A Doctor’s Rant

Below is a kinda long but interesting write up by a friend of mine currently working in the medical field. It’s related to the “Kuwait to segregate medical care” post from last week:

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Its not a sprint, its a marathon

We need help. Everyone can agree that healthcare in Kuwait should be paramount. We need to have a healthcare system we can be proud of and confident in. I need to feel proud of where I work and the job I do. The recent lobby towards segregated healthcare for none emergent cases is just one more example of a quick fix for many failed and saddening endeavours that we as a profession are at least partly responsible for.

From the outset I doubt that anyone working currently in Kuwaiti healthcare is evil or bad or totally and completely corrupt. In fact, I think many of us started our careers inspired and full of promise but were met by challenges that we cannot possibly overcome. At a healthcare system level, we need to refine our goals and find our way towards something more efficient and dare I say it welcoming to people.

How many people reading this have a family doctor?

I doubt many of you do. This may be because you are perfectly healthy but it’s probably because you show up at the emergency room if you need anything because you have no confidence in your local poly clinic or mustawsif. The fact of the matter is that I wouldn’t either.

We need to re-create the family doctors as the go to guy or girl for all things non emergency and as the primary referring physician (small bruises, vaccines, high blood pressure, diabetes control, breast and colon cancer screening). This will mean two big changes. The first is that one doctor or centre will have all your medical history and that from now on you won’t show up to the emergency room unless it is an actual emergency, otherwise the emergency department will refuse to see you (this is the norm in the US, Canada and the UK NHS, it is becoming the norm in many south east asian countries gradually as well). More importantly we need to equip our poly clinics and family doctors with information and facilities such as x-ray facilities, ultrasound and turn a rundown office into an actual treatment facility. We also need to mandate a minimum amount of courses to be taken by these doctors so that they remain up to date in their fields (this should be true for all doctors in general come to think of it)

Provided you’ve got a referral or are trying to see a specialist, how many of you see them on time?

The way things are now, if you live in Mishref, you go to specialists in Mubarak, if you live near Adan then you are sent there. This means that the areas with the highest population end up with the longest waiting times. We need a structured dynamic referral system. I’m sure that there is some sort of solution I’m just not sure what it is. Perhaps if there was a regular update of which areas had the shortest waiting time were made available to family practitioners on a daily basis (via email). It may mean that patients will get their appointments earlier.

The problem is that I doubt that a person living in Jahra would be happy coming to Amiri for his echocardiogram even if it meant he or she would get it quicker. Having referrals to different hospital for different things would mean that you need to have all the patients data accessible across different hospitals in a sort of a cloud. Lets face it people, I’m more likely to see a giant flying saucer deliver free red velvet cupcakes at 360 than I am to see the ministry of health manage a cloud based patient filing system.

Having exhausted all efforts to get an early appointment you decided to go private, how many of you see a physician in his private practice after trying to get an early appointment in his government funded one?

Many of us have a conflict of interest when we are employed in private and public healthcare. I know colleagues who completely neglect their public healthcare patients and I know others who have no interest in private healthcare. Regardless, clear guidelines have to be set so that a physician working in the private healthcare field does not neglect his or her public healthcare practice. A bill requiring all doctors working in private healthcare to have 50% of their practice as public or pro bono might be the best solution but it’ll also mean that you would be the most hated minister of health in the history of Kuwait. (Maybe if we start with 30%, doctors are less likely to revolt)

Lastly, how many of you actually see a specialist?

Defining the term specialized in Kuwait is very difficult. How many of you actually get to see a colorectal, or hepatobiliary surgeon or a surgical oncologist? How many of you see an actual sleep study specialist or an actual trauma surgeon in the emergency departments? I know they exist because I’ve worked with them and seen them get trained. The reasons why you don’t see them around are many.

The first is that the current regulations do not allow for unique subspecialties. For example if you are a colorectal surgeon your actually registered as a general surgeon in the ministry because colorectal is not recognized as it’s own independent discipline.

The second is because we don’t have the infrastructure or a way of providing it for the people who are trained in specialist fields. For example we have 6 transplant surgeons who can do liver transplants but we lack the resources required for them to perform them and do not mandate a need for these resources, specialties and departments to be built.

The third and most worrisome is how we treat people who are trained abroad. The current regulations mandate that anybody trained abroad having attained full specialist status is forced to return as a registrar or senior registrar for a number of years. By the time they finally became attendings or consultants they will have probably forgotten everything they have learned red and would be content running a general practice rather than have to keep up to date in their field and attempt to establish it in Kuwait.

Worst still we not only force these Kuwaitis into registrar positions instead of acknowledging their training, we also go and hire “experts” from the centres that trained them to do surgeries in Kuwait rather than make use of young talented experts in the field many of which we have spent money training. This has lead to a complete lack of specialization in many fields.

After three years of doing general surgery, a colorectal or robotic surgeon will have probably forgotten his original trade craft and would find it a lot less stressful to just stick to general surgey and a little stomach stapling every now and then. The alternative is to just leave the country and go back to work in the states or Canada or where ever else they’ve trained because for the most part, these people are actually damn good doctors.

Because of the complexity of problems such as these and many others; giving a minister of health a year or two to fix things will just result in a bunch of quick fixes that lead to no long term progress. I really do feel that we’re trying to sprint through a marathon when it comes to fixing Kuwaiti healthcare and I doubt the solution is a one year or two years plan, it should take time and it should be done gradually with perseverance.

That’s my two cents.

– Saud, a Kuwaiti doctor living and working/training in Montreal.
Twitter: @saudnz