Tag Archives: health statistics

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