Integrate local doctors as a profession

The best suggestion I have heard so far in the current debate on the medical malpractice bill was made by a group of surgeons from UP-PGH last Monday on Ces Drilon's talk show, Get Real on ANC 21. They proposed the integration of local doctors as a profession, the way local lawyers are integrated by law. This will make self-regulation work simply because the doctors will be required by law to police their ranks.

Apparently, there is another bill that had been languishing in Congress for many years, the one that seeks to update the present law regulating the medical profession. The proposed bill is comprehensive, regulating even the quality standards of medical schools. Heaven knows how much regulation is needed in the area of medical education with the mushrooming of med schools all over the country.

I don't remember the names of the doctors who spoke in Get Real, except that they represented the Philippine College of Surgeons and work with the UP-PGH Medical Center. They made a good point of how a malpractice law will make it difficult and expensive to practice medicine, specially for government doctors who are not adequately paid, to begin with.

While they did not dispute the contention of the congressman who sponsored the bill that defensive medicine is good medicine, they raised the question of affordability. Poor patients can not afford the cost of all the tests that doctors will require to cover themselves in case things go wrong for whatever reason.

I must say those doctors invited by Ces truly won my confidence. They were articulate and authoritative. And because they have experience in providing quality health care to the poor at PGH, they know what the situation is on the ground. But then again, it was obvious too that they are the cream of the crop. The malpractice bill was not written with them in mind. As the congressman commented, his bill was designed to protect us from the small number of incompetent and unethical physicians.

In fact, even in the United States where malpractice suits are filed all the time, horror stories still happen. Last week, I read of two cases, one reported by The New York Times and the other, an Associated Press story forwarded to me by our very own Dr. Ernie E.

Dr. Ernie E's story is datelined Oklahoma City. "The operation to remove a bone from high school basketball star Keith Smith’s heel went smoothly. Problem is, doctors were working on the wrong foot. Now Smith, one of the state’s top players, could miss most of his senior season because he will need a second operation to fix the foot that needed help in the first place. Officials at University of Oklahoma Medical Center, where the surgery was performed Wednesday, could only say they deeply regret the mistake."

Sorry, however, is hardly enough. The mistake drastically alters what could have been a bright future for a young athlete. The AP reports that Smith has a full-scholarship offer from the University of Colorado. He planned to sign with the university Nov. 11. His mother relates that he had his future all mapped out. "He worked hard to get where he is. His senior year, we didn’t expect anything less than him being player of the year."

Expectedly, Smith is in a state of shock. He awoke from anesthesia and realized it was his right foot that was bandaged and sore. The teenager is using crutches and faces a six- to eight-week recovery. "He’s in excruciating pain," his mother said.

The case reported in The New York Times is different but just as scary.

Federal agents raided the offices of two doctors and of the Redding Medical Center, the hospital at which they practice. The F.B.I., according to an affidavit, was gathering records as part of an investigation of accusations that the two doctors performed hundreds of unnecessary invasive procedures like catheterizations and open-heart surgeries, at risk to patients’ life and health, to make money from Medicare.

In an affidavit issued last week, the F.B.I. said that, according to a few other Redding cardiologists and doctors it interviewed but did not name, 25 to 50 percent of the procedures the two doctors performed might not have been necessary. The affidavit said that one of the doctors performed four to five times as many catheter procedures as his peers in California.

According to the affidavit, he would tell patients that they would die without emergency surgery, which would then usually be performed by the other doctor, a cardiac surgeon in the same hospital. One former patient, a priest, recalled that the cardiologist told him while he was still lying at the cath table that there’s nothing he could do for him because he needed immediate multiple-bypass surgery.

The New York Times reported that the doctor tried to schedule the operation immediately but could not. So the Catholic priest decided to have the operation in Las Vegas, where he had a friend in medicine. But several cardiologists there, after looking at his test results, found little wrong with him.

If this case can happen in California, the haven of malpractice, lawyers, that should show that even the threat of economic ruin from a malpractice suit will not stop practitioners who are determined to practice a form of medicine that is largely motivated by profit.

This is why second opinions are so essential. We must also make sure that doctors are open to peer review that is institutionalized in their hospital or medical society. The level and frequency of QA (quality assurance) conferences and similar reviews are key.

Well, the congressman who sponsored the malpractice bill said he also filed a bill that specifies the "patient's bill of rights." The doctors in Ces' panel that evening are supportive of that other measure. Maybe they will just consolidate the two measures in one that also integrates the doctors as a profession, like the lawyers. That may be just what we need.

What beer?

After an international beer festival, some of the brewery presidents decided to go out for a beer.

The guy from Corona sits down and says, "Hey Señor, I would like the world’s best beer, a Corona." The bartender dusts off a bottle from the shelf and gives it to him.

The guy from Budweiser says, "I’d like the best beer in the world, give me ‘The King Of Beers’, a Budweiser." The bartender gives him one.

The guy from Coors says, "I’d like the only beer made with Rocky Mountain spring water, give me a Coors." He gets it.

The guy from San Miguel sits down and says, "Give me a Coke."

The bartender is a little taken aback, but gives him what he ordered. The other brewery presidents look over at him and ask, "Why aren’t you drinking a San Miguel?"

The San Miguel guy replies, "Well, I figured if you guys aren’t drinking beer, neither would I.

(Boo Chanco's e-mail address is [email protected])