Problems and absurdities in Polish medicine. Episode 63

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you to another episode of the programme "Po Pierwsze Pacjent". In Poland, there are around 150 criminal cases of medical malpractice every year. And it is about these errors that we are going to talk today, but this time not with a doctor, but with a lawyer. With me is counsel Radosław Tyminski. Good morning, Counsel.

Radoslaw Tyminski
Good morning, Madam Editor, good morning to you.

Monika Rachtan
Your solicitor is involved in defending doctors in the courts, but he also handles cases involving medical entities. Is that correct?

Radoslaw Tyminski
My law firm and I handle medical cases defending medical professionals and healthcare providers. We also handle divorces, which means we scrape all those emotional issues for ourselves.

Monika Rachtan
Do you sometimes feel remorse when you see a patient's situation in progress? When a patient is actually harmed in some way by the medical profession or the system and you have to defend that healthcare provider, medical facility or doctor? Are there remorse?

Radoslaw Tyminski
Madam Editor, this question is very multi-faceted, so I will answer it this way. Firstly, I have the comfort of being able to pick out certain cases for myself as a lawyer, as an advocate to whom clients come. Secondly, I very often defend doctors and medical entities who have made absolutely no mistake, and yet they are accused or sued and someone claims compensation from them for the misfortune of their lives. And finally, at some level we have to say that mistakes happen to doctors, lawyers, drivers, cashiers, very different people and professionals, because we are human. We make mistakes sometimes due to fatigue, due to multitasking, due to very different circumstances. And the person who made the mistake, sometimes that mistake can have very serious repercussions. Everyone deserves to be defended and, as a lawyer, I have to do my job well, which is to defend to the best of my ability.

Monika Rachtan
Do we Poles, because we complain a lot about the health service, about doctors. Is it really the case that we are looking for ways to attack doctors, so that when a patient has died, as is the natural course of events in some diseases, and we are looking for errors here, we can still extract something from these doctors, from medical entities? What are your observations, Counselor?

Radoslaw Tyminski
Well, the observations are very different. In many situations there was a lack of communication, for example. That is, someone died and no one explained to the patient or the patient's family what happened and why it happened. I have witnessed in lawsuits a great many such situations, where this lawsuit was simply due to communication deficiencies. Anyway, this is an interesting thread, because the Americans have studied how many lawsuits stem from communication problems. And imagine that they studied over 20,000 lawsuits. That's a massive research group.

Monika Rachtan
In Poland, we would have waited several years.

Radoslaw Tyminski
Yes, and they investigated 20,000 lawsuits and it came out that more than 7,000 lawsuits, a third, are due to communication problems. So actually a massive proportion of the lawsuits are due to someone not getting along with someone. And this is something worth pointing out. It's a cause from which mistakes also arise sometimes. That is, someone mishears something, doesn't say something, misrepresents something and so on. This is one observation I can make that is the cause of these court cases. Patients sometimes go to court because they feel they have been mistreated. This is normal. Whereas the other cause is that there are people who are, I would say, conflicted and set in their ways. And a bit systemically we are helpless. I myself have advised several clinics on how to deal with a patient who complains one by one about the doctors, all of them about the nurses, who is constantly dissatisfied.

Monika Rachtan
It is likely that there may be a lawsuit some time from now and that is what you can prepare for. The medical facility can prepare. How to deal with such a patient?

Radoslaw Tyminski
First of all, a medical facility, unfortunately a rarity in Poland, should have a good legal service, especially a large medical facility. The legal service should be up to date, respond to complaints, prepare various documents in advance, train staff, audit medical records. That is, actually carry out a number of activities that can be decisive later on. Unfortunately, I can say from my own experience and observations, very often this organisation fails. A simple example that I come across very often is that healthcare providers have the wrong approvals for procedures, incorrect ones, because they received them as a gift from someone.

Monika Rachtan
From another facility.

Radoslaw Tyminski
Or someone has borrowed, so to speak, from another establishment. And this often just gets revenge.
Monika Rachtan
And we patients, the moment we interact with a doctor and see something worrying happening, we think the doctor has made a mistake. Is the litigation path the best way we should go, or is it better to make a complaint and try mediation first? Is this a better route to pursue if something has actually gone wrong?

Radoslaw Tyminski
Madam Editor, it is that I can generally say that in court you never know. I am a lawyer who litigates a lot. My law firm handles a great many cases. And I can say this: sometimes it happens that we win a case that we shouldn't win, and sometimes it happens that we lose a case that is impossible to lose. Every lawyer who goes to court knows that a court judgement is something unpredictable.

Monika Rachtan
It is fortunate that this is still the case.

Radoslaw Tyminski
I would say that this tends to be far more surprising than it should be, because we do, however, have certain rules, certain principles, it seems that we should be able to predict. Unfortunately, the judicial system in these medical cases, which are very substantive, specialised cases, is unpredictable. So I would say that it is always worth talking first, because even an unsatisfactory settlement is better than a lengthy trial. I litigated the longest case for 12 years.

Monika Rachtan
This is a very long time. And to the benefit of the doctor or the patient?

Radoslaw Tyminski
To the benefit of the doctor. After 12 years, I was able to win legally.

Monika Rachtan
And what absurdities in the Polish health service, in Polish medical care, do you see, looking at this department from a slightly different perspective? We look as patients, in the programme I talk to doctors and doctors look at the system completely differently. And how do you patrons look at it? Because sometimes he probably digs in to places that the doctors themselves maybe don't go.

Radoslaw Tyminski
I would put it this way: there are not as many of these absurdities as one might think. If there is something very absurd, the legislator, the Minister for Health, whoever it may be, tries to solve these problems. Of those things that have not been solved well, continue to cause problems, I would perhaps list, although I would not call them absurdities, just some problems to be solved. I would call the issue of prescribers. Here the Patients' Ombudsman is working very well, and Minister Chmielowiec has indeed taken some decisive action. Very good, because I personally believe that treating a patient without examining that patient verges on professional misconduct, so to speak, or in some situations may even be a tort and lead to further liability. And the first issue is prescribers.

Monika Rachtan
But why are they so bad? Our audiences are patients who use a variety of services, they navigate the internet efficiently. If I have a guarantee that there's a doctor there on the other side of the computer, and he's going to prescribe me a medicine, because I'll give him my symptoms and overall I know what's wrong with me, so I'll tell him. And I can tell him what I need, what medicine? What's wrong with that from a legal point of view?

Radoslaw Tyminski
I mean, the issue is ambiguous and multi-threaded, so let us try to unravel these threads a little. The first issue is that every medicinal product, every drug, colloquially speaking, is a substance that has an effect on the body. That is, it has a real effect demonstrated by clinical studies. Therefore, it will certainly affect you in some way. Secondly, every medicine interacts, which means that it can interact with other medicines, with food, with alcohol, with dietary supplements.

Monika Rachtan
And these in Poland we are taking in at a massive rate.

Radoslaw Tyminski
Yes, we take them in large quantities, we are one of the leaders in Europe in the consumption of dietary supplements. Now, please note that at the same time, every medicine should be tailored to the patient. It is not enough that the patient has an indication to take the medicine. Pharmacotherapy must always take into account the context, i.e. the patient's age, weight, whether they are pregnant or not, what comorbidities they have. Diabetes greatly affects the metabolism of drugs. We have drugs that are metabolised differently in obese people and in thin people, we have weight-dependent doses, so we have the need to establish this context of pharmacotherapy. In the vast majority of cases, the prescriber does not provide these opportunities and misses the opportunity to, for example, educate the patient about drug interactions, does not provide the opportunity to take a full history. And I would make a distinction here that, of course, getting a prescription for the medicines that one takes continuously based on the medical records. In the PCP, the patient can also receive prescriptions without a visit, but the PCP has their medical record, can check their medical history. This is safe. That GP knows that patient. The doctor who treats the patient knows the patient. That is safe. Whereas a prescriber where the doctor has never seen the patient with his eyes....

Monika Rachtan
And he writes a prescription.

Radoslaw Tyminski
And he writes a prescription, it seems to me, which is dangerous. I emphasise this aspect: medicines work. And the wrong dosage, the wrong way of taking or the wrong combination of drugs can even lead to the death of the patient.
Monika Rachtan
Do the doctors who sat on the other side of those machines, because someone had to write those prescriptions, what is their legal situation in our country at the moment, because we know that there were record holders who wrote, I remember, 300 000 prescriptions in a month. I wonder what kind of days they have. In terms of when they manage to write it.

Radoslaw Tyminski
I think they rather made their data available for discharge. But what is their situation? I would say that it is very different, i.e. please remember that liability begins when we have harmed someone or when we have simply endangered someone's life or health. And therefore we have to, in relation to a particular patient, demonstrate that. So, as a rule, criminal or civil liability does not come into play in relation to doctors who have been in prescriptions. On the other hand, professional liability certainly comes into play, i.e. that liability which is connected, which is exercised by the chambers of medicine, by the ombudsmen of professional responsibility. For certainly, in many cases, issuing a prescription without examining the patient can be treated as professional misconduct on the part of the doctor, a breach of regulations or of the code of medical ethics.

Monika Rachtan
Let us return to the irregularities. The first one you mentioned was the prescribers, about whom you spoke at great length. What else? What draws attention to irregularities in the Polish healthcare system?

Radoslaw Tyminski
An issue that I think is very important is the minimum staffing requirements for branches.

Monika Rachtan
That is, in a hospital ward.

Radoslaw Tyminski
For example, there must be y doctors on duty in a ward that has x beds. We do not have such requirements. I very often come across situations in which a doctor on duty has several hundred patients under his or her care. It seems that this issue should be regulated. Another issue that seems to be a big problem is the EDs and the queues in EDs. Please note that, unfortunately, very often patients use the ED as a kind of emergency medical service.

Monika Rachtan
I didn't get to the GP. And I needed, I called for three days, then I'll go to the ED, that's where they have to serve me.

Radoslaw Tyminski
This is the case and it seems to be a big problem. Because really, EDs are there to help people who are in a medical emergency. And if we come to the ED without a real need, then in fact someone may not be helped. So these are some problems that are still there, and somehow they have to be solved.

Monika Rachtan
I think it's a problem that is somewhat related to EDs, but also to the fact that patients can't get to a doctor. And I face it myself. When I call my paediatrician and hear that there is no room today. I say, but the child has a fever or has diarrhoea. And I need to consult a doctor because he has this diarrhoea at this moment and not in 3 days and I hear from the nurse, then please go to the night health care. I say, but hello, hello! It's ten o'clock in the morning, we don't have places.

Radoslaw Tyminski
This is a problem, of course. On the other hand, please remember that we are talking here about a situation in which a family doctor or a PCP. When you call your paediatrician, this GP actually has a certain number of places and a certain capacity. He can see one patient for 15 minutes, he can see one patient for 10 minutes. But in fact, if we reduce that admission time and he has and he manages to admit 30 patients rather than 20, it could be at the expense of the quality of that care. This is a systemic problem, it is not a doctor's problem.

Monika Rachtan
Of course it is. It's not a reluctance of doctors, absolutely. It's just that the problem is simply that there are a lot of these appointments, and specialists Now it's difficult to discuss at all whether there are too few or too many, because it's difficult for us to find a consensus on this whole issue, I think. But yes, it is a fault of the system that we find it difficult to get to these doctors. The kind of document that often comes up in the course of the trial, in the course of the trial, is the medical records. And I think we as patients downplay the importance of these documents that are written out by doctors. Often, for example, we withhold information by not stating when an interview is conducted with us. We don't talk about some test results, we don't talk about the medication we are taking. We conceal that we have been to some other specialist. And here the reasons vary, because patients respond differently. Why do they do this? But still, it is a fact that does not allow the doctor to have this complete medical record.

Radoslaw Tyminski
Full medical knowledge of the patient's clinical condition. Of course. On the other hand, please note that you are absolutely right. Telling the truth to the doctor is extremely important, or telling the whole context is extremely important. This is because the medical record is essential evidence in medical matters. And if it turns out, for example, that a patient has concealed some important information, this affects the doctor's actions. This is undoubtedly the issue at stake and therefore we need to be aware of this, and patients need to be aware of the fact that, firstly, medical records and what they say to the doctor is covered by confidentiality, which means the doctor cannot disclose it. Medical records are very heavily guarded. We have a great deal of legislation that governs the storage and release of medical records. Secondly, a prerequisite for making a correct diagnosis is to take into account the full clinical context. I spoke about this a little bit earlier and therefore the patient should tell the doctor. And thirdly, it is this documentation that determines the outcome of a dispute very often, so if it is well maintained by the doctor and correctly reflects the patient's condition, then please remember that it matters both to the doctor and to the patient.

Monika Rachtan
That is to say, by giving the doctor full information, we are actually taking care of our health, but we are also protecting ourselves in case something goes wrong, we have done everything right, we have told the doctor everything, everything has been recorded, if when a process happens, here we are, so to speak, clean.

Radoslaw Tyminski
As much as possible.

Monika Rachtan
Are medical records in Poland, which are created on paper, still in many places and records that are on different servers, in different software. Is this documentation that is actually so closely guarded? Because we have also heard more and more recently on television, there are situations where documentation is leaked somewhere, is made available to someone. How do you assess this protection of medical records in our country today?

Radoslaw Tyminski
First of all, let us start with the fact that, apart from certain units, such as the Air Ambulance Service, it is no longer permitted to keep records on paper. That is, if a clinic or hospital keeps records on paper, this is clearly an anomaly. Paper records can now only be kept where it is not possible to keep records electronically, i.e. an anaesthetist, for example, takes notes on a piece of paper during an anaesthetic operation. That's all well and good, because he doesn't have the opportunity to take notes on the fly. But as a general rule, healthcare providers should already keep medical records in electronic form.

Monika Rachtan
So this anaesthetist should then transcribe it all into the system?

Radoslaw Tyminski
No, it should be scanned, most simply. So this is very important. There should be documentation in electronic form. Is it well protected? In my opinion, it is mostly well protected, because we have certain conditions. It's just a question of whether all the entities stick to them. Because this is very often a question. Unfortunately, the problem arises from the fact that someone somewhere forgets something. But I can tell you from my own practice that healthcare providers and doctors really do keep a close eye on medical records.

Monika Rachtan
If facilities are obliged to create this electronic medical record, when, for example, a patient comes to a primary care doctor, brings a consultation slip from a cardiologist and the doctor takes that slip and just scans it into the system to have it all with him. It's whether he's operating within the law.

Radoslaw Tyminski
Because consultations, test results brought by the patient should either be recorded in the file or scanned and attached to this file.

Monika Rachtan
And do you often observe situations in which this medical documentation already has much to be desired in the course of a trial and that it is not always kept reliably by doctors?

Radoslaw Tyminski
Yes, I encounter this very often. I believe that very many of the patients' claims could be countered by doctors if they had reliable medical records. In fact, the medical record, and this is worth everyone knowing, both the patient and the doctor, is a silent witness to the event. Because it is impartial. Because it is created when there is no dispute between the doctor and the patient. I come to your editor, you are a doctor and I have no reason to spin something as a patient. And you have no reason to write something differently as a doctor, because there is no dispute between us. So this documentation is, firstly, such evidence, which is quite objectified, because it was created before the dispute. Secondly, no one had any reason to direct it somehow. Therefore, if it is unreliably drawn up, if it is badly drawn up, if it lacks a lot of important information, it is usually to the doctor's disadvantage.

Monika Rachtan
And there are still situations where this information is missing and a dispute arises, this documentation is created in hospitals.

Radoslaw Tyminski
Such situations used to happen, but now, in principle, the need to keep records electronically has eliminated this, because the prosecutor or the court has access not only to the printout of the medical records, but can also have access to the so-called metadata, i.e. who, when and what was changed in these records.

Monika Rachtan
This question has been asked many times in the training sessions for doctors that you have given, that I have had the pleasure of giving, in which I have had the pleasure of being an editor. But I will now ask from the patients' side can I record the doctor during the visit while I am sitting in the surgery?

Radoslaw Tyminski
The law says in this way that you can record events, conversations in which you participate and you do not need the consent of the other person. That is, we are allowed to record a conversation in which we participate. But note we are not allowed to record third parties. That is, someone is talking to someone and we record. This is already forbidden, it is only the services that can. On the other hand, if a patient comes to see a doctor, the patient can record the doctor without informing the doctor. However, there is an important rule that this recording cannot be made available anywhere on YouTube, sent to a newspaper editorial board, and so on. He can possibly use it in court or for his own use. Before the court, he will be able to disclose this recording. Of course, the court will assess how reliable this recording is, whether it has been manipulated, and so on. But to answer the editor's question, you can record the doctor as you attend the appointment, but you cannot make this recording public.

Monika Rachtan
I think, because a lot of patients argue why they are recording the doctor and when the doctor notices. Even recently I was talking to one doctor who was telling me that a patient was recording her and he didn't inform her and that when she noticed that he had the recorder on his phone, he said that he didn't agree to the recording. Well, and that if he wanted to record her, they just had to end this visit. But she asked why are you doing this? And the patient replied well because I am afraid I will forget everything. What we were talking about here, I'm creating this recording for myself so that I can go back to our conversation later. And today in this electronic world we generally often do that, that we record something, that we send someone a voice message, so it seems so obvious to us. And I think in a situation where we are partners in a conversation with a doctor, when we come in and actually these recommendations are complicated for us and we want to record this doctor for ourselves, it's just humanly enough to tell them. And that it's a very good idea.

Radoslaw Tyminski
I also think it's important to say that, by the way, there was once a pilot programme in England where they recorded all the appointments in a certain part of England and it turned out that it sort of serves a certain quality. On the other hand, please remember that it is worth telling the doctor that you are recording, because you want to remember. However, we have to look at this issue from two sides, i.e. from the doctor's side. From the doctor's point of view, it is such behaviour on the part of the patient, where he or she secretly records, that proves a certain lack of trust. So the doctor has every right to say that's fine, then I thank you. Then I don't treat you anymore, because if you don't trust me, do you? Well then look for another doctor. This is also the doctor's right. Patients need to remember this too. That is to say, except in situations where the patient's health or life is at risk, the doctor has the right to withdraw from treatment. And clandestine recording can justify something like this. Looking from the patient's side, he or she has the right to record the doctor, but it is also important to remember that if he or she tells him or her this, then perhaps this doctor will explain it to him or her in more detail.

Radoslaw Tyminski
There will not be this situation, this surprise or loss of trust. In my experience, because, as I said, at the law firm we also handle divorce cases. Well, I have to say that in divorce cases recordings are almost standard. In medical malpractice cases, no, they happen. However, in divorce cases, spouses for a certain final period, so to speak, of the marriage record themselves at a high rate.

Monika Rachtan
This is how they keep each other's records. While we're talking about recordings, I'm still going to ask about such a unique place as a pharmacy. Because we have this monitoring in the pharmacy and there are probably some rules about that.

Radoslaw Tyminski
Surveillance should not be audio, i.e. it should only be video.

Monika Rachtan
Because right now this pharmaceutical advice is coming in. And there's going to be a lot of this information being passed on at the moment, so it would seem that patients might be worried that they're being recorded during these conversations with the pharmacist and that some Mr John, who's in charge of the monitoring or sitting on the security guard's booth, is watching this pharmacy. The fact that he can hear everything.

Radoslaw Tyminski
It should not hear. First of all, monitoring should not enable this. However, when it comes to this pharmaceutical care and pharmaceutical advice, it is important to remember that this is a health service. And if it is a health service, there should be documentation of it. So, in fact, a pharmacist giving such advice should document it, normally document it. It seems that this is not really possible at a pharmacy counter, so such advice should rather be given in a separate room, which makes it possible, firstly, to maintain confidentiality and, secondly, to review the medicines in peace, question the patient and so on. So I would rather say that patients should not be afraid, but rather pharmacists should give such advice in a separate room.

Monika Rachtan
Well, but now the question is what do we mean by pharmaceutical advice? Because if I come to the pharmacist at the window and ask a simple question my child has a fever, I don't know whether to choose ibuprofen or paracetamol. What will the pharmacist advise me? This advice is brief advice. It probably didn't take long and the pharmacist can get out of it quickly. However, we do know that the two active substances I mentioned are drugs that we will also develop in the leaflet. The list of complications is very long. And what about in such a situation? Do we understand this in the context of pharmaceutical advice?

Radoslaw Tyminski
It seems that here, in a way, colloquially speaking, there is certainly some pharmaceutical advice. However, when I talk about health services in the context of pharmacists, I am mainly referring to pharmaceutical care and medication reviews. When a patient takes several medicines and the pharmacist tries to rationalise them. Please bear in mind that scientific studies show that patients who are multi-disease and take multiple drugs, at least one drug, may have less, so to speak. If this pharmacotherapy was managed rationally, which is important for adherence. Well, because it is, I refer a little to what the editor said, that often patients do not say everything, but scientific studies show that in Poland approximately 60% patients do not adhere to recommendations.

Monika Rachtan
Yes, and this is mainly due, in my opinion, to precisely those communication errors that you mentioned, that patients are, however, uninformed, afraid of change.

Radoslaw Tyminski
This is where I will enter into the editor's word. It is probably also the case that some of this non-adherence is due to the fact that doctors do not educate enough, but, in fact, scientific studies conducted in Poland on 27,000 patients have shown that the motives for non-adherence are very different. Some patients, for example, have no sense of illness, i.e. I took an antibiotic, the doctor prescribed it for 7 days, but after three days it had already helped me, so I put it off. Or a very common motive in not taking hypertension medication is that the pressure is normalising. I feel good and I'm supposed to ingest the pill. In contrast, it may seem surprising, but a great many organ transplant patients who have to take immunosuppressants put them off.

Monika Rachtan
It already seems.

Radoslaw Tyminski
This seems surprising. Why does she put them off? Because these drugs often have such an effect that women grow moustaches or obesity appears. And this is not acceptable. Please remember that one of the reasons for withdrawal from medication is also stigmatisation. So you take medication, and what do you take it for?

Monika Rachtan
And why so much?

Radoslaw Tyminski
And why so much? And patients start to feel ashamed. Then maybe I won't take it? Maybe I'll hide it today. So these motives for non-adherence are very different, but the fact is that almost 60% patients are not adherent, and this has a huge impact later on the effectiveness of the treatment, because we can say colloquially and it borders on truism. But a medicine that is not taken does not work.

Monika Rachtan
Yes, I, too, repeatedly emphasise that a prescription alone does not cure and that the fact that we have one in our wallet does.

Radoslaw Tyminski
We have this research from Poland that 10% of patients who leave the doctor with a prescription do not buy prescriptions at all.

Radoslaw Tyminski
In general, she walks out with a prescription, she doesn't even buy it. In other words, to put it simply, it lands in the bin.
Monika Rachtan
We were also discussing this very topic of bronchial asthma with Dr Dabrowski. And in fact, the doctor also stressed that that level of taking medication is probably only 50% patients who leave with a prescription from the doctor. In fact, he continues treatment by filling more prescriptions, and half just leave the subject.

Radoslaw Tyminski
We have studies that say that for COPD, which is a chronic surgical lung disease, after three months 80% patients do not use treatment.

Monika Rachtan
These are surprising results, especially as this is a disease that, after all, leads to many exacerbations, is chronic and significantly affects patients' quality of life. So it seems that these are indeed surprising data. But, Counselor, I would ask, as if, however, any of our patients were preparing our audience, preparing for a trial, for litigation. That is how best to prepare for such proceedings? What do you take care of? What aspects to pay attention to?

Radoslaw Tyminski
I will answer by quoting Julian Tuwim, i.e. a distinguished Polish barrister. Because not many people know that he was also an advocate. Julian Tuwim said that a court is a group of people deciding who has a better lawyer. Therefore, surely the patient should choose a good barrister or solicitor, i.e. a professional lawyer.

Monika Rachtan
There are lawyers who specialise in defending patients, like your solicitor, is he on the other side?

Radoslaw Tyminski
There are such lawyers. And certainly we have to remember that doctors or nurses have specialisations imposed by law, i.e. someone is an orthopaedist, someone is a cardiologist. We as lawyers usually specialise as well, but not legally, but I actually do divorce and medical law and that is my specialisation, but I don't do tax law, I don't do business law, I don't do any other areas of law. That being said, I would certainly advise patients to find a good lawyer, one who deals with these matters. One who has experience. And he should guide them, That is, he should analyse their situation with them. He should sit down with them and tell them how to prepare for this process and what to do. But I think the universal first step is simply to ask for the medical records, for a copy of the medical records.

Monika Rachtan
What should such a person who decides to go to trial prepare in their mind? Is it rather going to be months of battles, Years of battles? The longest case of 12 years you mentioned, but what is the rule? Does it actually always take that long?

Radoslaw Tyminski
I mean, we are touching on a problem related to the judiciary a little bit here. Namely, this is a subject that does not concern patients, but concerns us all. So I have to say as a person who, on the one hand, deals with law academically and is a university lecturer, I am a doctor of jurisprudence, but I am also a litigation practitioner. I have to say that we have a bit of a misallocation of resources in the Polish system.

Monika Rachtan
As in health.

Radoslaw Tyminski
So is health. Let me give an example. It is that if two adults want to get married, they can do so before an official. And if two adults with no children and no dispute want to divorce, they have to do it in front of a court, which has to hear the claim of one of these people and set hearings. It cannot do this without hearings. And this results in. With the number of divorces that we have at the moment, that very many judges in the county courts are busy with divorces simply. And in fact, in my opinion, if there is no dispute between the adults, they should be able to divorce in front of the notary, or I don't know, in front of the registrar who gives them this marriage. So we are talking about some systemic justice problems here. Therefore, our patient who is preparing for a court battle should be preparing for years rather than months.

Monika Rachtan
Bright. How do you judge the judicial system in Poland? He sides with the patient, with the victim. But is it the case here that it is the patient who has to prove everything? The patient has to present everything. Could this be better organised somehow?

Radoslaw Tyminski
The question of whether things can be better organised is rhetorical, so to speak, because things can always be better organised. On the other hand, does the system stand, does it stand on the side of the patient? My answer to this question is yes, it seems to me rather yes, because the patients are the judges.

Monika Rachtan
This is true.

Radoslaw Tyminski
In relation to this, I very often see that judges often have a patient's perspective, that judges very often sometimes do not fully grasp the context of the case, the medical or organisational context. As a result, sometimes my role as a lawyer defending a healthcare provider or doctor is to explain certain things. On the other hand, it is also the case that experts in court cases are doctors and very often some people do not decide to go to court because they think and this is professional solidarity. They will cover for each other. I can say that the practice at the moment is such that I don't see anything like that, that these opinions are extremely unfair. I mean, I often have many objections to the opinions of expert witnesses, but I cannot say that I have encountered such examples of professional solidarity that an expert doctor defends a doctor, the accused or the defendant, just because there is a doctor defending the doctor. This tends rather to happen probably very rarely, that is, incidentally, if it does happen. All the more so because very often the courts appoint as expert witnesses persons from the list of the district court or from the list of another court.

Radoslaw Tyminski
And in fact we often do not know who the expert will be. Often an expert who gives an opinion on a case from Warsaw is from Poznań or Wrocław. This happens. Therefore, it happens very often. Therefore, I think that in general the system is on the side of the patient. The judicial system because of the fact that judges have patient experience. Whereas, of course, it has to be said straightforwardly, judges try to be objective. Judges rely on expert opinions. And judges are also guided by the evidence they have in cases. So can you say that this system is good or bad? I would say that the system is like any other case.

Monika Rachtan
We today have moved a large part of our lives to the internet and there we see various influencer scandals. They also concern health, with some influencers undergoing questionable medical procedures, such as aesthetic medicine, and later accusing doctors on social media that the procedure was performed incorrectly or that they suffered damage to their health. How do you patronise this world of the internet and what is communicated in Poland about health? By people who are not necessarily in the medical profession?

Radoslaw Tyminski
This is a huge problem these days. One of the aspects I am concerned with is online doctor rankings. I have researched a lot of research on online doctor rankings and the publication of information about certain situations, events or judgements on the internet. In general, I can say that you have to approach extremely positive and extremely negative opinions with a lot of caution, because I have seen many times on the Internet that, for example, patients who criticised a particular doctor very strongly, later turned out to have lost a court case against him or revealed only part of the truth. I can give the example of a well-known lady who sued my client for a badly performed buttock operation. It turned out that the implants she put in herself were moving wrongly as she had wished, and she revealed this on the internet. Later, it all disappeared, but the court case was not. Why wasn't there?

Monika Rachtan
Well, what happened?

Radoslaw Tyminski
It turned out that there were also pictures on the internet of her attending a dance party a few days after the treatment.

Monika Rachtan
Well, clearly, then, it was not right for these implants to...

Radoslaw Tyminski
The case was over before it really got off to a good start. Therefore, these opinions, both negative and positive, about doctors should be approached very carefully. What can a patient rely on? It is well known that the internet is a valuable source of information, but we have to remember one thing: when it comes to doctors and medicine, we are dealing with situations that do not always have a certain outcome, just as with lawyers. Not every case can be won, not every patient can be cured. We need to distinguish between failure of treatment and when someone has made a mistake.

Monika Rachtan
In this programme, we have repeatedly talked about adverse events that accompany many medical procedures and that are inevitable in hospitals, in outpatient clinics. It is worth being aware that such things can happen. I would like to ask about the legal liability of people who educate us about health but are not practising health professions and are spreading misinformation on the internet. We can report their accounts on Twitter, TikTok, YouTub, etc., but with varying degrees of success, because these people appear again. The fact that we have disinformation actors who operate on social media is undeniable. There are also people who, instead of inviting experts to their studio and talking to them, create various health theses themselves and put them out on the internet. What is the responsibility of these people to create such content?

Radoslaw Tyminski
If they are medical practitioners and spread theses that are not in line with medical knowledge, they can bear professional responsibility. On the other hand, if they are not in the medical profession, they can actually say whatever they want. What is the responsibility of a man who says that 2+2 is November?

Monika Rachtan
Well, none.

Radoslaw Tyminski
In the same way, someone can say medical nonsense or unproven things and not be held liable. As long as it is not shown that a particular situation occurred under the influence of a particular person's recommendations, that person is not liable. Rather, for uttering medically incorrect views, a non-medical practitioner will not be held liable, unless he or she opens an alternative medicine centre and starts implementing these views of his or her.

Monika Rachtan
These are the ideas I think some people have too.

Radoslaw Tyminski
Then they can already bear responsibility. And such cases do indeed happen.
Monika Rachtan
But don't you think, Counselor, that this should be regulated somehow? Because when I browse through content on the internet and I see a person who is not a doctor and who, for example, at a time of a huge problem of high cholesterol in our society or high blood pressure levels, says that statins are evil, that steroids are drugs that can cause fatal diseases even in very low doses, and thus urges bronchial asthma patients not to take these drugs, I feel that such a person is really doing harm. Immediately, Counselor will say that I should go to court. But what do you think, shouldn't this somehow be regulated from above?

Radoslaw Tyminski
We have a certain freedom of expression constitutionally guaranteed to us and it is very difficult to draw a precise line. I could ask another question: is it possible to express incorrect views about mathematics?

Monika Rachtan
But it won't kill anyone if I say that 2+2 is November. On the other hand, saying that it's not worth taking statins if someone has a cholesterol level of 400 or 500 is....

Radoslaw Tyminski
Of course you are right, Madam Editor. However, it is very difficult to draw a line under freedom of speech and freedom to express certain views. And here we come to issues that cannot be delimited precisely. I think that the Ministry of Health has recently done an excellent job of putting health education on the agenda.

Monika Rachtan
We are all waiting and applauding!

Radoslaw Tyminski
This is the case and I think it is very necessary for patients and young people to be educated about health. So that they know what a treatment failure is, what a complication is and what an error is. So that they know that every medicine has side effects.

Monika Rachtan
Not just statins, but all drugs.

Radoslaw Tyminski
And that it is not possible to ingest medicines like a jiffy. Itd. What I'm saying is that this is the place for health education, not for bans or orders, because it's difficult to find the limit. We have traffic laws, someone can say that in Poland it should be like in Germany, where you can have 0.6 alcohol or there 0.8. Is that already stupidity?

Monika Rachtan
For me, yes. For someone maybe not.

Radoslaw Tyminski
Well. Please note that we have a difficulty. But in Germany it is like that. Someone might say. I point out that many things can be debated, but we should have an educated public that can draw conclusions, for example by checking whether the person who is speaking has the right education, qualifications and what experience he or she is based on.

Monika Rachtan
It turns out that communication, education and mutual exchange of information are very important in the patient-doctor relationship and avoid many conflicts. Therefore, today you and I appeal to you to expand your medical knowledge, educate yourself and talk to your doctors, because by doing so we can really save ourselves and our doctors a lot of nerves. We encourage you to educate and talk. Today's guest on the programme 'Po Pierwsze Pacjent' was Radosław Tyminski, M.D., lawyer. Thank you very much.

Radoslaw Tyminski
Thank you very much.

Monika Rachtan
My name is Monika Rachtan and I thank you for your attention.