Sunday, 4 December 2011

What Nobody Tells You About the Free Services We Provide

For all sakes and purposes, the hospital I work in, is truly a free hospital. That means that, technically speaking, the patient doesn't have to pay for anything at all ranging from investigations, medication or necessary surgeries to actually staying in an ICU ward. There is, however, a catch to all of this. Several catches, actually. Let me shed some light on them, and go into detail on one of them that particularly bothers me.

  • First of all, we will run all the necessary investigations to help reach a diagnosis, so long as our shit works. If you frequent this blog, you'll know we have an especially troublesome CT machine that tends to 'stop working' quite often. That's not all. Certain blood tests too, aren't readily available either. By readily available, I mean immediate. Let me give an example. In the Emergency ward in Pediatrics, it's a 24 hour shift. Now in the morning the main labs are open and stay open until about 2 pm. Now, if the main lab is open and you submit a sample at 8 am in the morning, they will not hand you the results until 2 pm in the afternoon. Protocol and beauracracy at its best. That means if a patient comes in at 8 am with severe anemia and you want to find the hemoglobin level not just to confirm the anemia, but to order a blood bag, they're going to have to wait until 2 pm. It's unfair too because if a patient comes in after 2 pm, then the emergency labs are open, and that only takes an hour for the results to yield. So if you ever need to go to the emergency department in a free hospital, fucking come late because coming early isn't worth the effort. Keep in mind that this isn't what bothers me.

  • We will give the medication for free, only if we have it. Some medication is simply not available in our hospital or requires a special order (that must be filled in only in the morning). Either way, if we don't got it, your best bet is to go buy the stuff outside. This is normally okay because even in the worst case scenario, most medication isn't that expensive. However, sometimes it can truly be heartbreaking. We had a patient that needed cyclosporine (a drug we did not have) and it cost them 1,200 Egyptian pounds to go buy. That's alot of money for the type of people we get in our hospital. It also becomes even more annoying when they end up spending money for investigations outside(to speed things up) and find themselves spending more money for medication. Alot of departments thankfully do get around the money issue by giving out donations courtesy of the older professors in each department. Sadly, not all departments have a heart. As sad as this is, it's also not what gets to me.

  • ICUs are readily available too, but only if they're empty obviously, and the problem with ICUs is well, patients tend to stay there for a while. So having to tell parents that they need to bust their asses looking for an ICU for their very sick child can suck at times but again, this is one of those things that is out of our hands. Again, as much as this sucks, this is not what gets to me.

  • Above all else, our hospital, is a teaching hospital. We have students readily coming in and patients regularly get examined by these students. Exams and classes with patients are prepared by the residents when the need arises and so on and so forth. It can genuinely be a bitch to find certain patients too. For example, neurology week would need different neurological cases. Cases we might not have, so we go around bargaining with other departments to give us their patients just for a while until the class ends. By bargaining, I literally mean bargaining. Usually, other departments also want other patients so we switch for a few hours until the classes are over. Just a few days ago, I had to go to the other Pediatric hospital across the street (we have two) and bring a patient for a class. It was especially difficult, because the mother was being difficult. Her kid had just had 7 samples taken out of her; she was tired and she wasn't ready for a class full of students palpating/groping her child. The mother had a point obviously, but she didn't have the right however. All patients admitted to our hospital sign an admissions form explicitly stating that we can do whatever we want and we have the right to use them for tests, classes etc. Now, I felt for this mother. Her kid was especially in high demand because the manifestations of her disease were easily shown to students. So this was her 5th day in a row. I managed to coax and convince her and she tagged along.  Now this may not sound so bad, but it gets much much worse when it comes to exams, especially Masters or PhD level exams. Higher level exams require complicated patients that fulfill very specific criteria according to the examiner (our professors) and they can be ridiculously anal on what they want. Our professors also will not take no for an answer. Again, let me clarify with a better example. We had a kid (who I'm going to call Adam) with Rheumatic Fever in our department. He was a really nice 7 year old with a great and understanding mother. He got on the medication, got better and we told his mother that come Saturday they'd be going home and continuing their evaluation at a clinic. They were ecstatic because let's face it, a hospital is not a cheery place. The Friday before, a few professors came in and asked us what our cases were and we told them. They looked at Adam and heard his heart (he had Mitral Regurge, a complication of the disease that reveals a certain sound on the stethescope known as a murmur). They came back to us and told us, "Keep Adam for a week. He's going to be in one of the exams." We argued back and told them that we told the mother he was leaving. Their response was simply, "Doesn't matter. Make something up and keep them for a week."

    Let me clarify what "Make something up" means. Make something up means going to the mother and telling her that we just need to make SUPER sure Adam's okay so we'll run a few more tests on him, JUST to be on the safe side. It's all bullshit of course just to keep him there. THIS IS WHAT I HAVE A PROBLEM WITH. Thankfully, the specific scenario of Adam ended on a happy note with one of the more senior professors deciding he wasn't fit for an exam (not because of his health, but because his case was too easy for Masters students)

    This sort of shit is what ticks me off. It gets much worse as well. A few professors had entrusted me to find cases for a PhD exam in a few hospitals, one of them being our own version of a Cancer Hospital. Their criteria was simply, "Try to find a super difficult case so that more people fail than pass." So not only did I have to go about finding patients with rare fucking findings, I had to do it so that other fellow doctors would fail their PhD. This story got much worse because when I got to the Cancer Hospital and spoke to my contact there (Yes, a fucking contact established through the professors) she showed me an especially hard case (that had cancer and rare findings) and then she told me to let her know if they'd want her because if they did, she wouldn't have to start the next dose of chemotherapy on time and delay it for a few days until after the exam (because the findings would subside after a dose of chemo)

    Not only was I dealing in patients but I was sometimes prolonging treatment. Now, to be fair, we're not monsters either. I mean, the 'delay' isn't going to harm the patient and everything is looked after so as not to deteriorate the patient's health.

    But goddamnit if it doesn't make you feel like an asshole.

So the next time people talk about how free hospitals really are free, always realize that nothing in this world is for free. There are consequences and repercussions to everything no matter how great it sounds on the outside.