Government Hospital Outdoors: aren't we scamming people?

The outpatient departments (OPD) of government hospitals in Bangladesh are perceived as the first-line healthcare for millions of people who cannot afford private healthcare.

However, hidden beneath the surface of this great public service lies a grim reality, the overwhelming workload and impossible expectations placed upon OPD doctors, which not only compromise their well-being but also cheat patients of the quality care they deserve. The OPD, meant to be a sanctuary for the sick, is fast becoming a theatre of chaos and inefficiency, exposing a fundamental flaw in the system that urgently demands attention.  

According to the official schedule, government hospital OPDs operate from 8:00am to 2:30pm. However, the reality is far more constrained. Most patients only begin arriving after 9:30am, and ticket sales for consultation stop at 1:00pm, as per traditional government directives. This leaves a mere three and a half hours or 210 minutes during which doctors must attend to an overwhelming number of sick patients.  

At any OPD room in a District Sadar Hospital, a single doctor is expected to consult anywhere from 150 to 300 patients during this short window. Ironically this translates to an average of just 42 to 84 seconds per patient from a Doctor. This fleeting moment must include everything: listening to the patient's complaints, conducting a brief examination, formulating a provisional diagnosis or whatever, prescribing medication, jotting down notes, writing medicine slips and entering the patient's details into the hospital register. Such an impossibly tight schedule forces doctors into a rushed process that can barely be termed as 'medical consultation', and patients are left with suboptimal care, a situation that is nothing short of a betrayal of the Hippocratic Oath.  

Photo: Courtesy

The relentless pace of OPD consultations is not just a disservice to patients but also a significant burden on doctors. The sheer volume of patients means doctors often cannot even take a brief respite to attend to their basic needs. A quick trip to the washroom or a few minutes to grab a snack becomes a luxury, leaving them physically drained and mentally fatigued.

Moreover, the absence of support staff compounds the challenges. Doctors are expected to manage every aspect of patient care single-handedly, from writing prescriptions to filling out paperwork. This lack of assistance creates bottlenecks in the system, further reducing the time available for each patient.  

Adding to this crisis is the influx of patients who misuse government healthcare facilities. Many individuals visit OPDs not out of genuine need but to take advantage of 'free OPD medicine', often without requiring medical attention. This unnecessary crowding stretches the system even thinner, leaving genuinely ill patients to bear the brunt of inadequate care.  

While the intention behind free medicine distribution is noble, its misuse undermines the purpose of the programme. Instead of prioritizing those in dire need, the system ends up catering to individuals who exploit its loopholes, effectively denying timely and quality care to those who genuinely require it.  

To be true, sometimes it seems that there is no cure to this 'OPD Disease' if we do not change our mentality towards receiving services from OPD. However, the solution to this crisis lies in implementing a robust triage system, a practice widely adopted in developed countries. In nations across North America and Europe, OPD consultations are structured around a system of prioritization. Patients are assessed by a trained medical professional upon arrival, who determines the urgency of their condition. Only those requiring immediate attention are seen by a doctor without delay, while others are placed in a queue or scheduled for later appointments based on the severity of their illness.  

This system ensures that doctors can dedicate sufficient time to each patient, enabling thorough examinations, accurate diagnoses, and appropriate treatment plans. The waiting time, though sometimes inconvenient for patients, ultimately leads to better outcomes by prioritizing quality over quantity.  

Another critical reform is reevaluating access to free medicine. While the intention to provide essential medications to the underprivileged is commendable, a stricter system of eligibility must be enforced. Free medicine should be reserved for those who truly need it, as determined by a preliminary screening process. Patients who are not in immediate need of medication or treatment should not be allowed to burden an already overtaxed system.  

Implementing these measures would reduce unnecessary congestion in OPDs, allowing doctors to focus on patients with genuine medical needs and provide them with the comprehensive care they deserve.  

The current OPD scenario in Bangladesh starkly contrasts with healthcare practices in first-world countries. In many developed nations, patient care is meticulously organized to ensure that each individual receives adequate time and attention. The emphasis on triage and structured appointment systems reflects a commitment to quality care, a principle that is sorely lacking in our healthcare framework.  

While it is unrealistic to expect Bangladesh to emulate these systems overnight, there is much to learn from their models. Introducing even basic triage protocols and enforcing stricter guidelines for free medicine distribution could significantly improve the current state of government hospital OPDs.  

The horrible discomfort of doctors in government hospital OPDs is a glaring symptom of deeper systemic issues. The lack of support staff, the misuse of resources, and the absence of prioritization all contribute to an environment where both doctors and patients suffer.  

Reforming this system requires a multifaceted approach. First, the government must invest in training and deploying support staff to assist doctors in OPDs. Second, a triage system must be implemented to ensure that only those who genuinely need immediate medical attention are seen without delay. Third, stricter regulations must be enforced to prevent the misuse of free medicine programmes, reserving resources for those who truly need them.  

Finally, public awareness campaigns are essential to educate people about the importance of using healthcare services responsibly. By fostering a culture of accountability and respect for medical resources, we can alleviate some of the pressures on our overburdened healthcare system.  

As a specialist doctor of a government hospital, I must admit that the current state of OPDs in government hospitals is unsustainable. It cheats patients for the quality care they deserve and leaves doctors exhausted and demoralised. 

The time has come to recognize the invaluable contribution of doctors and to create a healthy working environment that allows them to fulfill their potential. By prioritizing quality over quantity, we can ensure that every patient who walks through the doors of a government hospital OPD receives the care and attention they deserve. Only then can we claim to have a healthcare system that upholds the principles of justice, equity, and excellence.

Dr Rajib Dey Sarker is a surgery specialist and a health columnist.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views