THE UNACCEPTABLE – VERY ILL ORGANIZED HEALTH SYSTEM (E.S.Y) IN GREECE

 

In other Western countries their national health was established 100 – 200 years ago. In Greece the national health system (called E.S.Y. in Greece) was created in 1981! Also the ambulance emergency medical system was established in 1987 (after a heat stroke ‘epidemic’)! However, both of them are still very ill organized.

Starting from the medical schools, even though Greece is overly congested with doctors, it has 7 med schools that create hordes of doctors. Also in the medical schools in Greece are enrolled many students from (often low quality) university of Eastern Europe countries. These students just take exams and in case they pass them, they enter in a medical school in Greece.

The Greeks don’t mind to stop this unacceptable phenomenon of the doctor factory from all these medical schools in Greece. Today, in order to avoid an overpopulation of doctors in Greece, only 1 medical school should work, and the rest should close at least for 10 – 20 years! 

And which is the quality of the Greek medical schools? Unknown! In Greece in all the stages of the education systems the teachers and professors are not assessed and evaluated by anyone, not even their students. In other Western countries the college or university teachers are assessed by their students and the really bad teachers are fired. In Greece many teachers are useless and have zero communication skills; however no one minds for it. In medical schools many professors do their lessons just by showing some slides on the wall.

Another unacceptable thing in the Greek universities is that all the theoretical lessons are not compulsory, so in many cases in the amphitheater you can see just 5 – 10 students watching a (usually less important) lesson! So, once the theoretical lessons are not compulsory to attend, in fact the Greek universities (that are all public) are like open universities!

In the Greek medical schools, you rarely find modern norms such as ‘Evidence Based Medicine’. So students learn million of useless nonsense and do not learn medical guidelines and algorithms, they do not learn ‘evidence based medicine’ and ‘Cochrane’ and also do not learn proper history examination, physical examination and drug therapy.

The med school students training is the university hospitals is inadequate. The main reason is that often senior doctors (usually non university staff) do not bother to take the students by their side and teach them practical medical skills such as medical history, physical examination and practical drug therapy. So, when a medical student does not learn properly these main stem skills, the result is to have ill qualified doctors with inadequate medical skills.

Another problem of the Greek medical schools is that they are so ill organized, that from the 7 medical schools only 2 (Athens & Salonika) have anatomy lessons with corpses (cadavers). The rest have plastic dummies! Not even robotic or computer stimulators such as other modern countries (such as Germany) have. 

Moreover, the hospitals in Greece are so ill organized and the Greek doctors so ill skilled, that rarely a medical student will find in hospitals what he/she read on the medical handbooks i.e. the algorithms of ALS (Advanced Life Support) are rarely commenced e.g. on a cardiac arrest. Medicine in Greek hospitals is usually commenced empirically, often without any attachment to guidelines, algorithms and standards!

And which is the quality of the Greek doctors? No one does assess them.  Greece perhaps has the higher amount of doctors compared to its population (there are more than 60.000 doctors for a 10 million population!) and the main reason of the doctor factory in Greece is that many parents push their children to become doctors (or lawyers, or civil engineers, or to go to public section jobs) in order to earn a lot of money! However, all these jobs today have high unemployment rates (there are about 1000 – 2000 doctors unemployed in Greece)! 

Parents push their children to become doctors and if they can’t manage to pass in a Greek medical school they send them abroad to usually low quality universities (instead of a university in the UK, or Germany, or USA or another modern country ). Thus, many doctors in Greece have graduated from (often very low quality) universities of Eastern Europe countries. Although, today many of the above university are improving, Greek universities still haven’t improved.

After all, no one assesses the Greek universities and the Greek ministry of education does not pay any attention to the quality of the Greek professors, their communication skills and the quality of the curriculum. Furthermore, no one pays any attention to the Greek universities to improve.

Hospitals don’t sustain any kind of assessment as well! Generally, the Greek doctors, working private or hospital, do not sustain any kind of assessment, appraisal, evaluation and revalidation to continue holding their license! The Greek hospitals are very ill equipped. However, in many hospitals in Greece, the hospital’s authorities that manage the purchase of medical equipment and drugs have accused for stealing million of euros with frauds that usually have to do with over charging the price drugs and medical equipment.

The government seems not to mind at all for these frauds, however if all the public money that was stolen on frauds was given to improve the Greek medical system, it would be the best in earth!

In Greece, it is unbelievable, but many Greek doctors do a kind of fraud: they prescribe drugs from a specific drug company that ‘rewards’ them with ‘presents’ such as travels for (supposed) medical conventions and also with kitchen’s equipment and other stuff. So many doctors in Greece may prescribe drugs that patients don’t need or prescribe extra useless or not important drugs. Their motive is the drug company’s ‘presents’!

The number of the medical personnel in most Greek hospitals is inadequate. That means that doctors in Greek hospitals, especially in provincial, work too much hours and this may cause many problems. Doctors who are exhausted from work are more likely to make medical mistakes. However, Greece still hasn’t adapted the EWTD (European Working Time Directive) European directive that says that doctors should not work more than 48 hours weekly. In Greece, in many hospitals, doctors work even 60 – 70 hours weekly! That means that they have even 10 shifts monthly! However, when the doctors in Greece refused to follow EWTD because they earn more money by doing extra shifts, even though this make them vulnerable on making mistakes! 

Greek hospitals are very ill organized. The most ill organized part of the Greek hospitals is the A&E (ER) ED (emergency department). In Greece many specialties that exist in other countries, do not exist in Greece (such as elderly medicine doctor, podiatrist, sports doctor, sexologist etc). Some specialties exist not as pure specialties, but as subspecialties (e.g. an ICU intensive care unit doctor in Greece is a subspecialty that some specialists can undertake, contrary to other western countries where ICU is a pure specialty and not a subspecialty). 

One of the specialties that do not exist in Greece is the Emergency Medicine doctor! So emergencies in Greece are managed by junior doctors and specialties that are not emergency doctors! In the Greek emergency departments (and also at the wards after midday), the doctors that treat patients are resident doctors that are specializing (i.e. they are not specialists, but are specializing, namely they are unskilled). In other words, the doctors that initially receive and treat patients in the Greeks Emergency departments (and also at the wards after midday) are junior doctors!

Of course there are senior doctors that attend the emergency departments; however the main work is done by junior doctors! Many times, especially in the province where hospitals are more ill organized, some senior doctors do their shift from their home and in case they need them, they call them by phone! So in the hospitals, in some cases, the only who are present during their shift are junior doctors! However, the Greek law is clear and mentions that all doctors who are on call (and have a shift) need to stay inside the hospital! ‘I am on call’ does not mean to be literally on phone call, as some doctors do in Greece. 

Also, many times the senior doctors are not keen on helping the junior doctors on the emergency department, and when they call them often they take too long (even 1 hour) to come at the emergency department! Other problem at the Greek emergency departments is that triage does not exist. Triage is to sort out which patient is on worst condition and needs to see immediately a doctor and which is in a less severe case and does not need to see promptly a doctor, but can wait. So, in Greek hospitals there isn’t any kind of triage and that practical means a chaos in the emergency departments. Surely many patients have died because although they had an emergency (e.g. chest pain) there were not triaged as indicated and did not treat immediately…

The problem of triage complicates the fact that the emergency departments of the Greek hospitals visit many citizens that have now money (or are not keen on paying) and just want to see a doctor without paying, although they may not have a serious problem on their health. This problem is huge on the child hospitals in Athens where thousands of immigrants daily bring their children even though with a minor condition such as common cold or a mild fever! 

The Greek hospitals wouldn’t be over congested if in Greece the GPs work as in other countries where the GPs are community doctors and in the community everyone who has a medical problem visits free (the state pays) the GP’s surgery of his/her neighborhood and in case the patient needs to visit a hospital, then the GP writes a medical note for the receiving doctor (that may communicate with the GP, if needed by phone to take any extra information) and sends the patient to the hospital (it kind of a preliminary triage!).

In Greece all these years the role of the GPs hasten still established! In Greece, contrary to other western countries, the internal medicine doctors can hold a surgery and work as private doctors. But that means that they take the GPs job!

Furthermore, also contrary to other western countries, in Greece all the medical specialties have the right to open their private office (surgery) and work on private sector! In many medi – care insurance organisms there are doctors with different specialties who do the GPs job!

So, in Greece the GPs haven’t their real role established. Things are so confused, that in the government targets to hire GPs at medical centers and rural surgeries, but this is not their role. Provincial medical centers (that in Greece aren’t at all medical centers but just a place where you can find a doctor) should have emergency medicine doctors rather than GPs! Even in the Greek hospitals the GPs role hasn’t still established. Many times they do things that do not belong to their specialty. Often they are occupied with stupid things (see below) in the general internal medicine ward. The GP’s real role is to be community doctors, treat all the non emergency medical cases and send to the hospital the patients that need hospitalization. That simple!

In Greece the medi – care insurance companies are public, handle the medical care & pensions, and are also in high debts because of many frauds by doctors, pharmacists or public sector officers (such as illegal prescriptions) that overcharged the public medi – care insurance organisms. Also a previous government gave the public insurance organisms the right to play a part of their funds on the stoke market! Off course they lost their money, but it is said that the whole thing was a huge fraud. 

Other problems of the Greek emergency departments, and generally the Greek hospitals, are that they have insufficient medical equipment (although the money for purchasing medical equipment and drugs is often stolen on frauds that have increased the hospital’s depth to high rates), the emergency departments haven’t got all the emergency drugs (that you find in an ICU) and also the guidelines and algorithms (such as ALS, ACLS, ATLS, APLS/ EPLS, ALSO) are not used in daily medical practice because most doctors are unaware of these algorithms! They need to pay 250 – 400 euros to private organizations or hospitals that perform the above specific seminars.

Greek hospitals do not mind to perform regularly emergency medicine (such ALS advanced life support) seminars and lessons to their stuff, not even the emergency department staff! Also in Greek hospitals there are not any local protocols about several medical conditions and there is a lack of laws that order the doctors what to do or not to do on a medical case (especially on emergencies e.g. when Jehovah parents refuse blood transfuse to their children that sustained injuries). So the government does not protect the Greek doctors at all from malpractice and litigations. It simply doesn’t care to make protocols and guidelines in order to avoid malpractice and litigations…

Many times things on a cardiac arrest a totally chaos exists. In Greek hospitals EMT (emergency medical team) and ‘blue code’ (on cardiac arrest) do not exist! So, in case of an arrest they just call an anesthetist just to intubate the patient (often the anesthetist or on ICU intensive care unit staff abandons the ICU in order to offer help on an arrest), however during an arrest there is not a team to offer ALS (advanced life support), and also there isn’t any team leader to coordinate the team. So, practically, on a cardiac arrest in Greek hospital a chaos occurs! Everyone does whatever he/she wants. Many times, even junior doctors are left (on the wards or the emergency departments of the hospitals or in the rural medical centers) to handle emergencies such as cardiac arrests! Other times patient on arrest who are terminal ill (e.g. with cancer) don’t sustain any kind of resuscitation (even though there aren’t any directives for them) and the doctor just confirms the patient’s death with an ECG electrocardiogram (some times the doctors get inpatient when they wait too long for the patient to make a flat line on the ECG, in order to confirm the patient’s death!). 

In the province, things are worst. Actually the provincial hospitals are so ill equipped and have insufficient (in number and skills) personnel that its role is just to transfer the severely ill patients to the big hospitals of the capital Athens and the next largest city, Salonika! Many of the provincial hospitals and medical centers work without basic medical equipment such as CT scan. Most provincial hospitals have inadequate number of SPECIALIZED medical personnel.

The health centers and rural surgeries in the province work with unskilled junior doctors that haven’t even started specializing, but have just finished med school! Off course in the medical centers work also senior doctors, however many times aren’t always readily available.

The rural medical centers in Greece are paid million of euros; however they practically offer nothing. They are totally useless and work just as surgeries that you can find a doctor for a non emergency problem! They can’t manage emergency cases, but just refer them to hospital, many times without stabilizing it first! It would be better to close them and have better equipped ambulances to transfer the patients immediately on hospitals.

Many rural medical centers haven’t got adequate personnel for their ambulance and usually the driver of the ambulance is a citizen! Other, don’t even have an ambulance! Many times a junior doctor working in the medical center literally abandons the medical center in order to accompany a severe ill patient to the hospital! So in case the doctor was alone in the medical center and has left to accompany in the ambulance an emergency to the hospital, the medical center may be left without doctor! That’s because there ambulance system isn’t available in all cities, but just in the provinces capitals. 

In Greece the hospitals and medical centers have inadequate number of medical and nursing personnel (i.e. doctors and nurses) that can’t work properly. This has several complications e.g. many ICU/ ITU (intensive care/ therapy unit) beds in many Greek hospitals don’t work because they haven’t hired the adequate personnel to work them! 

The Greek hospitals also are ill equipped with the adequate medical equipment e.g. on the emergency departments you can find old monophonic defibrillators (that also many times don’t work as pacemaker), or oxygen masks that aren’t none recreating and also don’t have reservoir, or self inflating bags without reservoir (as ALS demands) etc. 

 About the ambulance system, it is ill organized as well. Actually it is organized only in the capitals of each province! But even there the number of ambulances is insufficient and even in the capital, Athens, you may wait 1 hour for an ambulance to arrive! Also in Greece ambulances are still inadequate equipped with machines, rest medical equipment and emergency drags. For example, the ambulances have just an AED (Automated External Defibrillator) that, by the way, is can be used also by citizens. They also haven’t got the equipment that ambulances in other westerns countries have. They don’t have even an intubation kit, not even a laryngeal mask that can be used easily by non medical EMT (emergency medical technicians). In Greece well equipped are only specific ambulances with medics, which are a few, even though in the capital Athens. The Greek ambulance public organization provides the specialty of emergency medicine just in 1 year, contrary to other countries where this specialty needs about 7 – 8 years in order to be obtained. 

In Greece they rarely use helicopters for transferring patients, and usually use them for islands, often under politician’s pressure! The paramedics in Greece are also ill educated (comparing with the EMT of the rest western countries); contrary to the paramedics of the USA that can offer advanced medical treatment, especially on trauma. In Greece, the seminar PHTLS (pre – hospital trauma life support) is also paid (it costs about 400 euros), even though it is organized by the Greek ambulance organism it’s self! 

About the skills and the qualifications of the doctors, often these are insufficient. As, mentioned, the doctors are not assessed, apprised and revalidated by anyone. In Greece, hospitals do not ask the person specification skills, such the ones that hospitals in UK do, when hiring a doctor. After all, skills that are mandatory and essential in western countries in Greece simply do not exists. Many Greek doctors lack on many skills such as personal appearance (you will never see a Greek doctor with a tie, unless he is a professor!), communications skills and bed side manner (many doctors are rude to patients, colleagues and rest hospital staff!), team work (it simply does not exist in Greek, everyone in Greece knows everything!), updated knowledge (many Greek doctors are just informed for new drugs from the drug company leaflets instead of medical magazines & books!), empathy, practical skills (practice in Greece is the biggest patient!), knowledge of guideline & algorithms (do not exist in Greece, where everything is done empirically!), Evidence Based Medicine approach (does not exist in Greece!), consultancy of senior doctors in difficult cases (in Greece a senior doctor may take 1 hour to come to the emergency department!) etc.

In Greek hospitals, the doctors do not sustain any kind of training and teaching, but just watch the other doctors what they do! There isn’t also a specific curriculum that the training of each doctor should follow. After all, there is not any training! Moreover, in Greece the resident specializing doctors are occupied with stupid, time consuming, things such as taking ECGs, or transferring the blood bottles to the Lab, or taking the results from the Lab or taking image studies from the CT or MRI room etc. These things can be done by a nurse. However in Greek hospitals the number of nurses is inadequate, so many times the doctors do the nurse’s job as well! 

About the private hospitals, these are good hotels! The only problem is that when the patient sees the bill, drops down with a heart attack! Another weird thing is that in case of emergencies many private hospitals transfer the patient to a public hospital! That means that many small private clinics are ill equipped for taking care of emergencies. Perhaps the government hasn’t applied rules and standards for the private clinics in order to ensure the patient’s safety... It is also said that private hospitals overcharge the patients for non necessary exams.

Finally, the most disgusting thing in the Greek health system is the phenomenon in which many doctors, usually surgeons, are bribed (with money enclosed in an envelope) in order to take care a specific patient or in order to overcome the long operation list (which usually is plasmatic)! This is called in Greece ‘envelope’. Moreover the surgeons who are bribed ask also money for the anesthetists! Recently the media announced that some surgeons gave their patient an off shore account in order to pay the money and bribe them, and not to be caught by the IRS.

Other doctors in Greece are occupied with frauds e.g. they are bribed by private hospitals/ clinics in order to send them patients for diagnostic exams (e.g. CT scan) and perhaps this is the real reason why many public hospitals lack of essential medical equipment such as CTs or MRIs! 

In conclusion, Greek health system is still very ill organized, contrary to other western countries. A lot of money has to be spending from the Greek government in order to improve the Greek health system. It is important for all the hospitals to have all the adequate medical equipment.

The government also needs to hire more doctors and nurses, because the doctors and especially the nurses in Greek hospitals are in insufficient number to provide proper medical care. To put it in a nutshell, Greek Health system has to follow the Swedish model where health system’s level is high and it is available to all.

However, there are many other issues that have to do with practical things that need to be organized such as a specific training scheme and curriculum for all the doctors specializing in hospitals, medical seminars and lessons for ALL the doctors in the hospitals (not only theoretical lectures as the ones that Greek hospitals consider as ‘lessons’!) etc. Also, Greek doctors need to learn all the essential skills mentioned above such as team work, updated knowledge, evidence based medicine/ medical guidelines and medical algorithms awareness, communication skills, personal appearance, empathy, bed side manner, advanced life support skills, consultancy of a senior doctor on an emergency etc. 

The med schools quality needs to be improved as well. All medical schools, except the 1 in Athens, need to close for 10 years, because they produce hordes of new doctors in a country that in over congested with doctors (more than 60.000 doctors for a country of 10 million citizens!). Also, the universities shouldn’t accept a single student from other foreign universities (especially the ones from Eastern Europe). 

About the ambulance system, it also needs to be improved and to be organized in all the cities (not the major cities as today); the ambulances should be better equipped with all the necessary medical equipment and all the necessary emergency drugs.

Also the ambulance EMT (emergency medical team) need to be better qualified with seminars and lessons in order to have the skills to deal better with emergencies. Perhaps following the USA model, where EMT can provide advanced medical treatment, is a good idea. 

Finally, the question is when all these will happen and by whom. All these years, all the Greek governments did not mind to improve the Greek national health system. Today the Greek Health System (E.S.Y.) is 30 years back, from other modern countries national systems. Also, Greek hospitals and the public medi – care & pension system has very high debts from frauds that have stolen the public funds. Isn’t it time for things to improve?

 

NOTE

The writer in order to support his notions in many issues over exaggerates. This text is subjective and contains the personal opinions of the author which the viewers aren’t obligated to accept. Much information mentioned is taken from media reports, and their reliability cannot be completely assessed. The viewers of this article are requested not accept a priory any information and opinion written in this text if first they don’t ascertain it from reliable recourses such as newspaper articles, books, TV and web reports etc.

 

NOTE

This text was send as a complaint to the European Union (commision) and also was sent to be published at international media.