Tag Archives: Iraq

In Iraq, the Sharks Are Sheiks

You think you’ve got it bad with malpractice in the United States? Try being a doctor in Iraq.

The Washington Post reported over the weekend that physicians are nearly being driven out of practice in many areas of Iraq due to the escalation of a long-lived tribal custom of using sheiks as brokers.

Photo via US Fish & Wildlife Service Pacific Flickr stream

According to Post reporter Stephanie McCrummen, it works like this: A patient who is dissatisfied with the results of a treatment or procedure contacts a sheik to intervene with the physician. The sheik generally tries to extract a sum of money from the physician in order to compensate the patient. There may be haggling and discounts. In one case, a discount was granted because the doctor admitted his error quickly.

While this may sound no different than a garden-variety interaction with a plaintiffs’ attorney in America, it gets worse. In some cases, the Post reports, if a physician does not give in to demands for money, the sheik may threaten to kill the doctor or his family.

The article says that this type of sheik-down has long existed in Iraq, but that it has gotten worse since the American invasion and occupation. Some sheiks were paid by American military or U.S. contractors to fight opposition forces, and now they’ve simply come to expect to get their due. They became known as “fake sheiks” or “Condoleezza Rice sheiks,” for the former U.S. Secretary of State.

One doctor said he’d employed a bodyguard to screen out potentially litigious patients. I guess it still might be cheaper than paying a malpractice premium.

— Alicia Ault (on Twitter @aliciaault)

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Filed under Health Policy, IMNG, Practice Trends

Surgeons Sound, Heed Call to Serve

As president of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dr. Jo Buyske has made it her mission to develop a “more humanitarian SAGES,” she said at the organization’s annual meeting last week in San Antonio, Texas.

Dr. Jo Buyske challenged her SAGES colleagues to share their gifts with those in need. Photo by Diana Mahoney

Toward this end, the University of Pennsylvania adjunct professor and associate executive director of the American Board of Surgery spearheaded a series of initiatives that debuted at the conference. On Thursday, a group of meeting attendees boarded a bus to a Habitat for Humanity construction site where they swapped their surgical scrubs and scalpels for hard hats and hammers to help build a new home for a low-income family. The following day, SAGES sponsored an on-site donor blood bank and a bone marrow testing station at the convention center – both of which were well utilized between sessions – and a number of SAGES surgeons offered to mentor local high school students with an interest in medicine who had been invited to the meeting for the day.

Throughout the week, attendees dropped off used medical text books for medical schools in China and old medical instruments and supplies that for shipment (via Medwish) to the Albert Schweitzer Hospital in Haiti. During the course of the week, SAGES members also gathered information about international volunteerism from the several medical volunteers’ desks located near the SAGES membership booth and Dr. Buyske announced the formation of a SAGES humanitarian task force, charged with identifying new service opportunities and resources for its SAGES members.

Dr. Buyske volunteering with Aloha Medical Missions in Bohol, Philippines. Image courtesy of SAGES.

The very vocal call to arms is more than just lip service for Dr. Buyske. In her presidential address, aptly titled, “To Whom Much is Given, Much is Required” [Luke 12:48], she described her own humbling experiences as a surgical volunteer in remote villages of Chiapas, Mexico; Bohol, Phillipines; and in the Republic of Mozambique, where access to sufficient water and electricity was erratic, at best, and where all of the niceties of surgery in this country, such as having assistants to help scrub, glove, and gown, as well as prepare and handle instruments, were non-existent. “I was not prepared for things as simple as having to pick up and unwrap my own instruments and choosing which sutures to use and which size needle. I was used to having everything handed right to me. It takes a different part of you brain to think about these things.”

Despite at various times having to pull anesthesia tubing from the trash to reuse it, having such poor lighting that she had to wait until the afternoon sun was just right in to perform cesarean sections, and having to use water from the local stream to scrub, Dr. Buyske said that each of the volunteer experiences made her a better person, and a better surgeon,. “You begin to think hard about what you use and why; you become more flexible; and you become more frugal. You revisit surgery in a way you might not have since medical school or residency. And though you’ll be exhausted, you will also be refreshed.”

As surgeons, “we have the great good fortune of doing work that allows us to go to bed every night knowing that just by doing our jobs, by our livelihoods, we have taken care of people; we have improved lives; we have done good. We should pause for a minute and savor the great good fortune, the luck, the wisdom, the hard work that went into a profession that is so fulfilling. but we should also be good stewards of our skills and our good fortune and take advantage of opportunities to be of service,” Dr. Buyske stressed. “As our Japanese friends and colleagues can tell us, our fortune and status can’t be taken for granted. There is no guarantee that it will be with us, even tomorrow.”

Thoracic surgeon Dr. Cameron Wright is a Colonel in the Medical Corps of the US Army Reserve. Image courtesy of MGH.

Dr. Buyske’s pledge to service was echoed by Dr. Cameron Wright, during the meeting’s Gerald Marks Lecture. A respected thoracic surgeon at Boston’s Massachusetts General Hospital, Dr. Wright is also a colonel in the Medical Corps of the US Army reserve, which he joined in 2007, “for many reasons,” including the obvious need for qualified surgeons to deal with the many casualties of the wars in Iraq and Afghanistan, and the opportunity to experience war surgery, he said. The most important reason, however, was the fact that his son, a heavy weapons specialist in the US Marine Corps “had skin in the game, and I decided I should put my skin in the game as well.”

In a moving slide presentation, Dr. Wright told his story through dramatic pictures, both of the soldiers with whom he served with and those to whom he ministered. Evident in all of the pictures are the camaraderie and sense of shared purpose that pervades military deployments, but also the human destruction that begs for the hands of a skilled surgeon.

— Diana Mahoney

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Filed under Blognosis, Emergency Medicine, Gastroenterology, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Orthopedic Surgery, Physical Medicine and Rehabilitation, Surgery, Thoracic Surgery, Transplant Medicine and Surgery, Uncategorized

Mental Health Providers: Uncle Sam Wants YOU

If the sheer volume of returning service men and women in crisis is not compelling enough reason for community-based mental health providers to join their military counterparts in the battle against post-traumatic stress disorder and traumatic brain injury, the opportunity to wear fatigues to work just might be.

“The uniforms have lots of pockets and you don’t have to shine your boots,” quipped Col. Elspeth Cameron Ritchie, M.D., M.P.H.,  the director of behavioral health proponency in the Office of the U.S. Army Surgeon General.

Image via Flickr user Nevada Tumbleweed by Creative Commons License

Clad in Army camouflage, Col. Ritchie made an impassioned recruitment pitch to clinicians and researchers attending a conference sponsored by Massachusetts General Hospital over the weekend titled “Complexities and Challenges of PTSD and TBI.”

In order to meet the increasing mental health needs of soldiers returning from Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom), “we have to partner with the community,” she said. While stressing that the Veterans Administration and the Department of Defense have implemented programs focused on mental health risk assessment, resiliency building, and treatment accessibility, the demand for available services far outpaces the military’s supply. In other words, she said, “We need YOU.”

And if you don’t want to wear a uniform, “there are a variety of different ways to come in,” Col Ritchie stressed. “For example, we’ve been working very closely with the U.S. Public Health Service, which is now giving us [mental health] providers at our facilities, so you could join the PHS,” she said. Or, at the very least, she urged attendees to sign up for TRICARE, the contracted health care plan  for service members and their families. “I know TRICARE is not an easy system to live with, but registering for it can let us get soldiers to you.”

The bottom line, Col. Ritchie stated, is that the U.S. military is at a crossroads with respect to meeting service members’ mental health needs “All of the low-hanging fruit has been picked,” she said. In order to meet the continuing challenges and to forge ahead, “we need to engage in a national dialogue, including the civilian community.”

—Diana Mahoney
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Filed under Family Medicine, Health Policy, health reform, IMNG, Primary care, Psychiatry, Uncategorized