BEIJING, March. 11 -- It is common and accepted that the patient who is about to go under the knife is also the individual who chooses which surgeon will be holding the scalpel.

    A patient has to conduct a thorough investigation to find out which surgeon is the best in a hospital before he or she makes such a decision.

    But for rural patients, who travel from their villages to hospitals in the big cities, it is almost impossible to make an informed decision in the limited time.

    Never fear, there are photographs in the lobby displaying all doctors in every hospital in Beijing. Patients can just take their pick from among all the surgeons.

    But a patient has to pay an extra fee for picking and choosing. And the money lines the pockets of the selected surgeons and beefs hospital general funds.

    On the surface, it seems reasonable that a patient can pay to have a say in the matter of his own life and death.

    Yet, it also demonstrates the patients' lack of confidence in hospitals. They clearly do not trust the decision made by a hospital on their behalf.

    How can a patient believe the information provided by a hospital about capabilities of its doctors if they do not trust the hospital? But if they trust the hospital, why do they pay to pick the particular surgeon to operate?

    It is a choice with resignation, and they have to trust someone in a hospital to treat their illness. Perhaps they believe that the extra money may nudge the surgeon to do a better job.

    Such a mentality and paranoia has developed from the rampant malpractice cases, in which illicit fees from patients secured a safe and quality operation.

    Having failed to find any way to root out such malpractice, the top authorities of public health gave hospitals the green light to receive fees from patients, who wanted to make sure a particular surgeon was the one making the incisions.

    Compared with the under-the-table business, the legalized practice seems to be fair by offering all patients a chance at getting the best surgeons for their operations. But in reality, it is only fair to those who can afford it.

    For low-income patients or those from poor rural areas, it is even less fair when their illnesses or conditions require a more capable surgeon than average. They are put in a dilemma: they have to pay an extra fee for a surgeon they believe to be competent or they risk their lives by choosing not to pad their medical bill.

    Such an extra fee has only made it more expensive for low-income residents to be operated on.

    For patients who can afford it, the money, not the rules, makes the difference.

    In a scandal late last year involving a hospital in the city of Harbin in Northeast China's Heilongjiang Province, a wealthy family spent more than 5 million yuan (US$617,000) on its fatally ill relative. Veteran doctors were invited from Beijing to analyze the patient's conditions, although the relative still died.

    Hospitals have lost their intrinsic right to put surgeons of different levels of competence into different uses in a responsible, thought-out manner.

    It yields embarrassing situations such as veteran doctor assigned to a minor operation that could easily be handled by a young surgeon simply because the patient has paid a fee to pick the former.

    It is reasonable for patients to care only about their own physical well-being, but it is not responsible for hospitals to ignore the need to designate the right surgeon for the right operation so the most people can be saved.

    Beijing municipal health authorities announced that such practices would be abolished starting from this month.

    The circular issued by the capital's municipal health authorities requires that hospitals in the capital will take back the right to arrange surgeons for patients in accordance with their particular needs.

    I am suspicious whether the hospitals will be able to do a good job in rational arrangement of surgeons.

    Even if some relevant authorities in charge do want to do their best to serve their patients in a fairly reasonable manner, wealthy clients will still probably try to break the rules by throwing out their money and getting the best possible medical service.

    I also wonder if the horrible practice of patients giving extra money to doctors in private in return for doctor's utmost best will revive.

    It is absolutely right for hospitals to reclaim the right that belongs to them. But we need a mechanism to prevent both patients and doctors from eroding the professional ethics of doctors, and rules as well.

    For patients, giving extra money to doctors in private is not always ill-intended, but doctors are likely to become spoiled and develop biases against those who do not do so.

    Of course, doctors who receive such money or even ask for such a favour, should be disciplined according to rules.

    Yet, doctors should get handsome pay for the responsibilities they shoulder for their patients.

    Many hospitals in other parts of the country still allow patients the right to pick surgeons, if they are willing to pay.

    Beijing has taken the lead to scrap the fee, but it remains a question whether other parts of the country will follow suit.

    It also remains a question if Beijing health authorities have measures in place to tackle the problems that may arise after the practice has been thrown out.

    (Source: chinadaily.com.cn)