Discussions about whether and to what extent it would be desirable to thank doctors for a job well done seem to slowly lose their relevance. There are many private clinics where you have to pay substantial sums for medical services, so the idea that you have to give the doctor something else probably doesn’t even occur to most patients. However, this has not always been the case.
Gratitude for a job well done, such as a successful treatment, can be compared to a tree with two ends. On the one hand it brings joy and perhaps even satisfaction to the person doing the work, but on the other hand it can cause big problems. In Latvia there are doctors for whom the voluntary gratitude of their patients has caused a severe headache. The arrival of young and socially active doctors in Latvian medicine has changed the attitude towards so-called thanks. At least I would like to believe and hope it is. Because it’s humiliating for both sides.
Earn money on the newspaper
In the July 1 issue, readers of the magazine were able to familiarize themselves with the life story of surgeon and urologist Irma Valija Berta Kantsones. One of her good deeds was training a young girl Skaidrīte Aivare (née Freimane) to become a doctor. Although the two were not related, Skaidrīte lived in Kantsone’s apartment during her studies. After graduating from the Faculty of Medicine of the Latvian State University in 1950, she began working as a neurologist at the Aizpute Hospital and Polyclinic. A closer look at the doctor’s biography reveals a completely incredible fact from a modern point of view. In 1963, Skaidrīte Aivare was tried and imprisoned for three years on charges of taking bribes. Why so? Because he hadn’t asked any of his patients about him.
This case was reported in the publication “Slav and truth” by Ārias Klimkāne, a veteran journalist from Soviet Latvia (newspaper “Cīņa”, no. 17; 20.01.1963). “The audience sitting in the courtroom became embarrassing when the witness Ausma Lapiņa said that Aivare accepted 10 rubles given by her as’ thank you ” for the treatment in the hospital. Lydia Grasman gave the same sum to the doctor when she consulted her mother. sick of Grasman at his request. (..) These and many other witnesses testified: “Deva … was taken …” “Deva … was taken …” Many donors were already elderly mothers of campaign. – No, the doctor didn’t ask for money, – they said. But what did he say when you gave? – “I don’t need it already” … but I accepted it anyway. But sometimes he just said: thank you! ” Reading Klimkāne’s article, it appears that it was not prepared by a journalist, but by a judge of an impartial court. Or a person who has finally had the opportunity to polish their feathers. “I don’t want to believe that Skaidrīte Aivere didn’t use the first crumpled banknote in his pocket. But the second didn’t seem so intrusive anymore. And then came the third …”
A test model initiated by Skaugi
You may be wondering why did it happen that Dr. Aivare had to sit on the dock? After reading other articles on the website «www.periodika.lv», for example, on Aivare’s success not only as a popular doctor in Aizpute, but also as a member of an independent theater collective, it is not difficult to guess the answer. Someone complained. Someone who regrets that the local press writes about Aivari every year and praises his merits as both a doctor and an independent theater actress.
What was the result? She listened to the complainant, organized a mock trial to scare others, and completely ruined the life of a talented doctor.
Bribes have been given and are being given
20 years ago, thanking a doctor in the form of an expensive envelope or drink was more the norm than the exception in Latvia. Although the level of corruption in medicine and education in Latvia is still above the European Union (EU) average, it has declined over the past 20 years. Last year, as evidenced by the “Global Corruption Barometer – EU 2021” report by the international organization “Transparency International”, in the last 12 months about 10% of Latvian residents gave a bribe to a medical institution.
The results of the study reveal that an average of 6% of EU citizens who have used state services (medicine, education, police, court, social insurance, issuing of identity documents) in the past 12 months have paid a bribe to receive medical services, while 29% used personal contacts. Since not all citizens of the country have had the need to use these public services in the past year, the actual level of corruption is likely to be higher than the study reveals.
The highest level of corruption in the medical sector among EU countries is recorded in Romania and Bulgaria, where respectively 22% and 19% of the population have paid bribes in the past 12 months. On the other hand, in the Czech Republic, Portugal and Hungary, there is a higher expectation of seeing a doctor on time if there is personal contact. 54% of the respondents in the Czech Republic, 46% in Portugal and 41% in Hungary admitted that they were able to receive medical services thanks to this aspect.
In the Baltic states the situation is more moderate. About 19% of the Lithuanian residents surveyed admitted that they paid “over the top” for medical treatment and 25% used appointments. In Estonia, 2% and 12% of respondents respectively admitted to this activity. In Latvia, 10% of the population surveyed offered bribes to specialists working in medical institutions, while 30% used personal contacts.
Let’s just say that a study conducted in 2005 revealed – in Europe it was believed that illegal payments in healthcare were between 3% and 10% of its budget.
Thanks to doctors are few and far between
Even 20 years ago, “thanking” a doctor was common practice. A 2002 survey conducted by the Center for Baltic Studies of the University of Latvia showed that up to 70% of Latvian residents surveyed were prepared to make illegal payments in medical institutions. 50% of respondents did not recognize that a bribe to a doctor (in terms of money) would be considered bribery. 45% thought a doctor’s compensation was normal thanks, 14% said doctors should be paid extra due to their low wages, and 6% hoped this would bring them more attention. 62% of respondents replied that they would never report a doctor who asked to pay more than the state or institution established. 56% of respondents were prepared to pay for not having to queue for a medical service. 50% believe that corruption in the healthcare sector has significantly increased over the past three years.
Although corruption in the health sector has declined over the past 20 years, Latvia’s rate in 2020 was double the EU average (5%), according to Eurobarometer research data on corruption in EU Member States published by the Commission European. A study conducted in 2020 reveals that every 10th respondent in Latvia who visited a state health specialist in the past 12 months, in addition to the official payment, gave an additional payment or a precious gift to a nurse or doctor or donated to hospital in exchange for welfare benefits.
The history of more recent times shows that corruption violations have occurred (and are they happening?) In connection with vaccination against Covid-19 outside of the order and procedure established in Latvia.
Reproaches for Zatler and Auder
It is time to remember that in 2007, when the then President of the Hospital Board of Traumatology and Orthopedics, Dr. Valdis Zatlers, became President, he was accused of taking bribes. True, they were called more correctly – thank you. Zatler made no secret of accepting money in an envelope as an additional payment for the work done in his doctor’s office. However, he stressed that he never asked for a bribe. If he gave, he took. Just that simple. Our anti-corruption fighters kindly determined that the information provided by the patients showed that – in all the years he worked at the trauma hospital, the money was given to Zatler only in two cases, in others – flowers, sweets, alcohol, works made by the patients themselves, and none of the respondents testified that Zatler before or after surgery would require additional payment for the operation. 377 patients agreed to provide explanations.
However, the great surgeon, former health minister Āris Auders, ended his life at the age of 55. His life was ruined by a patient’s complaint for double compensation for operations in 2002. As it was, as it was not, Auder gave up, despite earning a doctorate, discussing a thesis on trigeminal nerve microsurgery, studied at US University of California San Diego School of Medicine, obtained a US postgraduate certificate in neurosurgery and a certificate from the University of Bern in Switzerland. He was head of the Spine Surgery Center at the Hospital of Traumatology and Orthopedics. What he said about his own golden hands for performing unique trades was immediately grasped and variously played. Auders did not exaggerate his talent: in 2000 he was the first in Latvia to implant an intervertebral disc in a patient. But his life turned out differently: his talent as a surgeon was canceled.
How bribes were punished
We can tell the story to get an idea of the crime and the punishment and attitude of society. In 2007, an otolaryngologist from Jelgava hospital was sentenced to 100 hours of forced labor for asking for a bribe. He had requested 100 lats from a patient for a nasal cavity operation. In 2018, the Office for the Prevention and Fight of Corruption had asked the Attorney General to initiate a criminal action against a doctor who had accepted a “free” of 800 euros.
Several years ago, Latvia was shocked by the so-called corruption case at the children’s hospital, in which the defendants were sentenced to large fines, conditional imprisonment and forced labor. True, in this case the corruption case was related to the purchases, not to the “thanks” of the patients or their relatives.
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