Only when the press stepped in to reveal the real state of affairs did the CM finally decide to intervene personally. The worst aspect of this scenario is that the health secretary then tried his best to shift the blame for his own administrative failure on to the striking doctorsThe five-week long strike by young doctors in training has finally come to an end. The stalemate ended when a delegation of the striking Young Doctors Association (YDA) finally had a face-to-face meeting with Mian Shahbaz Sharif, the Chief Minister (CM) of Punjab. Even though no actual announcements about any of the YDA’s core demands were made, the YDA felt reasonably confident at the assurances offered by the CM that it decided to end the strike. This is good news.
After the meeting, the CM announced the formation of a committee made up of three senior members of his party and three representatives of the YDA. This committee will submit a report within two weeks for further action. Important to note is that the health secretary of the Punjab government was not a part of the committee. Whether the absence of the health secretary in this committee will satisfy the YDA (that had repeatedly demanded his dismissal) remains to be seen.
The Lahore High Court also summoned members of the Punjab government as well as representatives of the YDA to decide why the strike had been going on for so long and who was responsible for the unfortunate effects on patients. The court along with the CM has asked for a commission to be formed to apportion blame. However, trying to put the blame directly on doctors for these mishaps is entirely unwarranted. It would indeed be a bizarre twist to blame people not present at the scene for something that happened in their absence.
If we look at the last few days of the strike, when most of these unfortunate incidents took place, it is clear that the hospital administrators as well as the secretary of health wanted to convey the impression to their political bosses that ‘everything was under control’. To make the YDA seem irrelevant, the administrators kept talking about hiring new doctors to replace the striking ones who would then provide all the services that were needed. Everybody who has actually ever worked in a public hospital that offers advanced medical care knows that doctors brought in from district hospitals or hired ‘off the street’ can never replace the staff in these hospitals without months of training.
By perpetuating the lie that everything was under control and repeating it often enough, the secretary of health and his minions in the public hospitals clearly misled the CM and other higher officials. Only when the press stepped in to reveal the real state of affairs did the CM finally decide to intervene personally. The worst aspect of this scenario is that the health secretary then tried his best to shift the blame for his own administrative failure on to the striking doctors. Yes doctors carry some of the blame, especially if there are any proven incidences where doctors belonging to the YDA actually manhandled physicians and prevented them from performing their duties. These people should be identified and appropriate action should be taken against them.
Now that the doctors are back to work, it does not mean that their demands can be safely ignored for the time being. Frankly, having doctors that are unwilling to work to the best of their abilities is still a potential source of trouble and might actually create greater problems than their strike did. As it is, more people die during an average week in these hospitals when they are fully functional than they did during the entire strike. Most of these unfortunate outcomes are due to substandard medicines and medical supplies, inadequate ancillary care and lack of appropriate oversight by senior doctors. And, of course, due to the fact that many of the very sick patients arrive at these hospitals at a point where nothing can really be done to save them.
This already unfortunate situation in public hospitals will get worse if the young doctors in training become dispirited and disinterested in their work and start ignoring their responsibilities. Perhaps the most important reason to bring about needed reforms in the salary and service structure for these young physicians is to create a healthy educational experience for them that will stay with them and have them go on to become enthusiastic and caring physicians when their time comes to take on direct patient responsibilities.
One of the best kept ‘secrets’ about this entire situation is that all these young doctors in training who went on strike are not supposed to be taking independent care of patients in the first place but are really supposed to do it only under the direct supervision of senior doctors. During the height of the strike, senior doctors were made to provide care to sick patients in the emergency rooms and medical wards. This is perhaps something that should be continued to provide on site supervision of doctors in training to improve the educational environment as well as patient care.
The commission has also been asked by the learned judges of the Lahore High Court to have an expanded mandate. I sincerely hope that instead of starting a witch-hunt, this commission will actually look at the entire panoply of medical care available to poor patients in our great public hospitals. Frankly, the prevailing conditions are really most dreadful and an objective assessment must be done to determine how they can be improved. Along with this, an attempt must also be made to upgrade peripheral medical facilities to relieve pressure on the tertiary care in teaching hospitals.
Finally, this entire episode, unfortunate as it was, must serve as a ‘wake up call’ for the political leadership of this province as well as the entire country. Physicians in training are literally the future of healthcare in this country. How they evolve will determine how healthcare will be delivered in the future both in the private as well as the public sectors.
The writer has practised and taught medicine in the US. He can be reached at smhmbbs70@yahoo.com
Source : http://dailytimes.com.pk/default.asp?page=2011\04\11\story_11-4-2011_pg3_3
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