It was about people being sent home or transferred to other hospitals because of the increased influx of people during these days. There were of course the usual blue and red comments with one side saying that this was usual at this time of the year and with another side saying that this was not true and that even during the summer months they saw these crises.

While politics does come into these issues, I was rather surprised that the comments came from sectors which ought to represent patients. By representing the patient I do not mean seeing a sheep in lamb’s clothing, as it were. One obviously does not wish someone to use patients for political agendas. I do not speak about the TV stations, which obviously do and will continue to have their own agendas, legitimate or not. But I speak about organisation of health care professions, in this instance the MUMN. Whether the representative was speaking only on his behalf or on behalf of the union I do not know, but I assume, as the rest of the population, that it was on behalf of the union.

What worries me were two items. It is a fact that flu cases, and cases of chest infection, increase during this time of the year. It is also a fact that the chronically ill, such as those with heart, lung, kidney conditions, etc., are more prone to complications from flu. All this contributes to increased work loads in hospital. It is also legitimate that consultants, at this time of the year discharge patients home more liberally because when you balance the risks against the benefits of prolonging stay in hospital at this time of the year, the risks are on the increase and the last thing one wants is for sick people to get an illness from someone else. Thirdly, it is also legitimate for the hospital to transfer patients to other private hospitals. Economically this has been found to make sense and moreover it protects patients at both ends – at one because it relieves the workload, at the other, because the patient transferred (although I do not know what criteria are used) is put in an environment with less congestion.

It is therefore disconcerting to hear someone say that this situation was the same during the summer and not acknowledge what has been true for centuries – that the winter season brings with it increased medical cases. To say that the same situation exists in summer in the context of what was being said gave the wrong message. In effect what was being said, I assume, was that even in summer, patients were transferred. Now here we have to be honest with “il-poplu tagħna” (why I quote in Maltese will be evident in the next paragraph), because we all know that if the situation was the same in the last couple of summers it was because of the new hospital itself – even people who usually used to go private started to go to this first-class hospital and the average workload increased. While this could have been foreseen is not the point here, as one cannot tell whether it would have been a temporary or a permanent effect. But certainly the state-of-the-art hospital made people go there for some reason – other than feigning illness of course. There was a considerable increase in self-referred patients which had brought on that debate about GPs and that patients should always have referral notes.

One has to admit ‘hats up’ to the present minister of health who spent half his days, if not more, as parliamentary secretary – and I assume even now – setting up office at Mater Dei in order to be in the field of battle and have continual contact with colleagues. I have always been sceptical of ministers who only solve problems from a headquarters without seeing the actual battle and not speaking to the sergeants as well as the generals. The point is that health unions have to work with the ministries when it comes to patients. We all had our clashes with the Minister – his is not an easy job – but to resort to political jargon is hitting below the belt and when not done by proper politicians is, in my humble opinion, a tad unethical as well. So when you hear the union using terms such as “il-poplu tagħna”, rather than simply “pazjenti”, it smacks of politics, period. It is true that not all people (poplu) are patients, but to move from patients to ‘poplu’ is verging into the work of a politician, and in any case, il tono fa la musica – the way it was said, said it all.

While politics always comes into this – and legitimately so – we in health care must be careful to speak the truth as health professionals, unless we are also politicians, in which case we have to make this transparent to “il-poplu tagħna”. Health unions are political bodies only within a limited context. Whilst I am not working in hospital and cannot assess the truth or not of the context, I would say that comments should be factual and not coloured in languages which seem to support one party or another. The fact this is sometimes done abroad does not mean it is right – as if we get our morals from ‘abroad’.

As to fodder being the same for the goose as the gander, I speak for myself, and have made amply clear my affiliations in the past, although I have spoken my mind in the past and heard the metaphorical ‘off with his head’ only too often. One finds solace in knowing that there are different interpretations of the truth but one is hopefully guided by an informed conscience.

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta; he is also Ethics Advisor to the Medical Council of Malta. He is also former president of the Malta College of Family Doctors.