BSMMU, DMCH outpatient departments: Doctor-MR nexus leaves patients in the lurch

With painful urination, Abdul Zabbar from Narayanganj reached the urology outpatient department at Dhaka Medical College Hospital at about 7:00am on December 6.
His daughter collected an outpatient ticket and went to the urology department at 8:05am.
As Zabbar could not remain standing due to pain in the urinal tract, he had to wait lying on a bench until the doctor came at 10:30am.
At the medicine outpatient department at the hospital, three staffs of pharmaceutical companies, known as medical representatives, entered the doctor’s chamber as soon as the doctor came.
They sat in front of the doctor’s table for about 10 minutes, when already about 100 patients were waiting in queue outside the chamber.
The patients were then allowed to enter the chamber, but they had to talk to the doctor standing as the company people were still occupying the seats.
Coming out of the skin and venereal disease outpatient department at the hospital, an embarrassed female patient said that three staffs of pharmaceutical companies surrounded her when a doctor was attending her.
‘The patients need to talk to doctors privately, but how it is possible if other people even company people are present during visiting doctor?’ she said.
Abul Hossain, 45, was found confused at the general surgery outpatient department of Bangabandhu Sheikh Mujib Medical University on December 4.
He said that he visited a doctor at the department as he got a lump on his foot after a pin pierced it, but the doctor ‘prescribed’ him to visit a private clinic of skin care at Dhanmondi.
Showing the address of the clinic, Abul Hossain said, ‘I am a day labourer. How can I afford to undergo a surgery at a private clinic?’
At the head, neck and otolaryngology outpatient department of the university, a Gaco pharmacy employee was found to bribe a guard Tk 50 to enter a doctor’s chamber.
The Gaco employee said that the doctor allowed him to enter the chamber.
The guard, Delowar, said, ‘Why do you see our fault in taking money, if the doctors allow the company people to enter the chambers?’
The five incidents are just examples of how the patients, mostly the poor, get services at the outpatient departments of the two premier tertiary hospitals in the country.
Forty doctors are designated to attend about 5,000 patients at 20 outpatient departments at the Dhaka Medical College Hospital on every working day, officials said.
The doctors are supposed to come by 8:00am. During a spot visit on December 6, no doctor was found to enter their chambers until 9:00am. Many entered after 10:00am.
The doctors are supposed to leave the outpatient departments at 2:00pm. No doctor was, however, found after 1:15pm while many of them left even much earlier.
The ticket counter was also closed at 1:00pm.
About 300 staff of pharmaceutical companies were found nuzzling in and around the outpatient departments although were not officially allowed there.
They remain present at almost every chamber of doctors. Sometimes they take snaps of prescriptions.
Beximco Pharma marketing executive Parash Paul claimed that they were not barred from the outpatient department at the hospital.
He said usually each of the staff like him visited 20 doctors per day at the hospital to promote their companies’ drug.
The patients alleged that the doctors gave priority to the pharmaceutical company staff instead of attending patients.
Allegations have it that medical representatives often bribe doctors in cash and kind to prescribe their medicines.
At the university outpatient departments, the doctors were found reluctant to come at the stipulated time, 8:00am.
Officials said that there was adequate number of doctors at the university outpatient departments, where about 6,000 patients visited every day.
During visit at the university outpatient departments on December 4, it was found that no doctor entered the chambers 8:30am and many came after 9:30am.
Pharmaceutical company people were seen to enter the chambers keeping patients waiting in long queues.
Staff at both the hospitals were also found making money, manipulating the serial of patients.
Anyone can get early entry if a staff can be paid Tk 50-100, said a patient who managed to get the deal at the medical college hospital.
The medicines at the medical college outpatient departments are supposed to be given to patients without any charge, officials said.
The patients alleged that hardly got all the medicines they were prescribed.
Doctors issue demand letters for providing the patients with medicines from the medicine store.
It was found that the staff at medicine store at the medical college hospital were providing fewer medicines, but recording that the full course were given.
Fatema Begum, 55, who was provided with a demand letter of 30 tablets and capsules of three generics, said that the medicine store recorded all the medicines but gave 22 tablets.
This correspondent asked 10 more patients randomly if they were given all the medicines from the medicine store. Nine of them said they were given fewer medicines, but the store staff recorded that they gave the full course.
When asked, the staff said that they could not give full course of medicines as they had run out of stock.
Patients at both the hospitals said they had no place to lodge complain of the irregularities.
They alleged that doctors and staff got angry if they say anything against irregularities.
‘I am poor…I do not want to clash with the doctors or staff because they would not attend me sincerity if I question their irregularities,’ said a patient, Hasan Ali.
No journalists are allowed to enter both the hospitals without permission.
DMCH deputy director Khwaja Abdul Gafur said, ‘Why do you want to talk to us if you find irregularities?’
He claimed that no doctor of came late than 8:00am at the outpatient departments. When he was informed about the spot visit, he said, ‘We will investigate it.’
Asked about the doctors leaving early and even at 1:00pm, he said they left if there was no more patient.
Asked about why the ticket counter is closed at 1:00apm, he said, ‘We would look into it.’
About pharmaceutical companies entry, Gafur said, ‘We do not want to have clash with them, but we are trying to motivate them not to enter.’
The university director (hospital) Brigadier General Abdullah Al Harun was not found at his office on December 4 while additional director Nazmul Karim Manik declined to comment.

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