A feature of Hungary’s National Health Service which is as alien to most people as it is outrageous, is the institutionalised habit of ‘tipping’ doctors.
Exactly when and how it started seems to be the topic of some debate, but what is certain is that it existed before the beginning of Communism. In villages it appears it was a tradition to bring the local family doctor produce from one’s garden or allotment, the spoils of a pig killing or some home-made wine. Similarly, other esteemed figures in small town life, such as the priest, could also count on having their meagre incomes supplemented in this way.
In cities, this presented somewhat of a problem, as most people did not have access to such produce, and naturally resorted to giving money instead.
Quite when this became expected, compulsory even, is unclear, but that it did, cannot be disputed.
Before 1989, almost everyone earned a standard wage, irrespective of their type of work: a teacher, a doctor or a bus driver, earned within a few hundred forints of each other. A combination of the already-ingrained habit of giving doctors a ‘present’ following certain types of treatment and all hospital surgery, and a feeling that they deserved more than the average worker, completely established this custom.
Thus, if you were going into hospital, your preparations – alongside packing your own toilet paper, cutlery and mug – was to enquire from others what the going rate for this intervention currently was. The requisite amount was then put into the customary envelope, in readiness to slip to the surgeon at a suitably private moment, out of ear and eye-shot of colleagues and nurses. This could generate a certain degree of cloak-and-dagger activity, in those instances when the doctor could not be found except in others’ company – though most doctors generously gave their patients an opportunity to pass over the envelope when issuing them with their discharge notes, in the privacy of their offices.
When I enquired whether my friends feared the doctor might not take care with an operation or the like if he were not paid, it was explained to me that the money was always given following surgery, and not in advance. Logically, then, he could not know beforehand whether he would be tipped or not. However, people always feared that if they had for any reason to return, to have some further treatment, not giving money could prejudice the doctor against them. It should be added that nurses – who are indisputably poorly paid – also expect small ‘presents’ to attend to their duties.
Typical of the double-think that anyone familiar with Orwell’s 1984 will already be aware of, every department on every floor of every hospital had to display a written declaration outlawing the giving and the acceptance of such gratuities – universally ignored. These framed edicts were still hanging there after ’89 when income tax was first introduced, and when the government decided to tax doctors on these very ‘earnings’!
Today, in a society where there are extreme disparities in earnings, and when some kind of attempt is being made to stamp out corruption in all its various forms (with only varying degrees of success), the situation has become more complex. There is no ‘going rate’, and patients are reluctant (at best) to discuss what they are giving the doctor. An enquiry made to a fellow patient who is in for the same surgery, as to what they think is the appropriate amount to tip, is inevitably answered with: ‘Whatever you can afford.’ Not a lot of help.
How much simpler it is in the private clinics, where the rates are publicly displayed for all patients to see. As it is, whatever you decide to give in the ‘free’ National Health system, you feel it is probably too little, leaving you with the uncomfortable feeling that should you be forced to seek that particular doctor’s help in future, he may be ‘too busy’ to deal with you.
Though a few brave souls actually choose not to tip, how much better it would be if this system which demeans both patient and doctor alike, and undermines any truly professional relationship between them, were well and truly stamped out altogether.
Exactly when and how it started seems to be the topic of some debate, but what is certain is that it existed before the beginning of Communism. In villages it appears it was a tradition to bring the local family doctor produce from one’s garden or allotment, the spoils of a pig killing or some home-made wine. Similarly, other esteemed figures in small town life, such as the priest, could also count on having their meagre incomes supplemented in this way.
In cities, this presented somewhat of a problem, as most people did not have access to such produce, and naturally resorted to giving money instead.
Quite when this became expected, compulsory even, is unclear, but that it did, cannot be disputed.
Before 1989, almost everyone earned a standard wage, irrespective of their type of work: a teacher, a doctor or a bus driver, earned within a few hundred forints of each other. A combination of the already-ingrained habit of giving doctors a ‘present’ following certain types of treatment and all hospital surgery, and a feeling that they deserved more than the average worker, completely established this custom.
Thus, if you were going into hospital, your preparations – alongside packing your own toilet paper, cutlery and mug – was to enquire from others what the going rate for this intervention currently was. The requisite amount was then put into the customary envelope, in readiness to slip to the surgeon at a suitably private moment, out of ear and eye-shot of colleagues and nurses. This could generate a certain degree of cloak-and-dagger activity, in those instances when the doctor could not be found except in others’ company – though most doctors generously gave their patients an opportunity to pass over the envelope when issuing them with their discharge notes, in the privacy of their offices.
When I enquired whether my friends feared the doctor might not take care with an operation or the like if he were not paid, it was explained to me that the money was always given following surgery, and not in advance. Logically, then, he could not know beforehand whether he would be tipped or not. However, people always feared that if they had for any reason to return, to have some further treatment, not giving money could prejudice the doctor against them. It should be added that nurses – who are indisputably poorly paid – also expect small ‘presents’ to attend to their duties.
Typical of the double-think that anyone familiar with Orwell’s 1984 will already be aware of, every department on every floor of every hospital had to display a written declaration outlawing the giving and the acceptance of such gratuities – universally ignored. These framed edicts were still hanging there after ’89 when income tax was first introduced, and when the government decided to tax doctors on these very ‘earnings’!
Today, in a society where there are extreme disparities in earnings, and when some kind of attempt is being made to stamp out corruption in all its various forms (with only varying degrees of success), the situation has become more complex. There is no ‘going rate’, and patients are reluctant (at best) to discuss what they are giving the doctor. An enquiry made to a fellow patient who is in for the same surgery, as to what they think is the appropriate amount to tip, is inevitably answered with: ‘Whatever you can afford.’ Not a lot of help.
How much simpler it is in the private clinics, where the rates are publicly displayed for all patients to see. As it is, whatever you decide to give in the ‘free’ National Health system, you feel it is probably too little, leaving you with the uncomfortable feeling that should you be forced to seek that particular doctor’s help in future, he may be ‘too busy’ to deal with you.
Though a few brave souls actually choose not to tip, how much better it would be if this system which demeans both patient and doctor alike, and undermines any truly professional relationship between them, were well and truly stamped out altogether.
Some years ago I was given a box of chocolates by a gynaecologist for whom I had done some revision of a translated article he was hoping to publish. On opening it at home, I found an envelope containing 20,000 forints in the wrapping paper. He had obviously been presented with the chocolates by a patient (in preference to just an envelope), but not realising what lay within, and having no use for the chocolates, had passed the gift on to me. I hardly knew him, and he was thus surprised to find me waiting for him in the hospital the following day. However, as I explained the situation as delicately as I could, he gave not the slightest hint of any embarrassment or awkwardness. Pocketing the envelope he wished me good-day, and returned to his waiting patients.
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