So, old news: our healthcare system is dying. Long ago, it was diagnosed with a severe case of my country’s mentality. Symptoms: incompetence, greed, commercialism, ignorance, carelessness, mishandling, negligence – all stemming from a much more internal characteristic like selfish nature of the entire spectrum of people in the chain. To put it simply, the suits are debating away to kill time while their terms are running and obscenely high salaries pour in, leisure and pleasure abound and nothing ever happens, because they just don’t care. And for the people, it’s like Waiting for Godot, where Godot’s reason to never show up is that he felt like the guys are a bit of a drag, so he took an expensive trip to Tokyo to dine in his favorite sushi restaurant.
The guys decide to hang themselves, right. Well, so did our family doctors. It always boils over sooner or later and if no-one listened before, they sure listen now. In my home town (along with many others) 23 family doctors out of 34 quit their jobs, leaving some 40 thousand people without a doctor. But let’s rewind a bit. The story goes: A family doctor in my country has about 2000 patients. That’s next to impossible to handle. They work fast, have less than seven minutes a patient, are overworked and prone to mistakes. The government decided they should take in another 300 patients, and the doctors flipped.
This comes at the end of a long line of disfunctionalities in our healthcare system, ungodly long waiting periods leading the way. For example, you developed a heart condition and if you happen to rambo yourself through all the fronts of your doctor’s passiveness and capitalism-induced evasion, a heart MRA on a regular referral will leave you waiting (to die in between) for a nation-wide average of four months, and if you happen to be referred to (or it is your only option) our nation’s biggest, most successful, most top of tops whatever superlative they tend to use clinic in the capital (I call it a barn), you’ll wait for a whole year. Or less, depending on when you drop dead. If you happen to be blue in the face and the doctor reluctantly decides to give you an “urgent” referral, you’ll still be suffering a heart attack for a month. Good luck with that.
Check this out! Cardiac calcification CAT scan. If you want to die of a heart attack immediately, take a look at where in this country the waiting periods for this thing are the longest and where they have the shortest. In both cases it’s the old faithful Barn and in BOTH CASES – yes, you read that right, the shortest and the longest period – is 306 days!!!
Luckily for them, it’s just around three to six people currently (March 1, 2019) that they might kill by waiting. Collateral.
The Barn’s waiting periods are so long that during research for this blog I discovered that when you click on the link that should take you to a page where their waiting periods are listed, you get the epitome of our public services: The website does not exist or was removed. You will be redirected.
But to draw this apocalyptic landscape out for you further, let’s take an orthopedic checkup for example. There are 13.483 patients waiting for an appointment, 7.155 of which are waiting over the acceptable waiting period! Take into account that this country’s population is two million. Or let’s take something more relatable. Let’s say your kid (for the purposes of brevity, say you have a son) keeps running into doors and can’t see shit in class. It’s urgent, but he’ll be bashing his teeth in for another 46 days before his checkup on an “urgent” referral. 114 days on a regular one. And if you decided to take the kid to our “best care provider”, The Barn, you might bring in an adult, because your appointment is due in two years.
Worse yet, imagine your child needs an adenoid and eardrum surgery. Sure! If it’s “urgent”, just keep his screaming to a minimum for 58 days. If he needs it quick it’s 143 days, so if (or when) it gets much worse in between, well, hang in there, sport! And if the doctor decides a regular referral is fine, because, you know, they get fined for issuing other referrals if they are not 100% justified, well it’s 230 days of whining and watching your kid suffer. Great. Just shoot me in the knee. No, wait, not the “emergency room”. That takes at least 12 hours to get seen by a doctor!
Now let’s hop back to family doctors, the overworked martyrs of local health centers. Some of them really work like slaves. Probably. But let’s see the loudest one in this mass resignation extortion case. (“see” – that’s funny, considering how much it takes) Self-sacrificed to the cameras, my own doctor is crying wolf about the strain of having so many patients. A young one that’s been in our local health center for just over a year. He also devotes his time to alternative medicine, healing with plants and herbal potions etc., lecturing and educating and running workshops in the field (literally?). His Monday shift starts at 14 (numerological?) minutes past the hour (seriously, it’s written on the board), and that’s about the number of calls it takes to get through to his nurse in order to sign up for an appointment - that you’ll land in about a week. Well, that’s not entirely true. Often, no-one would pick up and you’d have to physically go there to sign up. Well, that’s not entirely true either. Often you’d do that and he’s not in.
See, our doctors’ shifts change from morning to afternoon with each day. So if he works the afternoon shift today, tomorrow he’ll be there in the morning. Wrong! Not this special case. See, this one decided instead of the morning shift, he’ll have the afternoon shift every first, third and fourth Wednesday of the month. Groovy.
Now he is all over the news spearheading the wave of resignations. I checked how many patients he has, those records are public. Much less than the average family doctor in our local health center. But let’s go back a year to better illustrate his job.
A year ago, I had some digestive problems and weird pain in my right side that wouldn’t go away, so I went to see him. He said it’s “probably nothing”, but ordered bloodwork, stools and an abdominal ultrasound. Blood was fine (based on a handful of general parameters that they check without being forced to), stools (a good week later) were fine, ultrasound was due in half a year. He told me to wait, it’s probably this and that and could be that and all those reasons were the most banal he could think of. I did wait and it didn’t get any better. A weird pain in the middle of my chest emerged. People asked me if he checked for bacteria, since it was all about digestion. It turns out they check the very basics or less, but of course they wouldn’t tell you that, otherwise you might demand that they do their fucking job. So I navigated and waited through numerous days when he wasn’t working and was being replaced by some other doctor, and went back. See, that’s his specialty. Almost whenever you need him, he’s not there. What a shocker. But I did get him this time and I told him it wasn’t getting better. He downplayed it again. So I assumed his difficult role and asked him myself to check for bacteria and do pancreatic tests again (a tip from a doctor friend). And then this happens: He pulls out an entire sheet of paper while telling me they don’t do tests on blood but on stools.
Great, that takes at least a damn week.
That paper was edge to edge scattered with names of bacteria and brackets to check.
“Which one?” he asks.
WHAT THE FUCK?! Who’s the doctor here?!
Son of a bitch! First you wouldn’t do your fucking job and when I tell you to do something that’s clearly the first thing you should do in cases like these, you backfire like that? Damn, you’re really confident in your negligence, are you!
Well, I’m not a doctor, but I’m obviously an idiot, because I told him to check for H. Pylori (I knew that) when I could’ve just said all of them. So he sent me away to test my shit, assuming (but not really making sure) it’s something to do with GERD. I probably look really damn smart, because he didn’t tell me jack shit about GERD, what to eat, how to eat, exercise etc. Antacids? None. A rerun followed. I called in the other day and I didn’t even get to talk to him – the nurse interpreted the blood test, saying it’s “OK” and that I have low cholesterol. Meanwhile, new symptoms emerged, and I told him about them when I came in with the stool test results. He ignored the new symptoms, you know, they’re just complicating a simple act of getting off easy. They truly weren’t severe, but were a tell-tale sign. Instead, he told me what I already knew (I can read): there’s no bacteria, so we’re all good, and if it gets worse come back. That was it. He still didn’t know what it was, wouldn’t do additional tests, so he just sent me on my way to wait it out. Of course it got worse, so I went back. Surprise surprise he wasn’t there and the substitute doctor actually put some thought into it. She ordered allergy tests and lactose tolerance test. Turns out I’m lactose intolerant, but – weird – without much symptoms. That was the answer they needed to get off the hook, but it didn’t quite fit with the new symptoms that clearly had something to do with either stomach or esophagus, not lactose alone. I went to see the white martyr when I had the results and heard a lot of guessing and assumptions about the other symptoms, but no new ideas. Another couple of months pass. Some symptoms go away, others worsen. Whatever was partying in there was moving upwards, up the esophagus. So I went back to pester him some more. Downplaying it, he concluded it was acid reflux and gave me antacids for a month, and again I was supposed to go back if it didn’t get better. And of course it didn’t.
Stop guessing, you idiot!
Over the next couple of months, it got much worse, so I went back and again, he wasn’t there. It was the other doctor that was filling in. She finally considered all the symptoms, the belching and chest pain, and decided it may not be just swallowed air. She ordered an upper endoscopy. It was due seven months later.
Oh boy, oh boy, oh boy, so fast! You’re all angels!
She also told me what other measures to take, and they were successful in stopping the most serious stomach symptoms.
Seven months pass – now it was just under a year since it all began – and I go in for the endoscopy. It was endoscopic version of an elevator pitch. Come to think of it, so is every doctor’s appointment in this godforsaken country. They rush me in, don’t even have time to listen why I’m there. They ask because they have to, but five words later, I am rushed onto a table. Cut mid-sentence. “On the table, come on, come on.” – that’s a quote!
I realized later that they examined three patients in half an hour. All under sedation. You can imagine how thorough they are, if they work that fast. And that was clear when the results came in. There were signs of gastritis so something was going on in the stomach at some point in the past when my doctor was telling me ‘oh, that’s normal’. And something was off in the duodenum, but of course when you work that fast, you happen to take too little tissue for biopsy, so the lab could not conclude whether it was atrophy or not. Bottom line, it was again a guess more than it was a conclusion. All hail our doctors, the great hacks!
In my final visit to my poor overworked doctor, he simply told me what I already knew, read the results to me as if I’m suffering from illiteracy, and send me on my way. By then, I had enough of his passive attitude and constant absence. I got a chance to change my doctor (our healthcare’s equivalent of being nominated for the Nobel prize), but found out I had to be with this guy for longer than a year first. Honestly, you could’ve fooled me, I thought that shit went on for at least 14 (!!!) months. So I waited and a couple of days ago, I went there during his shift to sign off.
Twenty minutes into his shift (that’s 14 plus 20 ;) ) when nobody went in and nobody came out, the nurse comes rushing out the door, talking on the phone: “But we didn’t know that. Who is substituting?” That wasn’t difficult to decode.
She goes back in and five minutes later comes out again, apologizes and disappears into another office. Ten minutes later she comes back and announces that the doctor is absent and will be absent for three days. Ok, so what else is new? She also tells everybody that there is no fill-in (ah, there it is), but there will be one for the next two days. A man waiting tells her he needed a referral for tomorrow’s checkup. She tells him to come back tomorrow. (Logic doesn’t live here anymore). She also learns that following the pattern of shifts the Wednesday substitution is arranged for the afternoon, not for the morning. I hear her talk on the phone: “Why can’t he have normal shifts like everybody else?!” But he’s not like everybody else, is he? Overworked and stressed out. Everybody descends on her and she begins her crisis management, doing what she can to fix the mess my doctor put her into. And maybe some other nurse might have done it faster, but we happened to run into one that typed with her index finger alone, taking painfully long to hit the right key. A decade later when it’s finally my turn to say I’m out, her face lights up. She’d do the same if she could. So after an hour of waiting and witnessing the regular chaos of our public healthcare, I knocked on the door of my new doctor’s office, signed in and was out in two minutes.
As for the white martyr, well, he can pursue a career in television, now that he quit his job.