- Email: [email protected]
Viktor Schultz: physician in a Russian municipal hospital
Perspectives
Profile Viktor Schultz: physician in a Russian municipal hospital Viktor Schultz, chief urologist at Moscow’s Hospital No 54, was not at Russia’s recent “Doctor of the Year” awards, but to his grateful patients he is no less worthy than the physicians who received bouquets from the Minister of Health (see Special Report). “Thank you very much. I am feeling much better now”, says a middle-aged man, checking out of the state hospital after an operation. “We’ll have you back again for another little check-up in 3 months”, replies Schultz, shaking the man’s hand before disappearing into his modest, plant-filled office. “I’ve been a doctor for 33 years”, he says. “I saw Soviet medicine. There used to be a joke about that. Soviet medicine was like a good woman: accessible, free, and very experienced. I witnessed perestroika, when little private clinics sprang up, everything in plastic, all cosmetic. And I would say this: in medicine, there is no substitute for experience. To be any good, a doctor needs to work for at least 10 years after qualifying.” It is the shortage of experienced doctors that concerns Schultz. “We have good equipment now. I’ve been to Germany and I can say that the equipment in our hospital is no worse than theirs, both in terms of quantity and quality. We have good medicines. We have passed that difficult period when we had to rely on humanitarian aid; when we received tablets with only 6 months left to the sell-by date. We now seek tenders and buy from the best pharmaceutical firms. But we are short of experienced doctors—that’s the real problem.” According to Schultz, “There’s been a terrible brain drain. The experienced doctors have left for Israel, for the USA, for better salaries and a better quality of life. The young ones are not coming through to us. They study but then they don’t go into practical medicine. They sell tablets.” Money seems to be a key factor with graduates receiving lucrative starting salaries from pharmaceutical companies that are more attractive than doctors’ monthly pay, which starts at 20 000 roubles (£420) and reaches a ceiling of 35 000 roubles (£730) only after years of service. There are similar problems with the recruitment and retention of nurses and auxiliary staff, as Schultz explains, “Nobody wants to do what’s seen as menial work. Cleaning in a hospital is a very special kind of work.” He confirms accounts from patients’ relatives that in the absence of auxiliary staff, they themselves often have to clean wards, but he does not think that this is necessarily a problem. “The nice relatives see that sometimes they may have to take a bit of responsibility themselves. But others just dump their old folks on us and then complain that we are not looking after ‘Mum’. A hospital is for curing people, not for serving them like in a hotel.” Schultz, born in 1952 in the Siberian city of Barnaul, graduated from the Tomsk Medical Institute, also in Siberia, www.thelancet.com Vol 371 March 1, 2008
in 1975. He worked as a general surgeon in Tomsk for 8 years before seeing an opportunity to move to what was then Leningrad, where he specialised in urology. In 1989, his chance came to develop his career further in the capital. The hospital whose urology department he now heads is an ordinary municipal hospital, built in 1954. Schultz says he dreamed of being a doctor from a young age and was particularly inspired by the discovery of DNA. “It excited my fantasy; it brought me to medicine”, he says. His philosophy as a doctor is simple: “I must do all I can to help the patient, whether or not I like him, or her, as a person.” Schultz is not particularly nostalgic for the Soviet era and values freedom—and the other side of the coin, responsibility— that came with the market reforms of the 1990s. “In Communist times”, he said, “doctors were not allowed to tell patients the truth. We all knew that Honecker [Erich, the former East German leader] was dying of cancer but we could not say the ‘c’ word. Cancer is not always a death sentence. Patients need to know if they have cancer, so that they can take appropriate steps. Now we can tell them but before, a doctor could be sacked for telling a patient he had cancer. It was thought the truth would traumatise them.” “The patient needs to understand why we suggest certain treatments—that it’s not just the whim of the doctor”, he continues. “We can’t return a patient’s youth but we can try to maintain his, or her, present quality of life. But patients have to take responsibility too. They can’t expect to drink and smoke all their lives and have healthy hearts, kidneys, and livers. We’re seeing many drug addicts now, too, something I never saw in Soviet times.” He says he would even go so far as to favour preferential treatment for patients who make an effort to maintain their health and lower insurance benefits for those who engage in self-damaging behaviour. Asked what other changes were needed at his hospital, he says: “Redecoration. That would help us psychologically. Unfortunately, we still have facilities in the corridors instead of toilets in each ward.” And he leads the way out into the wards, which are indeed dingy but not exactly dirty. Patients share, four or five to a room. A matron’s booth stands at the end of the corridor. “The matron’s my right hand”, says Schultz, adding that inhospital infections are not the problem he has heard they have become in some hospitals in the UK. Elderly patients in dressing gowns shuffle towards the dining hatch for plates of rice and meat. “Doctor, doctor”, they call out, hoping to catch his attention. “Enjoy your dinners”, he says, “I’ll be round to see you in a little while.”
See Special Report page 711
Helen Womack [email protected]
717
Profile Viktor Schultz: physician in a Russian municipal hospital Viktor Schultz, chief urologist at Moscow’s Hospital No 54, was not at Russia’s recent “Doctor of the Year” awards, but to his grateful patients he is no less worthy than the physicians who received bouquets from the Minister of Health (see Special Report). “Thank you very much. I am feeling much better now”, says a middle-aged man, checking out of the state hospital after an operation. “We’ll have you back again for another little check-up in 3 months”, replies Schultz, shaking the man’s hand before disappearing into his modest, plant-filled office. “I’ve been a doctor for 33 years”, he says. “I saw Soviet medicine. There used to be a joke about that. Soviet medicine was like a good woman: accessible, free, and very experienced. I witnessed perestroika, when little private clinics sprang up, everything in plastic, all cosmetic. And I would say this: in medicine, there is no substitute for experience. To be any good, a doctor needs to work for at least 10 years after qualifying.” It is the shortage of experienced doctors that concerns Schultz. “We have good equipment now. I’ve been to Germany and I can say that the equipment in our hospital is no worse than theirs, both in terms of quantity and quality. We have good medicines. We have passed that difficult period when we had to rely on humanitarian aid; when we received tablets with only 6 months left to the sell-by date. We now seek tenders and buy from the best pharmaceutical firms. But we are short of experienced doctors—that’s the real problem.” According to Schultz, “There’s been a terrible brain drain. The experienced doctors have left for Israel, for the USA, for better salaries and a better quality of life. The young ones are not coming through to us. They study but then they don’t go into practical medicine. They sell tablets.” Money seems to be a key factor with graduates receiving lucrative starting salaries from pharmaceutical companies that are more attractive than doctors’ monthly pay, which starts at 20 000 roubles (£420) and reaches a ceiling of 35 000 roubles (£730) only after years of service. There are similar problems with the recruitment and retention of nurses and auxiliary staff, as Schultz explains, “Nobody wants to do what’s seen as menial work. Cleaning in a hospital is a very special kind of work.” He confirms accounts from patients’ relatives that in the absence of auxiliary staff, they themselves often have to clean wards, but he does not think that this is necessarily a problem. “The nice relatives see that sometimes they may have to take a bit of responsibility themselves. But others just dump their old folks on us and then complain that we are not looking after ‘Mum’. A hospital is for curing people, not for serving them like in a hotel.” Schultz, born in 1952 in the Siberian city of Barnaul, graduated from the Tomsk Medical Institute, also in Siberia, www.thelancet.com Vol 371 March 1, 2008
in 1975. He worked as a general surgeon in Tomsk for 8 years before seeing an opportunity to move to what was then Leningrad, where he specialised in urology. In 1989, his chance came to develop his career further in the capital. The hospital whose urology department he now heads is an ordinary municipal hospital, built in 1954. Schultz says he dreamed of being a doctor from a young age and was particularly inspired by the discovery of DNA. “It excited my fantasy; it brought me to medicine”, he says. His philosophy as a doctor is simple: “I must do all I can to help the patient, whether or not I like him, or her, as a person.” Schultz is not particularly nostalgic for the Soviet era and values freedom—and the other side of the coin, responsibility— that came with the market reforms of the 1990s. “In Communist times”, he said, “doctors were not allowed to tell patients the truth. We all knew that Honecker [Erich, the former East German leader] was dying of cancer but we could not say the ‘c’ word. Cancer is not always a death sentence. Patients need to know if they have cancer, so that they can take appropriate steps. Now we can tell them but before, a doctor could be sacked for telling a patient he had cancer. It was thought the truth would traumatise them.” “The patient needs to understand why we suggest certain treatments—that it’s not just the whim of the doctor”, he continues. “We can’t return a patient’s youth but we can try to maintain his, or her, present quality of life. But patients have to take responsibility too. They can’t expect to drink and smoke all their lives and have healthy hearts, kidneys, and livers. We’re seeing many drug addicts now, too, something I never saw in Soviet times.” He says he would even go so far as to favour preferential treatment for patients who make an effort to maintain their health and lower insurance benefits for those who engage in self-damaging behaviour. Asked what other changes were needed at his hospital, he says: “Redecoration. That would help us psychologically. Unfortunately, we still have facilities in the corridors instead of toilets in each ward.” And he leads the way out into the wards, which are indeed dingy but not exactly dirty. Patients share, four or five to a room. A matron’s booth stands at the end of the corridor. “The matron’s my right hand”, says Schultz, adding that inhospital infections are not the problem he has heard they have become in some hospitals in the UK. Elderly patients in dressing gowns shuffle towards the dining hatch for plates of rice and meat. “Doctor, doctor”, they call out, hoping to catch his attention. “Enjoy your dinners”, he says, “I’ll be round to see you in a little while.”
See Special Report page 711
Helen Womack [email protected]
717