A healing touch?

Although the dust has settled on the matters raised by Dr. A.H. Sheriffdeen’s letter to the President of the College of Surgeons of Sri Lanka (CSSL) and the heat generated by the issue has now cooled, it is worth reflecting on this matter. Emeritus Professor Sheriffdeen has acquired a well deserved reputation as an excellent surgeon and teacher of the highest calibe and it was natural that what he had to say struck a resonant chord among a wide section of society not only because of what he said but also the way he said it. Anybody who read his letter, widely publicized by both the mainstream and social media, would have clearly seen the anguish with what he wrote and empathized with the reality that things were much better in times that are now long past.

Both Dr. Sheriffdeen, in a subsequent letter, and Dr. Jayaindra Fernando, President of CSSL, have expressed dismay about the original letter being publicized the way it was. Fernando has said that the College of Surgeons “were surprised and dismayed” by the publication of what they termed was a “private letter” intended to be read by its members. Sheriffdeen has said that he is appalled that an “internal email” to the President of CSSL had been published as it was. Given the excellent tone and tenor of of what followed, we do not wish to strike a discordant note but want to say in defence of the publication, that the letter did not say it was private and confidential or meant only for the reading of a select audience. Also, at least the mainstream editors (we can’t speak for the social media), would not have seen it as a ‘plant’ – something not common in our line of work. We might add our belief that is was a good thing that a matter as important as this was widely disseminated and provoked extensive discussion among those who matter – both in the medical profession and elsewhere.

The response to the original missive by the paediatric surgeons working at the Lady Ridgeway Children’s Hospital (LRH) deserves the highest commendation by all for the way in which it was worded. This letter was formally released to the press by the President of CSSL and although published elsewhere earlier, is republished in this issue of our newspaper both for the reason that we ran the original story as well as the need for the widest possible dissemination of what for the lack of a better word be styled as the “rejoinder.” The LRH surgeons who called themselves a “Paediatric Surgeon’s Collective” wrote in lighter vein that “it is said in jest that every story has three sides – your side, our side and the truth.” We professional journalists are trained to investigate both sides of what we write in the hope that the truth lies in-between your side and my side and would hopefully be discerned by the readers.

The rejoinder was a model of the best diplomacy which conveyed what the writers had to say with no offense to anybody. It called Prof. Sheriffdeen “one of our beloved and respected teachers” who had striven during his career to impress upon his students the ideals of being a good doctor. They did not try in the slightest way to criticize Sheriffdeen for what he wrote saying “the exasperation of a man who feels betrayed and thwarted is understandable (and) if his impassioned communication…..did help to restore his equilibrium, as he expected, then we will somehow try to take in stride the damage done to our reputation and that of the hospital.” Most letter writers would have socked in the words with which that sentence ended, “even though the events that had taken place are misrepresented.” There was no strident accusation of misrepresentation or any kind of fault finding.

In essence the LRH surgeons made the point that standards of care for any condition is ever-evolving and they are guided by what is appropriate at that point of time. Presently, acute appendicitis in children, does not have to be rushed into the theatre in the night (unlike in Sheriffdeen’s heyday they did not say to their eternal credit). They explained that in the contentious case under discussion, it had been decided to do the appendectomy after fluid resuscitation and antibiotics. It had been planned to operate on the child as the first case the next morning, successful surgery performed and the patient who was fully recovered had been discharged. They agreed that the consultant surgeon does not stay in after normal working hours “but is only a telephone call away.”

All’s well that ends well we are tempted to say with no two-fisted attack on anybody. But there is no escaping the reality that there are great deal of deficiencies in the state healthcare system and that most people in the country have a perception that private healthcare, despite the enormous and in most cases unaffordable cost, is preferable to going to a government hospital. Knowledgeable people know that the finest and most skilled services are present in the state sector. But it is also true that healthcare is today a lucrative business not only for the private hospitals but also for specialist consultants permitted private practice despite being employees of the state health service. We do not think that all these doctors can place their hand their hearts and swear that they put in the necessary hours at their government jobs at the cost of their private practice. There are many who do and perhaps many more that do not. Hopefully the wide discussion of all the issues arising from Prof. Sheriffdeen’s letter will be a healing touch on the country’s healthcare system.