Some very honest words about Hungarian doctors (1)

István Mikola's outburst about gynecologists/obstetricians started a vigorous debate about the very sad state of Hungarian health care. As I wrote yesterday, the new government hasn't given any indication of its future plans. The few changes the new ministry introduced are all to the benefit of the doctors at the expense of the patients.

The Fidesz-inspired referendum put an end to any attempt at restructuring the healthcare system; it works exactly as it did during the Kádár regime–corruptly. The doctors at the top of the heap were the ones who fought tooth and nail against the reform plans of former minister of health Lajos Molnár. After all, they are the beneficiaries of the current system and they see no reason to change anything. How does it work? Most of the physicians who officially are on the staff of a public hospital also have a private practice. But because these doctors' offices are not fully equipped, these "private doctors" use their hospitals' facilities, equipment, and supplies gratis. This is a good deal, especially if one considers that their "fee" is tax free.

Interestingly, this "dilemma" is often viewed as the acceptable norm, not a problem at all and hence not worth tackling. However, there seems to be a fairly easy answer. Let's take obstetrics. If the expectant mother insists on having her private doctor deliver her baby, it should be legal for this doctor to set a fee. He naturally could use the hospital's delivery room, but only also for a fee. So, it would be a contractual arrangement. If I understand István Mikola correctly, he himself is in favor of such a solution.

According to László Tamás Papp (HVG, June 8, 2010) demanding money for services rendered is not limited to obstetrics. It is also the case in surgery, internal medicine, urology, ophthalmology, orthopedics, rheumatology, and oncology. Not too many specialities are left off of this list. Apparently, the money that is being demanded is not for extras. Not for single rooms or VIP room service. "People have to pay the extra money in order to be treated as human beings should be treated." Apparently, if someone doesn't pay he will get inferior service. Doctors will talk to him in an inappropriate manner, he will get a doctor who is not the best around. "A cynical, cruel cold war will go on in which only the patient loses."

So, in reality "free" healthcare is a sham. According to Papp, the "average man" is quite accustomed to the present system. He knows that good service costs extra money. The problem is that there is no guarantee that for an extra sum of money the recipient, the doctor, will actually keep his word. It can happen, and Papp heard many such stories, that the doctor took the money and instead of delivering the child or performing the surgery, he left for his summer vacation.

On the very same day that Papp's article appeared in HVG, Dóra Ónody-Molnár reported on the case of a woman, Andrea Mezei, who in the last half a year lost her sister and her father. She told the horror story of two very sick people's treatment in several Budapest hospitals. Andrea's sister was losing a great deal of weight and she felt terrible pain within her bones in her back. It took two weeks for the doctors at one of the hospitals to come up with the diagnosis of cancer in a gland in her neck. Meanwhile she was in terrible pain but received no painkillers.

Since there was still no complete diagnosis, Andrea took her sister to a private hospital where in ten minutes a complete diagnosis was arrived at: cancer that had started in her tonsils and subsequently spread everywhere from her liver to her bones. In the public hospital two weeks were not enough to discover the real situation. Back to another hospital to an oncologist who came up with the brilliant idea of removing her tonsils. After all, it started there. Well, yes, but if it is already in the bones and the liver, taking out the tonsils, especially since by then her sister was skin and bones, didn't sound like a great idea. So, off to another hospital specializing in ear, nose, and throat problems. There the doctor was invisible and her nurse was afraid to call her and ask when she would show up. As Andrea said, and many people confirm, the hierarchy that exists in the Hungarian medical profession can only be described as "feudal." The staff lower on the totem pole "shake with fear" at the sight of their superiors. She described them as lap dogs. But they are not alone. The patients are also afraid to ask the great doctors anything about their own problems.

When at last the doctor arrived, she talked to Andrea and her sister in an unspeakable manner. "What do you think–that I will operate on somebody in this condition?" The result was that the patient who should have been given some encouraging words fell into a state of depression. The treatment wasn't any better at another hospital where the young doctor on call mostly yelled at them. Or at least until her superior arrived on the scene. "Then suddenly she became all sweetness and light."

I will leave the story of Andrea's father for tomorrow. Unfortunately, these stories are not unique. We hear all too frequently about inhumane treatment by doctors who feel that the patient should be grateful that they even take a look at them. Often, they are unable to diagnose the problem or they send people home without actually examining them. Then the patient dies a few days later. This is clearly negligence, but most people don't even dare to report.

In any case, Andrea Mezei after her experiences decided to start a movement! Let's hope that she will follow through.