July 15, 2003

     Practicing medicine nowadays is not what it used to be according to my older colleagues. Going, going and gone are the close ties and family oriented practices of the olden days. It used to be that the whole family sees the same doctor for everything, literally; and the family doc is pretty much part of the family. And, being part of the family, it was close to unthinkable for somebody to throw that nice neighborhood doctor into jail and grab all of what he has.

     Well, it’s just a different climate now. It’s become a big, complicated, crowded material world. A doctor is JUST a doctor now; or you might say, a “healthcare provider”. What have we become? An EMPLOYEE. Courts, institutions, and most of all managed care organizations have reduced physicians to become just another set of professionals who get a job, get paid for it equitably, and get punished if they do not do that job well.

"100,000 deaths by mistake pale in comparison to the millions of lives we save. But if you commit one error, you will be remembered and punished for that error, despite all the good you have done, which often goes unnoticed and unrewarded."

     Anyone who went through medical ethics class knows that when a patient seeks medical care, there is a “contract” that is established between them, forming a “physician-patient relationship”. Being a legalistic society, there are laws that protect both the patient and physician. The problem is, while there are more and more rules to assure the welfare of the patient who may have been injured by malpractice, there are few laws that protect those who strove to heal them in the first place.

     Now, there are many factors that have breached this “physician-patient relationship”. In fact, most of the time, there is no “relationship” at all, other than the actual physical act of treatment. What are these factors?

1. Volume of patients. Sometimes there are just too many patients to care for. Few doctors can even remember who they treated a month ago, much less, recall what conditions, medicines or allergies they have. Too little time is spent with the “client”, and no relationships are formed with the person or his family.

2. Specializations. The medical world and its educational system have teased out medicine into fibers, macrofibers and microfibers. The degree of knowledge goes deeper yet narrower, and more and more there is a need for specialized and subspecialist consults. These docs in response see the “referral” as a case to deal with, rather than a person, and rarely form any other meaningful relationship with the patient.

3. Commercialization. Everybody seems to be in it for the money. Physicians would like to charge as much as allowable while insurance companies or government healthcare agencies would like to curtail doctors’ earnings so they can save and earn more. Of course, the Philippine Medical Association placed a strongly worded (through confusing and pretentiously profound English babble) statement against HMO’s (Health Maintenance Organizations), without mention of its benefits too. Of course, someone with a health plan would be hugely helped in times of illness, despite the fact that the HMO doctors get paid less and the patient has fewer choices on which doctors or hospitals to go to. It is a trade in, but it is selfish for doctors to only think of how much they earn without regard to patient’s dire financial situations too. That is why HMO’s, PPO’s, Medicare and Public Aid have their place because not everyone has cash or land or carabao’s to sell if they get sick.

4. Urbanization. Barrio doctors and established older doctors still have the distinction of being doctors of the people. However, as urbanization and overpopulation increases, there is more movement of people and availability of other practices (competition). So, if someone is not satisfied with the doctor, he or she can just move on to another one. (This is one way drug addicts get prescription narcotics too). If they get disgruntled, there is not enough correspondence, trust or relationship therefore lawsuits are more likely to ensue.

5. etcetera, etcetera

     The bottom line is that because of these changes in the climate of medical practice, more and more patients tend to rise up and sue the doctor for whatever reason they are not satisfied with in their medical care. It also matters not whether the damage or negligence may be perceived or true. In addition, there are those who just demand for money and lawyers who represent them for pure monetary gain. Remember: patients always have the right and reason to complain or sue. Especially if they were injured and there is reason to suspect the physician’s or staffs’ culpability. If you did not do your job well and if you did not establish that crucial relationship with the patient and his family, you would more likely be placed in the hot seat.

     The caveat of the matter? Defend your profession and block any oppressive law. Treat the patient as you would treat yourself.

     Top five reasons malpractice crisis would not be a big issue in the Philippines:

1. The patient dies of iatrogenic injuries before he or she can sue.
2. If the patient is still alive, someone makes sure he doesn’t stay that way too long.
3. When the patient finally dies, the family gets a death threat.
4. If the family survives, they get paid to drop the case.
5. If the family can’t be bought, the judge gets bribed. That’s the end of it.

     Let us look at it in the patient’s perspective: in the US, approximately 100,000 deaths per year are attributed to medical errors. Worldwide, it is estimated that about 18 to 25% of patients have experienced being a victim to physician or hospital negligence or mistakes. Of the thousands of lawsuits being filed in the US against doctors, only about 1% succeeds, but many more are settled. The sheer number of people hurt or killed by us physicians is staggering. Unbelievable. How much more in the Philippines where there is much less equitable justice especially for the poor? There is indeed a reason for the heat against doctors. You and I are partly to blame.

     Of course, 100,000 deaths by mistake pale in comparison to the millions of lives we save. But if you commit one error, you will be remembered and punished for that error, despite all the good you have done, which often goes unnoticed and unrewarded.

     Do you know that over 110 million people use the internet for health information? A recent survey by Harris Interactive also showed that 90 % of these surfers would love to be able to communicate with their doctors online in one form or another. It is still the information age. It is the “rise of the machines”. What does this mean to you?

1. Not all patients are morons who would believe you without question and swallow hook, line and sinker. More often than not, they will hear about new medicines, treatments and significant medical events ahead of you. YOU will be the one who’ll look like an idiot if you are uninformed. You need to catch up and be updated. Also, assess the patient’s or folk’s intelligence level and discuss their treatment at that level, so there will be comprehension and true informed consent.

2. You need to be visible online. There are online databases where patients or potential patients can look up hospitals, doctors and services offered. There are even websites they can surf to verify if you are licensed, have previous lawsuits, check years of experience you have and what procedures you are qualified to perform. With the explosion in population and technology, people beside the road in the internet highway will get noticed sooner and therefore will have the edge. Unfortunately, most local hospitals (including WVSUH) don’t even have websites, or just have pathetic webpages that are non-interactive and pretty much useless.

3. You have a wealth of information at your fingertips. What is in the textbook is at least 2 years old. What you can find in the peer-reviewed journals, which are available online, is current. Live not on obsolescent knowledge but move on and stay current! Get to know Medline and how to navigate it. Bookmark good medical websites and try to get continuing medical education. Communicate with other colleagues by email or chatting in a forum if you have a difficult case.

4. Lastly, you need to know how to use a computer!!!! For God’s sake, buy a computer, rent one, get to an internet café and know what the future is all about! (Or at least the present). It is a shame that many established “batikan” doctors don’t have email ads, or much less, even know how to switch on a computer. Have you heard of palm pilots, Windows CE, and pocket PC’s??? Geeezz. Also, there are more productive things in the internet besides porn and email (this website for one, ahem). We need more computers in our schools and libraries, and these need to be integrated more and more in medical education.

     I hope these random thoughts are hitting some heads, even if they bounce. At least, even if there were lack of response to some serious issues, I hope that they leave an impression that sooner or later, some green intern or aging sage would find useful.

Feedback: send your comments to the editor (anonymously, if you wish) e-mail the author at docdan1(at)pol.net (private and personal, if you prefer)

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