More patient choice please

Efficiency appears to be the buzz word in the political circles of the United Kingdom at present – the various political parties are attempting to outbid each other in the race to establish their credentials as efficient managers of the public purse as the general election looms near.


In the current global climate, the need for austerity is made all the more obvious as each government seeks to protect their credit ratings in the financial markets. It is traditionally thought that such moves would lead to declining investments in social spending. But it might perhaps be more palatable to critically review the investments that have already been put in place and ensure that the funds are used both efficiently and effectively.

Most government healthcare services are monolithic enterprises that slow innovation and act as obstacles to improvements in efficiency. With this in mind, the British government had introduced changes to the National Health Service (NHS) in 2006 that brought in more competition and allowed greater patient choice with regards to the hospitals from which they could receive treatment.

Information was made freely available to the public with regards to hospital quality. And hospitals were given more freedom to choose the methods in which they could increase the quality standards on site.

This contrasted to the previous scenario in which hospitals were not rewarded on the basis of the number of patients they attracted; in fact patients had no choice regarding the hospital they attended, irrespective of quality standards. This meant that the motivation to improve performances was minuscule.

However, since the introduction of patient choice within the NHS, indices of quality have showed improvement – the waiting time to see a doctor has dropped, patient satisfaction has improved and productivity has increased as well. These changes do not only make the statistics look good; more importantly they have led to a perceptible improvement in the patient’s journey through his or her treatment.

Similar lessons can be applied to our healthcare service in Malaysia.

Perhaps most importantly, the first step that should be taken is the dissemination of information with regards to the quality of care that is available in our local hospitals. For example, the culture of performing clinical audits as well as completing the audit cycle in order to ascertain the improvements brought about by any particular intervention should be introduced and these findings should be shared with the general public.

Private healthcare entities should take a page out of this book as well and provide their patients with an avenue to make informed decisions.

The improvements brought about by such a policy are readily apparent to the patient, but may be more opaque to the healthcare providers themselves. However, it is useful to note that the provision of such data will not only empower the patient, but will lead to them having greater faith and confidence in the service that is provided to them.

Government hospitals should be given more autonomy to introduce innovative practice to improve their service, which will lead to the hospitals being looked upon in a more positive light. The system then should allow private institutions to compete with the government hospitals to ensure that the rakyat gets the best range of choices when it comes to the important decision of managing their health.

Of changing personalities

I sometimes like to practice the communication skills that I have learnt in settings outside of medicine. This involves both the positive aspects as well as stuff that you’re not supposed to do – e.g. I was having an argument with a person a couple of weeks ago, and decided to change my body language by facing the person and leaning forwards.

It was intellectually intriguing to note how the person’s body language changed and mirrored my own. It’s also quite interesting to note how one can influence the flow of a conversation by certain manoeuvrings of the body and I frequently utilise this when I’m not in the mood to converse with the barber (which is almost always).

However, I am still finding my feet with regards to communicating with my junior staff. I am a good manager, but I am not a good leader. At least not yet. And part of it is dealing with the new position that I am in the clinical hierarchy.

For example, looking back over the past few months, I have realised that I have been too friendly with some of the junior staff. While this has its benefits, there’s also the fact that it makes chastising them a lot more difficult should the situation warrant it. And similarly, because the interaction is skewed towards friendship, there is a lack of recognition of the severity of events at times.

With the next batch of juniors, I made a conscious effort to remain a little distant from them and I must say that things have improved. One is able to appreciate effort and reward results more appropriately, and the lack of close friendship also allows constructive criticism to be dished out in a more effective manner. It might mean that I won’t be looked upon in as positive a light as before, but at least it means that things can get done in an appropriate manner.

Let's get ready to partaayy...

I went for a christmas party last week. It was organised by a company of professionals, and although I wasn't terribly keen on attending it, I decided to force myself to go in the end to have an idea of how things pan out.

I'm usually not terribly comfortable in parties - I tend to be that guy who takes a drink from the bar, retire to a corner, look around for someone I know, chat with said person and slowly get to know the people who join our conversation. I usually end up leaving a party knowing an extra few people well; I'm not able to do the flamboyant bit of being the life of the party and committing everyone's name to memory.

I suppose it's a good thing that I'm not a salesman. At the end, the party was ok though. Pretentious, as one would expect it to be, but my consultant was there along with another surgeon that I work with, and they were good company. Also got to know a couple of lawyers who were trainees themselves, and we ended up spending a fair amount of time laughing at the silliness of things.

Next trip out will be to catch Paul Oakenfold, and that's something I'm looking forward to. Then it's watching Avatar at the new IMAX in Newcastle (no more having to drive to Bradford to catch The Dark Knight!) followed by a quiet Christmas. I've got an invite to join the Msian crowd in this town for a belated celebration for Eid, but I've yet to decide if I should go or not.

Reflection

Most people look at me with incredulity when I say that the medical programme that bears the most resemblance to real life is Scrubs. I'm not talking about the bits where they day-dream themselves into fantasies that range from floating talking heads to hints of BDSM, but more about the struggles that they go through and the challenges that they face, both from a medical point of view as well as 'softer' aspects of having to deal with colleagues etc.

Things do not occur as dramatically as they do in ER, nobody is able to do everything and nothing as they do in House, and there isn't quite the same level of personal disintegration that occurs in Grey's Anatomy. But I suppose another reason why I enjoy it is that I can see myself in similar situations, and great television tends to occur when you feel that the show is speaking to you.

This is not as silly as it sounds; my medical career started around the same time as the show, so the challenges that the characters faced when they were house officers and then interns were quite familiar to me when I was a house officer and now that I'm a reg. I suppose it's similar in a way to how some people say they 'grew up' with Friends. Funny isn't it, how you can sometimes relate to characters that are the product of another's imagination?

The episode I watched yesterday involved Turk and Elliot wondering if they'll be doctors for the rest of their lives, something that I'm sure most doctors have thought about. Coincidentally, a couple of close friends mentioned sometime last week that they can't see me being anything but a doctor, even if I win the lottery.

There have definitely been times when I've wondered if I was in the right profession, and I still don't know if I want to be a clinical practitioner for the rest of my life or to get involved in aspects of administration. But I'm quite fortunate that I'm specialising in a field that I actually want to do and derive a certain amount of satisfaction from that. It helps that Sweetie thrives at her job, and that ppl like WK, RT & my best mate are equally enthusiastic about their specialities - Yes, I do geek out about certain things, but there's a certain intellectual thrill of knowing that you've done a good job and you've sorted out problems.

These past few months have been great, and I'm actually starting to feel like a proper doctor (and this is in spite of everyone warning me that my current workplace is one of the most horrible places to work at). In fact, looking back, it's been quite an eventful year with plenty of obstacles strewn across the way, but I'm in a good place now and there's plenty to look forward to. I suppose this is what Maslow meant when he was talking about his hierarchy of needs.

All I gotta do is enjoy this period, before an inevitable tragedy occurs. Part of the cycle, eh?

Frustration incorporated

For better or for worse, one of the things that tend to develop within you when you’re a registrar is a sense of ownership of your patients. You tend to not work for someone, but more for yourself as you feel that you have the added responsibility of ensuring that things run smoothly during the continuum of care.

The plus point is the fact that one automatically becomes more conscientious, and this has its knock-on effects with regards to making you think on your feet and be extremely organised with your day, as you have to juggle an n number of variables throughout the working hours.

The downside of this is the fact that you can get immensely frustrated when your junior does not perform the way you expect or want them to. It is a rather tiring job having to double check things or waiting for things to be done in an hour, especially if you can do said job in ten minutes. And it’s even more tiresome to listen to nonsensical excuses that make you want to grab the guy’s head and pulverise it to a pulp.

But one has to learn to inhale. And exhale. And have a listen to some music over the iPhone. Before going back and trying to remember that failure to delegate is failure to manage and that I have to spend time teaching, even if it’s something as basic as ‘blood tests that you ordered need to be looked at’.

Inhale. Exhale.

Dinding

Every now and then a colleague will confess to me that he or she feels powerless at times, and that having to deal with the feeling of helplessness when confronted with a dying patient can only be dealt with through experience. It is not something that can be easily taught in medical school, as it is a rather abstract concept, and each encounter between a doctor and a patient is unique, both in terms of the circumstances as well as the individuals involved.

Having said that, I myself have never felt this way when dealing with a patient. Even when things do not go well, I am assured by the fact that in most circumstances everything that could have been done, was done. And in my mind, there is always the fact that human beings are fallible and eventually, the body fails the mind and we all die. Sometimes it is tragic and unexpected, sometimes it is a prolonged process that everyone wished had happened earlier. The end result is the same though; we live and then we die.

The only time I do feel helpless though is when someone dear to me is faced with a problem with is not easy to solve. On one level, I know that sometimes all that needs to be done is to be there for your friend, and provide a shoulder to cry on or a ear to listen. But on another level, I can’t help but wish that I could jump in and make things better.

And I suppose this begs the question – do I not feel this way about my patients because I do not care enough for them? Or because I have a very effective mechanism of building a wall and ensuring that I do not become too emotionally attached to them, unlike my friends, whom I am very attached to?

Endless

In approximately two weeks or so, I will be commencing my training to be a respiratory specialist. This also means that I’ll be a general medical registrar, which has both good and bad connotations to it.

The medical registrar can be viewed in one of two ways – the person who runs the show or the person who’s everyone’s bitch. Which one I’ll end up being remains to be seen. Trepidations aside though, it is a significant step up the ladder that is my career, and I am rather looking forward to the challenges that I will face from both clinical and organisational point of views.

As I embark on the next chapter of my story, it is perhaps without much surprise that I have decided to revisit an old chapter from the past. Having spent a small fortune on purchasing the Absolute collection of The Sandman series, I have spent the last few days going through (in wonderfully, glorious detail) the 75-issue arc that makes up the series.

As with all great works of literature, each reading brings about a different level of appreciation, and you end up empathising and being emotionally attached to the characters.

Having last read the series when I was in high school, it was interesting to note the similar and dissimilar ways in which I reacted to the story, both intellectually and emotionally – from smiling as Delirium spews forth a description of the world that is scarily similar to mine to appreciating the interwoven plots of Norse and Greek mythology to feeling the leaden weight of despair as you follow Dream’s slow and inexorable downward spiral.

It would not be an exaggeration to say that The Sandman played an influential role in my teenage years, helping mould the manner of my thinking and allowing me to further indulge my fascination with all things ethereal. It has been a fun and nostalgic trip down memory lane and I am sure that when I take it off the shelves in a few years, I’ll appreciate it even more.