Privilege

Privilege is defined as a right or benefit enjoyed by a person beyond the advantages of most, which is often a source of pleasure to that individual.

Lately I’ve been thinking a lot about hospital privileges. 

When I decided to set up my medical practice I applied for privileges at my local hospital. I filled out an application and met with the hospital privileges committee who determined my fate. They asked me questions about my scope of practice and whether I planned to deliver babies and how many shifts I would do in emergency. My success on acceptance was based on my answer to these questions and the general feel of the interview. 

Securing privileges allowed me to build my practice and gain favor with the local medical community. Not applying wasn’t an option, and without these privileges it would have been a tough slog indeed.

Well, let’s see what my privileges allow me to enjoy in 2011. I have the benefit of coming to the hospital on a daily basis to see my admitted patients and helping to coordinate their care. I am then available during the day if any other problems arise with these patients. 

If they require surgery I will cancel my office and assist during their operation. If the operating room runs late or my patient is bumped for a more emergent case, I will have to cancel more office patients. I also get the pleasure of sharing rounds with my office colleagues on weekends.

I am then privileged to be available after hours as part of a call schedule so that I can get woken up at 3 a.m. because someone has just noticed that Mrs Smith’s urea is less than it was yesterday (I’m not making this up). Admittedly, this “call” is only monthly as there are around 30 of us family doctors still working in the hospital, but on a weekend you are available for 24 hours and handle numerous pages for the privilege of no remuneration.

Another benefit that brings me pleasure is renting a pager for the sole purpose of being available to my hospital. I also fork out an ever-increasing amount of money for the privilege of parking at my hospital. The parking rates are controlled by Impark and set at a regional level. The hospital re­mains the only place in my large community where you have to pay to park. 

The most poignant benefit I get to enjoy beyond the advantages of most is watching my hospital deteriorate to a shadow of its former self. Patient care has deteriorated to the point where I would not want to be admitted there anymore. Let me be clear: I admire and respect so many of the dedicated staff that work at my hospital. They truly are unsung heroes struggling with an ever-increasing workload. 

My hospital is overcrowded, and its occupants are served often unrecognizable rethermalized nutrition. Vulnerable, frail elderly patients of different genders are separated by thin curtains. There is a shortage of nursing coverage and auxiliary personnel such as physiotherapists, occupational therapists, social workers, and more. 

There appears to be a lack of basic patient care, and sadly the focus has become on getting patients out whether they are really ready or not. The majority of people making the decisions don’t have a vested interest in our community and it has become more about dollars and cents.

Frankly, I am embarrassed about what I can offer my pa­tients when they are admitted to the institution I am associated with. 

What a privilege.
—DRR