TTB Central Council President Prof. Dr. Alpay Azap: Unfortunately, we will remember Minister Koca for that money-counting gesture

The Minister of Health has changed, but both the incoming and outgoing ministers continue to be discussed separately. 

Turkey's largest medical chambers are listing their assessments of the “Fahrettin Koca era” for the outgoing minister point by point, and are even publishing his report card. 

Doctors and professional organizations are clearly revealing what kind of period was actually experienced by healthcare workers under former Health Minister Fahrettin Koca. On the other hand, it is also obvious that existing problems cannot be resolved with this change alone. Professional organizations emphasize that changing the minister will not be enough and that the healthcare system itself must also change. 

I am curious about the assessment of the change in the Ministry of Health by Prof. Dr. Alpay Azap, the head of the newly appointed Central Council following the recent elections of the Turkish Medical Association (TTB). One of his most significant sentences was, “Unfortunately, we will remember Minister Koca for that money-counting gesture.” 

In his farewell speech at the handover ceremony, Fahrettin Koca recounted his 6-year term, listing his achievements in many areas from city hospitals to violence against healthcare workers, mentioning the improvements they made, and even saying, “We have largely solved the problem of violence in healthcare.” However, what is seen from the perspective of physicians is not quite as Koca declared. 

When I asked Prof. Dr. Alpay Azap what he objected to most in former Minister Fahrettin Koca's speech, he said, “He said that violence in healthcare has decreased. That was what I wanted to object to the most. Just two days ago, there was a knife attack on a senior student friend of ours and a security guard in Erzurum. During the minister's term, there were attacks that resulted in loss of life.” 

Stating that a decrease in violence reports does not mean that violence has decreased, according to Prof. Dr. Alpay Azap, healthcare workers have reached a point where they feel “nothing changes whether a white code is issued or not.” Stating that they do not have any observation or information that violence has decreased, but on the contrary, they face this problem every day, Prof. Dr. Azap said the following: 

“As physicians working in the field, we see it, and we are in communication with many of our physician colleagues. Unfortunately, such a situation exists, and a new one is added every day. I do not think that violent incidents have decreased or that sufficient measures have been taken against them. In fact, there are many measures that can be taken. The TTB and professional unions have brought forward many suggestions regarding this. Unfortunately, because these are not implemented, patients and physicians are pitted against each other. In fact, both are groups that are harmed and suffer from the healthcare system. But the real culprit steps aside, and patients blame physicians because of the government that imposes this healthcare system. This is one of the points I object to the most.” 

HE COULD HAVE STOPPED THE CITY HOSPITALS PROJECT!

Prof. Dr. Alpay Azap, who also opposed the information provided by Fahrettin Koca that he prevented city hospitals from being a burden on the budget, explained the problems experienced in city hospitals, which they have objected to from the very beginning, as follows:  

“Minister Koca continued the health transformation program, but if he had wanted to, he could have stopped the city hospitals project. He could have chosen not to open new hospitals. This issue could have been solved by addressing the infrastructure deficiencies of hospitals that are extremely efficient within the cities and by carrying out renovation works. But right now, city hospitals have become both a huge burden on the economy and a problem so large that the healthcare system cannot handle it. 

City hospitals are such massive centers that they are very difficult to manage. An ideal hospital should have 300 - 600 beds, a maximum of 900 beds. A 4,000-bed hospital might sound nice and look huge and impressive, but everything in those hospitals is a separate problem. Moving a patient from one place to another, a physician who needs to perform a consultation going to another department, cleaning, heating, etc., are all problems. If a doctor whose time is so valuable is walking for 10-15 minutes inside the hospital, how much time will they spend with the patient? How many patients will they consult per day? 

It was very obvious that these would happen, and that is why they were objected to from the beginning. Unfortunately, scientific objections were not listened to. As a result, we were left facing these problems. How can this problem be overcome? That is also a difficult question…”

BOTH PATIENTS AND DOCTORS ARE UNHAPPY 

Expressing that neither patients nor doctors are satisfied with the healthcare service provided, Prof. Dr. Alpay Azap shared the following information about the reasons for this: 

“At first, the huge city hospitals were seen like 5-star hotels. Speaking in terms of patients; being able to reach a doctor and having a specialist doctor constantly looking after them felt good to them. But reaching a doctor does not mean receiving good healthcare. Ultimately, doctors are given very limited time to evaluate the patient. Within that limited time, even if you are the greatest expert in the field, even if you have dedicated years to this area, it is very, very difficult to understand the patient's problem, make a diagnosis, and plan the treatment in a short time. 

Taking the patient's history, which we call anamnesis in medicine, correctly and completely is very important for making a diagnosis. First, the patient is examined, then laboratory tests are requested. But now the doctor does not have enough time, and we urgently direct them to laboratory tests. When the test results come back, you try to look at them quickly, make a diagnosis, and treat, which is not an appropriate method at all. Because laboratory tests can be misleading. Therefore, what is essential is what the patient tells us and the findings we obtain during the examination. However, in recent years, they are asked to see so many patients that there is no opportunity to do this. 

When that happens, patients cannot find a cure for their problems and go from doctor to doctor. This is the reason why the number of applications to doctors has increased so much. The patient applies to another doctor or even another branch. For this reason, the number of applications to both outpatient clinics and emergency services has increased incredibly in recent years. This is boasted about, but it is not something to be proud of... How can a population twice the size of a country apply to the emergency room in one year? It is an incredible situation. It means we are a very sick society. Or it means we are doing something wrong. 

In short, this situation is an attempt to manage health through numbers. Looking at the quantity of the work done rather than its quality, and rewarding this, inevitably leads to this.”

HE RAN THE SHIP AGROUND!

In a press statement made by the Ankara Medical Chamber the other day, it was said, “We would have liked to remember Mr. Koca's term fondly, but both during his appointment process and throughout his tenure, instead of an understanding in favor of solving the structural problems in our healthcare system, he insisted on policies that led to new problems. 

Mr. Koca, who is on the board of directors of one of Turkey's largest hospital chains, was placed at the helm of the public healthcare system. Unfortunately, the ship has run aground!

We unfortunately did not think well of the ministerial term of Mr. Koca, who left his post after commercializing healthcare services and creating a wreck in the healthcare system!” 

Important reminders in the Ankara Medical Chamber's statement were listed as follows: 

- Mr. Koca did not listen to the warnings of the TTB and Medical Chambers, who wanted to serve with their professional knowledge and experience during days when crises in the health sector intensified, from the COVID-19 Pandemic that shook our country and the medical community to the February 6 earthquakes, and avoided meeting with us.

- While 522 healthcare workers, including physicians, nurses, midwives, technicians, paramedics, and hospital workers, were lost due to COVID-19, he remained indifferent to the struggle that the TTB and Medical Chambers persistently continued, stating that “COVID-19 should be considered an occupational disease regardless of the causal link.”

- He could not (or did not) ensure accurate and transparent data flow in the fight against the COVID-19 Pandemic. The numbers he shared in his monthly press statements and the case and death numbers he gave from his personal social media accounts contradicted each other. These contradictions strengthened the infodemic and facilitated anti-vaccine and anti-science propaganda.

- He displayed a pacifist performance in the face of violence in healthcare. He either did not share the White Code data regarding violence or announced it late and incompletely. He could not create effective policies against the more than 121 thousand physical and verbal violence reports since the White Code system was established. Our workplaces became insecure and unprotected.

- During Mr. Koca's ministerial term, we lost our colleagues Dr. Fikret Hacıosman (2018) and Dr. Ekrem Karakaya (2022) as a result of violence in healthcare. Tens of thousands of our colleagues were subjected to swearing, insults, threats, humiliation, battery, and armed attacks.

- He remained indifferent to the heavy workload, working conditions, education, and shift problems of assistant physicians. Assistant Rümeysa Berrin Şen (2021) lost her life in a traffic accident while returning home after a heavy shift because there was no post-shift leave. Unfortunately, after our young colleague lost her life, we were able to obtain the right to post-shift leave as a result of the determined struggle of assistant physicians. However, working conditions that drive physicians and healthcare workers to death, such as mobbing, long working hours, and violence in healthcare, continue.

- He did not take any constructive steps regarding the improvement of the situation of retired physicians who have to live on a salary below the hunger threshold, and did not use his public authority.

- While he did not speak out against the closure of state hospitals for City Hospitals, he included the Medipol Hospital, which he founded, in the scope of support, enabling it to receive 5.9 million liras in incentives in 4 years. In addition, Medipol Hospital received a total investment incentive of 4 billion 834 million 799 thousand TL on April 18, 2023. 

- He used his public influence, which he did not use for other matters, for his own hospital. In 2019, he had the 50 thousand square meter Ankara Train Station area allocated to Ankara Medipol University. 

- He pushed preventive health services into the background in order to increase the market share and profit margins of second and third-level private hospitals.

- He was content with watching the demands of family physicians and family health center workers from afar. He insisted on not seeing the family physicians who have been in the fields for weeks with the demand for tax justice.

- He did not stop the City Hospital projects, which both cause problems in the organizational structure of healthcare services and cause a black hole in the public budget, and continued them. The total cost of City Hospitals to the public in 2024 will reach 83 billion 697 million TL.

- While he should have defended the honor of the medical profession and the rights of his colleagues, he remained silent in the face of the phrase “If they go, let them go.” At a time when more than 3 thousand physicians received a Certificate of Good Standing in 2023 and the feeling of a lack of future became widespread among our young colleagues, Mr. Koca attempted to discredit physicians as money-grubbers with his money-counting gesture.

- He left his post by laying the foundations of a system that imposes seeing patients in 5 minutes or less, instead of the 20-minute examination time foreseen by the World Health Organization for a qualified examination.

ISTANBUL MEDICAL CHAMBER PREPARED KOCA'S REPORT CARD: POOR

The Istanbul Medical Chamber shared Fahrettin Koca's ministerial report card on its X account yesterday. Stating that “The former Minister failed the class,” all grades on the report card were given as POOR.  

* Effective measures against violence towards healthcare workers: POOR 

* Creating an environment where young physicians will not migrate abroad: POOR

* Eliminating the reasons why some specialty branches, especially surgical branches, are not preferred: POOR

* Ensuring that the HPV vaccine is free: POOR 

* Demonstrating a transparent management during the pandemic period: POOR

* Providing and planning qualified healthcare services in earthquake regions: POOR 

* Organizing emergency services so that only emergency patients can apply: POOR 

* Giving importance to preventive health services and preventing vaccine-preventable diseases: POOR

* Preventing private practice physicians from being forced to work for private hospital bosses by restricting them from performing procedures in private hospitals: POOR

* Ensuring that patients can get their appointments within an acceptable time frame and that examination times are at the recommended durations: POOR