Declining passion for the job

Commercialization of Medicine to blame

Health Minister Datuk Seri Dr Chua Soi Lek’s warning to doctors to resign if they do not want to attend to patients when called to do so is timely. The ministry should take a serious view of this issue of doctors refusing to attend to patients, even those critically ill.

I agree with Dr Chua that doctors are burdened with more work due to the increasing number of patients at government hospitals but this is no excuse for failing to be present when needed. We must understand that while the number of patients may have increased drastically but the number of doctors and specialists have also increased proportionately over the years. Patients’ expectations are also much greater these days.

We have now reached a stage where medical officers and specialists should be made stay-in when on call, especially in urban areas, where traffic congestion makes it impossible and dangerous for them to rush back in time for emergencies. Comfortably equipped rooms and proper food should be provided for those on call.

In the seventies and eighties we had very much fewer doctors and specialists. Major clinical departments then were run by 1 or 2 specialists and a couple of medical officers and housemen. The specialists were on call daily, seven days a week. There was no such thing as public holidays or weekends for them. Moreover no overtime or call allowance of any sort was paid at all.

Despite these shortcomings and frustrations, work went on reasonably well. The driving force behind was the commitment of doctors to their patients. All patients admitted were seen by the respective specialists daily without fail, sometimes more frequently as the needs dictate. Work went on irrespective of whether it was a weekend or public holiday.

Today the scenario is very much different. These clinical units are now staffed with 5 to 10 times more specialists and medical officers. There are also the super-specialists in the various subspecialties. I am made to understand a specialist these days just goes on call 3 or 4 times a month. Furthermore they are given time off on the day after the call (post-call).They are also paid handsome overtime allowance (call allowance).

Despite having more doctors in the public hospitals we still frequently get complains that specialists do not see their patients, even the critically ill ones, for days at a stretch. The patients, especially after office hours and on weekends and public holidays, are left to be managed by junior doctors with minimal clinical experience.

Why are our doctors and specialists adopting such uncaring attitude towards the welfare of their patients? Why are they indifferent to the plight of the sick and dying? The Health Ministry should seriously look into the reasons behind this lack of passion among our doctors and specialists.

The underlying cause of this malaise is the commercialization of the medical profession in general. Medical training and treatment have become lucrative industries that are quickly tapped by big business corporations. Like in all industries, there is no place for medical ethics and compassion for the patients. It is strictly “you pay, I treat” relationship.

This has indirectly been reflected onto potential doctors early in their training days. It has become necessary for doctors to quickly obtain the necessary paper qualifications and leave the public sector to join one of these corporate institutions or risk being left out. Compassion and dedication to for the patients are lowest priority in this pursuit.

In this medical industry, patients may continue to receive treatment but for the wrong reasons. The final loser in this “you pay, I treat” medical business will be the poor penniless rakyat. Privitisation and commercialization of our heathcare may be unavoidable to a certain extent but the government must decide how far it is going to allow these to undermine the nobility of the medical profession.


Dr.Chris Anthony

Comments

The Malaysian Medical Service probably scored a first when doctors from the Klang General Hospital phoned or handphoned a specialist to ask how or what to do in that emergency when the arm of an infant eventually needed to be amputated.Another MALAYSIA BOLEH case that was not publicised to attract mothers to be to give birth in this country?Malaysia is breaking new grounds!

By sentosa007, 11-Sep-2007


Agree with your initial statements. Doctors owe a care of duty to their patients. There can be no justification for death through neglect of patients. This is an issue that the profession must deal with through the local medical registraton authority and leaders of the profession.However, one must not paint all doctors with the same brush just because of the inecusable behaviour of some in the same profession.

I have personnaly known doctors who are dedicated to their patient care and who choose to continue working in the government sector despite the temptation of huge financial rewards in the private sector. We must remember that doctors are also human and subjected to the same needs and weaknesses as anyone else. Doctors pay the same price for everything in life, may that be food, housing, clothes, education for their children or even healthcare for their own family. This is just to put things in perspective.

The fact of the matter is that the commercialisation of healthcare is one of the major challenges in this century for all govenments in the world. In the developed nations, the problem is now even more acute with 40 million americans without health cover while the rest of the population have over the top health care through health care insurance. I have met doctors working in the public run hospitals that cover those 40 million without health cover and have been told that they are worst than hospitals in Africa despite being only a stone throw away from the private hospitals on the same road.There are no easy answers to problem. The govenment have taken the right step by demanding accountability from the medical profession.

They should not expect any less from themselves.Efforts are needed to make the govenment hospitals centres of excellence, so that the people that work in them, may they be doctors, nurses or porters, can feel proud of the good work that they do and commit 110% of themselves depite being paid comparably less than in the private sector.This would be much more effective than having any govenment legislation or any other form of enforcement.

Put our hands on our hearts and we know that the public contributes to this problem by having a negative outlook on our general hospitals and the staff working there. It then becomes a self-fulfilling prophecy with no end in sight.This solution is already in practise in the UK. ALthough the private health care sector is thriving, no one would willingly go to a private hospital if they have a life threathening illness, as they know that the most experienced and skilled physicians are in the National Health Service. That is also why the majority of UK doctors remains in the public sector, where they can devote themselves to good patient care, research and the education of future generations of young doctors.

This is the way forward...

Here's an interesting article on the same issue in America..only that it happened many years ago..Scholars, Investigators, and Entrepreneurs: The Metamorphosis of American Medicine. Perspectives in Biology and Medicine - Volume 46, Number 2, Spring 2003, pp. 234-253


The introduction of the article is as follows: "WHEN I ENTERED MEDICAL SCHOOL in 1948, specialization and group practice were developing rapidly, but most physicians were still solo practitioners, often maintaining their office in their home. As proprietors of this cottage industry, physicians were usually financially comfortable, but not rich. They were respected, often revered members of their community, making useful contributions to the health and lives of their patients.

For most patients, the relationship with their doctor was mutually trusting and gratifying. Five decades later, the medical profession has undergone changes much more drastic than the social transformation that raised physicians' incomes from relative poverty in the 19th century to modest affluence in the first half of the 20th (Starr 1982).

The changes of the past 50 years can be quickly summarized with the following three vignettes of conversation that might occur when someone met a doctor on a social occasion.

In 1957, the statement might be, "So you're a doctor. Hey doc, what do you think about this rash on my arm?" In 1977, the speaker might say, "So you're a doctor. Where's your Porsche?" In 1997, the comment might be, "So you're a doctor. Let me tell you what some damned doctor and health care plan did to my sister." [End Page 234]

Why has this change occurred? How did medicine evolve from a caring profession to a business? And how and why did doctors trade their professionalism for commerce? I shall try to answer those questions as an internist whose career allowed direct observation of the cited events. First

Half of the..."Here's the weblink to the article.(http://muse.jhu.edu/login?uri=/journals/perspectives_in_biology_and_medicine/v046/46.2feinstein.html)The late author, Alvan R. Feinstein, was the Professor of Medicine and Epidemiology at Yale University. (http://www.yale.edu/opa/v30.n9/story12.html)