General practitioners should be first port of call - minister
Video: Paul Spiteri Lucas
The Maltese tended to seek specialist advice when suffering from pain or an ailment, rather than going to a general practicioner, Health Minister Joseph Cassar said this morning.
Addressing the press, the minister said the issue of primary health care was a major problem since GPs were specialised in looking at patients in a holistic manner and should be the first port of call.
Primary healthcare was being reformed and changes and improvements were taking place constantly.
The perception that only a few people used primary healthcare services, he said, was wrong.
Giving some statistics to prove his point, the minister said that between January and July this year 678,682 services were offered at the eight health centres and 42 clinics.
These included over 243,000 examinations by GPs in health centres, nearly 62,000 in clinics and nearly 10,000 home visits.
Primary Health Care Department CEO Edward Borg said that it was estimated that by the end of the year there would be 1.4 million services given at health centres and clinic.
He said that his department, together with Mater Dei Hospital, had set up a committee to work on synchronising services offered in both hospital and health centres.
People discharged from hospital, for example, did not need to go back to hospital for follow-up treatment but could be directed to health centres.
Another committee was looking into why certain patients were being referred to hospital and not health centres.
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C. Sammut
Aug 9th 2012, 07:26
“I don’t think your boss should get to control the health care that you get. I don’t think insurance companies should control the care that you get. I don’t think politicians should control the care that you get. I think there's one person to make these decisions on health care, and that is you.”—President Obama on women’s health
Josephine Borg
Aug 8th 2012, 11:58
One of the points made is that private medicine is expensive. Of course we want everything of the best quality and for free. The Minister never suggested you have to pay: The Health Centres are there and for free. Do you now also expect not to wait? If your wife goes to a Hairdresser, does she not wait? And is the price she pays comparable to what she pays a private doctor who comes to visit you in the comfort of your home? Ask a man to come and clear your drains and see what you pay!
The truth is that we are a nation of Maltese gemgem. All the Minister is trying to do is reduce waiting time in the Emergency department - so you do not grumble...
John Attard
Aug 8th 2012, 06:54
Primary health care is at its infancy and past steps by The Authorities to reduce primary health care services has now provided an expensive end result. Mater Dei just cannot take the onslaught of every whim. A Minister s job is to be able to assess a situation and provide guidelines after having discussed at Cabinet level. However all boils down to sustainability . If ire the man of the house and your income is one hundred then you cannot spend two hundred. And this is what is happening in the health sector, the public is very demanding and rightly so, and now we have waiting queues never endingq to see any consultant. For transparency s sake the authorities should provide a list of consultants at mater Dei and their current waiting time........how long it would take me to get an appointment with Mr X or Mr Y if I qneeded to see him. Then decisions need to be taken.......but surely the idea of keeping the publicq away from Mater Dei is not the best solution and not the best one in the interest of the public
Edward Zammit
Aug 8th 2012, 18:42
Primary Healthcare has been KEPT at its infancy, at least where available services are concerned. Fortunately the level of training of GPs and nurses, not to mention the allied professions, has improved substantially.
In fact young GPs earn their specialist status after intensive training and much sacrifice, and provide specialist level care.
The idea is not to keep people from Mater DEi, but to divert them to Primary care where they should have gone in the first place. The State has to invest more in Primary Health.
David Magro
Aug 8th 2012, 06:27
Dear Minister, I refer again to the question I put forward to Dr.Muscat last Sunday- I can assure you that nothing was prepared as I did the question out of my free will- Go back to the system of the Polyclinics. Get back to the basics so that you put an end to the bottleneck that we have at Mater Dei. Give more empowerment to the polyclinics, I am very positive that certain emergency calls will and can be handled at these centres. Unfortunately it seems that you and your GonziPN are stubborn and not willing to admit that it was a mistake. Get back to the basics when the polyclinics were sought by people. We ended up with nice castles in localities such as B`kara, Mosta but you are not maximising their usage. At least Joseph is willing to listen and ready to change....you are being stubborn!
S.M. Cuschieri
Aug 7th 2012, 23:50
@ JC Borg
For your info, I have a medical background and I know what I am doing...both for me and my family.
Edward Zammit
Aug 8th 2012, 19:00
Then your family is lucky, but and a good GP always respects patients with medical backgrounds (emphasis on good).
I wish you would have the same respect for GPs, their extensive knowledge, and their hard earned specialist status.
J.C. Borg
Aug 7th 2012, 16:46
Once we were promised "A doctor of your choise" - I understand it meant that we go to our doctor and the state will pay him.
If that is implemented, the waiting at Health Centres and the A and E Section will be much shorter.
J.C. Borg
Aug 7th 2012, 16:46
Once we were promised "A doctor of your choise" - I understand it meant that we go to our doctor and the state will pay him.
If that is implemented, the waiting at Health Centres and the A and E Section will be much shorter.
C. Sammut
Aug 7th 2012, 16:37
I want freedom of choice. No one should dictate to me where to seek healthcare services from. I am the only one who should make decisions on matters relating to my body.
J.C. Borg
Aug 7th 2012, 16:49
Although you are 100% correct, you should keep in mind that 'those who know' advice us what is the best way to follow. Then it is up to us to take that advice or not.
Francis Saliba M.D.
Aug 7th 2012, 16:50
@ C Sammut, today at 16:37.
If you tried to do what you like "on matters related to your body" by trying to sit in my lap when I was sitting patiently in the A & E section of Mater Dei Hospital where I had been referred by my family doctor, I would soon let you know what to do with your body and your pretended "freedom of choice" to do what you like in a society that is supposes to be civilized.
C. Sammut
Aug 8th 2012, 01:15
Dr Saliba I did not stop you doing what you wanted to do. Ergo I am civilised.
Francis Saliba M.D.
Aug 8th 2012, 09:25
@ C Sammut, today at 01:15.
Your INABILITY to stop me from doing what I do legitimately, is not enough, by itself, to authorise you to claim to be civilised. A civilised society demands that the freedom of choice of the individual be limited by the freedoms of the rest of society. The arbitrary use of the specialist services at Mater Dei Hospital, with special reference to the A & E section, is circumscribed by the real needs of genuine serious cases that cannot be met at GP and primary care levels.
The claim to be civilised implies much more than that. Ergo, you have proved precisely nothing.
cesco di luigi
Aug 7th 2012, 16:03
if one is turned away from the polyclinic at the flimsiest of excuses, what the hell does he expect?
Ray Buhagiar
Aug 7th 2012, 16:34
I was never turned away. Do you have evidence that patients are being turned away at the flimsiest excuses. If you do not have such evidence why do you write such things in public?
cesco di luigi
Aug 7th 2012, 18:41
Mr Buhagiar
I have my own evidence. If you go at a certain time they don't open...if you go at another time they wont give you a certificate even if you are ill..if you go at another time they wont give this that or the other...come on man, a doctor is a doctor ..if you are sick and need a certificate what the hell does it matter to them if you go at 7 or at 12????? Some common sense please and cut out the beurocracy and by the way how is the patient meant to know whether he needs a specialist or not? First he has to see a doctor...but the doctor has to be presnet at the polyclinic first. OK?
Edward Zammit
Aug 7th 2012, 19:10
The 3 main Healthcentres are open 24 hrs a day, 7 days a week. It is the other, smaller ,healthcentres which
close at specific, fixed, verifiable times. If you live closer to one of the smaller ones, and it is closed, rest assured that one of the major ones covers your area during that time. You just have to take the initiative and
check for yourself.
Yes, there are appointments and specific times for certain services. It is the same everywhere and in every institution, including the bank. I do not hear people complaining. And please no jibber jabber about the
importance of health first - you will not die if you do not get a certificate.
J Farrugia
Aug 7th 2012, 15:50
The biggest problem is people have become hypochondriacs, even my collegues at work as soon as they have a slight issue their like omg i better go to the doctor or emergency because i have an eyelash in my eye and it might get infected and i might die. Grow up, stop being such a bunch of woosies, eat healthier and stop wrapping your kids in cotton wool.
S.M. Cuschieri
Aug 7th 2012, 14:28
I for one only use specialist care. I find it easier, when I realise that there is a certain problem, to find the nature of specialist and go directly to him/her. For instance if I suspect that I may be suffering from a thyroid problem, I tend to seek the services of an endocrinologist instead of first going to a GP who will ultimately refer me to a specialist. So I just bypass that and go straight to the specialist. I am not one for spending money on vanities but I do believe in spending money when it comes to our health. I will only go to GP for every day ailments. On the other hand, I also only have pride and good words for the doctors and staff at Mater Dei. They are understaffed but their service is brilliant.
Francis Saliba M.D.
Aug 7th 2012, 16:13
@ S. M. Cuschieri, today at 14:28.
Keep in mind that a specialist in medical science is someone who knows more and more about his speciality but less and less about all the other branches. For example he may be extremely wise about his own branch but he may not realize that the patient in front of him is a psychiatric case well known to the family doctor. In your effort to "bypass" you may be making the wrong choice of specialist and proving that what appeared to you to be the shortest way home was actually the longest way round.
Your kind of reasoning is the main cause why the excellent specialist clinics at Mater Dei Hospital, notably the Admission and Emergecy section, are swamped by minor cases to the detriment of other genuinely serious cases.
J.C. Borg
Aug 7th 2012, 16:40
Going directly to a specialist instead of a GP, only shows that you have made yourself a specialist of your health. Dr Francis Saliba's in this blog is telling you the same thing.
We should keep in mind that GP's see thousands of patients yearly and at first sight might know your what is wrong with you.
Edward Zammit
Aug 7th 2012, 19:14
My colleague, Dr. Saliba, has given you a concise and well written answer.
A suggestion: You can spend less and get more value if you have a good GP. A good GP will tackle a wide variety of conditions involving various systems, in all family members, from birth till the deathbed. No other specialist is trained to do that.
S.M. Cuschieri
Aug 7th 2012, 23:46
@ Dr. Francis Saliba M.D.
I do agree that there are good GPs out there and I am not condoning them at all. But I do not swamp the Mater Dei A & E. The A&E dept.is swamped by people who,ignorantly just go there without thinking or caring about anyone else. Because some cases are really minor. Also, Gps do know a lot over all but they do not specialise. And a psychiatric patient can hide his condition from his GP too.Especially if it a case of Munchausen's!! LOLOL!!! And like I said, the GP himself will refer if he realises that it is a certain condition that needs expertise. Throughout my pregnancy I went to one particular obstetrician, and I can safely say that he saved both me and my daughter with his expertise. He knew me and my pregnancy inside out. But once again Dr. Saliba, I do not condone GP's. And I am always certain of what specialist I need to go to. I have not been wrong yet :).
Dr Alex Bugeja
Aug 8th 2012, 15:05
It sounds to me like Dr Saliba is the voice of reason and experience on this...
VV Bartolo
Aug 7th 2012, 14:26
il-ministru jaf li biex jigi jarak id-dar il-GP jitolbok €20 (bla rcievuta) u jekk tmur ghandu int €12? ahseb u ara kemm l-ewwel li mmorru ghand specjalista! ma nafforfjawx GP let alone a specialist!!
Charles Grixti
Aug 7th 2012, 14:07
Malta's health service is not truly 'free' if primary care physicians are to be paid for by the patient.
Two options to address this:
Include GP visits in the universal health care system by having patients register with a GP, who in turn will be reimbursed by the Health autorithies for each patient he sees.
or
Have government funded Clinics in each town and village where people can see a GP free of charge instead of having to go to Mater Dei hospital to get this service free of charge.
cesco di luigi
Aug 7th 2012, 18:42
GOOD ONE! AGREE 100%
Edward Zammit
Aug 7th 2012, 19:18
The first option was in the pipeline 2 years ago, and very likely it still is.
The second option is the current situation. The small bereg are, of course, no true healthcentres and offer limited services, but Malta is a small island and the larger healthcentres are just around the corner.
Besides, it takes a long time to train competent GP specialists and nurses.
Ramon Saguna
Aug 7th 2012, 13:13
Tmur ghand il GP.
Jitfak off-track, tkun uzajt medicina hazina, tkun infaqt f'medicini hziena ghal xi 4 xhur.
Tmur ghand l-ispecjalist.
Jurik li l-GP ma kinex jaf x'qed jghid, u tibda tinkwieta.
Jghidlek ezatt x'kellek u, jew isserrah mohhok, jew tishet il-mument li ltqajt mal-GP u hlielek 4 xhur kura.
Conclusion, mur ghand l-ispecjalist millewwel.
PS. Mhux il-GPs kollha ma jafux x'qed jaghmlu..imma kif ha tkun taf il-GP tieghek jafx x'inhu jghid? Kif ha tkun taf izommx ruhu aggornat? Kif ha tkun taf hux qed jibbluffja jew jekk hux qed ihawwad?
A Cachia
Aug 7th 2012, 13:47
Kemm ghandek impressjoni hazina tal-GP's habib......
Il-GPs huma specjalisti daqs kemm huma specjalisti ohrajn.
Issa li ghandek bicca informazzjoni tista tibda ir-ricerka tieghek fuq li ktibtlek u tivverifika...
Nehhi minn mohhok l-ideja ta "Bicca Tabib"
Ray Buhagiar
Aug 7th 2012, 14:30
General Practitioners are considered specialists. The only problem is that they do not work in group practice and therefore do not invest in medical equipment. Some of them work in run down clinics.
They should be allowed to at least refer patients directly to health centres and use the equipment available. Controls (ehealth) are mandatory to ensure that the services are not abused.
Francis Saliba M.D.
Aug 8th 2012, 05:34
@ Ramon Saguna, yesterday at 13:13.
You are much more likely to go off-track if you rely on your lay judgment rather than that of a professionally trained doctor. The evident solution to your problem is to change your GP (or perhaps your specialist).
Edward Zammit
Aug 8th 2012, 18:56
1. GPs huma specjalisti
2. Tiggeneralizzax, hemm GPSs tajbin u ohrajn hziena, bhalma hemm specjalisti ohra tajbin u dawk hziena.
3. Xi kultant hemm min jipprova jwaqq l-GP ghac-cajt ghal xi agenda personali. Naf x'jien nghid. Din hi nuqqas ta' etika u tista tigi rrapurtatha lil Kunsill Mediku. Mhux ser naghti ezempji, ghax hi wkoll nuqqas t' etika xxandar ismijiet fil-pubbliku
4.Jekk ma' joghgbokx il-GP ibdlu.
PS Fejn taf jekk l-ispecjalista hux ihawwad jew jibbluffja.
Francis Saliba M.D.
Aug 7th 2012, 13:09
Consulting a family doctor first is a reasonable first option because many complaints are too trivial to merit precipitate attendance at a hard-pressed E & A unit at Mater Dei hospital and in more serious cases it would favour the correct choice of the apposite specialist whether in hospital or at the specialist's consulting room.
Edward Zammit
Aug 8th 2012, 18:50
Agree with you of course. I wish to add that a minimally competent GP (by College standards) can deal with much more than trivial complaints. Depression is a good example - competent GPs do a very admirable job of tackling this common, and very serious problem.
I am sure that you know all this and you do not need strengthening of your argument. My comment was directed mostly to lay persons.
Jonathan Camilleri
Aug 7th 2012, 13:01
I agree, I do the same mistake sometimes, because I worry too much about my perceived condition.
G.A. Scicluna
Aug 7th 2012, 12:34
why not make the GP a gatekeeper , that is no patient can be seen by a specialist unless referred to by a primary care GP..both in private practice and public service.
M Borg
Aug 7th 2012, 13:52
Why should anyone prevent me from going and paying a specialist if I want to ?
S Micallef
Aug 7th 2012, 14:26
@ M borg the problem is that unlike you many will not pay for a specialist but will go and clog up hospital queues when probably they would not need a specialist in the first place.
If all people shared your mentality we wouldn't have any problems, but unfortunately everyone wants everything for free in this country.
J. Debono
Aug 7th 2012, 14:45
@ M.Borg
It is for your own good.
GPs have the knowledge to guide you to the best specialist for your problem.
In fact this is how other countries work. You cannot go to a specialist before you go to a GP.
Even in Malta if you go to a specialist and not to a GP, you will not be covered by insurance.
K. Vella II
Aug 7th 2012, 14:45
This is more or less the case in the UK with the NHS. Can't say that it works well.
Ganni Borg
Aug 7th 2012, 12:33
if i'm not mistaken there is no allied health professional in any of the subgroups mentioned by in ceo in the video
leo briffa
Aug 7th 2012, 19:53
No just nurses health assistants and Doctors, none of the other so called allied healthcare professionals are present, ie Physios Podologists radiographers etc.
the situation is so out of hand that no one really knows how to combat this monster we have all created called NHS...this is costing us 1.1 Million euros a Day, that's approx 370 million a year. that equates to approx 1000 euros per person per year, so a family of 4 will dish out 4000 euros a year from our taxes,
Then when you really need the service ---you end up paying the private sector cause you find a queue infront of say 9 months.
I say give the money back to the honest taxpayer and let him take care of his health. government services can then compete head to head with the private sector and no one will go for the service just because he happens to be in the vicinity of a Free Health centre.
Edward Zammit
Aug 8th 2012, 18:45
@leo briffa
There is no 9 month queue for doctor and nurse services, so you do not need to go to a private clinic if you do not want to. Free, high quality service.
Please choose the reason of your report below: