I Can’t Treat You Like A Private Patient

Dear Patient-at-Public-Hospital

Let me start by saying, I’m sorry you had to come to hospital. While hospitals are never a good place to be, coming to a State hospital in South Africa provides a unique set of challenges – to your doctors and nurses, but also to you.

dear public patient

There are things that private patients get that I wish you could have too: fluffy duvets, enough pillows, air-conditioning, smaller wards, speedier test results…

I wish all my patients could have a “private patient” experience; but I need you to know that there are certain things I will not do.

When you ask for a “full body screen”, to do “all the tests”, I will not. I will test what is indicated – based on your family history and your lifestyle, your age and your risk factors; and of course, your recent symptomology. Not a single test more.

This has nothing to do with you as a person, and everything to do with my code of ethics: If a test is not indicated, then doing it is a waste of your time, my time, and money that the hospital could spend on other projects or equipment. In running unnecessary tests, I would be complicit in the national  shortage of funds for healthcare.

I cannot keep you in hospital a day longer than is needed. It breaks my heart that we send so many patients back to less-than-ideal circumstances; patients who prefer to be in hospital because they know they have a bed to sleep in and three meals a day guaranteed. But every day that you spend in our wards, is another day that you are surrounded by sick patients. Hospital acquired infections are nasty and you don’t want them.

Our hospitals are full. We are chronically at 100% capacity, and if you stay in hospital longer than needed, it means that somebody who is sick, someone who might be actively dying, is lying on a hard stretcher down in casualty while there are no beds available for them.

Dear Public Patient: understand that public and private hospitals have different motivators. Remember that private hospitals in our country need to AIM for a certain bed occupation. So maybe they can afford to keep patients longer than needed. They are reliant on their patients for business; and they are eager to abide by their wishes because it means they (and their family) will return to there hospital one day, too.

Me? I don’t want you to come back. Not because I don’t like you, but because I want you to stay healthy!

Please understand that you are coming to a setup where we are all struggling with the challenges of a healthcare budget that is inefficient.

I can’t necessarily treat you with all the bells and whistles that private patients get in their hospitals, but I can assure you: I will take damned good care of you.


Your doctor


  1. Nancy Ackelson says:


  2. Zed says:

    It’s really sad when patients rather be in hospital than go home. Or when they believe they need to be in perfect shape before they can be discharged. One consultant put it this way “when I think you are better off at home than you are in hospital, then we’ll discharge you”. I think it’s hard for patients to fathom they could become more sick the longer they’re in hospital

  3. The Elderly Young Adult says:

    Such a relevant post that is actually really heartbreaking to bear witness to.

  4. Therese says:

    I come from a developing country and we share this dilemma. We hear comments like “just because we are poor, you deprive us… etc”. We also hear “we pay our taxes but we don’t feel it”. It’s quite hard on our side because we have political/corruption problems but all we can say to our patients is that we are doing the best we could given what is available. It is sad and frustrating.

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