I want to start by saying that this situation really genuinely bothers me alot, because we are talking about a suitation where someone who is lying in a hospital bed and their body is failing them and the conversation going on around them is about money ,not about what they need or how to save them, but about whether they can pay, me i find that really wrong.
The Hippocratic oath is not just something doctors say when they graduate, it is a promise that they make at the beginning of their career, They promise to do no harm and to preserve life,
"I will do no harm, I will preserve life," and turning a patient away from a surgery they need because their account balance isn't where it needs to be is harm, It might be slow, indirect, dressed up in administrative language but it is harm.
I understand that hospitals are not charities, i understand that surgeries cost money equipment, personnel, medication, theatre time, aftercare, i understand that a hospital that bleeds money trying to treat everyone for free eventually closes and then treats nobody, I genuinely hold all of that, the economics of healthcare are real and I am not pretending they aren't.
But understanding something and accepting it as the final answer are two different things, becos here is what bothers me most, the system that turns patients away for inability to pay didn't arrive by accident, It was built, Decisions were made at government level, at policy level, at institutional level, that created a healthcare structure where survival is means tested, where your life is worth exactly as much as what you have in your pocket, and we have gotten so used to it that we have started treating it as natural, as just how things are, it isn't natural, It is a failure that we have normalized.
What are the better ways? I think about this seriously, health insurance that actually works and actually covers people not the watered down, full of exceptions versions that exist in many places, but real coverage that catches people before they are lying on a table unable to afford the next hour, government funded emergency intervention that ensures no patient is turned away from a life saving procedure regardless of financial status, payment structures that allow treatment first and billing conversations after, when the person is alive and stable enough to have that conversation, charity partnerships, NGO involvement, structured community health funds, none of these are new ideas, they exist in various forms around the world,the question is always political will and prioritization.
And for the doctors personally , I know the system puts them in an impossible position sometimes, the decision to turn away a patient isn't always coming from their heart, It is coming from an administrator, a policy, a management structure above them, but I still think there is a responsibility to push back,To advocate loudly within whatever system you work in, To not become so accustomed to the machinery that you forget there is a human being at the center of every case.
A price tag on an oath is not an oath anymore.
It is a transaction.
And medicine was never supposed to be that, we built this system, which means we can build a better one, if we care enough to try.
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