From Dr Abdul Hamid Abdul Kadir
The issue of overcrowding in the outpatient departments (OPDs) and emergency departments (EDs) of public hospitals, with long waiting hours and delayed admission to intensive care wards, has been raised many times.
Various suggestions have also been given to remedy the situation.
The provision of healthcare, promptly, effectively and with the least distress and discomfort to the patient, has always been a matter of universal concern.
The primary aim of the doctors in the OPDs and EDs is to save lives and limbs.
When doctors are faced with a whole range of emergency and non-emergency cases, it takes time to triage and identify patients who need emergency care, hence the long waiting hours.
It is evident that the overcrowding in OPDs and EDs is primarily due to patients turning up with minor as well as major health problems, including those due to injuries.
The crux of the matter lies in us finding a lasting solution, based on the experiences in other countries, which have to a large extent remedied the situation.
How can we reduce the overloading and overcrowding in OPDs and EDs at government hospitals?
The answer lies in educating or sensitising the public about who needs emergency care and who does not.
For the public, everything from a swollen knee, cough and fever in a child, or pregnancy-related problems, is an emergency.
Who indeed is the best person to help them identify the seriousness of their illness before coming to the OPD or ED, other than the doctor at a Klinik Kesihatan (government health clinic) or private general practice (GP) clinic?
The World Health Organization recognises primary care as the best, cheapest and fairest way to improve health outcomes for countries.
There are more than 7,000 primary care clinics, private and public, in our country, which are positioned to provide first-line care.
The principle of patient-centred primary care is for the primary care doctor to provide treatment for the not so seriously ill patient, and identify the seriously ill patient and refer them to a secondary care hospital.
This “gate-keeping” control of access to higher-level care for non-critical illness or injury will definitely reduce congestion in the OPDs and EDs at government hospitals.
To facilitate access to primary care clinics or Klinik Kesihatan, members of the public should be registered with a primary care clinic within a defined distance from their home or place of self-employment.
This will improve personalised care and follow-up of patients by the same primary care doctor.
Corporate bodies, with more than 200 employees, should have their own primary care doctors within their places of work. These should operate without the involvement of third-party agents.
This would mean that only patients seen by primary care doctors and found necessary to be referred for secondary or critical care, with a referral letter, should receive treatment at a government hospital.
Generally, the primary care service needs to be improved, with the professional skill and level of care of the doctors enhanced, including management of minor injuries.
This may be achieved through coordinated government-funded or assisted initiatives, as shown in other countries.
Besides those referred by a primary care doctor, who else should have direct access to secondary healthcare service in government hospitals?
- Patients with pregnancy-related problems, whether or not referred by primary care doctors;
- Infants and children aged below 12, whether or not referred by primary care doctors; and,
- Patients brought in by a first-line ambulance service.
In any case, the follow-up of such patients after emergency treatment, whenever possible, should be referred back to the respective primary care doctor.
These suggestions are made so that the government can consider taking appropriate steps to overcome or ameliorate the existing problems in OPDs and EDs at all public hospitals.
This is with the hope of achieving, in stages, the desired improvements in the foreseeable near future.
Dr Abdul Hamid Abdul Kadir is an FMT reader.
The views expressed are those of the writer and do not necessarily reflect those of FMT.