Sunday, 27 October 2013

The Public Sector vs The Private Sector (Or How I Grew Up To Be a Dickhead Doctor)

Okay, I'm about to go on a rant and ignore the fact that I haven't posted here for over a year so bear with me here.

Now you all know how much I bitch about the public health system here in Egypt. It's a mess. Facilities are minimal and the load is heavy, but despite that I like to think that sometimes we do good work. It's not the BEST work, but at least I can go home and sleep at night without having any ghosts of dead children wallowing and wailing over my sleepy carcass.

I've recently started to work in the private sector, specifically a post operative ICU. That means I work in an ICU that receives kids that just had major surgeries and it's my job to manage their recovery and make sure they, you know, don't die.

I had all these thoughts about how much better the private sector was going to be. After all, why wouldn't it? Better equipment, better facilities and better yet, there should be a lesser load (as in number of patients)

I was wrong. I was horribly wrong.

I mentioned previously how being a doctor, you sort of have to kill off the part of you that really sympathizes with patients, not all of it mind you, but just a little bit so you're able to function without any preconceived emotions clouding your judgement. Working in the private sector, I've realized that you have to kill off ALL of it.

Let me explain why using my favorite method of analysis: bullet points!

  • In the public sector, the problem is always that there's no money and too many patients. So what happens in post operative ICUs is that there is a limit to two things, the number of patients you can have in the ICU, and the number of surgeries you can have in one day. The first one is self explanatory. If there are 20 beds with 20 ventilators, you can't have 21 patients. The second point means that there's only a finite number of surgeries a day because the surgeon working in the public sector isn't getting paid shit. That means that after he's done with his surgery he'll have to go work in the private sector to make his money. It has its cons for sure, for example there's a never ending list of patients, but that can also be a good thing.

    For example, say a child has chest infection or a fever and he was scheduled for surgery today. In the public sector, that child's surgery gets rescheduled and another patient ends up getting the surgery. When the sick child eventually gets better, he'll have the operation. It doesn't matter for the surgeon because he knows he's going to work 2 cases a day. It doesn't matter which cases he works so long as he works them.

    Now let's imagine this scenario in the private sector. Let's say a child has a surgery scheduled for today but he's got a chest infection. FUCK THAT SHIT, let's cut him open anyways. Why? Because there's a finite number of patients and the surgeon gets paid handsomely for each surgery. He has incentive to perform the surgery, fuck all consequences because at the end of the day, he's going back home with a big fat stinking check devoid of humanity. Now let's say we have 4 beds left but there are 6 operations scheduled for today. In the public sector, the ICU is closed until the beds get empty again, whether through death or recovery. Not true in the private sector. Something called 'overbedding' happens where there are more patients than there are beds. I do not need to explain what this means because obviously, you can understand how horrible a situation like this is. Why doesn't one of the surgeons cancel his surgery you might ask? Well, why would Surgeon A cancel his surgery when Surgeon B is working his and gets paid? Fuck that shit, I'm going to do the operation myself and we'll see what happens. After all, I get paid for the surgery, not for the welfare of the child afterwards.

    This game I call "Penis Envy Surgery Chicken" needs to stop. It doesn't though. Because like I said, money.

  • This one is going to suck ass at explaining but here we go. Okay, so let's say the kid had his surgery and complications happened, whether in the ICU or during the operation itself. In the public sector, we cut no corners in explaining how bad the prognosis of the kid is. Sometimes, doctors are extra harsh in dealing out this information. If the parents dare complain or put the blame on someone, they are constantly reminded that the operation was a costly endeavor and that they should thank God that their kid was at least given the chance of a life free of any problems, even if it didn't pan out so well.

    The way doctors look at their work in the public sector, it's sort of like a 'charity'. I'm not getting paid for shit and you already signed away any legal rights you might have had with our iron clad 'pre-surgery' contract. Sorry your kid's going to die madame, but those are the ropes, EVEN if the surgeon or the ICU doctor (intensivist) made a huge mistake. You aren't worried about consequences because as far as you're concerned, no legal action will ever be taken so there's no need to pad out the horrible news.

    Now the private sector, that's different. The patient is 'entitled'. He's paid money to have the surgery. He gets his say in what's happening. So what do the doctors do? We pad the truth so much it becomes a downright lie. Things like "Oh he's got some secretions in his lung but he'll respond to the antibiotics we hope" are said instead of "Well, he's got pneumonia and we're not sure the antibiotics are working." Why do we lie? Because the truth means more questions. "Why did he get pneumonia?" "Why is hygiene piss poor?" "What do you mean the operation didn't work out as planned?" The more questions asked, the more likely it'll be evident that somewhere down the line, something could have happened to prevent the child from deteriorating.

    So we lie, and my God does it takes its toll on the soul. 

  • But at least we've got the facilities in the private sector right? Right? Also not true. In the public sector, we are funded through two mechanisms: Government money and donations by people. Most of the money goes directly into providing whatever facilities because money is scarce and because no one, thankfully from what I've seen so far, is going to steal from donations (which is where most of the supplies and medication comes from) Now who funds in the private sector? Hospital managers and owners. People. Not institutions. And they're trying to make as much buck as they can. So corners are once again cut. Why buy new ventilators when we've got perfectly ancient but functioning ventilators. Monitors aren't working? Come on, do you REALLY need to monitor a patient's fucking vitals? I'm exaggerating a little bit but that's the truth. All the hospital managers care about is getting by with the least amount of money invested into the hospital so that they can make a fatter profit. Paychecks are sometimes delayed or handed out in increments. Nurses are especially fucked in this scenario (at least in the hospital I work in). 

Okay, so 3 massive bullet points, but you get my point. All this, gives the doctors a sense of superiority and grandiosity that feeds their ego and turns them into dickheads. In summary:

You are getting paid handsomely, for half-assing medical care, with no worry whatsoever of any legal or ethical (because that dies out early on) consequences.


PS: Obviously, I'm focusing on the horrible here. At the end of the day, the private sector does ensure a better survival rate but there are different reasons for that which I'll one day explain in a different post that'll have a somewhat brighter view. 


  1. i just found your blog from eldahshan
    please keep writing

  2. Assalamualaikum,

    I'm a Malaysian student studying medicine at Al- Azhar. I understand the mindset of arabs slightly better than most of my friends so I'm not as surprised by matters such as these compared to them. Though that doesn't mean i don't find them depressing. I think these sort of problems are present in almost every hospital world wide. the only difference is frequency of occurence. But thank you for sharing your experiences with such honesty. It's truly humbling and allows readers who are entering the field to better prepare themselves mentally for what they are going to face which is something we sorely need.

    Do I hope and pray for a better future? Always. I think if I stopped doing that I'd go crazy but hoping is useless without action and I honestly and truly hope that reading your entries will inspire me to try harder in improving what is wrong with our systems.

    I don't believe that just because I'm malaysian I should only concentrate on the betterment of my own country. I understand Egypt for what she is. I love her just the same. I truly hope and pray one day I can do something to help Egypt as much as my own country