Guidelines that help set basic standards for the delivery of healthcare in Cayman are an important missing piece of the islands’ public health jigsaw, according to outgoing Chief Medical Officer Dr. John Lee.
In a final interview with the Cayman Compass, Lee said implementing a set of “clinical standards” for Cayman was one of the key unfulfilled goals from his tenure.
Lee’s stint as CMO was dominated by his leadership in the country’s response to the pandemic. But he acknowledged that almost every other ambition he had for the job had been forced to take a backseat, as COVID-19 consumed his time and resources.
His greatest regret as he departs the role is that plans to bring in a set of guidelines that would help standardise care and control costs have not come to fruition.
Lee, who has experience working in the UK’s National Institute for Health and Care Excellence, said a similar infrastructure could provide appropriate guidelines to help guide healthcare in Cayman.
He said the aim would be to ensure that patients have access to an acceptable and understandable level of care – no matter which doctor, or healthcare provider they go to.
“It is an important area of medicine that many people gloss over,” he said.
“It is fundamental, because it is how you control costs and it is how you maintain professional standards.”
He said guidelines on clinical standards would help ensure medical interventions were appropriate to the complaint.
Citing the high number of children in past generations who had their tonsils removed, he said research and data analysis, both from a medical and economic perspective, has since shown that, in most cases, this was not necessary.
As a result, it is no longer standard operating procedure as a response to repeated tonsillar infections.
Lee said the idea is to create a template for the “ideal process” for treating a variety of complaints to maximise patient health outcomes and minimise their attendance at healthcare facilities.
He said this would also serve to reduce the risk of “supplier induced demand” – where healthcare providers recommend treatments that serve the interests of the providers.
“That is the way that healthcare costs rise and rise as doctors get richer,” he warned.
While he believes that Cayman has a strong and diverse group of providers, Lee is keen to see stronger regulation for the whole healthcare sector. He said modernising and strengthening the governance structures would help ensure providers’ continuing training was up-to-date and would keep costs down and prevent malfeasance.
Prior to COVID, he said, he had set up a clinical standards group to advance the issue and had received support from most local practitioners as well as from Public Health England.
“This is an issue for all the Overseas Territories and actually much of the Caribbean does not pay as much attention to clinical standards as they could.”
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Re “Clinical Standards” article on Dr. Lee: People from developed countries should know that there are very low barriers to practicing “medicine” in Cayman. Inspect your provider’s credentials and degree-conferring institutions carefully. There are well-meaning, but unlearned practitioners in the same area as some of the best, developed-world doctors here.
As a retired physician, I agree totally with Dr. Lee’s aspirations and comments. The average patient does NOT understand the concept of “clinical standards” until he/she seeks a second opinion and realizes that there are other options to treating certain conditions including: observation, medication or even surgery.
Too bad he didn’t have the time (or possibly government cooperation) to bring this to fruition. It’s a massive undertaking and requires many people. Perhaps the easiest way to do this would be to modify and accept those standards used by Public Health England.