As England celebrates with pride 70 years of the National Health Service (NHS), it is alarming to see repeated mismanagement, wrong treatments and inequalities in the healthcare sector in Bangladesh. A recent incident inthe Bangladeshi healthcare sector was the death of Rafida Khan Raifaon 28 June 2018 due to the administration of wrong treatment and the negligence of doctors at the privatelyrunMax hospital at Chittagong. During the investigation by a mobile court,the initial reactionsof doctors in Chittagong was to refuse to deliver private healthcare services in Chittagong for an indefinite period, which was not only unethical,a threat to government agencies and harassment of the deceased’s family,but it also left thousands of innocents to suffer. There are hundreds of cases inthe healthcare sector in Bangladeshsimilar to the above, which are either unacknowledged or undetected. It seemsthe Bangladeshi healthcare sector is in a terribly distressing situation. Some patients have already lost their trust in local healthcare and started relying on doctors in neighbouring and other countries, which is costing a fortune every year.
Being a British citizen from a Bangladeshi background, I have had opportunities to observe and experience the health services of both countries. Doctors in England try to discuss lifestyle issues as possible causes of illness to figure out the root causes,and they do not prescribe any medications until cause and effect are known. The interesting thing is that the doctor in England discussed the possible side effects of the medication so that if any of these side effectsemerged and were difficult to manage, I could stop taking the medication.Medications such as antibiotics are referred mostly by the senior doctor or consultant. I also found that whenever I discussed something with a consultant, doctor, nurse, and/or healthcare assistant they gave full attention to what I was saying as well as to the symptoms of the illness. Additionally, in England, nurses, GPs, consultants and others leave their seat and welcome their patients from the waiting room and take them into the chamber. These practices are completely absent among most Bangladeshi doctors as they are surrounded by assistants, compounders, and junior doctors.
From my experience, I found that most of the Bangladeshi doctors dominate their patients, are prejudiced that patients do not know anything, are reluctant to establish relationships with patients, and discriminate against patients. In contrast, doctors in England consult with their patients, value their patients’ opinions, emphasise the doctor–patient relationship, give importance to informed consent, and treat illness irrespective of a patient’s background. Most noticeably, doctors in Bangladesh enjoy greater autonomy when it comes to prescribing medications and suggesting tests,both of which are difficultto do in England in most cases.By looking at the commercialisation of the healthcare profession in Bangladesh, it seems to me when I go to the doctors in Bangladesh, they are more inclined to take out their calculator than their stethoscope in orderto calculate how many commissions they can get by referring me to a diagnostic centre, hospital or clinic or even by writing excessive medications. In England, whether it is public or private healthcare,the relationship between doctor and patient is identical and ethically and lawfully bound.
Indeed, it is irrational to compare and contrast Britain’s healthcare system with the Bangladeshi one asthe twocountries are very different frommany perspectives, including economically and culturally. But the World Medical Association emphasises the setting and promotion of the highest standards of ethical behaviour and care by physicians. Hence, ethical issues associated withmedical professionalism, patient care, research on human subjects and public health are more universal than local. Most countries around the world, including England,follow the “Code of Medical Ethics” set through the Geneva Declaration and accepted by the General Assembly of the World Medical Association inLondon on 12 October1949. By analysing some of the cases in healthcarein Bangladesh, it seems the “Code of Medical Ethics” is just some written formalities tobecoming a registered physician,as in most of the cases there is no application of the code by Bangladeshi physicians. Thismight be because medical ethics as well as laws have not been developed in Bangladesh for years. Although we have seen many cases of wrong treatment in Bangladesh over the years, our policy-makers andregulatory bodies rarely intervene in management to set medical best practice in real world situations, to illustrate common ethical and legal problems,or to giveadvice on how best to manage them fromBangladeshi perspectives.
Recommendations
The government should fund the building of well-resourced diagnostic and screening centresto accommodate all patients’ needs at a local level. Because these diagnostic, screening and monitoring centres will be commission-free, physicians will be discouraged from prescribing any avoidable tests. Also, the government should put heavy regulations and monitoring on the private diagnostic and screening centres so that they can perform their duties without any manipulation or falsification of medical test results, and work towards accurate test results.
To ensure quality healthcare and control drug use, the government should review current prescriptionmechanisms and regulate the system, creating the posts of pharmacists and pharmacy technicians. This would safeguard the fit and proper dispensing of medications, as well as turn pharmacies into local health and advice centres.
With the rapid growth in information technology, including in the medical sector, the government should introduce a unique health-record system where the medical records of patients are preserved by physicians and are accessibleby others with the each patient’s informed consent. This record system would help both patients and physicians to build up a medical history for treating the disease efficiently. Also, it would givean extra boost to thefulfilment of digitalisation in Bangladesh.Importantly, the regulatory framework must respect the privacy of patients and the confidentiality of their information.
All the government initiatives will remain impotent, however, if our physicians do not ensure ethical practices and perform their duties and responsibilities from a moral perspective. Doctors should reduce unnecessary onerous tests and medications, focus on trigger points of illness and subsequently not shy away from referringa patient to the right doctors. For me, quality healthcare remains in the heart of every doctor and is almost impossible to accomplish without them.
The writer is Chairman, Panacea+ (the organisation works with the people suffering from their compulsive behaviours), and a Human Resources Consultant based in London.
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