I am humbled by the overwhelming outpour of support and love from within the fraternity and beyond in response to my previous letter, “I’m Sorry, I’m Leaving”.
I wrote the letter for a few reasons. I sought to give voice to the multitude of government doctors and other health care professionals who have valiantly strove hard to make it work but ultimately found their efforts to be in vain, and are now leaving the country weary and disappointed.
I also hoped to illustrate that while financial remuneration might be a factor in the decision to leave, there are other intangible aspects at play, such as lack of job satisfaction and opportunities for self-actualisation.
On a more personal note, I wrote it as a form of closure to my dream of lifelong public service in Malaysia.
While that personal dream has vanished, my dream for the Malaysian health care system is still fighting to see the light of day. What can I say? I am a stubborn idealist and fervent dreamer.
I dream of the day when our health care system is optimally staffed at all levels and properly equipped. The day when “work-life balance” is a reality, rather than an aspiration.
The day when we no longer worry about disruptions in the availability of laboratory tests and medications due to funding issues. The day when we can rely on regularly maintained equipment rather than roll the dice with malfunctioning ones.
The day when staff nurses and assistant medical officers are not forced to cover gruelling double eight-hour shifts every other day, because there is simply not enough manpower.
The day when we read about doctors dying in car accidents after pulling 36-hours shifts in history books, rather than newspapers.
I dream of the day when the workload ceases to be overwhelming. Only then would each patient receive the time that they deserve to understand their illness and medications better.
Doctors and pharmacists would be able to properly educate and counsel every patient.
No more would they be compelled, under the pressure of time, to barrage patients with an avalanche of information and hope that it sticks, all within a grand total of two minutes per patient.
Perhaps then will our patients have good health literacy.
I dream of the day when Malaysian patients and doctors are equal partners in the pursuit of health. Patients need to take ownership of their own health, and to seek treatment earlier rather than later.
At the same time, we also need to ensure that they are able to do so by ensuring easy accessibility of tertiary services, not just primary care, across the country.
The elephant in the room in any discussion of health care reform is of course health care financing. Without funds, the whole matter becomes moot. The lack of a sustainable financing model underpins all other symptoms of our ailing system.
This thorny issue has been debated multiple times before, with no concrete outcome. Before we demand for action from the government, perhaps we, the rakyat and the owners of the Malaysian public health care system, have to recognise the hard truth – the current financing scheme is not tenable, and needs urgent review.
A cup of coffee costs way more than RM1 these days, yet we somehow expect that same ringgit to cover a doctor’s consultation, adequate staffing of allied health support services, costs of laboratory and radiological investigations, and even medication supply.
This is one pipe dream which will never materialise.
On the other hand, I know that my Malaysian health care dream is definitely within our reach. Our country has the brains, and it is slowly building up the necessary will required to effect these changes.
Sustained public discourse and institutional action to revamp health care financing is imperative, lest this dream remains exactly that – a mere dream.
Happy 2023, Malaysia. May this year be the year of healing for our public health care system.
Dr Leonard Goh previously served as a contract doctor in a Ministry of Health hospital from 2019 to 2022. He has since resigned from government service and will be moving overseas to further his career in the near future. The opinions expressed here are his own and do not necessarily reflect those of the organisations he is/was affiliated to.
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