Limited Tokens in JDWNRH compels people to use fee based system

The system of issuing limited tokens to consult a doctor at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu has frustrated patients who feel they are being compelled to use the fee based special consultation services offered after 4 pm.

“I was not allowed to register in the Out Patient Department (OPD) nor given a token to consult doctors though I clearly mentioned that my case is not simple,” said Kencho Wangmo, 23, from Punakha.  “Instead I was told to see the doctor at chamber 4 where I was charged for checkup.” She was further advised to do a CT Scan where she was charged Nu 1500. She was unaware of the special service and its formalities until then.

Another 27-year-old, Geeta Gurung, said, “I was at the OPD to register at 10:15 am but was told tokens for the day are finished. Many other patients along with me were told registration is not done after a certain token number.”

Aum Namo, 48, said there is no point in visiting the hospital early or later in the morning since no extra registration is done in the OPD beyond a fixed number of tokens.

Health minister Tandin Wangchuk said that no one has the authority to force people to use the fee based special consultations services from 4-7 pm. “It is an option for the people to use or not,” he said adding that it is recommended for people who want special consultations and cannot make it during regular hospital hours.

Lyonpo said the hospital was giving more importance to increasing doctors to cater to the increasing number of people visiting the hospital.

The national referral hospital has 10 general doctors and 71 specialists and continues to see an increasing number of patients.

OPD attendance increased from 494,792 in 2014 to 524,760 in 2015 excluding surgeries. Surgeries performed increased from 6743 in 2014 to 7669 in 2015. Users for the other services such as endoscopy, ERCP, colonoscopy, CT scan, MRI X-ray and dialysis increased from 16,242 to 19,927 from 2014 and 2015.

Thimphu hospital superintendent Dr Gosar Pemba said an average of a 1,000 people visit the hospital in a day but the number is not consistent and in winter, doctors wait for patients.

For a specialist the total number of patients in a day is set at 60 and 100 plus for general doctors.

“A patient coming to see a specialist means a more complicated disease, so we want the doctor to spend least 7-10 minutes a patient for a more thorough examination,” Dr Pemba said. “To provide quality service, we are restricting patients for specialists to 60.”

Considering the hospital timing (9am to 3pm), and each patient requiring at least seven minutes, 60 is still a large number according to the superintendent.

Dr Pemba said that of every 100 patients, a third need not see a doctor since it would be minor cases and a certain percentage of people would not visit the hospital even if a minimal fee were charged for a severe case.

He also said that since each department is handling separate OPDs, unavailability of token should not be a problem except in the case of general medical service. Besides the OPD is open from 3pm to 9 pm for those who couldn’t visit during regular hospital hours.

But the hospital still needed more doctors for the ENT, pathology and surgical departments according to the superintendent. On the lengthening waiting time, he said that it could be due to frequent breakdown in machines like MRI and CT scan, which are very old.

On complaints regarding line jumping, Dr Pemba said it is difficult to monitor such practices since staff must be providing such favor to a known patient.

The hospital is planning to create an appointment system, where timing for consultations can be planned and waiting time reduced.

The hospital is also planning to increase the general doctor chambers to six from four to reduce waiting time and do away with the shift system currently practiced.

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