It is always a pleasure and an honour to be invited to chair any meeting by an organisation. And so it was by chairing the debate on Health workshop of the PN General Council which took place this weekend. Whilst it is not proper to discuss here what was said in regards to the proposals for motions in preparation for the general assembly, I would like to notice some impressions which certainly should give one pleasure in noticing political maturity by people.

Such meetings are usually loaded, in my experience, with self-laudation and ‘how good we are’ attitudes and speeches with people congratulating each other on their fine work and successes. There is then the usual angry person who voices his wrath on his sorrows and pains. This valve is understandable and allowable. But this time, although the meeting was not heavily attended, I noted the public conscience and maturity with which people were speaking. It was not complete exaltation of what the government is doing. After 20 years, the people understand that we must continue to move forward. There are many misconceptions which had to be cleared up by the parliamentary secretary who was present – for example when someone mentioned that there is hearsay that the pink cards, allowing free medications to people, is to be withdrawn, he explained that this was not so and that they were simply looking into certain things which seem unjust, namely, why is it that only certain categories benefit from such services. If you are a diabetic you get a pink card, if you are an asthmatic you do not. If reassurance is needed at such meetings one can understand the misunderstandings out there, and indeed advantages some may take of these opportunities. A job for the PR indeed.

I was pleased to note that what I have been saying all along in this column about primary care is somewhat shared by others. The parliamentary secretary for health, Joe Cassar, made a point in the beginning and reflected with nostalgia on the days when the family doctor was not only the families’ doctor, but their counsellor and friend. Doctors went out all times of the day. The exercise the government is trying to do with the representative bodies is to restore this culture.

Polyclinics had destroyed something years ago which we can only dream of retrieving. What with all doctors being able to practise, whether they are specialised in family medicine or not, and with the amount of doctors qualifying, unless there are professional and fair restrictions, patient registration will not be enough. Health centres cannot simply be abolished. It is neither politically sound, but even less socially warranted when the country has grown used to a system for so long, no matter how it serves the people. Things have to be phased in and the jobs of current doctors working within health centres be preserved. In my opinion they should continue to serve the public in liason with private family doctors, who, should they be the ones with whom patients are to be registered, have to be networked and guarantee access at all times of the day and on holidays and sick leave. One augurs that the improvements will benefit doctors as well, who can earn the much deserved 20-day leave which many of us simply cannot afford to take; let alone sick-leave.

A specialist present reassured people that the private work of specialists will not suffer if people had to access specialists through their family doctors. Indeed, unless specialists want to do general practice and still charge a specialist fee (which is not the case in most circumstances) their work will increase as a more formal system will oblige the family doctor to refer when patients do indeed need a specialist and not to refer when unnecessary. But it is unknown in the medical world where family doctors do not refer patients to specialists even for reassurance. So no one should worry that his or her rights to visit a specialist should be affected. If a specialist is good, people will go to him or her anyway. Even if they are referred by GPs, their choice of specialist should always be respected.

The system certainly needs more coordination and not one pointed out the matter of a discharge letter not being handed to the patient and the patient not having everything explained to him. I do not like to think of this neglect as negligence, but rather that one (person or profession) leaves a job for another. Clearly some formal protocol and formal procedure can help in wards where this is a problem. But apart from these things, what many referred to was how the unprofessional attitude of some may reflect badly on the whole system. One of the people present referred how she still remembered after 20 years a small gesture by a houseofficer, who offered to call her relatives, it seems, when she was worried about something. Small gestures go a long way. But faults are not always malicious or committed with intention. It is the fact that even professionals need training in certain communication and people skills. This should not merely be part of an MD or nursing course. They should be obligatory professional development programmes intended to be done by everyone working within the environment. They should be offered by every hospital.

I have had the privilege of attending a teacher’s course organised by the Malta College of Family Doctors. It was not only a teacher’s course, but a personalised skills course. It thought one about one’s attitude to patients and students and how we interact in our daily lives leaving impact, both positive and negative, which we could never have imagined. A hospital experience is always a trauma for anyone. To be left in a bed, waiting for a verdict, being punctured and given meals on a tray is in itself, no matter how comfortable we make people feel, something which brings people to their senses when they have nothing else to do but sit around in a pyjama and be subject to ‘lights out’. Having homely people around makes all the difference. I would dream of the day when these skills are taught interprofessionally and not separate for doctors, nurses, orderlies etc. We all work together in the same work environment. Doing good makes you feel good. But if you are feeling bad, it is not justified, in a hospital environment, to transmit those feelings on someone who is vulnerable. These are skills which do not come automatically, and which need to be refreshed periodically.

The Embryology Act

In my last column I concerned myself with how government should respect normative values in passing legislation. I referred to the Embryology Act and how this was written by a priest. In and of itself, the statement should not be a matter of shame to either Church or Government but it raised eyebrows and a statement from the Chairman of the Bioethics Committee, which of course worked much towards the proposal of the bill. This person I referred to also phoned me and pointed out that he only contributed toward it. I may have misunderstood. I certainly did not want to convey the message that a law is written by one person without going through the various stages. Of course one cannot assume that others who are not on the committee would have been asked for their input.

So I will have to retrieve that statement, without prejudice to the main argument however of a demo-Christian government resorting to all stake holders, especially those who uphold the values and traditions of the people, in biotechnological legislation. I was only referring to the initial drafting stages. It was ironic and chilling however that our ethics committee should use such scathing remarks and adjectives. I take it that by saying ‘We dare say... etc., etc.,’, all members gave approval for the letter. A point was also made that I am not a member of the committee. Were it not for the fact of pointing out that I could not have known some of these facts, in which case the adjectives are certainly unwarranted, I do not know what the committee meant by driving in this sore point publicly. Usually it is through its secretary that a committee, after something is brought to its attention, issues a public statement. I hope the above has clarified the matter.

Professor Pierre Mallia is Associate Professor of Family Medicine and Patients’ Rights, former President of the Malta College of Family Doctors and former secretary to the Bioethics Consultative Committee. His is also ethics advisor to the Malta Medical Council.