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Monday, July 23, 2007

The Self-Regulation of the Medical Profession

Oh grand charge boy...!
"If you want to give the Minister the whip to discipline doctors like grandfathers and grandchildren, you are contributing to a mass exodus," (Dr. Neil) Singh said during his contribution to the Medical Board (Amendment) Bill at yesterday's Senate sitting at the Red House, Port of Spain.

Singh, who is also secretary of the council of the Medical Board, argued that the Amendment to the Medical Board Act serves only to give the Minister more power and "it is an insult to tell me and my colleagues that we are not capable of self regulation"

"You are already discouraging young potential doctors from entering the scene because you have a Minister controlling their career," he said, adding that this country, after the mass migration of doctors, will end up with only Cuban doctors and under-qualified health care practitioners.

Dr. Neil Singh, Temporary UNC Senator
from Trinidad Express article, "UNC Senator warns of mass doctor exodus"
But you know what? Given all that we've seen and heard over the last few years, the medical profession, or at least the sitting Board, appears to not be capable of self-regulation. I have heard too many horror stories over the years about doctors who continue to practice although their service quality may be considered less than sub-standard. Just recently, I'd heard spoken of a senior doctor who claimed that he had been performing a procedure that ran contrary to established and documented practice for years and that he would continue to do so because, "ah ent kill nobody yet."

Now, if the Medical Board is not publicly censuring persons such as these, preferring instead to coddle those who would hold the public to ransom for increased salaries, then indeed, a responsible Government must step in.

I say let the legislation pass and let the few recalcitrants leave if they wish. They will quickly return when in the U.S they get their first medical malpractice quote, or in Canada and the U.K., they realise that they are really expected to work and show results in the public health infrastructure.

Further, let the Cubans come. Cuba has always been one of the first nations to send medical help in crisis situation anywhere in the world, and their service is always considered top notch. And if the quality of care meted to four Americans in Michael Moore's new documentary "SiCKO!" is any indication of what our Northern neighbours bring to bear, I can fully understand why the Prime Minister chooses to head there for treatment. They and their expertise will indeed be welcome.

Perhaps a Cuban medical administrator with their humanist and socialist context, someone who knows what it is to deliver quality care regardless of station and despite a dearth of resources, is what is required here to revamp a medical system in which these handful of seniors, by many accounts, have no genuine interest. Perhaps it is what fresh eyes will see that they are afraid of...

Trinidad and Tobago though has a long history of international medical professionals, including an African who produced a revolutionary treatment for gramoxone poisoning. Adding a few more foreigners to the mix should not prove problematic. Indeed, with quite a few Caribbean nationals now training in Cuba, Cuban medical practice is near destined to return to our shores in any case.

But while Singh clamours and makes grand statements about mass exodus, he like so many who get up on soapboxes nowadays have no authority to speak for the groups to which they lay claim. Like the "Diego Martin and Environs Committee" who speak for neither Diego Martin nor its environs, nor even their near neighbours around the Diego Martin Savannah.

There are many hard working medicos in the system who do what they can despite the mismanagement and seeming dearth of resources. They also do so without speaking out against their peers for fear of censure.

The back of the medical boys' club must be broken as part of a wider programme of health sector reform, including a re-evaluation of the regional health authorities. We also need to perform a critical examination on private health facilities, something that the Government is also behind. After all, if some of the latter dump their most difficult cases as well as those that run out of money onto the public health system, perhaps we do need to take a closer look at their capabilities and operations.

As with BWIA and Caroni Limited, in the public interest the Government must take the medical sector into grip. After all, our people's well-being and our very lives are at stake.

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