Medical follies

21 September 2012
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With the wonders of modern medicine, people in most countries no longer regard becoming ill as a catastrophe, or as inevitably fatal.
Unfortunately, one cannot say the same about the situation in Namibia.


Unless you are on the Government medical aid scheme or a well-funded private scheme, many people feel they can pretty well kiss their lives goodbye if they develop a serious health ailment.
Whether rightly or wrongly people fear that if a doctor admits them to a State hospital with a serious medical condition, the only way they will leave the hospital is in a coffin.
As we have stated before, gross inefficiency and mismanagement plagues the State healthcare system to the extent that it has almost brought the whole system to the brink of collapse.
It does not help matters that the health authorities also seem to adopt policies in an ad hoc manner that only aggravates the situation.
They do not seem to think policies through thoroughly, or consult adequately with all stakeholders.
This week a controversy erupted over the decision by medical aids funds that they will no longer pay for injections that private doctors give their patients unless the doctor obtains prior approval from the medical aid.
One cannot help thinking that this sounds curiously like a script for the next sequel to the film ‘Dumb and Dumber’.
You actually wonder who could have thought up such an idiotic idea.
The Supreme Court in June ruled that the Ministry of Health’s Medicines Regulatory Council has the right to regulate who may, and may not, dispense medicines.
The court’s ruling was in itself slightly confusing because at the same time it appeared to rule that the NMRC cannot take into account the location of a doctor’s medical practice when determining whether or not to grant a dispensing licence.
There is a good case for discouraging private doctors from becoming pill pushers.
In theory at least, medical doctors should be just as qualified – if not better qualified – to dispense medicines than pharmacists. After all, they write the prescriptions.
It comes down to a question of priorities. What is the primary function of a medical doctor and what is the primary function of a pharmacist.
The danger exists that when doctors become too preoccupied with dispensing medicines it can detract from their primary function of diagnosis and treatment.
The money-making possibilities of dispensing medicine could also potentially compromise their professional integrity.
It could subconsciously push them into the dangerous territory of dispensing drugs the patient does not really need.
Pharmacists need protection from competition by doctor’s surgeries when it comes to dispensing medicines.
Pharmacists have to carry a full inventory of all the medicines members of the public might require at any time, which is quite a substantial financial burden.
They cannot carry this cost if doctors undermine their business by competing with them in the field of dispensing medicines.
However, commercial factors should not be the primary consideration but rather what is best for patients and society as a whole.
Doctors should not place themselves in situations that could potentially compromise their medical ethics.
Equally, it is incumbent on health authorities and the courts not to force doctors into a position where they might have to violate their professional ethics.
The first duty of a medical practitioner is to heal and save lives.
Therefore, it is highly improper and almost amounts to a criminal outrage for medical aid schemes to dictate to doctors how they should treat their patients.
Where do the medical aid schemes come into the picture? After all, what do medical aid companies know about medicine? They are only in it for the money!
The directive that doctors should refrain from giving immunisations shots might have some justification, but to order doctors not to give any injections whatsoever is not only ludicrous but dangerous.
A patient might initially walk into a doctor’s surgery just feeling unwell, but the discomfort could rapidly develop into a real medical emergency.
Does this mean that if the patient suddenly has a heart attack, the doctor cannot administer a potentially lifesaving injection?
Similarly, a patient might present symptoms of a severe allergic reaction or asthma where they go into anaphylactic shock accompanied by respiratory failure.
Do they really expect that in a crisis a doctor first has to phone the medical aid scheme to seek approval before giving emergency treatment?
The switchboard at the medical aid might be jammed up or it might even be after hours when everyone has gone home.
The idea that patients should go to a hospital for all injections might sound good in principle, but everyone knows that in this country that is unrealistic.
In some towns, the hospital might not have the emergency medication and might have no more than the proverbial Panado.
With regard to medicines in general, some towns do not even have pharmacies, forcing people to travel long distances to obtain the medications they need.
As some people have pointed out, HIV/Aids patients feel stigmatised and are often too embarrassed to collect their medication from a pharmacy and rather prefer the privacy of a doctor’s surgery.
Not only does the NMRC have to think through its decisions with more care, but medical aids have no business making treatment decisions.

 

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