The number of institutions providing health care in Jeddah has been rising steadily. While this comes as a relief to the general public and to those suffering from a variety of diseases, it seems that the increase in the number of hospitals and clinics has not reduced the pressure on doctors who have to cope with seeing a large number of patients every day, nor has it led to an increase in the personal attention patients receive from their physicians. There is a also a widespread feeling that some of these medical institutions are merely out to make money, and that the first question that a person is asked upon entering their door is if he or she is covered by health insurance. Some feel that tests are prescribed and administered just to increase the size of the final bill. There are medical institutions whose owners want doctors to see as many patients as possible. While some doctors resist this, there are others who are only too willing to toe the line and oblige. The pressure of the owners plus the sheer number of patients that doctors see often results in what can be called superficial attention, lack of guidance and inadequate briefing of patients, which can lead to serious medical situations. Given such a state of affairs, which it should be stressed is due to a variety of reasons and not necessarily to a doctor's incompetence, patients have to look out for themselves and be on their guard at all times. Mahendra Shah, an engineer, told Saudi Gazette that he went to see a doctor because he had been feeling a bit weak and exhausted. “So, I got an appointment with a doctor. He said it was a liver problem. I was not convinced, so I went in for a second opinion. The other doctor came up with a heart problem. Of course, all of this worried me no end. The third doctor was very aggressive. He said I had a kidney problem, which could only be solved by removing it,” said Shah. Shah said that he told the doctor that he wanted to see another specialist, but the doctor would not allow him to leave the room unless he signed a letter saying he was leaving on his own account and at his own risk. “I had no other way out so I did what he asked. It has been more than seven years now, and, thank God, I haven't had any of the problems that the various doctors diagnosed,” he stressed with obvious happiness, and added, “It was just a simple case of overwork and fatigue.” In another case, a physician asked a woman patient to have a Doppler Study done, which was not available at his clinic. He wrote on the request form: “Doppler Study legs.” There was another word before “legs” that he had cancelled out. “My husband went to the hospital to check on the request for me and straight way headed for the laboratory, because most of the tests involve the labs. They asked him to go the to the X-ray department, which in turn directed him to the ultrasound section,” said Muneera Abdul Muneem. The lady at the window asked if it was a unilateral or binary study – meaning for one or both legs. “My husband came home because he did not have the doctor's phone number with him. He called the doctor and asked if the test was for one or both legs, and he went to the hospital again the next day and told them that it was a binary study,” she said. The lady at the window said that was not clear if the test was for the arteries or the veins. “This time my husband had the doctor's number with him. ‘It is for veins,' the doctor said, and commented, ‘It looks like these people are new at this,”' she related. The husband said he found the doctor's comment very shallow. “To me these people were doing a good job – making sure what exactly was needed. Personally, I believe it is a doctor's duty to brief the patient about the test, and where exactly to go for it. That can save a lot of time and tension. Also, this makes the patient feel comfortable and confident, which is an important part of the doctor-patient relationship,” he added. He said another thing about that particular physician was that after his wife took the test and the doctor was shown the report, he asked the patient, what medicine he had prescribed to her before. “I wonder what the patient's medical files are for if not for noting all the details of the visits to the doctor,” the husband asked, and added, “When we came home, I saw that the medical report was in the envelope. I think the doctor should have filed it in my wife's medical file for future reference.” A similar incident was related by Shaukat Azmi about his visit to a dentist because of a toothache. “Without any explanation or briefing as to what he was doing and what I was supposed to do, he tried to put an X-ray film on that side of my mouth where the aching tooth was. It was quite painful, which I could not bear,” Azmi said, and added, “He did tell me that he was going to take an X-ray, but nothing more. Instead of forcing the film, which hurt, had he told me that I should press and hold the film in that particular place, it could have been accomplished without pain.” Later, the dentist said cleaning of the teeth and gums was necessary, but again did not explain what the procedure entailed. “Again there was avoidable pain as he wielded the ‘drill' with pressure, and without giving me an opportunity to spit out the accumulated water, which went into my stomach with whatever particles had been removed from my teeth,” said Azmi. According to him, at one stage the dental nurse, who was attending, laughed saying “he is swallowing everything”. “In the absence of being given an opportunity to do so, I was scared to make any movement for fear of being harmed,” he explained, and added, “As it was, one tooth had been loosened because of the hard drilling. Then another. The dentist said he would fix both, and did so in the next sitting, by wiring them. But I don't think that is the same as having them rooted naturally.” He said that personally, he had nothing against the dentist. “I think he was doing his best, and I consider what happened to have been just an accident. All I can say is ‘doctor heed thyself' because I think he is a capable dentist, but just has to be more careful and caring,” he said. Azmi recalled that many years ago he had undergone surgery at the National Guard Hospital. The doctor briefed him very well as to what the procedure entailed. “He told me that if I felt any pain or felt unusual at any stage, I should signal with my finger or hand, and he would stop. That was very comforting and reassuring,” Azmi said. Extreme cases of carelessness can lead to medical mistakes with serious consequences. According to a report by the Ministry of Health, more than 26,000 medical mistakes took place in the Kingdom during the 2000-2006 period and the largest amount of money paid as compensation for a medical mistake was SR800,000. In view of such eventualities, medical professionals are increasingly responding to the Health Professions Practicing Law issued three years ago. Article 41 of the law makes it mandatory on all physicians and dentists to obtain a medical malpractice policy covering possible errors and omissions while doing their work. The Saudi Commission for Health Specialties' has decided to link the granting of licenses to physicians to the purchase of medical malpractice insurance policies. Medical malpractice insurance provides a mechanism to indemnify those exposed to medical malpractice by up to SR1 million. Insurance also helps expedite settlement of lawsuits related to medical malpractice. In 2007, a total of 323 convictions for medical mistakes were registered in the Kingdom. The Ministry of Health, however, said the convictions represented only about 1.6 percent for each 100,000 people in Saudi Arabia while the ratio of deaths resulting from medical mistakes was around 0.5 percent for the same number of people. According to local newspapers, the ministry admitted its inability to closely follow up or assess the performance of the private health sector due to limited resources. The report called for supporting its various departments with more doctors, dentists, pharmacists, technicians and other personnel.
