Need to move from ‘best care’ to ‘best possible care’
Newly-inducted CCP President urges physicians
Sri Lanka’s health system is in dire crisis and this is what got the full attention of the doctors serving the masses across the country.
Setting the right tone recently, the newly-inducted President of the Ceylon College of Physicians (CCP), Dr. Duminda Munidasa told the eminent gathering that “our dedicated members continuously spend their time and energy while expecting nothing in return, to continue college activities ..... The ultimate goal being to serve our patients to the best of our ability and while not being content at the best, striving for new ways to make the best better”.
He said: “The CCP is in a unique position to guide the future of healthcare in Sri Lanka. It is no secret that healthcare is at a critical juncture. The fallout of the 2022 economic debacle on healthcare will truly be felt in 2023. The shortfall in the supply of medicine, consumables and equipment, suboptimal infrastructure facilities due to restricted funding and scarcity of human resources due to the alarmingly high rate of brain drain with emigration of trained staff, will be a severe impediment to our attempts to deliver holistic healthcare to a population already burdened with economic constraints and psychosocial distress.
“This will affect the public and private sector healthcare services alike. We are already witnessing an increase in patient numbers in the public sector due to obvious reasons, further stretching the resources available to the Health Ministry than ever before. If we are not to buckle under the pressure of too less facilities and much more to do, a change in perspective is called for.”
Moving from “best care” to “best possible care” is not an option but a necessity, said Dr. Munidasa, adding that in practice, this may seem an impossible feat at first. However, when there was no fuel, we started walking and cycling. We knew how to do both, but had conveniently forgotten when faced with luxuries.
Looking inwards, he said: “We have learned that 80% of a diagnosis is provided by history and 10% by examination. Only 10% is afforded by investigations. Yet, with the availability of the modern day plethora of tests, we have conveniently chosen to spend less time with our patients, handing over diagnostic duties to machines. Then in the name of evidence based medicine and bombarded by guidelines, we have resorted to prescribing long lists of medications per disease. None of these is affordable by the people or the government anymore for the time being.”
Dr. Munidasa said that the CCP, together with its sister colleges, can formulate local guidance considering the cost effectiveness as the prime criteria for all to follow to render healthcare more sustainable. Some of the sister colleges in collaboration with the CCP have taken a step in this direction.
“Using the available resources with care through shrewd management, using lessons from the history, moving towards more clinically oriented practice of medicine will help to rationalise the use of investigations and medications, thereby preserving resources. Hence, rather than being disheartened by the constrained resources, can we move back to our basics and lean towards clinical medicine in diagnosis and rational prescription? In the current context, in a situation as fluid as this, business as usual will
“We have learned that 80% of a diagnosis is provided by history and 10% by examination. Only 10% is afforded by investigations. Yet, with the availability of the modern day plethora of tests, we have conveniently chosen to spend less time with our patients, handing over diagnostic duties to machines.
not be the path to take. Changes in mode of delivery of care are called for,” he said.
Referring to the traditional biomedical model being used now, he said its main drawback still seen widely is that healthcare workers tend to see the disease while being conveniently blind to the person with the disease. In 1977, this is what Dr. George Libman Engel tried to reverse – this dehumanisation of medicine and disempowerment of patients, offering a holistic alternative. He recognised that to understand and respond adequately to patients’ suffering, clinicians must attend simultaneously to the biological, psychological and social dimensions of illness.
“Adapting the biopsychosocial model to any form of illness is feasible. This will help in caring for our patients more humanely, curing some, relieving the suffering of some and comforting all. The concept of holistic care is that patient management needs to be addressed in many facets. Hence our theme for 2023 – ‘Holistic care amidst constraints’, he concluded.
Meanwhile, the CCP’s Outgoing President Prof. Arosha Dissanayake, moving away from convention, shared five lessons in leadership which he had learned when leading the CCP.
He said they are:
Art of Captaincy – How to get the best out of each team member in the council by identifying the unique skill set of him/her and communicating what is expected from that person in the form of ‘role clarity’. The danger to avoid was ‘role overburdening’.
Zero to One – There is much the medical community can learn from the business world. Emotional intelligence came from business psychology, casebased discussions from
business and law, reflective practice from business management. ‘Return on investment’ and ‘Laws of diminishing returns’ all are most useful concepts. The lesson from business is to recognise the brand value of the CCP and keep adding to that value.
The Obstacle is the way – Last year was probably the most difficult year all of us faced and the leadership lesson learnt is the importance of being resilient and motivating those around you also to be resilient.
Courage is calling – I learnt that to lead the CCP at a difficult time, I needed courage. Two instances were when the Health Ministry sacked the National Medicines Regulatory Authority (NMRA) board, including the CCP representative, and the second was during the height of ‘Aragalaya’ when there was pressure to support the people's struggle. I said “No” on three reasons – the CCP’s constitution did not cover this eventuality; there were CCP members on both sides of the divide; and my political acumen told me that what started as a middle-class struggle had been taken over by different political entities and I did not want the CCP to become yet another tool of evil machinations of politicians.
Ego is the enemy –You feel the need to leave a legacy, something that will make people remember you as the ‘Greatest of All Time’ (GOAT). No one can be the greatest of all time. Someone greater will always come in the future. For the CCP President, there is only one legacy – “It’s not Me, it's the CCP.”