June 22, 2010
There are ton of things I still can’t figure out, but I have one that’s weighing a little heavier than the rest. Many of the doctors have been irritated with me for taking up a half hour of their time because there are pregnant women, some of whom are in labor, swarming the clinics and hospitals. That seems totally reasonable to me, especially since most of them didn’t know that they had to participate in an interview until an hour or so before. (Side note: they have secretaries here, but they don’t seem to do the same things as the United States secretaries.) The thing I don’t understand is that they don’t seem to be as excited about medicine and the science behind medicine and invested in patient safety as doctors in the United States. I know that the United States is famous for being lazy, but one of the things that I love about the medical field in the United States is that it does a pretty good job of drawing in the people who are very passionate about medicine. I’ve been discussing the medical admissions process with people from England, Norway, the Netherlands, and Switzerland and they go to medical school when they are 18 or so and then spend 6 or 7 years in medical school. I like the United States system because it allows more time for exposure to the field. When I was 18, I didn’t think that I wanted to be a doctor. It wasn’t until I was 19 that I decided on medicine, and that would have been too late for me in Ghana or any of those countries. So… anyway, it doesn’t seem like these doctors are living, breathing, and sleeping medicine. I guess that’s not good or bad, it just is.
Also, one huge turnoff of practicing medicine in the United States is that there are so many rules. Many doctors are terrified of being sued. Many more are afraid of breaking rules, even if it would be beneficial to the patient. Being in research, I have learned to hate the rulebook. Sitting through 3-hour meetings about how to handle lab rats and use dogs in research (neither of which I do) has driven me crazy, but I have to do it. Here, though, it seems like the system could benefit with some rules. Patient confidentiality: no way. In my interviewing adventures, I have intruded on at least 5 appointments (the doctor who is helping me led the way). These doctors tell me to sit down and wait until they’re done with the case, and then they continue talking to the women about prolapsed uteri or the best contraceptive of choice. Also, all the examining rooms are connected and air conditioned (they are lined up in a hallway that is open to the air), and Sabina (the doctor who is helping me) and I have walked through all of them to get to patients. It’s very bizarre to me, especially since these are all male doctors talking to women about reproductive issues. That is usually almost as confidential as mental health issues.
Another potential confidentiality issue: Forget the computerized medical records movement. The hospital here is using 6” x 9” packets (made out of the same material as blue books) that say “patient record” on them. As far as I can tell, the patient is responsible for bringing their record from the nurse to the doctor. I can’t tell if the patient is allowed to bring the record home with them, but I have seen thousands of patient records lying around, on desks, bookshelves, benches, everywhere.
My personal philosophy about patient confidentiality is that we need to lighten up a little and understand that everyone is human. My (very naïve, I’m sure) belief is that if everyone were able to be open about their diseases or conditions, those things would be less stigmatized. I understand why, in the United States, with media and tabloids and stigmas, medical records must be kept confidential. I guess my complaint about the system at this hospital is that it allows for so much error. Patients can pick up the wrong packet. The packets are hard to identify immediately, making alphabetical filing a nightmare and creating a situation where it is very easy to lose a record. Patients can lose the packet. Patients could alter their medical record, maybe to get drugs or a desired opinion from the doctor. Anyway, I think it is scary that patients have more than read-only access to their medical records.
The title of the post is what one of my earliest interviewees said to me. We later realized that the interviews only take approx. 20-30 minutes, but he kept telling me that he made a ton of money and didn’t have time for me. I thought it was a strange thing to say to a student researcher.
Ghanaian proverb of the day: It is the fool's sheep that break loose twice.
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