Dear Editor,
I HAVE written multiple letters to the media advocating the empowerment of patients, and the need for the independent monitoring of all healthcare facilities in Guyana. Events over the weekend, where a patient advocate was arrested and incarcerated for publishing anonymous patients’ complaints on her social media ‘wall’ has brought this into sharp focus.

I would not comment further on it, because, for reasons beyond me, it is a criminal matter, and any comments would be sub judice. Apparently, the city hospital under the microscope threatened the Guyana Chronicle with a $100M lawsuit if they were to publish any of those anonymous complaints or letters. I have placed the very complaints on my Facebook ‘wall’, and I am awaiting the clowns to either sue me or send their buffoons to arrest me, let me handcuff them to my gates for an indefinite period.

Mr. Editor, it did not have to come to this if my suggestions were taken seriously. Now we have a situation where the tail is wagging the dog, while the poor patients suffer. In the UK, patient care and experience are taken seriously. All hospital by laws must have an independent department that patients can lodge their complaints. It is called PALS, which stands for Patient Advice and Liaison Service. All complaints are investigated by an independent consultant who was not involved in the case. All complaints are investigated, regardless of how frivolous it may appear. There is a strict timeline for a written response to the complaints, and the response must always begin with an apology, lessons learnt from the incident, and steps that would be taken to minimise the chance of the incident arising again.

To complement that, patients are given the opportunity to provide anonymous feedback on their experience. Patients can also provide anonymous feedback on the care the doctor provided. And it goes further; even family and friends provide anonymous feedback. Also, staff provide feedback as to whether they would choose to use that hospital’s service if ever they were to become unwell.

This now takes me to the independent monitor. In the UK, they are called the CQC, which means Care Quality Commission. This inspector body is made up of medical and non-medical personnel. Their role is to inspect hospitals, both announced and unannounced. They do a physical inspection, looking at simple things like if a patient’s records are left open on the wards for all to read, hence breaching data protection laws. In essence, they do a thorough inspection, interviewing patients and staff. Those patient feedbacks and complaints I alluded to earlier are very important. They look at those via a microscope. They also examine the hospital’s adjusted mortality rates and serious untoward incidences, e.g. patient being vincristine in their spine. After a thorough inspection, they classify a hospital as excellent, good, satisfactory, very poor or unsafe. They have the power to close down hospitals which are deemed unsafe, and they have done so in the past. The CEO of the hospital is answerable to the CQC.

Mr. Editor, if you check your archives, you would see I suggested this on multiple occasions. If a hospital does not provide a medium for patients to make a complaint, what should the patient do? If patients think that they were financially exploited, e.g. the doctor ordering tests that they do not need and that hospital does not have an independent unit to investigate it, then what should the patient do? They would do exactly what that young lady was arrested for doing this weekend. Post it on social media.
In Guyana, hospitals monitor themselves; hospitals regulate themselves. Private hospitals see patients as cash cows. Multiple useless scans would be done, and if that is not enough, they would be prescribed a cocktail of useless multivitamins. No evidence-based medicine; just financial-based medicine.

It is time the government starts empowering patients. We as doctors took an oath to serve our patients. We should see it as a privilege when a patient entrusts us with his or her ailing body. For the patient and their loved ones, that is quite distressing and a frightening experience. The least we can do, as healthcare professionals, is to put them at ease. Be kind. A smile. A hug. Show love. To try to exploit a vulnerable patient is inhumane. I am a doctor, but my allegiance is to the patients. I do this for my mom, who died due to a doctor’s negligence when I was eight years old. We were poor and powerless. I stand here today with tears in my eyes, hoping that the day would come in Guyana when doctors see themselves as servants and not Gods; when patients are empowered, and doctors are held accountable.

Regards,
Dr.Mark Devonish, MBBS MSC MRCP(UK) FRCP(Edin)
Consultant Acute Medicine
Nottingham University Hospital

UK