Saturday, November 21, 2015

One Bout of "Pneumonia"

One Bout of “Pneumonia”
A
Viewpoint on Quality of Service
And
Private vs. Government Management


        It all started in September, 2015 when I had a persistent cough which I thought was only an allergic cough which persisted for weeks. I am a dialysis patient at the Regional Hospital of  Gov. Celestino  Gallares (GCGMH) for four years  now and I had one bout of pneumonia since last 2012. I had no fever and my body is functioning normally aside from my cough so the doctor assigned at the Hemo Dialysis Unit (HDU) finally decided to conduct a thorough listening on my lungs and said that she heard something on my left lung and prescribed me with an anti-biotic which I deliberately took as prescribed. My condition did not improve and the other HDU doctor (the former doctor was reassigned) conducted another thorough listening on my lungs and again said that my left lung is “noisy” and suggested that I should have chest X-Ray. As an obedient patient, I had a chest X-Ray on October, 2015 at the Ramiro Hospital. The result said that I had pneumonia at my left lung and my right lung is “clear”. The HDU doctor was informed and she prescribed me with more potent anti-biotic to treat the infection. I trusted the doctor more since her diagnosis is “right”, but I told her that I do not feel anything in my left lung, instead I feel something in my right lung and I also have pain at the right side of my back. The HDU doctor replied “how do you know?” I was taken aback by her authority and decided not to reply back. I could have told her that I feel that my sputum is coming from the right lung and I feel that my right lung is sore. After taking the prescribed anti-biotic, my condition improved a little bit but I still have a persistent cough so the HDU doctor advised me again to have a chest X-Ray so that she will know if she will prescribe me with a broad spectrum anti-biotic. So I had again a chest X-Ray on November, 2015 at the Ramiro Hospital and the result said that I still have pneumonia of my left lung but it is improving and my right lung is “clear”. This time my wife and I decided to consult our pulmonary specialist who is also our family friend. We showed the X-Ray plate and the result and upon examining the plate, he said that I have no infection on my left lung but my right lung showed some cloudiness. He said further that probably what the radiologist saw in the left lung as pneumonia is actually a “thickening” of tissues as a result of my last bout of pneumonia in 2012.  We were amazed by his findings and realized that all the time the HDU doctors have been treating my left lung which have no infection and it finally turned out that it was my right lung which need to be treated. What is most amazing is the result of the two successive  X-Rays which showed that my right lung is “clear” and have no infection. The radiologist and the HDU doctors simply failed to see the true condition of my right lung which the pulmonologist easily saw. How come that this has happened? After having laboratory tests of my blood, our pulmonary doctor friend concluded that I have no more infection and prescribed me with anti-allegy tablets. If I did not consult a specialist, I could have been prescribed with more potent anti-biotics  which could have affected my liver. I also concluded that the patient is more sensitive of his condition and the doctors could also be mistaken with their diagnosis.

         The question now is: who should have an “eagle” eye in reading the X-Ray plate, is it the Radiologist or the Pulmonologist? It should be the Radiologist since he has specialized in reading X-Ray plates while the Pulmonologist has specialized in diseases of the lungs. I could only surmise that due to the busy schedule of the Radiologist, he is quick to decide that the interstitial infiltrates which he saw in my left lung is pneumonia and the rest of the lung fields are “clear” and he decided to stop to carefully scrutinize the cloudiness in my right lung. He could have concluded that anyway the patient will be treated with antibiotics which will affect the left and right lung. I cannot blame the Radiologist because he does not know my medical history, but he should have been more careful with his X-Ray readings because these could result to incorrect diagnosis that could endanger the patient’s life. In my case, what if I had no lung infection and it was only an allergy; and because of incorrect diagnosis I was treated with strong antibiotics that could have affected my liver. I am a dialysis patient and it is my liver that takes care in eliminating toxins from my body. If my liver is damaged, I would die because dialysis alone is not enough to keep me alive. No wonder, even doctors in Tagbilaran City are more confident to have their medical check-ups in Cebu City rather than in Tagbilaran City to avoid incorrect diagnosis.

        It is here, that quality of service plays a vital role in medical institutions. The medical personnel are dealing with their patient’s life and they should be fully qualified or re-qualified through further trainings to perform their tasks. This is the modern world and what is applicable in the past may not be applicable today and nurses, doctors and radiologists are sent to seminars to update their skills and knowledge to be more competent in doing their duty. Of course, dedication to duty is also important. Combining all these factors, I am sure these medical personnel can sleep soundly without being bothered by their conscience.

       The Top Management also plays a vital role in keeping their medical personnel to perform in their maximum proficiency because management is all about planning, leading, organizing and control. Be loose in one of these tasks or focusing only in some will affect the performance of the organization. Not sending medical personnel to trainings and seminars will cause stagnation of their knowledge that will result to poor performance and incorrect diagnosis that will result to aggravation of the condition of the patient and the worst, it could also mean death.

       I cannot stop comparing private management of hospitals to government hospitals because I am a patient myself and I regularly enter hospitals for treatment. Top Management of private hospitals is strict in the implementation of duties of their personnel. One complain from a patient or patients means reprimand, suspension and in worst cases even dismissal of the personnel involved, while in government hospitals, lapses of medical personnel are tolerated and you would be lucky if they get a reprimand from their supervisors and Top Management. That is why the quality of service of government medical personnel is not at par with their private counterparts. Why is this so? In my opinion, government medical personnel are regular, casual or consultants. The regulars are always protecting their position so they can have a good retirement with their lump sum and monthly pensions. For this, they should have a political rapport with their co-employees. So if a patient complains, the Supervisor or even the Chief of Hospital is very careful not to put their staff in bad light because of this political bond with each other.


      My Kudos goes to the Top Management of Gov. Celestino Gallares Memorial Hospital (GCGMH) where I am a dialysis patient. Finally, the Top Management has decided to apply for ISO (International Organization for Standardization) accreditation to upgrade the level of service that will hopefully make the hospital one of the best in the Region. This act is more appropriate to remove the stigma that government service is equal to poor service because of the wrong notion that government personnel have low salaries and should only perform according to what they are receiving. I can dream of that one day when government medical personnel are proud of their institution and they can face their patients with politeness and say: “You are most welcome sir/madam to our hospital which can provide you with quality service” and not to utterly say to patients: “If you are not satisfied with our service then go to private hospitals. This is a government hospital, what do you expect from us?”