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18.10.2006 | Aleksandr Bogdanov

“On a doctor’s liability, and not only..”

   

“Each person answers for his or her actions before God and man”

“For unto whomsoever much is given, of him shall be much required”

Why am I citing these common truths, let alone in relation to medical practice? The fact is that over the last years our country has been swept by a wave of prohibiting or restricting laws, rules, instructions, various acts and norms often running counter not just to commonsense, but also to current legislation. The examples are legion.

A first example: a great deal has been said and written about the existing and constantly toughening restrictions on prescribing strong medicines with sedative effects, as a result of which, in the absence of vitally needed medicine, each day thousands of by no means drug addicts, but really ill people actually  suffer (and sometimes die). To get a special prescription requires such a huge number of formalities that doctors quite often confine themselves to giving substances of little effect, such as bromide with valerian.

Second example: the Law on psychiatric care aimed supposedly at better observing human rights is so complicating, contradictory and imperfect that it makes timely hospitalization of even socially dangerous people with psychological disorders extremely difficult to achieve. In much the mythical protection of the rights and freedoms of the psychologically ill fails to take into account the right of relatives, neighbours and simply those around to a peaceful or, at least, safe life.

Third example: Issuing a patient or his / her relatives with many medical certificates is often complicated by the requirement for not only the signature and personal stamp of the doctor treating the person, but also the signatures of the person in charge of the unit and the head doctor. Sometimes also the relevant formal request is also demanded.

Why is this necessary? If the doctor has the relevant qualifications and personal stamp confirming his/her absolute and inalienable right to work as a doctor, then why not give the absolute right to personally answer “for his/her actions” – writing out prescriptions for all medicines required by a specific patient, issuing all documents confirming the corresponding facts (the illness, inability to work, the indicatory factors to suggest sanatorium treatment, transfer to a lighter work regime and so on and so forth).  Who needs these additional signatures and consent, generally formalities? After all everyone knows perfectly well that the top management in the vast majority of cases simply “stamps with their signature the signature of their staff, for quite objective reasons not especially delving into the actual cases. Yet in the event of any conflict (over, say, a dodgy certificate) they share responsibility with their subordinate, in the role of the “guardian” of an unthinking diploma-holding child.

Why are psychiatrists with the appropriate training and certificate of specialization unable to singly decide on urgent hospitalization of specific patients? After all a driver at the wheel of a vehicle takes full personal responsibility for all consequences of his or her actions, not laying this, say, on the company’s boss.  Why is it impossible to trust a doctor with considerably more professional training to answer for his or her own actions?  You, controlling bodies, thoroughly check the justification for what has been done and in cases of abuse of their position be severe in asking, punishing, holding to answer those responsible! But don’t refuse to trust doctors without any justification, given them the chance to fully treat their patients rather than occupying themselves with filling in masses of papers and running to the management for signatures and stamps.

In the event of real practical need virtually any doctor will not spurn the opportunity to consult with more experienced and qualified colleagues and in complicated situations will try to share the burden of responsibility with senior staff and management.

And this is all for the good of those ill and suffering and not for the sake of senseless circulars written by militant bureaucrats.

 

“PL” commentary

I imagine that anyone even remotely familiar with the contemporary situation with medicine here do not require proof that the present state of affairs is a threat to the national security of Ukraine. However for some reason the authorities, unlike the public, show no concern. Sociological surveys carried out by the civic organization “Maidan” Alliance showed that almost all those living in Ukraine regardless of the region – in Donetsk or Lviv – are equally disturbed by the healthcare situation and this is natural. One could draw people together in this one thing, in something natural and immediate to each Ukrainian.

Yet our authorities have not been bothered for the last 15 years. They stubbornly carried out a policy of “happiness is not in life” – but not for citizens. Like in the Soviet days there was sausage “for the population” and “for people”.

Perhaps it is the Soviet remnants which get in the way of reform in general and that of medicine in particular?

Instead of this, and worse so than in Soviet times, we see the lack of liability of doctors increasing, the mortality rate rising and the spread of tuberculosis and other dangerous infectious illnesses. There is an ever narrowing range of medical services available free of charge, even where vitally needed..

If it is plain to everybody that a patient died as the result of a doctor’s mistake or simple through carelessness, then somebody is reprimanded, and as a rule not at all the person responsible.

Even administrative, let alone criminal, responsibility for those who should answer is the exception.

The medical field, unreformed and almost in ruins, is not able to provide effective medical care to its citizens who have reached a stage in correlation between the birth and death rates which is of danger to the state.

All ministers of health over the last 15 years, coming to power, have at first talked of the need for reform, however very quickly begun doing everything so that such reforms did not take place.

In the Verkhovna Rada from back in during the last session there are laws lying about on compulsory medical insurance, however our politicians, as always, have no time for such laws since they don’t get treatment in ordinary hospitals, or even in Ukraine. And the life and health of their citizens is of no concern to them whatsoever. Foolishly not since, for example, tuberculosis or hepatitis can affect a person regardless of their social situation and deputy identity card.

However what is strange is that our politicians are able to fill the heads of their citizens with problems of NATO or whether governors from the “wrong camp” should be in power, and to not think about more important problems of health which concern each individual, each family, which will have repercussions for many years to come.

And so we live like in Central Africa and our medical functionaries find that absolutely fine. And according to their usual ritual they make noises about “the people” and “reforms”.

And the price is the impoverishment of the nation, high mortality rate and the reduction in the country’s population.

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