There are huge problems in medicine worldwide and this text will provide suggestions for better doctors and hospitals worldwide:

1) It is necessary to have a specific international medical literature & international medical protocols and guidelines, so that there is a guide for medical practitioners and rest scientists worldwide. I suggest that the international medical literature (in the form of books and website), the guidelines and the protocols can be organized by the World Health Organization (WHO). These international guidelines should include the ‘Good Medical Practice’ guidelines of the NHS in the UK’s system. Off course the international medical literature, guidelines and protocols should involve all specialties and should be offered in translations in all languages.  Protocols, guidelines and medical manuals of the WHO should be based on EBM (Evidence Based Medicine).

Today, each country has its own medical literature and its own strategies and there is Babel, confusion, of opinions about the same topics. An internationally recognized medical literature today does not exist. Perhaps this is for the favour of the private editor companies. For example, in a matter of General Medicine which book is better for a doctor to follow? Is what Harrison or Davidson or Oxford Handbook write? Furthermore, we can’t ignore the different prospective amongst, for example, the American or British or German school.

Which book is the best? With what criterion we consider American and British books as the best? Aren’t, for example, German or French or Italian books equally good? There is also confusion about research in a specific hospital of a specific country. For example, epidemiological studies about the use of specific antibiotics for specific diseases may be different in different hospitals in different countries (often they are different in different hospitals in the same country!).

2) To my mind the ‘real’ and most respectful doctors are the members international organizations such as ‘the doctors without boundaries’ and ‘Red Cross / Red Crescent’ doctors who often work for free or with a low compensation and offer their medical services to poor refugees, often under adverse conditions such as war. Actually great physician (doctor) was Che Guevara that we visited with his motorbike South America offering free medical services, although he had asthma ... Today, many doctors are ‘slaves of money’, as I use to say.

In ancient Greece were the Asklepieia. The ancient Greeks gave importance to natural forms of treatment such as spas. Today, the recovery time is something we need to shorten (by administering many drugs) at all cost, in order to maximize the profits of the hospitals that in many western countries are large corporations...

 
In order to have better doctors I propose that all the medical schools in the world should interview their candidates for medical school, in order to fill specific criteria to be chosen. Medicine – schools need doctors who genuinely want to help their fellow human beings and not to enrich through medicine. Furthermore, written and verbal tests are needed to choose foreign doctors in the country. This entry examination must be difficult as the UCMLEs tests in the U.S. Today we do not need many doctors, but good qualified doctors.

Very good is the UK scheme in which all the medical specialties work in hospitals and the only who can have a private surgery are the GPs (general practitioners, in the US may be known as ‘family doctors’). The rest specialized doctors are all working in the hospital! Visiting a GP in the UK is free (paid by the government).

Someone can be registered on a district GP. The GP will assess the patients’ situation and if it is simple he/she will administer appropriate medicine. If the patient’s case needs hospital care, then the GP will refer the patient to the hospital with a written note. So with the GP available free for all the system avoids the emergency departments to be overcrowded even with minor cases that could be managed simply by a GP. 

3) The ambulance crew and emergency department doctors & nurses of the hospitals often are not assessed for their performance. The emergency personnel (doctors, nurses, paramedics) in many countries don’t do their job properly, for example they may neglect resuscitation issues (especially if the patient is very old, especially with dementia, or if the patient is mentally incapacities). They often make a brief resuscitation and abandon the patient fast, neglecting him/her.

I propose, therefore, ambulances and emergency departments (EDs) of hospitals to have hidden cameras to record whether the rescuers (doctors, nurses, and paramedics) do their job properly, such as the cameras in patrol cars (patrols) in the U.S. The surveillance will minimize the risk of medical mistakes or medical negligence (malpractice).

4) The emergency departments in the whole world (including most western countries) are chaotic. It is necessary to assess the patients with ‘triage’ and categorize them from most serious cases (that need fast treatment) to less serious. When we speak about less serious cases in the emergency department, there is the classic phenomenon of many citizens who visit the emergency room of a hospital to find a doctor for free!

This phenomenon would not exist if all the countries followed the UK’s example in which everyone can visit his/her district GP (general practitioner, family doctor) for free and in case the GP finds that the patient needs hospital care, then he/she refers the patient to the hospital with a written note. So with the GP available free for all the system avoids the emergency departments to be overcrowded even with minor cases that could be managed simply by a GP. 

The biggest problem today is the indifferent (apathetic) doctors. In hospitals, the patient is a number that is a ‘burden’, since he/she ‘holds a bed’ and should quickly leave, partly because he/she costs the insurance system.  Many days of hospitalization for the patient’s recovery cost a lot in the capitalist system. Often the hospital staff, especially doctors and nurses, works overtime hours like slave who work for the interests of the hospitals that often in western countries are big corporations. This excess working time is the main responsible for medical mistakes (malpractice).

Health today is not free (only in the socialistic countries regimes health, as well as education, are free). Anyone who hasn’t got insurance medi – care is excluded from hospital facilities and is condemned to die... In some countries (often with the help of charities) they offer partial hospitalization in people without insurance. In other ones they kick them out from the hospital.

5) In many countries it is a real crime that the emergency departments (and also many clinics- departments) in hospitals are on duty of junior doctors (residents) and not under the direct supervision of senior attendant doctors. Often in many countries the junior doctors work unattended. It is unacceptable junior doctors, who don’t have the experience and knowledge, to deal with a serious medical cases and emergencies without the supervision of senior attendant doctors.

Also many doctors pay less attention in the elderly, the mentally incapacitated and the chronically ill patients e.g. on an old person with dementia often the attempted resuscitation in the clinic or the emergency department is likely to be minimal. Often doctors on the above patients neglect official full resuscitation and instead they usually do an ECG just to verify the patient’s death. All the other impressive things (defibrillation ‘shock’, adrenaline, etc.) rather occur in TV movies like the ‘ER’!

So the resuscitation in the emergency department and the intensive care unit is usually performed properly usually on the young patients, but again the young are often victims of car accidents and injuries from guns and knives, so even for them the prognosis is poor. The conclusion here is that when the doctors don’t offer a proper and full resuscitation (advanced life support) then they literally let the patient die. It’s a kind of euthanasia!

In many countries senior attendant doctors are literally ‘on call’ by waiting a phone call from their home in case of an emergency! In that case they give advice by telephone. Furthermore, many doctors who are in a hospital’s clinic are reluctant to visit the emergency department, so they prefer giving an advice by phone. This often occurs in Greek hospitals and health centres (especially in the province).

It would be better a hospital officer, or even a DA (district attorney) in every country to do often surprise visits to the hospitals and health centres in the region to check if all the doctors are attending their post in the hospital or if they have left unskilled doctors alone to face the medical problems. Also, they should check if there are shortages of medical equipment and medical supplies and in case if there is any shortage they should do the appropriate to be covered immediately.

Most doctors have the mentality of ‘the one who is to live, he/she will live’. This indicates a belief in fate, instead of doing the utmost for the patient to live. Resuscitation must be help properly in all patients, whether they are very old, or criminal, or with dementia, or with non-metastatic cancer, or Roma (gypsies) or foreign immigrants/ refugees, or alcoholics, or homeless and so on. Doctors must treat all patients the same. But they often don’t do.

A few years ago in Greece, the mayor of Patras suffered fainting episode and went to the hospital. Then the best doctors – professors and immediately found him a bed in the intensive care unit (even though in the media was reported that he had just fainted!)... The same occur with a minister who visited Alexandroupoli (a city in Greece) and fainted, a few years ago.

In many countries specialties such as ‘emergency medicine’ and ‘acute medicine’ do not exist.  In the UK, the first one is separate specialty and the second subspecialty of internal medicine. Without these specialties the emergency departments and the health centres can’t work properly.

6) The emergency departments should be fully equipped with modern equipment and a team of experienced doctors and nurses specialized in emergencies (off course the team should have a team leader) and should follow the guidelines of advanced life support and advanced trauma life support. In many countries trauma centres for adults and also children are a few or do not exist.

 
The recovery time should be short because the recovery costs the capitalist system in lost working hours! Furthermore, many tests (laboratory and imaging such as CT and MRI) are not justified by some insurance companies of the patient, although they may be necessary for the diagnosis or treatment of the patient ... This is especially true in the U.S. Insurance companies require the maximum profit with minimum possible cost. In many countries (including the U.S.) insurance companies guide health care in hospitals!

Also research in medicine today is driven by major pharmaceutical and biotechnology private institutions that manipulate medical research for their own profit (selling drugs).

7) The ambulances must be well equipped with all necessary equipment and drugs. The paramedics in the ambulances should be able to offer proper and adequate resuscitation as the U.S. paramedics do. In some countries such as Greece there is a stupid idea that advanced resuscitation can be held only by doctors, but this does not occur in ambulances in more advanced countries, nor are there so many doctors to cover all the ambulances ... Simply the best emergency system is the one of the paramedics 911 in the USA.

8) There should be international Directives on what is and what is not ‘euthanasia’. Legally, euthanasia occurs when a doctor helps a (usually terminal ill) patient to die. However the failure of providing proper medical care and consequently leading to the death of the patient is also euthanasia. But there is a moral point of view... For example, it is not moral to resuscitate someone with metastatic cancer or an elderly person with a heavy stroke or an elderly with dementia who suffered arrest.  

Also transferring the above patients to the intensive care unit (and depriving someone younger from a bed in intensive care unit) may still be considered non ethical. Of course something that is not moral does not mean that is legal.

In most countries there aren’t any legal Directives about ethical issues and the doctors are legally unprotected! However, we need international Legal Directives for ethical issues regulated by the World Health Organization (WHO / WHO) that will be followed by all the countries. Otherwise there is a risk that the physician be converted to God and to decide (as Dr. Megkele in Auschwitz) for life or death of a patient and the problem is specific on the resuscitation of the elderly, or the patients with dementia or with mental retardation or with low educational level, in which non resuscitation ‘for the good of the patient’, ‘to avoid make him/her suffering’ means that they let them die and it is a kind of euthanasia. However, without legal directives doctors are legally unprotected in most countries for such moral issues!

In parallel, there must be legal guidance by International legal Directive by WHO on when the patient in the intensive care unit can be detached from the life saving machines (that still is kind of  euthanasia). In this case there is a risk relatives who want to earn the estate of a patient (and inherit his/her fortune), to rush signing up for disconnecting the patient from the life saving equipment in the intensive care unit. However there are cases of patients who recovered from a coma several years...

9) It is essential hospital beds in the ICU (Intensive Care Unit) ICU to be adequate so as not to exclude patients (especially elderly and cancer patients without metastatic cancer) to die. Unfortunately, today in most countries beds in ICUs are few, so the doctors there play God and chose who will live and who will die. They usually leave the ICU beds for young patients.

The system uses a kind of euthanasia by condemning the elderly to die, by refusing them a bed in an ICU, regardless the fact that they paid their insurance medi – care during their whole life and deserved the best medical facilities, including an ICU bed. Also, it is necessary for many countries to establish pain clinics and palliative care units, particularly useful in end stage cancer and end other stage diseases.

10) In most hospitals the number of nurses and doctors is inadequate. However, hospitals need not only more doctors and nurses, but need good qualified nurses and good doctors, with empathy, to care the patients.

11) Finally, in some countries patients and/ or their relative bribe the doctors (especially the surgeons) in order to look them better. This is also a plague. The Greek journalist Makis Triantafyllopoulos has done a lot of research about this ridiculous phenomenon in Greece. Another problem in Greece is the manipulated prescription (probably involves most doctors in Greece) from drug companies that lured doctors with many presents (such as travels to foreign countries and kitchen equipments).

That was investigated by the Greek journalist Kostas Hardavellas. Unfortunately, apart from the two journalists, the Greek government did nothing to solve the problem. A third journalist, Nikos Evangelatos revealed a huge corruption in the supply of medical equipment in public hospitals (he found incredible frauds of overcharging the hospital equipment).

ABOUT THE PROBLEMS IN HEALTH SYSTEMS

There may be poor countries with low health system, but in western civilization countries there are many problems. In many countries, especially in the USA, doctors, especially junior, work as slaves. In their hospitals working time is ‘elastic’ and often doctors rather than 8-hour working, work in fact two and three hours extra. So they returns home late in the afternoon, have dinner and sleep. Also, doctors who are working overtime are amenable to making mistakes. In England the contract for doctors (e.g. SHO) in hospital is 6 months!

Unacceptable is the fact that in England in many medical  job applications (application forms) doctors are asked to fill in private details as if they are gay or not, if are they disabled, or about their race (e.g. Black Caribbean) and so on. It is surprising the GMC does not react to it.

The U.S. system is regulated by the insurance companies and thousands of Americans are uninsured. See Moore's documentary. If we compare health systems, then the best health system is Cuba! It is also free and is not subjugated to the insurance and pharmaceutical companies...

Problems in health systems does not exist in poor countries, but in wealthy as well. In many capitalist countries like the U.S. doctors (especially junior) work for long hours like slaves and even work overtime unpaid for the extra hours. In the U.S., the health system is enslaved to the insurance companies who decide who will live and who will die, by justifying a medical examination or an operation.

About the supposed good hospitals in developed countries, yesterday I saw a documentary about a medical condition in a hospital in England. An elderly person with abdominal pain had a computerised tomography (CT) that and proved thrombosis of his mesentery artery in his abdomen.

The surgeon who they called in the emergency room to assess the patient came with his costume (like a salesman) and said the patient that he would die in the surgery if he operated him. But he didn’t stress that without operation he would die anyway. Eventually the operation wasn’t held and the patient died. Perhaps the surgeon did not want to add that patients on the mortality statistics of his operations.  

I remembered an obstetrician gynaecologist in my university who informed a pregnant for amniocentesis and emphasized that the rate of abortion is 5% (although it is 0.5 – 1% on 16 weeks gestation, and 4% if they used dichorionic and monochorionic villi biopsy) without intoning that if case a problem in the fetus remained undetectable, the mother would be suffering for a lifetime, if the child has a disability...

Also, in countries like the U.S. and Australia, the doctors tell the patient directly his/her condition, e.g. ‘you have got cancer and you will die in six months’, though many books intone that there is a special way to inform the patient only what he/she wants to hear and what can stand to hear. The doctor should inform the patient about the disease, but if the patient does not want to hear the prognosis, then the doctor should respect it.

In conclusion, there is no international medical literature, nor are there any international standard, protocols and guidelines, for example from World Health Organization (WHO). We have split into fractions such as the European model (e.g. EPLS), the American model (e.g. ATLS, APLS), etc.

Physicians, (especially junior doctors) often work like slaves, and are completely uncovered in legally ethical issues such as if they need to resuscitate a cancer patient in cardiac arrest. The stupid books say that it is immoral to do, but there are no any legal directives on most moral issues, so the family can sue doctors.

 
The doctors working under pressure are prone to mistakes. Patients also may act with an inappropriate way. Indeed, many patients come to hospital and they say – ‘Doctor just give me some medicine’ (as if the medical practitioner is a chemist) and if their doctor recommended them hospitalization to investigate them further, they leave the hospital without even sign that they don’t accept admission. And if they die at home, the relatives sue the doctor!

Also, I remembered a doctor who went to help in a car accident, but the victim had serious injuries and died. However, relatives of the victim sue to the doctor because he failed to save the victim!

CONCLUSION

The impressive things that we see in movies (like the ‘ER’) for hospitals rarely happen in real life. Especially if you're old (and with dementia), mentally disabled or homeless, or refugee, or you belong to a minority. The system often acts with negligence and in case the patient dies, this is a form of euthanasia. After all we should not forget that the capitalist system encourages private health system that is regulated by the private insurance companies. So in the U.S. the one who does not have to pay the hospital, dies...

NOTE
Some of the information referred to the article is based on media report and thus it is impossible to verify its reliability, so do not accept a priori anything without ascertaining it from a reliable source (book, newspaper article, and internet). The author often over exaggerates in order to emphasize some things in this article.

NOTE (OCTOBER 2010)

The president of the USA announced recently that the health system in the US will eventually change and equal access to health system facilities will be available for all. However, during the economic crisis, it is doubtful how the state will found the money for a free health system.