Housemen need guidance, not punishment

Lately, there has been a lot of discussion on the plight of medical housemen in our country who are compelled to work long hours uninterruptedly. It is really shocking to know that having gone through the system some 30 years ago, is still has not changed for the better.

It was acceptable then for us to work long hours non-stop as there were at times when only a single houseman was available for each department. At that time, we had just one university producing less than 100 doctors a year.

Today, more than 1,000 doctors are churned out by our 19 local medical colleges every year and they are all absorbed into government hospitals for housemanship and subsequent medical officer and specialist training. Despite this mass production, it is puzzling why we are still short of housemen and that they are still forced to work 36 hours at a stretch.

We are also told that we are not only short of housemen, but also of medical officers, specialists, nurses, and all categories of paramedical personnel. In fact, you name the discipline and we will be told we are short in that area. What is happening to all the doctors being produced by our own universities? When will these shortages ever be overcome? It may not be the actual number that is in short supply but rather the manner in which they are deployed and administered.

I sympathise with the housemen for being blamed for all the complications and death that may arise in the management of their patients despite their long hours of dedicated hard work. It is important to understand that a houseman is the lowest in the hierarchy of the doctors in the medical team.

Although they have very important roles to play, they are the least experienced, needing a great deal of guidance and supervision in carrying out the various treatments. They are practically attached to the specialists who are responsible for not only for their clinical training but also ethical training as well.

Unfortunately, these days some housemen go through their entire clinical posting of several months without ever seeing their heads of department who are too busy with everything else but training their juniors. The training of junior doctors has become the least of their priorities and left to the less experienced. In such a case, it can only be described as the blind leading the blind.

It would be unfair to blame the junior doctors for all the flaws in our health delivery system when they are not properly guided. Unless the senior specialists and consultants lead by example; we will never improve the quality of care for our patients.

Most of us who have been with the system would agree that the quality of medical care on the whole has deteriorated despite the government’s efforts to build the latest sophisticated hospitals. The reason for this is obvious – a lack of dedication. Our present system is breeding dedication to the almighty ringgit and not to the profession and patients.

There is a need to re-look the reasons for the deteriorating standards of our health care. Unless we bring back the magic called dedication into our work ethics, no amount of money spent will restore the excellence our health care once had.

Privitisation of ambulance service not the solution

 

 

28 September 2006 Ambulance service,solve not shelve the problem

I refer to your   report “Corporatise ambulance services, says MMA” (Star, September 28).

It was shocking though not surprising to know that there is a critical shortage of ambulance in the country. The health ministry is finding it difficult to cope with the increasing demands of ambulance service. 

Accidents, which comprise about 5,000 a day, are only part of the medical emergencies, what about the other non-accident emergencies?   

The delay in the arrival of an ambulance at the site of an emergency is not a rare occurrence. It is also not uncommon to have an ambulance that is ill-equipped and inadequately trained-staffed to render proper resuscitation to a seriously injured victim in the all important “golden hour”.  

At present in all major towns, the all important ambulance service is provided by the Malaysian Red Crescent Society, St.John’s Ambulance, the Department of Civil Defense and private hospitals. Within their constraints they are doing a good job but there is a dire need for much improvement in these services. 

We are told that the Health Ministry is planning to purchase 800 new ambulances and it is also looking into the possibility of privatizing the ambulance service to make it more efficient Health Minister Datuk Seri Dr Chua Soi Lek admits that the ministry faced a “big problem” with the ambulance services and had proposed outsourcing the services. This is the typical way problem are solved or rather shelved these days – privatization.  

The onus of providing an efficient and modern ambulance service throughout the country is on the Health Ministry. Other voluntary bodies may be roped in to help but they alone are responsible to provide this vital service to the people. It should not abdicate its responsibility to the rakyat with its excuse of improving efficiency. 

Privatisation may not be the solution to this problem as it would be profit driven and nothing else. Like all other privatized projects, it would not only bring hardship to the people but also be subject to abuse for monitory benefits. Imagine having to pay hundreds of ringgit to transport the sick a few kilometers to the nearest hospital. Who would foot the bill especially in case of road accidents and dire emergencies?. 

Purchasing modern ambulances is important but it should also be accompanied by well trained and motivated staff to provide the service with passion and dedication. Without the latter it would a waste of taxpayers’ money to buy expensive vehicles fully fitted with state of the art equipment. 

Medical care including ambulance service is a basic right of every citizen and they should be easily accessible at an affordable cost. 

 

Dr.Chris Anthony

 

Medical schools everywhere, none of calibre

Too many medical schools, none of calibre
 

With the announcement of Kolej Universiti Islam Antarabangsa Selangor (KUIS) to offer medical degrees courses, the total number of medical schools in the country will be 17.
This figure exceeds the number of medical schools in Singapore(1), Canada(16), Ireland(5) and even Australia(11). This figure I’m sure will keep multiplying fast over the years as privatization of our health and education systems continue. The proposed Health Insurance Scheme will further enhance its growth in the name of achieving a developed status by 2020.
In the enthusiasm of increasing the number of doctors very quickly, we have overlooked the two most important prerequisites for the training of doctors. These are adequate experienced qualified teachers who themselves are practicing clinicians and secondly a properly equipped and administered teaching hospital. If one were to closely scrutinize our medical schools, both public and private, none of them will fulfill these 2 important criteria.
As a result we are churning out doctors who are lacking in clinical skills. This was lamented recently by the Director General of Health.
In the private medical schools, the centers are basically run by expatriate lecturers, who are here for a living, least so for the training of our doctors. These schools attract students by awarding degrees from foreign colleges, a program fashionably termed,  twinning.
They do not have their own hospitals and the lecturers are not fully practicing clinicians.  We have medical students who pass out as doctors without proper clinical exposure. It is like football coach teaching to play the game without the players touching the ball.
In the public medical schools, emphasis is just on the lecturers-student ratio and not on the quality or experience of these lecturers. We may have adequate number of lecturers but they are mainly junior and inexperienced. The brain drain has depleted our medical schools of invaluable experienced and dedicated specialists.
Medical training is a stewardship where the student has to be “attached” to his teacher all the time, in the emergency room, in the wards, operation theatre, outpatient clinics and finally during follow-up visit after discharge. He learns to manage the patient by observing and assisting the teacher, who is actively, involved in the management the patient himself. In the process the knowledge, skills and ethics of the profession are transferred to the potential doctor.
Regrettably this form of training, once a standard practice, is not seen in our medical schools these days. Although exorbitant fees are charged but the students do not get their money’s worth in return.
We have many teaching centers with excellent equipment but none of our medical degrees are recognized internationally. What is more distressing is that our authorities are least bothered about international recognition. We want to become a regional centre for medical treatment and training but our standards are in fact declining over the years. In contrast Australia with 11 medical schools and Singapore with just 1 have achieved excellent international status in medical practice and are far ahead of us.
 

Dr.Chris Anthony
 

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Medical Industry and substandard doctors

 The Medical Industry and Substandard doctors
 

The front page report “Excuse me doc,do you know what you are doing?  (NST, Feb1) and medical colleges churning out substandard doctors may be shocking to many but to those in the medical profession, it is nothing unexpected. These facts were revealed by none other than the Director General of Health,Datuk Dr.Ismail Marican himself.
 
Gauging by the speed at which we were privatizing our medical and health services it is no surprise that we are producing not only substandard doctors and nurses but also suboptimal medical services to our patients in both government and private hospitals. The privatization has produced a lucrative medical industry for the advantage of business entrepreneurs.
 

We have many modern teaching hospitals and with the latest state of the art equipment but the skills of our doctors and medical staff are rapidly depleting over the years.  
 

We have many institutions of higher learning and medical schools but insufficient quality teachers of our own. We desperately depend on low caliber foreign expertise to train our own doctors. We are just interested in quantity to fulfill the lecturer student ratio without considering the quality.  
 

All we need is a handful of quality public medical schools staffed with our own experts who are fully committed and dedicated to the training of our own medical students.
 

Our premier medical schools were doing just that until this the privatization policy was introduced.. Dedicated and quality doctors and specialists were shown the exit to “greener pastures”, many leaving rather reluctantly. In the private sector they were reduced to mere businessmen doctors, slowly but surely losing the hard acquired clinical skills and experience, similar to what we call disuse atrophy in medicine. I’m sure Datuk Ismail Marican will bear testimony to this.
 

Meanwhile numerous private medical schools with hardly any resources have sprung up all over country to take advantage of the increased demand to do medicine. Quick profits were reaped from poor parents some of whom spent all their life savings with the hope to create doctors of their children.
 
The medical profession, once renowned for its nobility, is being mutilated by big business co operations to reap huge profits from medical education and the provision of medical care to patients, which ideally should be provided freely by any caring government.  
 

Dr.Chris Anthony
Butterworth