Where to go when doctors can do no more

A month ago, M.D. was diagnosed with advanced cancer after undergoing tests at a major Athens hospital. The consultant told her family that the hospital could do no more for her and that she would have to be discharged. No further information was given to her children about where to turn when their mother’s condition deteriorated. Usually, in these cases, patients are referred to a palliative care unit, which monitors their condition and provides pain control as well as psychological support. However, neither M.D. nor her family members were provided with any such information. «We were given some medication to ease her stomach pain, and told that later she would need ‘further treatment’ but were given no more details,» said her daughter Katerina. «At the time, we were so upset taking in the news that we didn’t think to ask.» A pensioner, M.D. is insured by her state health fund; she has no private insurance or other resources apart from – and fortunately – whatever her children are able to provide. Her daughter Katerina made an appointment with her attending hospital physician and asked whether he would be available for consultation as her mother’s condition deteriorated. This was where she made a mistake – in her distress at the thought of what lay ahead, and partly prompted by urging from acquaintances, she did what thousands of other Greeks do in her position – she offered the doctor a «little envelope» (an unofficial payment in hope of better attention), which he took. Unfortunately, it did no good. A week afterward, when her mother began suffering severe back pain, Katerina called the same doctor, but was given short shrift. So she did what most people are forced to do in a country with no system of local general practitioners, and called for an ambulance. The hospital where M.D. had been treated was not on duty that day, so she was taken to another. They had to go over her condition again with the doctor on duty, who gave her an injection of a painkiller and sent her home after taking an X-ray of her back. «Not only my mother, but other elderly people who are very ill have to wait their turn in a crowded space while a kid with a sprained ankle is treated,» said Katerina. Back home, they later found a sympathetic private practitioner in their neighborhood, but the family was not able to afford her services over an extended period and she could not be on call at all hours. Fortunately, a friend directed them to the Pain Control and Palliative Care Unit of the University of Athens School of Medicine. Housed in a four-story building made available by the Jenny Karezi Foundation, the unit includes a day-care center, an outpatient unit, research room and seminar-education area. Patients receive help on many levels, its director, Kyriaki Mystakidou, told Kathimerini English Edition. «We treat patients with any chronic illnesses that have symptoms, not only cancer, but others such as diseases of the central nervous system or arteriosclerosis. We have some patients with multiple sclerosis and just a few with AIDS. These patients have many different needs, and what we provide is an interaction between symptom control and psychological support. Palliative care is more than just pain control,» she explained. Patients are usually referred by the hospitals where they have been diagnosed, but this does not always happen, as in M.D.’s case. All treatment and palliative drugs are free of charge and the center refers patients for tests. It does not provide hospice services, but there is a day clinic. Help is available 24 hours a day by telephone. «We were lucky – we have put ourselves in their hands,» said Katerina. «We feel reassured, particularly now that my mother has started having some symptoms. Before, I used to panic but now I have someone to call who knows what to do. We are given mobile phone numbers to use after hours, but they have informed us so well that we are prepared for every symptom that might appear.» Mystakidou said that while the unit could use more staff, no one is turned away. «We see about 20 patients a day and get about 70-80 telephone calls a day from people seeking help,» she said. It is a far cry from the overcrowded, overused outpatients’ departments of major hospitals, which are fortunately not the only option open to those in pain.