Saturday, September 22, 2012

kill.thatdamnpatient.com

kill.thatdamnpatient.com

2 cents on Kuwaiti Healthcare

Posted: 22 Sep 2012 12:53 PM PDT

We have a problem, we all know we do. Our healthcare system is a money pit that keeps patients angry and makes employees want to get shot in the thigh just to get a week off work. Clearly we need a solution and fast but the question is what? What can we do to fix things? How can we fix it? and before you say we’ve never tried bite your tongue because we have and every effort has failed epically……

Attempt Number 1 and the “Canadian Syndrome” outbreak:
Government funded scholarships are the best thing to ever happen to this country. It has revolutionized our education and business landscape across the board. People at Kuwait university will recall that the first generations of Kuwaiti professors and lecturers all based their teaching methods and curricula on what they had learned during their time abroad. These forefathers managed to take concepts learned at various institutions and adapt them to the circumstances they had at the time, then evolve these curricula to suit the times we live in and any person who has been to Kuwait University will tell you the educational aspect of things aint half bad (although the social life and maturity of some of these students leaves much to be desired). Unfortunately unlike PhD programs and Masters degree programs which are set up to develop a skill set that is translatable. Medical residencies and specialisation schemes (or boards) are designed and have evolved from apprenticeships and concentrate on the development of a management style as well as getting you used to a healthcare system.

So the trouble with doing residencies abroad is that you are trained to work in one system, given titles and degrees as well as a whole gaggle of research projects that eventually lead to a blisteringly impressive CV; then asked to comeback to a healthcare system in which you don’t know how to function. When one is used to being able to get a battery of tests in 5 minutes and come to a place where it takes a week because the resources aren’t there they become frustrated and end up blaming the system for the fact that they can’t function in it. This; coupled with the fact that their veteran Kuwaiti board graduate can do the same job with half the tests makes them seem arrogant for no good reason leading to the birth of what many Kuwaiti doctors have dubbed “canadian” syndrome. An arrogant, lazy, bored doctor who feels under appreciated and often gives up and lives in his office doing fuckall but bragging about how good that center he worked in back in Miami was the best etc …..

Attempt 2 the Rise and Rise of Private healthcare:

If the government cant do it surely private business will! It worked for the internet, mobile phones and schools (yeah right …..). It’s very had to convince me that privatized healthcare will improve things. Simply because it hasn’t. People who own private hospitals in Kuwait are often very weary of venturing into doing anything risky because they land in the papers and that will mean less money and more lawsuits. Thats why most unstable patients land on the doorsteps of Amiri, Mubarak, Adan and Farwaniya Hospitals. Simply put our current private institutions don’t want to handle anything of high risk and thats that. You make more money from treating 6 easy conditions over 1 day than one complex one that you know will end badly.

Attempts number 3 Outsourced Management:

2011 saw our boldest and most promising effort to try and fix our hospitals….. get white people to fix it for us. We signed a contract with Mcgill University to try and management our Chest Hospital. This worked brilliantly ….. but was and still is very painful for everyone involved. Many of the staff from Mcgill were frustrated at the lack of resources and casual nature many Kuwaiti specialists had that simply didn’t exist at their center. Furthermore it’s been more than a year and we’ve yet to see any change in outcome either through hearsay or publication of data or evidence that any data has been recorded (we don’t know if this change in management has increased productivity, changed mortality or morbidity rates or made heart surgery in Kuwait any safer.

So after all the waffle and the mind vomit where does the solution lie?

Apologies, chances are I’m not the guy who’s going to solve your problem Kuwait, like most true blue Kuwaiti’s I’m very good at complaining but pretty bad at actually fixing things (fact of the matter is; I’m just not qualified)

But I do think we can learn alot from the revolution the NHS in the UK underwent under Tony Blair. We need to admit that abolishing government run hospitals is impossible. I fundamentally believe that every person living in Kuwait deserves free healthcare and if they don’t get it then we have failed. I also believe that private healthcare needs to be kept alive as well. At a government level we need to say that all unnecessary and minor procedures and investigations be performed within a private healthcare system.
This will mean that our government hospitals will have more time for more difficult and complex cases as well as provide our Kuwaiti board candidates a chance to get exposed to tougher cases which will give them more robust training. As these cases become harder those afflicted with “Canadian syndrome” will eventually have to face the music and humbly go back to trying to work and understand the system they are stuck with. At first they will be frustrated but eventually they’ll be able to work hand in hand with everyone else as their expertise becomes more and more relevant and the case load becomes more interesting.

Next we need to mandate screening programs through private healthcare in which everyone screened for say … prostate or breast cancer gets put into a database. This will allow us to gauge the demographics of disease within the country and plan for the future. (Screening programs are easy, everybody scopes and everybody get an ultrasound at some point, you just need to make sure it happens as part of a screening program).

Lastly we need to get the more experienced people to champion these initiatives as well as public awareness campaigns. I have literally worked in more centers than you have fingers and to this day I have yet to see people match the expertise of some of Kuwaits more senior doctors and hospital administrators. These people need  to get involved in managing and establishing guidelines for cases deferred to private hospitals and those that are sent to ministry hospitals, they also need to set up screening guidelines and raise public awareness, not just because they are truly experts in their fields but because we trust them.

This should have been an open letter to the Ministry of Health, KIMS, KMA (even though it now seems presidentless) and the private healthcare sector …. but I’m pretty sure they won’t read it anyway.
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