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| Miranda Mason Class of 2019 |
I was overjoyed when I was accepted into the Atlantis Project, a program designed to send students from the United States to countries all over Europe and parts of South America and New Zealand in order to shadow doctors in different healthcare environments. I was selected for placement in Athens, Greece, the origin of western culture, where I could shadow doctors in public and private hospitals. As a future doctor pursuing a political science minor, this was the ideal opportunity to see how a socialized healthcare system worked, and more specifically, it was a time to see the system during an economic crisis. After all, if a system is going to last, it has to be able to survive difficult times. Most importantly though, I wanted to see how patients and doctors benefitted or were disadvantaged by the system.
Having seen the public healthcare system in Greece, it is clear there are flaws: doctors are often overworked, and the patients’ wait for care is often very long. The public hospital I visited, Evangelismos Hospital, was crowded, and some of the equipment was old. Sometimes supplies were hard to come by. There was an obvious contrast from the private hospital, Iaso General, where there were nowhere near as many patients, easier workloads for the doctors, and more advanced equipment. Iaso was very much like one of the standard American hospitals, which are also private. The previous observations are plain fact, but now I will divulge details that are based on my interpersonal relationships with hospital staff and common people of Athens and on observations of general trends in the hospitals.
I believe that Evangelismos has a fresher outlook on medicine. The public hospital may
be chaotic, but it is a beautiful chaos. Why is it beautiful? Simply, anyone can go there. Any
Greek citizen can walk into Evangelismos and be treated as an equal. It’s very democratic in that manner. No person has to suffer without treatment. Yes, treatment may be slow in coming, but all emergency treatments are administered immediately. The first question patients are asked is not “Do you have insurance?” but rather, “What is the problem? How can we help?” Evangelismos is also a teaching hospital, where residents can take part in procedures and treatments in a hands-on way that alleviates the strain on doctors and acts as a trial by fire, which prepares them to be doctors. Of course, they are not paid as much (proportionally) as doctors in the United States, but their schooling is free.
Allow me a tangential moment to discuss Greek medical education, which is similar in many ways to those of several European countries and various others around the world, such as Cuba. After the equivalent to American high school, Greek students may take an exam meant to measure their intellectual aptitude to attend medical school. If they do extremely well, they can enter medical school, which is six years long and paid for by the state. The first couple of years train students in the science courses that are required in pre- medicine programs in the U.S. The next years they learn what U.S. medical students would, followed by similar clinical rotations. After they have completed medical school, students are usually required to fulfill a year or so in which they devote themselves to the good of the state by performing physician duties within the military or rural areas that need doctors badly. Finally, after repaying the debt they owe to their country for their education, Greek doctors can go on their way, choosing whether to remain in a public hospital as a physician, take part in a fellowship and become a professor, leave the country to practice abroad, or take a job at a private hospital where they will only treat those patients who can afford to buy private insurance.
At such a private hospital, doctors will make more money, treat fewer patients, and have more resources to do their work. Doctors take on fewer duties at hospitals such as Iaso, but tend to be more experienced than public doctors. Of course, doctors in those hospitals can be very competitive. I recall shadowing one cardiologist who told me he knew his fellow doctor had missed a key piece of evidence that would allow him to properly diagnose a patient. I asked if he was going to tell this to the other doctor, and he said that he would never do that, because he worked too hard to gain his knowledge to give it away to someone who wasn’t doing his job correctly. I felt uncomfortable with that, and asked him if it seemed to him that he was going against the Hippocratic Oath by not sharing his knowledge in order to help the patient. He assured me that he felt justified, but after a moment of seeing my look of disdain, he said, “Perhaps I’ll give him just a hint,” and he circled a piece of data and scrawled a few words on the echocardiogram before sending it in the report to his fellow cardiologist.
This selfishness of knowledge was not to be found in Evangelismos, partially because the way departments of the hospital operated allowed doctors to obtain just as much credit for their work but while working in teams. In the Intensive Care Unit, for example, each morning the physicians gathered together to discuss the patients they had viewed the day before. They discussed what symptoms could mean, and what treatments had been and should be administered. At times, meetings could get, admittedly, very heated, as they would argue for which treatment was best. Finally though, the most experienced professors would explain why they believed one or another doctor was most accurate, and after doing so for every case, the doctors would part and go to care for the patients they were each assigned. It was very interesting to see this huge difference between a public teaching hospital and a private hospital.
Of course, the differences between private and public hospitals were not the only differences I registered. I also became aware of many differences between how Greek culture shaped medical practice as compared to American culture. In many ways, Greek culture is much more family-oriented. For this reason, individuals rarely have living wills to dictate how they would like to be treated in a life or death situation. Instead, in case a patient is incapable of making decisions for themselves, their treatment options are always chosen by family. If they had opted to donate their body to science or to have their organs donated, their choice doesn’t carry any real weight. Of course, patients leave their trust in the hands of doctors more than even their families. When I was shadowing in oncology, I asked the nurse I was with a question about chemotherapy that she was administering. She gave me a nervous look and said, “We don’t say cancer or chemo. We just say they are receiving therapy.” Apparently, some patients only know they have cancer, but not necessarily what type and stage. I was extremely confused to hear that, but Greek doctors realize the power of the mind, and thus try not to dampen the psychological effect on healing by allowing patients to dwell on the extremity of their disease.
Personally I’m not a fan of leaving a patient out of the decision-making in their treatment, but it is common in both types of hospital in Greece. I am fonder of their policy for children’s and women’s health centers. Hospitals which specialize in obstetrics, gynecology and pediatrics are separate from general hospitals. While I did not get to visit those, I think it is quite logical that children, pregnant women, and women who may be preparing to get pregnant can receive treatment away from the infectious diseases and stronger bacteria that are prevalent in general hospitals. Not to mention that it makes having children much easier for a woman, who can go to the same health center for sexual health advice, fertility advice, prenatal care, labor and delivery, and finally to have her child cared for if he or she becomes sick. It is a very convenient set-up that is beginning to appear in some American cities, and I would actually prefer to work in such an environment when I’m a doctor.
Since I came back to the United States, people have been asking me how the hospitals were, and wondering of course, if America is better. America has very good healthcare, if you can afford it. If you can’t, you get very little assistance from the government. Then, many people, rather than pile debt on their families, choose to suffer, and sometimes die. In Greece, sometimes healthcare takes longer to receive, but everyone can get it, and have a chance at tomorrow. Many Greek doctors are not compensated well, but they can choose to work their way up to a better compensating job, perhaps in a private hospital that is equivalent to one in America, leaving their positions open to younger physicians to work their way up too.
Miranda Mason is a sophomore McConnell Scholar studying political science and liberal studies at the University of Louisville.