The global burden of non-communicable diseases (NCDs) has reached alarming levels, posing significant challenges to public health. Acknowledging the gravity of this situation, the Ministry of Health and Wellness (MOHW) in Jamaica has taken proactive measures to combat NCDs and promote healthier lifestyles among the population. They have focused their efforts on: Promoting awareness and education, Encouraging healthy lifestyle choices, Strengthening healthcare infrastructure and Collaborating with stakeholders.
However, while respect and gratitude must be offered for the steps taken by the MOHW, I do think they are missing the Heart of the matter and that in the absence of a shift in priority, they will fail in this mission. As a primary care physician that has been practicing for over 10 years, I have come to recognise the one factor that has consistently driven people from the public clinics into my private office is Service. This includes issues with all members of the health care team, and these complaints are not limited to the public system, but for the purposes of this article I will focus on the complaints regarding some of the doctors in primary care in the public sector.
As a fellow doctor the act of criticizing my colleagues is not taken lightly. I gave the public system my internship year alone and I struggled with burn out and the strain of being inundated with patients from time to time. This no doubt affected my bedside manner. So, I do not speak of the physician that is simply doing all they can to offer some care to the patient with limited time and resources. I am speaking of pill pushing, impatient doctors that have no time to hear patient complaints, and who provide no guidance, explanation, or information as to why they are recommending a certain course of treatment; a description I have heard enough times to accept that there must be some truth to it. Such practices breed mistrust, fear, misunderstanding and dissatisfaction which result in individuals avoiding interacting with the system for as long as they can. Therefore, no early detection and no prevention.
Doctors are the gate keepers
I focus my attention on the doctors because we are the gate keepers. We are the ones the patient come to see, the ones whose advice they have come to seek, the ones whose words have the most weight and who the patient is expecting to trust and rely on. So, we have the ability to make a poor experience with the administrative and nursing staff fade into the background because of how we treat the patient when they sit across from us. This is a burden and a privilege, one that should be enforced and reenforced periodically so that we never lose sight of the inherent power and responsibility of the title and position we hold.
Communication and engagement gaps:
Most of the doctors do not fall within the category most complained of, but I can’t say I believe that most are effective communicators. Effective communication and engagement between doctors and the patients they serve are vital for building trust, disseminating important health information, and addressing specific needs. Doctors must actively engage with communities, listen to patients’ concerns, and provide clear and accessible information to foster a collaborative and inclusive approach to healthcare. They should be the champions of preventive care, focusing on promoting healthy lifestyles, disease prevention, and community education. However, the MOHW has failed to put any visible effort behind strengthening this aspect of service delivery within the public service.
In my own practice, tackling NCD’S has not been as simple as creating access. I have found that patients need to understand each test, the risks, the benefits, the procedure, and the implications of the results. They need a sense of confidence that if they should get some sort of adverse result, their doctor will be there with them each step of the way to guide and support them through. This is the type of doctor-patient relationship that needs to be fostered within the public service. Otherwise, we are asking people who have had a bad experience with the health care system to go fishing for more reasons to interact with the same system that leaves them feeling less than human. This is a fatal mistake and an oversight that will cost millions if not billions of wasted dollars being thrown at form over function.
A progressive training programme developed to equip doctors with the necessary skills and mindset to deliver supportive and compassionate care by focusing on patient-centred principles, empowering doctors to build strong doctor-patient relationships, enhancing communication skills, and encouraging the prioritization of the holistic well-being of their patients must be implemented.
One of the primary factors contributing to the lack of service and care from public health doctors is the constant herding of patients through the door and the resultant lack of time to facilitate this kind of attention to detail. While I do not consider the volume of patients to be an excuse for treating people like cattle, the MOHW must make an effort to manage the number of patients that must be seen by physicians daily. They must be active in creating an organized system that utilizes Artificial Intelligence to set appointments for persons based on the urgency of their complaint and must double down on the appointment system being the only way to access the clinic, thereby limiting daily appointments to something more manageable for the doctors.
All public sector physicians have received a recent salary increase: an increase I support and agree with as this government has said they are trying to meet industry standard across the region. However, we need to ensure that we are holding the doctors to acceptable standards of service, knowledge, and professionalism as well, and the public needs to see, feel and trust that this is so. As it stands, patients complain that there is no one to complain to, and as a result there is no way to affect any change. This must change in order to signal to the public that if they are not treated well, someone will have to answer for it. I therefore challenge the MOWH to implement feedback stations at every hospital and clinic. A simple system of rating 1-5 stars and the name of the doctor. Place them at exits and allow the patient to select the name of the doctor they saw and rate them. Indicate to all doctors that if they get lower than an average of 3 stars each month for three consecutive months, they will receive some sort of sanction that may include termination and keep good on that promise. I am optimistic in believing that there will be a significant shift and that there will be no need to terminate anyone. But for the few who make no effort in improving, let the teeth that have been sharpened show that they do indeed bite.
If we are to make any headway in decreasing the burden of NCDs on the healthcare system, it is essential for governments and healthcare organizations to recognize the importance of patient-centred care. This can only be done by prioritizing training and sensitization of doctors to play a vital role in promoting the health and well-being of communities. Proper and clear standards of care must be set, and all providers must be held accountable. There needs to be an infusion of care and compassion that encourages the public to interface and subject themselves to the scary and daunting tests that are required to detect and prevent these NCDs. If we can do that, we can conquer this giant.
This article was published in the Jamaica Gleaner on June 12, 2023