¿Es no ética la práctica de la medicina privada?

 

¿Is private practice of medicine unethical?

John Dean wrote in a Personal view in BMJ (1) that the priveta practice of medicine is unethical and that doctors shoul leave. I have worked in public national medicine for 39 years and 31 years en public and private medicine, and I disagreement with these views (and now, April 2025, I am still working alone in private medicine).

In Spain, in the 1980s exclusive dedication to public hospitals was introduced. Doctors who welcomed it, with the same working , had better pay. The fundamental reason that was exposed by the then health minister was that doctors under exclusive contracts consecrate their free time in the afternoon  to study the problems of their patients, however, thos working in private medicine in the afternoon could not. This neves happened. Most doctors who were exclusively dedicated , then and now, for the evening were dedicated to their hobbies and favourite sports, to be with their family or out walking. The other, without exclusive dedication, devoted the evening to work and study to compete with other doctors to have more patients (clients).

In Spain, the best doctors in the hospitals, in general, are those that also have private consultation. Previously, these doctors used to be department heads. Lately, because to be of a medical or surgical service is almost a sine qua non to have exclusive dedication, these charges are granted to mediocre doctors. Public hospitals in Spain are governed by politicians and are these who appoint managers of hospitals, which are usually chosen to be of the same political color or between relatives Friends.

Also John Dean said that the public medicine fellow may be asked aid for diagnostic problems you have and this can´t be done in private because they are competitors. Precisely what does not exist in public hospitals in Spian is competition between doctors and that´s no Good for patients. Best and the worst doctors have the same salary in the hospitals and this ends up discouraging the most competent doctors.

John Dean also refers to the lack of honesty  of private medicine. I do no agree. The four Hs a doctor must have as William Osler said are honesty, humanity, humilty and humor, and all doctors need them  either practising in public or private healthcare. Another thing is that doctors working for private insurers might become dishonest and do more testing and make more revisions to a patient without needing them. I do not work for private insurance companies, but if I did I am convinced that it would be equally honest.

John Dean, after practising private and public medicine for some time, has come to the conclusión that it is unethical. It happened to him like St. Paul, when he fell from his horse. If it is unethical, why did he practice it? Is private medical practice unethical or are some doctors unethical who practice it, like other doctors in national public medical practice? 

I conclude with this quote from Ayn Rand, who said that “Doctors are not the servants of their patients. They are traders like everyone in a free society, and shoul be proud of the title because the services they offer are of crucial importance”.

Joaquin Lamela López

Pulmonary Medicine, M. D.

 2025 ; 350 doi: http://dx.doi.org/10.1136/bmj.h2299 (Published 05 May 2025)

(1)    BMJ 2015; 350:h2299