The Doctor’s View: Hospital Hierarchy

By Denise Kavuma, Uganda:

“The patient is your boss.”

I felt my eyes widen at the statement as everything in me rebelled at the idea. Everyone else in the meeting-room remained in the same positions with looks of boredom which had been the dominant expression on their faces for the past hour or so. Even Batman would have been impressed with their poker faces. Granted I had been one of those zombie-looking, bored, wishing-they-were-elsewhere attendees but all that had changed promptly with the utterance of a statement so radical, so ridiculous, so…so blasphemous, it was all I could do to let the speaker have her say before I interrupted.

Long before she was done however, I found my head rotating from right to left repeatedly in the universal sign of 'oh hell no' as I valiantly tried to hold back the condescending look but failed miserably. Thankfully, the lady finished speaking before my upper lip could curl itself into a sneer and I leaned forward eagerly to have my say, opening my mouth quickly before anyone else could.

But I shall start from the very beginning of this tale.

I was working in a small hospital somewhere in a quiet town an hour away (on a good day, which it rarely is) from the central city in Uganda. This is as good a description as I can give because while the hospital doesn't have a fully automated medical-records system, nor does it have some of those fancy machines (yes CT-scan and MRI, I'm looking at you) we still managed to treat our patients and refer them in a timely manner in case they needed further management elsewhere. This was the sort of place that behaved like a closely knit community and so anything out of the norm was easily noted and word would go around. Basically what I'm saying is that a lot of gossiping happened in that place and I'm certain it still does.

Now imagine that the kind of person who just loves to be noticed and wants to command attention everywhere he goes, walks into the hospital expecting the medics to practically bend a knee and kiss his ring before they do anything else. Imagine for a second that he's got the good looks of a Tolkien-esque elf but the menacing atmosphere of Sauron; he'd still come second to any medical emergency that pops up during the time that he's graced us with his visit. At this point, I'd like to emphasize that while I'm a doctor and consider my work service, I do not consider myself a servant, nor do I see myself as a slave. I'm most certainly not the kind of person who would do anything for money, so that is out of the equation. I do not however, act rudely towards patients and the worst I could do is glare as I refer you to another doctor to deal with your bullshit; professionalism is key, after all.

So before we had the above mentioned meeting, a series of private patients that came from a particularly snooty (yes I said it, like I'm back in high school) company had been complaining about our service at the hospital. They insisted that we'd always prescribe for them the same drugs even if the combinations hadn't worked before and that we made them wait at the laboratory too long. When these concerns were forwarded to us, it was baffling for these were the exact same patients who were known for never carrying their medical forms so we could see their previous treatment and would instead spitefully ask us why we didn't have a fully automated system yet. Now, it's particularly the venomous type of douchebag that would walk up to someone who is clearly trying to achieve a goal but still ask them why they're not at the finish line. Like those jerks at the gym who make fun of overweight people, but I digress.

These patients are also the kind who are always asking for bizarre out-of-the-way tests that have nothing to do with their symptoms and so end up having a longer waiting period for the results than other patients. I'm not trying to be defensive (and even if I were, I'd be right) but it was more than clear that these guys were the cause of their own problems. When the complaints were raised in the meeting and the causes were explained, the next question to ask was whether the speaker had explained the causes to the company heads, for she knew them as well. Her response was that she couldn't because the patients were our bosses.

That was the belief of the administration at the very least.

You know that feeling of dominance and euphoria that has been expressed by some employees when a client makes noise about one thing or another and demands for the manager who ends up telling the client the exact same thing the employee said in the first place? Well that doesn't happen in this place because the big cheeses always take the side of the patients. It doesn't matter if someone complains that you explained the diagnosis in too simplistic a manner, or that you don't make enough conversation, or that you punched them in the jaw, no one will ever be on the medic's side.

So there I was, bewildered and feeling frustrated at the idea that no matter how difficult a patient was, I was to grin and bear it. Oftentimes, I've had to take clients aside and tell them to stop giving the nurses a hard time or told someone to take his issues to another hospital because I couldn't take the bullshit anymore. Hospitals are not restaurants or hotels that are there for pleasure; we're in the business of life and while we may try to carry it about with as much professionalism as possible, we won't tolerate tantrums from adults.

Evidently that's not true.

The meeting really ended with us realizing that no one is ever going to tell the company heads our concerns and that they'd continue cracking their whips over the administration's heads who in turn would press their boots harder upon our necks. This is the reality of most hospital environments and so when motivation is lacking in medics and cynicism takes its place, don't wonder why, just come and read this page, I'll tell you all you need to know.