Letter from Prague

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There has been a great deal said about the plight of young doctors and nurses in this country. They are terribly overworked and shamefully underpaid, resulting not only in a brain drain but in the danger of doctors who have been on duty for far longer than the law allows making irrevocable errors in judgement, and damaging a patient's health beyond repair. Whether or not extreme fatigue was the reason behind the horrifying case in which a team of doctors removed a patient's healthy kidney instead of a malfunctioning one is something we will never know. However, this is what leads me to talk about patients' rights.

The right to a doctor who has had eight hours of sleep instead of two, the right to a second opinion and the right to decide about the course of treatment once the options have been made clear. A recent change of legislation now commits doctors to informing patients about their state of health which means that we will no longer have to resort to stealthily opening clipped-together files en route from a specialist to our GP and then taking a short cut to the local library to find out just what those Latin expressions mean. However, the other rights I mentioned are often way beyond reach. Hospitals are short staffed, doctors with a good reputation have more patients than they can handle and it is often a question of knowing someone who happens to know someone who knows the doctor's nurse. Even in serious cases, getting a second medical opinion - a standard procedure in the West - is rare in the Czech Republic. Partly because of misplaced "injured pride" on the part of some doctors and partly because second opinions are not covered by most health insurance companies. Again, when Czechs want a second opinion they'll look for friends who have friends who know of someone really good. As for choosing their therapy once the options have been covered that too be a problem.

A team of Czech cancer specialists have been testing a new cancer cure in recent months. The cure, known as de-vitalization, entails cutting off the blood supply to the cancerous growth and although 8 of the 12 patients it was tested on died, doctors feel it is something worth following up. According to one cancer expert involved in the experiment, the cure would work much better if it could be applied at an early stage of the illness. The de-vitalization method is based on the body actively fighting the disease, which it cannot do after losing its immunity in chemotherapy and radiation. However, Czech legislation does not allow patients to undergo de-vitalization treatment before every other cure in traditional medicine has been applied. A hopeless Catch-22 situation. Patients are furious, cancer specialists are shaking their heads, but the health ministry remains adamant. "No reason to change the law at this point. Trust us, we know what we are doing," the health ministry's spokesman told journalists recently. Somehow, it's not a reassuring attitude.