then do they expect to be treated in public as they would in the private sector?

Perhaps these are some of the issues that the proposed National Health Insurance aims to address. For the meanwhile, public and private healthcare remain two ends of an unjust spectrum.