Saturday, October 9, 2010

Saudi-Arabia and VIP patients

Saudi-Arabia still has the outdated practice of VIP status, even in hospitals. To me as a Scandinavian this term of a "Very Important Person" just seems so antiquated and even ridiculous.

VIP as a concept does not exist in our society (exception some nightclubs VIP sections). Finland has always been a reformer and a pioneer in medical ethics. Back in 1964 the Declaration of Helsinki was developed and it is regarded as the cornerstone document of human research ethics.
If someone would declare themselves a VIP in Finnish society (which is highly unlikely) they wouldn't be taken seriously and it would be seen as nothing but a joke.

All patients receive the same treatment in our free or low cost government provided hospitals. Even Bill Clinton recently commented on the Finnish healthcare and schooling systems, saying "America should be more like Finland". Well I would have to agree!

For americans VIP patients are a more familiar concept. I googled it and found many articles from the States about VIP patients and how to treat them. I guess that might be where Saudis copied the system from, but here its implementation is far worse.The VIP in Saudi can be royal family member, a high ranking government or military official, a diplomat or just a person from a very rich family with serious wasta.

VIP and patient just don't go together. It's against all medical ethics. But in Saudi it seems to be like a normal thing accepted by everyone. To me it's like living in the medieval times.
Actually it wasn't always like this, VIP syndrome is definitely a result of the oil boom, sudden wealth and feeling of supremacy it brings to some Saudis. In fact during the medieval times Muslim hospitals were institutions which treated patients of all ethnic backgrounds and financial statuses equally. Including patients who were male and female, civilian and military, child and adult, rich and poor, and Muslims and non-Muslims alike.

Muslim physicians were expected to have obligations towards their patients, regardless of their wealth or backgrounds. The ethical standards of Muslim physicians was first laid down in the 9th century by Ishaq bin Ali Rahawi, who wrote the Adab al-Tabib (Conduct of a Physician), the first treatise dedicated to medical ethics.Read more here.
So Muslims were way ahead of the west when it came to medicine back in the day and actually one of the features in medieval Muslim hospitals that distinguished them from their contemporaries was their higher standards of medical ethics.

As a Finnish nurse, dealing with these kind of VIP patients and their often silly requests needed some getting used to. I used to ask: Am I supposed to ramp up my quality of care as if I have multiple standards depending upon the prominence of the patient? Why is my job at risk if I choose to prioritize care according to my judgment leaving the VIP waiting for 10 minutes? How can I be genuinely compassionate to a person that treats me with disrespect and like a maid, not a professional?

I still do not to this day compromise the care of my other patients just because the VIP is requesting for a glass of freshly squeezed orange juice or his or her shot of whichever drug they are addicted to. However I know many nurses who have lost their job because they didn't succumb to the whims of their VIPs. Some have been sent home the next day if the upset VIP was a high ranking royal. On the other hand nurses of Asian nationalities seem to take the VIP "seriously" and seem to be intimidated and will never question even their most absurd requests.

From the minute the VIP steps into the hospital, their whole course of stay will vary dramatically from the "ordinary patient".
They have their own entrance, clinic, ward, doctors and in the ER, they have a VIP fast track. Which means they will be treated first in all cases, even if there is a dying baby in the next room, the princess with the pimple  will be first priority. And yes they have come to ER for treatment of a pimple!

In case the patient is admitted, regardless of diagnosis he or she will most likely go to the designated VIP ward. Needless to say the rooms are huge and glamorous and anything the patient wants extra will be catered to. The problem I see with this is that in fact the patients are not necessarily receiving the best possible medical care. When patients from all medical fields are combined in one ward including deliveries and babies, the amount of knowledge and experience the staff should possess in order to equal the quality of care on the regular wards is enormous, even impossible to achieve. Some VIPs have realized this and request to be assigned onto the specific wards and "suffer" the consequences of smaller rooms.

Another issue that diminishes quality of care and slows down the treatment process is that physicians are reluctant to make diagnosis without consulting a multitude of specialties first. They are so terrified of making a mistake and loosing their jobs, they will be hesitant to start treatments further worsening the prognosis of the patient in some cases.

They will also prescribe drugs and treatments of no benefit or even harmful to the patient, just because the patient requests them. This is the case with drug addictions, there is no such thing as weaning the VIP off the drug and upsetting the patient.

What the patient does acquire with VIP status in addition to the larger room is 5 star hotel like service. This is assumed to be delivered by all personnel, from housekeeping, maintenance, food services and of course, nurses. The patient can order any type of food from the VIP kitchen 24/7, the can get extra golden armchairs and sofas brought in for visitors, if they need service of hairdresser or masseuse the nurse wll arrange them, their rooms are filled with flower assemblies reaching to the ceilings and in addition to all this have private nurses and maids serving them.
If the patient is not satisfied with the service provided they have their own representative in the hospital who will arrange any arising problems.

I've had many wonderful and genuine VIP patients that don't seem to be bothered of their status too much and are not overly demanding. But there are patients with a bad case of VIP syndrome, which can be a hassle for the staff to deal with.
My conclusion is VIP status does not in fact benefit the patient from the medical point of view but it serves more of an egoistic purpose.


Qusay said...

Yes, the VIP status, it is in everything, from phone numbers to car license plates, and hospitals are not exempt :(

But isn't the best medical care only available to those with money? From private rooms in almost any hospital in the world, to access to the best doctors and medical teams?

And of course I've heard that those who treat the VIP patients very well, get good tips, sometimes monetary, sometimes nice expensive gifts... is that true? I heard some doctors get nice diamond brand name watches and things like that.

Hesham said...

Many thanks for shedding the light on this issue. As a common man, I suffer greatly from this minority that consumes most of the resources in this country. Unfortunately, they are too powerful, and this way of thinking is so deeply rooted in the society to the point that I'm not sure if I'll live long enough to see the day it all ends.

Layla said...

@ Qusay

They might have better access to medical care and doctors, but utilising them is another thing. If there are 10 expert doctors involved in the care, they will not agree and everyone will approach from their specialty point of view.In a way they try too hard, involving so many people will only cause confusion and delay treatment.
How does the saying go, too many cooks makes the soup too salty?If you get what I mean :)

What you say about the gifts is true, although more often I have received things from the ordinary patients. Some VIPs believe it or not are even very scroogy! In addtition to money, patients have given me perfumes, jewellery, watches, scarves and
a princess once got me an evening gown!

Soile said...

Another great post! I really enjoy reading these :-)

Dentographer said...

being a dentist who worked in saudi and know how healthcare is in this country.
and having suffered my cousins death from medical misdiagnosis for somthing that was as bright as the sun.
i became very reluctant in providing any kind of treatment or being treated in saudi arabia.
i used to work in a low class private clinic,majority of my patients were poor,but every now and then i used to face situations were the owner of the clinic calls me and say "there is someone at ur door,treat him next" while there are 12 or 15 patients been waiting for 40 minutes or so...and u cant do anything about it,,cos he might be the guy who writes ur check.

Saudi Business said...

One of the business meeting etiquettes in Saudi Arabia is that appointments are necessary and should be made several weeks to one month in advance if at all possible. 

American Bedu said...

There is also a hierarchy as to who gets precedence on the Royal floors too. I remember when a family friend's daughter was placed on the VIP floor. She was battling cancer. However when a certain Royal was placed on the same floor, my friend's daughter (12 years old) had to be removed immediately to another area of the hospital!

Layla said...

American Bedu-thanks for sharing! You're right they do have a ranking order on the VIP ward and there are tens of thousands of royal family members!

WendyLou said...

I know I am late to this post, but what is the beautiful flower box thingie on the wheelchair with the nurse? What is inside the little boxes? Is it a very fancy candy box?

Layla said...

WendyLou-Yes it is collection of small boxes which each contains chocolates in them. Stuff like this is very common for patient to have in their rooms they offer the chocolates to visitors (and sometimes nurses get the rest when the patient is discharged)

P.s I saw your comments on Images of Saudi blog and just wanted to point out that men no longer are allowed to sell lingerie for women here. The shops inside the malls are now staffed with Saudi women, but the souqs that sell lingerie among other clothes re still predominantly male staffed.