Sunday, June 16, 2013


After a prolonged and deliberate hiatus, I'm resuming my blogs for a number of reasons. The foremost is the simplest. I miss writing. The other reasons don't seem to matter now.

It's been three and a half years since I've graduated. I've settled into working in the Public Health Service. While I have no intentions of being permanent here, it is where I am at present, and so I not only make the best of it, but I aspire to make it better.

In my short stint thus far in the service, it is clear why doctors become frustrated and fed up. It is no wonder that they pack up seeking greener pastures. At the very basis is the clear lack of professionalism from those who seek to administer healthcare in Trinidad. Doctors, who are the ones ultimately responsible for the welfare of their patients are routinely disrespected, humiliated and forced to work in conditions akin to indentureship.

At the very outset, I contend that I speak for the vast majority of doctors who are dedicated and committed to their jobs and their patients. I acknowledge that there are those who are suboptimal, but that is a feature not unique to medicine. However, as a result of sensationalism generated by the media and the failure or inability of doctors to adequately address the clear misconceptions or outright lies published have rendered us at the mercy of a public who is poorly educated about what their expectations should be about the health system that they access. Doctors who work in the public hospitals have had their constitutional right to freedom of speech muted by the courts and the contracts which prohibit medical professionals from engaging with the media. This, despite the fact that they may come under direct attack with reputations at stake. Instead, it is left to the communications departments of the Regional Health Authorities (RHAs), to address these matters. Indeed, the personnel charged with this responsibility, while they may be advised medically, usually have no training or experience in working in a health related field.

The lack of respect transcends just the patients, however. There is a complete breakdown in the hierarchy of the delivery of healthcare in this country. Doctors are rendered impotent when directives for management are undermined by nursing staff who fail to execute the daily plans for patients or by attendants who refuse to do their jobs of transporting patients to and from various facilities within the hospital. (eg. from A&E to the ward or to get a simple X-Ray or CT Scan)The result of this is that doctors are therefore forced to do the jobs of the auxillary staff. 'So what?', you may be thinking. 'Doctors feel they do big to do them things?' Well firstly, doctors are not hired as nurses or attendants. But more importantly, when doctors are left to do the jobs not being done by those who have been hired to do them, the collective care of patients suffer. This is because there is now less time for doctors to manage the actual care of their patients since this time is wastefully spent on, for example, wheeling a patient to get an ultrasound.

There is a fine line between disrespect and humiliation, but it is distinct. And there has been, lately, what seems to be a concerted attempt to deliberately humiliate doctors. There is the vexing issue of the unilateral removal of a vehicle tax exemption usually granted to travelling officers by the Chief Personnel Officer. This, despite the fact that it is included in a legally binding contract that has been signed by doctors. This blatant attempt, coupled with the fact that no new collective agreement has been signed since 2008, only serve to accelerate the rate at which those with high aspirations and the means to escape, ultimately do. This is a blatant failure of the Medical Professionals Association of Trinidad and Tobago (MPATT) to seriously deal with issues directly affecting the conditions and compensation of the most important link in the health care chain.

On further examination, however, things begin to clear. The immediate past president of MPATT is now Chairperson of an RHA, a direct conflict of interest in any corporate circle. Another former president sits on the board of another RHA. This revolving door, aided and abetted by political connections and aspirations have enabled a scant few from within the very profession to augment the populist sentiment that it is acceptable to humiliate those who provide health care in very trying circumstances.

Finally, with the appointment of the latest Medical Chief of Staff, doctors have been threatened via memos and other intimidatory tactics that they should not claim their legitimately worked for overtime or compensatory days. In which other profession would this nonsense be condoned? This is in clear contravention of the contracts which we have signed. Instead, tactics which include merging non compatible departments in order to lessen overtime sessions or outrightly refusing to sign off on legitimately worked extra sessions have become pervasive. Compensatory days, which was a compromise in itself, so that doctors can be compensated for hours worked in lieu of cash, has been taken away, ultra vires the contracts which have been signed. And all this with the apparent consent of the employer.

The profession of medicine in this country has been and is continuing to be systematically undermined. Doctors cannot give priority to delivering the best health care to patients when all of the above bogeys are constantly being held over our heads. The final insult is the posturing by administrators who have little or no medical knowledge purporting to make medical decisions which they claim to be in the best interest in the public. This includes, but is not limited to the reversal of decisions made by qualified, sometimes even specialised health professionals. These decisions are usually populist in nature and have no basis whatever in proper and due medical practice. When the outcomes are then, predictably, disastrous, the blame is then placed squarely at the feet of doctors.

A friend of mine once pointed out to me that, in general, doctors come from the cream of the academic crop. We have usually strove for excellence from primary to secondary to tertiary levels. We have worked hard and fought through a multitude of obstacles to arrive at the point when we can be called doctors. A great majority enter the profession with that wide eyed innocence of seeking to make a difference. That personality doesn't change upon the conferring of a medical degree. The drive for excellence does not change. What changes are the extraneous, unnecessary challenges that we are forced to cope with, along with quasi qualified personnel who, for some reason wish to 'play' doctor, rather than letting actual doctors do their job in as least stressful and conducive environment as possible. The profession of medicine has been outsourced to the most obstructionist, egocentric and unqualified people. It makes for a worse health system and a sick, sick nation.

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