Dear Health Minister, please, it’s not “instant noodles” medicine
posted in - Nation, - Palmdoc |
We read in the news that the Health Minister continues with what his predecessor set out to do: cut down waiting time in public hospitals.
Health Minister Datuk Liow Tiong Lai said yesterday that patients currently waited an average of 90 minutes before being attended to by specialists.
“I have already set a target waiting time for general outpatient treatment. Now, we will study what should be the ideal time for specialist treatment,” he said after a working visit to the Kajang Hospital.
Liow said the targeted waiting time for specialist treatment would not be 30 minutes that he set for outpatient treatment.
“One must understand a specialist takes more time to examine patients,” he said.
Doesn’t the Health Minister realize the irony of his statement in the last line? The reality of it all, is that after waiting for “specialist treatment”, the patient is in fact more likely to encounter a medical officer rather than a specialist in the “specialist clinic”.
I’d like to repeat once again the wise saying of Bushido@Dobbs (indeed I’ve incorporated this into one of the MMR Quotes which you see randomly displayed in the upper right hand corner of the page):
The practice of medicine is not like instant mee – it’s not how long you wait but what you get at the end which matters
Precisely, dear Health Minister. I think you should forget about waiting times. Concentrate on Quality. There are issues which are far more important to the doctors running the clinic which could improve efficiency. Lousy records management resulting in 404 situations (that’s Internet-speak for “file not found”). Missing or untraceable lab results. Computer system going down. Actual specialist not around – too busy attending some mesyuarat somewhere.
In any case, this pursuit of “shorter waiting time” is an exercise in futility. Why? That’s because many patients don’t keep their appointments anyway! They either don’t come on time or sometimes don’t show up at all. That’s the Malaysian style lah. You know, Malaysian time!
What I suggest is that the MOH (or any hospital for that matter) could put up a Doctor and Patients’ Charter which reads something like that:
We Guarantee Patients a Clinic Waiting Time of Not More Than 30 Minutes
** Terms and Conditions Apply
And in the small print, the T&C are:
1) If any patients don’t turn up on time or are late for their appointment, then the guarantee for the day does not apply as this messes up the appointment system.
2) Turning up earlier than scheduled does not necessarily mean you will be seen earlier, duh.
3) Turning up on the wrong day means we are likely to reschedule you to another day. There is no guarantee of being seen on a non-appointment day.
4) Don’t expect the specialists clinic to see you quickly just because you feel your problems are “urgent”. We have the ER for that.
5) Patients in the wards should be considerate enough not to suddenly become ill or arrest during clinic times as the doctors will have to leave or be late for the clinic to attend to them. If any of them do, then the clinic waiting time guarantee will not apply.
Any doctor working in a Government clinic will tell you that practically everyday, you’ll see 1, 2 or 3. So hey, it’s impossible to guarantee you short waiting times, dear patients, simply because some of you don’t know how to keep appointments! It works both ways!
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May 16th, 2008 at 10:47 am
Haha well said Palmdoc! The best noodles are cooked with love and care plus quality ingredients.
May 16th, 2008 at 12:32 pm
Maybe our present DG has a solution to this? Who knows… We should ask him instead?
May 16th, 2008 at 2:32 pm
I’d posted this in a doctors’ only forum, but I think that the lay public should also know this:
“Even a junior MO who is in his/her first week as MO right after completing housemanship, can also be asked to see patients in the “specialist clinics”. Simply put, the “specialist clinics” are those clinics which are not OPDs.
If a patient had been discharged from a ward, the patient will attend followup in the corresponding “specialist clinic” corresponding to the department or ward from which the patient had been discharged.
Patients in these “specialist clinics” are certainly misled if they think that they are seen by specialists who are properly qualified. Often, it’s simply a matter of luck whether the patient gets to see a junior MO, or a senior one.
In the wards, where the clinical specialists or consultants do ward rounds, there is often better supervision of management of the inpatients. But with the high volume of outpatients in the clinics, the specialists can’t oversee the management of each one, and often the MOs manage as they see fit, and reserve consultation with the specialists only for the “more complicated cases.”
Whether the management for the “less complicated cases” are correct or sound, is often a matter of capability and experience of the individual MO. Often, it’s simply a matter of luck which MO the patient gets to see.”
May 17th, 2008 at 11:34 am
“Doesn’t the Health Minister realize the irony of his statement in the last line? The reality of it all, is that after waiting for “specialist treatment”, the patient is in fact more likely to encounter a medical officer rather than a specialist in the “specialist clinic””
Well, you have a point but this is the opinion of a frustrated doctor who choose to opt out of the system because they cannot solve this problem and thus chose to run away from it. For us who choose to stay and willing to serve and see these poor patients who can’t afford to spend money getting the ‘specialist care’ in the private hospital, I would like to ask for constructive suggestions forme who run a specialist unit with 3 specialists, 7 MOs and 6 HOs in a public hospital specialist unit with 130 patients for each specialist clinic session and 3 sessions per week. Please tell me how to serve the patients better so than to avoid this siuation of patient not to wait more than 2 hours and not getting ‘medical officer rather than a specialist’ (In my clinic, no HOs see my patients, this is the best I can promise). A lot us just know how to talk, criticise but unwilling to help. Afterall all specialists start as a MO.
May 17th, 2008 at 11:48 am
There are those who opt out of the system not out of frustration but because we can now serve our patients better in a more efficient environment where records are seldom misplaced and lab results are traced and available on time.
We are not criticising the system but the futility of the Health Minister in his quest to shorten waiting time.
May 17th, 2008 at 11:14 pm
specialist should be efficient.
30 secs would be just fine
30 mins. that must be the MO.
here’s the thing. http://www.wretch.cc/blog/pilocarpine/14030712
be real.
May 17th, 2008 at 11:27 pm
perhaps the government should learn to spend money more wisely,
to ensure that specialists stay in the government service, and not want to make the jump into the private sector?
It is said that the National Service which is unpopular, and which stated aims are a huge joke, has spent RM500million in the first four years of implementation.
Thats RM125million per year.
If the government were simply to outsource specialist treatment to private specialists, perhaps that RM125million would be better spent?
OR, even better, that same amount of money is used instead as inducement to government specialists from leaving?
Just off the top of my head, with a rough calculation:
if the private specialists were to be given a discounted (considering that it may be considered as partial ‘national service’) consultation fee of RM35/patient,
then 130 patients/session X 3sessions/week X 52weeks/year, would have cost your department RM709,800.
Multiply that by say, 6 departments (assume the lesser specialties are not all that busy, and specialists can cope), and say 15 major hospitals nationwide, that would only be RM63million.
That’s only half of the NS annual expenditure, and ALL of the specialist clinic workload taken off the govt specialists!
With that kind of monetary incentive, who knows, even private specialists might want to come back to work for the government, on a fee-per-patient basis. They might see 4 patients per hour, and in a 5 hour morning, earn RM700.
Even if the private specialists do NOT come back to work for the government, the same rate offered to existing in-hospital government specialists will stem the outflow of specialists into the private sector.
I wonder, if existing govt specialists are offered RM35 for each patient which they see, would they be able to see 5-6patients per hour, and be at the clinic bright and early at 8am, and stay until 1pm?
30patients would net them RM1,050…
130 patients divided by 3 specialists?
maybe have to ‘invite’ one or two more from the private sector?
May 18th, 2008 at 8:54 am
Your suggestion is good but I think it is not ‘right’ because you don’t pay an already paid employee (even though they are paid a low salary)to do the job that they are actually hired to do so.
You cannot increase the scale of salary because this is fixed by the JPA for all the gov servants. So the only way is to incrase the income is to increase the various allowance. I believe by increasing the specialist allowance by 100% for the newly qualified specialists and 200% for those more than 3 years and 300% for those more than 5 years will definitely stop the majority from migrating to the private sectors.
May 18th, 2008 at 9:08 am
I agree with poor doctor — also to shorten waiting time — we need a more efficient lab and record retrieval systems. so many times appointments are delayed just because the file not found r lab results still pending *last week my INR clinic was delayed until afternoon just because lab INR machine broke down.. bah… not the doctors fault but guess who the patients complain to?