“I want only to see you”

TeachinghospitalThe dilemma in teaching hospitals of whether patients can or should choose their doctors remain. If a patient chooses to visit a teaching hospital, the understanding should be that they may be subjected to “student” doctors or at least specialists in training. Well, it is not as straightforward as that.

If a teaching hospital also services the public, then on most occasions, patients have not much of a choice when choosing a public hospital. They may still hold the right to choose the doctor that he/she wishes to see. After all, for a successful patient outcome, the doctor-patient interaction is key. How then can the patient achieve a good outcome if there is distrust in this relationship.

“Does the doctor know what he’s doing? He’s still learning after all, isn’t he?”.

Ideally, a doctor in training should “practise” under strict supervision of a senior staff. Decisions must be made after consultation with the senior staff, preferably the attending consultant. This is necessary to safeguard the patient from harm and the doctor from legal consequences. So really, are those worries unnecessary?

The reality however, is chilling. Certainly, many junior staff do not consult their seniors enough. More often than not, it is for the fear of revulsion. Stories where derogatory expletives were directed to the junior staff is abundant and continues to this day. Hence, many junior staff attempt to manage patients to the best of their knowledge and level of skill.

Consultants are also too few despite a deluge of new medical graduates. They cannot possibly manage a large number of patients, trainee doctors and specialists in training. Hence, many consultant duties are delegated to the Specialist registrar or even to more junior levels. It is therefore impossible for all patients to be seen by the consultant.

So patients may find it impossible to choose their doctors. Having to contend with any doctor is the only choice patients at teaching hospitals have. In fact, at this moment, it is similar in any public hospitals in Malaysia.

As medicine and technology advances, so are our patients. They are gathering more sophistication and knowledge. They are challenging their doctors more often than not. The internet has become an infinite resource, right or wrong. So many want to choose their doctors, for a perceived better intellectual discourse.

Who wouldn’t want to be able to choose their doctors!?

Some of us may have been patients at some point and we do treasure the choice of choosing the doctors that we trust and can interact with. It does give us a sense of comfort and will no doubt aid the medical outcome. Most teaching hospitals should strive to achieve this, without compromising the need for junior doctors to train.

Better engagement with the patients may be necessary including introducing the patients to the team should the patient request to see a specific doctor. Perhaps this may help allay the fears that their “usual” doctor is no longer in charge. Dropping by to “check-in” will likely be a necessary duty of the consultants in such a hospital.

It is a marriage of educating doctors and ensuring patient safety. Rather than separate them, there must be a compromise between the two at a teaching hospital.

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