When elephants fight

A.P. DANSO

THE PLIGHT OF THE PATIENT

• Between 2005 and 2010 our health system was badly affected by the country’s political , social and economic difficulties

• Inflation rates of 10,000% affected the delivery very negatively

• The nation developed a new national health strategy for 2009 to 2013 .

• This strategy was adopted in 2010

NATIONAL STRATEGY

• This document includes a new PATIENT charter spelling out

• HOW PATIENTS SHOULD BE TREATED THROUGHOUT THE HEALTH SYSTEM .

• As we emerge out of the maze . Is the patient better off today than in 2008 for example?

The Patient

• Why 2008 ?• That is when a Patient preferred/could only

buy medication for 2days instead of a PRESCRIBED ONE WEEK COURSE ! WHY ?

• Because the money was not available .

Questionnaire

• Methods : • We sent Questionnaires to Patients =350• We interviewed Patients =157

RESULTS

• 413 patients believed that the Patient of today is not better off than the Patient of recent past 2005-2010 ( 81%)

Details1

• The patient of Today is confronted with • 1 the difficulty of Accessibility and

Affordability – trying to find a place where appropriate care is offered

AT A REASONABLE COST (323) (64%)

Details2

• The difficulty of Location –finding the appropriate treatment at one place and of having to go from pillar to post and yet not finding the right treatment . (301)(59%)

• Mafioso to Mafioso , friend to friend referrals!

Deatails3

• The difficulty of being used as a tool eg going through 5operations and still not knowing what they are doing to you

• Patient with uv junction stone , basket manip , JJstenting , reimplantation , insertion of Stent ,removal of stent . Stone still in situ and yet the doctors are “bamboozling you with some BIG WORDS AND EXTRA TERRESTIAL TONGUES (352)(69%)

Details 4

• The difficulty of the absence of recourse for the patient .

• The difficulty of getting a hearing if things go wrong .

• Mr A . G . Presented to corp24 on 7th of July with a sudden onset of of right sided testicular pain . >>>>ultrasound scan = dilated cystic tubular structures noted extending to inguinal region and to lower back . =dilated thrombosed varicose veins

Details

• Patient discharged home on pain killers and asked to come back in 3days . 3days later he is referred to the specialist . Torsion >>>>orchidectomy no recourse (298)(59%)

• Penectomy for verruca /warts • Mastectomy for no neoplasm

Details 5

• The difficulty of overcoming the built in prejudice caused by the friction between funders and providers

• Patient must go to “our “ lab . Psa –normal , psa above 4 , psa below 4. , below 6. , below normal.

• Go to my radiologist , to my preferred specialist , go to my lab , go to my practitioner

• Where is my freedom of choice ?

Details 6

• There is no cohesion !!!• When will cohesion come ? • At what cost will cohesion come ?

• What can a practitioner do to ease the plight of the patient ?

Details 7

• The difficulty of –”when you do not have the money upfront or a Medical Aid and you are very ill –what does the HEALTH CARE SYSTEM OFFER YOU ? and how quickly can you get treatment ?

• Patient with a catheter , needs prostate surgery planned for feb 2015 .

• WHAT CAN WE ALL DO?

LESSONS LEARNT

• When elephants fight it is the grass under their feet which suffers .

• When funders and providers disagree for long periods , it is the Patient who suffers for long periods

• So long as there is no cordial relationship between funders and providers .

• There are far too many “ vestigial “ funders

Lessons learnt

• We must put back the patient at the top of the pile and as the most important entity in the Healthcare system .

• The Patient must have a choice where to go and where not to go

• A little bit of policing amongst practitioners will be send a better wake up call to us all

• A less fragmented Health care system will be ideal and will help the Patient .

Recommendations

• A better and a workable relationship between the Patients (consumers) the providers and the Funders will go a long way to lift the patient’s plight in this maze of the healthcare provision .

• A better policing of the professionals is mandatory .