Battling the "paternal" relationship between doctors and their patients

Czechs have always been envied for their health care system. Unlike in Britain, the United States, or neighbouring Germany, for example, in the Czech Republic, only a very small percentage of the population have no health insurance. Czechs have a sore throat; they go the doctor and get some tablets, they have a slight temperature and get to stay home on sick leave for a week - all of this covered by insurance, of course.

This system worked perfectly under the socialist system but is certainly beginning to crumble 16 years after the fall of communism. And while the government is desperately trying to find ways of reforming the health sector, politicians are only now realising that there is another problem that needs to be dealt with - one, which will take generations to fix. In today's Talking Point, we look at the battle against the "paternal" doctor-patient relationship in the Czech Republic.

Those of you, who have been to the Czech Republic and have unfortunately been forced to get medical treatment will have experienced it - you spend half the day in waiting rooms only to see the doctor for five minutes during which you tell him what's wrong, he makes his diagnosis, and you're out the door - any questions are met with a strict look, followed by a sharp, brief "yes" or "no". Czech doctors have a paternal relationship with their patients and until recently this trend has not been questioned.

Tomas Julinek,  photo: CTK
"After fifty years of communist rule, people have lost their sovereignty and drive to make their own decisions. It's a behaviour, a way of thinking, that has been persistent in this country for decades. And, it will take generations to change this way of thinking. We have managed to make a difference in some areas. Czech citizens, as customers in a free market economy, are beginning to learn about their rights and know what they want. But as far as the health care sector is concerned, it continues to be a behaviour that's viewed as taboo."

...says the opposition Civic Democrats' shadow health minister Senator Tomas Julinek. Czech patients undoubtedly have very little information about types of treatment and the medicine that is on the market.

According to Czech law, any medication on prescription cannot be advertised. The drugs that are sold freely can but under strict regulations. Pharmaceutical companies have been accused of finding a way around the law by "luring" doctors and pharmacists - with the help of attractive rewards like a one-week stay by the sea-side or other small "gifts" - into prescribing or selling their products. Some doctors take the offer and others don't. But how can the patient know what group his doctor belongs to?

Senator Julinek believes the more citizens learn about the various types of drugs - for example through a more relaxed drug advertising law - the more inclined they will become to ask questions and make their own choices. But Doctor Otto Herber is sceptical. Judging from his own patients, he fears they will not change overnight and, most importantly, out of their own initiative:

"I think we need to make patients take more responsibility for their health. I feel that they aren't even interested in being healthy. The 21st century has been marked as the century for prevention. The first thing we need to do is educate the patient on the right way of life, the healthy lifestyle. The patient must be pulled into the prevention process to see how he would actually benefit from a healthier lifestyle - not just as far his health is concerned but financially too. According to the law, patients can have a free preventive check-up but none of my patients do it. But when it comes to a free check-up on their car, they are the first in line. So we see this trend that they get very little motivation in health care.

"On the other hand, the way things are now they do not have the opportunity to make their own decisions on what they do with their money. Insurance companies have to change their attitude first. They need to be the ones to motivate their clients and invest into them to care about their health themselves first. The doctor should only come in after all of that. He should play the role of the provider of an expert opinion, advice and service."

The ordinary Czech needs to be driven and motivated to accept responsibility for his own health. And, doctors, pharmacists, politicians, and to some extent representatives of pharmaceutical companies have so far failed to play that important role.

But pharmacist Petr Krpalek believes very little stands in the way of patients getting all the answers right now. His customers come into pharmacies, get their medication, but do not bother to ask for advice, as would be normal practice in other countries:

"I think Czech patients have a lot to learn. They should try and get more information actively... not just through ads but from other sources too. They can easily consult the staff at pharmacies to get a second opinion on whether the treatment they are undergoing is suitable for them. Our staff is definitely educated enough for that and the public simply isn't aware of it."

In the case of pharmacists, this could be true but overall, Senator Julinek has his reservations about the current state of affairs:

"It sounds like we have a great system here, where most health care is covered by insurance, but when patients try to make use of it, they find out things aren't as they seem. Insurance companies often give patients wrong figures when it comes to the cost of treatment that's only covered partially and sometimes one can't stay in a hospital because there is no free bed. So it's all a game in which we claim everything is cared for but in reality it is not.

"The idea is very simple. We are talking about customer service here. We should stop believing that health care is some remote island in the economy. It's a service that citizens are paying for. And, we need to make the doctors and insurance companies realise that their pockets are full of money because of their patients, who are paying for their salaries. Then they would definitely behave differently."