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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 233-234
In Response to Doctor's Diary Article


Kanoo Kidney Center, Dammam Central Hospital, PO Box 11825, Dammam 31463, Saudi Arabia

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How to cite this article:
Karkar A. In Response to Doctor's Diary Article. Saudi J Kidney Dis Transpl 2006;17:233-4

How to cite this URL:
Karkar A. In Response to Doctor's Diary Article. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2019 Nov 18];17:233-4. Available from: http://www.sjkdt.org/text.asp?2006/17/2/233/35799
To the Editor:

Dear Sir,

I read with great interest the Doctor's Diary Article "The Strong Territorial Instincts of Doctors" Saudi J Kid Dis Transplant, 16 (4): 603-605, 2005.

I think there are a few important lessons that can be learnt from this experience. How­ever, I believe the most important of which is that "wherever you struggle with a decision, think of yourself in court being asked to justify your decision by a judge or a coroner about why you did this or did not do that".

In my experience, it is true that the "Territorial wars" are more common than what we think. There is always an excuse to shift the patient from one specialty to another; every specialist or consultant is happy to shift and follow up the patient in other subspecialty section, but not to admit in his own allotted section! Surprisingly, neither the patient health status nor the rarity of the medical condition would help or excuse for accepting the patient!

This attitude in west may be explained by the large number of admitted patients and the lack of inpatient beds, and/or occasionally due to the attitude of some of the consultants! In comparison with this part of the world, this may reflect the frustration and fear of some of our medical staff in private and public health sectors.

Medical staff working with the Ministry of Health ( MOH) are exposed more to stress, as their priority is to run services in the presence of shortage of staff, see patients in overcrowded clinics and do their best to avoid patients' complaints, whereas quality comes at the bottom of the list. They enjoy the least back up supportive medical services, few well qualified and experienced staff in other subspecialties, less equipped and updated medical libraries besides the lack of adequate recreational facilities. In fact, their income is amongst the lowest, while the load of work is among the highest. Their requests of new medical tools and equipments, and/or adding new drugs may take long time to be approved and delivered. The processing of their official documents, by administration, takes ages to be done. They are frequently asked to be active members of different scientific and admini­strative committees, work extra hours, write up policies and procedures for their departments, report on or investigate a medical complaint, take part in surveys and administration and cover the work or duties of other resigned or on holiday colleagues without any extra payment or- even appreciation.

Ironically, the staff of the MOH would be severely humiliated and punished if they had committed trivial errors. In fact, the follow up and investigation departments find no excuse or consideration; any of the medical staff has to be investigated and questioned in writing, despite their good previous medical records and achievements, even if the complaint against them is fictitious!

Despite the vital role of the medico-legal committees in protecting the patients and the public from malpractice of some medical staff that lead to malfunction or loss of an organ or cause death, they bound to prevent the accused staff from traveling, except in the presence of a sponsor, until the full investi­gation of a medical complaint has been completed. This may take several months to be resolved. However, the crucial issue here is the persistence of the committee to pursue its course, with the continuous restrictions on the involved staff, in spite of the lack of evidence for the allegations or the clear personal aim of the complaint from the results of the initial investigations. The worst bit is that when a medical staff has been proven innocent, sadly there is no compensation for the humiliation or the defame!

Obviously, there is no wonder that this status would leave most of the medical staff frustrated to develop the standards of medical services, less enthusiastic to hold responsi­bilities and unwilling to accept critically ill patients under their direct responsibility.

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Correspondence Address:
Ayman Karkar
Kanoo Kidney Center, Dammam Central Hospital, PO Box 11825, Dammam 31463
Saudi Arabia
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PMID: 16903636

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