In an application made by a doctor in Ordu, requesting that appointment intervals should not be less than 10 minutes, the court decided that the Ministry of Health's 'Additional Appointment' request did not have legal support.
Making a statement on the subject, the Turkish Medical Association said, "The application of a colleague from the Army, requesting that the interval between appointments given on his behalf through the Central Doctor Appointment System (MHRS) be not less than ten minutes and that no additional (backup) appointments be opened, was implicitly rejected by the Ministry of Health. In addition to the decision to stay the execution in the case our colleague filed in the administrative court; It has been stated that the defendant administrations have not been able to demonstrate that the appointment intervals were created by the plaintiff doctor and approved by the chief physician in accordance with the legislative decisions, and that the additional appointment practice does not have legal support. We find this decision of Samsun Regional Administrative Court 3rd Administrative Case Chamber, objection number 2024/44 YD, valuable and valuable in terms of observing doctors' appointment intervals and the right to set additional appointments. "We congratulate our colleague for his legal pursuits," he said.
In the statement of the union, it was said, “We would like to remind you that; Our union wrote a letter to the Ministry of Health on September 90, 7, regarding reducing the MHRS appointment interval to five minutes and asking physicians to examine more than 2021 patients a day. In the article, which recalls the stages of the examination process such as registration, anamnesis, preparation, physical examination, requesting a test when necessary, reviewing the tests and arranging the treatment, it is pointed out that a five-minute period will not be sufficient and will lead to lack of care and medical practice errors. It is also noted in the article that the practice results in increased violence and loss of satisfaction for doctors, and inability to access adequate and qualified diagnosis and treatment for patients. "We state that under these circumstances, our colleagues cannot be held responsible for medical malpractice that may occur contrary to medical knowledge and scientific evidence, and that the managers of health institutions will be held directly responsible for any errors that may arise." It is also emphasized in the article that the adaptation of the appointment infrastructure to scientific requirements and the termination of the performance application should be addressed together.
Excessive Patient Examination Pressure Is Against the Law
“Immediately following the letter written to the Ministry of Health, a sample petition was prepared for physicians to submit to the chief physicians of public hospitals. In the petition example, it is stated that the main goal in providing health services is to diagnose and treat the patient in accordance with scientific necessity and professional deontology rules; In this context, it has been noted that the time required to be allocated to the patient to provide qualified healthcare services is at least 20 minutes, and in some branches this time should be even longer. Although it was stated by the Ministry of Health, another statement was made by our union on November 12, 2022, due to practices such as creating additional appointments in some hospitals against the wishes of doctors and opening investigations against doctors by the administrations to examine patients who have made additional appointments, and without the approval of doctors, doctors are required to provide qualified health services. It has been underlined that the pressure on them to examine too many patients in a way that prevents them from giving medical treatment is against the law.”
Appointment deadline should be 20 minutes
More importantly, in our opinion; A lawsuit was filed in 2021 regarding the process of giving appointments to two patients ten minutes apart with MHRS. In the lawsuit application, it is stated that this process is against the law because in this case, a maximum of five minutes can be allocated to a patient, whereas the time that should be allocated to a patient should be at least 20 minutes, that patients cannot be expected to be accurately diagnosed and appropriate treatment planned within the specified period, and that medical malpractice may occur as a result of this practice. Cancellation and suspension of execution of the process on the grounds that it will increase the number of unnecessary examination requests, and keeping patients together for a long time, ignoring the existence of risky conditions that are not suitable under normal conditions and that increase even more during the pandemic period, due to the fact that many outpatient clinic rooms are not adequately ventilated, will have foreseeable severe social consequences. It was requested.
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In the case heard by the Eskişehir Administrative Court, our request was found justified and on December 9, 2021; It was decided to suspend the execution of the process on the grounds that this appointment system was contrary to public interest and service requirements.[4] Later, the decision regarding the stay of execution was objected to by the provincial health directorate and unfortunately this positive decision was annulled by the Bursa Regional Administrative Court.
One of the main problems is that the functioning of the health service is determined by the Ministry of Health through regulatory processes that completely eliminate the autonomy of doctors and the powers of the provincial organization. Failure to inform doctors about regulations that conflict with each other and have no legal support also restricts the ways in which the addressees of the practice can seek their rights. Thus, unregulated practices and unimplemented regulations emerge.
Inspection Period Should Be Resolved by Consensus
The fact that different results were reached in these two cases involving the same request is one of the consequences of the acceptance of the appeal in the administrative justice system. With the acceptance of the appeal legal remedy, the appeal procedure for many administrative disputes has been closed. Final decisions in these disputes are made by the appeal chambers of the regional administrative courts. This situation brings with it an impasse and causes different decisions to be made by different regional administrative courts on such issues. In the current situation, the fact that these two cases, which contain the same request in terms of their results, have different decisions is a result of this situation.
However, it should be noted that; In the decision of Bursa Regional Administrative Court, “The practice of giving appointments to two patients in ten minutes via MHRS is a technical regulation made to ensure the right of access to health services for people who cannot make an appointment through the system and should be considered as the first examination period, and the treatment planning period when the results of the examinations and analyzes to be performed are shown to the physician. - The right to determine the duration (regardless of 5 or 10 minutes) according to the condition of each patient belongs to the relevant physician, in accordance with the decisions of the Medical Deontology Regulation, and the issues arising from this practice are determined according to the requirements of the healthcare service in cooperation with the hospital administration, physicians, the Ministry of Health, medical chambers and healthcare unions. "There is no doubt that it can be resolved by consensus." It is said. However, to date, the ministry has not cooperated with either the doctors or the doctors' professional organizations on this issue.
Physicians must meet with the chief physicians of the hospital where they work and request appointment intervals appropriate to the diagnosis and treatment period, taking into account their expertise, and this request must be fulfilled by the management. We would like to inform you that if these requests are not taken into consideration by the management, doctors can apply in writing, and if they receive a negative response or are implicitly rejected by not responding within 30 days, they can apply to the administrative court to request the cancellation of the process within 60 days from the date of rejection.
