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The new doctor–patient relationship in the age of AI

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When Patients Become Partners:

 

The Waiting Room That Never Empties

Picture a government hospital outpatient department on any weekday morning. Rows of plastic chairs fill before five o’clock. A mother holds a feverish infant against her chest, a folder of lab reports on her lap. An elderly man has travelled two-six hours by bus from his village. When she finally reaches the doctor, perhaps after three hours of waiting, the consultation lasts 2-4 minutes. A prescription is written in a hand that only the pharmacist has any hope of deciphering.

This is not a story of negligent unempathetic doctors. Most of those doctors are exhausted, processing 60 or 70 patients before lunch, doing the rough arithmetic of a system stretched well beyond its seams. Some patients jokingly compare busy clinics to a skilled coconut plucker moving rapidly from one tree to the next—not because doctors lack compassion, but because the system often leaves them little time to pause. In the private sector, the metaphor shiftsbut only in its economics, not its pace. There, the imperative is to climb as many coconut trees as possible. What changes is who bears the cost of the hurry.

A legacy worth defending

Sri Lanka’s public health record is, by any regional measure, something to be proud of. Free healthcare at the point of delivery, a maternal/infant mortality rate that rivals middle-income countries far wealthier than us, these are not accidents. They are the product of generations of political will, professional dedication, and the idea that good health is a right, not a privilege.

The economic crisis of recent years sent a wave of trained doctors and nurses toward the Gulf, Australia, Canada and the United Kingdom. Specialists, who took a decade to train, departed within months. Meanwhile, the cost of private consultations has climbed beyond the reach of ordinary families, pushing them back toward an overstretched public system, or toward no professional care at all.

Patients who did their homework

Something else has changed, and it has changed faster than the system expected. The patient sitting across from the doctor today is not the patient of 10 years ago. She may have spent the previous evening consulting reputable online health resources or AI assistants, such as ChatGPT, to better understand her symptoms. He may have photographed his blood test results and run them through an AI tool that flagged an anomaly before the doctor mentioned it. They arrive with questions, about what additional tests are necessary for further diagnosis, about whether a test is strictly necessary, about what a particular reading on their lipid panel actually means for their life, especially when their life-styles are different. This is what educated, anxious human beings do when something threatens their health. The information age did not ask permission. It simply arrived.

The response from some doctors has been impatience, the feeling that an informed patient is a difficult patient. But the more productive response, increasingly voiced by thoughtful practitioners, is to see this shift as an opportunity. An informed patient is an engaged patient. An engaged patient is more likely to follow a treatment plan, more likely to return for follow-up, more likely to catch an error.

Authority to partnership

The old model of medicine was hierarchical by design. The doctor knew; the patient obeyed. That model had its logic, in an era when the knowledge gap between professional and layperson was absolute. That gap has not closed, but it has narrowed leading to a partnership.

There are doctors in Sri Lanka who already practise this way: arriving on time, spent 15-30 minutes with patients, contactable over the phone specially after a difficult procedure, for communicating plainly and without condescension. They are proof that the ideal is not utopian. It is achievable, which means the question is how to make it the norm rather than the exception.

Smarter, Not Harder

This is where technology enters, not as a replacement for clinical judgment but as a tool for reducing the friction that currently exhausts both doctor and patient.

Take the laboratory report cycle. A patient visits the doctor, is sent for tests, and a second appointment is required. A patient who arrives having already run those results through an AI-assisted tool is not trying to bypass clinical judgment or sidestep any genuine treatment decision. They are trying to eliminate a visit if they “know” that sole purpose is simply for an interpretation of the lab results. That second visit consumes time, money, efforts and transport. AI-assisted interpretation tools, not diagnostic systems, but educational ones, can give a patient a plain-language summary of their results (sometimes using Sherlock Holms’s theory of process of elimination to narrow down the possible causes) before they even walk into the consulting room. The doctor’s time is then spent on clinical decision-making, not on explaining what a haemoglobin or platelets count is.

Then there is the prescription. Illegible handwriting on a small slip of paper has long been a quiet patient safety hazard, and it is worth noting that AI tools have already begun helping patients and pharmacists decode what was written. But digital prescriptions go a step further: they eliminate the ambiguity entirely, and allow a patient to scan what they have been given, learn the name of each drug, understand what it does, and be alert to any side effects. This is not a challenge to the doctor’s authority. And when a patient discovers in the process that an approved generic equivalent costs a fraction of the branded price, they are empowered, not endangered.

Telemedicine, which got a reluctant push during the pandemic and has since retreated in public imagination, deserves a second look. Follow-up consultations for stable chronic conditions, blood pressure reviews, diabetes management, post-operative monitoring, need not always require a physical journey. The technology exists. The will to use it more widely is what remains to be mobilised.

Wisdom in herb garden

No conversation about healthcare in Sri Lanka is complete without acknowledging the parallel system that millions of people have never abandoned: traditional Hela medicine. Ayurveda, Siddha, Unani, and the vast informal knowledge embedded in village practice, these are not simply alternatives to modern medicine. For many Sri Lankans, they are the first resort.

The relationship between indigenous knowledge and scientific medicine has too often been one of mutual suspicion. Modern practitioners dismiss traditional remedies as unproven; traditional practitioners regard clinical trials as a foreign imposition. Neither position is adequate.

Consider Heen Bovitiya — known to botanists as Osbeckia octandra and to generations of Sri Lankan grandmothers as a trusted remedy for liver complaints and jaundice. Serious liver disease remains one of the conditions for which Western medicine offers no easy answer: its definitive treatment is a transplant — costly, risky, and followed by a lifetime of expensive immunosuppressant medication. Against that reality, a plant with pre-clinical evidence of hepatoprotective and anti-inflammatory properties is not a curiosity. It is a serious research priority. The studies so far are promising. They are also, as yet, large-scale clinical trials in humans have not been conducted, and questions of optimal dosage, mechanism of action, and drug interactions remain open.

The honest position is neither to dismiss the remedy nor to prescribe it uncritically. It is to say: this is a serious candidate for rigorous investigation, and Sri Lanka, which grows the plant, knows its traditional uses, and has the academic institutions to study it, is precisely the right place to conduct that research. AI tools that can process vast pharmacological datasets may accelerate that work considerably.

The future of healthcare should not be a competition between Western and indigenous medicine, but a commitment to evaluating all treatments by the same standards of safety, effectiveness, and quality.

Future Is Not a Machine. It Is a Better Conversation.

The fear that artificial intelligence will replace doctors is, at this stage, a distraction from the more important question. AI cannot examine a patient. It cannot feel the anxiety in a room. What it can do is handle the transactional, the look-up, the summary, the cross-reference, so that the human part of medicine can breathe.

The future worth working toward is not AI versus doctors. It is AI and doctors and informed patients, each contributing what they do best. The doctor could bring clinical expertise and the irreplaceable capacity for compassion. The patient brings self-knowledge, lived experience, and, increasingly, preparation. The technology brings tireless availability and pattern recognition at scale.

What we measure matters. A consulting room’s success should not be counted in patients seen per hour. It should be counted in patients who leave feeling informed about their condition, respected as partners in their own care, reassured that someone is genuinely attending to them, and confident about what to do next.

The Thing Patients Remember

There is a truth that experienced nurses know, that the best doctors quietly understand, and that patient experience research consistently confirms: patients may forget the prescriptions. They may forget the name of the drug, the dosage, even the diagnosis. But they rarely forget how they were treated, pleasant or rude.

They remember the doctor who looked up from the desk. The one who said, “That’s a good question.” The one who spent two extra minutes to listen, drawing a small diagram to explain where the problem was. They remember being seen, not just examined, but truly seen, as a person rather than a case number.

Sri Lanka has those doctors and nurses, in every district, in every ward, working against the odds. The task now is to build a system worthy of them, and of the patients who place their lives, without much choice in the matter, in their hands.

Technology may transform medicine. Artificial intelligence may transform diagnosis. Digital health may transform hospitals. But trust will always define healing.

(The writer, a senior Chartered Accountant and professional banker, is Professor at SLIIT, Malabe. Views expressed in this article are personal.)



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From the missing to the missing truth and beyond

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A file photo of Foreign Minister Vijitha Heath addressing the UNHRC.

by Jehan Perera

The government is preparing to meet the challenge of the UN Human Rights Council next month. A Sri Lankan delegation led by Foreign Minister Vijitha Herath is expected to attend the 63rd session of the UNHRC in Geneva, where the UN High Commissioner for Human Rights will present a written update on Sri Lanka. The government has already submitted its response to the advance version of the report prepared by the Office of the High Commissioner for Human Rights. The Foreign Minister, accompanied by officials from Colombo and Sri Lanka’s Permanent Mission in Geneva, is expected to explain the progress made on reconciliation, accountability and human rights. This is therefore an important moment for the government. It is an opportunity not merely to defend its record but to make new commitments.

The government has been criticised, as were its predecessors, for the manner in which it has dealt with past human rights violations, especially those connected with the thirty year war. The vexed issue of thousands of missing persons remains at the centre of this criticism. The government has sought to strengthen the Office on Missing Persons by providing it with additional staff and resources. It has also given support to the excavations at the Chemmani mass grave. Justice and National Integration Minister Harshana Nanayakkara has told Parliament that the government has allocated Rs. 57 million for the excavations and related legal work, though that figure has not been set against the cost of comparable forensic operations elsewhere.

The government also took the significant step of holding a national event in Jaffna to mark the International Day of the Victims of Enforced Disappearances. Minister Harshana Nanayakkara attended the event together with the Chairman of the Office on Missing Persons (OMP), Mahesh Katulanda, and other senior officials and political representatives. Their presence was meant to demonstrate the government’s commitment to addressing the issue. But on the victims’ side there is continuing dissatisfaction. The commemoration in Jaffna was met by a protest outside the District Secretariat, organised by families of the disappeared, who demanded to know what happened to relatives who, according to their accounts, surrendered to or were taken away by the military and were never heard from again.

Jaffna Protests

The protests in Jaffna are a reminder of the gap that remains between what the government is trying to do and what the victims expect. For these families, compensation and death certificates are not substitutes for knowing what actually happened to those they lost. The protests, and the police action taken against some of those who demonstrated, were reported by the international and Tamil media and by international human rights organisations, and overshadowed much of what the government had hoped to showcase at the Jaffna event. The OMP’s mandate is to establish the fate and whereabouts of missing persons, clarify the circumstances in which they went missing, and provide redress and assistance to their families. Accordingly, it has sought to verify complaints, remove duplicate entries, encourage people who have not yet made complaints to come forward, and facilitate compensation and other forms of assistance. The families of victims expect the OMP to do more to clarify the circumstances in which their loved ones went missing. An example would be the disappearance of 158 displaced Tamil persons from the Eastern University campus in Vantharumoolai, Batticaloa District, who were rounded up and forcibly removed in front of thousands of other similarly displaced persons, including the officer in charge Prof T Jayasingam.

The government has also increased the support available to families of the missing, and says it is accelerating the OMP’s investigations. But the scale of what remains undone is stark. There are around 11,000 complaints remaining to be investigated, according to the Justice Minister, while the OMP has reported that final information has been established in only 31 cases, communicated privately to the families concerned. On the government’s own figures, that puts the clearance rate for establishing fate and whereabouts at well under one percent of the outstanding caseload. There is a limit to what the OMP can do even with more resources and time. Its mandate is primarily to establish the fate and whereabouts of individual missing persons. It was not intended to produce the comprehensive, public account of the past that victims and the country as a whole require.

In 2015, the government headed by President Maithripala Sirisena and Prime Minister Ranil Wickremesinghe committed itself to establishing such a commission as part of a comprehensive approach to dealing with Sri Lanka’s past. Human Rights Council Resolution 30/1, which the government co-sponsored, specifically welcomed the proposed establishment of a “commission for truth, justice, reconciliation and non-recurrence”, together with an Office on Missing Persons and an Office for Reparations. However, the commitment to a truth-seeking mechanism was never fulfilled. The government should consider setting one up now. There is a growing feeling among Tamil people in the North and East that the government is failing to deliver on promises that are important to them. On issues important to them, they feel this is once again a Sinhala-dominated government like all the ones that came before.

Establish Truth

For the past two years the government has been concentrating on problems that it deems are important to the country as a whole such as the economy, development, poverty alleviation and corruption and criminality. However, the government needs to demonstrate that national unity means addressing the concerns of all communities, including those whose wounds from the war remain unhealed. Some of its own institutions have begun to act on this. The Office for National Unity and Reconciliation recently staged a drama entitled From Yakaweva to Nandikadal, depicting relationships between people that transcend the destruction caused by war. The drama portrayed the sufferings as well as the prejudices on both sides of the divide, from the Kebithigollewa bus bombing to the final days of the war around the Nandikadal lagoon. Its central message is that without forgiveness there cannot be reconciliation.

Particularly moving was the fact that the actors themselves came from families touched by the violence on both sides. The son of an LTTE Black Tiger leader and the daughter of an Army officer were among those who performed, alongside others who had experienced and survived some of the sites of carnage. The fact that a state institution is taking this message of reconciliation forward is itself a testament to the government’s openness to dealing with the past. A government institution can reach a population far larger than any civil society campaign could reach on its own, simply because the machinery of the state is so much more extensive. It is in this context that the government needs to give serious thought to setting up a Truth and Reconciliation Commission as the next step in the truth-seeking process. Special care will need to be taken to ensure that those who are appointed are not only politically non-partisan, but are acceptable to all the communities.

A Truth and Reconciliation Commission cannot by itself resolve all the wounds of the past. Nor can it replace criminal investigations or judicial proceedings where these are necessary. But it can provide something that existing institutions cannot provide on their own. This would be a comprehensive national process through which victims can be heard and the truth can be established. The general population needs to understand what happened, so that the country can begin to acknowledge its past without passing it on indefinitely to future generations. The government has already taken several steps. It is supporting the search for the truth at Chemmani. It has begun reaching out to families of the disappeared. Its own institutions are producing messages of reconciliation. But these are still not delivering the results that the victims and their families want. The next step should be to bring these efforts together to begin the journey from the missing to the missing truth, and from there to comprehensive justice.

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The long road to educating Sri Lanka’s Bhikkhunis

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Bhikkunis: Image courtesy Buddhist Society of South Asia

A robe without recognition:

 

by Anushka Kahandagamage

Education is the right of every child. Yet somewhere between childhood and the robe, that right becomes precarious for many Buddhist women in Sri Lanka, threatening not only their social standing, but their fundamental access to learning and the institutional discrimination they face. This piece is not about Buddhist disciplinary rules, which discriminates women, rather about how the state’s refusal to fully recognise bhikkhunis as bhikkhunis quietly determines what they are, and are not, permitted to learn.

Unlike dasasil mathas, who occupy a distinct and unofficial category within Buddhist renunciation, bhikkhunis belong to a formally ordained order recognised within Buddhist monastic tradition itself. Dasa sil mata means ‘ten-precept mother.’ They are women who observe the ten precepts (rather than the fuller Vinaya) and live a renunciant, celibate life, often in robes, but formal ordination has not translated into formal recognition by the state. Even after a Supreme Court ruling affirmed their right to be identified as bhikkhunis on their National Identity Cards, many still do not hold one. This stems from the hesitation of the male-dominated Buddhist hierarchy to recognise these women as part of the Theravada tradition, specifically refusing to validate their higher ordination. The identity card lists her title as Dasa Sil Mata. The ruling exists on paper, but they are still waiting for their identity cards. This is not a small bureaucratic oversight. It is the first link in a longer chain, one that reaches, eventually, into the classroom.

A Name Withheld

In Sri Lanka, there are 827 pirivenas, traditional monastic colleges that have, for centuries, served as the primary institutions of Buddhist education. Of these, only 12 are dedicated to female renunciants at all, and of those 12, just five serve fully ordained nuns specifically. The imbalance is stark on its face: 827 institutions for monks, five for fully ordained nuns. But the discrimination here is not only a matter of numbers, but it is also written into the very language used to name these institutions. Monks’ schools are called pirivena, a term carrying centuries of institutional weight, historical continuity, and state recognition under Sri Lanka’s education laws. Bhikkhunis’ schools, by contrast, are not called pirivenas at all. They are designated Buddha Sravika Meheni Adhyapana Ayathanaya (Institute for the Education of Buddha’s Female Disciples), a separate, parallel term that, however similar in function, withholds from bhikkhuni institutions the same legal and institutional status that the word ‘pirivena’ confers. Since there are ten-precept mothers, the institutes have not given the same name as the pirivena and lack the official as well as social recognition they deserve.

A Pattern a Century in the Making

Following the decline of the Buddhist nun (bhikkhuni) order after the Polonnaruwa period, the first woman to be robed again was ordained in 1905 as a dasasil matha. Although dasasil mathas have long served important religious and societal roles, they have historically lacked access to formal education. Unfortunately, today also, this pattern continuous to exist. Education, in this context, is never just about literacy or dhamma study. It is the currency of religious authority. A bhikkhuni denied equivalent education or educated in an institution the state refuses to name a pirivena, is denied that religious authority. She may know the Tipitaka as well as any monk yet will lack the institutional stamp that would make a lay community trust her reading of it. It was not indifference from the public; it was the accumulated effect of a system that has spent centuries teaching devotees, implicitly, that a woman’s robe does not carry the same weight as a man.

The female renunciants, both dasasil mathas and bhikkunis, although they wear robes, have not been regarded as individuals capable of comprehending or preaching dhamma, simply because they are women. This is most visible in education, the pirivena system, developed historically to train bhikkhus, offered dasasil mathas and bhikkunis no equivalent institutional pathway, no comparable curriculum, certification, or state recognition. This exclusion is notable because it runs counter to Sri Lanka’s broader educational trends, where women have historically outnumbered men in general university enrolment, the gap here is specific to monastic/religious education rather than a reflection of wider societal restrictions on women’s schooling. The country’s National Education Commission Policy has a section on Pirivena education. However, it does not address the education of Buddhist nuns, nor does it mention nuns within the policy. I recently learned that the policy was being reviewed, with a committee appointed by the Ministry of Education, scheduled to begin the review on the 1st of September. This presents an important opportunity to raise the issue of nuns’ education and advocate for its inclusion in the revised policy.

The monks and nuns’ education institutes are funded by the government, which allocates only 5,000–6,000 LKR per student for the entire year. This sum is grossly inadequate to cover even basic institutional needs, accommodation, food, learning materials, and the maintenance of the physical premises, let alone to support any meaningful expansion of the curriculum. With this level of funding, these education institutes are struggling to sustain themselves, and many are forced to rely almost entirely on external support simply to remain operational. This is where the disparity becomes most visible. As female renunciants have historically not been taken seriously, regarded neither as authoritative teachers of dhamma nor as figures worthy of the same reverence extended to their male counterparts, their education centres receive far fewer lay offerings than those for male renunciants. The result is a widening resource gap that mirrors and reinforces the very discrimination that caused it. Underfunded institutions produce fewer well-trained female scholars, which in turn reinforces the perception that female renunciants are less capable, a perception that then justifies continued underinvestment. Without deliberate intervention, either through equitable government allocation or targeted lay support, this cycle is likely to persist rather than resolve on its own.

Sitting Alone at the Bo Tree

I was at Jaya Sri Maha Bodhi in Anuradhapura, where a few monks sat preaching in the shade of the Bo Tree, each surrounded by small clusters of lay devotees. Nearby, I noticed a few female Buddhist renunciants, though I could not immediately tell whether they were bhikkhunîs or dasasil mathas, since visually, in their robes and demeanour, they appeared indistinguishable to an outside observer. Most of them sat alone, without the small crowds of devotees gathered around the monks nearby. This, too, is not incidental. Because women cannot enter the sâsana through the same pathway to ordination, available to men, many Buddhist female renunciants remain dasasil mathas, a status that carries the appearance of monastic life without its legitamised spiritual standing. They observe the 10 precepts, wear robes, and live in renunciation, yet occupy a lower, unofficial rung in the religious hierarchy, one that grants them neither the ordination lineage nor the institutional recognition given to monks. However, in June last year, the Supreme Court of Sri Lanka delivered a landmark majority ruling in SC/FR/218/2013, affirming that fully ordained Buddhist nuns have the fundamental right to use the title ‘Bhikkhuni’ on their National Identity Cards, legally recognising the de facto existence of the Bhikkhuni Sanga.

A Closed Loop

Social discrimination and educational discrimination feed each other in a closed loop. Because bhikkhunis have fewer, less recognised institutions, fewer are formally trained to a standard the public recognises. Because fewer are recognised as authoritative teachers, fewer devotees seek them out or support them. Because they attract fewer devotees, the education institutions of female renunciants remain under-resourced and easy to overlook in state budgets and in popular imagination alike. A dasasil matha or bhikkhuni without an active following also lacks the economic support that following brings, since in Sri Lanka’s monastic economy, devotees are patrons as much as students. The precarity is not only spiritual or bureaucratic; it is material, and it compounds across a lifetime spent in robes.

Until bhikkhunis’ education is named, funded, and recognised on the same terms as that of bhikkhus, this will remain a story not only about missing ID cards or under-resourced schools, but about an education system that continues to decide, quietly and continuously, which students are worth investing in. Education was supposed to be the one place where the women can speak for themselves, instead, for these women, it has become just another place where women have to ask permission to be heard.

(Anushka is a Sociologist who is working on contemporary Buddhist movements. She was formerly attached to the University of Colombo)

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

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‘Memories of Milton – Live in Concert’ to enchant Dubai

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Seven Notes: Doing it in Dubai

Sri Lankan music knows no borders. Wherever our people go, our melodies follow — and our musicians make sure of it.

From Qatar’s Exit, to Melbourne’s EBONY, to Toronto’s Ceymphony, and Dubai’s Seven Notes, Sri Lankan bands abroad continue to keep the community connected to home, through song.

In July, Rajiv Sebastian set the Dubai stage alight with the band Seven Notes, creating an unforgettable night for Sri Lankans in the UAE. And the live-wire behind that magic? Niluk Uswaththa of Seven Notes.

Well, Niluk says he isn’t stopping there.

Now, Dubai is preparing for something truly special — ‘Memories of Milton – Live in Concert’, a grand musical tribute to one of Sri Lanka’s most beloved voices: Milton Mallawarachchi.

For more than a decade, Milton Mallawarachchi was a trending force in Sri Lankan music. With nearly 850 songs and over 35 albums to his name, he gave us melodies that became the soundtrack to our lives — songs of love, longing, and life itself.

On Saturday, 26th September 2026, from 8:00 PM to 3:00 AM, the Mercure Hotel, Al Barsha Heights, Dubai, will transform into a space of nostalgia.

Ranil Mallawarachchi; Carrying forward his father’s legacy / Yenuli Neriah

With the spotlight on Ranil Mallawarachchi — Milton’s eldest son, carrying forward his father’s legacy — along with Yenuli Neriah and Tharaka, the evening will certainly bring Milton’s timeless classics back to life … on one stage.

Seven Notes will do the needful, providing the live music that made Dubai dance before.

According to Niluk, this isn’t just a concert.

“It’s designed as a nostalgic musical journey — to bring cherished memories and beloved songs back to life,” he says.

And he promises: 26th September will be a night to remember.

In fact, Niluk Uswaththa has become a driving force for Sri Lankan entertainment in Dubai.

Through Seven Notes, he ensures the community always has something special to look forward to — especially when it comes to music that feels like home.

The success of these overseas shows naturally raises one big question back in Sri Lanka.

Yes, music lovers, in Sri Lanka, are keen to know whether the Seven Notes band will pop up in Colombo, sometime soon, for a live performance?

Music lovers, island-wide, will be watching … and waiting!

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