KUALA LUMPUR, Dec 21 — An emergency medicine doctor has suggested that the government run public health clinics (Klinik Kesihatan) 24 hours a day to reduce overcrowding in hospital emergency departments (ED).
Dr Avicen (pseudonym), who practises at a public hospital in the Klang Valley, noted that ED overcrowding is both a nationwide and global problem, citing the United Kingdom that is facing similar issues in its A&E departments.
This surge in patients, said Dr Avicen, was “predicted post-pandemic… [and] it has been an existing problem already occurring before the Covid pandemic.”
Therefore, to alleviate the burden on hospitals, the public must be educated on when to go to the ED. To ensure that people have constant access to health care, the operating hours of government clinics must be extended to 24 hours a day, 365 days a year, similar to 24/7 emergency rooms in hospitals, said the emergency medicine doctor.
“The idea is that most of the cases that come are acute, and there are cases that are not emergencies. Therefore, congestion comes to the emergency department or to our hospital because there’s so many patients seeking treatment,” Dr Avicen, who requested anonymity, told CodeBlue in an interview.
“Actually, about one-third of cases are actually not emergencies. So, attempts have been made to invite the public and educate the public on the usage of the emergency department for emergency care.
“So emergency basically means real emergency, but many of the public do not understand that.”
By educating the public on when it is appropriate to visit the emergency room, Dr Avicen intends to redirect non-emergency cases to either public health clinics under the Ministry of Health (MOH) or private general practitioner (GP) clinics.
“Therefore, we are trying our best to educate the public and redirecting cases that are not emergencies and advising them to go to the health clinics or utilise the GPs adjacent to their area to seek treatment first. That is also not easy because sometimes they adamantly want to stay, and they don’t mind waiting.”
Unlike Klinik Kesihatan that typically operate only during business hours from 8am to 5pm on weekdays, remaining closed on weekends and public holidays, the majority of private GP clinics are open from 8am to 10pm every day, including on weekends and public holidays. Less than 10 per cent of private GP clinics are open 24/7.
Dr Avicen said MOH is trying to implement a double shift in Klinik Kesihatan to operate until 10pm, run by two doctors, amid pushback from critics who cite insufficient manpower, logistics, and the lack of patients.
The emergency medicine doctor, who runs a 24-hour health care clinic, discarded the argument surrounding the lack of patients after 5pm by explaining it as teething issues that will fade once people get used to the availability of 24-hour Klinik Kesihatan.
To strengthen his position on the need for 24-hour public health clinics, Dr Avicen looked back on how he had once asked his superior whether it was possible to close up the Green Zone (non-critical zone) of the ED on weekends, so that he might divert the manpower to his department which suffered staff shortages.
His superior had rejected his request as there were still one or two patients entering that zone of the ED on weekends.
“The need is there. Therefore, that’s why we open up 24 hours. So now there is a need for a 24-hour GP staff clinic in the government facility. So why can’t we open 24 hours? Why can’t you open up a Klinik Kesihatan when you have 12 MOs (medical officers)? The only difference is that I see emergencies, they see non-emergencies — the cough and colds, the sudden abdominal pain.
“So that is something that in the future we are looking at.”
CodeBlue reported last week that critically ill patients, including ventilated cases, are stranded for up to six days in the emergency department of Raja Permaisuri Bainun Hospital (HRPB) – a general hospital in Ipoh, Perak – due to insufficient critical care beds and staff.
HRPB doctors said most of the seriously sick patients coming into the ED are presenting with advanced non-communicable diseases (NCDs) – such as heart disease, kidney failure, and stroke – after the disruption of care from two years of Covid lockdowns. They also said the situation in HRPB’s emergency room this year has worsened from pre-pandemic days, when patients back then waited one and a half days at the most for a bed in a ward.
Building New Hospitals Not The Solution, Adopting A Healthier Lifestyle Is
Dr Avicen opined that building more hospitals was not the solution to full wards and overcrowded EDs, saying that new hospitals would only increase demand on current limited human resources.
“So proposing to open up a new hospital to decongest an existing hospital is not logical because we need more manpower. And the manpower that we have now put is not enough to cater or maybe enough, but it will be tiring for all to cater for the surge that we are facing now in Malaysia.”
Therefore, Dr Avicen held that the way to truly address this issue was to focus on preventive health amid an NCD crisis in Malaysia. Findings from the National Health and Morbidity Survey 2019 indicated that 3.9 million adults lived with diabetes, 6.4 million had high blood pressure, and 8 million with high cholesterol.
Around 1.7 million Malaysians had all three chronic conditions, and about half of adults in Malaysia are overweight or obese. NCDs accounted for 67 per cent of premature deaths, and 70 per cent of diseases.
“So the only thing that we see that will help in the long term is basically public understanding long term to live a healthy lifestyle. Try to avoid getting sick or getting this diabetes, hypertension, but if you do [have it], you cannot avoid it,” Dr Avicen said.
“Therefore, take care of yourself as best as possible to avoid complications because we cannot avoid the traumas, accidents. We cannot avoid the acute conditions. For example, appendicitis. You cannot avoid dengue, but you can try by taking care of your household.
“But again, these acute things need to be treated. But the stroke, the hypertension, the diabetics with complication, all this can be avoided if there is a healthy lifestyle started at younger age.”
Thus, for Dr Avicen, the government should invest more in health education, primary health care, and family medicine specialists to prevent complications from chronic disease that require hospitalisation. This will, in turn, reduce the number of patients turning up in the ED.
“Therefore, if you are healthy, or if you identify your problem earlier, it can be controlled rather than require admission.”