Who killed the doctor?

by Dr. Samarasinghe

(November 28, Colombo, Sri Lanka Guardian) The violent death of Dr S W Palitha Padmakumara who worked in the Batticaloa district brings up the question of the fate and future of Doctors serving this country. Members of the noble profession are left wondering what the future holds. The recent past has seen two brutal killings of doctors who were on duty. The question begging an answer is how and why Sri Lankan society came to a juncture at which "another doctor gunned down" is a usual item in the evening news bulletin.

The doctor is regarded as a universal figure who has essentially no part in active warfare. He is the representative of civilization who attributes value to the lives of warring parties be it friend or foe. The doctor is expected to treat and save lives of any person regardless of the direction of fire. Hence, the red cross of the doctor is the sign to "STOP firing and allow healing". This is why even with so many countries at war throughout the world; a killing of doctors is heard of no more, except alas in Sri Lanka!

Violence against doctors climaxed at Bandagiriya when a young lady doctor was slain by a soldier. As usual, the incident was forgotten until the incident.

Sri Lanka is known to have an exceptionally high level of health care on par with developed countries. With very little development in the infrastructure and a minimum allocation of funds, the said achievement owes much to the relentless dedication of doctors to their duty. The work load carried out by a doctor on a daily basis in this country exceeds the amount of work done by a doctor in United Kingdom per week (eg. Seeing 80 patients at the OPD). The concern and compassion of Sri Lankan doctors is often taken for granted and comments are made of how courteous and polite the doctors of a foreign country are. I was pleasantly surprised by the revelation of the true state of affairs in another country recently. A couple told me their horrifying story of having to wait for the doctor till the "appointment" time with their son who needed immediate surgery. Had it been in Sri Lanka, they said, our doctors would have taken him to the theatre immediately. Of course there would not be a nice flower pot at the "lobby" of the hospital and a pretty girl at the reception. Nor will the doctor ask whether they had coffee in the morning and whether there was any problem parking their car? Yet, the doctor will attend to the patient and do whatever is necessary and quickly rush to the next patient. The severe mismatch of the doctors to patient ratio has compelled doctors to cut down on chit chat and rapport building and get down to business straight away. Long and hectic work schedules have caused doctors to be irritable and rude at times. However, an unmarried female doctor, working alone in a far away rural area, riding on a bicycle pillion to attend to the ill and sick at night, will only be found in a place like Bandagiriya, Sri Lanka.

So, what causes the public to revolt against doctors? Or is there really widespread public displeasure about doctors in general? A careful probe would reveal that certain incidents which were given wide public exposure by the media are simply the exploitation of people’s tragedies to increase newspaper sales. Some incidents are blown out of proportion to tarnish a person’s name or that of an institution. Complete fabrications are published simply to achieve personal agendas. The irony remains that, once the truth is revealed, nobody is keen to publish the correction. A good example is the infamous incident of "amputating the wrong leg" at the Negombo Hospital. Doctor’s being blamed for something or the other is seen frequently in the newspapers and television. Allegations of negligence, misconduct and ill-treatment capture the headlines often. Have the doctors in this country become an arrogant, inconsiderate, and acquisitive bunch who could not care less about the poor patient?

The paradox however is that there is still an overwhelming majority of patients vesting their faith in doctors especially in the government sector. Further, the high standards of health care would be impossible to achieve if the practice of the majority of doctors are as depicted in the media. Yet the continued slandering instigates doctors to be subjected to public anger and disrespect. A few questions should be answered with regard to this.

What are the contributory factors on the part of the doctors for the current scenario?

One must concede that there are instances where doctors have not done their duty to the best of their ability. And there have been instances where the profession has been disgraced by the acts of a few individuals. It should be emphasized that doctors are also a representative sample of society even though the arduous training is expected to bring about uniformity in attitude and behavior. Nonetheless, a broad generalization of these incidents would not do justice to the overwhelming majority of hardworking doctors. An appreciative note about a doctor who had done extraordinary service is a rare in the media.

What is the role of the media?

While retaining the right to unbiased and independent reporting, awareness of the context is most important. The limits of discussing highly technical and academic issues in the public domain as well as the effect of misunderstanding such matters should be well comprehended. Medicine deals with life and death. Not all lives can be saved. The grief of a loss or illness should not be exploited for petty popularity. The power of the mass media in educating and informing the public is unmatched and should be used to improve the health status of the community.

What is the driving force behind the current "doctor bashing" trend?

A significant change of the social appraisal of the doctor started to develop in the late nineteen nineties. A new Health Minister had assumed duties and instigated a relentless witch-hunt of doctors. While crediting the glory of a superior health service to himself, the favorite pastime of the minister has become attacking doctors. The minister has managed to build up a formidable thrust in the media and public sector to ruthlessly tarnish the image of doctors and to reduce the public respect they command. While fiascos such as the "penta vaccine failure", is given passing mention in the media, the minister has allegedly become a mogul of mismanagement and corruption. While doctors are toiling with minimal facilities and immense hardships under an administrative structure in disarray, the minister is eager to achieve his personal and political agenda. His ego has driven him to seek cheap public popularity by posing as the champion of the poor and revolting against the doctor. Yet, doctors are faced with difficulties in coping with demand due to faulty equipment, substandard medicine, insufficient beds, lack of medical investigation facilities, lack of infrastructure facilities (transport, electricity, water etc), and at times delay of their own salary and increments. The doctor has become the "enemy number one" of the minister.


In this context, the social and psychological strain on the average doctor has almost reached breaking point. The threat to one’s life is the supreme impediment to continue to perform duties. While some reproach doctors for opting to seek greener pastures abroad, very little has been done to create the background for the doctors to stay behind. Services are provided with "priority" to the Armed forces, Professionals, Government officers and Teachers by doctors at hospitals and clinics. In contrast, doctors are being abused, harassed and at times assaulted (The recent incident at the Ragama Railway Station). The most alarming aspect of the entire scenario is that society has become numb to these issues and the very people the doctors strive to serve have failed to protect them.

Therefore, unless the people rise up and restore the dignity and respect of the doctor and create a proper environment for him or her, an exodus of doctors is imminent. - Sri Lanka Guardian