After recently doing an attachment in another hospital, meeting other MOs who are based in many different hospitals all over Malaysia, I’ve had an opportunity to discuss with them regarding health care issues at their respective setting, and about how they run their service in their respective hospital. My eyes were open to the fact that no system and no service is perfectly run. But we must continually improve the system, regardless. The conversation that I had with fellow attachment doctors reminded me that I had written about some of these issues that we have talked about a long time ago.
I wrote this article below about one year ago, before the GE 14. But I did not publish this post publicly because it was still a bit of a sensitive issue at that time. Now that we have changed to a new government, I decided that I should publish this post publicly. One year ago, I had written this article after a very emotionally-charged encounter with a patient that made me feel defeated. That made me feel like I couldn’t do much for her. That made me question myself regarding why I was even a government servant? That made me want to migrate elsewhere! That made me feel very hateful of the BN government! Last year, there were so many issues that affect the provision of healthcare in Malaysia that made me wonder if I could ever be the kind of doctor that I had always envisioned myself to be.
And I blamed the government then. Hahah.
Of course after the GE 14, I am all hopeful and optimistic these days. But I also think that the issues I had ranted about one year ago are still relevant. And therefore, since I am having a writer’s block at the moment and have no materials or issues to update in this blog for the time being, I decided to publish this old article of mine that had been collecting dust in my hard drive. (One blogger had asked me regarding how I manage to maintain my blog since 2009 and not suffering from a writer’s block like her? Most of my friends’ blogs were not updated for many years. Writer’s block is real, people! It is the most dreadful thing that can happen to a writer. So I told her that I write a lot of things that I don’t always immediately publish in this blog and simply keep them in my hard drive. When I have no materials with which to update my blog, I will simply choose one of those unpublished articles to be posted. Writer’s block sometimes can persist for months, folks. So when I do have things to write, I would go on a binge writing session and put those articles away as reserve. When the next writer’s block strike, at least I would still have something to post in this blog. So that’s the secret. Maximize your articles productivity when your thoughts are clear and chockablock with ideas but don’t publish all of them immediately in your blog. Keep a few of them away to tide you over in the months when you are suffering from lack of productivity secondary to writer’s block)
So here’s the article I had written one year ago and it was about social justice. Enjoy!
For The Sake of Social Justice
The problem with me is that I have a pretty high expectation about most things. I really do.
I am not a perfectionist, though. I am a practical idealist (though some would argue that the term ‘practical idealist’ is an oxymoron).
You see, there are times when I can relate to difficult patients, because I am pretty difficult myself (with very good insight about my difficult temperament. Hahaha). Trust me, you don’t want me as your patient.
For example, if I had waited for four hours to see a doctor, you can bet your little finger that I expect a lot from the consultation later. A lot!
I would feel pretty disappointed (like I was short-changed) if the doctor simply asked “Ada dengar suara bisik kat telinga? Ok, tak ada. Ubat makan tak? Boleh kerja? So, semua okey? Okey, kita sambung ubat macam biasalah.”
Four hours of my time yields only 5 minutes (or even less) of consultation?! Any REASONABLE patient would feel short-changed (let alone a demanding and a difficult one!). The patient might even decide to default follow up next time because he/she didn’t feel the consultation was worth the trouble and the waiting time. (I certainly know that I am the type of person who HATES waiting. Hahaha. Orang macam aku takkan mau dah jumpa doktor kalau aku rasa tak berbaloi! I won’t do something that don’t give me worthy outcome!)
Sometimes, I feel so terrible about my inability to spend more time to see each and every one of my patient. There are times when I want to prolong the consultation simply because I want the patients to feel that their waiting was worth it. But when I look at the piles of cases left to be seen in front of me, all my good intentions fly out the window.
However I always make sure that I ask a token question of “Ada apa-apa dak nak tanya lagi?” or “Nak habaq apa-apa ka sebelum kita habis?” or “ada apa-apa lagi nak bincang dengan doktor sebelum habis?” (Nampak tak perkataan ‘sebelum kita habis’ dah ada unsur-unsur nak kejar patient? Unsur-unsur nak menutup consultation, tetapi masih berlapik. Hahah)
You know, it is laughable. Usually we said “Sebelum kita habis, ada apa-apa lagi ke nak tanya or nak habaq?” for a conversation that has been going on for a long time.
BUT! If they just came and ‘bontot pun tak panas lagi” and then suddenly I used the phrase “sebelum kita habis…” Hahaha. God… it is ridiculous, isn’t it? (If I were the patient, I would go, “You mean, we are already about to finish? We barely even started, doctor.”)
Most patients would say no. That they have nothing else to say or to ask. And some chronic Schizophrenic patients with negative symptoms really have nothing else to ask. In the first place, some of them are monosyllabic in answering questions. And some of them have poverty of thoughts and would not volunteer any information that is not directly asked. They don’t elaborate much on their answers because after years of illness and cognitive impairment, they are not able to produce the sort of spontaneous speech that we all have taken for granted.
And some patients who are rushing to pick up their kids from school really don’t mind that the consultation is short. (“Saya tunggu lama sebab nak ambil ubat ja. Memang saya nak rushing balik kerja/ambil anak/nak masak. So tak pa lah, doktor sambung ubat ja lah.” they would say with an annoyed tone because they have been waiting for so long just to continue medication) But I still ask that token question of “ada apa-apa nak bincang dengan doktor?” just to comfort myself that I have done my job. That I have invited them to say their piece. That I have fulfilled my obligation to hear them out after they have waited for so long. And if they said they were fine, then I won’t feel guilty if I decide not to probe further. So it makes me feel better that I have asked. (As if my ‘ajak-ajak ayam’ to talk further is good enough! LOL)
Of course, we KKM staff can comfort ourselves by saying “Ni hospital kerajaan. Nak buat macam mana? Kalau nak cepat kena pi private. Patient lain dok tunggu lagi lama. Kalau tak boleh tunggu lama, pi lah private. Kalau nak luah perasaan lama-lama, kena pi private. Kalau nak dapat doktor yang layan awak macam raja, kena pi private.”
Is that gonna be our tagline? “Kalau malas tunggu, pi private” or “Kalau nak demand, pi lah private”, dan yang sewaktu dengannya?
Whatever the patients want that we cannot fulfil, let’s direct them to the private clinics, huh?
So, other than our routine core business of seeing patients (furiously fast) what are we doing here as a government staff?
See…we in the government, have no choice but to prioritise. Some cases are difficult and we do spend more time exploring their issues to their hearts’ content (and our hearts’ content). Not all cases can ‘touch and go’. Affective disorders (with new stressors) will take up almost half an hour of our time, at least (and in the mean time ,’to be seen’ cases keep piling up in front of you. Patients keep knocking on your door, asking for you to hurry up because they have some other urgent matters elsewhere).
Some people think Schizophrenia is difficult to see. (“Pesakit Schizophrenia mesti aggressive. Susah. Mesti lama nak kena settle,” some inexperienced non-psychiatric doctors might think). But actually, psychotic disorders are the best cases to handle when you are rushing. When they are aggressive, you just jab them with IM Haloperidol. (If they are already stable and not aggressive, you just asked “Dengar suara tak? Kalau tak dengar suara, dose ubat ni kira dah oklah. So, kita sambung ubat macam biasa.” End of consultation. That’s the main gist of it, with some variations. When you are rushing, you cannot be as thorough as you like. It is so sad.)
It is the affective disorders that always make me feel guilty when I cannot see them longer than I want to. They would cry, then they need to talk…and talk…. AND talk. And they will cry some more. They deserve my time… and I cannot fulfil their expectation, sometimes. Not because I am rushing to go out for lunch. But because other patients are waiting too and they keep rushing you! I could forego my lunch if patients are willing to postpone the rest of their activities just to wait for me to thoroughly see each and every one of them. But they are not willing to postpone picking up their children, are they? They are not willing to postpone going back to their office too, are they? They are not willing to postpone getting back home so that they can carry on with their routine, are they? THEY couldn’t wait! And therefore, I couldn’t spend more time than I would have liked to if it were up to me.
But when I DO spend my time with them, we get distracted a lot. By noises! By people going in and out. By conversation crossing over, here, there and everywhere. I lost focus. My irritability raises quite a bit when I am forced to converse in noise. I hate it.
It’s just not ideal.
The ideal side of my ‘practical idealist self’ finds it intolerable. But the practical side of the same self know that I should learn to accept the situation and make do with whatever we have.
If I were the patient, I would write a letter of complaint to Pengarah and said “Dahlah masa menunggu lama. Bila masuk bilik, jumpa doktor tak sampai 5 minit. Dalam 5 minit tu pun, bilik penuh, sendat macam dengan apa. Saya cakap pun kena kuat-kuat, sebab bising. Bila saya cakap kuat, pesakit sebelah lagi pun cakap lagi kuat sebab dia pun nak didengari juga. Doktor saya pun terpaksa cakap kuat sebab bising. Doktor sorang lagi pun akan cakap lagi kuat. Belum lagi medical students yang dok berkeliaran sana sini. Saya rasa saya lagi stressed out. Dalam bilik tu kena share punya ramai orang! Ada 4 doktor dalam satu bilik, campur empat pesakit dan campur keluarga mereka sekali dalam bilik tu. Dan student-student dok pi mai, pi mai. Rasa-rasanya, saya ada mood tak nak cerita masalah peribadi saya dalam suasana yang macam tu?”
(I told you that I am a difficult person. You really don’t want me to be your patient. See? You have no idea how thoroughly I can voice my complaints, and how profoundly I can elaborate on it. When I have something to say, I REALLY say it. Haha)
But as a pragmatic, we deal with the limitations that we have. We make things work because we have NO OTHER CHOICE. And this situation is similar in ANY government setting. Consultation rooms are shared because there are simply no more extra room to be used. When I talk to my friends elsewhere, they told me that in certain settings in KKM, even the pantry is used to see patients! (Again, if I were the patient, I will definitely complain.)
We in KKM might say, “So what? Bayar RM5 saja, dah mengada-ngada. Patients tak berhak nak demand dengan RM 5,” Eh? Betul? Cuma kita sebagai doktor, patut ada rasa tak puas hati bagi pihak pesakit. Kita kena ada rasa nak improve kita punya service. But who would care about what the doctors had voiced out to the admin? People would only start to care once the patient himself/herself complains against any hospital in the social media and it becomes viral.
Imagine if all doctors told their patients, “Encik pi lah mengadu. Nah….ni borang aduan. Lagi banyak encik mengadu, lagi senang kami nak justify buat perubahan. Semua ni perlu budget yang kami tak ada.” Why don’t we encourage patients to complain against us?! You see….that’s what the practical side of my ‘practical idealist’ self would think as a good solution. My practical side thinks that encouraging our patients to complain against us is the most effective way to get the ball rolling. To get the attention of the higher up.
But no! Once you are in admin, you don’t want to hear complaints kan? Sebab nanti kau yang nak kena jawab. So…I don’t know. It’s a Catch-22 situation. Damned if you do, damned if you don’t. Maybe admin should welcome complaints as a method to pressure the powers that be to pay attention. When called to produce an explanation letter, we can simply write as follows: “I have nothing to explain. The patient was right in everything she said. Now, you deal with it! How can you help me to improve my service with the paltry, minuscule budget you are giving me? Call me when you have the answer. I am most anxiously waiting.”
Tak cukup staff kat ward sebab memang tak ada pengambilan staff baru… okey, we deal with it.
Tak boleh start appropriate medication untuk patient sebab tak ada quota, we deal with it.
Tak boleh nak provide more comfortable consultation environment for the patient, we deal with it.
Tak boleh claim elaun untuk provide good community service during oncall, we deal with it.
We are okay to deal with it as long as we think the government has no money through NO FAULT OF THEIRS. But that is not the case! The case is they are very much at fault! Where the hell is the GST money? Budget cuts for health is starting to affect our patients.
The case is, the government is very incompetent through blatant corruption that has been swept under the carpet again and again.
The case is, all these difficulties are secondary to greedy politicians swindling money right, left and center!
That’s the case!
So nowadays, I push all my patients to apply for OKU cards and allowance. I used to dread seeing the OKU forms being brought by patients…. because it meant that I would have to go to my specialist, wait outside her door and pounce upon her once she has ended her consultation with her patient in order to get her to sign the OKU form. I hate waiting. The time waiting for my specialist to sign the OKU form can be used to see patients. That’s why I used to feel a sort of chest heaviness whenever I saw my patients bringing OKU forms that needed to be signed (In my mind, I went, “habislah masa aku terbuang menunggu depan bilik specialist untuk sign OKU form”. I generally don’t like to interrupt an on-going consultation and would wait until my specialist has finished with his/her patient before I would ask them to sign the OKU form. I project my own tendency to feel irritated when people interrupt my session with my patients. So I would have to wait in front of the specialist’s door until his/her patient comes out of the room… only then, I would enter the room to get the form signed.)
But nowadays, I stop rushing or thinking about wasted time. I give away OKU forms to most patients who don’t yet have an OKU card, even when they didn’t ask for it. “Nah, ni borang OKU. Akak balik isi borang ni, nanti bawa mai kat saya.” Some of them did not know that such welfare money is available, but I would voluntarily tell them to go and apply for it, overzealously pushing them to get the OKU card.
I want my patients to get the money, because otherwise those money will only sit around waiting to be swindled by other greedy hands. My patients have the illness, and they are entitled to it, in a way that no politicians are. At least I know that some of the taxpayers money are spent where it should be. That is my version of social justice. Distribution of wealth of the nation must be fair. In the cases when it is grossly unfair, then we should do everything in our power to help tip the balance.
In my current situation, the only thing I can do is to promote to every patient to apply for all sort of welfare aids that are available in the country. My patients are more deserving of the money than undeserving kleptocrats. Khalas! And if it means that I am going to have to waste some time getting the OKU form signed, then be it! For just a little bit of social justice, the wasted time would be worth it.
Because, really, what else is there to do? When you are working as a public servant of a corrupted government, what else is there to do to ensure just a little bit of social justice takes place? Maybe… the time has come to really grieve.
When I read back the above article that I had written one year ago, I remember again all the anger and frustration I had felt at that time. But I also experience that bittersweet sensation one usually feel after having defeated an oppressive opponent in a torturous drawn-out battle.
Bitter from remembering the anger I had once felt against the government! Sweet because I had played a small part in toppling the kleptocratic government when I became a PACA for PH!
When I heard that a movie has been made about the saga of GE 14 and it would be released this September, I just couldn’t wait to watch it! Guys, I don’t usually watch local movies, but I do watch all local movies when they are about patriotism! And this one is special… because this patriotic story happened in my lifetime. I was a witness to a great history! And now that it is made into a movie, I will not miss watching this.
And what makes the movie even better is, one of the directors for the movie, Nik Amir Mustapha, was my batchmate in MRSM Langkawi! So, there are so many reasons why I am so excited to watch this movie.
Come on guys, let’s watch it when it is released on 16 September 2018! Tempt yourself by watching the trailer of the movie below. The trailer is inspiring!