Where the two are fighting – the patient loses
Fr. Marek Łuczak talks to Bolesław Piecha – the chairman of the Seym Health Commission
FR. MAREK ŁUCZAK: – On 11 January the Health Commission was discussing the changes in the Refunding Act and today (12 January), the marshal of the Seym Ewa Kopacz demands a report. Why is such a rush?
BOLESŁAW PIECHA: – I think that on the coalition and government side we can notice pressure to get rid of any inconveniences quickly connected with the new law. In this case the rush is a wrong advisor because it looks that by solving one problem (although, unfortunately, not completely), we open a vast field for conflict in another place; because doctors have not been pleased till now and now we can hear about the discontent among apothecaries, as the law is constructed in such a way that it resembles a system of connected vessels: if we add some liquid to one container, the level of the liquid rises also in another one. So there were attempts of softening the tension of the doctors’ environment, not completely fulfilling its postulates, however it cause the growing discontent among apothecaries who became the so-called boy exposed for beating at present. Personally I feel sorry that the whole commotion has additionally a propaganda dimension. Legal acts do not prove that the government is doing something but excuse the social life. And in the case of the refunding act it is about assurance of health security of Polish patients.
– Doctors were protesting, to whom apothecaries acceded now. What doesn’t this social group want to agree with?
– So far we have been dealing with an attempt of giving impracticable duties to doctors, whereas, at present, the whole responsibility for shortcomings is put on apothecaries. Certainly, here it is about the financial responsibility, which has an additional significance in the case of this social group, because we often deal here with small family companies and some conglomerations. Many pharmacies function in small villages and lots of work is needed to keep them. And today we deal with such a situation that there are no pharmacies in some communes, not mentioning even countryside. In this case punishing with fines resembles draconian law and an additional problem is the fact that even if a punishment was justified in particular cases, so, according to the law – apothecaries would not be able to appeal against it.
– Doctors do not want to be checked and nor do apothecaries. So, how to control the common budget? How to seal the system?
– Certainly, we will not do it through introducing senseless punishments. The law punishes for impracticable things. Let’s imagine the following situation: a doctor prescribes an antibiotic which is described in a big document placed on websites. According to this description, the medicament is supposed to be applied for ear, throat or kidney inflammation. However, it turns out that an ill person is suffering from the inflammation of urinary bladder. However, if the antibiotic is effective in the treatment of the bladder inflammation, the doctor will surely prescribe it, because, first of all, its treatment should be effective. Unfortunately, according to the defective law, if this antibiotic was not mentioned in the description that it should be prescribed, in this situation there would be a reason for punishing the doctor.
– So, such regulations are aiming at absurd...
– There are more such absurd situations. For example, apothecaries are punished for such faults as a not properly written number, which should be on the right side, whereas it is on the left side because there is not enough space.
– So, why are these ridicules?
– It is probably connected with creating a possibility in case of the lack of money. It will always be easy to find a blamed doctor who prescribes medicaments in a wrong way or who prescribes wrong medicaments. Punishing doctors with a fine will help to save the budget. The essence of the doctors’ and apothecaries’ protest is that fact that fines are used for matters which are not possible to do or a situation is caused in which the first and the latter ones are forced to practices contradicting with the common sense.
– However, if a doctor’s qualifications are higher than demanded, how to punish him?
– A doctor should be punished for bad results of treatment but not for what he prescribes. If a doctor has higher qualifications than demanded, and prescribes a wrong medicament, so, according to the binding law, he undergoes strict punishments, including depriving him of the right to do his job. In addition, there is a possibility of judgement. However, there should not be senseless punishments here.
– And maybe the scale of bad practices or even unintentional faults is so high that there appeared an idea of penalisation.
– That is not true. In Poland there were not any scandals of ‘dead souls’ as they had taken place in Germany where reimbursed medicaments were prescribed for not living people. There were not any scandals in pharmacies either. The National Health Fund controls the market and even if faults happen, they are very occasional. So, if the idea of introducing punishments for pharmacies is a consequence of irregularities determined in nearly six cases in Poland , then I say ‘no, thank you’. We are protesting against the lack of logics and against vexations towards medical and pharmaceutical environments.
– We have been asking the question about a reform of medical service for years...
– Unfortunately, this question is still valid. We have an insurance model, which, in fact, is not an insurance model. The constitution says that everybody has an equal access to medical treatment. If a homeless or unemployed person gets to hospital with appendicitis, the person must be operated. So, the attempt of identification of insured people is senseless, if a doctor must give help such people, anyway. We have not decided on such systems as in Switzerland, Norway or Denmark where it is obvious that everybody citizen in the country is a patient whose medical treatment is paid by the country. The ordinary Social security numbers, and ID card would be enough here.
(AA)
"Niedziela" 04/2012