Hippocrates' Scornful Glance

Confession of a Doctor Who Left the Profession

Grandmother was a sickly woman and fought the disease for a long time. The simple woman looked at the doctors who eased her pain with admiration. She often told her grandson about her life and always ended her remarks with: "Study, my little one! Become a doctor so you can cure Grandma."

One day grandmother was taken to the hospital. "Lung cancer," the doctors said, and she was sent home unconscious to die. When the boy visited her at her deathbed and took her weak, emaciated hand, she felt it and opened her eyes. She looked at the boy with love and said: "Become a doctor so you can heal me!" That same night she died.

The boy was a good student. He began his last year of high school but still didn't know what he wanted to be. Actor, professional athlete, teacher, detective, biologist, veterinarian — possibilities swirled in his head. In his dreams he again talked with his grandmother on the porch of the old country house by the meadow. "Become a doctor, my son!" — the loving, pleading words rang in his ears, and he applied to medical school. Near the end of summer the postman brought a letter. The boy took it and opened it. With an inarticulate scream he ran into the house. His mother ran out pale as death. "You were accepted," the boy whispered, shaking with sobs. They embraced and cried together.

The boy moved far from his parents' home. To ease his financial worries and not burden his parents, he worked alongside university. Mostly he did loading and manual labor. He had excellent physical strength and earned several times what his parents could have given him.

In his final year he searched for his future workplace. He couldn't get into the attractive positions at large metropolitan institutes. Those went to the sons and daughters of well-known chief physicians. This injured his sense of fairness.

A friend worked at a small-town hospital and said an internal medicine position had opened. The ward had 75 beds; the chief physician and six female colleagues waited. On the first day he found himself in the clinic. He realized this was deep water and threw himself in. From colleagues and nurses he learned what they don't teach at university: the secrets of ward routine work.

In one examination room he found a computer covered with a sheet. It had stood there for years. The chief physician understood the call of the new times and, using the young man's computer skills, acquired new instruments. He bore the cost. He examined, diagnosed, handled administration, and, when needed, repaired computers and devices. With the new procedures he soon became the owner of a huge database and a wealth of experience. He regularly reported results at various medical conferences.

His son was born. He wondered how he would support his family — at that time, in the mid-1990s, he brought home 16,000 forints a month. He had an idea and, building on his computer skills, started a graphic studio. He worked at the hospital by day, then sat at his computer in the evening and worked on brochures and multimedia presentations until dawn.

He had been working at the hospital for several years, but since his arrival the medical staff had not held a meeting. Very expensive instruments stood in the examination rooms unused. Instead of performing procedures locally, patients were sent to other institutions. He initiated the creation of a "self-study group" so representatives of different specialties could inform each other about possibilities. The hospital's scientific committee — despite the fact that they themselves had done nothing for years — judged his attempt a brutal attack. He stood before the chief physicians and realized they were afraid he would think for himself. The hierarchical order of the medical profession must not be disturbed… He felt a strange emptiness and some invisible thread snapped inside him. But he had not yet given up.

Sudden changes occurred on the ward. Several colleagues left; four remained on the ward: two chief physicians and two interns. He got half of the 70-bed ward (33 beds), including the intensive area; he ran the outpatient clinic, the diagnostic tests and the medical administration. He had 10–12 on-call shifts a month. He spent 80–100 hours a week on the ward. By then he was preparing for his specialist exam and had been completing his required practical training.
One spring weekend he drove to his parents with his family. "Dad," said his four-year-old son while watching the passing landscape, "I hate that you are a doctor!"
He slowed and turned around in astonishment. "Why, my son?"
"Because you are never home with me in the evenings!" — the child said and went back to playing.

The words lay on his chest like lead, and thoughts raced through his head. He had been working continuously for years; recently he brought home 26,000 forints with on-call allowances (late 1990s), received a few eggs, a chicken and 30,000 from patients. He lived in a 48-square-meter service apartment, his car was 14 years old (a gift from his parents), he spent a hundred hours a week at the hospital, slept 2–3 hours (but not always, because on call he often had no time), and he hardly saw his son. His own apartment would perhaps come when he was 45–50 years old, a good car only after that. He wanted his sons to attend quality schools. They hadn't been on a holiday since he finished university. He realized that without his advertising graphic work he could not maintain his apartment and old car and would barely have enough for daily food.

"Forgive me, Grandmother!" he said to himself and made a decision.

On a late Friday afternoon the chief physician sat in his office, having finished his work. He rubbed his tired face with both hands. They mutually respected and liked each other.
The young doctor searched for words:
— "Boss, I will be leaving from the first of the month," he finally blurted out, somewhat uncertainly.
— "On leave? For how long?" — the chief physician was taken aback by the statement. Neither had been on vacation for months.
— "For good. I'm leaving the medical profession," — the young man said now decisively. The chief physician raised his head and didn't want to understand. — "But you're about to take your specialist exam."
— "I'm tired of it," he said, and felt pathetic, because his boss had been doing it for 30 years.
They talked a little more, looked into each other's eyes, then parted with their usual firm handshake. The young man has not examined a single patient since.

Since then the former doctor has been waiting for confirmation. A sign to convince himself.

Statistics show that the number of patients continuously increases while resources for care decrease. The system is "held together" by money (informal payments). Ninety-five percent of that money ends up in the pockets of the physicians at the top of the hierarchy (who make up 2–3% of the total number of doctors); the remainder goes to the others. Meanwhile the leaders could change the system, but it is far from their interest. The medical system is feudal, where the chief physician is the almighty lord — and it seems it will remain so for a long time.

The government calculates well: the doctor knows nothing else but healing. So he should not complain but be grateful that he can do what he dedicated his life to.

The vast majority of doctors swallow and toil, but in reality they live at the subsistence level. Those with language skills who were not bound by some family tie long ago looked for work abroad. Those who remained at home see the growing tide of patients, worsening conditions, decaying institutions, and that within foreseeable time they will not receive a wage commensurate with their superhuman work, in ever smaller numbers and with ever greater bitterness.
The state secretary (office) does not even pretend to want to do anything to "put the health system in order." Most hospitals and clinics struggle with daily financial problems. Silence before collapse.

From the distance of two decades the former doctor now feels he made a good decision for himself and his family.

But he feels Hippocrates' scornful glance on the back of his neck.

Postscript: I wrote the story in 2002, so some sentences are no longer valid today (for example: informal payments, doctors' salaries, etc.). I do not plan to change them; I leave the article in its original form.