Why are Poles afraid of preventive check-ups? Episode 92

Monika Rachtan
I would like to invite you to listen to the programme First Patient. Hi, Monika Rachtan. A very warm welcome to you. This is the third special episode produced during the Patient Organisations Forum organised by the Institute for Patient Rights and Health Education. You know me well and know that oncology topics are very close to my heart. So oncology could not be absent from this year's forum. Today, I will be talking to Mrs Dorota Korycińska about many aspects of treating oncology patients, but above all we would like to focus on prevention, because we should also be responsible for prevention ourselves. Hello, Mrs Dorota, good afternoon.

Dorota Korycinska
Good morning.

Monika Rachtan
Ms Dorota. Today, Poles have a huge problem with the implementation of preventive examinations. We have excellent preventive programmes on the stage today from the Ministry of Health. There is only one problem, however, and that is that they do not work, because Poles are not taking advantage of these tests. What can be done to encourage Poles to take part in preventive examinations?

Dorota Korycinska
A very good question. I think I have the answer to that question. What to do? First of all, find out what the reasons are that Poles do not go for preventive examinations. Most often, if we look for an answer to the question of why Poles do not go for preventive examinations, the answers are in terms of guilt. Is it the fault of the patients or the fault of the Poles? It could be the doctors' fault, it could be a fault related to unequal access to health services. That is, the fault of limitations in communication, in public transport. It could be the fault of ignorance, because Poles do not know. However, I am firmly opposed to talking about blame. On the other hand, I would prefer that we started talking about the causes. Why is that? First of all, the causes should be investigated. I, too, have no patent on the solution to this problem. What can be done to get Poles to come in for preventive examinations? Apart from one thing, let's examine why Poles do not go for preventive examinations. I may have some hypotheses.

Monika Rachtan
Mrs Dorota, but you are the President of the National Federation of Oncology. You also bring together a number of institutions, but also patient organisations, which have been mentioned here today in particular. Whose job is it to investigate why Poles do not take up preventive examinations? Perhaps patients' organisations should be involved in this? You guys are doing a great job with things that are not getting done.

Dorota Korycinska
Oh thank you very much. How do you check the causes? Well here, unfortunately, I think I am going to disappoint the editor. Patient organisations are not in a position to check everything, although that does not mean that they are not doing anything about it. There is the Sarcoma association sorry, because the whole name is longer, but I will not quote it at the moment, lest I do not.

Monika Rachtan
Friends are familiar with this association, which.

Dorota Korycinska
In 2022, it made such an attempt to investigate why Poles do not examine themselves. I think there is even a similar title for this study in a report on the association's website and you can see the report for yourself.

Monika Rachtan
And the key findings of the report?

Dorota Korycinska
The main conclusions are frightening. Well, the Poles do not know. So here we have a lack of information. As it turns out, I'm not going to quote the exact percentages at the moment because I haven't written them down myself. Well, but more than 30% of people surveyed do not know that preventive examinations can be done within the public system, i.e. they are free. Certainly more than 30 per cent of patients do not know, excuse me, the people surveyed do not know which preventive tests they should have themselves. Also, a very high percentage of patients, people do not know which ones, where in the nearest area they can have these tests. So what is the conclusion of this? The conclusion is that people simply do not know. However, someone should be responsible for providing this information, because it is a lack of information, and we cannot blame people for not knowing, but only try to draw conclusions from this study, so that if people do not know that it is free of charge, that they should have the tests, and where to have these screening tests, then this is the direction we need to take.

Monika Rachtan
Ms Dorothy.

Dorota Korycinska
And make sure that this knowledge is there.

Monika Rachtan
I chaired a very passionate panel today on chronic disease prevention. We were absolutely not talking about cancer, we were talking about all chronic diseases. And the Director of the Department of Public Health at the Ministry of Health convinced me that we have prevention programmes, we have information on the website of the Ministry of Health about what prevention programmes are, we have posters in primary health care centres encouraging people to get checked, and the statistics are what they are. And now the question is, are these actions that we are doing, that the Ministry of Health is doing, this information campaign, is it then ineffective, is it not reaching the Poles? Does it reach? No, no, these channels are being used. Maybe some way of communicating it is wrong? Well, because the Ministry says clearly that we are giving a programme, but people do not want to be tested.

Dorota Korycinska
That's right. That is, we talk about guilt all the time. And this is the fatal interpretation of what is happening. I will ask you, editor, a question. May I?

Monika Rachtan
Of course.

Dorota Korycinska
Please, please tell me, when was the last time you looked at the Ministry of Public Transport website?

Monika Rachtan
I thought you were going to ask me, Dorothy, about the Ministry of Health, Infrastructure. Absolutely not. I do not look at the website.

Dorota Korycinska
Please answer my question as to why the average person would look at the Ministry of Health website every day?

Monika Rachtan
Because his health and life are at stake.

Dorota Korycinska
Well, we can look at the website of the Ministry of Infrastructure, because we go there practically every day, and yet we do not do it. Well, this is not, in my opinion, a source of information, because no one looks at the websites of all the central offices, because we would have to start practically every morning to look at what information is on the websites. No, it is not that.

Monika Rachtan
But, Dorota, I will make an argument, which is not my argument, but I am sort of trying to represent everybody, and we will say that every Pole is practically able to use an Internet search engine. I type in the phrase prophylactic tests for 50-year-olds and the website of the National Health Fund, or the Ministry of Health, should come up first. Or it should at least be on the first search results. And then you have the answer. You can check what programmes are available.

Dorota Korycinska
OK, but first this 50-year-old needs to know that there are any preventive tests for him at all, so that he knows what to look for.

Monika Rachtan
And whether at all.

Dorota Korycinska
The Poles do not know? If you will allow me. For many years, I do not know, several, several years, we have been saying that we absolutely need health education in schools. What is education for? To also create awareness and to create a need. If, as part of health education, we know that we should take care of our health, how should we take care of our health? And part of that taking care of your health is health vaccinations, is screening. That is when we will look for information on where to do it. However, if there is no such education, if there is no awakened awareness, well, it is difficult to expect us to check all public institutions day after day or even once a month, because maybe there is something there for us. Well yes, it doesn't work. First there is the need for education, it serves to arouse needs, among other things. And then information should follow. But this information has to be good. I am sorry, I do not agree with the previous speaker, but I do not think that the Ministry's website is the right place for health education and for such information about screening. It should be completely different.

Dorota Korycinska
There is the issue of local authorities, there is the issue of schools, there is the issue of our everyday public space. Madam Editor, if I may say so, if each of you looks at your everyday life in this way. We shop, we drive to work, we get around in our own cars or by public transport, but each of us does our shopping, we watch television. What do we have there? We have the promotion of unhealthy lifestyles. We have competition between large retail chains for cheaper vodka. We have advertising like buy three multipacks of beer and get the fourth one free.

Monika Rachtan
We also have advertisements aimed at children that sell fast food, for example, and that too.

Dorota Korycinska
Fast food, fast food advertising. What else do we have? Name days at an aunt's house or a barbecue where you can eat very fatty food because all you have to do afterwards is take a miracle pill, or a dietary supplement. What else do we have? I have been paying attention to this. Look at all these popular, let's say small shops. There used to be kiosks, today they are called something else. I won't use names, but please note how everything is there, how the goods are arranged. An adult sees nicotine products in front of their eyes. By contrast, what does a child have in front of his or her eyes? Within the sight and hands of a small child are sweets laid out, right? That is the everyday message that flows to each and every one of us. This is the message. That's what my colleague told me, as it is expertly called. It's a matter of consumer choices. And these are the very fatal choices. The architecture of consumer choices. This architecture is arranged in such a way that the incentives, the messages, the information about eating as badly as possible and living as badly as possible are constantly flowing. However, I would like to ask you, the editor, and each of you, where do you see health in this consumer choice architecture?

Dorota Korycinska
It doesn't.

Monika Rachtan
Ms Dorothy.

Dorota Korycinska
There is no such thing. Therefore, please do not be surprised that the public reacts the way they receive information. It is not just information under the title There is information on the website of the Ministry of Health about having a cytology. Information is what we encounter day in and day out, going to work, going to school, shopping, watching TV. It is our environment. This is the information that flows to us, and it is difficult to expect Poles to suddenly know by themselves that they should act differently. All the more so because there is no education.

Monika Rachtan
Ms Dorothy, I, in preparation for our interview, interviewed one person, one 70+. I asked her What are you most afraid of in life? Disease. What are you most afraid of in life An illness. One that will make me not independent, that I will have to, that I will need to be cared for by another. Well, but what kind of illness, for example? Well, for example, cancer. And what else? Well, I'm afraid of having a heart attack. What do you do to avoid having a heart attack? And the person looked at me and said What can I do not to have one? It's not up to me. And that's when it dawned on me that exactly what you said, that we are lacking in elementary health education, our generation, my generation, all those people who are above the education that's provided in schools, and that we, by giving kids the tools, it's great that we're educating them, but we're not going to make up for the years of neglect that we've had in terms of adult society. Because an adult Pole, for example my 70 year old doesn't know what he can do to avoid getting cancer.

Monika Rachtan
On the other hand, I replied like this And did you know that you do things that make your body get cancer? What do you mean, I take care of myself. And I asked And do you, for example, reach for sweets? Well, yes. How often? I don't know. Well, once a week there. A bar. And do you eat cake with every dinner afterwards? Well, yes. And did you know that excessive weight promotes cancer? No, that's definitely not it. And just noticing this problem. In my opinion, when it comes to our society, it's not a problem that the Pole doesn't want to. It is a problem that the Pole does not know why he should want to. And that there is a great deal of work to be done here, not just in terms of children. Because we can't keep relying on the granddaughter coming home from school and saying to grandma, come on, let's go for a walk, and grandma will start to move because of that. We just have to find a way to get the message out to the public and, to make it an effective message, measure our effectiveness afterwards.

Monika Rachtan
Because if we just talk, talk, talk, talk, I'm sorry, but you also go to medical conferences a lot and we've been talking for 20 years.

Dorota Korycinska
And unfortunately, yes.

Monika Rachtan
And nothing comes of it.

Dorota Korycinska
Yes. And that is why I keep insisting that until we start from the dawn of time, to think about this architecture of consumer choices, it will be no good if we do not start targeting Messages directly to the people who should be interested in this from our perspective, that is, the very lady you spoke to. People have the right not to know because they have never been taught something. It is absolutely wrong that we expect people to know how to take care of themselves. I sometimes hear this discussion and say, Well, what do you mean? After all, everyone should know, right? Knowledge is not an innate thing, it's an acquired thing. So if there is no education, and by education we don't just mean school education, but also adult education or awareness-raising if there is not, well, it will be like it is now. This lady has the right not to know that daily dessert and obesity has an impact, can have an impact on the development of cancer, because how is she supposed to know that? By herself, she doesn't. The problem, on the other hand, is that there is no place in her social environment where she can receive such information.

Monika Rachtan
And even worse, there are still places that sow misinformation and tell her eat. After all, you don't know how much life you have left, Then eat.

Dorota Korycinska
Yes or just what I was talking about which is in the adverts You can have a fatty roast, you can eat a huge piece of cake. There's no problem at all. You take a miracle pill, miraculous in inverted commas, and you'll be fine.

Monika Rachtan
After all, Poles love dietary supplements.

Dorota Korycinska
Poles love supplements.

Monika Rachtan
Honey on their hearts.

Dorota Korycinska
Exactly right. Poles love knowledge supplements, diets. You can't blame people for not taking care of themselves. Until every effort is made, every effort is made to explain to them what the problem is with their health too. Of course, a healthy lifestyle isn't everything, because we can't grow carrots in the middle of a primeval forest with perfectly clean air either. We live where we live. Nevertheless, the more care or effort we can put into our daily lives, the guarantee that we can live better, live longer in good health, can be very necessary and can actually be beneficial to our lives. This is a great example of just this lady. It is absolutely not a fault. That's why I don't like it when you talk about guilt at all. It is so good this person does not know. That is a fact. Well now you have to consider what the reason is that she does not know. Well, she doesn't know because nobody taught her, explained it to her.

Dorota Korycinska
Therefore, now that we know what the problem is, what the cause of the problem is, it is now necessary to look for solutions, what to do so that the lady with whom you spoke to the editor has this knowledge and is still able to put it into practice. And that is very difficult. Let's not blame people. Let's not look for blame. I say this all the time. Let's find the causes and look for the solutions, because that is the most important thing.

Monika Rachtan
Dorota, do you think that the Ministry of Health, but also the National Health Fund, when it wants to introduce preventive programmes that are introduced with Poles' money, should also create measures to measure the quality of these programmes. Because, unfortunately, when we do the Prevention 40+ programme, I do not remember whether it was 5% or more or maybe less Poles who joined this programme at all. The other thing is that they did not come back with the results of these tests at all. And I also heard such a statement today that, well, what could we do if they didn't come back with these test results, it was all done wrong. But who did it? Well, the Ministry of Health did it. So now the question is, if we do decide to spend millions of zlotys on prevention programmes, then let us know why they have benefited us and what benefits they have brought us, or let us ask ourselves why they have not benefited us and how much it is all costing us. Yes.

Dorota Korycinska
Personally, I think that the Prevention 40+ programme is an example of how prevention should not be done and, in fact, we talk about the same thing all the time. If you give something, for example a programme, you still have to do everything to make that programme work. And again we ask ourselves why the programme didn't work, colloquially speaking. Why did it not work out? What happened that there was such a low enrolment? Has this been investigated at all? In my opinion, it has not been investigated. In my opinion.

Monika Rachtan
It has certainly been investigated, as I asked the President of the National Health Fund about this today.

Dorota Korycinska
That is, it was simply accepted as a fact that it was because people did not want to. OK, I can agree with that, but again, let's look for the reasons and see why people didn't want to. I come from the Warminsko-Mazurskie region and I must admit that when I started this programme for the first, I think, two or three years, I looked at some of the towns and villages in the Warminsko-Mazurskie region. I don't know what it looks like at the moment, because I haven't looked, I admit frankly, for at least half a year, But there were towns that had 10, 15, 20 thousand inhabitants, where the inhabitants couldn't do examinations under this programme Profilaktyka 40+. Well there we already have the answer. You can't. The second thing is the lack of information on this subject. The third thing it seems to me that this was a programme that GPs should willingly use, because this programme took off, as it were. The resources that.

Dorota Korycinska
The need for funding. Well then the question is why did the PCPs not use this programme?

Monika Rachtan
Because nobody paid them to inform patients. I think there must also be a reward for primary care doctors.

Dorota Korycinska
I am not so convinced that we always have to have this reward system. Really? Does the primary care doctor here have to expect a reward for saying to the patient Mr Smith, please use, please use the Prevention 40+ programme. Does there really need to be a reward for that? Let's not go overboard with these rewards. It seems to me that the very reward for PCPs was that they will have it funded so, they will not be charged for a particular service.

Monika Rachtan
Maybe no one presented it to them in this way because.

Dorota Korycinska
All right, but again, Madam Editor, we are talking, we may be thinking, and what does that prove?

Monika Rachtan
Well, that has not been done.

Dorota Korycinska
About the fact that it has not been, No evaluation has been done looking for causes and solutions. The Prevention 40+ programme was, in my opinion, a perfect example of how prevention programmes should not be done, because it was. I had the impression that it was something like. Okay, we give you a fantastic in our opinion solution. Everyone can get a check-up and that's it. No, we don't do promotion of this programme, we don't talk to doctors, for example in primary care, to encourage patients. We don't say what benefits they might have from it. What else was fatal about this programme, that the patient received results that they had to interpret for themselves? I'm not the one who is against it, that there were discussions that everyone can, because the norms are described in these results and everyone can check themselves again. No. It's not about everyone checking for themselves, it's about them having contact at the time when they do the tests, having contact with the doctor simply and that's it. The fact that someone is within the range is not everything, and he or she may, for example, have a 'bad' blood test.

Dorota Korycinska
An overly reassured feeling that everything is ok, yet there may be a nuance there that needs to be paid attention to. On the other hand. Well, causes, causes, causes of causes. Unchecked. And we sit and wonder what happened so that this programme had such low effectiveness In fact, what is the evaluation? I asked at parliamentary committee meetings. A year ago, two years ago. I think. A year ago, maybe not, but two, three years ago, since the beginning of this programme and how many people have been diagnosed on the basis of screening prevention programmes, including I meant the 40+ programme. What conditions were detected in. How many people were diagnosed with these conditions and what was the subsequent patient pathway? And I heard something every time that amazed me immensely. No such screening is done. That is, we do screening, but we don't really know how many people have been detected with the diseases, what the level of severity of the diseases is and what the patient's next step is.

Monika Rachtan
The efficiency I mentioned. When we spend money, are we not able to see what we have detected, what we have succeeded in treating early, and what has resulted from this for the system? Because, after all, the point here is that we are also devoting some resources to this. Dorota, I would like to ask one more question, and I will move on to oncology and to how we diagnose patients, because prevention is one thing, but the other thing is early detection of cancer. We know that cancer detected early is very often a cancer that we can fully cure. Now, again, what is not working in Poland, that patients very often come to the doctor with a stage three diagnosis of lung cancer, or stage four, when they can no longer count on surgical treatment, and systemic treatment has to be applied? What about here? Is there a lack of education here again? Us healthy people who do not yet suspect cancer in ourselves, but it is already going on?

Dorota Korycinska
But we talk about the same thing all the time. All this is missing all the time. So we say yes, first of all there must be primary prevention, that is, disease prevention, a healthy lifestyle, not smoking, not drinking, because alcoholism also causes many diseases, including cancer. You know that. What else should. A healthy eating style after all, fast food and these unhealthy foods of ours. I put it very nicely in inverted commas. It brings us closer to colon cancer, for example. So, above all, disease prevention. Vaccinations. Let's not forget. Let's not forget about vaccination. HPV vaccination yes can significantly reduce the risk of cervical cancer. So we have primary prevention, which is prevention of disease. Secondary prevention is early detection of disease, but early detection. And again, we have already talked about this. The prevention programmes, which are there, work poorly. Enrolment in screening is dramatically low. I was talking about the Sarcoma Association's research, that people just don't know what tests, where these tests are, that they are free, for whom, at what age. So again, we are at the level of lack of information and it is no wonder that people have cancers detected at very late stages.

Dorota Korycinska
Once they feel that something is very wrong in their bodies and, with apologies, a lung cancer patient reports to the doctor when they are spitting blood. Yes. So then there's really something wrong, because they thought maybe they had a cold, and then it turns out they have a cough, they're spitting up blood, they're having tests. So then it turns out. Obviously this pathway takes a while. Well, and it turns out that he has advanced lung cancer, yes? I'm not talking about the fact that he might not smoke, because he shouldn't smoke. But what I'm saying is that he should have these screening tests more often. So maybe there is hope if he is already, say, smoking, if he is eating badly. But we are talking about lung cancer. If he smokes, if he had an awakened health consciousness that this really could be a cause of lung cancer in the future, then if he is no longer able to give up these cigarettes, although I regret it, then at least he should have himself screened more often, see a doctor, but it has to work.

Dorota Korycinska
Whereas as long as we live in a system under the title of guess, you should know and so on, no, it won't work like that, unfortunately.

Monika Rachtan
Well, and if a patient is already performing these imaging tests regularly and manages to detect cancer, let us say stage one and stage two lung cancer, is what doctors have at their disposal today optimal and allows patients to often be cured of this cancer. I will say why I ask this question, because people also often think I have cancer, I am going to die. And they do not distinguish at all between this gradualness and the possibilities of modern treatment.

Dorota Korycinska
Yes, and here we are moving all the time in terms of these fatal myths. And this is one more myth. Cancer detected early is a curable cancer. I will say more, even in the later stages, but not too late, of course. Cancer is also curable, and you can certainly live a long time. And today's medicine already offers quality as well. Because we are not only talking about treatment, about the disease, but also about quality of life in the disease, which is also very important. Of course, the earlier the cancer is detected, the more treatable it is. I cannot talk about these things in most cases of cancer, because I realise that in a moment the heckling will start after the material is published, that it is not true. Not every cancer can be cured, but we are talking about such a very high probability. And really, ladies and gentlemen, there are a great many people we know who have gone through cancer and are alive. They are living proof that cancer detected early, or even at stages of detection, can be cured. I wanted to draw your attention to the fact that most of the people who run patient organisations are people who have experienced the disease, or carers, or these people themselves, and they are living proof.

Dorota Korycinska
Very many of my female colleagues who run associations, foundations for various cancer conditions. They have experienced it themselves and what? And they live and show that it is possible to live and work and still act for the benefit of others. They are living proof of people who have recovered from cancer, so cancer can be cured. On the other hand, we are operating in a huge space of so-called myths, that once you have cancer. There used to be a saying cancer is a sentence. No, ladies and gentlemen, cancer is not a sentence. There is only one condition: you have to be examined beforehand and, in general, you have to take care of yourself and lead as healthy a life as possible. Although I am not an absolute radical, there are things you absolutely mustn't do, but to improve the proportion of what is, let's say, less healthy to healthy in our lives, move more, sometimes walk more than take public transport or use a car, but give up one cookie in favour of an apple. Don't smoke. Maybe it's better to grill yourself a vegetable than a piece of meat? Excuse me. It is possible, ladies and gentlemen, it is possible to do a lot for your health and to check where you can get screening tests.

Dorota Korycinska
And for goodness sake, don't avoid them. It really is that important.

Monika Rachtan
Mrs Dorothy, we have talked about the fact that cancers detected early can be completely cured. Do you see any shortcomings and something that the system could offer us to further convince us of this treatment, to make better use of the potential of drug programmes?

Dorota Korycinska
Do I see any shortcomings? The shortcomings alone. I can list them. The first problem is the lack of health education, which means that we are still moving in the same area. The second problem is the lack of information on screening. The third problem is, unfortunately, limited accessibility, because we know very well that there are very long queues. From the level of primary care to specialist centres.

Monika Rachtan
Often patients wait up to seven months from the first symptoms to diagnosis. I am talking here about the detection of cancer. Is there anything we can do to get these patients to specialists more quickly?

Dorota Korycinska
I do not know. I do not know. I am not the expert here. I would very much like it to be so, but I do not know. I mean, theoretically I know, but I would have to go back again to what we are talking about. It is better not to get sick. That is, it is better to prevent. Secondly, to do screening so that cancers can be detected at early stages. This will then unblock the queues of those people who already have advanced cancers. But these are systemic and multi-year measures.

Monika Rachtan
Yesterday, the President of the National Health Fund mentioned that the rules for outpatient specialised care will change and that a patient who goes to see a specialist for the first time will be referred by a primary care doctor, will be a priority for the facility, as they will be better valued than a patient who comes back for the second time. Do you think that such a solution could relieve some of the burden on the system? So that those primary care patients who are waiting for a diagnosis will have a chance to be diagnosed more quickly?

Dorota Korycinska
We have such a dramatic problem with queues that I am not in a position to say whether this is a good solution or not. I am not an expert here. I have heard it said that there may be a situation in which patients, so to speak, who have already been in the system for a long time, are discharged in order to re-register and become first-time patients. Well, we have a dramatic problem of queues and I still have the impression that in our various proposals for system solutions, we are doing more of what is called queue management, i.e. we are creating queues for queues. At the moment we have, I think, about a dozen eligible groups. Queue management it seems. And it's a sort of. Some kind of terrible paradox that we have queues in the system. There shouldn't be queues at all. They shouldn't be so long. And here we are dealing with how to shorten them. We manage the queues. We are creating queues for queues, further groups of entrants. This is some kind of attempt. This is what the President of the Health Fund said. However, I am afraid that I am not sure, to put it briefly, that this will be a very good solution, that it will not lead from one pathology to another pathology.

Dorota Korycinska
Unfortunately, whoever you talk to, every system complains. A 7 month wait for cancer treatment from the moment of detection is something that simply does not fit in your head. Ladies and gentlemen, because what I often say, I will say again. Cancer does not wait in line. It does not stop, it progresses all the time. And a person who was diagnosed with cancer, let us say at the very beginning, after these seven months, may already have spread cancer. And this is the point at which you can actually say later that the treatment was ineffective. The earlier it is detected, the more curable it is, of course. I am not in a position to comment on this concept to your editor, except for one thing. Time will tell, but I fear that it will not be a good solution.

Monika Rachtan
Can we go back to the drug programmes and think about it some more, because we have a lot today. We also talk about money and we also talk about oncology. A great deal of money is allocated to drug programmes in Poland and, of course, patients are, or at least should be, treated effectively thanks to this. Do we have any holes through which this money is pouring out of us? In drug programmes. I am thinking particularly of oncology programmes.

Dorota Korycinska
I do not know at the moment whether we have such holes. What I do know firmly is that we have an accessibility problem again. I remember probably two years ago at a conference of one of the organisations that belongs to the cancer federation, there was a conference called Ona Life. I spoke to a patient who had qualified for a drug programme, but she cannot use it because she has no way of getting to the hospital. On the other hand, the hospital she has nearby does not provide this drug programme. So here it is. Here is also the problem of whether we have any holes. You hear more and more about patients qualifying for drug programmes, while there is no money to implement these programmes. And this is also another huge problem in the health care system that I have no idea how to deal with, in terms of the waste of public funds in the health care system. It undoubtedly is. I just wanted to say that for more than a year. The National Federation of Oncology has been talking, asking, appealing for this. Please note that genetic cancer tests can be carried out on an outpatient basis and not in a hospital. Imagine, in order to draw a patient's blood for molecular testing, you have to put them in hospital.

Dorota Korycinska
And we've been talking about it for a year and it's been going on all the time. What money is unnecessarily spent on patient stays in hospital?

Monika Rachtan
We involve people in this, we involve everything.

Dorota Korycinska
So if we are talking about waste, let's talk even about these, let's say, small things. This is just a blood draw. Does a person really have to lie down in a ward? Every one of us, well maybe not everyone, but at least most people have had their blood drawn at some point and just in an outpatient clinic, right? Whereas with molecular testing it has to be in hospital, where it's practically the same thing. These are the things that are a waste of public funds. And these are the little things.

Monika Rachtan
Mrs Dorota, and are we also wasting money and patients' health when patients miss out on neoadjuvant treatment or post-operative treatment, Because that is also one of the options that is increasingly available in drug programmes. And it's often the case that precisely because genetic testing is not done, because for some reason the patient doesn't get the information that they can get, that treatment is immediately put on the table, for surgical treatment, and then there is a relapse, and it could actually have been prevented by giving the treatment that is available in the drug programme.

Dorota Korycinska
Yes.

Monika Rachtan
And what to do about it? Is there a need to create awareness among doctors here? We talk all the time about awareness education, that is, education is needed by the public, needed by decision-makers. It comes up and doctors need it too.

Dorota Korycinska
Yes, I think it is. I think somewhere we have a huge problem with this circulation of information in the system. Again, we are entering the zone of conjecture and what I call. We think because we do not have the data. Unfortunately, we also do not really know how things happen. We know, we know how things happen, we just don't know the causes. The Polish Anti-Cancer League and the Polish National Federation of Oncology recently presented a report on the implementation of the European Code of Oncology Care Ten Rights of the Oncology Patient. I had the honour of discussing the results of this study in the Senate. It was at the end of last year. And what did we find there? That, again, patients do not receive adequate information about the fact that, for example, there is another treatment option, they do not receive information about the quality of treatment in individual hospitals, they do not receive information about the fact that there are clinical trials. But these are facts. Again, however, we need to look at the reasons why this is happening, why these rights of the cancer patient, in accordance with the European Code of Cancer Care, are not being realised? I am far from blaming the doctors here. You simply have to ask them.

Dorota Korycinska
They may simply not have the time, They may simply not have the knowledge. They may not know that it is possible to pass on such information. They may forbid it. They may not know whether or not it is okay to tell patients about clinical trials. I am guessing at the moment, but I wanted to point out to the editor that we have been guessing the whole time we have been talking about what the reasons are. And I would like the clue of this conversation to be that we should stop guessing.

Monika Rachtan
And that we discover the cause.

Dorota Korycinska
That we discover these causes and, on the basis of these causes, that we start to create such a really appropriate, good for the patient wine healthcare system, because this is common. Guilt does not cure and guilt will not cure anyone. On the other hand, diagnosing the causes and finding solutions can bring improvements and in individual cases, but also in what is so nicely called public health, which practically does not work.

Monika Rachtan
The National Oncology Strategy The National Oncology Network are two proposals from the Ministry of Health to cure Polish oncology. Decision-makers convince us that things are not so bad in Polish oncology. Doctors say that we have increasing access to modern therapies, and patients appeal that changes are needed to improve access to prevention, to research, to modern treatment and to improve the awareness of patients, doctors and decision-makers. Will all this be realised in 2025? I leave this question open. On the second day of the Patients' Organisations Forum, my guest, but above all your guest, was Ms Dorota Korycińska, President of the Polish National Oncology Federation. My name is Monika Rachtan. This was the Po Pierwsze Pacjent (First Patient) programme. Thank you very much for your attention and I invite you to visit my social media. If you are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan. You are invited.