Waiting for your doctor…
A shortage of specialist doctors is the main reason behind the crisis
It was 7:55pm on 30 March this year. There was a large crowd of patients waiting in front of the doctors' chambers on the second floor of Labaid Hospital in the capital.
Rubel Hossain from Gazipur had brought his uncle and mother to see a cardiac specialist there. Even though they had an appointment with the doctor at 5pm, they actually saw the doctor three hours later. After seeing the two patients together for 10 minutes, the doctor prescribed different medical tests.
The patients and their relatives, however, were not satisfied with the length of the doctor's consultation. "If a doctor sees a patient for only five minutes, then why did we come from Gazipur enduring so much difficulty, wait for three hours, and pay the doctor Tk1,500 in consultation fee?" said aggrieved Rubel, adding the doctor would charge again for reviewing the test reports.
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At 9:00pm on the same day, while on a visit to the chamber of a neurologist on the third floor of Comfort Tower at the city's Green Road, The Business Standard found the waiting patients crowding around the table of the doctor's assistant.
The neurologist was supposed to start seeing patients at 5pm, but he came to the chamber at 6:30pm. Some 60 patients were waiting to see the doctor that day.
There, TBS talked to Fatema Begum, 65, who came from Brahmanbaria with head and neck pain. She was scheduled to see the doctor at 7pm, but the doctor called her into the chamber two and a half hours later. The doctor spent less than five minutes with her and prescribed some medicines and an X-ray of her neck. She was asked to come back to the doctor's chamber with the X-ray report after two days.
Many people like Rubel and Fatema prefer private doctors spending more money as the government hospitals in the country fail to provide adequate services as they are severely overcrowded with patients.
But there are complaints that even in private chambers, doctors do not take the time to listen to the patients, or answer questions, and do not spend enough time with a patient. Sometimes they write prescriptions without listening to the patients and do not explain the prescriptions properly, alleged many patients.
On 31 March, TBS visited the Dhaka Medical College Hospital and found that a huge number of patients were thronged there at the outdoor services. The crowd of patients was the biggest in the outpatient section of the medicine department. But when the patients managed to enter the doctor's office after a long wait, they could hardly get one or two minutes of consultation with the doctors.
Asked about this, a physician working at the orthopaedic department of the DMCH, told TBS, "There are only six doctors on duty in the outpatient section of our department but more than 400 patients come here every day."
"We can't give the patient more than two minutes even if we want to, and there is no scope for gathering information about a patient's history in such a short time," he said, wishing not to be named.
Doctor shortage is a major reason
Experts say the number of specialist doctors is very low compared to the number of patients in the country, which is one of the main reasons behind the crisis. Besides, doctors cannot see their patients at the appointed time due to various reasons including traffic jams, having multiple offices etc.
Sometimes, when the pressure of patients goes up, they are forced to cut their consultation time short, they said.
Dr Ehteshamul Huq Choudhury, secretary general of Bangladesh Medical Association, said, "A specialist doctor should examine all the reports of the patient. Otherwise the treatment would not be satisfactory. But as the number of specialist doctors is very low, they cannot give enough time to patients."
"There are only 1,200 medicine specialists, 1,300 paediatric specialists, 200 neurosurgeons, and 250 specialist psychiatrists in Bangladesh for around 17 crore people," he added.
According to the World Health Organization's health worker density in South Asia data, in 2020, there were six doctors for every 10,000 patients in Bangladesh. The number is 25 in Singapore, 23 in Malaysia, 21 in Maldives and 12 in Sri Lanka.
Bangladesh Medical and Dental Council data shows that the number of registered doctors in the country is around one lakh. However, it is not known how many of them practice privately.
There is also no data on the average consultation time at private chambers.
Meanwhile, according to a BMJ journal published in 2017, the average consultation length of the physicians in Bangladesh was only two minutes in 2015.
Trend of going abroad for treatment increasing
According to people concerned, the trend of patients to go abroad for treatment is increasing due to the situation and those who cannot afford to go abroad are not getting the proper medical treatment in the country.
Mohammad Asaduzzaman, who lives in Jashore, visits India frequently for any kind of treatment for his family.
He said, "Doctors in India explain all the problems to the patients. They give more time. So it is more satisfactory although it costs more money."
Dr Syed Abdul Hamid, professor, Institute of Health Economics, Dhaka University, said contrary to Bangladeshi doctors, their Indian counterparts treat patients more sincerely.
"India has adopted this strategy. When a patient from Bangladesh visits them, they give more time. As a result, when the patient returns to the country, they refer their neighbours and relatives who need treatment to India."
Patients' rights compromised
Experts say every patient has the right to know the details of the treatment that they are getting from a doctor.
"Bangladesh is lagging behind in this regard. The doctors here cannot provide psychological and emotional support due to overcrowding of patients. But patients are more aware nowadays so the doctors have to be more communicative," said Professor Sharmeen Yasmeen, adviser to the Public Health Foundation of Bangladesh.
Need for building referral systems
Professor Sharmeen said specialist doctors need to build referral systems to deal with the crisis. For this, upazila health complexes should be utilised. If the treatment of the patients is possible at the local level, that should be given there. It would reduce the pressure on the specialist doctors at Dhaka."
Situation no different outside Dhaka
However, the situation is almost the same in the private doctor's chambers outside Dhaka.
In Rajshahi, about 200 doctors practice privately in 7-8 diagnostic centres. Most of the doctors consult more than 100 patients per day from 5pm to 12am. There are also allegations that a doctor consults seven to eight patients at a time and prescribes medical tests or medicines without listening to their problems properly.
Bulbul Habib, a journalist, took his wife to consult a gynaecologist at the Popular Diagnostic Centre in Rajshahi city on 26 March.
He said, "My wife, along with seven or eight other patients, was taken inside the doctor's room. There was no privacy for the patients. The doctors asked my wife to do some tests and wrote a prescription. There was no chance to talk to the doctor although we paid Tk1,000 for the visit."
What private hospital authorities say
Private hospital authorities have admitted that many patients complain about the delay that they have to face during an appointment and the lack of time given by the doctors.
Dr AM Shamim, managing director of Labaid Group that has chambers of around 800 doctors in its hospitals and diagnostic centres across the country, said, "The huge number of patients, managing more than one office, emergency patients, and traffic jams are the main reasons for the crisis."
"But we will work closely with the doctors to solve the problems. If the doctor cannot see the patient within the stipulated time, we will make sure that he or she informs us two hours in advance," he added.
Sajjadur Rahman Shuvo, in-charge of the media and communication wing at United Hospital, told TBS that they also get complaints that patients have to wait to see doctors in private chambers.
He, however, claimed doctors at their hospital spend enough time with their patients, which is why patients waiting for their turns sometimes have to wait extra hours.
"We are working to make sure doctors see patients on time," he concluded.
