A Letter from the Front

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A medical doctor has written to me about the isolation of those who do his job, trying to save human lives every day.

Dear Beppe,
I read your post about avoidable deaths. Consider the numbers given by official sources. It would be useful to have an interpretation rather than sensationalism. In Italy passing the hot potato is one of the most popular of sports and we get caught in the middle between the people who want to survive beyond infinity and the insurance companies who turn things round against the doctors so that they don’t have to pay.
Here’s a simple example: a person dies. Their relatives bring a legal action. The hospital has an insurance company that makes an agreement with the relatives with a relatively low sum of money that is usually accepted straight away. They grab 15-20 thousand and they are off.
The problem is that, from the point of view of the criminal law, the doctor is left on his own because the legal action does not stop just because the insurance company has paid out. In Italy the criminal proceedings have to continue. And his situation gets worse as the hospital drops him to avoid the costs. This is done in collaboration with the insurance company who otherwise would not have agreed to see to the contract. Result: the doctor is in the sh..t. The insurance company has saved because it risked nothing and so on.
Those people who love their family members in an absolutely disinterested way are a tiny handful. And unfortunately it really is like that. Often even if everything went according to correct procedures, legal actions are often taken on no basis, with the hope of making a bit of money.
In the USA, a really serious situation is arising. Many critical care doctors are turning to easier specializations or they are directly changing their jobs because the insurance companies don’t want to know anything more about them.
I don’t remember in how many States in the USA where there are only a handful of people left who are prepared to operate on urgent cases. For too many risks.
There is a defensive behaviour that is ever more common. Rather than stay standing all night and perhaps even the following morning, not just working for 16 hours at a time, and taking really difficult decisions and having blood coming at you, or vomit, or shouts. Having to listen to mad people and looking for beds in the hospital when there are always fewer available. Do I then have to pass the rest of my time with lawyers and judges?
There’s too much ignorance and too much bad faith. Then someone starts to judge me while I am trying to avoid the collapse of the blood pressure and having sorted that, an arrhythmia starts and I inject amiodarone in the vein just in time… but it produces an allergic reaction in the patient who changes from being arrhythmic and becomes one in anaphylactic shock. They become red and blue. Their bronchi start to whistle and the air no longer gets through. So I try to sort out any other disasters and while you are doing this the telephone rings a hundred times because there are other episodes here and there.
You try to do what is possible and you are full of coffee and your stomach is burning but you have to be able to concentrate. OK. There you are. Then the next morning you finally get to the bar and you read in the newspaper: “another case of bad medical practice” as though it was a camorra mafia homicide, as though we were a homogeneous band of criminals. As though there were no facts to be analysed studied and understood and a decision taken. Is there fault or not??
If in Italy you have to increase the meritocracy and reduce nepotism, I can assure you that I know an infinity of colleagues who are putting in all their efforts and yet they feel ever more constrained in this mesh of annoying people who are ignorant and money-grabbing, evil lawyers and oncology barons who are willing to teach everyone using data that needs checking.
If a medical doctor has to be a little bit of a manager, a little bit a psychologist, and also a bit like a brother, why on earth do people not try to be a little bit of a doctor? Perhaps after closing their scruffy little office or between a marketing meeting and the next, they have a great ride on the motorway where there is a German lorry driver who’s really drunk and he has just transformed a small Fiat Punto car into a little dot with a young couple all mixed up inside, one of whom is dead and the other almost dead and the fire officers on the radio say “5 minutes and we’re there” and you are there cutting yourself on the car body while you try to find the vein in what you hope is the correct arm.
After perhaps 2 months with hepatitis C that you’ve got from the woman who was drug-dependent and a great trial looming because the ex husband has decided to take action as a precaution. I’m sure that people would have a few more reasons to understand how things are.
And then there’s VAP (Ventilator-associated pneumonia). I assure you that it is a much more complicated problem. For example, did you know that 40% of all those in the intensive care unit for any reason, within the first 24 hours develop reduced immune defences that are more serious than definite AIDS? It’s not just a matter of lifting up the back-rest. We even put people on their fronts (using a mattress that costs about 18,000 Euro) And we get doses of radiation to do chest X rays with the portable equipment so as not to leave them on their own.
The truth is that someone who is good at getting in the way could happily keep us in a sticky situation for months. Believe me. We are always in the wrong. And if there are certain news items on the TV News or on the Radio News, trust me, there’s a lot of approximation and a lot of demagogy probably because it is easier to lay the blame on those who do the work rather than face up to problems that are structural and cultural.
Good Heavens! This week I have done 74 hours work and I’m paid for 38. Then. Shit. I find on your website even another reason to feel stressed. It makes me want to change my job and this doesn’t normally happen to those who enjoy what they are doing every day. “
Marco

Posted by Beppe Grillo at 12:37 AM in | Comments (12) | Comments in Italian (translated) Post a comment | Sign up | Send to a friend | | GrilloNews | listen_it_it.gifListen | TrackBack (0) |
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Comments

Ragazzi... ci siamo di nuovo: in America stanno ritirando milioni di confezioni di Paracetamolo (Tachipirina, Efferalgan) contaminate da microparticelle di ferro. (vedi google news US)... Se si leggono un po' di notizie si vede che stanno ritirando anche quelle prodotte 3 anni fa!!!!!!!

Qui in italia non ne parla ancora nessuno.... che sia un caso?
Michele.

Posted by: Michele M. | November 11, 2006 07:04 PM


We are talking about doctors and lawsuits,aren't we??

Or is it the subject on nurses and
their rounds??? :o))

Posted by: paola filinesi | November 8, 2006 04:42 PM


Birotella: you forgot to go fly your kite today!!!!

Posted by: Enrico Rossi | November 8, 2006 12:20 PM


"The doctors are good to me here in Italy. They give me all those pills that keep me sedated. I only wake up to write something here, on this wonderful blog.
Sorry, have to go now. The nurse is coming!"
Oh dear, I appear to have spawned a clone - The Alex R who wrote the above is not the same Alex R who posted the first comment to Mr Grillo's post about the doctor's letter......
Interesting tactics from someone - wonder why? Do I have a twin I do not know about?? Sorry about going off topic - but personality theft is a bit worrying.... Oh, here comes the nurse again...

Posted by: Alex R | November 8, 2006 10:58 AM


"The doctors are good to me here in Italy. They give me all those pills that keep me sedated. I only wake up to write something here, on this wonderful blog.
Sorry, have to go now. The nurse is coming!"
Oh dear, I appear to have spawned a clone - The Alex R who wrote the above is not the same Alex R who posted the first comment to Mr Grillo's post about the doctor's letter......
Interesting tactics from someone - wonder why? Do I have a twin I do not know about?? Sorry about going off topic - but personality theft is a bit worrying....

Posted by: Alex R | November 8, 2006 09:47 AM


Alex R. can you please send some of your pills to This Block ,it seems very angry, it need to calm down...........regarding doctor's the area were I live we did not had a doctor for nearly 3 years, last one left, and now works in a medical center ( I call them globalized cattles clinic,another thing imported from our ally),where heard of patients wait to see the fist doctor available,in this clinic, they do not take any bookings, if I like to see my old doctor, he take me 1/2 hour by car to get, thereof I am lucky, 3 hour waiting another, 1/2 hour to come back home,I told him it is easyer to see the Pope,then him, kind of think he sold out to the enemy,globalize medicine,if I like to have all my records,I have to pay $50 to the clinic, thankfully now we do have two doctor, one of is an Indian ,and they are both wonderful doctors and we are very very lucky to have them here,ciao

Posted by: evakulnura | November 8, 2006 01:00 AM


The doctors are good to me here in Italy. They give me all those pills that keep me sedated. I only wake up to write something here, on this wonderful blog.

Sorry, have to go now. The nurse is coming!

Posted by: Alex R | November 7, 2006 06:40 PM


Vanni: you have not mentioned Hollywood's demented movies, Coke and Pepsi, humongous motor vehicles and many other byproducts of a ruthless capitalist Country.

Posted by: Enrico Rossi | November 7, 2006 06:36 PM


The compensation culture that's ruining every
aspects of our daily life is yet another import
from our " friends and allied " the yanks.
It just adds to the list of other imports:
RE: warmongery, pollution on an epic scale and
obesity(ready meals, fast food). I wonder what
will be next!

Posted by: vanni zanella | November 7, 2006 06:04 PM


Doctors are not the only professionals to be persecuted by greasy fingered lawyers. In the engineering field very often we avoid superior and more creative solutions just to avoid the potential of a lawsuit. Frivolous cases abound in North America where lawyers solicit work from potential clients by promising to pursue a possible legal case without charge and billing them only when the lawsuit is successful.

Posted by: Enrico Rossi | November 7, 2006 04:54 PM


Doctors are usually attacked for various reasons...
Their profession deals with human life, this automatically makes them very vulnerable to critisism.One day they are heroes and the next they could be reduced to scum....
Unfortunately this is the price they pay for saving human lives...
Very unfair and unjust but as it always the case, no one can improve the situation unless they fight for themselves....
They fight for their own rights, make known to the public the problem they face while practicing medicin,make known the reasons that caused failure in each major case and try to go public as often as they can.
I know that probably this is contrary to many doctors’ ethics and characters but in my opinion this is the only way to deal with slander.

As Ales R. said
"The media are great at getting us to take everything out of context, alas."
Why don't use it to their advantage???

Posted by: paola filinesi | November 7, 2006 03:33 PM


Interesting that this doctor mentions nepotism - one wonders how many doctors get qualified only because they know someone who knows someone else. At least in other environments nepotism does not generally lead to loss of life.

And as Nick said - doctors are only human and put have to put up with a level of stress that normal humans rarely face.

I do have some direct experience of the health system here and apart from antibiotic mania, I've generally been impressed with the quality of both medical and nursing staff.

While 90 deaths a day seems alarming, maybe we need to know the full picture before attacking the doctors. For example: What is the doctor to patient ratio? How well organised are the medical facilities? Is there a shortage of trained doctors? And if so, why?

The media are great at getting us to take everything out of context, alas. At times this approach can do more harm than good - but at least the problem is getting some attention. Let's hope the attention leads to action.

Posted by: Alex R | November 7, 2006 10:58 AM


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