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Thursday, July 19, 2007

Suatu Masa Dulu.........dalam sejarah...

MMA opposes move to replace doctors as Hospital Directors


The MMA is concerned that there seems to be a move to replace the present Hospital Directors with Paramedics or Administrative (PTD) Officers.

Firstly, contrary to what was reported in the Press recently, in most hospitals in the country, doctors doing Clinical Duties are not "doubling up" as Hospital Directors. Rather, Hospital Directors are those doctors who have chosen to use their clinical acumen and experience to practice CLINICAL GOVERNANCE of their hospitals so as to ensure a high standard of patient care. This is much the same as a Senior Teacher who uses his teaching experience to run a school in such a way that the standard of education in the school is high. In the same way, the head of the JKR is also an Engineer.

Secondly, the primary function of a hospital is to provide quality patient care. This can only be done if the quality of care is monitored by a doctor who practices CLINICAL GOVERNANCE. Only a doctor who has been trained in Medicine can perform CLINICAL GOVERNANCE. This cannot be done by a paramedic or a PTD officer. Aspects of CLINICAL GOVERNANCE include :


1. Doing ward rounds and reviewing case notes to ensure that medical officers and specialists are practicing a high standard of medical care.

2. Ensuring that Clinical Practice Guidelines are adhered to by all doctors, including specialists.
Discussing and finding solutions to Clinical problems faced by specialists.

3. Ensuring that Infection Control guidelines are strictly practiced in the hospital.

4. Chairing Mortality and morbidity review, and quality assurance management meetings. It is important that the Hospital Director chair these meetings, so that Remedial measures can be put in place when there are Shortfalls in Quality.

5. Determining the Drug policy of the hospital by chairing Drug Committee meetings and ensuring that adequate and appropriate financial resources are provided for the purchase of drugs. It will be difficult to explain drug efficacy and interactions for each of the many clinical disciplines to non doctors.

6. Determining the Antibiotic Policy of the hospital, thus ensuring that doctors do not prescribe very powerful antibiotics as a first line of treatment of minor infections.

7. Determining and prioritizing the Medical Equipments to be purchased for the hospital. Only a doctor trained in medicine will be able to discuss the specifications of the medical equipments to be purchased so that they meet the specific needs of the clinicians.

8. Ensuring the maintenance of a high standard of Medical Record keeping and documentation.
Chairing the Investigating Committee when there are public complaints about the standard of medical care given to a patient.

9. Reassuring the public that adequate, timely and high quality medical care will be provided their family members. The hospital director will be able to elaborate on the queries on diagnosis, medical care, investigations, the course and the prognosis of the illness.

10. Advising and teaching junior medical officers on the clinical aspects of patient care in District Hospitals without specialists.

11. Developing contingency plans for the hospital to cater to medical emergencies arising from disasters, epidemics, outbreaks etc. This was clearly demonstrated in the recent SARS
Outbreak when the Hospital Directors and Public Health Specialists exhibited excellent team work to ensure that adequate resources and appropriate contingency measures were provided to control the outbreak.

Thirdly, in a hospital setting where there are other professionals like Specialists, Doctors, Pharmacists, Dieticians, etc, the Hospital Director MUST be a professional trained in medicine to understand the specific needs of these other professionals and to command their respect. The hospital directors are today responsible for assuring the quality of all facets of the care provided. It is also much easier to ensure cost efficiency and effectiveness of the various interventions when one has a good working knowledge of the underlying basic and applied sciences.


Fourthly, this present system is working very well, as evidenced by the high quality of medical care being provided by the government hospitals in this country as is often touted by our government. Ultimately, there are about one and thirty public hospitals and even if we send all of them to the wards and clinics all the time; we will be unable to even make a dent in the thousands of vacant medical posts. The government needs to look at constructive long term measures to attract and retain doctors in the service.


Finally, the doctors who are Hospital Directors are not the ones advocating the change. They receive regular clinical feedback from their clinician colleagues, and do provide some clinical care in the hospitals as well as keep abreast of the current advances in clinical medicine. They are content and proud of their responsibilities in ensuring the standard of medical care in this country. They have been doing an excellent job for decades and they should not and cannot be replaced by officers who are less qualified.


These trained and experienced doctors lead a very busy and stressful working day, managing the many areas of service provision in the hospital. They are often at the forefront of any public complaint and have to be responsible to the higher authorities for all aspects of the service. Their contribution to the health care delivery system is often not recognized and it is very disappointing that their services are being belittled and undervalued. This is, indeed, a very sad day, for with this proposed change, the quality of medical care in the Government Hospitals will definitely decline and the victims will be the public.


Basically, the issue can be summed up by acknowledging that it is much easier to teach a doctor management skills than to teach a layperson the complexities of medicine. The MMA appeals to the government to seriously reconsider this decision and we will be able to establish and provide further evidence based support for our arguments.


Datuk Dr Teoh siang chin
President
Malaysian Medical Association

2 comments:

Anonymous said...

Beza minda perajurit dengan NUTP


WAJAH-wajah kesedihan yang jelas kelihatan pada semua keluarga mangsa nahas helikopter Nuri Tentera Udara Diraja Malaysia (TUDM) yang menghiasi muka depan semua akhbar pada minggu ini cukup untuk menitiskan air mata saya.

Di saat bumi Malaysia sedang bersiap siaga untuk meraikan kemerdekaan ke-50 tahun, kita telah kehilangan enam perajurit negara. Walaupun jumlahnya sedikit tetapi merupakan aset negara yang tidak ternilai kerana mereka terbukti sanggup memperjudikan hidup demi negara tercinta.

Di celah-celah laporan perkembangan operasi mencari dan menyelamat pesawat Nuri ini, terselit juga berita dakwaan Presiden Kesatuan Perkhidmatan Perguruan Kebangsaan (NUTP) yang menyatakan 50,000 guru dari skim Pegawai Perkhidmatan Pendidikan Diploma yang menyambung pelajaran ke peringkat ijazah pertama teraniaya disebabkan gaji rendah yang bakal diperoleh berbanding dengan rakan-rakan yang tidak menyambung pelajaran.

Sehari selepasnya, Menteri Pelajaran menyatakan hanya 8,000 guru sahaja yang terlibat. Pada masa yang sama, pihak NUTP juga memutuskan satu resolusi untuk menyerahkan memorandum kepada Menteri Pelajaran menuntut agar penstrukturan semula Jabatan Pelajaran Negeri tidak diteruskan hingga memaksa Menteri Pelajaran mengeluarkan kenyataan penangguhan penstrukturan semula itu.

Umum mengetahui bahawa salah satu alasan terbesar NUTP yang mewakili kelompok guru meminta dikaji semula idea penstrukturan semula ini adalah fahaman yang berakar umbi di jiwa mereka bahawa kemasukan pegawai dari skim PTD, teknologi maklumat, kewangan akan mengekang penguasaan mereka di JPN. Isu ini sebenarnya sudah terlalu usang tapi tetap menjadi perjuangan NUTP.

Sebagai orang luar dari kelompok para pendidik dan perajurit, saya melihat wujud perbezaan yang amat ketara dari segi budaya pemikiran dan minda antara pendidik dan perajurit negara.

Semenjak berita kehilangan pesawat Nuri tersebut, rata-rata rakyat mempersoalkan umur Nuri yang menjangkau usia 39 dan 40 tahun tapi masih digunakan oleh para perajurit negara tanpa sebarang penolakan atau memorandum kepada kerajaan memohon pesawat baru.

Selepas 18 nahas melibatkan Nuri, akhirnya kerajaan akur untuk membeli pesawat baru menggantikan Nuri yang telah berkhidmat sekian lama kepada negara. Keputusan kerajaan ini dibuat secara rasional dan logikal tanpa sebarang tekanan daripada pihak tentera sendiri.

Terima kasih kerajaan Malaysia atas keprihatinan yang ditunjukkan. Saya pasti pihak tentera khususnya TUDM bersyukur dan akan memacu semangat mereka untuk menjaga kedaulatan negara.

Berbanding dengan tentera yang tidak banyak kerenah, saya melihat kelompok guru yang dinaungi oleh NUTP kerap kali cepat melatah. Dengan justifikasi yang ditambah dengan data yang kerap kali tidak benar, pelbagai tuntutan dikemukakan yang kerap kali memberi tekanan kepada kerajaan.

Salah seorang mangsa tragedi Nuri telah bertugas 10 tahun di Kuching demi tugas dan baru sahaja kembali ke Kuala Lumpur untuk bersama keluarga. Demi keselamatan dan keamanan negara, para perajurit rela meninggalkan keluarga kerana mereka memahami erti sebenar profesion mereka.

Saya teringat dua tahun lalu media massa diwarnai dengan kemarahan dan bantahan daripada NUTP berhubung dengan arahan penempatan lebih kurang 300 orang guru ke Johor yang mengalami kekosongan guru Bahasa Inggeris. 300 orang guru ini enggan bertukar dari ‘zon selesa’ mereka dan rela mengorbankan kepentingan anak bangsa yang perlu dididik tanpa mengira tempat.

Tindakan kelompok guru ini menggambarkan mentaliti mereka yang tidak memahami erti sebenar profesion guru yang dikatakan perlu berada di barisan hadapan dalam pembinaan dan pembangunan modal insan seperti mana yang digariskan oleh Pelan Induk Pembangunan Pendidikan (PIPP). Tambah mengeruhkan suasana, NUTP seolah-seolah merestui tindakan anggotanya.

Bayangkan, apa akan berlaku kepada negara apabila semua rakyat mementingkan keselesaan sendiri dan rela mengorbankan tanggungjawab yang sepatutnya dipikul?

– MISJIJAH MARUL,

Kajang, Selangor.

lee kuan yew said...

huargh boring. asyik merungut dan cari salah orang lain je. cermin muke dulu kot-kot banyak kita kate kat org tu sebenornye reflects diri kita. gih le buat kerje tu encik admin.