Doctors, especially those from the Emergency Department, say that the overwork of staff in Romanian hospitals is an increasingly acute problem that can give rise to tragedies, such as the one at the Hospital in Buzău. And the factors are numerous, from the number of patients to societal pressure.
Urgent Reception Unit. Photo: The truth.
The case of Ștefania Szabo, the 37-year-old doctor from Buzău Hospital, found dead on Tuesday morning in the guard room, brought back to the fore a serious problem encountered in many hospitals in Romania, especially in very crowded wards, with many presentations and medical interventions: staff overload. At the Emergency Departments, in many hospitals, the number of patients is increasing, and the number of doctors is insufficient. To all this, employees from the health system testify, there is added the pressure of time, relatives and society in general, which seems to hunt potential errors of doctors. In these conditions, the doctors add, a tragedy can happen at any time, and one of the employees can succumb at work due to fatigue and stress.
“A disaster medicine where demand outstrips supply”
Ramona Guraliuc is the head physician of the Emergency Department of the “Mavromati” Botoșani County Hospital, the largest medical unit with beds in Moldova. She says that staff overload is a reality of the Romanian health system and can always have dramatic consequences:
“The risk of overwork, as you also see in the media, can be a cause of a death that occurs spontaneously in a doctor. Without him knowing that he has an associated pathology, more precisely comorbidities. And then fatigue, overwork, stress, everything that means medical activity that exceeds a normal level, so to speak, and that depends on the individual to the individual, leads to sudden tragedies”says doctor Ramona Guraliuc.
And one of the main causes of overload is a disproportionate ratio, especially in the Emergency Department, between the growing number of patients and the reduced number of staff, especially medical.
“I will speak from the perspective of the doctor who works in the emergency medical service, which, from my point of view, is one of the most requested specializations that exist in the medical field. This overload also occurs because of the large number of patients that we examine in 24 hours, more than was examined before. And then we are simultaneously faced with the small number of medical personnel, with the large number of patients who assault our emergency service and we are doing a disaster medicine in which the demand it’s practically beyond supply. We hope that these things will be resolved little by little and we hope that we will not end up collapsing from the point of view of the medical body.”adds the chief physician at UPU “Mavromati”. According to statistics, in Romanian hospitals, there is a severe shortage of doctors. More precisely, 30,000 more doctors and nurses would be needed to ensure optimal functioning. The most affected are the hospitals in the province, because the majority of doctors prefer university centers.
More than half of the 55,000 doctors who have the right to practice freely work in Bucharest and in five other counties in the country with university hospitals. In the rest of the medical units there is a crisis of radiologists, specialists in intensive care, emergency rooms and other fields. Consequently, in hospitals with low medical staff and large numbers of patients, the risk of overcrowding is huge. In counties with a large rural population living in communes without a family doctor or nearby health facilities, such as Botoșani, most of the villagers go directly to the Emergency Department, leading to an avalanche of presentations. The head of the UPU from Botoșani says that the number of patients will increase even more after the elimination of the co-insured status. In a county with numerous social problems like Botoşaniul, it means more people coming to be treated for anything at the Emergency Department.
“And the number of patients has increased and I think it will increase steadily for these reasons that have been put into practice from a legislative point of view. That is, the co-insured or those who do not have health insurance cannot benefit from care in the pre-hospital phase in the individual offices of the family doctor. And then a number that is low of senior medical personnel and here I mean doctors, but also nurses, because with the increase in the number we function as a chain of survival, we are links that build a chain. And if one is overloaded it will obviously lead to a malfunction of this chain”says Ramona Guraliuc.
“Let’s not forget that the doctor is also a human being like everyone else”
In addition to the undersized staff factor, doctors say that another reason for the overwork is the increasing pressure in recent years on the sanitary corps in hospitals. It is, above all, about the patients’ relatives. In some cases, doctors say, they want unrealistic intervention times relative to the health problems found. And this in the conditions where there are enough people in serious condition that require immediate intervention. Last but not least, medical staff say there is also media pressure, focused on potential mistakes by nurses or doctors.
“Everything has to happen in a very short time, then there are the threats, the media pressure on the medical body. The medical conducts that were defective from the point of view of some have become generalized to the entire medical body. And these lead to the increase of the pressure on the doctor, the assistant, the nurse, the man who works in the hospital and which, as you also insist, can come to an unfortunate end. Let’s not forget one thing, the doctor is also a human being like everyone else, but from whom sometimes the expectations are more than normal”adds the doctor from Botošan. Overcrowding is a reality for people working in Emergency Departments around the world. For example, Petri Aspegren, a lecturer at Finland’s Oulu University of Applied Sciences and a former paramedic, says that often the consequences of overworking doctors under high stress and pressure can lead to “multiple and complex” physical and mental health problems.
“In emergency care, for example, the work involves exposure to death, human suffering, violence and the threat of violence, which is extremely traumatic, with the risk that it can lead to post-traumatic stress disorder(…). People in these situations often feel a sense of helplessness and hopelessness. These are normal reactions, but attempts to suppress and avoid them only make things worse. It is therefore important that those whose work involves managing situations difficult to have a safe space to share their experiences and express themselves as human beings”, states Petri Aspegren for the World Health Organization.
