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Conflict of Interest in the ER…

November 25, 2010

I entered the cab near the hospital I work at heading home. A couple of minutes into the ride, the driver, a young man in his late twenties or so, asks me: “A doctor at the hospital?” “Yes, but I’m still new, a fresh graduate.” I answer. He looks at me and says: “Man, God help you on your work!” “Why?” “That place is a butchershop (masla5)…”

For those of you who the state of public hospitals in Jordan, this should not come as a big surprise. Clinics are super-overcrowded, doctors are overworked, stress levels run extremely high, all of which lead to suboptimal healthcare at best. I actually found that the word butchershop (masla5) is a fairly common, and apt, description among the people I meet; that driver was certainly not the first person to mention it to me.

“It unfortunately is.” I respond, not wanting to totally speak my mind. He then goes on: “The other day, my nephew hit his head and cut his face right here…” and he points to the area above his right eye. “So we went to the ER (in the hospital the one I work at) and got his face stitched, the doctor was in a hurry and in the end it was ugly. The kid’s face was ruined! So next day we went and got the boy’s stitched up again by a private doctor, and we returned to the ER and beat the doctor up.” (Spoken in a peacefully nonchalant way, I might add)

Knowing the situation the doctor must have been going through working in that notorious emergency room, I knew that it is not necessarily his fault. I said that the doctor might have been really stressed, with huge numbers of patients to follow. I said that patients, with the tough situation they are in, might act as if they’re the only people the doctor has to see, without realizing that there are tons of patients waiting. He then interrupted me:

“A doctor should treat the boy like he treats his own son.”

This got me thinking, and honestly, I didn’t find anything to say. Could it be this simple? Should doctors just treat patients like their mothers, fathers, brothers and sisters? I know that if take my little brother to the hospital, I’ll make damn sure he receives the best treatment. Shouldn’t we do this to everyone?

Later, it struck me that it is not that simple. Nobody can treat customers like family; I could have told him to treat his passengers like family and not take fares from anybody, but we all know he can’t do that.  By the same token,  that doctor couldn’t have treated every patient like a close one because he will never be finished.

Ideally, a balance between the numbers if doctors and patients should be maintained so that every patient receives the attention he deserves, but as it currently stands, I don’t think there is any other solution. What do you think?

And as one of the doctors told us once: “When a fight erupts in the hospital, take off your white coat and run! (Ekwi was the word he used actually)” 🙂


From → Life in Medicine

  1. Will, you know what, Stalin once said “you kill one person it’s a tragedy, you kill ten thousand people it is a statistic.” Add to that “eno sh3abak bagar” who do not understand that a doctor’s job is not easy and you can really feel the burden you guys face, not to mention what you already mentioned =)

    2 weeks ago, I had a secondary infection, and my neck was enlarged, so I went to see a doctor (he is a prof at JU named Musa Al-Jamal, so you may be know him) anyways, while waiting for my turn, a guy came with his kid, an infant, he was in the ER in Jordan Hospital, and they refused to admit the kid because the man’s health insurance covers fees in certain hospitals only, so the man went up to see the doc, and wanted to show him the infant without paying. Now, I am not sure what happened, but he started quarreling with the secretary, so I went for a walk outside, because I don’t like hearing people quarreling.

    He obviously was kicked outside by the Prof. because he was very rude, throwing empty threats which irritated all of us at the clinic, and killed any chances of the doctor helping his kid for free. But I think that we all are entitled for a good quality health care, I really felt sad for the infant, but the dad should have been more polite, docs are humans after all… Yalla, Allah b3enko Doc 😉 no body appreciate what you do, but if you did a mistake, you will find a whole tripe waiting outside the hospital for you!

  2. haitham permalink

    U know Ehab, it`s almost in EVERY public sector/domain! Sadly to say of course.


  3. Haitham,

    Patients have it hard as well. I guess it’s not easy for anyone to put themselves in others shoes…



  4. hmm…..sadly everybody see the problem from his own view, the cab driver think that it will be fair to beat the doctor up , after-all he didnt do his job perfectly -as he thinks- and actually maybe he didnt ! but even so the situation is not straight forward , i dont know if you are talking about “masla5 ma ghero” but this applies to all public hospital in jordan , the “situation” is so miserable , and the first one who take responsibility for that is the ministry of health, we have a lot of new-graduated doctors, but the problem to attract them to work with the ministry of health!

    the solution is so easy , but simply “we” dont want to .

  5. W7l,

    Yep, howe el “masla5 ma ghero” the one and only, the original… The whole situation is tough on everybody, and I believe there has to be some sort of shift in the way we teach and practice medicine… but that’s another story…

  6. This is a problem that sadly, is not localized. I spent the bulk of my life working in American hospitals, mostly in Emergency Rooms. The beds were always 100% occupied, the reception area was always filled to overflowing and every single patient and family member present thought his problem was the most acute and must be seen immediately whether it was trauma, infection or a simple headache. Staff in the triage area must constantly prioritize and re-prioritize the waiting patients by the acuity of their presenting symptoms, history, etc. Once inside the treatment bays they are re-prioritized and staff who are overworked and unappreciated must do the best they can. We become somewhat “robotized” in that we enter the patient’s area, assess the situation and do what is necessary so we can move on to the next patient.

    Sadly, all these circumstances make it impossible for any physician to “treat the boy like he treats his own son.” The most basic thing everyone forgets is that an Emergency Room is not a hospital. The primary mission of the ER is to treat and stabilize emergent symptoms in order to transfer the patient to the appropriate in-house service or discharge him home, as in the boy with the cut face. It’s sad the boy would have a scar for the rest of his life, but the ER is not a plastic surgery suite. The doctor’s job was to control the bleeding and close the wound. It’s that simple.

    I’m afraid this is turning into a sermon, so I will stop at this point. I’m really enjoying your blog Ehab. I hope you will find time to visit mine.

  7. Jim,

    So it’s unfortunately an universal phenomenon…

    Thanks, and I’ll be sure to check your blog out

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