Sub Intern in a Socialized medicine hospital

Here I am finishing up my last rotation as a medical student and I chose to do this part of my training at a government hospital. This is socialized medicine. All the patients are seen free of charge and all the doctors, nurses and ancillary staff are paid by the government. The doctors do not have to carry the same type of malpractice insurance because they do not get sued and if they do the US government steps in as the one being sued so the doctor faces a different form of liability than a private doctor would face in a regular private practice.

The first thing I have notice is that no one really wants to work. Everyone spends a lot of time trying to avoid work. If the emergency doctor can refer the patient to the medical floor he/ she will and if the medical floor doctors can get the patient admitted to the ICU or surgical floor or somewhere else they will do it. There is a ton of pass the responsibility at all levels of care. Often the patients are left confused and wondering what is going on because no one takes the time to communicate the plan to the patient.

I am not saying that nothing gets done or accomplished because we are treating lots of patients but we are very inefficient and slow. Often our hands are tied because the CT scanner is backed up or ekg tech has exceeded the government allowed number of ekgs so they have to stop doing ekgs for the day. There is red tape and paper work which makes doing very simple tasks like taking the patient's temperature a 7-10 page document that multiple people have to sign off on each step of the way. This creates many opportunities for error and many bottle necks in the process.

A patient that would be in a private hospital for 23 observation gets trapped in this government hospital for 3 - 5 days and have multiple tests and unnecessary things done or necessary things not done because of all the red tape and confusion. Imagine the DMV. It is a lot like the DMV and there is almost zero customer support. No one looks at the patients as customers but rather the patients represent more work. It is really sad.

On the good side, because I am motivated and want to learn a lot I am able to get procedures and do things that I might not get to do at a private hospital. The patients are very grateful for even the smallest acts of kindest. They are not used to being talked to in a nice manner, so when I say "Hi Mrs. y, how is your morning?" She grins and appreciates the gesture.

More stories to follow. I have seen a bunch of complicated late stage cancer this past week and some other crazy illnesses.