“Capable leaders are needed in medicine to shepherd and influence continued evolution of dynamic healthcare systems. The changes we face are profound and have crept up on doctors and many professional bodies. The ‘professional bureaucracy’, characterized by disseminated power, individual autonomy and inflexible structures, has difficulty in responding nimbly to external forces. For individual doctors, the model of professional work has moved from control by individuals to constraint by systems, from flexibility to rigidity of practice, from primacy of an individual blend of art with science to management by multi-professional teams, and most importantly for many in the profession, stability has been replaced by uncertainty and ambiguity.” ~ SB Dowton, in Leadership in medicine: where are the leaders? MJA 2004;181:652-4.
“Illness is the night-side of life, a more onerous citizenship.” ~ Susan Sontag, in Illness as metaphor and AIDS and its metaphors. New York, Picador, 1990.
Once every 2 years we elect a new president to steer and lead arguably our most representative body for the medical profession in Malaysia, the MMA.
Representing some 11 thousand members (out of around 17000 MMC-registered practitioners), carries indeed an onerous if seriously responsible task.
This duty however should never be relegated to some one or any one who is faint-hearted and who might feel that his time has come to take charge, as of one chancy opportunity by being there at the right place and at the right time.
It should never be given away by default, and the aspiring leader must earn that position of trust and know full well that the membership expects nothing less than a sterling and steadfast performance.
We expect that our president must be capable of grappling with all the issues pertinent to the medical profession and our health care, and he must robustly represent the medical professional’s views vis-à-vis any agency or authority that the MMA deals with, including the Ministry of Health and its Minister and officials.
Importantly the MMA president must be totally engaged in defending our professional interests as well as those of our patients, who have placed their implicit trust in us to speak on their behalf, on such issues as appropriate access to health care, rising healthcare costs and insurance, medical systems failures, mishaps and errors. The post of president or indeed any other position of leadership should never simply be for just any ‘seat-warmer’.
Although we need the greater participation from more of our membership, we must also not be complacent or indifferent. We need more than just the staunch worker or supporter, or the solidly loyal foot-soldier—we need more cognoscenti, who have been well-apprenticed, deeply involved and experienced in the arts, the mechanics and nuances of the mission and the spirit of the Association.
We need visionary and people–focussed leaders who can take charge by showcasing their insightful knowledge and passion in wanting to further enhance our profession, not just simply in our own narrow patch of earth or in our parochial specialty fields, but much more so in the wider perspective of national health issues and concerns.
Although this may sound pompous, it is nevertheless a genuine plea for greater involvement from all of us out there who may feel challenged or belittled. I know for a fact that there are great leaders out there who have championed multifarious causes and have led or are leading great voluntary or public organizations. We need more of you to step up to the podium and be counted.
We need not just armchair critics or backseat drivers, but more drivers, action-stars even heroes to come forward and lead. We need greater numbers of committed loyal and dedicated people willing to carry the heavy burden of apprenticeship and commitment for at least 6 years—2 as president-elect, 2 as president, and another 2 as immediate past president. This is indeed a lot to ask for, but assuredly, the personal (though not the financial) rewards can be worth the while.
For the aspiring ‘young’ leader out there, the time to act is now—get interested, committed and become involved in medical professional issues which will serve as the necessary spring board for the future.
There is nothing wrong in wanting to become a leader. Develop your zeal and your ambition early by becoming an active even vocal member, and not just serve as background noises. Get recognized as a doer and a potential chief.
Weak leadership with too little preparation or ignorance, can demean the highest position of the MMA, and belittle the lofty goals and clout which the MMA has nurtured thus far. We need more people of the highest caliber to carry the flame of a strong beacon to spotlight our mission and goals.
What is required of the enlightened leadership in this new era of changing healthcare scene?
As medical professionals we need perhaps to redefine our mission and goals. Perhaps we need to articulate a better and more meaningful identity not just for the doctors but also for the community.
Leaders need to showcase more positive and successful stories of where we the medical profession has excelled or innovated.
We must highlight our effective or contributing roles in nation building, as well as in the more sanguine aspects of healthcare delivery, promotion and research.
We also need to engage more vigorously our invited input in helping to refashion some of our national health policies and redesigning some of its strategies.
We need to serve as indispensable cross bridges for disparate groups or entities which have some stake in our health care system, always anchoring on our premise as our patient’s chief advocate. Because we are directly involved in being the primary healthcare provider, we must strive to simplify and translate the complexities of the criss-crossing pulls, tugs and tensions from all interest groups.
To quote Prof. Dowton, leaders must play a vital role in advocating for “an appropriate balance between the professional needs of individuals and their collective responsibilities to the institution, system or society”.
In other words, we need to take the lead in promoting all aspects of health or medically-related issues, so that the public can understand our commitment to their causes, as well as to our own professional ones.
Among the most pressing issues must be included:
- the right of every Malaysian to have affordable and equitable access to health care;
- the right to the best treatment available especially for catastrophic and unavoidable ailments;
- the right to reasonably inexpensive medicines and therapies
- the right to be covered by some mechanism of community-rated insurance benefits which favour the insured (preferably government-owned and run) and not the insurer or the managed care organisations;
- the right to proper and evidence-based medical or health-related information (with bogus or dicey claims being properly debunked as quackery and unscientific);
- the individual’s right to be aware of the options of cost and effectiveness, and be able to choose his own physician and healthcare system of payment or reimbursement.
Our leaders must address these complex issues of uncertainties and help interpret them so that the public and other stakeholders such as third-party payers and employers can understand the nuances of health access, costs and choices.
We must learn to plan and project ahead so that whatever financing schemes we develop in trying to provide universal healthcare for all our citizens, we must not forget to inform and apprise the authorities on the escalating trends and dizzying technological leaps which can and do ‘cost an arm and a leg’.
We need to inform the public that healthcare costs money, often lots of it, and that this cannot always be subsidized forever.
We need to demonstrate the balance sheets of healthcare expenses and reality cost invoices, so that we can become better aware of the true nature of how much is needed and are spending.
We must show that what the public has been used to paying is in reality a pittance and will no longer be an affordable option for any modern government or health authority to continue to sustain.
And we must advise the government that we have to take hugely politically-unpopular measures to counteract this fiscal disparity.
We must temper the public’s demand and physicians’ enthusiasm for newfangled technical advances with a humane touch of dispassionate aloofness and rational rationing for the greater public good.
In other words, we have to practise ‘fiscal conservatism’ with regard to utilizing our finite healthcare resources. We must push towards cost-effectiveness and efficiencies, so as to make our healthcare Ringgit lasts that much longer and for better reproducible outcomes and benefits.
Because we do not live in a vacuum, we will have to deal with other professionals and other organizations which may have divergent and perhaps even diametrically opposing views from us.
Our leaders must quickly learn to walk that thin line in accommodating and creating effective linkages with such agencies and organizations, especially healthcare system managers and our health authorities.
Nevertheless, our positions of interests and policies must always be a reflection of the membership’s wishes and resolutions. Thus, our interests must always be made very clear to those who challenge us.
Our president must defend our members when their rights and rice bowls are in jeopardy.
This pertains especially to the escalating and wanton abuse of the dispensing privileges of pharmacies, of late. Pharmacists or assistants in white coats, acting or falsely purporting to be doctors are rampant and fearless—we urge the pharmacy association to restrain their wayward members, and remind them of their code of ethics and practice, lest they be charged with the full burden of the law upon them.
Yet our leaders must also frequently and repeatedly articulate our medical professional duties and ethical concerns when these are breached by our errant members or other non-member medical doctors.
We know that a minority amongst us abuse their sacred trust and duties and engage in unethical and unprofessional conduct, and they must constantly be reminded to steer clear of such short-sighted activities.
Short-term gains and quick-fix money making enterprises must be scrupulously avoided and weighed against the potential backlash of besmirching our professional status. If one wishes to dabble in ethically-ambiguous business schemes then the onus is on oneself to switch totally to that business, and perhaps leave aside medical practice…
We must always fall back on our Hippocratic Oath and our ethical compass, when ambiguous desires surface. We must learn to challenge our conscience often and seek the path of moral clarity and not of expediency, connivance or other venal interests.
Our leaders are expected to show great transparency, integrity and authority in being able to focus on such issues and keep our membership so enlightened.
Leaders must inspire amongst us the role model to follow and adhere to. And members must be clear that they have chosen a profession which has more stringent boundaries than many others. For this singular honour, we have been bestowed upon us the prestige and trust by the public, from time immemorial. Alas, of late, some of this shine has been fluffed and lost…
We must strive to regain much of the glory and esteem of bygone times and reinvent the profession such that most if not all can admire and aspire to.
We must dispel the growing disenchantment which has been permeating the medical profession especially among our older practitioners and leaders.
We must fight the despondency from infecting our younger and more hopeful aspirant doctors and imbue them with a new generational ethos of hope, enthusiasm, excellence and mission.
Medical leaders of today and tomorrow are expected to stridently develop and advocate a set of core professional values that will help to stem the ‘current crisis of confidence’ that swirls around the medical profession.
Aside from the politics of election, we must now begin to think out of the box, and renew our commitment to serve and serve well.
Doctors, rise up to the occasion and be counted! We need all of you to be leaders.
(MMA News Editorial, March 2005)