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
Malaysian Medical Association