The majority of Saudi Doctors who are over the age of 40 years likely received their training and performed their residency outside of Saudi Arabia. However in recent years Saudi Arabia has built up its own excellent colleges of Medicine and can now teach and train the next generation of Saudi doctors exclusively in the Kingdom. This new generation is comprised of both male and female students who are bright, eager, dedicated and passionate of their work. The ones who I have spoken to all have a keen interest in community based medicine (CBM) as well as traditional clinical practices. They understand the needs to reach out to the communities for proactive and preventive health care as well as the need to educate families on basic issues of health and health care. I see these physicians taking initiatives and giving much of their own limited time to further their knowledge and skills as medical practitioners.
In general, another observation I have seen across the board in regards to Saudi physicians as compared to western physicians is an added level of compassion and caring. Now that is not meant to imply a western physician does not care or is not compassionate. I do believe the cultural traditions of Saudi Arabia tend to make the Saudi physicians more attentive with their patients. What do I mean by this exactly? Before beginning an examination, the Saudi physician will generally chat with the patient for a few minutes discussing family, weather, work, etc., and will do so in a manner that the patient does not feel rushed or pressured. The Saudi physician may even phone a patient at a later date to check on how he or she is doing (if not admitted to a hospital but still undergoing care or medication). And last I have known Saudi physicians who will make house calls to the residence of a patient to treat them or simply to check on them. These are practices which also used to apply in the Western world but modern day demands now have these practices becoming more and more outdated – in the West.
Filed under: Health, Saudi Arabia, Saudi culture, Saudi education
It is very interesting to read about healthcare in KSA, It’s difficult to explain, but almost feels to me as if it is a different world inside another world.
You’re right Aafke. When I have spoken to expat nurses and expat doctors here, they say while the care and treatment is basically the same they have to readjust their mindset and align themselves and how they give care to the Saudi culture.
One other example too is that at most Saudi hospitals a female nurse can treat a male Saudi patient but some hospitals have restrictions prohibiting a male nurse from treating a female Saudi patient (although male nurses may and can do treat female expat patients).
Hi Carol, i’m just curious whether there are many practicing plastic surgeon’s in Saudi. If so, do they cater for a cosmetic market or do they limit their work to corrective surgery?
Welcome to the blog, Julie. Plastic surgery is actually a booming market in KSA in spite of some controversy on what is “islamically correct.” I wrote an earlier post related to this subject which you may enjoy:
http://americanbedu.com/2008/10/08/the-newest-craze-to-hit-saudi-arabia-%E2%80%93-laser-lyposuction/
The docs here vary just like anywhere else…some have horrible bedside manners and others are great.
I like that they say bismillah before the procedure and i surgury will encourage you to say lailaha illallah! makes me feel better
The cultural differences in approach to patients (as opposed to technical care) were born out in a comparison of Western and Arab nurses during a research project with which I was involved. The differences are related to profound differences in the view of the person, family, illness, social hierarchy, and sense of connectedness and responsibility. Both cultures value all of the above but conceptualize them and how to deal with them differently–to the point where an empathy scale developed in the West scored Arab nurses as unempathic. Of course the culture bias of the scale was the problem, not the nurses.
Social norms of “chitchat” and greetings as well as institutional practices (regarding time, money, and ethics) lead to the differences you describe. Newer doctors also receive more training in contemporary non-authoritarian approaches to medicine and community-based medicine. Saudi doctors doing sub-specialty training in the West usually have to adopt a less paternalistic (even in the best sense of the term) attitude than they are used to, even though their technical and interpersonal skills are usually excellent.
Culture and medicine–an excellent and complex topic.
Thanks.
Chiara
Is this treatment the same across the board? Have you talked with people from the lower stratus of society in Saudi and see if the treatment is the same?
It is my understanding that whereas all Saudis have free medical care, it certainly isnt equal medical care.
Of course class is an issue in all countries, but it is my experience in the Middle East that class/money/connections are often the sole determinates as to what is available to you, the help you get, and what kind of treatment you get.
Here in the USA we all know that the quality of care one gets at a private hospital, when you have insurance, will be much different than the type of care you get at a public hospital without insurance.
Is it the same in Saudi or is the healthcare system more egalitarian than most other aspects of Saudi culture?
PS Glad to hear Saudi is increasing training its own physicians for excellence in preventive health, community and primary care. That is always a boon to a culture.
Once again an excellent post!
Chiara
And once again, I find chiara’s comment very interesting. I am a researcher, and thus I like Chiara’s comments (which are mostly research based).
Thanks Carol.
Thanks Chiara.
Keep up the good work!
Thank you Chiara for your insightful comments.
Abu Sinan – in regards to the manners and customs of Saudi physicians, in my observation at least it does seem to be across the board. I happen to work at an institution which treats a lot of ‘bedus’ (this is repeating what Saudis say; not my words there) and I see how the doctors (and nurses) are very caring and compassionate with a lesser educated beudioun as with Saudis from other social strata.
Nader – glad you have enjoyed the post and subsequent comments.
Abu Sinan- I would say that the care in the government hospitals is not as good as the care in some of the private hospitals. I say some, because some private hospitals are about the same in care with the government. And it isn’t about the drs but rather the strain of having at times double to triple the amount of patients the clinic was set up for.
I agree with Carol’s assesment of Saudi Doctors. I’ve only found one that I could scream at because she was rushed, arrogant, and has a habit of talking down to a patient.. yea one of those you want to slap.
Some interesting things that have stuck with me along the way.
1. was a comment my mothers dr. in a government hospital during her chemo treatments. She covered but didn’t veil and her cancer was getting worse as time went on and my mother was of course emotional on one visit and he told her how having her as a patient was such a change for him. Because his other female patients, being saudi all veiled, and he didn’t have to come face to face with the emtions of his patients very much because of not only the veil but the cultural interaction between male and female even in dr patient relationships. Her emotions had an impact on him which he normally didn’t have to deal with
2. a dr. that treated my FIL who was not really sick just feeling down because he was getting older (he was over ninety when he passed) but the dr. sat and talked with him, just chit chated, and was able to draw from him what may have been missed if he didn’t take that extra time with an older man.
3. a dr. that treated both my children and my MIL so we spoke many times. I brought my MIL and he told her the source of her complaint and I just looked at him like he lost his mind. He smiled and said that she was an older woman in this culture and he had to speak to her in a way she not only understands but will eccept. How he spoke to me about her complaint was much different because I was an American, younger, and more educated.
Besides saudi drs. I have come accross some super fab Jordanian drs.
Thank you Nader and Carol.
Nzingha–Your comments were an excellent reminder of the role of gender and age (more than of the patient’s social status) in the relationship between Arab health care provider and patient. I am not sure I understand what the Dr said to your MIL that was shocking–my fantasy is he related the source of her illness to a more spiritual , interpersonal, or folkloric etiology than he would have with a younger more educated Saudi or a Westerner. Or I could be 100% wrong!
By the way. the study I mentionned was done in Jordan, and the main difficulties were in adapting Western medical research norms to Arab culture–eg. maintaining an anonymous, detached stance from the research subjects (in this case the nurses who were interviewed about their interactions with patients and observed at work); cutting off all contact at the end of the research period; expecting spontaneous narration of their experience and criticism in public of their institution. The lead researcher (a Jordanian nurse ) ended by modifying her methodology, including the informed consent protocol (asking an Arab to sign for their consent implies distrust of their verbal commitment). As much good research came out of the cross-cultural challenges as the original topic of empathy (in itself culturally determined).
Sorry to be long–a topic near to my heart!
Chiara
Which are the top specialties for Saudi doctors? Are there any gaps in specialties that Saudis feel need much more attention but are not currently available as part of the various Medical programs in KSA?
And I have seen, heard of, known some Saudi doctors who know nothing about medicine. Hence, the mistakes being done on patients as mice labs start!!
Nzingha – thanks for sharing and adding to the understanding on how medicine (and beside manners) is practiced here.
Inal – You will find Saudi doctors who have specialized in all facets of medicine. I think rather than the top specialties for doctors certain hospitals instead become known as “the place to go” for particular treatments such as National Guard Health Affairs is now world renowned for separation of conjoined twins and King Faisal Specialist Hospital in Riyadh is world renowned for its cancer treatments and so on.
I’m not sure if I would call it a gap or not but there continues to be a stigma of patients who have HIV/AIDS. The medical care is there but these patients are usually very much isolated and in some cases admitted to private facilities where they are only known as a number. It is pretty typical if a patient is diagnosed with HIV/AIDS they are isolated and not treated as an outpatient.
His Sweetheart – I do hope that the incidents of which you are aware are of the minority. Working in the health care sector I have been extremely impressed daily by the care and treatments I see in Saudi Arabia.
So, are the disparities that may present themselves -due to how doctors are organized- such as in hospitals whether specialized in a particular are or not- as opposed to individuals or small medical groups that cater to a variety of needs? Or because of society’s makeup and what it dictates on doctors on how they treat the illness of the patient as opposed to how they treat the patient? Your example of HIV patients for one- is it the illness or the patient with the illness that is treated?
How about Ancillary services- the diagnostic groups as an example…are these contained within large hospitals or have they set up shop outside the facilities? If so do they pose problems of access to those whose medical coverage may be prohibitive monetarily?
Asking -to try to get a sense of why so many Saudis prefer to leave the country for healthcare if they can afford it? And what truly happens for those who can’t move anywhere for healthcare reasons?
I have read in other places the worries that come about Saudi doctors not being trained competently- whether this is true or not I can’t tell…but I would like to know if the percentage of expat docs is being replaced by a steady increase of Saudi docs…
Very good questions Inal. I could attempt to answer but my answers would be more guesses than citing facts which I don’t think is what you are looking for. I hope that others will respond with the answers you seek.
My own view is that in regards to your first question it can vary whether the illness or the patient with the illness is treated. For example, if one goes to an emergency room, the staff want to know the symptoms, the problem and fix it which is more treating the illness rather than the patient for we all know that symptoms can be indicative of problems but if you have not identified the specific problem then you are only treating and abating symptoms.
There are many many specialized clinics throughout Saudi Arabia staffed by Saudis and expats.
I don’t think that “so many” Saudis when compared to the population of Saudis who are ill actually go outside of KSA for treatment.
Now I may be wrong but it seems to me there are fewer expat doctors in the Kingdom and an increase of practicing Saudi physicians.
chiara- lol it wasn’t so dramatic really. The story is my MIL complains a lot, typical old Gulf Arab woman things. She is the type that is dying every six months or so. At one point she complained of a “woo woo woo” sound in her ears that was bothering her to the point where she would walk around all day telling me about this ‘woo woo woo’ sound. So I took her to the ENT dr. who explained to her it was due to luxuries we have indoors, namely air conditioners, as this is not something she grew up with and now we have them in every room and her ears just tend to be more sensitive.. yadda yadda
I thought he lost it.. air conditioners?? This is the same Dr. that performed surgery on two of my children and this was his suggestion. He than told me nothing was wrong and he had to speak to her in a way she would accept, being older and an Arab woman. I said ok.. left.. and my MIL never complained about a woo woo woo sound in her ears anymore.
And we have central air
Carol- with the HIV/Aids treatment do you think that it is because 1. there isn’t that much need for care specific to HIV/Aids in the country overall, Saudi numbers of infection being low, non saudis being deported. 2. The social stigma of HIV/Aids having a huge impact on how one is treated as a patient?.. and the known as a number.. is that to keep their identity hidden? Would any Sauid with HIV/Aids want his/her identity known or being at risk to be known?
I would say that government hospitals are lowering their numbers of expats vs that of private hospitals. Private hospitals still have a very high rate of expat drs. I think part of this is because the repayment contract that many saudi drs and even nurses find themselves tied to by the saudi government. Which is why their pay is garbage for many saudi drs.
Nzingha – I believe in regards to HIV/AIDS the biggest challenge still remains social stigma and impact. And I do doubt that any Saudi would want it known that he or she were HIV/AIDS positive. Stay tuned, I have a specific post forthcoming on this subject.
Dear Nzingha
Thanks for the story. This enquiring mind wanted to know! I would file that explanation under “contemporary folkloric”. He sounds like an excellent surgeon treating both the complaint and the whole person. His diagnosis ranks right up there with that of a French physician who told my Moroccan friend(young, male, educated) that his aches and pains were because his body, born and raised in Casablanca, wasn’t built for the cold of Nice (!?!); or the Latin American psychiatrist working in a Canadian ER who cast the evil spirit from a Latina who presented with paralysis due to a hex–10 minutes in ER as opposed to years of psychotherapy and meds.
Dear Carol
I look forward to the HIV post. I am especially curious as to the rate of infection–genuinely low, or numbers hidden behind alternate diagnoses, non-reporting, and seeking help outside the country? You are probably aware of similar denial of alcohol and drug abuse problems in Muslim countries because muslims don’t drink or do drugs for religious reasons–not!
Chiara
I grew up in Saudi and I’m now doing my post-graduate studies in alternative medicine in Germany.
Two points I would like to raise/answer regarding Arab physicians in the West. However, my observations are currently restricted to Germany:
a) Arab physicians, although there ample exceptions to the rule, tend to be more caring and compassionate towards their patients, especially the elderly due to the heavy emphasis on family and community in Arab culture.
In general terms, we (those in the healthcare sector) are taken aback at the emotional misery and isolation many seniors face and live with.
I credit Saudi (other issues notwithstanding) and my family in instilling respect for the weak and sick that at times surprises Germans. This is not to say that Western/white physicians are cold-hearted and lack compassion.
However, my own experience in this area has made me somewhat biased when entering or visiting a hospital in this country. When my own brother was dying, a Polish physician coldly asked his wife in the ambulance why are they here in the first place, he is going to die anyway. There is a general disdain, to say the least, towards foreigners (non-European/non-white) who live here and many doctors (often East European) tend to show that openly.
b) regarding Saudis who go abroad to seek treatment. That really depends on the treatment itself. Although the Kingdom, and the Arab Gulf countries, have built a high standard of medical care, the area of rehabilitation (regardless whether post-OP, physical or general convalescence) is VERY lacking and to quote a German doctor “sub-standard” and “from the Middle Ages!”
The methods still used in many facilities across the Kingdom are not up to date and there are very few (if at all?) research centres in this particular area let alone locally trained therapists.
Another point that is seldom discussed yet very apparent is the social stigma connected with certain ailments, diseases and the like. Whether substance abuse, HIV-infections or even cancer, many Arabs prefer to remain anonymous and go on with their treatment without the fear of being “found out!”. Over here they are just another patient (albeit with loads of cash) and can let their hair down and enjoy the mild weather for a change. These are the reasons given by most Arabs I have met so far.
Also, a sad reality in the Arab cultures of the Peninsula is the “foreigner complex / uqdit al-ajnabi” ie. the belief (in many cases a conviction) that if is from abroad, meaning Europe or the US, then it MUST be good. This is something I have to face at times when in contact with Arab patients.
PS. excuse any possible typos or errors, I am just getting used to writing in English again. Verdammt nochmal!!
Appreciate the recent comments.
Palestinian – you raise such very good points and I agree with your views, particularly how many who can afford treatment outside of KSA do so to avoid any perceived “stigmas” with their ailment within the Kingdom.
Ironically a lot of Saudis were so surprised when they learned that I as an American chose to be treated for cancer in KSA instead of returning to the USA. My care was outstanding and everyone who treated me was the most professional and compassionate. In fact, all of my doctors here in KSA (oncologist, gyn, plastic surgeon, etc.) are all Saudis. I feel very comfortable and at ease with all of them.
Interestingly when I first arrived in KSA and had a touch of bronchitis, my husband took me to a private clinic where I was seen by a Syrian doctor. In this case the doctor spoke to me through my husband and also examined me through my abaya. Needless to say I asked my husband to find another clinic as I was not comfortable in that situation.
This post made me wonder: How is it possible to combine effective modern medication and a good medical personnel-patient relationship, pre and post treatment?
Are you asking in regards to Saudi Arabia or in general?
I think in many cities in the states, the volume, time and demand make it so difficult to balance a good personnel-patient relationship.
My question is generalised but since the previous commentators had given their bits of experience, I don’t see any reason why I should ask any further.
Only if such personnel-patient relationship can happen in many places but like you’ve said, the volume, time and demand had made it so difficult to balance a good relationship between two of them.
I am however very impressed by the personnel-patient relationships that I see here in Saudi Arabia.