Health Centres were originally set up as Polyclinics in the 1970s. There are various ones scattered around the islands and they provide 24 hour 7 days a week cover for emergencies.

MAM has always insisted that non urgent cases in health centres are seen by appointment. These are people who require prescriptions, ‘check ups’, blood investigations etc that do not have to be seen immediately.

The rationale is that the service can be better organised by giving patients a time and date when they can be seen. This has advantages all round; the doctor has a known workload, the patient will not have to wait in long queues and emergency cases will not be bogged down by non emergency cases in the same queue. Another fundamental advantage of this system is that patients can be seen by the same doctor and this will lead to an improvement of the patient/doctor relationship.

Unfortunately some patients object to the appointment system and resort to threats and seeking ‘help’ from ‘friends in high places’. Doctors are then demoralised when forced to break the established protocols and see non-urgent cases immediately.

If the current system of appointments is dismantled there will be chaos in Health Centres with all cases bundled together with long queues, disgruntled patients and demoralised doctors. Some emergency cases may also suffer by not being attended to promptly.

What is needed is an information campaign to educate the public about the appointments system in health centres and that this will ultimately lead to an improved service. The public should also be informed about the criteria for home visits by doctors which are also designed to provide a better and more focussed pattern of care. This has to be accompanied by a robust administration system at health centres that is determined to support the appointment system. Protocols should always be followed and patients should be informed about them with the aim of providing better care.

Unfortunately it may be easy for some aggrieved patients toseek ‘help’ from someone in authority to be seen to immediately, even when not entitled to. Although these individuals may mean well for the patient, their actions undermine the system. These peopleshould reflect on changing their attitude to explaining the advantages of a system that, if it is allowed to work, will improve the standards of care in health centres for all and not for just one individual.

Gordon Caruana Dingli

President, Medical Association of Malta