The glitz and glamour of being a doctor as portrayed on the small and big screens is a far cry from the gritty reality of undergoing your junior years in the Maltese public health system.
Stefan Buttigieg, a 25 year old junior doctor, speaks to The Malta Independent about Mater Dei’s way of doing things, particularly when it comes to the public health’s IT system. The medical community in Malta is closely knit, and very few doctors are willing to speak out about the challenges faced in their working lives.
“I sometimes get the feeling that I am more of a clerk rather than a real doctor, as we have to do a lot of bureaucratic paper work. You have to spend a lot of time behind a computer, writing in notes, filling a large amount of paper forms and calling endless numbers of people”
Dr Buttigieg calculates that on a three-month rotation, about 20-30 hours are spent simply rewriting treatment charts because nurses run out of space on the chart.
“There are some wards that allow for the chart to be rewritten and the doctor can just sign it off, but some wards expect the doctor to fill it up from scratch. There are so many issues, and so much paperwork to get through, that I as a doctor sometimes do not have time to train and improve my skills during my normal working hours and most of the time I have to undergo this training in my spare time.”
The lost files
“Mater Dei needs an electronic records system and an electronic prescription system. There are already a number of electronic systems in place but none of them deal with the crucial aspect of the patient health and medical record. There is also a really big issue with medication reconciliation. Sometimes you spend a lot of time on this reconciliation, trying to figure out which medicines were stopped by which doctor and which medicine was started by which doctor. If there was a proper electronic system this would be done automatically, and you would have much greater peace of mind and make sure that the patient is receiving the right treatment,” Dr Buttigieg said.
Dr Buttigieg explains that the current paper system at times leads to records going on walkabouts.
“You would have a good idea of the medicines being given to a patient, but sometimes you just have to give up and seek other alternative routes, because you look through the file and find out that the information is extremely time consuming to obtain”
“Sometimes papers can be lost very easily. At times, whole medical files are actually lost, and sometimes they can take days to find the file and in the interim we won’t know enough about the patient.”
Doctors are either faced with having not enough information, or being overloaded with it.
“A lot of data is being lost, sometimes you go to the ward to take the medical history of a patient who was already clerked from admission, yet you end up doing the clerking again, leading to a lot of repetition of data.”
“Most of the time the issue lies in the fact that paper medical records are being used. I can understand that you have to examine the patient from casualty to the ward, but why do you have to take a whole history of the patient again. At times, the patient can’t even say what medication he is on, and you have to figure out from his relatives and the boxes that he brings with him to the hospital.”
He says that at times, precious minutes are wasted trying to figure out the patient’s medical history, as the files are indecipherable.
“If there was an electronic medical record system at Mater Dei, I would be able to have the patients’ history at my fingertips. Malta has the opportunity to be the first country to have a nationwide electronic health record system. Each patient in the country would have a full electronic health record. Things are already moving in this direction and we have this opportunity to be a centre of excellence in that way, and that is why I am so passionate about this subject.”
Inhumane working hours
It is not uncommon for a junior doctor to work a 70 hours week, leaving very little time for rest, let alone a functioning social life.
“Once I had this issue where I had day work, a night shift, maybe I slept three or four hours and then I was back on the day shift. As the shifts are structured, you have to cover for other doctors in your firm in order to ensure that everyone has enough time to rest. As things stand, it is very difficult to be able to be off the day after the night shift, because after a night shift, they need someone to cover for you.”
Dr Buttigieg explains that the day shift starts from 7.45am to 2.30pm then the night shift starts at 2:30pm and goes right the way through till 7:45am of the next morning. The doctor usually works the day shift, the night shift followed by another day shift. The doctor then has to work the day shift on the following day.
“One time two people were on sick leave, and there were only four people covering the medical wards during the night rather than the normal six people. There are times when you will be so tired that you are far from functioning at your full efficiency and effectiveness.”
Inconsistencies between departments, wards and lack of support
“When I need to obtain intravenous access, different wards place the equipment in different areas depending on which ward you are in, making it impossible to get used to one ward. Ward rounds sometimes happen so fast that you are very easily put in a position where you miss out on things,” Dr Buttigieg explains.
The support offered to junior doctors is mixed and varies across the wards.
“Senior doctors do take up responsibility when things go amiss, but many things fall on you. If you miss out on something, then you might get the blame for it. It depends on different working character, some doctors are understanding and try to help you out, but other doctors might work and treat you differently.”
Dr Buttigieg says that on his current surgical rotation, he forms part of a firm that has an average of 35 patients. He explains that all 35 patients have to be seen on a daily basis, with the senior doctors often having to also deal with a full operating theatre list.
“When you want to ask for a consultation from a specialist doctor, you have to first page the doctor and then wait for him to answer the page. There are a lot of barriers in communication with other healthcare professionals and the paging system is not perfect, but right now it is the working solution we have, but I’m definitely sure that we can harness many other technologies to improve this.”
Dr Buttigieg says that the local Medical Association needs to play a bigger role in offering its support to junior doctors.
“There needs to be more work done by the Association. We need more support. There’s this mentality in the hospital where more experienced doctors take on a ‘been there, done that attitude.’ They think that things do not need to be changed, as ‘I’ve done that and survived.’ Healthcare has to move forward, a country without the proper level of health care is not worth living in, it must be that kind of service where things move forward and improve for the better.”
Technology, the way forward
Dr Buttigieg is far from being an armchair critic. He is a big advocate for technological change in the sphere of healthcare.
He is hard at work developing a mobile application designed to improve life for doctors at Mater Dei.
“We are trying to create an app, which will hopefully be the first step towards an improved workflow at Mater Dei hospital. When I go to hospital it feels as if I am stepping back 10 years. I wish that I had information that was specific to my hospital. I want to start working towards an app which offers doctors the necessary information to be able to work at Mater Dei in a much more efficient way and advise on how best to treat a patient based on already existing guidelines gathered by expert doctors who work at the hospital ” Dr Buttigieg explains.
“We want to create a platform allowing for accessible information on the go, sometimes you can’t even find a free computer to use at Mater Dei, or if you need a doctor’s telephone number you have to rifle through the directory, imagine if you had all the information on your phone or tablet, all the information would be a tap away.”
Sahha
Dr Buttigieg and his team have set up a Start-Up Company known as Sahha, where they were awarded the 2nd place in the first ever Malta Start Up Weekend. They have set up a web presence for their latest project at tabib.co with a thorough explanation of the features that the mobile application will offer.
“I have a team of people working with me, we met up at the Start Up Weekend three weeks ago, and within the span of two days we had a working demo of the app which looked great. I had to recruit people to my cause, and there were all the challenges that come about when creating a business.”
“Sometimes I feel as if healthcare in general is behind other industries in Malta. Other industries have moved forward with technology, imagine going to a bank and all the processes were all carried out on paper without the aid of technology, that’s how things happen at Mater Dei hospital”
Dr Buttigieg has floated his idea to the hospital, and he says that the management “have been very receptive and have shown a big interest, but there is still a lot of work to be done.”
He insists that Malta has a golden opportunity to become a centre of excellence in this regard, as it is could be much easier to deploy a new technology in a country with a small population.
“My vision for the hospital is to do away with paper records and have everything at the palm of your hand on a tablet. Digital literacy also needs to be included in the medical curriculum. As things stand, doctors are not exposed enough to technology. There needs to be a culture change and more doctors who take the step forward and be innovators within the healthcare system.”
