A medical doctor has written to me about the isolation of those who do his job, trying to save human lives every day.
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. “
Posted by Beppe Grillo at 12:37 AM in Health/Medicine
(12) | Comments in Italian (translated)
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