Thinking Liberally
The Star, Tuesday October 8, 2013
Waiting for 12 hours at the ER
We should maintain
high expectations of our public services and not expect better services
only when we can afford to pay for them.
Let me start with a very important caveat. In this article, I will discuss my recent experience at Serdang Hospital.
My family and I have been regular users of services at the hospital and, overall, the services have been very good. This is not a generalisation of services provided by the hospital. I am using this example simply because it helps to illustrate a point that I want to make. The focus here is on the system itself and not the individuals within it.
Early evening on Thursday, Sept 19, my mother complained that both her legs were painful and it was difficult for her to walk. She is an elderly lady with a history of various leg problems. But this time the pain was unlike the usual.
My brother and I took her to Hospital Az-Zahra in Bandar Baru Bangi. She was diagnosed with cellulitis. The doctor recommended a course of intravenous antibiotics and she needed to be warded for that. Unfortunately, there was no bed at that hospital at that time.
So we decided to take her to KPJ Hospital in Kajang. Within 30 minutes she was attended to by a doctor, and was allocated a room after the diagnosis was confirmed.
I visited my mother at KPJ Hospital on Friday afternoon. After discussing her full history with the doctor, I was advised to take my mother to Serdang Hospital because she has been under their care for many years and they have her full records.
I called Serdang Hospital at around 4.40pm on Friday and asked to speak to the specialist who handled my mother’s case all this while. The receptionist told me to hold and then told me that she has spoken to the specialist who advised me to take my mother to the emergency department at Serdang.
We saw the triage nurse at Serdang Hospital at around 6pm. The waiting area was packed with people and was very stuffy. The air conditioning was not working well.
We finally saw a doctor at 11pm. By then my mother’s legs had started to be inflamed and was swollen again.
I told the doctor that we were worried because before we left KPJ Hospital, the swelling and inflammation had subsided. But the doctor took a blood sample and told us to wait for another two hours because the number of patients that night was exceptionally high.
At around 1am on Saturday, the blood test results arrived, and the cellulitis was reconfirmed. We were told to go into the observation room and wait for the on-call surgeon.
There was only one empty bed in the observation room and the nurses decided to reserve that bed for other cases that might be more urgent. So they put my mother on a sofa. Sitting does not help. The oedema and inflammation on her legs were visibly worsening. She was finally given the bed at 3am.
We continued to wait for the surgeon to come down. I repeatedly asked the nurses why was there a delay but all they could tell me was “Sorry, we don’t know”.
The surgeon eventually arrived at 4.15am. I understand that doctors can be very busy and it was indeed busy that night. So I thanked the doctor for coming down even though she was busy. But I was baffled when, with a curious look, she said she was not that busy and that she had only got the call to come down at around 4am. I still do not know why we were made to wait for so many hours.
My mother was finally admitted at 5.10am. When we arrived at the room, I asked the nurses to help lift my mother because she was in too much pain to stand up. But I was told to do it myself. I did what I could, helped her settle into her room and then left at around 6am. So it took a full 12 hours between arriving at the emergency department and being given a bed.
With this story, I want to illustrate a point. If a well-equipped and relatively large hospital like Serdang can be that busy and crowded, just imagine what it is like in rural areas where the hospitals are older, smaller and not as near to the patients. How many became worse before reaching a hospital or while waiting to see a doctor?
I have visited relatives in several rural hospitals before. The situation in those hospitals was really depressing. The wards were crowded, there were not enough chairs for visitors, toilet seats were broken and the doctors and nurses were overworked.
Many may say that the difference between provisions by a private hospital and a government one is expected. They lower their expectations when it comes to a government hospital. This is wrong. Why should better services be monopolised only by those who can pay?
We should maintain high expectations of our public services, and find ways to ensure the villagers in Kapit and Chini enjoy services comparable to that of ministers and politicians living in Damansara Heights.
I do not yet have a solution to offer. The purpose of this article is to invite readers to think about the situation in the hope that a solution can be found.
However, I do believe that we need to change the way we think about funding for public services. At the moment, the Government funds hospitals, doctors and nurses. We need to radically shift this so that the Government funds services users not service providers.
Private hospitals must serve their patients well because their income is dependent on user satisfaction. But government hospitals will not lose anything even if they treat patients poorly. Surely there are ways to inject some market discipline and pressure into how our hospitals (and other public services) operate.
> Wan Saiful Wan Jan is chief executive of the Institute for Democracy and Economic Affairs (www.ideas.org.my). The views expressed are entirely the writer’s own.
Let me start with a very important caveat. In this article, I will discuss my recent experience at Serdang Hospital.
My family and I have been regular users of services at the hospital and, overall, the services have been very good. This is not a generalisation of services provided by the hospital. I am using this example simply because it helps to illustrate a point that I want to make. The focus here is on the system itself and not the individuals within it.
Early evening on Thursday, Sept 19, my mother complained that both her legs were painful and it was difficult for her to walk. She is an elderly lady with a history of various leg problems. But this time the pain was unlike the usual.
My brother and I took her to Hospital Az-Zahra in Bandar Baru Bangi. She was diagnosed with cellulitis. The doctor recommended a course of intravenous antibiotics and she needed to be warded for that. Unfortunately, there was no bed at that hospital at that time.
So we decided to take her to KPJ Hospital in Kajang. Within 30 minutes she was attended to by a doctor, and was allocated a room after the diagnosis was confirmed.
I visited my mother at KPJ Hospital on Friday afternoon. After discussing her full history with the doctor, I was advised to take my mother to Serdang Hospital because she has been under their care for many years and they have her full records.
I called Serdang Hospital at around 4.40pm on Friday and asked to speak to the specialist who handled my mother’s case all this while. The receptionist told me to hold and then told me that she has spoken to the specialist who advised me to take my mother to the emergency department at Serdang.
We saw the triage nurse at Serdang Hospital at around 6pm. The waiting area was packed with people and was very stuffy. The air conditioning was not working well.
We finally saw a doctor at 11pm. By then my mother’s legs had started to be inflamed and was swollen again.
I told the doctor that we were worried because before we left KPJ Hospital, the swelling and inflammation had subsided. But the doctor took a blood sample and told us to wait for another two hours because the number of patients that night was exceptionally high.
At around 1am on Saturday, the blood test results arrived, and the cellulitis was reconfirmed. We were told to go into the observation room and wait for the on-call surgeon.
There was only one empty bed in the observation room and the nurses decided to reserve that bed for other cases that might be more urgent. So they put my mother on a sofa. Sitting does not help. The oedema and inflammation on her legs were visibly worsening. She was finally given the bed at 3am.
We continued to wait for the surgeon to come down. I repeatedly asked the nurses why was there a delay but all they could tell me was “Sorry, we don’t know”.
The surgeon eventually arrived at 4.15am. I understand that doctors can be very busy and it was indeed busy that night. So I thanked the doctor for coming down even though she was busy. But I was baffled when, with a curious look, she said she was not that busy and that she had only got the call to come down at around 4am. I still do not know why we were made to wait for so many hours.
My mother was finally admitted at 5.10am. When we arrived at the room, I asked the nurses to help lift my mother because she was in too much pain to stand up. But I was told to do it myself. I did what I could, helped her settle into her room and then left at around 6am. So it took a full 12 hours between arriving at the emergency department and being given a bed.
With this story, I want to illustrate a point. If a well-equipped and relatively large hospital like Serdang can be that busy and crowded, just imagine what it is like in rural areas where the hospitals are older, smaller and not as near to the patients. How many became worse before reaching a hospital or while waiting to see a doctor?
I have visited relatives in several rural hospitals before. The situation in those hospitals was really depressing. The wards were crowded, there were not enough chairs for visitors, toilet seats were broken and the doctors and nurses were overworked.
Many may say that the difference between provisions by a private hospital and a government one is expected. They lower their expectations when it comes to a government hospital. This is wrong. Why should better services be monopolised only by those who can pay?
We should maintain high expectations of our public services, and find ways to ensure the villagers in Kapit and Chini enjoy services comparable to that of ministers and politicians living in Damansara Heights.
I do not yet have a solution to offer. The purpose of this article is to invite readers to think about the situation in the hope that a solution can be found.
However, I do believe that we need to change the way we think about funding for public services. At the moment, the Government funds hospitals, doctors and nurses. We need to radically shift this so that the Government funds services users not service providers.
Private hospitals must serve their patients well because their income is dependent on user satisfaction. But government hospitals will not lose anything even if they treat patients poorly. Surely there are ways to inject some market discipline and pressure into how our hospitals (and other public services) operate.
> Wan Saiful Wan Jan is chief executive of the Institute for Democracy and Economic Affairs (www.ideas.org.my). The views expressed are entirely the writer’s own.
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