52 posts tagged “health system”
“In Putrajaya Hospital, you need to make an appointment three months in advance for such a service. In Kepala Batas, more than 4,000 patients had been treated since January,” said Health Minister Datuk Liow Tiong Lai. Traditional complementary medicine (TCM) will be introduced in three more government hospitals in Terengganu, Sabah and Sarawak next year following the good reception to such treatment at three hospitals that had offered it first.
The full article here
As I have mentioned, this is not about medicine nor well-being of patients. This is about business. The Health Minister implies that TCM must also be good until there is need to expand it. (You can't expect the Health Ministry to expand a service which is not good for the well being of patients right?) And it also implies that the longer you need to wait, the more terrific the treatment must be.
So why the fuss if patients have to wait for a 3 month appointment to see me? They can take the TCM route first and then wait for my 3 month appointment too...and don't complain if your tumour has grown to a size of football...3 months for my service too...
I have my reservations on how the Ministry plans to regulate the extremely diverse TCM with their rather "unscientific" practices when they cannot even issue the full registration/ annual practising certificates(APC) for bona fide doctors on time every year. There are even bona fide doctors practising without valid APCs for years in public hospitals.
I'm positive if the all patients ditched proven modern treatment and goes to the TCM route, the Health Ministry will close all current hospitals and convert them into TCM hospitals. It's just business, business and business...supply and demand. Nobody mentioned anything about whether the treatment works or not.
I was just thinking and reading some articles on doctor's morale. Seems like the morale of the medical profession is declining around the world thanks to the complexities involved in medical care. It's not as simple as patient gets sick, sees doctor, get some medication, pays doctor, goes home and gets better.
Now medical care is tangled in a complex web of government policies, increasing legislation, increasing costs of healthcare, the entities of managed health care organizations, insurance companies and the pharmaceutical industry. This is coupled with the increasing expectations from patients and the lack of resources to cater to this expectation.
We often hear of some malpractice suits, patients' complaints..etc. etc..as long as something goes wrong it get's publicized. How often do we hear the doctor's side of the story? We have all heard of the baby in Klang whose arm got amputated because of alleged misplacement of an intravenous canulla. Till today, no one has heard the doctor's side of the story. Or was the doctor asked to keep mum?
Does the public hears of doctors' laments? How doctors work 36 hours in a stretch without sleep? How doctors do not even have time to take a meal nor a bath? How doctors do not even have a place to sleep? How doctors work through weekends and public holidays? How doctors work in a hostile and under extremely trying conditions? How doctors get needleprick injuries and occupationally acquired infectious disease? And at the same time can MAKE NO MISTAKES?
NO the public doesn't want to know about the deficiency of the system. All they know is they are sick and they want the BEST for themselves (without paying much lah). And nothing should go wrong. If anything goes wrong, they'll head for the newspapers or the lawyer's office. Somebody must pay for that mistake.
How often have I given Medical Certificates to patients out of compassion rather than due to sickness in its truest sense? (which I have ceased to a large extent) Patients who wants MC for 3 days for a 15 minute consultation. One day to travel to see the doctor, the day itself for consultation and the next day to travel back. Sometimes MCs for you to collect your medications at a later date too! Yes MCs for your convenience (despite knowing you could have done all those in a single day if you want) so that your salary is not deducted and to save you from taking your annual leave. MCs for your flu, MCs for your stomach pain, MCs for your diarrhoea, MCs for your headaches, MCs for your toothaches. Even MCs for your back pain because you slept the wrong way. Even when your finger wound has healed but you claimed it to be still painful. Still cannot write konon...
However for doctors it is a different story. Every MC taken by a doctor is viewed with suspicion. Got flu only mah..still can work. Fever? Just take a panadol and go to work. Diarrhoea? Go to work after going to the loo. Cannot take MC. Sometimes hospital administrators additionally demands that the MCs to doctors must be issued by a higher ranking doctor. Meaning House Officers and Medical Officers must obtained the MC from a specialist. Never mind if it's just some URTIs. Cannot take from fellow MOs. Somehow there is this perception that doctors are dishonest and always trying to avoid work. How insulting!
Anyway, if it is true that doctors are always avoiding work then something is very very wrong with the system. People avoid work because of no motivation, low morale, hostile & difficult working conditions and along the usual overworked, underpaid line. Very few people will avoid work purely because of disinterest or sheer laziness.
And if it is true that doctors are frequently getting sick and taking MCs frequently then it implies exactly the same thing as above! In addition to a hazardous and dirty working environment. With no time for proper nutritious food, adequate rest and exercise.
And why are colleagues upset if you take leave? Because it means that they have to do your work! And why are they upset having to do additional work? Same reasons as above.
How sad our state of affairs are. An organization can only produce good results if it's workers are highly motivated. If not, everybody will avoid work or just do the bare minimum with no pride nor intention to achieve excellence. With low morale, even a large army can be easily decimated. But as usual, the powers that be chooses to turn a blind eye and continue believing in their own lies of "first world infrastructure and first world mentality"
I'd better rant this off before losing steam.
Have you noticed a new generation of bureaucrats in M'sia who are obsessed with form over function? Or it has always been this way..
If we were to built a space shuttle to space, these bureaucrats would be more concerned if the rocket is painted red or blue, if the rocket has a signage writing "Made in Msia"..in the right font and size. If the writing is in black or blue color. And if the engineers building it had taken their PTK exams. If not, you will not be paid and no lift off.
These attitudes of bureaucrats who are essentially controlling the administrative system has bred a new generation of M'sians with stifled thinking. Not to blame our young people, coz the system has forced them to toe the line according to the bureaucratic stupidity. Like must print out in A4 size paper, must write in capital letters, must use black and not blue pen, must use 2B pencils, font must be New Roman size 12 with double spacing...etc. Or else it's no go, it will be rejected. This robotic stupidity has caused a new generation of Malaysians who think that form is more important than function. They worry that if they don't do exactly according to these stupid instructions, they will be rejected. Thus their creativity and critical thinking are stifled.
Never mind if the rocket's engine is not powerful enough or if the design is unsuitable for spaceflight, the most important thing is the colour of your rocket. Alternatively even if your rocket is highly sophisticated and sought after by many countries, it will be rejected by our M'sian bureaucrats if the words "Made in M'sia" painted on it is the wrong font size.
This stupidity exemplified the system we are in now. And the frustration of the people under these administrative conditions. The few really clever ones will manipulate the system to their advantage but by and large most will suffer. The honest ones.
Why have we evolved into this stupid bureaucratic system? Because M'sians of substance have left the country and we are left with many graduates with dubious qualification and training absorbed into the civil service administration. We are producing so many graduates and somehow the government must provide jobs. And since these graduates cannot comphrehend substance, they can only worry about the form. Sad..sad..
Administrators are essential for any organization but when they lose touch with the core service providers and set their own standards based on their whim and fancies...
Admin : We cannot achieve our "Piagam Pelanggan" ( Clients charter) of providing a medical report in 4 weeks when requested by patients. We need the doctors to complete a report by 2 weeks and submit to us. We can only achieve our "Piagam Pelanggan" 30% of the time.
Doctors : Well, 2 weeks is too short. Doctors have other important work to do also...and sometimes doctors go on leave, for courses etc..
Admin : Why doesn't the department assign certain doctors to write medical reports only? ( and not by the doctor who treated the patient ). Thus it's easier for us to track down the couple of "medical report writing" doctors. (basically it means to harass them periodically for the reports)
Duh...yeah I wonder why.
Well for starters, hell I'm going to write a report for a patient I've never seen in my life. It's like asking me to write an MC for a patient I've never seen in my life. Nobody can force me to write any report for someone I've never met in my life nevermind treated. This is my absolute professional perogative and it's wrong to do so.
And if the admin ever read any insurance claim form, the first line would be "How long have you been the claimant's medical attendant?" or "Are you the claimant's usual medical practitioner?". According to the proposed system of "medical report writing" doctors by the admin, the right answer would be "Never seen the patient in my life. I've been asked to write this report based on the case notes". Then the doctor can legally and with conscience sign at the end of the report at the column "This report is written as truthfully possible in my best of knowledge" Doesn't it sound ridiculous?
Well, this is the result of setting your own "Piagam Pelanggan" without consulting your doctors. You could have asked your doctors what is the reasonable time for providing a medical report before coming up with your piagam. Taking into account the lack of doctors and heavy workload.
To be fair I think the admin officers are being harassed by the patients for their reports also. Well, it's just too bad. The patients will just have to wait. This is not a concierge service.You have been given essentially free treatment, free medications and you are well now. It doesn't hurt to wait for a couple of weeks for your report. Overburdened doctors have other pressing matters to attend to like getting a bed for ventilated patients. We hardly have the time nor the place to prepare your reports quickly. And to make matters worse, we cannot do it after office hours because we are not allowed to bring your case notes home.
However, some doctors love writing reports because they are paid a token fee by the patients through the hospital. So if you write say 30 reports a month, the additional income could be useful. But as for me, most of my patients don't even have enough money for bus fare to the hospital, how could I ask them to pay for a report? So it's charity work as usual. And I can't remember when it was the last time I got a check from the admin for my occasional paid medical reports. Ironically the most common report I'm asked to fill is to the welfare department asking for financial aid.
And compare the token fee for a medical report to some contract prepared by a lawyer...it's kinda insulting.
It doesn't end. There is no beginning and there is no end. There will always be another patient. Another admission. Another referral. There is no end to what should be done.
Where does the doctor's responsiblility end?
Patient defaults - Why didn't you trace him up?
Patient defaults because he wants to do...on that date - Why didn't you adjust the schedule for him?
Patient has no money for whatever - Why didn't you refer him to the social worker/social NGOs?
Patient refuses treatment - Did you explain it yourself? If yes, then your explanation is no good...
Patient got no transport - Why didn't you ask for an ambulance?
Patient is cachexic - Why didn't you ask for high caloric diet?
Patient did not take medication according to instructions - Did you explain it to him?
Patient's investigations got screwed or delayed - Why didn't you ask him to do privately?
Patient's sample got missing - Why didn't you bring it yourself to the lab?
Patient's result not available yet - Why didn't you call and trace?
Patient developed complications - Why didn't you tell him it can happen?
Patient developed further complications - Why didn't you refer to that department earlier?
Patient developed more complications - Why didn't you refer to Dr X instead?
Patient passed away and family unhappy - Why didn't you explain to the relatives of the risk?
Patient gets better and wants to claim insurance fast - Why didn't you write the medical report faster?
Patient doesn't want to go home and thus no more beds - Why didn't you discharge him earlier?
When patient goes home - Life goes on. Till the next patient. And it goes again...
The doctor is always left with the burden of doing everything and explaining himself to everybody. This is the end result of lack of personnel, lack of funds, lack of facilities and an overwhelming number of patients. With unrealistic expectations. Worst still if your superior is not living on planet earth...
Treating patients is only part of the doctor's life. There is more to life than the hospital and the job. Patients will never end. Precious moments with family and friends and opportunities in life might be lost in this job. When one can't take it any longer, it's time to say goodbye.
Day by day, I think my enthusiasm for this profession is fading away little by little. I think it's because of the way our health system has turned out. Not only in M'sia I guess but around the world too. Darn...I could have taken any course...I mean any course in university.
You can't blame some doctors for a little nonchalant about their patients, a little cold hearted at seeing death or a little non-committal to treatment decisions. Today there is a paradigm shift in patients' thinking. Today's patients do not put priority on "tender, loving, care". They want guarantees they get their diagnosis STAT, they want to be cured STAT and they expect state of the art treatment FOC if possible. As soon as something adverse happens, they are quick to point fingers. Somebody must be responsible for that. After all the government keeps on harping that we have "World class infrastructure, world class facilities and world class expertise" so nothing should go wrong. (Btw, I thought it is mainly medical personnel that is migrating south in droves but a recent article in the newspapers, lawyers, architects etc etc are also leaving M'sia in droves)
Well, so today's doctors also have a paradigm shift. Avoid being blamed at all costs. Despite knowing the futility of treating an extremely poor prognosis patient who will obviously die (some people may argue that a miracle can happen), doctors offer all kinds of "possible" investigations and treatments. Never mind that we do not have access to the treatment, never mind that we do not have enough beds for treatment, never mind that patient obviously cannot afford it and never mind that it is unlikely to be of any benefit (but still "possible", yeah anything is possible). But if the patient gets worse or dies, the doctor is absolved of any "negligence". "Hey, I told you so you need this and that but you couldn't get it/it's not available so it's not my fault"
I just wonder if it is ethical to offer a treatment which we obviously have no access to. Patients will feel shortchanged and distressed that he is not getting that "elusive state of the art treatment" and lose hope. But hey, that's not the doctors' problem. Doctors are just adapting to the demands of todays' healthcare and society's expectations. Defensive medicine. Avoid being blamed at all costs. Perhaps later must refer the patient to psychiatry for depression as well...how ironic!
Patients also are are quick to demand anything in the public sector, but if it is the private sector I guess you'll have to talk till your jaw ache to justify a RM100K medication which is no miracle cure either - but patients expect a miracle cure because they are paying so much !! On the other hand, once you mention the costs of treatment to the public patients, they shut up very quickly, just for a brief moment...before they open up again and say why can't they get it free from the government !!! Dang...can never win one.
Anyway defensive medicine is here to stay whether anyone likes it or not.
There is a new circular going around to all the department heads. Apparently the matter was agreed upon by the state health director and some heads. Guess what was this circular about?
The circular states that specialists MUST teach house officers in their department. If not....brace for this...they must be reported to the State Health Director. Wah lau...whose bright idea was this?
Firstly I think this is a feeble attempt to rectify the increasingly poor quality housemans. Yes, now they are pushing the responsibility of training doctors to the extremely busy government specialists rather than addressing the underlying issue of poor quality students being admitted to the mushrooming medical schools to the various "dubious quality" medical schools. It's like blaming the examiner if a student cannot pass an exam. Yeah, blame the piano teacher if the child doesn't have any musical acumen.
Secondly, how do you enforce such a directive? How do you "force" someone to impart their knowledge? Can you? How do you prove that teaching did or did not take place? Especially in a field where learning takes the form of an apprenticeship. What action can be taken if a specialist did not teach his housemans? Sack him? Is it in his job description to teach housemans?
Thirdly, what is the ratio of government specialists to housemans? Considering the large number of graduating medical students nowadays.
Fourthly, what about Medical Officers? They do not need to teach housemans??!!
The specialist may be obligated to teach his housemans but is he legally compelled to? Teaching an apprentice is the perogative of the teacher. What is taught and how it is taught is the perogative of the teacher. And it depends on the apprentice's capability. Can you throw a monkey to a kung fu master and expect him to turn the monkey into Jet Li?
I think a better method is giving some incentive eg paying overtime after office hours for the specialists to teach housemans, as teaching housemans can be very time consuming. For example a senior doctor can insert a chest tube in 10 minutes but teaching a houseman to do it can take hours. After all if you have 40 patients in the ward plus some on the floor and another 40 waiting for you in the clinic, your priority is how to finish seeing all the patients in time for clinics...and how to find more beds for new admissions. If one were to spend teaching housemans at the same time, one might as well forget about going home that day.
Hmm...I wonder is this the result of some complaints by HOs?
I found this list of "Quality activities" in the ward. Wow...this list exceeded my expectations. Never knew some of it existed. There are 25 "quality" activities in the hospital to ensure "quality service"!! But who are doing these activities? The same handful of doctors and nurses, in addition to their overloaded work and responsibilities with an overcrowded ward. Seriously which clinician is interested to do all these crap activities? All I can say is, please leave me out of it. Cannot "tahan" doing crap paperwork. Unfortunately I was "trapped" into doing one of them though :(
Please feel free to scrutinize the list!
Notable crap activities are : Corporate cuture, Development of administrative circulars, Total Quality Management, Innovation, MS ISO 9001:2000, Accreditation, 5S, Communication & Information Technology, Bench marking, Quality Control Circle and lastly Therapeutic garden!
I think we are trying to squeeze water out of stones.
Rice, is something we may have taken for granted. In the era of MacDonalds, steakhouses, Japanese cuisine and fine dining, rice is something regarded as cheap food. It is not surprising to see people in buffets ignoring the rice and target the "expensive" food like meats and seafood instead. In the restaurant, we have often seen extra rice being asked and then not finished and left on the table.
In a country where natural resources are aplenty, yesterday I was given an insight on how a local family, as the guardian ( also known as "jaga") of a probably multi-million dollars sports complex had for dinner. The local lady was given a room (more like a store room) beneath the spectator's seat to live. 3 elderly ladies were sitting around a discarded table and heaps of discarded chairs which was used once for some VIP parade in the stadium but were now left to rot. A couple of malnourished cats roamed nearby.
The lady had plain white rice for dinner with a bowl of Maggi Mi for company. Yup, plain white rice and maggi mi as the "vegetable". Something tugged at my heart. In our country where natural resources are aplenty, and multi billion mega projects are cropped up on a daily basis, this is something that should not happen. (to me at least)
Poverty is a disease which needs to be eradicated. When our country can boast the tallest and longest and can offer ONE MILLION RINGGIT to an Olympic gold medal, I can't help but wonder about the priorities our country is taking.
What is the point of having the most sophisticated scan machines and medications when patients do not even have proper nutritious food to eat due to poverty? Who benefits more from the the purchase of medications? The patients or the middleman or the pharmaceutical company? If you ask me, proper nutrition and food has more benefit than the few hundred ringgit anti-platelet agent. Proper nutrition and food is going to help the bed bound stroke patient with horrendous bed sores more than the few thousand ringgit of antibiotics.
Poverty is endemic around here. We have read about the apparent fair distribution of the country's wealth in various forms and agendas but to me what's more pertinent is the fair distribution of opportunity. Every citizen should be given equal opportunity to better themselves rather than dishing out money to them. If lazy people do not want to work despite given the opportunity then they themselves are to be blamed. But I can't help but feel that most people here (especially locals) do not have the opportunity to better themselves as these opportunities are being siphoned by the "powerful connected" people leaving crumbs behind.
I'm sure many of our leaders' children are busy studying overseas while back at home there are so many children who are not schooling due to poverty. They have to find means to put food into their stomach instead. Some schools are in dilapidated conditions too.
With the rising price of rice, I'm not surprised if some poor village people may need to resort to eating tapioca to survive. Which reminds me of the time of the Japanese Occupation as told to me.
Poverty, is the world's most prevalent and deadliest disease. Not heart attacks. It is the greatest tragedy of all times if a person dies of malnutrition due to poverty in our country. Which I'm sure is under-reported.
I was sponsored for a weekend talk held in a luxury hotel :) There has been on and off debates whether this is an unethical practice. In fact there has been an explicit circular from the director which barred doctors from accepting any form of sponsorship.
Well, I accepted it anyway. So did many consultants and even heads of departments from hospitals all over Malaysia including participants from Korea, India, Japan, among the many Asian countries. In any case, there was a disclaimer stating that the sponsorship is "not conditional upon any obligation to use, recommend, promote or purchase the product or intended to influence you to do so", which I take it as face value. In any case, it is the only opportunity to listen to 2 prominent researchers, one from Italy and the other from a renowned institution in Texas. I don't think the government can or rather will sponsor them to come to Malaysia for our benefit. Sure, the company promotes their product but it is also for the benefit of our patients. Sad to say without the pharmaceutical industry support, we will probably be still living beneath our coconut husks.
The hotel was luxurious. But the best part was meeting up with friends and have a good chat.
It was great, but after 2 days I can't wait to get back to my spartan room. I suppose I'm comfortable with familiarity. I wasn't able to sleep well despite the luxurious bed and pillows. It just shows that money can't buy some things. There wasn't the familiar feel, familiar smell, familiar touch. And I didn't even use most of the things in the room.
However I managed to take a few snapshots of the surroundings with my camera ;)
