Today’s post was inspired by an article that appeared about a week ago in Népszabadság. Actually, it was more like a letter to the editor describing a young woman’s frustration with the Hungarian healthcare system. In this short piece of writing (about the length of one of my posts) we encounter an incredibly rude physician, long lines for most likely unnecessary procedures, and broken equipment.
Klára Kovács, the author of the article, is in her thirties. And, as she remarks in her piece, “nowadays for people like myself, in their twenties and thirties, it is taken for granted that we find recipes, music, news, and basic medical information on the internet.” So, by the time she decided that she should visit a doctor because of severe pain behind her left knee, she had a fair idea that she was dealing with a Baker’s cyst, a pocket of fluid that forms a lump behind the knee. A baker’s cyst can be caused either by an injury or by arthritis of the knee. Once the original problem is treated, the cyst may go away on its own. If not, the cyst can be drained or the doctor can prescribe a steroid shot to reduce the swelling. The literature available on the internet also mentions the possibility of ordering an MRI “to see a picture of the inside of your knee.”
It sounds simple. Well, let’s see what happens in Hungary to someone who goes to a doctor with a strong suspicion that she has a Baker’s cyst. First, she called her district clinic, where she was told that they cannot deal with her problem because her cyst can be handled only in a surgical facility. This piece of information turned out to be erroneous, and although the surgeon on duty was pleasant, he wouldn’t treat her. She had to go to the orthopedic department. There she encountered a real brute who accused her of circumventing the system by first getting an appointment with a surgeon, which allowed her to get an immediate appointment with him, instead of going to the general practitioner as is the rule.
The doctor went on and on: “Do you think that everything is permissible around here? You think that we are here to wait on hustlers like yourself? Show me your problem. Stand normally! You can’t even stand right?” He gave her hell for not coming earlier and informed Klára that Baker’s cyst is a symptom and not an illness by itself. Of course, Klára must have known all that without him because the Hungarian website’s explanation is just as thorough as the English-language one. It was also quite sensible of Klára not to rush to see a doctor because these cysts often disappear on their own after some rest and home remedies. He ended his harangue by telling her all sorts of frightening misinformation about her illness. For example, that “it is possible that the cyst will explode and with a little luck together with your whole leg will go.”
In any case, after this terrible scene Klára was sent for an MRI so the doctor could learn more about why the cyst appeared. What surprised me about Klára’s encounter with this doctor is that he asked nothing about her general health and lifestyle. Does she do any sports? Could she have had an injury? Did she have any operation on her knee? (As it turned out, she did.) Does she have signs of arthritis? One could find out a lot without immediately resorting to an MRI. Moreover, by then Klára was in considerable pain. According to her own description, the cyst behind her knee was as large as her whole knee. Why didn’t he drain the cyst in order to relieve the pain, at least temporarily? The Hungarian internet is full of forums of people whose cysts were drained. It is a painless procedure lasting only a few minutes.
Sending Klára to have an MRI meant starting everything from scratch. She had to go back to her general practitioner because, for an MRI, she needed a blood test to ascertain that her kidney function was okay. My first question: Why couldn’t the orthopedist give her a piece of paper which would allow her to have a blood test? My second question: Did Klára really need the blood test? While doing research for this post I learned that for some MRI scans contrast materials have to be injected, which for people with poor kidney function can be dangerous. The likelihood of impaired renal function is substantially higher in patients over 60 years old and/or people who have certain illnesses, such as diabetes. At UCLA older patients are required to have the blood test. Other patients get a questionnaire on the basis of which the doctors can pretty well identify those people who are at risk of having renal problems. They thus avoid ordering blood tests for all patients. But I guess the Hungarian healthcare system is less frugal with both money and the time of doctors and patients than UCLA is.
The second stage of Klára’s battle with the Hungarian healthcare system began with a wait in her GP’s office for an hour and a half to get a piece of paper ordering the blood test. The next day she spent two hours waiting for the blood test itself. She had 67 people ahead of her and only two nurses drawing blood. She got an appointment to have the MRI three days later, which “is considered to be a miracle in Hungary.” As it turned out, however, her praise was premature. When she arrived for her test, she was told that something went wrong with the MRI machine and if she urgently needs to have the procedure done she must try her luck at another hospital at the other end of the city. They couldn’t guarantee that the procedure would definitely be done that day. She was supposed to be there within half an hour, which given the afternoon traffic seemed an impossibility. She therefore asked for another appointment. But they couldn’t accommodate her because all the slots had already been filled for the month. She was advised to phone sometime during the last week of the month when they work on the schedule for the following month.
Luckily for Klára, she didn’t have to make that telephone call. The following day the cyst painlessly erupted. Gone was the pain and the swelling. Contrary to the doctor’s prophecy, her leg didn’t explode. The cyst disappeared without any medical assistance. “It seems that even the cyst didn’t want to have anything to do with this healthcare system,” Klára concluded.