Doctors are stressed, stressed, stressed. They are tired, they are overworked, they are unmotivated. Some are barely coping and depressed; others are full of apprehension about the future and ability to survive the current predicament.

There are very few doctors who are entirely happy about the situation they are in now or totally satisfied with the current healthcare system and the future of it.

There are two main groups of doctors, those that work in the public service and yes, they are serving the public literally, and those in the private sector where it's supposed to be the more lucrative field for a Doctor to work in.

Every year there is a mass migration of doctors from the public services to the private sector searching for better income or freedom from government bureaucracy and rules.

Well, those traditional patterns of migration, as well as the presumed lucrativeness of the private sector, is unfortunately no more and from both sides of the fence, doctors are feeling the heat.

Those in the government services are complaining there are too many patients to attend to, too much bureaucracy to provide proper patient care and often they feel very much alone in the quest to give their best without much support when they fail to do so.

The demands of the patients are increasing at such a frantic pace that they feel inadequate to cope at times.

The burden seems too heavy at times for the motivated and the passionate causing them to lose the drive to perform and considering migrating to greener pastures locally or abroad.

This is sometimes compounded by the fact the non-performers are retained in services; not lightening the strain but often adding to it after automatic promotions based on seniority.

Junior doctors who should be feeling on top of the world as newly graduated doctors, having the power to heal, are feeling the 'doom and gloom' of the situation. They feel insecure with the seniors not trusting them to do anything and yet not having enough opportunities to train or being supervised as there are too many of them

The seniors, on the other hand, are feeling overwhelmed as work and responsibilities are thrust upon them, leaving them with very little time to supervise the juniors or even have a bit of time for themselves and with the ever hanging threat of increasing medico legal suits, it's no wonder they are feeling unmotivated.

Public pressure, political pressure and expectations are heaping more pressure on what is already a pressure cooker situation in some public hospitals.

On the private side, it's no bed of roses either. Those who work in hospitals are working like employees with their fees tightly regulated by law, whereas the hospital's fees increase exponentially year by year unregulated.

Hospital management is not much of a support either in times of need or unforeseen patient outcomes as most management decisions are based on the bottom line of returns of investment. At times, in cases of unforeseen patient's outcome, not only is compensation expected from the doctor to the patient, but also from the doctor to the hospitals as well if the unforeseen events from the doctors' action or inaction.

Outside the hospitals, those brave souls who dare to venture in the minefield of setting their own clinics or centres are occasionally having second thoughts.

From the moment they set up private practice, the ever demanding Private Healthcare Facilities and Services Act will make sure they toe the line and they mean it all the way from the width of your clinic consultation door in centimetres to the direction of your toilet door swing, what services you can offer, what patient charter you need to put up, what organisational charts you need to display, what emergency procedures are in place and on it goes in great length and details.

Often you will find primary care clinics with a whole bound book on these requirements and what is more interesting are new rules being drawn up periodically until one has nightmares in case one transgresses any.

Examples are the Poisons Acts whereby the pharmacy enforcement pays regular visits to the clinics, the Clinical Waste Disposal regulations whereby the Department of Environment follows suit.

They can come from the Employees Provident Fund, The Workers Insurance scheme (Perkeso) , the Income Tax Department, the Fire Department , the  local authorities over the signboards and of course the latest , the Personal Data Protection Act and the GST Act.

There are also requirements by the localhealth authorities for regular patient data reporting or reporting of Infectious diseases, as well as reporting of high risks pregnant mothers.

Then comes the Milk Team , yes the Milk team , believe it or not from the Ministry of Health, enforcing baby friendly policies, breastfeeding is the order of the day.

If this is not enough, the increasing tendency for medico legal action by patients in cases of unfavourable outcomes hangs like a Damocles sword over the heads of all doctors.

Eyeing the lucrativeness of the private sector, third parties are increasing dipping their hands into the honey pot. The advent of these third party administrators and mnagement organisations acting as go between the doctors and the patients create increasing costs as these third parties have to be paid also.

Even that does not end as some third parties are known to subcontract their work to fourth parties. Every one is having a party, except of course the doctors and the patients.

There is also gross mismatch between theregulations governing the private sector and what really transpires on the ground. Many of the rules and regulations are impractical or not applicable. Further more many complain that these rules while applicable to private sector, are not similarly implemented in public or government sectors.

What about the patients? Well, they are the losers most of the time.

When seeking medical treatment in the public sector, they are faced with a long wait, due to the overwhelming number of patients.

Adding to their woes, often front liners who attend to them are junior and inexperienced, even medical assistants at times. Direct access to specialists is a major challenge for a lot of patients.

The quality of doctors they are faced with is another issue. Undeniably, there are many highly qualified and great doctors in the government, as well as private sector,, but with the rate Malaysia is producing doctors, a manifold increase compared to previously, and the mushrooming of so many medical schools in such a short length of time, quality in training has to suffer .

Some patients go to 1 Malaysia clinics that are mushrooming everywhere, only to find that medicines are limited and they are either attended by nurses or medical assistants who are not much help.

Also the 1 Malaysia clinics are situated mostly in urban areas where many health care facilities are nearby. Very few 1 Malaysia Clinics are in rural towns where they are most needed.

This mismatch of healthcare facilities is not only are confined to clinics, butalso to hospitals too whereby there are numerous state of the art hospitals built in far flung areas and towns with latest equipment and facilities, but lack specialists or skilled doctors to attend to patients.

When patients seek treatment in the private sector, again it's no bed of roses with escalating bills, especially when admissions or operations are necessary. Att times these bills can drain a lifetime's resources of patients if treatment gets complicated or prolonged.

In the final analysis, all stakeholders and parties to the healthcare system mean well and their intentions are good spirited.

The challenge is to understand each other better and to replace mistrust between parties by sincerity and the belief in each other. To realise that without the other, we cannot progress, same as the right hand will always need the left hand.

The systems need healing, the doctors need healing and the patients need healing. Let us all work together and join hands so that we can heal all.

source: the malaysian insider