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In medicine, quality and governance are crucial to improving standards.Corportae and individual accountability for clinical performance should be demanded and failure of such responsibility should be legally punitive.

The medical profession in Jordan is very good at selling itself as a major contributor to our economy. We hear constantly of the excellence in health care provisions in Jordan and of the high quality of our doctors; the reality is very much different.

Jordan significant leap into 21st century medicine has brought benefits to its people and helped the expansion of a booming private sector that accounts for 34% of nationally available hospital beds. It is unfortunate that celebrating this success has allowed complacency to set in and standards have fallen significantly.

In the 1970’s and 1980’s the Royal medical services(RMS) have set the standards and lead the way in offering Jordan high quality medical care and investing in high quality medical training. The RMS has been crucial in offering other health sectors the trained medical, nursing and other health care professionals. Unfortunately this is no longer the case. Access to good medical training is far more difficult than used to be the case.

There is almost no access to international surgical training. We are no longer able to send our young doctors to gain surgical exposure abroad. In surgery, our excellent services are concentrated in few senior surgeons. The new Jordanian surgical graduates are far below the standards that are required for the 21stcentury medicine. Moreover the social fabric of Jordan has changed since those golden years. Changing social values no longer rewards hard work and academic achievement.

Our society no longer rewards talent and ability. Wealth, family connections, class privilege and cronyism are more determinant of social position than hard work and education. Medical ethics is also rapidly changing and it is sadly the case that this has reached worryingly unacceptable levels.

The medical profession is in a moral vacuum, this is also complicated by lack of governance and regulation which in turn has created an environment that is rife for deteriorating standards, deteriorating medical ethics and lack of social responsibility.

The absence of regulation is crucial to our predicament and the government has to realize its responsibility in imposing such regulation. Many services in Jordan has regulatory boards, the medical services does not. Self regulation and monitoring of standards have clearly failed. Raising the standards of medical training is essential. Quality is mandatory; quantity is no defense for poor quality.

It is common sense to acknowledge and utilize existing Jordanian skills and set policies to incorporate such skills in training programmes. Competition based on talent and ability will improve standards. A cultural shift is needed where doctors appreciate the limitation of their training and seek help and advise when needed, an attitude of life long learning is essential and professional development programmes should receive government financial help. Government driven initiatives in governance and a drive to stop poor practices is crucial to reversing the deterioration in our medical services. Ideas for good practices could include clinical risk reduction programmes, evidence based practice in day to day use, detecting and investigating adverse events, detecting poor clinical performance and dealing with it early on to prevent harm to patient and collection of high quality data to monitor clinical care. All medical institution in Jordan would be challenged to produce data that reflects clinical outcome.

Success of any health care system is measured by the strength of the public confidence in it. Today Jordanians are wary of failing medical standards and deteriorating medical ethics. Pockets of good medical practices are swept by the tide of mediocrity and corruption. Hard work and discipline is devalued. Self regulation is no longer acceptable and a new framework for continuously improving the quality of medical practices and safeguarding high standards of care is needed to create an environment in which excellence in clinical care will flourish. Political courage is needed, only government sponsored regulations could attempt this. Lack of leadership is proving a disaster for the Jordanian health care services, the government must act.

Dr Ibraheem Hijazi

Consultant Orthopaedic Surgeon