“Don’t let the world around you squeeze you into its own mould, but let God re-mould your minds from within...”
Romans 12:2

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Hilary's Desk

Dr Sharad Paul – an ‘out of the mould’ doctor

Hilary Butler - Saturday, August 09, 2008

Today, the Canvas magazine in the Herald had a very interesting article about Dr Sharad Paul, who arrived in New Zealand in 1991 with a guaranteed job as a plastic surgeon. That is, until they looked at his face, and saw he was an Indian.

Fortunately, an Indian of resolve, since the ludicrous behaviour of New Zealand medical authorities simply made him more “bloody-minded”, as he put it. Now, not only is he an asset to this country as attested by his 2003 New Zealand Health Innovation Award from the Ministry of Health, but he also is prepared to tell the truth, something that is not always applicable to this country.

You can tell that Sharad doesn’t belong in a clique, since if he did, his mouth would be firmly zipped closed. The fact is that he doesn’t “have” to belong to a clique, is because, unlike most doctors, Sharad very sensibly has eggs in lots of baskets.

He’s a writer with three books to his credit, and one which never will be. We’ll get back to that one.

Sharad is the owner of BACI ‘book and coffee’ stores, times three: Auckland, Brisbane and Chennai next. He works one week a month in Australia. One of his books is a hit in India. He has very happy staff who adore him, and patients who wouldn’t swap him for the world. He has made sure he lives life differently, and definitely out of the mould.

So he doesn’t need any New Zealand system to cosset and protect him. If the New Zealand medical system turns on him (and chances are it might at some point) no doubt the rest of the world will snap him up in a flash, and it would be their gain, and our loss.

But here’s the truth: He doesn’t think much of the New Zealand medical system as a whole. Join the club Sharad. Obviously we kiwis have some very good apples in the barrel. The problem is that your chances of meeting the bad ones are high. Something Sharad has also discovered.

So, to Sharad’s book which will never get written. It is said that if a writer was to write honestly, they wouldn’t have a “friend” in the world. What a sad statement that is, but it’s true. The book which Sharad will never write, is set in the world of surgery, and would have been based on the “unsavoury characters” amongst medical collegues he’s met over the years, “who he may bump into again tomorrow”. And he says, “none of them were patients”.

He points out that the medicine he’s seen here is different to what he saw in missionary medical work, “Medicine in New Zealand is quite commercial, run as a business; the way it’s practiced here isn’t really patient-focused. It’s all about numbers, money, politics, yet doctors are supposed to be compassionate. I’ve always believed in treating patients as I would myself or my own family.”

As the article describes, Sharad does a lot of things for patient, free, the total cost of which would fill a treasure trove if they had to pay. A measure of his dedication is that single handedly, by operating on some of Waitemata Health patients in his own clinic, he has slashed waiting times for skin cancer treatment from almost a year, down to a month. Which means that not only his patients benefit, but so do the rest of the tax payers who probably didn’t know Sharad’s name, unless they read the Herald’s Canvas magazine article.

Two important things come out of this article, which need recognition. The first is that the only reason Sharad can speak out, is that he doesn’t NEED the system. In general, the medical system in New Zealand is exactly as he says. I look at all the long term names that have not changed over the years, and see no evidence of any of them criticizing the system, or making any real attempt to change it.

In my opinion, that’s because Sharad is right, but it’s worse than he knows, because being on the outer, he may not know just how bad it really is. The basic rot of the New Zealand medical system will remain, because the system is specifically designed to support and protect itself, right to the core.

Take the community I live in. Just say a new doctor arrived from overseas in Franklin with enough money to set up a sole practice. Just say this new doctor, like Sharad, had a really good reputation, but didn’t want to “belong” to a group. He just wanted to do his own thing. Guess what? He wouldn’t be able to. Why? Because medicine in this country is a protectionist monopoly. Most of the people around me, who walk down the road to their local doctors’ practice never question why it is, that there is NOW only one practice in this area. That’s because they don’t know that that one practice pays a fortune every year for a license which entitles them to “patch” protection, preventing “competition” coming in and raking off potential income.

In order for a new hypothetical doctor to practice in this country, they would have to apply to an already established practise, (unless an area license was not already allocated) and be part of a bonded "group". To be a ‘Sharad Paul’ these days, would be just about impossible.

On a national scale, when it comes to protecting individuals in the system, another old-boys network exerts a different inflence.

A few years ago, when fronting an ACC case in court, I had a problem. The ACC wanted my client to get a “local” second opinion. After all, that would be cheaper. Furthermore it just about guaranteed that that “opinion” would say exactly the same as the first. On the other hand, I wanted to go for a well known Harley Street expert. ACC were horrified, and did everything they could to prevent that. However, the judge on the case knew exactly why I was asking him to okay the overseas second opinion. He stated in court, that in another case, he had struck the same problem. The Judge also happened to know the only two “experts” on that topic at the time, in this country. They worked in the same building, and played golf together.

The judge granted my request. I got the second opinion I needed, which as expected, went against the first opinion of the New Zealand expert. I knew it would, because it was blindingly obvious to me, a non-medic, that the first New Zealand ‘expert’ was wrong.

Revenge from the New Zealand medical fraternity can be exacted in many different ways, right down into ACC itself. The judge had ordered ACC to organize the second opinion. Five months later, it hadn’t been done. ACC didn’t want to do it, because, as they told the judge, they didn’t see the need. The Judge immediately ordered me to do it, and I had the full report within a few weeks.  

The Judge then ordered the ACC to pay the bill, and I thought that would be the end of the matter.

A year later, there was a knock at the back door, and lo and behold, there was an international debt collector, wanting to be paid for that report.

Since I had been the last port of call for the Harley Street expert, I was expected to cough up.

I invited the debt collector in, picked up the phone and rang ACC. No-one knew anything, of course. So I rang the Judge’s office, and his right hand lady was absolutely aghast. I faxed all the paper work through to the Judge from the debt collector, as well as the copy of the bill from Harley Street from my files. From a later description from the Judge’s right hand lady, the Judge was furious, and rang up the relevant person in ACC reaming out both ears and brain as well.

Not long after, I received a bowing, scraping, thoroughly insincere phone call from said ACC person, saying all the right words, and explaining how it ‘inadvertently ‘got overlooked. Right? No. I know that bill did NOT get overlooked, because I made sure that it arrived on the correct person’s desk, in multiple copies and ‘signed for’!

I’ll tell you what I think happened. I believe that the relevant two-horse expert fraternity were very upset at being “outed” by a foreigner. Their only recourse under this situation, was to make sure that the said Harley Street expert would never again think to do another overseas “second opinion”. Simple really. You make sure that the bill isn’t paid, and the Harley Street expert gets super septic. Next time a request comes, what will Harley Street expert think?

It’s the way things are done. The old-boys-network is why it’s damned near impossible in this country, to get a doctor to say something another doctor won’t, and why so often, the ACC system is a sick joke.

And that’s why the article in Canvas was so exceptional to me. There was one caring doctor, who sincerely loved his job, his patients, and life, but wasn’t so stupid as to be dependent a medical system, and was prepared to call them on it, even if only obliquely.

Good on you Sharad. You’re one of a few shining lights in the dark morasse that is the New Zealand medical system as it is today. And you had the courage to tell it as it is.

But I have to tell you this. You might be able to add a few more nasty characters to your mental list for that book on surgery in the future, because if the experience of New Zealanders is anything to go by, the kiwi-old-boys' system has memory tentacles longer than you will ever know.

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