Slovakia struggles with ethics in a health system undergoing rapid change

Health care workers have been stirring up public debate having gone into their first major strike in history, leaving several hospitals with emergency care only. The strike could be called a success as poorly paid health workers will get a 20% salary increase. But wages are only part of the story. Big changes are being made to Slovakia's health sector with the reformers describing patients as customers. Katerina Richterova looks into the ethics of health care in a system undergoing dramatic change:

The waiting room at the doctor's is not the most pleasant of places to be stuck in. Crammed in with fifteen other patients, the nurse comes out of the door and asks: Who is here for the abortion? It certainly doesn't make you feel at ease. Or imagine being examined by a doctor while another patient is in the same room, getting undressed and ready for an examination. You're probably thinking this is just a bad joke, but in some Slovak health care institutions it is the reality.

Cases like this should not happen at all, since doctors and other health care professionals have a code of ethics that they should follow. However one does hear about such incidents quite often raising the question: where are the ethics in health care?

"The law states that doctors should be experts, with a human approach and respecting the patient's dignity. In case a patient complains about the doctor, or wants to change to a different doctor, it should not be held against the patient."

Eva Vyvodova, head of the office that overlooks the provision of health care quoting the code of ethics. These are the rules, but are they always kept to? In a little more than one year, the office that overlooks the provision of health care investigated over 2,000 complaints filed by patients against health care professionals.

"We get complaints about inadequate provision of health care. In average we get approx. 50 phone calls per day, from patients mainly complaining about health care personnel not respecting visiting hours or fees."

The office has not received any complaints about not respecting ethical principals or discretion.

"Maybe such cases do happen but people don't talk about them. Maybe in a year's time the number of complaints will be different than now."

Another body monitoring the work of doctors and nurses is the Slovak Medical Chamber. Jarmila Ambrusova is the chairwoman of the Slovak Medical Chamber:

"Last year we received 170 complaints about the provision of health care of which 2 were about inadequate privacy in health care facilities."

For non-ethical behaviour doctors can pay a fine starting from 50 000 SKK, which is some 1,200 Euros, certainly having no top limit. As the number of complaints to the bureau as well as to the medical board indicates, more and more patients seem to be aware of their rights when going to the doctor's. Eva Vyvodova:

"I think that doctors are being more careful and maybe also thanks to the Medical Chamber, that is their controlling body. They are more careful also in handling the patient, because now they see that patients are no longer afraid to speak out."

"The legal awareness of doctors has increased. They know that the issue of ethics is very frequently discussed and closely watched. It is also in their interest not to lose patients and that is why they are trying to provide them with a pleasant environment and also ensure them privacy."

... concludes Jarmila Ambrusova, chairman of the Slovak Medical Chamber. Statistics suggest that there are more complaints from patients from bigger towns, where there are also more doctors and patients, but this does not mean that in smaller towns or villages the situation is better. On the contrary, says Jarmila Ambrusova ....

"Mainly in cases of small villages, where there is only one doctor, he or she feels that there is no competition. Where there is bigger competition, doctors try to provide patients with the best service possible."

Ethics in medicine have only been taught at the Faculty of Medicine in Bratislava since 1993. This means that for 40 years, medical professionals were not taught ethics at all. This could be one of the possible explanations for the current situation. Those doctors in practice right now have not learned at school how important and strategic it is to communicate well and ethically with a patient. As Maria Mojzesova, lecturer of medical ethics at the faculty of medicine in Bratislava says, educating medical students in the area of ethics is important. But in the end it comes down to the individual, his character and inner beliefs.

"Their inner abilities to be humane and have empathy with the patients and their families."

"Sometimes it just becomes routine because there are many patients..."i

... says a young doctor, judging from her own observations. With the new generation of medical professionals, can we look towards a brighter future, in terms of being treated well at the doctor's?

"I hope that in the future, through young medical professionals, medicine will be better and more ethical in our country."

Maria Mojzesova, lecturer of medical ethics says not only knowledge and skills make a good medical professional, but it is the right approach to a patient that makes the difference. However, with all the things going on in the health care sector in Slovakia today, many say respecting ethics is not a priority right now. Patients, unlike doctors, did not go on strike, but this doesn't have to mean that they don't want a change in the way they are treated.