It is quite common for doctors in Taiwan to see an excessive number of patients, meaning that the time spent with each individual is too short, even when clinic hours are extended. In response to this phenomenon, the Control Yuan recently issued an order calling on the Department of Health (DOH) to come up with measures to improve the situation. It is a curious matter as to what these measures might be.
Bureau of National Health Insurance officials say a policy that doctors see a “reasonable number of patients for clinics” instituted in the third year after the launch of the National Health Insurance program has been ineffective. That policy cuts consultation fees paid to doctors beyond a certain number of patients, as a way of encouraging them to better manage patient numbers.
If the DOH thinks seeing too many patients is inappropriate, then why has it failed to take action on the issue by investigating the dubious conduct of doctors? Surely officials should investigate whether the therapeutic results achieved by popular physicians who see a large number of patients are any better than those of their peers, whether indications of the need for surgery and medication comply with the stringent requirements of evidence-based medicine and whether return consultation rates for these doctors are higher than their colleagues.
A more important point is the need to instill awareness that providing chronic disease sufferers with comprehensive health education is essential to good treatment. There is not enough time to offer health education when a doctor sees 200 patients in the course of a day, let alone 50. Clearly, accepting too many patients runs counter to medical ethics. So why do DOH officials call this a “natural phenomenon” that should be tolerated, saying that Taiwanese doctors traditionally do not have the heart to turn patients away and tacitly accept that some experienced doctors are capable of diagnosing a lot of patients in a short time? If DOH officials seem to believe in the superhuman skills of certain doctors, how can we hope to break the public’s irrational faith in them?
The Taiwan Healthcare Reform Foundation recently published 10 major healthcare complaints. One of those is the availability of hospital beds for patients who need emergency care. In one hospital, more than 200 oncology patients in its emergency department were waiting for beds. A few months ago, the head nurse of a hospital in southern Taiwan that has nearly 1,000 beds said that, because the hospital often had no room to let chemotherapy patients stay in its wards, it was applying to build a 1,000-bed cancer care center, but complained that the DOH was dragging its feet on granting approval.
Lining up for a clinic in the middle of the night and emergency room queues extending into the lobby are two freak characteristics of Taiwan’s healthcare system, highlighting problems in the operation and management of local hospitals. For example, cancer treatment needs to follow a particular course and hospitals should, of their own accord, arrange to accept sufferers as inpatients. Having patients go to the emergency department to wait for beds is an abuse of that department’s resources. It also infringes on the rights of patients whose medical condition is so urgent that failure to provide prompt care could be the difference between life and death.
At present, the Sun Yat-sen Cancer Center, with around 200 beds, cares for about 8 percent of Taiwan’s cancer sufferers. This suggests that Taiwan needs no more than 3,000 cancer beds. Why, when Taiwan’s medical centers have so many beds, is it so hard for patients to get one when needed? The answer lies in hospital mismanagement.
Andrew Huang is president of the Koo Foundation Sun Yat-sen Cancer Center.
TRANSLATED BY JULIAN CLEGG
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