Navigating the Social dynamics of Russian Healthcare
Rudrakshi Shetty, 4th Year MBBS
The Covid-19 pandemic has exposed the long-standing issues in our healthcare system, right from the lack of hospital beds and medical staff up to the sluggishness of the system which funds medical care. With the progression of the pandemic, the system was in a critical position due to the failure of medical reforms that had not been updated for years. There was a dire situation due to the over-exhaustion of the frontline workers and there doesn’t seem to be a way to recover from all of this anytime soon.
All this can be determined and adapted based on statistics, but when it comes to figuring out the social dynamics in a system, especially in a country so foreign, it can be quite tricky. It all comes down to your personal experiences, perspective, and willingness to adapt to a completely different setting. Healthcare in Russia is free for all citizens under Obligatory Medical Insurance (OMI). This presents flawlessly on paper but in reality, it had its very own limitations. The accessibility of this is under question since many people in rural areas still don’t have access to it. Even now, the healthcare situation is more favorable in the European parts of the country as compared to the Asian ones. People who can afford private medical insurance are at an advantage and this ends up creating a huge disparity in the treatment received and can influence the attitude of the healthcare staff towards the patient.
There have also been instances of discrimination against transgender people in the form of verbal abuse, refusal to allow them to be blood donors, and even denial to provide emergency or planned medical assistance.
Case examples: 1)N, a transgender man from Siberia had a high fever and called for an ambulance. The paramedic gave him an injection and recommended hospitalization. On discovering the name and gender on N’s insurance card, he started insulting him and calling him “a pervert”. He then refused to drive him to the hospital.
2) Vladislav, an intersex person identifying as male, from Novosibirsk, was refused help for a fracture covered by his medical insurance. The staff accused him of using his sister’s insurance because his appearance did not match his female ID. He didn’t receive timely treatment leading to further complications.
It’s quite difficult to present everyone under one umbrella but for the most part, the doctor-patient relationship tends to follow more of a paternalistic model. This is where the healthcare professional makes decisions for the patient with or without consent since they believe this is in the patient’s best interest. There are a couple of ways to look at this. This may be inevitable at times like when a surgeon has to make a call instantly in the middle of a procedure or a while dealing with a rare complication where there aren’t many options of management. The argument in favor of this model talks about the years of clinical experience the physician has and also takes into account the patient’s state of mind where they have to deal with decision making in a weakened, vulnerable state while dealing with an illness. Here the patient’s emotional involvement may make it rather difficult for them to come to a rational conclusion. There could also be times when the patient may be uneducated so this might be the right thing to do. But there have been several instances where physicians have withheld crucial information from patients to have management done their way or for experimental research, knowing that if the patient had complete knowledge of it, they wouldn’t comply. This seriously risks the patient’s autonomy and tarnishes their faith in the healthcare provider. This obviously doesn’t stand true for all doctors, in fact, there has been a more informative and/or interpretive approach observed in younger physicians and the trend seems to be changing with time.
As for dynamics in the hospital, it exhibits many different variations. From experience, I’ve observed more of an autocratic group dynamic where the consultant or the resident takes charge of the entire decision-making. Many physicians insist on inoculating a homogenized dynamic where everyone is encouraged to participate and share their thoughts on the said case. This motivates everyone to bring their best to the table and establishes a sense of leadership. Regardless of what the dynamics are like, students are never discouraged from learning or asking questions. With time and observation, your opinions may or may not change on how your relationship should be with your peers and your patients, but as long you have your patient’s best interest at heart, that’s all that matters!