The Legal Responsibilities

The hospital system is the mash up of many different specialties, all with the common goal of patient centred care; people are sick, so they come to hospital to get better.

With these different specialties, comes different responsibilities, and if you overstep your boundaries and encroach onto a different specialty, there are legal liabilities. Hence, a physiotherapists providing medical advice about orthopaedic problems becomes a legal issue.

I understand why there are such legal liabilities, and in fact, I think these boundaries are necessary to protect patients. But having been in the hospital system, I think it can get pretty ridiculous at times. For instance, at the previous hospital I worked at, an ultrasonographer could mark out the level of pleural effusion, but would not mark the spot for fear of legal liabilities should any issues arise if it was drained. Hence the doctor (usually a resident) would need to come and mark the site that the ultrasonagrapher had indicated. So as a result, any issues with a drain insertion would be blamed on the resident, even though it was the ultrasonographer who technically marked out the site.

In a way, I feel that some of these legal responsibilities leads to a decay in upholding good moral standards. The other day I was asked by the nurse to come and console an anxious patient who had her belonging stolen by an outsider. It was a strange request, because what was I supposed to do as a doctor? I felt that a social worker would have been more appropriate. So I arrived and sat at the patient’s bedside, and started listening.

“Ms X, I’m sorry to hear about what happened to you. How are you feeling?”

“I feel terrible. This everything has gone missing including my phone and all my credit cards. I have at least 12 credit cards in my wallet!”

“Ok. Have you started trying to cancel your credit cards yet?”

“I have Westpac here in Australia, and all the others are in England. But I wouldn’t know how to cancel the cards.”

“Ok, maybe I can try and call the Westpac number and we can try and cancel the card.”

I went back to the doctors desk, and asked one of the nurses if social work was doing anything about cancelling the credit cards. Apparently, social work thought it was not their job to cancel credit cards, and declined to help (it was a Sunday anyway).

Anyway, the dect phone I was holding was too unreliable and kept cutting out, so I ended up asking the patient to come to the doctors desk to use the landline. Partway through, one of the surgical doctors asked me to come into a side office. When I got in, she stated firmly “You need to stop what you are doing. It’s not your role to cancel credit cards, and there are legal boundaries in helping her to do so.”

I had a think about this, and could definitely see where she was coming from. It looks sketchy to say the least when a doctor is helping a patient to cancel her credit cards. Almost like I could somehow financially benefit from the situation. I know I couldn’t do much for the patient aside from listening, so I thought the least I could do was to help her cancel her credit card to prevent someone from stealing her money.

In the end, her daughter arrived, and I quietly left the patient in the care of the daughter.

It frustrates me that because of legal issues, it prevents us from doing something decent. It’s something that I hear about to no end in China, where people are too afraid to help people on the streets who are hurt or ill, due to the fears of legal proceedings against them with false accusations.

But then again, in any system, if things like that are allowed to happen, then people end up changing. If the patient made a complaint against me, or if I was penalized for what I did for that elderly woman, I would be pretty stupid to do it all over again if something similar happens.

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The Chinese Doctor

Fascinated by the Chinese culture, I had researched what it was like to be a doctor in China. My thinking was that if my Chinese was good enough, I could go to China to practice for a few months to a year or so, and develop more of my Chinese, as well as see how healthcare works in another country. I didn’t mind if my wages would be much lower, but it was the experience that would make the decreased wages worth it.

My research led me to see how fractured and weak the healthcare system in China was.

Doctors are overworked, and underpaid. A lot of doctors provided substandard health care as a result of an overwhelming number of patient demand that could not be met by the health care system. With a country that has over a billion people, it’s no wonder. Coupled with the fact that there has been a net migration of rural residents flooding into the cities, and this will burden the health care system a lot.

Last year, my grandma needed to pay a visit to the hospital as a result of what was likely an asthma attack. In the hospital, everything is based around the almighty dollar. A deposit of around 5000 yuan was required upon being admitted as a patient, just so that you will be able to pay for your medical fees. And what should happen if you end up spending all that 5000 yuan? You get refused medical service. My aunty managed to bargain with the doctor’s in hospital and was able to bargain the deposit down to 2000 yuan. But a couple of days as a patient, my grandma was not given her morning medications. When asked why, the nurse advised that her 2000 yuan deposit was all spent, and no medications would be provided until this amount was topped up.

Other things that seem to be wrong with the health system there, is the encouragement of the “hong bao” or red envelope. In China, a red envelope contains money, and is often given as a token of goodwill. For the rich in China, giving a red envelope gives them a sense that things can be accomplished more quickly, that the doctor will spend more quality time with the patient. My mum who had been to one of the hospitals had clearly seen a Chinese sign that states “No red envelopes allowed”, yet I’ve heard that this gets curtailed by the use of credit cards given instead that are loaded with money.

The way that the doctor gets paid is also shocking. Doctors seem to get paid for prescribing things. In that way, this ends up to a lot of unnecessary prescribing for the sake of earning extra money. My father who had gone to one of the hospitals because of an upset tummy and 1 or 2 episodes of diarrhoea was offered IV fluids. He wasn’t dehydrated or anything, and didn’t need the IV fluids. Why give someone something when the risks of infection from the cannula etc outweighed the benefits? Perhaps by giving IV fluids, it is relatively “safe” and makes good money as well, and in the minds of other patients, they think something is being done.

Finally, perhaps the most disheartening thing I’ve read, have been doctor killings from patients. A times article sums up this perfectly here.

It’s quite sad actually, but I’ve been told that being a doctor in China is not what people aspire to, given the great responsibility and little financial reward given. I don’t blame them given the way doctors are being treated there.

 

 

GP Placements

Having just had about 4 weeks of annual leave, I wish I could say that I had a pleasant holiday. However, aside from going to a foreign country that has a great big firewall *Cough* *China*, I have to say that it felt incredibly busy, almost as if I was working.

For starters, on return from my trip from China, I would have to sit a Chinese written exam. I suppose being in China helped somewhat with this by being exposed to the language, but what we get tested on is entirely based off a textbook, which I had to carry around and study in my spare time while at the hotel.

The next most annoying thing, was that I had somehow organized an oral assessment task for my paediatrics diploma for the 3rd of June, also a few days after I returned back home from China. So I ended up studying for that as well, staying up late at night in the hotel to study. It was only after 2 weeks into my trip to china that my assessor advised me that she couldn’t make the 3rd of June, so I was able to push it back to the 17th of June.

Another thing (the tasks just keep piling!), was that I had to do some research into the application process for next year’s GP practice intake. This involved lots of boring reading online about the steps needed, the rules and regulations etc… And I also needed to update my CV, and write a letter of application, not to mention thinking about interview questions and how to best answer them. So this too involved long late nights of work in the hotel as well.

So my holiday kind of went like this….

  1. Arrive in Guangzhou, China all exhausted
  2. Find hotel and place to stay
  3. Study
  4. Go to Guilin and Qingdao by train and plane respectively
  5. Study on the train and on the plane while going to destinations
  6. Start stressing out as date of chinese exam, paediatrics assessment task and GP application date starts approaching
  7. Big sigh of relief once assessor postpones oral assessment task
  8. Continue to study in hotel till late night anyway despite the above

After that, I came back home, having happy memories of my time spent studying in the hotels…….

Well, I still need to work on my applications for GP, which I shall hopefully submit tomorrow.