Greece should focus on doctors’ training, says top epidemiologist Dimitrios Trichopoulos

It looks like we getting some value for what we pay our doctors. Indeed, these past few years we have noticed a rapid decrease in mortality rates in Greece. This is a happy development, though it also could create social problems in the long term for the management of retirement plans and health services. At this stage, though, prevention is vry important (in monitoring conditions such as high blood pressure, high cholesterol and obesity), and it doesn’t cost much. The evolution of technology itself essentially created a need for these applications as preventive medicine has become very effective. For example, there are so many treatments available to help prevent heart attacks, including medication and surgery. Heart attacks used to kill one in three people. Now, they kill one in seven. We also have effective medicine for high blood pressure and hyperlipidemia [excessive presence of lipids in the blood]. Progress has been explosive. Of course, after age 65, even if you cut mortality rates in half, it won’t mean a person will live many, many years. To do so after this age requires significant economic investments. Increasing expenses The problem though, is that the resources aren’t there. In America, total spending on health is at 15 percent of a very big gross domestic product (GDP). In Greece, we have a much lower percentage of much smaller overall revenues – that is without counting what is paid under the table. But in matters of health, where people will go to great lengths, the pressure of rising costs will be constant. What, then, is the problem in public healthcare? Public healthcare is not too bad in Greece. But the healthcare system hits a snag on well-known problems, such as poor cooperation between public and private sectors, hospital management, and the fact that we cannot know what is happening financially with patients – because of those under-the-table payments, which are painful for patients and which are almost impossible to factor into official statistics. Also, we have gotten used to enjoying good health, but we haven’t considered how the everyday Greek’s health profile has also changed: He is fatter, he doesn’t exercise, he smokes. These are facts that call for preventative measures. The cost of healthcare is hard to bear and isn’t covered by most insurance companies, even in an urgent case. For example, it costs 3,000 euros for two hours in the emergency room. What are your comments? The insurance system, public or private, could allow people to choose and face (realistically, though) the requirements of whichever hospital they select, public or private. It’s true that the private insurance sector has developed considerably. Some say that’s because it offers good hospital care. Others attribute it to the good hospital rooms there, and still others say it’s because of the attention the staff in such institutions show their patients. There seems to be a tendency in the private sector to select relatively mild or pre-scheduled cases, leaving the public sector to deal with serious cases and emergencies. There should be quality control everywhere so we can understand what all hospitals offer, especially when diagnosing patients. In such a comparison, it’s easy to see if hospitals in either the private or public sector are indeed efficient. My impression is that they are good – both the good public and the good private hospitals. But this must be substantiated. Quality of doctors Are there, in fact, good and bad hospitals in relation to doctors? It is true that patients here do not feel as secure walking into any public hospital as patients in, say, Sweden would. That’s why we see gurneys substituting for hospital beds. The point should not be the abolition of guerney use or telling the hospital management to stop taking in more patients if they don’t have vacant beds. To get to the root of the problem, you must ensure that patients feel safe at whatever hospital. The question then becomes the quality of doctors as well as the equipment in the hospital. And if the standards of the equipment depend on state funding to hospitals, then the standard of the doctors is an explosive issue, which leads back to the quality of their education. The best doctors in Greece can easilly hold their own againt the best doctors in any other part of the world. But, we also have a category of doctors that, due to the problems inherent in our educational system, do not meet the requirements to practice. You can’t be sure all doctors are good. So this creates pressure on the other doctors and their hospitals, which, naturally, cost more and have waiting lists… The state has two responsibilities: doctors’ qualifications and their bedside manner, in terms of their financial demands on their patients and their overall treatment of them.

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