Good morning

                     I tuned in to ONE TV this evening and heard Mr Charles Grixti ,an orthopaedic consultant, comment on the problems of the Health services in Malta and the way forward to solve these problems. I listened to other various contributions which were interesting, some politically biased, some, difficult to understand as to whether this was patient orientated or purely for personal reasons. One case in point was the comment about IVF. one could say that the law proposed on IVF will not work or is ristrictive but at least there is a law proposed, whereas before nothing existed, free for all. If one believes that the embryo is a human being and not a bunch of cells than this law is needed. Knowing that we have a 21 year old IVF-delivered and other children, adults human beings in Malta who were successfully in vitro fertilised, we do not know how many thousands of embryos died in the process , no record exist . I will discuss IVF in detail in another Post

                     Back to the programme. I was not impressed by the discussion . The emergency department came into scrutiny with many, not knowing what actually happens there, what improvements were made to the system in general whether by increasing human resources; the number of consultants, increasing the number of HST and BST ( higher specialist trainees and Basic specialist trainees ), increasing the number of Doctors to tackle Category 3 patients or by Increasing  cubicles in area 3 so that doctors are able to visit more patients. Mr Grixti mentioned that area 2  was transformed into an admission ward. Very true, but you have to be there when you are faced with a sudden surge of  patients needing hospital treatment which cannot be given at home. One easily forgets the times when we had rows of patients in the corriders of St Lukes Hospital. The problems than was not Casualty but cubicles in wards  transformed into 2,3,4 and more bedded to accomodate the inflow of patients. I am not mentioning Social Cases ( I hate the word ): patients who actually do not need any treatment in Hospital but who are unable to be taken care of at home. This requires its own solution because the problem is there, it will remain there and it will definitely increase in the future. These poor patients are referred to A&E  normally by their own GP with ailments which are not actually "emergency" but which would require twice or more daily visits by gp/nurse /physio / frequent blood tests etc... which is impossible to perform in a primary care setting with the present setup, but these turn up at A&E. They take a cubicle, a doctor and hours to settle them after routine investigations and a place for admission.

         

                       No one in the programme  mentioned that all patients who turn up at A&E are seen by a nurse and a doctor. No one is refused a consultation. Patients turn up at A&E with a one year history of an ailment  or with ridiculous rash (for me but this may seem to be serious for the patient) or hoping to get an urgent appointment at outpatients  or for some investigations; we see all. That is why sometimes A&E see more than 300 patients a day.

                       One young doctor who contributed during the programme mentioned group practices in the Primary care setting. He said these should be encouraged so that the doctor can take his break but still hand over his patients to the doctor in his practices. This was the concept in the Primary Care Reform. I want to tackle this in another post because it requires detailed analysis. I am against group practises. The time when i decide to enter into a group practise is the time when I should decide not to continue working as a family doctor. It is very easy to treat a patient with any ailment if he presents with an organic (tangible) cause but it is very difficult to treat a patient with possible psychosocial cause unless you know the patient well and the patient is willing to trust you with his inner deep feelings. He will never do this if today he finds one doctor and tomorrow he finds another. No one appreciates that 90% of the workload of a family practitioner is psychosocial related

                        Not one person mentioned the huge investment we do every year in the health service. The ever increasing number of operations a day in every sector we are performing. The state of the art technology we are investing in every sector of the health whether oncology, new treatments, human resources. We do this because of a healthy economic structure unlike other neighbouring countries which have to reduce their Health Budget due to their economic woes.