Education Quality For Medical Professionals

arete92

Member
Jul 5, 2018
70
1
8
As the punch line implies i'm curious about the education quality. Before I start allow me to clarify I am asking this question for honest anwers and am being objective as possible with the statements.

I am rather concerned; Over that past 6 years I have known this culture and the langauge something always bugs me and it's medical delivery and education. I know some things have been improving but some things are degrading and really raise peoples eybrows. What education quality do Dominican doctors receive ? i'm sorry but the amount of antibiotics that are prescribed and unessisary surgical procedures are manic. There has been so many instances of people dying from anesthesiologist errors as well as doctors. The other thing that really iritates me is the business perspective; prescribing medicating not needed or charging different prices for the same service; look, I know people need to make money but as medical professionals taking care of your community how can you entertain to lie to people and have no empathy regarding human life. I have many doctor friends in my home country as well as D.R but in respect to even the way things are conducted on a personal basis are remarkably different mainly involving logic and critical thinking I do not see so much impulsivity here and if there is they loose their right to practice medicine but in the D.R how do you deal with these things? and what are peoples opinion on the level of education received?
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,966
919
113
Many Dominican doctors are as good as anywhere on the planet.

Many private clinics are excellent.

But those doctors attended the best Dominican medical schools and did their internship and residency offshore in the US, Mexico some SA countries and Europe, especially Spain.

The public system is a different story altogether.
 

Cdn_Gringo

Gold
Apr 29, 2014
7,330
324
83
Patient A (Patient A - because person hasn't given me permission to post about them) presents at an emergency room on their own 2 hours after a moto accident. Patient has clearly visible cuts, abrasions and contusions on their hands, legs, arms, feet and nose.

Patient A has showered, cleaned and dressed their own wounds. Knew they were going to be sore so went to Emergency for piece of mind and hopefully a prescription for pain medication.

Patient A interacted with two doctors, two nurses and an x-ray tech.

No one asked if patient was wearing a helmet, no one showed any interest in the cut on patients nose. No doctors palpated for internal injuries or bleeding despite some serious bruising on arm and torso. Most were really impressed with the patient's colourful self-adhesive wraps and quality gauze pads used to dress the worst of the road rash type injuries.

X-rays taken for one arm due to bruising. Nothing broken. No head, torso, leg or feet x-rays done.

No treatment for patient's hands or feet despite despite cuts and abrasions being present.

After treatment, patient A did not get a prescription for pain killers despite asking. Patient was asked to sign an extra blank insurance claim form. Back at home patient A replaced all of the poor quality bandages applied at the hospital with quality medical supplies... and taped two broken toes together.

The initial exam was nonexistent. No examination for head trauma, no exam for internal injuries, no questions to determine level of alertness or awareness. No questions about the specifics of the accident and an apparent lack of interest in any abrasions less than the size of a silver dollar.

Patient A reports they were the only person in the emergency dept at the time so it's not like the facility was busy, just a gaggle of medical people chatting up the attendants at the front desk.

Granted, this is just one story on one specific day. You should be able to determine if Patient A received the minimum acceptable level of medical care for the type of scenario that precipitated their arrival at hospital.
 

cavok

Silver
Jun 16, 2014
4,522
419
83
Doctors here seem to be extremely reluctant to give any kind of decent pain killers - no matter how much pain you're in. At best you might get something with codeine in it. I don't think the farmacias even carry anything stronger(?).
 

cavok

Silver
Jun 16, 2014
4,522
419
83
A friend of mine had bladder cancer and had to undergo an extremely complicated surgery where they replaced his bladder with part of his intestines.

He went to one of the top surgeons in the US for this type of cancer and surgery. He got his medical degree here in the DR. Like CB said, he did do his internship and residency in the US though.
 

arete92

Member
Jul 5, 2018
70
1
8
A friend of mine had bladder cancer and had to undergo an extremely complicated surgery where they replaced his bladder with part of his intestines.

He went to one of the top surgeons in the US for this type of cancer and surgery. He got his medical degree here in the DR. Like CB said, he did do his internship and residency in the US though.

That seems to make a world of a difference, but from what I have seen ones who have completed their intership in the D.R don't have the best mentors to ask questions to, could be perhaps because all the good medical professionals leave? and we're left with the "passing" ones, but at the same time like the other member stated; the level of initial care offered is horrendous.
 

arete92

Member
Jul 5, 2018
70
1
8
I don't have any insight to offer but could ask a family member who worked for many years at a very popular pharmacy ;) is it perhaps expensive in the D.R? could be social stigma or false beliefs to go along with handing them out pain-meds.
 

arete92

Member
Jul 5, 2018
70
1
8
I took my son to the a clinic on the north coast he was around 1.5 years old at the time. They determined in 10 mins that he should have anti-biotics without doing any additional work and instructed he take the pills until complete( atleast they said until complete) but then said come back tomorrow for a feces collection reason why this made me upset is because an infant needs to develop their immune system and kids and general and antibiotics should be reserved for when needed and plausible cause. another one, my partners aunt was operated on due to an autoimmune disease ( was 15 years ago) died in operation of undetermined causes. Recently as some of you may have heard there was an accident near puerto plata involving a motercycle collision with a cow. He was not wearing his helmet unfortuantley but did most of the time, collided with the animal had internal bleeding and hemmoraging in the skull, broken rips and ruptured spleen I believe; ambulance brought him to the clinic where he was in life threatening condition where hours later he died I imagine of internal bleeding. Fact of the matter is the whole sensitve situation was not dealt with properly and a lot of distrust in the hospital for delays. Personally the situation sounded overwhelming for even an American or Canadian team but, the way everything was dealt with inbetween is wrong I just mean simple logical steps and empathy for human life.
 

dv8

Gold
Sep 27, 2006
31,271
358
0
some doctors are good, many are very bad. the good ones - that i know - all studied abroad. many did residencies or specialties abroad, few in the USA and most in spanish speaking countries like mexico, spain, peru, argentina or cuba.

one thing that should be noted is that the treatment in DR matches the patients, so to speak. in the pharmacy we had many clients who came from the public hospital consult and handed us a piece of paper thinking it was a prescription while in reality it was a diet plan or general instructions regarding food/exercise for those with high sugar and/or blood pressure. each time the client was royally pi**ed they were not given pills but some stupid garbage advice and they tossed the paper directly to the trash. if you have patients like that no wonder the doctors cannot be bothered with any advice further than "take this medicine". not to mention people demanding we give them antibiotics for every affliction from cold to headache and red rash on the ass.

on a side note, hard core pain drugs are available in DR to general public upon special prescription in selected pharmacies only. some are limited to treating terminal patients or for hospital use.
 

arete92

Member
Jul 5, 2018
70
1
8
Do these doctors come back to the island? I imagine if so they go for the capital or Santiago. I can understand that I suppose, people in D.R tend to think the pill will fix everything and there is no effort on their part, iv'e been laughed at so many times and cheapy shamed for being vegetarian and exercising it really amazes me that if someone walks or runs they are labeled as poor :) I've never really understood this from a logical perspective but it's a shame culture and I think you are kind or reflecting your frustrations as well with different clients, I think this comes down to education again though in context of patient demands etc.
 

cavok

Silver
Jun 16, 2014
4,522
419
83
That seems to make a world of a difference, but from what I have seen ones who have completed their intership in the D.R don't have the best mentors to ask questions to, could be perhaps because all the good medical professionals leave? and we're left with the "passing" ones, but at the same time like the other member stated; the level of initial care offered is horrendous.
All I can say was my wife was in an extermely serious moto accident about a year and a half ago. Many serious injuries.
Lost a lot of blood. Those at the scene thought she would die for sure. Thanks to the docs in the emergency room at Bournegal she's alive and recovering well.
 

Bob K

Silver
Aug 16, 2004
2,500
89
48
The basic medical education here is a joke at best. Yes there are a few good docs around but almost all will have completed post grad work (internship and residency) elsewhere.
If you are an Expat make sure you have evacuation insurance.
Bob K
 

william webster

Platinum
Jan 16, 2009
23,796
669
113
It can be 'hit or miss' in the DR - certainly
The general population generally is not well educated - another almost certainty

But doctors & lawyers generally tend to be regarded with esteem the world over, more so than other professionals.
This confuses me - many have post graduate education.... engineers, business, dentists....
But the medical and law ones fit in differently

I find that the treatment here is good generally.
I particularly like the fact that when speaking English, the doctor can't couch his words, obscure his meaning with indirectness.

The diagnosis/prognosis just comes out in blunt terms... the truth

In USA/Canada - any time they say -
take 3 of these and call me tomorrow....
They are testing the waters... Will this work ? Hence the double check manana

I ahve just been through a lot in a new field of treatment.
One where almost nobody has much depth of experience.
Answers were often - not sure, we'll see.....

I was learning as fast (or faster) than they were.

Medicine is not an exact science.... as many think it is.
Act and react.... in many cases.

To get good care here, you need to build a network....
know who to call - and be prepared to travel

my 2 cents
 

Hillbilly

Moderator
Jan 1, 2002
18,943
498
83
I suppose that I could pontificate about health care here in the DR, but let's just look at some of the realities:
1: There are med schools and there are med schools. The "for profit" universities hand out degrees in medicine like toilet paper.
2: The government puts all med school grads through two processes: Internships of 1 year and Practice (Pasantía), also one year. They do not care where you have studied. The Internships are not paid but many if not most of the Practice year are paid positions in public facilities--oftentimes Primary Care facilities just newly opened,
3. This year, over 4200 persons (med school grads who had done the two years of Internship and Practice) took the Unique Exam for Residencies. Of these some 600+ managed to pass. 12%!!
4. Of the government's several hundred residency programs in public health facilities, nearly 200 went begging for a lack of applicants!!! Family Medicine, Pediatrics, Medical Pathology, Nutrition slots went begging. The government later opened up many of these for persons who had applied to other specialties and not been accepted. Some private clinics offer residency programs, but they pay poorly, and most applicants want to go to the public hospitals to learn. Cecanot, a public hospital, is one great example of this.
5. Yes, many graduates, those that can afford it, do go overseas, but things are changing, and what was once a fairly easy process to enter is now extremely costly. Places like Spain now have big exams for medical residencies, and they are flooded with applicants.
(You see, those 3000+ that failed the Dominican exam can go overseas, pay their way into other programs--especially in places like Venezuela, Brazil, Argentina, Mexico. Of course, it is obvious that not all--in fact MOST--cannot afford to do this. But "MOST" means that close to 1500 or 1000 can and do go overseas.)

As Mr. Webster has so wisely pointed out, you do need to build a network of health care professionals that can attend to your particular needs.
Emergency care is a whole different story. Pain meds are very strictly controlled as DV8 has mentioned and only a few doctors have the forms needed. However, there are some good ERs, but you need to research in your area. In Santiago there are four or five (HOMS, Centro Medico, Unión Médica, Corominas, Materno-Infantil) that can handle most cases. In Santo Domingo, there are even more. Abreu, Cedimat, Gómez Patiño etc...
I am sure that people in La Romana and Punta Cana can point out some ER that they trust. On the North Coast, I hesitate, but leave it to the ones that know...

Folks, considering where we are living and the costs, for those of us that have medical insurance, things are not so bad. Perfect? Nah, no way, but the same applies to the US and other developed countries. It is often hit or miss.

Cordially,

HB
 

william webster

Platinum
Jan 16, 2009
23,796
669
113
Yes, HB.... the world over medicine can be a crap shoot

As we both said - Hit or Miss.... it's as much a fault of the science itself as the practitioner - I say

Finding a good combination of the two is the secret - and that takes work and research - as you point out.
 

USA DOC

Bronze
Feb 20, 2016
1,783
1
36
...many good points are talked about.....if you can, and the medical problem is severe ...go to USA.........Doc.....
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,966
919
113
Four things I really like about the Dominican health care system:

1) One can easily establish their own network of excellent physicians & facilities and be on not only cordial basis but a direct cellphone connection.

2) The cost of care is a fraction of that in the states, and excellent care delivered.

3) The personalization with one's physicians is direct, no gatekeepers, no mandatory physician referrals, no physician helpers, a direct one-on-one for as long as professionally necessary.

4) Lack of paperwork and onerous bureaucracy and legalese that stand in the way of patient-physician contact.

I wouldn't want a heart or kidney transplant in the DR, or advanced cancer therapy, but if one knows their way around the medical world, the DR has excellent care and below reasonable costs in comparison to the US.
 

william webster

Platinum
Jan 16, 2009
23,796
669
113
DOC
We all agree ... civilized world for deep serious...

CB is right....
like nice thruway stop is what medicine is here

EZ in - EZ out

But but but
You need to know your stuff and be very aware

As someone said earlier... when you’re out cold on the road.... you have no input

That’s when the feces might interfere with operation of the fan
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,966
919
113
As someone said earlier... when you’re out cold on the road.... you have no input

That’s when the feces might interfere with operation of the fan
We tell our guests that one main reason we will ride conservatively is because we do NOT want to test the Emergency Medicine system in the DR.

It is getting better with many more trained EMT's and ambulances---even in Jarabacoa---but it's no way near First World standards. In fact, should not be mentioned in the same sentence.
 

JasonD

Bronze
Feb 10, 2018
990
0
36
No problem here attending and seeing a medical professional in the DR. Here I actually get to see a Doctor, not a Nurse, not a PA but a Doctor and for the most part no need for referrals. Great one-on-one interactiona nd follow ups as needed.

Trust them, like them, great services by most.