From Dr M. Asciak MD

In a way I was glad that you were appointed Minister of Health ably assisted by Mario Galea and Joe Cassar. The PN rightly states that the Minister of Health need not be a doctor, as the position is an administrative one, although I still long to see the day when a doctor is appointed Minister of Justice (without prejudice to the present one in whom I have full confidence). The reason I am short of elated is that our health services need a strong dose of rationalisation. St Thomas Aquinas defines man as rationally capable of partaking in God’s eternal law (i.e. natural law through reason). John is known for his rational and active qualities and our health services need a strong dose of both.

It is interesting that he is not amused by our long waiting lists for operations. There are several causes for this but I also suggest that he takes a closer look at the reception office that makes the appointments, as a bird told me that appointments are not kept in the order that they come in. I am not here referring to the occasional letter by the physician to the concerned consultant regarding the acute state of a particular patient who has been waiting for years requiring a more urgent consideration of his/her appointment. That is the prerogative of the physician and the consultant. I am referring to the blatant abuse of the appointment system by certain individuals including MPs (the one I have in mind is not of the PN genre) who are well known for obtaining quicker appointments for patients than would otherwise be possible. May I remind everyone that a couple of years back, an MP in the UK was caught doing exactly this and was forced to resign from Parliament!

Twenty years ago when I was vice-president of the MZPN Executive Committee, I wrote a report aided by several physicians and nurses, about the state of our health services. Many considerations from that report for secondary health care have been implemented. However, the considerations regarding Primary Health Care seem to have been put on the backburner. Twenty-five years ago I used to work for a very short period of time at one of the Polyclinics. At present, I have been forced by circumstances to take up that work again on a casual basis. I see that apart from the fact that they are now called Health Centres and that patient records are kept, little has changed. I am glad that the full-time doctors have had their pay upgraded, but as one able physician curtly implied when I pointed out this, money is not everything and many doctors are still very unhappy working there. It may be the reason why there is such a short supply of doctors there. It seems that GPs have been elevated to consultant status only in name and to pay the idiotic yearly €35 fee just to have one’s name on the medical council register. Seems you even have to pay to be what you are!

I myself am not really happy with the conditions and pay. I am paid €8.74 (Lm3.75) an hour for two hours before tax, which leaves me little more than €7 (Lm3.00) an hour after tax. Nurses on a casual basis are even worse, receiving €4.66 (Lm2.00) an hour! In this time I have sometimes seen up to 20 patients or more, done innumerable emergency procedures such as stitches and nebulisers and answered many calls giving advice on the phone. Now if this had to be rationally revised, I presume many more doctors and paramedical staff would take an interest in doing this sort of work even on a casual or part-time basis! But what really gets me is that there is no rationalisation of the patient-doctor relationship. Patients are not twinned to their own physician. Many resources are wasted this way. Many patients easily abuse the system. Staff is visibly burnt out.

I have seen some patients everyday since I started working at this health centre for trivial, non-descript reasons. I have had to literally fight off patients who aggressively demand certain medical treatment and medicines when these are not indicated. One patient I had just seen the day before, again came in with a febrile viral sore throat complaint and demanded to have a well known antibiotic worth at least €20 prescribed. When I explained that it was not indicated and that I would not be prescribing it, all hell broke loose to put it mildly. I of course know my rights as a physician and those of the patient and reacted accordingly, but this is something of a regular occurrence. Reminds me of the time when a previous Minister of Health under Labour phoned me at 3am to go and take the blood pressure of a patient, who was not acutely ill, at a village about 10 kilometres away! But that was then, this should be now. There are other things such as red tape that needs to be seen to, but the fact is that one can go a long way in improving the service for the public and making it more attractive for staff to work there.

I have full faith that if you look seriously at the workings of the health centres and lend yourself to the problems you might not even have to think about importing foreign doctors to grace our health centres.

Michael Asciak