Abstract
Dear Editor
I thank the anonymous author for his or her great Editorial (1) which compared two health care systems, the old patient-centered system (PCS) and the new finance-centered system (FCS); the patient being the center of activity of the first while financial gain being the center of activity of the second.
Being from the “older generation” (1) who practiced almost all his career in the PCS, I sense the impact of the FCS on medical education and research. A Chinese proverb states “If you are planning for a year, sow rice; if you are planning for a decade, plant trees; if you are planning for a lifetime, educate people.” During 1993 to 1995 and in the old system, Professor Sten Lennquist, a great surgeon, researcher and educator, gave me his unlimited generous support to be trained as a visiting PhD student in trauma and disaster medicine at Linkoping University, Sweden. The educational fees for the whole 3 years were only 100 Swedish Kroner (US$12). Was this cost effective?, definitely not in the new FCS which will not be interested to address the huge global research gap between developing and developed countries (2,3). Properly training a researcher from a developing country, although was almost free of charge, has paid off 25 years later. This reflected back on a whole developing country with more than 250 publications related to injury prevention, trauma and acute care surgery in high ranked international journals and their positive impact on the community. In comparison and in the new FCS, residents are trained to over-code the disease and unnecessarily increase the text of their notes so as to get the maximum revenues even if not precise. This has major negative impact on quality of research. Proper research becomes difficult to perform due to the augmented jargon in the FCS compared with the concise old paper file system.
I still remember the voice of Professor Bo Eklof, a great vascular surgeon and a great mentor and educator, who told me once “Fikri once we die our students should carry our mission.” Hearing his deep voice, I try my best to carry this noble mission even in an uncomfortable environment. In the FCS system, we struggle to express our thoughts to our students in the rush business-based rounds and meetings. There is no time to dissect the critical thinking process of managing patients. Compare this to the 4-hour teaching surgical rounds that we used to taste and enjoy every Wednesday 30 years ago, learning from extraordinary surgical role models who taught us that doctors are passionate human beings that give their life for their patients.
Being a medical learner and educator for the last 40 years and being exposed to both systems, and if I want to choose again between the two, I would definitely choose to be educated as a doctor (not as a health care provider) and treated as a patient (not as a consumer) where passion, real human patient care and caring surgical role models will prevail.
