Introduce referral system to reduce patient pressure

People always speak in favour of those who receive services. But, we have to take into account the fact that the number of patients in the chambers of specialist doctors increases in the afternoon.

On the other hand, the number of specialist doctors is so small compared to the population of Bangladesh that a doctor has to see about 100 patients in their private chamber in the afternoon after daytime hospital duties. This is practically impossible.

In Saudi Arabia, a specialist doctor does not see more than a dozen patients. In the developed world, referral cases go to specialist doctors, the number of which is very low.

If a patient goes to a specialist doctor, the doctor will examine all the reports. Otherwise, no one will be satisfied. But there are about 1,200 medical and about 1,300 paediatric specialists in Bangladesh for around 17 crore people.

If the number of specialists does not increase, the problem will not be resolved. This is the main reason behind doctors giving less time to patients in private chambers.

There are also reasons behind patients' dissatisfaction over the services in government hospitals.

I worked in the outdoor section of Sylhet Medical College 15 years ago. I used to treat about 110-120 patients a day. As far as I know, the number of medical officers has not increased at the outpatient section. It is still running with two or three medical officers, but the number of patients for each medical officer has reached 150-200.

It is not possible for a doctor to consult, talk and examine 150 patients with a smile on their face from 8.30am to 1.30pm per day. It is annoying for both doctors and patients.

Consulting 150 patients in five hours means a doctor has to see two patients per minute. If a doctor cannot spend a minimum of five to seven minutes per patient in the outdoor department, the patients will never be satisfied and no accurate diagnosis will be possible.

We can strengthen the union subcentres and upazila health complexes to solve the problems. We can also develop a referral system so that no patient would be able to go to Dhaka Medical or other medical colleges without the referral documents. It would reduce the patient pressure by 50%.

Then we can tell the doctors of the medical colleges that they should give 4-5 minutes per patient. Without this solution, if a doctor starts to give five minutes per patient, they would be able to see only 40-50 patients a day and then the other patients standing in line will attack them and vandalise the hospitals. So, the solution is the referral system.

We have repeatedly recommended that the government develop a referral system. But sadly, the health ministry is reluctant to address these issues. They are working on an ad hoc basis. But it is not possible to resolve the problems in the healthcare sector on an ad hoc basis. For this sector, we need short, medium and long term solutions.

If the health ministry thinks that their job is to issue some orders or to allocate money then the problems will not be solved. That is why we say ministries should be for the professionals. The people in the technical ministry understand the technical issues. I am saying this from my professional experience, but no secretary will understand this.

If the people concerned do not listen to the problems and do not take a holistic approach, then these problems will not be solved even in 100 years.

Dr Ehteshamul Huq Choudhury is the Secretary General at Bangladesh Medical Association