Doctors being made scapegoat of management's deficiencies

With reference to the article "Hospital inspection sparked off by complaints of patients' waiting times" (June 16), the Medical Association of Malta must once again draw attention to several points which warrant ethical review and consideration.

The article quotes "health department sources" and while keeping the sources anonymous, made very serious allegations on the behaviour of consultants at the outpatients, as if this were "established fact". Indeed, a Sunday newspaper identified the source of its allegations as Health Minister Louis Deguara.

Such allegations should be substantiated by fact, and properly investigated after those concerned have had time to give an adequate explanation. Sweeping statements issued prematurely to newspapers are harmful to the medical profession, to the health ministry and indeed the good reputation of the public health service. The vast majority of dedicated and conscientious doctors are deeply hurt by such inappropriate and most inopportune tactics.

These "sources" state that only three doctors turned up late to the outpatients department. MAM has already contacted two of the three who clearly had very good reasons, while it is still to contact the third. That means either one or no doctor at all was late. Furthermore, nobody was late for the operating theatres.

There also appears to be a very clear contradiction when these sources first state that "consultants bring their private patients without an appointment" and then state that they then resort to make "ghost" appointments.

Clearly, this does not make sense. Do they or do they not have appointments? It would have been much wiser had the "health authorities" investigated the matter with the individuals concerned before splashing lame anonymous statements onto the media.

The thousands of patients who attend the outpatient departments daily can confirm how often files, results of blood tests, and X-rays are missing. These are the real problems which lengthen waiting times, and it is here that the authorities have to get their act together.

Unfortunately these "sources" seem to be completely detached from reality, when they fail to realise that operations done after hours or after 2.30 p.m. are done on a voluntary basis and in most cases without remuneration.

In fact, it appears that a significant number of the other 16 doctors labelled as "late for work" had been granted permission by their director to come in late as they had an operation list from 1 p.m. to 6.30 p.m..

As regards ward rounds, anybody who is in touch with what goes on in the hospital wards knows that routine cleaning of the wards, and washing of ill patients often lasts till 9 a.m.

It is for the convenience of patients and other hospital staff that ward rounds start after 9 a.m. Furthermore, medical students are only able to attend for ward rounds after 9 a.m.

MAM has never resorted to any form of personal attack on government officials, and indeed these "sources" must be aware that according to ILO conventions, union officials have a right to be allotted time for their activities.

Such a public smear of union officials, without waiting for appropriate explanations from the said MAM official who was involved in a genuine activity, is not only unethical but completely undemocratic, reminiscent of the pre-1989 Solidarnosc days behind the iron curtain.

Surely the health authorities' efforts should be more effectively directed at the real problems afflicting the national health service. For example, six months ago MAM wrote that one of the lifts in the children's department had been malfunctioning. Only last week, after a doctor got trapped in the lift for 20 minutes with a very seriously ill baby, was action taken.

MAM has always used discretion when dealing with shortfalls of the health service and the way it is being managed, believing that constructive criticism and cooperation are the real way forward in such a sensitive sector as ours.

The medical profession is the first to experience, and indeed bear, the brunt of doubtful management decisions; very often, doctors are reluctant to be whistle blowers for these deficiencies. It is therefore very unfair and unacceptable that the profession is being made a scapegoat for these shortcomings

However, it comes as no surprise that shortcomings in management such as these, have led government to conclude that the whole management structure of the health services needs to be reviewed. On the other hand, tens of thousands of patients can testify that doctors' dedication to their profession is one of the strong points of the service.

Whoever in management intends to implement rigid and unrealistic work practices for doctors, something which would be unique worldwide to this small island, will also have to shoulder the responsibility for the cancellation of all the work done outside the normal work schedule.

As it appears that the health division is out of touch with the real problems afflicting the health service, MAM will soon start pointing out these numerous deficiencies for the good of one and all.