black and gray stethoscope

專欄|約定在2017年2月

有很多人問我香港公共醫療系統是否爆煲?我認為不是。

很多專家說今年的流感並不是特別厲害,上年世衞估錯針,今年沒有;之前流感病毒曾出現抗原基因飄移,今年也沒有。為何今年會有廣泛報導?我認為是剛巧今年政府凍結醫療經常性撥款、強行通過大型基建追加撥款,雖然我不同意借題發揮鬧政府,但是我認同政府對公營醫療是有最終的責任。

每年的一月至三月都是冬季流感高峰期,去年有兩間電視台訪問我關於流感爆發病房爆滿的情況,今年訪問我關於流感的報導有七十多篇。我在二千年畢業後一直做內科病房,十五年來親身見證了每年冬季流感高峰期,這是內科結構性問題,病房「倒灌」和「滿瀉」行為正常化,醫管局要認真處理內科和急症室每逢冬季滿瀉問題。

在沒法大幅增加資源下,醫生和護士多年來已經用了自己的方法,提高兩倍三倍工作效率,辛苦為病人安排牀位。內科病房的醫生護士固然辛苦,其他科的病房和護士肯加牀幫手接收和照顧內科病人,也令人十分敬佩。病人等了很久才能見醫生和上病房,首當其衝的一定是前線醫護,有誰想上班照顧病人時被人罵呢?政府官員、醫管局高層和坐在辦公室內的管理層會明白嗎?

在沒法大幅增加資源下,我認為醫管局可以做到更多,其實今年有大部分醫院已經一早做好準備,在內部調動床位、制訂應變指引去應付冬季流感高峰期,甚至有兩間正在重建的醫院也能勉強應付。被傳媒點名的來來去去都是兩三間醫院的急症室和內科病房,我們應該去了解某兩三個部門有何困難,如果是山頭主義問題,醫管局應該派出強力部門專責處理這個關乎公眾利益的事。

在沒法大幅增加資源下,我們怎能變出病床和人手呢?每年的冬季流感高峰期都是在二月,我建議將部分非緊急手術和內視鏡檢查,由二月撥前到一月和撥後到三月,預留幾十張病牀作為內科「滿瀉」病床。也建議各位高層、管理層、主管、部門護士經理,在二月減少行政工作和減少開會次數,到內科病房和急症室上班,體驗生活、體察民情、激勵士氣、增加人手,一舉四得。

除了以上的短期方法,長遠要想想是否要增加內科病牀人手和急症室人手,冬季流感高峰期「內科住院病牀於午夜時的佔用率」可以達到130%,即是現有的內科病牀及人手要至少增加30%才能應付需求。

約定大家為2017年2月冬季流感高峰期,花一年時間去準備,亡羊補牢,未為晚也。

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