Over-working of hospital doctors posing a danger to patients, warns doctors group

Photo: CTK

It was extremely windy down by the Vltava last week when around a hundred Czech doctors gathered for a rather unusual protest - a trip on an open-topped boat normally used for tourist excursions. The doctors headed in the direction of Hamburg on what was a short, symbolic voyage. The reason: they wanted to highlight the dangers posed by Czech doctors leaving to work abroad, and to draw attention to the fact that many who stay at home are doing huge amounts of overtime.

Men are holding a coffin with the name 'Czech health service', photo: CTK
"We've gathered here because in our country there is a great problem with overtime, with the number of hours of overtime that doctors have to do. This mostly concerns hospital doctors, who are not self-employed."

says Dr Lukas Velev, vice chairman of the Czech Doctors Union and one of the organisers of last week's "happening". Just before the boat left its moorings, near Cechuv most, he explained the roots of the problem.

"This problem has existed for a long time. It's something of a tradition in our country that doctors have to work almost non-stop. It's common to work 24 hours without a break or to work Friday, Saturday and Sunday, which is 80 hours. It's a kind of left over from the communist days, and reflects the communist attitude to doctors."

But communism collapsed in 1989, and since then the Czech Republic has joined the European Union. Hasn't that led to an improvement in this area?

Czech doctors on a symbolic voyage, photo: CTK
"Unfortunately even in the new conditions since EU accession, when we took on board European norms, EU labour law with all the consequences that go with it...But those in charge of the Czech Republic's health system just weren't prepared. Doctors are still regarded as machines who can work without a break any time and who MUST work without a break any time."

Czech doctors say they are being forced by hospital management to work long hours. That said, there is also an element of them volunteering for extra work - for the cash. They say it would be impossible for them to enjoy a lifestyle comparable to their counterparts in western European countries if they only worked a standard 40-hour week.

At the same time, some are opting to earn more and work less by upping sticks and moving to states such as Germany, the United Kingdom and France. An estimated 400 Czech doctors are going west every year.

"Qualified doctors are the ones who are going - there is more interest in their services. I have to say that today the Czech health system functions in large part thanks to colleagues from Slovakia, where things were very bad for a while. Around a third of the doctors working in Czech hospitals are Slovak. They've come here in search of better work, but of course they too could leave for western countries, if things don't improve here. I'd understand it if they did leave."

Some areas are experiencing bigger shortages than others.

"There are problems in various branches of surgery. There's an absolutely critical shortage of anaesthetists. We're beginning to see problems in areas of internal medicine. And 'unattractive' fields such as pathology are another problem area. Many areas of medicine are experiencing problems at the moment."

As I say, 400 or so doctors are believed to be leaving the Czech health service every year. Dr Velev tells me several of his acquaintances are among those who have left.

"They all say, I'll come back in two or three years. But now those years have passed and they're saying, I've got used to a certain lifestyle. They wouldn't consider going back to a Czech hospital and being paid peanuts. What you can earn in Germany or England is many times what you can make here."

Getting back to those Slovak doctors who are helping make up the shortfall in Czech hospitals - do Czech patients mind the fact that so many of the doctors treating them are from Slovakia?

"Basically, I think it doesn't bother the patients, thanks to our long years of co-existence. And at the moment the language barrier isn't great, although we are finding sometimes there are problems with younger people who didn't experience living in a common state."

Dr Velev says what really bothers patients is the fact that overworked doctors simply don't have time for them.

"They are working at speed, they're tired. Sometimes they don't behave as they should towards patients. That's because you're tired, you're exhausted, it's 10 pm and you know you'll be working again in the morning...And then if a patient bothers you with something you don't regard as important it can happen that you let them know what you think. It's not good, I don't agree with it, but I do understand it. Everybody gets tired sometimes."

It goes without saying that irritability and rudeness do not make for a good bedside manner. But far worse, of course, is the idea that if doctors are badly overworked they could make the kind of mistakes that could have serious or even fatal consequences for their patients.

"Obviously it's dangerous for patients, and that's something we're drawing attention to in our protest campaign. If somebody is working for 24 hours and manages to sleep just three or four hours and then the next day you have to perform a difficult operation, say, it can result in the patient being harmed - just because tiredness has led you to make a bad decision."

So there is clearly plenty that needs putting right in the Czech healthcare system. Looking to the future, how optimistic is Dr Lukas Velev that the situation can improve?

"Well, I could say things look bleak but I'm an optimist by nature. But if we're not able to hold a meaningful dialogue with those who run the system then of course the outlook will be bad. But if we're able to agree on what the problems are and agree a solution then we will be able to move forward. We've decided to leave things as they are this year, but we are calling strongly for changes in the coming years so that we are no longer so overworked."