One hears far too many horror stories about patients in need of urgent care who are being bounced from hospital to hospital. The staff in one hospital claims that for one reason or another they can't handle the case and recommends that the patient be transferred to another institution. To those of us who are not familiar with the workings of Hungarian hospitals these trips from hospital to hospital and often from city to city seem quite mysterious. The latest case, involving a 57-year-old man complaining about a bloody stool who a few hours later lost consciousness en route to a third hospital and subsequently died, prompted me to study the matter a bit.
Let's start with some facts and figures. There are 51 hospitals in Budapest with a population of 1.7 million (2009). In New York City (population 8 million) there are just over 70. How is that possible? As far as I can see, most of the Budapest facilities are specialty hospitals. I found several children's hospitals and hospitals that specialize in cardiology, or internal medicine, or surgery. Of course, there are a few general hospitals as well. But even then, it can often happen that the hospital has several buildings located in different parts of the city. This system to my mind is anything but economical, efficient, or medically satisfactory. After an examination in one hospital, the doctors might come to the conclusion that the case needs further tests that are available only in some other hospital. Then, depending on the condition of the patient, an ambulance might have to transport him, and we know that this is not an inexpensive undertaking. In a more centralized hospital it would be a simple matter of wheeling him to another floor or another wing of the same building.
But that's not all. There are the "anomalies" of the emergency service. The Hungarian system is based on the old decentralized German system. First of all, not all hospitals have an ER, and those that do offer only certain kinds of emergency treatment on certain days. Cases that need surgical intervention on Sunday, let's say, must go to X hospital, while with some other ailment the patient must go to Y hospital where there is a team of doctors specializing in internal medicine. There is a central coordinator who organizes all this. But, of course, it's virtually impossible to know in advance just what is wrong with the patient. So the patient arrives at hospital Y. The internal medicine team at hospital Y decides after an examination that the patient should really be at hospital X, which specializes in surgery. So the patient is transported by ambulance to hospital X. But what if the team at hospital X decides that the patient really doesn't need surgery? Or that he needs surgery, but perhaps cardiac surgery that is not offered at hospital X? It's easy to see that this old method is flawed.
What the Hungarians should do is to introduce the so-called Anglo-Saxon method that offers "complete service" at one place–"one-stop shopping." This is not just my view, which might be attributed to my Anglo-Saxon bias. I heard the director of one of the hospitals involved in the latest case state that the Hungarians should adopt this "new" system.That is something of a conceptual breakthrough in Hungary. He claims, however, that the introduction of comprehensive emergency service would require additional money, not available to Hungarian healthcare at the moment. My feeling is that a total reorganization of the whole system of hospitals could save a great deal of money. Hungarian critics of the system claim that both "poverty and waste" are present in the Hungarian system.
Let's return to our 57-year-old man whose case vividly illustrates the problems with the system. A family doctor was called out who, based on the patient's bloody stool, decided that the man was suffering from gastric hemorrhaging. The doctor gave him a piece of paper that allowed him to go to the district hospital, which happened to be the Sándor Péterfy Street Hospital. The doctor on duty decided that the man must go to a surgical unit, but on that day there was no surgical emergency service in Péterfy. So he was sent over to the Szent István Hospital where three surgeons were on duty. The surgeon who examined him decided that after all the man's problem was not of surgical nature. So he ordered him sent back to Péterfy, but not by ambulance because the patient's condition didn't seem to warrant immediate attention. The patient was told that he might have to wait a few hours until a medically equipped car, not an ambulance, could pick him up. The relatives accompanying the man obviously decided that they had had enough and without saying a word to the medical team put the man into their car. Instead of going back to Péterfy, they decided to go the Szent Margit Hospital where they knew a doctor. On the way there the man lost consciousness and by the time an ambulance came to his rescue the man was practically dead. He died the next day in Péterfy.
The doctor at Szent István was suspended, the ministry ordered an investigation, and the staff of Szent István is very upset because they feel that the media handled the case unfairly and inaccurately. Today the result of the autopsy revealed that the man's death had nothing do with to gastric hemorrhaging. He died of an aneurism.
Most likely the man's death was inevitable, but the story is still not pretty. I believe that the doctor at Szent István followed the rules and regulations when he sent the patient back to Péterfy, but I can also understand the relatives who considered going back to the same place where they started worse than a waste of time.
Healthcare reform was aborted a year and a half ago, money today is even scarcer than then, and problems are on the rise. And on top of everything else the directors of hospitals, all 170 of them, are threatening a hunger strike if the government doesn't give them an additional 23 billion forints from the central budget. These same hospital directors did everything in their power to prevent the implementation of any kind of change. I find the whole thing distasteful.