Pediatric Primary Health Care Clinic: Another Conveyer Belt?
Muhammad Zeitsev Azman
“But also every person who comes to the ranch is in charge of taking care of someone else; whether it's cooking for them, cleaning them... or even as simple a task as listening. That makes them doctors.
I use that term broadly, but is not a doctor someone who helps someone else? When did the term "doctor" get treated with such reverence?
As, "Right this way, Doctor Smith"
Or, "Excuse me, Dr. Scholl, what wonderful footpads"
Or, "Pardon me, Dr. Patterson, but your flatulence has no odor"?
At what point in history did a doctor become more... than a trusted and learned friend who visited and treated the ill?”
- Hunter “Patch” Adams (the fake one from the movie).
The day I went to the pediatric primary care center and met Dr. Jovan
evi changed my opinions on medical care in general. I used to volunteer for Raleigh Community Hospital, which is part of the DUKE university health system, and since then have never seen more of an ‘above and beyond’ attitude towards health care. The day I walked into his clinic was a quiet day. A slow stream of neonates, babies and children filled the seats as quickly as Jovan
evi was pumping them back out. This was a sight that I was expecting; a conveyer belt type of health care much seen at the ambulantas of REBRO or any other government hospital in Zagreb.
Things were done by algorithms and formulas and at first sight; the situation was much the same and quite disappointing. However the longer I stayed, I realized that this was just masking efficiency and not the industrial line of patients that the usual public service doctors have made them into.
Dr. Jovan
evi, in his slight subtleties, managed rapport, trust and confidence in just a few sentences and not by being a doctor, but by being a person. The conveyer belt system was most probably his way of dealing with the fact that the government had increased patient quota to 1500 a month. To put this figure into perspective, a normal patient needs at least 15 minutes of personal input and investigations to obtain a minimal workup. Working non-stop, this would constitute a 12 ½ hour work day EVERY day!
With this explanation from Jovan
evi, I then realized the indifference needed when meeting each patient; the need for that conveyer belt system much seen in Croatian hospitals. Many patients do fit the industrial line criteria, especially in primary care. However, some patients have special needs for further medical attention and Jovan
evi seemed to have been able to do much more for them. Although just a medical officer, Jovan
evi has told us how he has had to stretch the line of Croatian bureaucracy to get things done with his extremely busy schedule.
One story that stuck to mind was the time he went out of the way to find an appropriate doctor for a child with a retinopathy. Although there were bureaucratic barriers, Jovan
evi managed to raise money and support to send the child for surgery in the United States under the care of a specialist in that area. To much of his dismay and with many patients piling into his clinic, he had to simultaneously deal with the Ministry of Health to get this done.
This heart-warming example and other stories of Jovan
evi’s accomplishments have thus altered my opinion in general about the way things are done here and why things are done this way. The lack of doctors in this country needs to be addressed and the little respect that doctors get from the lay people is discerning. With high risks and a multitude of red-tape, doctors are underappreciated and often undermined. This will only change if the basis of government changes or if the entire health care system becomes more privatized, which will then lead to other public health care issues.
However, it is refreshing to learn of one doctor who will do more than necessary and if there were more people like this, then many things can be done without the need for expanding resources. By visiting the clinic, I realized the need for more altruistic acts; a rare concept in a transitional country. This topic would have to be discussed in another conversation or written in another essay. Although related, it will have no room or reason for this short opinion-based essay.
As a conclusion, I would like to pertain to the quote mentioned at the beginning of this essay. I found it appropriate because when I look at Jovan
evi, I find a bit of Patch Adams in him; his need to find ways to make health care more accessible, opening a private clinic at minimal cost for the patient or his need to listen and learn from patients as much as they learn from him. He made me realize why I went into medical school in the first place and what defines a doctor, “a trusted and learned friend who visited and treated the ill.”