Hospital Hell

Junior doctors say conditions in public health system placing patients at risk

BY KIMONE FRANCIS
Senior staff reporter
francisk@jamaicaobserver.com

Tuesday, August 13, 2019

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JUNIOR doctors in the public health system have shared multiple horror stories of the conditions in which they work and which, they say, are putting the lives of patients at risk.

Among the complaints of the junior doctors who spoke to the Jamaica Observer in a series of interviews, on condition of anonymity, are a lack of resources, absence of supervision by senior doctors and that they have had to manually ventilate patients for hours.

“Where our medical system falls short, as junior doctors we're expected to fill that gap physically. For example, if a patient is very ill and we don't have a ventilator available and we need to wait until the patient's relative comes to the hospital so that they can consent to us discontinuing care, then an intern or an SHO (senior house officer — a non-consultant) becomes a ventilator for four, five, six hours. You manually ventilate the patient,” said one doctor.

“We're not as privileged as first-world health-care spaces. We're expected to work with inferior tools. We don't have things in place like first-world medical care. They expect us to work longer hours than we're contractually obligated to on the basis that it is in the patient's best interest, but at the same time consultants don't spend more than about 20 hours a week at the hospital, depending on the speciality, because their contracts allow them to work outside of the hospital,” a male doctor explained.

He described the doctor-to-patient ratio as “ridiculous” with one intern or junior doctor attending to at least 30 patients during rounds.

The junior doctor hammered consultants, noting that they operate without care for the lower-level staff or patients, allegedly leaving major tasks to young colleagues.

“They don't really care how things are done. They just want to know that it has been done. If there's no porter available and we need an X-ray before carrying a patient to surgery, we have to do the lifting. On multiple occasions I've had to lift people myself onto the X-ray table, injuring myself in the process. We basically do everybody else's jobs. I've worked at hospitals where there are no registered nurses on ward. So I have to search and ensure I give every patient their medication myself; all IV medication,” he stressed.

“The implication is always, if you don't do this, do you really care to become a doctor? So you take the abuse because their friends are in big positions and have the ability to stop your career,” he alleged.

The doctor said because of this, some of his colleagues leave the public system or the country.

“The Internal Medicine Department at KPH (Kingston Public Hospital) has an extreme shortage of doctors because the working conditions are terrible. In a lot of the A&E (Accident and Emergency) departments in the country the oversight is poor. At Bustamante (Hospital for Children), at KPH cases are not reviewed by senior doctors. Some are not present at nights. Patients that are misdiagnosed are being sent to the wrong firm. A patient who has a surgical complaint is being sent to medicine because no senior doctor is there to make sure that the staff is making the correct decision. The staff bears the weight of the mismanagement that is occurring in the medical system,” the doctor said.

“I love my patients, but ultimately every human being must care for themselves as much as they are caring for others. I, as a physician, cannot give my best service to someone if I'm ill or chronically tired, which almost 100 per cent of doctors who work in secondary settings — Bustamante, KPH, Spanish Town Hospital, Linstead Hospital — are. We're tired. I can say that I have not been giving my best. You find yourself becoming short with patients, becoming easily frustrated. I personally don't wish to continue my service in the public sector because it's not worth it,” he said.

Equally, he pointed a finger at the Jamaica Medical Doctors' Association, insisting that the union is aware of the strenuous tasks those they represent face, but remain mum.

A second doctor, with whom the Observer spoke, expressed extreme concern over a shortage of equipment at KPH, which, she said, forces patients to visit private doctors for tests.

“A lot tests that we need to be done, we have to ask the patients to pay for them privately. We ask them to do that because KPH only has one ambulance and that ambulance may be in use; we have to ask the patient's family to take them in their car or a taxi and bring them back. This is dangerous, because in an ambulance a nurse would go with you, but if you go in a private car or by taxi that won't happen. Anything can happen to the patient and no nurse goes with them while they are out there. So that's an issue,” the doctor said.

Added to that, she said a shortage of nurses at the KPH — the largest hospital in the English-speaking Caribbean — has slowed the pace of work in some sections.

As the doctor put it, “nurses are leaving by the second”. This, she said, places significant strain on junior doctors.

“They are all migrating, so it's hard. For example, the ward that I work on has a capacity of 40 patients and on average each night we admit about 10 patients — half of whom are with gunshot wounds. The other half is motor vehicle accidents. For this number, you only get three nurses to attend to them, but because it's just three nurses, myself and another doctor never get much done. They (nurses) can't handle that many, so it falls on the doctors. Operations there are just ridiculous. So the patients don't get the care they really need,” she said.

She was backed up by a colleague at the same level, who also alleged that junior doctors are being left unsupervised.

She voiced concern, too, about the long hours prescribed to her and others, who have been reportedly told that they are being trained for the “misery” ahead.

“There are times when as junior doctors we are left unsupervised. There are many times when I didn't feel comfortable but I had to do what was asked of me with no guidance whatsoever,” one doctor alleged.

The female doctor said at times she worked 13-hour shifts — from 8:00 am to 9:00 pm — without additional compensation.

“You're made to believe that you're not human. You're made to feel as if your worth is dependent on your productivity. If you fail at any task there is absolutely no excuse. Senior doctors will publicly humiliate you in front of patients,” the doctor said.

A fourth doctor, who works at the University Hospital of the West Indies (UHWI), described his role as picking up the slack for others.

He shared that his experience has not been different from his colleagues', noting, too, that he has had to ventilate a patient.

“If the nurses, for whatever reason, refuse to carry out a particular task you, the junior doctor, will have to do it. If we don't have any ventilators, you, the intern, have to sit and bag or manually ventilate a patient for eight, nine hours. What we do is that patients who cannot breathe on their own, they put a tube down their throat and that tube is connected to a plastic bag. You squeeze that bag, which draws in air from outside and then that air goes into their lungs. So you're basically breathing for the patient. We don't have adequate equipment and that's the norm. We're lacking staff, nurses,” the doctor said, adding that patient record-keeping is woeful.

“That is something we really don't talk about and it really affects the efficiency of the hospital. At UHWI, if a patient doesn't have money we have to run down administrative staff, beg and plead for them to do a scan, for example, for file. Then there is the issue of medication. There are patients with diseases that are treated by specific antibiotics which would be the most effective. However, we don't have that so we have to be using [an] alternative and in some cases, it doesn't cure the problem. It just prolongs their hospital stay. ICU (intensive care unit) space is non-existent,” the doctor stated.

He also lamented the long work hours, claiming that senior doctors instruct them from the comfort of their homes.

“Another thing that I believe that we all have in common as junior doctors is experiencing the poor attitude of senior doctors. They disrespect us without consequences. It's really demotivating and a lot of people wonder why we're so cold and distant. We enter the profession as happy, joyful, charismatic people. The system jibes us and we become unkind and short with patients,” he said.


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