Viet Nam News talks with doctors about their hopes for healthcare and job concerns on the 61st anniversary of Vietnamese Doctors' Day today.
Over the years, the quality of the country's health sector has much improved. The contributions of hospital doctors and medical workers to improving people's health are considerable. Are there any concerns about the job or the health sector that you want to share with our readers?
|Nguyen Ba Duc
Professor Nguyen Ba Duc, deputy chairman of the Viet Nam Cancer Association and former director of the National Cancer Hospital
I'm concerned about health sector operational policy in Viet Nam. The sector has not found a happy medium between the necessary operating expenses and the need for developed, modern healthcare for everyone.
On the one hand, we ask for the best medical services. But on the other hand, financial investment in the sector remains insufficient.
Action regarding the prevention and cure of cancer in Viet Nam is still weak, while the number of patients is rapidly increasing.
It is estimated that there are about 150,000 to 200,000 new cancer cases every year in Viet Nam. And the statistics do not include those who do not come to hospitals for treatment, those who do not know they have cancer, or those who died of undiagnosed cancers.
Many Vietnamese hospitals and departments specialise in cancer. But treatment quality is still limited at grassroots levels. One reason for this is that patients from rural areas keep coming to central hospitals, causing overloading for these hospitals. Sometimes three or four patients have to share a bed. How can we treat patients well in such conditions?
|Le Hong Nhan
Doctor Le Hong Nhan, head of the Department of Neurosurgery, Viet-Duc Hospital, Ha Noi
Over the past years, we have seen great progress in the health sector in general and in the neurosurgery field alone. The government and the health ministry had invested considerably in the heath sector and such investment is greatly welcomed. However, the lack of proper facilities and advanced medical equipment is still one challenge we face, especially in the neurosurgery area.
For instance, at Viet Duc Hospital, the number of patients waiting for surgeries is always higher than the number of operation rooms we have. Waiting time might increase risks for patients, especially those with neurotic injuries. But on many occasions we do not have a choice, because we cannot just put a patient who is already on the operation table aside because another patient needs to be treated.
Overloading is also a pressing problem. I appreciate efforts made by the sector to reduce this situation at hospitals at central level, but more needs to be done. We always have more patients than the capacity at Viet Duc Hospital, resulting in many patients having to share beds. And also because of such limitations, we sometimes have to discharge patients earlier than they should be though we know there might be risks.
Overloading is not only bad for patients. If we doctors at major hospitals have to deal with too many patients who hospitals at grassroots level could handle, we will not have time for in-depth research and study for more complicated cases or advanced skills and technologies.
Doctor Nguyen Quoc Kieu is a northern Son La Province medical practitioner whose clients are mostly ethnic minority groups
What concerns me most is the deterioration of the healthcare sector, especially at the district-level hospitals. Professional performance is declining in almost all hospitals in districts across the country. It is unacceptable that there is only one physician on weekend duty at district-level hospitals.
Often when I asked my patients to show their previous medical records, the paperwork does not document the diagnosis. In most cases, there is no paper documenting that the patients were ever discharged from hospital. As a result, people have no idea what their diagnosis is. For instance, last month I asked a male patient about a scar on his belly and he said ‘I had a gastric ulcer operation'. As it turned out, he was wrong about the reason for his surgery.
|Le Thi Thanh Van
Doctor Le Thi Thanh Van, National Hospital of Obstetrics and Gynaecology
Overloading is one of the major problems. It is quite understandable that patients and their families want to go straight to big hospitals at the central level for treatment. It is very important for patients that they feel they can trust doctors who treat them. So what we need to do is to improve the quality of doctors and nurses at grassroots level to win trust from people. We have been doing that by sending doctors from major hospitals to those at grassroots level, but it is not enough. I think one alarming fact we have to face is that many students are now learning not for acquiring real skills that they will need, but for the degrees that they will get.
Nguyen Hoai Thu, cardiologist, HCM City University Medical Centre
Issues relating to the implementation of an incentive policy are still not completely resolved. Surgeons in general, and heart and cardiovascular surgeons in particular, are currently paid a very low wage not worth their devotion in comparison to their colleagues in Southeast Asian countries.
A majority of interventional cardiovascular doctors cannot even support their families despite the fact that they work as co-ordinators for several hospitals.
I appreciate a recent government programme to improve attitudes of health care workers in hospitals as well as the programme to encourage young doctors to work in remote and under-privileged regions by providing them with special financial support and hope such effective campaigns continue.
Senior doctors also have to mentor young doctors and medical students. What do you tell them about the job?
Duc: As a mentor, I always encourage the younger generation to make great efforts to fulfil their task of curing and caring for patients. Despite all the challenges I have mentioned.
My advice to young doctors and medical students is to be patient to the utmost. Do your job whole-heartedly. And dedicate yourself with passion and kindness to being a doctor. That's the core of the professional conscience.
I never forget to remind the young generation of doctors and students to be proud of being angels in white shirts who cure patients.
I always tell my students to work hard if they want to be good at the job. While integrity and morality in this job are indispensable, you need to be really good at your job. Because being a doctor means people placing their health, their lives in your hands – if you are not good, you will fail to save lives, which you are supposed to do from the very beginning.
I encourage them to work hard. You just cannot learn things in the medical field in a short time, it is knowledge collected day by day. One very important thing is that those who want to devote their lives to a medical career should be very passionate. I myself love my job very much. It is hard, yes, but I never stop loving my job, just like many other colleagues of mine. Because it is a hard and tough job, you need to love it very much to overcome all the hardship you will encounter.
What else do you want to share?
I was lucky to visit many countries during my 40 years working in the medical field, as well as during my many years working in a management capacity.
The healthcare sector in Viet Nam has many achievements and developments.
For instance, we are using most of the latest advanced healthcare techniques and medicines in treating and curing cancer that are being applied in the world. We are using the world's best cancer technologies.
But healthcare services for patients in Viet Nam are still limited.And there are not enough medical workers to serve the huge number of patients.
There is no country where doctors have to work under the conditions like in Viet Nam, where doctors must examine hundreds of patients a day, accepting payment of just VND35,000 (around US$1.5) for a major operation.
Patients are suffering, too, especially cancer patients. They must wait too long or elbow others out to get a ticket for medical care, tests or treatment. The Minister of Health once exclaimed that hospitals are not hospitals anymore, but refugee camps.
Society needs to join together in improving hospital quality and solving such problems. It is hard for doctors to whole-heartedly care for patients if doctors are still worrying about their own financial subsistence and survival.
: I remember in the past, people used to have a very warm attitude for teachers and doctors. Nowadays, it is not so popular anymore. I understand that the society has developed and things have changed considerably, and I cannot ask patients to act as if it was 30 years ago. But it is essential that patients understand that successful treatment does not only depend on us doctors alone. It depends a lot on patients and their families themselves co-operating with doctors and nurses during the whole process.
: Doctoring is praised as a noble job but praise is always followed by criticism and this causes intense pressure on us. Many doctors and health workers complain that they feel as if they are sitting on a "hot chair" while at work as they could face a negative reaction from society at any time.
The health care sector is actually a sensitive service as it relates to human health and life. Moreover, as they are being raised to take on noble work, doctors should never allow negative actions.
However, as doctors are also human beings, a mistake is sometimes unavoidable.
I feel sad whenever I come across any media stories that raise a doctor's mistake as a negative action to accuse a group of doctors or even the hospital that he or she was working for, in a way that creates a terrible image of doctors or devalues the trust of patients about the whole health care sector.
Instead, media can play an important role by contributing good ideas or support us to solve problems that arise.
: The closer I get to impoverished people, the more I see how disadvantaged their access to health care services really is. Sometimes, we charge lower fees or we do not charge medical fees for those who have no money.
I provide medical check-ups for around 40 patients a day. My patients are mostly the H'mong who do not speak the language of the Kinh majority. Normally there is an interpreter. But in most cases, patients themselves can not exactly describe their symptoms, so that's also a challenge.
Like any medical practitioner, I need to make a correct diagnosis, based not only on medical instruments but on my own experience. Healthcare facilities in mountainous areas are not equipped with modern tools and facilities.
So clinical diagnosis is extremely importance. When I say ‘clinical diagnosis' I mean the experience that one gains from your own failure and success over years of medical practice. Based on knowledge accumulated from practical experience, you learn and eventually fix your mistakes to make things right.
I wish that people would live more meaningfully and responsibly. The health ministry should attach great importance to training activities and avoid unfocused training.
Medical institutes should teach medical students about charity and medical ethics. An educated medical practitioner will kill patients if s/he has no ethics. — VNS