Saturday, January 09, 2010

lazarus #2: a system gone wrong

the family of the patient "lazarus" from the previous post has requested that he be transferred to a public hospital because the cost of private medical treatment is now a strain on their resources.

i don't blame them. private medical care has become so expensive the average man on the street would shun it solely because of this. no matter what the private hospitals promote about themselves, be it service from the heart or to make a difference in people's lives, they are mostly profit-driven organisations.

which means, money talks.


the final bill essentially consists of 2 portions, the hospital's charges & the doctors' fees. the latter are guided by a schedule sanctioned by the malaysian medical association & if any dispute concerning doctor's fees arose, this schedule would be used during arbitration. however, the hospital's portion is a lot more ambiguous & variable because its charges are guided by "market forces."


which means, anything goes.


that's just one side of the coin. why wouldn't the public avoid government hospitals if they can afford private healthcare? notwithstanding that some are fungus-infested & others have non-functioning operating theatres, public hospitals have always provided affordable (sometimes free) medical care to the masses but with a few drawbacks, like they double as training grounds for new doctors & nurses. sometimes, with minimal supervision.


which means, things are more likely to go wrong.


now, as the country realises its 2020 vision & attempts to achieve developed nation status, it is
, amongst other ventures, churning out doctors like production lines in a factory, to attain that "magical" ratio of 1 doctor for every 600 population. a ratio that was taken out of context & now applied to this country. with a proliferation of public (9) & private (12) medical schools & a generation endeared to becoming healers, it's a recipe for a mismatch at best, & a disaster, at worst.

which means, doctors will very soon be a dime a dozen, & not all properly trained.


in a way, i'm sad for "lazarus" & at the same time fear for him. he may end up in one neglected corner of a general ward where he may be seen by a junior doctor just once a day, when instead he should be properly treated in intensive care, a setting where he was originally & miraculously resurrected.


any outcome other than for him to walk out of hospital alive would be a tragedy in a system that's gone wrong.

19 comments:

suituapui said...

That's the sad thing. Money makes the world go round!

But to be fair...not all doctors at private hospitals are good and not all those at the private ones are not good... It all boils down to each individual - who they are and what they are capable of.

I have a lot of horror stories about doctors...but no point telling. In every profession, it's the same. Life's like that! God has made us all different and unique in our own ways...

Unicorn Girl said...

I truly understand Lazarus situation as me and my family were put in a similar situation last year when my mum fell ill. The only difference - we moved her from the government hospital to a private one because of the cardiologist - and we even not charged for the consultation fee :) I guess not all of us are ' lucky ' sometimes . But I have to agree with you predicament concerning the medical field here.

Michelle Mak said...

oh dear... i nvr trust government hospital... will only go if i personally know the doc and the doc knows me...

but all in all i thank Him cause i have good docs surrounding me and family... hehe...

*shall just pray for ur pt that he will continue to be safe in His mighty hands*

doc said...

STP,

this post is about why ill patients generally don't get the attention they deserve. in public hospitals, the junior doctors are the frontline care-givers while in private, because critical care is by nature labour-intensive & equipment-dependent, & medications are very extensive, the cost is prohibitive.

for the record, this patient's total bill is just over RM40K!!

if only there were proper management of govt finances & money spent on unnecessary glamour projects (monsoon cup? submarines?) were instead channeled into healthcare & only deserving students are trained in medicine, perhaps patients like "lazarus" would have been better treated in a public hospital instead.

if only.

doc said...

Unicorn Girl,

wouldn't you wish the treatment your mum received in the private were available at subsidised rate in a govt hospital?

it's always sad when we have to transfer patients to the govt hospital because of cost constraints.

doc said...

Mich,

thanks for your prayer.

Yan said...

I am quite a doctor-shy person. I do not like seeing doctor. But, I am interested in talking to doctor as a journalist. I was forced to see three eye specialists - two in private practice, one in government hospital - during the past seven months. Three because I think I need a doctor to know my case in each location that I would be spending my time there.

I am not a difficult patient. If I am allow to comment, two of them could benefit from a course for cultivating an agreeable "bedside manner".

Yan said...

doc,

BTW, the Korean story that I promised has been posted today!

JoMel said...

And that is the cold hard truth. Money talks!

doc said...

Yan,

yes, some are more "professional" than others, but there you are, you have choices!

you didn't mention about churches in Seoul - my friend said there are so many, often a few on the same street.

doc said...

Jo,

let's all be grateful for good health!

ilene said...

IF only all the nurses at the public hospitals are more learned and compassionate in their chosen field.

IF only the doctors in the public hospitals could carry out the system of following through with the same patient at each appointed dates.

IF only public hospitals could accommodate appointments in a shorter period of time.

IF only the private hospital misc charges were minimised. (The doctor's fees are reasonable and some are compassionate enough to give a bit of discount).

IF only I have sufficient money to shower my mum with comfortable care at the private hospital. (In a period of 1 year, we spent almost RM150k).

IF only ....

In conclusion, IF you have money, your life could be prolonged.

doc said...

Ilene,

both doctors & nurses would do well to remember our "oaths" to serve, whether written or spoken, & carry out our duties with diligence & care, but often, our quests are defeated not only by our own deficiencies but also by the system in place.

however, we still try.

missyc said...

Sometimes Money talks & from my experience one must also be knowledgeable & assertive to get the attention public or private.

My father was hospitalised in govt hospital & he received prompt specialist care coz we know who to approach & make a request. The overworked doc was caring enough to sit & talk with him post op. You hardly get a surgeon to do that even in private hospital (I know I've been down that road 2x)

Sometimes we don't understand why the system fails. Everybody wants immediate attention even for minor ailment. When one is ill, 10 mins wait seems like forever.

Public or private, its really up to what one desire and how much one can afford or willing to pay or else patient's family will go bankcrupt on medical fees alone.

This story was related by a relative. This guy from out of town with a blackened arm went to see a highly recommended specialist at a private hospital (KL) After going thru his records, given treatment option & expected fees, patient says, Doc I have no money but can you go ahead and treat me 1st? The doc redfaced in frustration, promptly threw the file in disgust & stomped off. The guy bewildered went away not knowing what the problem was! Someone told him, got no money why go to private hospital ?

doc said...

Missyc,

in private, even if the surgeon doesn't spend a lot of time explaining, it's still the same surgeon that you'll see till discharge from hosp. in govt, unless you know the surgeon, you could be seeing a few doctors on different days.

same with your relative. if he knows a particular surgeon that i know in HKL, he would have got his fair treatment without much fuss. but you put yourself in your relative's doctor's position - if you are selling a product or providing a service, are you prepared to incur a substantial loss should the customer fail to honour his payment AFTER you have given away the product/service??

again, money talks & there's really nothing you can do about it.

missyc said...

Yes money always talks louder.

Both patient & doctor are equally 'wrong'.
Patient should not have gone to private hospital knowing his financial limits but the doctor should also not show his frustration & throw the file! No bedside manners. He could just have explained that he doesn't own the hospital thus the medical fees. Any sane person would understand.

doc said...

Missyc,

thanks. point taken.

Adino said...

Private hospitals are businesses that, first and foremost, have to answer to shareholders.

The advantage is, they can afford to invest in better facilities and employ quality staff.

The disadvantage is, you need an insurance plan or lots of money before you think of going there.

And sometimes even with money, they can still choose to take your case or not. Few years ago I wanted to admit my dad to a private hospital, and I was turned away by two hospitals.

doc said...

Adino,

all unfortunately true.

sometimes, the hosps have limited critical care beds, eg ICU, & that's why patients are turned away, not because the hosps want to.

in those days when we had only 1 neurosurgeon, everytime he went on leave, head injury patients were similarly asked to seek treatment elsewhere.