39 posts tagged “hospital”
“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"
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.
On and off I do come across some hilarious debates with patients. Brightens up the day. Usually they are the very elderly ones from interior districts. Usually they have some chronic disorder, not too serious but may not be too benign either. And they inevitably will refuse any invasive investigations.
It usually goes like this (via translation sometimes):
Me : Makcik kenapa tak mahu?
Makcik : Takpe lah, dah tua. Bagi ubat saja lah.
Me: Tapi kalau tak tau apa sakit, apa ubat nak bagi?
Makcik : ...ubat sakit-sakit...ubat dugal...sini sakit...sini ada angin...sini asam...etc..
Me : Makcik...macam kereta...kalau tak jalan sudah mesti bukak enjin tengok apa rosak...Kalau itu kilang rosak...mesti tengok apa yang tak jalan...
Makcik : (smiling)
Me : Macam kereta...badan tak ada spare part...mesti baiki jugak.
Makcik : Takpe lah..sudah tua...lain kali sajalah
Me : Kalau lain kali...nanti sudah lambat...nanti...nanti...
Makcik : ...boleh terus masuk gol lah...hahaha...
Another familiar conversation:
Pakcik : ...sudah tua...sakit sini..sakit sana...
Me : Masih muda pakcik...boleh hidup lagi sampai 100 tahun
Pakcik : Hahaha...dulu masa zaman Jepun...bla...bla...bla...dulu ada sakit-sakit sikit tapi sekarang jalan pun susah...
Me : Ya pakcik..memanglah macam ini...macam kereta...minyak enjin tak cukup, tayar sudah botak...jalan pun bunyi-bunyi...
Pakcik : Ya betul...betul...doktor, terima kasih banyak-banyak
Interesting to converse with analogy :)
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.
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.
I don't know if it's a coincidence or a result of the recent fuel price hike but ever since the price hike is announced by the government, my ward is packed like sardines. Not in a neat row on the floor, but in whatever position to accomodate as many as possible. And today for the very first time, for a very very long time...we ran out of camp beds! Mattress were literally put on the floor. The last time I remember this scenario was perhaps 7 years ago? It was made worse by the fact the a private medical center was desperately trying to transfer an ill, bed bound patient over to my ward. No prizes in guessing the reason lah. Can't blame them, they are not a charity organization. What to do? Take over lah...
Maybe I should make my own "incident report" and suggest my own remedial measures which would be umm...3 orang kongsi 2 katil? Hahahaahahahaha
On a more serious side perhaps sending them to district hospitals may sound good, but many refused because there are no specialists there and "tambang pergi balik mahal" - for those who are just waiting for something eg scans, endoscopies etc hahahaha.....back to fuel price again. They prefer to stay in hospital and wait for 2-3 days. Free food, got missy to call, got company to chit chat, can complain if service not good some more...
Desperately wanted to take a picture of the ward but then to protect the patient's privacy I refrained.
But ONE patient made my day. A really old charming cheerful lady who said "Saya mau balik jaga ayam saya...kalau tidak tiada orang jaga" and laughed. I asked how many chickens she has, she mumbled something and we laughed together. It is always the VERY ELDERLY "uneducated" village folks (ladies usually), many of whom can't even speak proper Bahasa, who have the most sense of humour. I salute them for having such a cheerful outlook and sense of humour even though their days are numbered. Perhaps we can learn something from them.
At the end of the day, it was the chickens that made my day.
Remember these familiar words? Yeah the famous words of mini buses' conductors in KL perhaps 10 years ago...the pink BMW (Bas Mini Wilayah) ones which will stop anywhere...yeah anywhere you ask even at the roundabout. Aahhh....the memories of my student days in Uni.
Today these magical words brought back those long lost memories. My ward is like those mini buses....boleh masuk...belakang boleh lagi...(Translated: Come in...can come in some more...behind can some more)...hahahaha...despite having camp beds on the floor till the nurses counter. A patient with oxygen was waiting on a stretcher waiting for a bed at the counter. It gets more amusing reading this where our Health Minister said Govt Hospitals were getting ready for increased volume due to the price hike/inflation. Yup we are still in the Bus Mini era. Masuk...masuk...belakang boleh lagi masuk...
Sad to say the measures taken by MOH are NOT WORKING. It's not just because 300 medical officers and 50 specialists resign every year. It is not just about getting enough doctors...To treat patients you need BEDS, you need MEDICATIONS, FUNDS $$$, DISPOSABLES, BLOOD BANK SUPPORT, LABS, DIAGNOSTIC EQUIPMENTS, LAB TECHNICIANS, NURSES, DIETITIANS and the whole lot..etc. Problem is we are still not past the "getting enough doctors" stage yet.
It's really no point getting enough doctors and cut down waiting time to 30 minutes then say no budget for medications, no beds, no scans available etc etc. Unless you want doctors to practise some traditional healing and use "miracle water" to do some chanting....ZAM ZAM ALA KA ZAM! and poof patient gets better! Hey, maybe that's what the MOH wants.
Currently also cannot cope already how to get ready some more ? Duh...
Some sort of healthcare financing scheme gotta be implemented soon.
Ah...the inevitable. The rise in petrol prices.
There will be 40% price increase in petrol (ULG 97) from RM1.92/litre to RM2.70/litre today but there will be a rebate of RM625 per year for each car below 200cc capacity.
Hmm...reminds me of the many "charity work" some of us did many times in the past. Frequently we had to drive about 30km to another hospital to see referrals. Initially we were only allowed to claim mileage, later it was changed to passive on-call claims. I remembered my claims for a couple of months' "expired" because I didn't have the time to drive there during office hours until the end of the "closing account date for that year". That is for Medical Officers.
For specialists though, currently we are doing "charity work" also. On calls for 2 hospitals but claiming only for one. The other hospital which is 30km away, mileage claim could be done if we did go there. But then we need to drive 30km x 2 (to and fro) to see a patient after office hours and then 30km x 2 again during office hours to hand in the mileage claims (a stack of them). Most of the time I just forgo the claims or just don't go. Too much hassle and not worth the effort nor trouble.
The amount that you can claim for a trip = 60km x 50 cents (say 50 cents/km, check out here) = RM30. But you actually travel 120km (additional 60km to hand in the claims during office hours!). With the petrol price of RM1.92/litre with a consumption of say 10km/litre ( your car damn efficient lah, and no jam) , you'll be spending RM1.92 x 12 litres = RM23. The RM30 ringgit mileage claim seems appropriate.
But with the petrol price increased to RM2.70/litre, you'll be spending RM2.70 x 12 litres = RM32.40. So essentially if the mileage claim remains unchanged, you'll be paying RM2.40 to go and see a patient. I repeat, you'll be paying to see the patient even if you claim mileage !!!
Don't know whether my calculations are correct or not.
Anyway it doesn't sound like a good deal to me and to quote someone, "What about the wear and tear to your car?"
