Teaching Hungarian doctors to say hello

On June 2 several newspapers reported that a pregnant woman, after leaving the Ferenc Jahn Hospital in Budapest and while waiting for a taxi, collapsed in an epileptic seizure. The taxi driver had the good sense to hold her head to prevent her from injuring herself on the hard pavement. With the help of a passer-by he phoned the ambulance service. The dispatcher wouldn’t send an ambulance and instead suggested going to the hospital for help. But the door was locked and no amount of knocking or honking the car’s horn elicited a response. It took several more calls before the woman’s physician appeared at the door with a nurse. The taxi driver rightly pointed out that the problem is not only the state of Hungarian healthcare but also the attitude of doctors to their patients. I should add that this incident occurred at the same hospital where for several days no one noticed that there was a dead body in a restroom that served visitors to the neonatal unit.

I don’t know what our taxi driver would have thought if he had listened to a conversation between György Bolgár of Klub Rádió and a physician a day after the incident. The illustrious colleague explained to Bolgár why the hospital did what it was supposed to do. Just because the woman collapsed in front of the hospital, the institution had no obligation to accept her. He illustrated the case with the following example. Can anyone whose BMW breaks down in front of a BMW factory expect his car to be fixed right there just because the trouble occurred in front of the plant? People in a hospital have no time for such unexpected incidents. Who can go out? A doctor who is with another patient? Or a nurse who has to look after 40 patients? Yes, the taxi driver could only phone the ambulance service. Soon enough another physician, a woman this time, phoned in. She kept repeating, robot-like, that “there are rules,” and the rules say one must turn to the ambulance service in such cases. Period.

Where it all happened

And what was the reaction of the hospital administration once the story got out? The statement the hospital issued revealed that the security guard inside was fully aware of what was going on in front of the entrance. In fact, he was taking notes. “Everybody knows,” the hospital said, that between 11:00 p.m. and 4:00 a.m. the main entrance to the hospital is closed. One must use the entrance to the emergency department. As for the incident itself, “it is unfortunate that an epileptic seizure may occur at any time in the case of an epileptic patient.” The hospital administration conducted “a thorough investigation” and found that everybody followed the expected protocol. I should add that the emergency entrance is almost a whole kilometer away from where the incident occurred.

Only a few days after this incident the Állami Egészségügyi Ellátó Központ (ÁEEK), or National Healthcare Services Center, published a so-called performance evaluation, covering the 2013-2015 period. It is an extremely detailed manual of more than 1,000 pages on every possible aspect of the Hungarian healthcare system. Those who are not quite ready to wade through the incredible amount of information should at least read the summary (összefoglaló), which is depressing enough. Within the European Union, Hungary, together with countries like Bulgaria, Romania, Latvia, and Lithuania, is at the very bottom, whether as measured by mortality rate, life expectancy, or number of healthy years. There are incredible regional differences. For example, in Central Hungary, which includes Budapest, men live 6.6 years and women 8.4 years longer than their fellow citizens in Northern Hungary. The correlation between educational attainment and health is a well-known fact, which has a large literature. A man with a grade 8 education will die 12 years earlier than a man with a college degree. In the case of women, the difference is 5.6 years.

But what made the greatest impression on those who read about the study in the media was the notion of “avoidable deaths” which, according to the study, in 2014 was 26% or 32,000 deaths. Fourteen percent of these “avoidable deaths” could have been prevented by timely and appropriate care while 12% of them could have been prevented by better public health practices. Half of those who died before the age of 65 could have been saved if people were more health conscious. With these statistics Hungary ranks 26th of the 28 member states.

In addition to this massive study, Political Capital together with the Friedrich-Ebert-Stiftung organized a conference, “Can healthcare be cured?” Attila Juhász of Political Capital published a short, 30-page study with the same title which he summarized at the conference. Zsófia Kollányi, assistant professor of health policy and economy, mostly talked about Hungarians’ ever worsening health and societal conditions. She gave a few intriguing examples of the depth of the problem. For example, Swedish men live 9 years longer than Hungarian men, but the “real drama” is that if we compare college-educated Swedish and Hungarian men the difference is only five years. On the other hand, if we compare Swedish and Hungarian men with elementary educations the difference is 12 years. So, a greater emphasis on education would also most likely improve Hungary’s health statistics. However, the Orbán regime’s educational policy is moving in exactly the opposite direction.

After Fidesz won the election in 2010, one of the first moves of the Orbán government was to abolish a recently established independent organization that dealt with patients’ complaints. I’m sure that this was at the request of the medical profession, which in those days at least was a strong supporter of Fidesz. This independent watchdog organization was not exactly the favorite of physicians. Márton Asbóth, the lawyer in charge of health issues at TASZ, told the audience that every year 3,000 people turn to the Hungarian Civil Liberties Union with their complaints. So, there would be a great need for the resurrection of such an organization.

Finally, as György Leitner of the Primus Magán Egészségügyi Szolgáltatók Egyesülete (Association of Prime Private Healthcare Providers) said, “Hungarian doctors must be taught to greet people and shake hands.” Andrea Mezei of the Emberibb Egészségügyért Közhasznú Alapítvány (Foundation for More Humane Healthcare) also complained about the attitude of Hungarian doctors toward their patients. According to her experiences, “a cashier at the checkout counter is able to greet the shoppers, but in the doctor-patient relation this is often not true.” Healthcare facilities are like “islands” out of touch with Hungarian society at large. Her foundation tries “to bring normalcy into hospitals” by organizing training for doctors and nurses. They are not welcome in every hospital, and in fact in one hospital the nurses petitioned the hospital administration to prevent them from organizing such training. Leitner, representing the private healthcare providers, seconded Mezei’s observations by saying that not only is money missing from healthcare but also the positive attitude that adds to the satisfaction of the patients.

Which takes us back to the Ferenc Jahn Hospital’s attitude toward the woman with the epileptic seizure and the doctor who compared a hospital to a BMW plant.

June 16, 2017
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vomart huli
Guest

Antisemitism is the gravest problem

gdfxx
Guest

Far from me to defend the situation of the Hungarian healthcare. However, my experience with the American one in cases similar to the one described at the beginning of this article is not very different. Large hospitals do not lock the gates or doors of the various entrances at night. However, only at the emergency room do they have personnel available to deal with emergencies. One can walk into those places (ERs) or be taken by an ambulance. And in many cases, the entrance to the ER is a very large distance from most of the other entrances.

aida
Guest

When I arrived in SF in April I had to visit a local hospital for pain relief. I was examined and given anti biotics and pain killers. The nurse who brought them to me asked me if I wanted ice in the water to help me swallow them. I chose no ice, but even so the bill together with the prescription came to $1150. I am still waiting for the travel insurance to settle the claim.

Guest

Since I used to travel regularly to the US (first alone, then with my wife – once a year) I’ve been on a German forum for US travelers and they tell similar horror stories about ER costs, but also how to avoid them by going to a doc whose office is open on a weekeend etc …
And of course having a comprehensive travel insurance has top priority – though I’m lucky to say that in 50 years over hundreds of holidays all over the world I never had a real problem that forced me (or a family member …) to go to a hospital …

As an EU citizen I’m insured over most of Europe – that’s another point that some people seem to forget …

aida
Guest

It is a very important benefit the EU gives us. The English forget this but they will pay the price. Soon, I hope

az angol beteg
Guest

thank you very much

Member

Yes, but Hungary is a Christian nation and its doctors serve a Christian government. They all know the message of Matthew 25: 41-43:

“Then [God] will also say to those on His left, ‘Depart from Me, accursed ones, into the eternal fire which has been prepared for the devil and his angels; for I was hungry, and you gave Me nothing to eat; I was thirsty, and you gave Me nothing to drink; I was a stranger, and you did not invite Me in; naked, and you did not clothe Me; sick, and in prison, and you did not visit Me.’”

wrfree
Guest
‘In nothing does man nearly approach the gods than in giving health to man’…Cicero Centuries on observers of the progression of medicine can indulge in viewing the irony of medical care in a modern Pannonia. For Cicero would see another truth of his statement where a lackadaisical and inattentive partnership towards healing can get the many to ‘approach’ the gods but also a bit earlier than he probably conceived of where here ‘no one gets out alive’. Which brings up another consideration. The lack of vigor and attention in health care issues must have a psychological component. It’s almost as if it is suggested unconsciously no doubt to get out of ‘here’ as quick as one can. It doesn’t appear that the current health care setup enhances the quality of lives but simply exists to treat each and every illness as an isolated medical ‘incident’ through a physical process. It is not looked upon as part of a ‘whole’ in the Magyar experience of life. As for human basics, forints flow to shelter and to etterems and supermarkets to indulge the need to eat. And the forints to healthcare? Nothing like the old ‘tip’ to the fellows in white to… Read more »
Guest
My experience with the Hungarian healthcare was always positive – probably because doctors here in Hévíz make (most of …) their money with the tourists and there is a selection process at work … And my wife knows which people to trust – not only in the medical profession. On the other aspects of life expectancy: Many (or most ?) Hungarians indeed lead a very unhealthy life, the consumption of calories, in fact very fatty and sweet products and alcohol and cigarettes is unbelievable! Which is really crazy because Hungarian agriculture produces lots of fantastic fruits and vegetables – at good prices. Right now we are having a daily feast with the products from our garden – and much of what we don’t grow ourselves we get from our neighbours – like the first new potatoes which my wife just cooks instead of frying them with a lot of fat … This surely is an aspect of education – but also tradition here in Hungary. So the numbers speak for themselves – but maybe the government doesn’t want them to change? Of course it’s better for the pension system if people work as long as possible and after retirement die… Read more »
Member

I posted this on my Facebook feed earlier this week: While I was cycling home on Monday afternoon, I came across a man lying unconscious in the bushes in an industrial zone in southern Pest. I stopped to see if he was OK, but could not rouse him.

It was very strange. The man’s jeans were pulled down around his knees, his wallet was lying by his side, and his credit cards were strewn around on the ground. There was no sign of alcohol consumption.

I called the emergency services. The dispatcher was polite, the ambulance arrived promptly and the medical technicians immediately began helping the man. I rode away impressed, especially since my previous experiences with the Hungarian health-care system were far from satisfactory.

Later, I told a 63-year-old woman about the incident. She got angry and demanded to know how I could be so inconsiderate.

“What are you talking about?” I asked, perplexed.

“You left him there with his wallet on the ground,” she said. “You should have known the ambulance workers were going to steal his money! Now he’s never going to get it back!”

Bastiat2
Guest

The health care in Hungary needs huge reforms and saying hello to patients by doctors is the least of them.
First, building real hospitals of the XXIth century rather than football stadiums for 30000 seating capacity in a town of 15000 people.
Without modern facilities and decent salaries for doctors all the good ones flee this dismal state of affairs for Germany, where they are welcome with open arms, given modern equipment to work with and good compensation. Those who stay in Hungary, as usual, are not the best ones, with some exceptions since I was well treated once by a eye surgeon for free…

wrfree
Guest

Re: the good ones flee this dismal state of affairs for Germany’

And I knew a Magyar one who came here to the US. Was my template for the conduct of doctors throughout my life. I now wished I could know his biography. I would have liked to know about his life , where he got his medical degree and what drove him to emigrate to practice in the US.

He today would be considered a ‘primary care’ md in the function of a gatekeeper for other services in healthcare.
He was a good one. That guy stitched me up numerous times. And I don’t have ‘scars’…;-)…

Istvan
Guest
As Eva has discussed before in several essays problem number one for Hungarian heath care are low wages. Since the US health care system has been brought up in posts it’s important to note in the USA we have the complex problem of private health care and insurance providers dominating health care which now is the battle ground for repeal of President Obama’s health care program that attempted to create an entitlement to health care for the poor and working poor here. Real doctors, and certified nurses along with other licensed medical providers here get paid well, lower medical workers with lower educational requirements not so well. I am personally covered by the Tricare system under the Defense Health Agency (DHA) combined with Medicare the national system for older adults in the USA, I pay very little for health care as a perk for my military service. Most Americans are not so lucky, on the other hand I am lucky to be alive after having been in the military for over 20 years including reserve duty. But the big problem for the Hungarian health care system are wages and the flight of health care workers from Hungary. The problem also… Read more »
dos929
Guest
Being ‘lucky’ experiencing healthcare in different countries I must say that Hungary is at the very bottom of my list, and getting lower by the day. Of course it is not all the fault of the current regime, but since they got into power some 7 years ago it is downhill all the way. The general state of repair inside and outside, the standard of care and services are with a few exceptions are at par with the so-called 3rd world countries. In more affluent countries people wouldn’t trust even their pets into such ‘care’. But more to the point is the fact that was referred to in the article is the correlation between the level of education and the state of the general heath of the population at large. And as a follow up, we can only extrapolate the affects of the current regime reducing the age limit for the compulsory education from 18 years to 16. It seems that the Orban regime wants to kill off the elderly and the sick people who are a ‘burden’ on the new society that they are working towards. In the meantime approx. a thousand doctors leave the country each year, and… Read more »
Drew
Guest

My five years of experience living and working in Budapest has shown me that this is a cultural characteristic. More specifically, a lack of empathy. I work in education and I’ve seen many other examples that demonstrate this lack of empathy, though perhaps not as shocking as the subject of the blog.

gdfxx
Guest

Eva, could you please ban this person from here?

wrfree
Guest

???????????????

aida
Guest

Please do not waste your valuable time on these scum. We all know what they are worth.

wrfree
Guest

I am sorry Prof has to deal with those plus the personal attacks which are out of line.
State of political ‘dialogue’ today ….everywhere.

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