Saturday, May 28, 2005

Comments on the proposed medical malpractice criminalization bill

Just a few additional thoughts on the proposed medical malpractice bill filed by Philippine Senators.

1. This discussion has been ongoing for a few years now. While on principle I am against it, the continuing discussion and pressure to enact such a law may be reflective of the frustration and lack of action against erring doctors.

2. This situation then is also reflective of the impotence and neglect of the Philippine Medical Association (PMA) and other oversight or regulatory bodies on ensuring quality medical service from its members as well as resolution of malpractice complaints from the public.

3. Thus, the problem of medical practice can be seen at multiple levels both structural and professional. At the structural level, the medical profession is overworked, understaffed, poorly compensated, lacks equipment, unevenly geographically distributed, perhaps under-trained, frustrated, and discouraged, among others. Many have set their eyes on working abroad.

4. The national economy is not robust enough for prioritizing nutrition, health, and preventive medicine. Environmental degradation threatens national health, hence making heavier the workload of medical practitioners.

5. Note however, that it is the task of the national government to be more proactive rather than reactive. The root causes of medical malpractice should be determined. Are we training cohorts of incompetent doctors or is the system turning aspiring, dedicated doctors into frustrated, unhappy, and disillusioned doctors?

6. It is government’s task to create a positive, encouraging, and LEVEL, playing field for medical practitioners. I don’t have the answers to these deep structured problems, but a few initiatives may help.

7. The first of course is to stem the hemorrhaging of our doctors/nurses leaving for abroad. While we should encourage them to seek the best training wherever, they must return to ensure the health of the nation is not compromised.

8. This means a creative set of initiatives both financial and non-financial to retain our doctors and nurses, as well as to encourage those abroad to set aside some time during the year to practice in their home country and perhaps retire here to do consulting.

9. Because of its strategic location in the Asia-Pacific region and its deep talent, the Philippines should naturally be the regional health center of the region. Medical costs are rising in the Western world and the baby boomer generation will be retiring soon. Coupled with a deteriorating environment, health issues are on the rise. The Philippines should prepare to capture a slice of the growing health and medical services sector nationally, regionally, and globally.

10. Medical practitioners still need to be held accountable for their actions. Anecdotal evidence abounds on erring doctors, corruption, the negative side of the seniority and medical fraternity old boy/girl network, the pervasive influence of the pharmaceutical firms, etc. Short of legislating morality and competence, what else can be done to ensure accountability?

11. If one were an economist, one would use the market to ensure that competition brings out the best in everyone. The market works when the rules are enforced and there is perfect information. On the first, I think we have enough laws to address professional neglect/incompetence. On the second issue, perfect information, instead of laws we should develop a way where we can monitor the effectiveness of the medical practitioner, keep track of their professional progress (or errors), and relay this information to those who need it.

12. When we were a young nation and our communities more cohesive, the community doctor had personal and long-term relationships with one’s patients. I myself only visit doctors/dentists recommended by friends or family. The few cold calls I made resulted in less than satisfactory treatment. Community relations ensured that the doctor did his/her best. Communication, an essential component of medical service, was intense and of good quality. Rumors of negligence or incompetence were enough to kill a doctor’s business in a locality.

13. Monitoring, evaluation, and feedback work in business and industry. If it is transparent, participatory, and easily accessible this may be a better alternative to new laws that may further drive doctors/nurses abroad or raise the cost of medical services across board.

We need to think our problems through. The problems of the medical sector are deep seated and medical malpractice is only a symptom and not the underlying cause. It involves structural issues and not just the personal capabilities of the medical practitioner. Philippine society is different from the litigious American society. Maybe there is another way of ensuring both professional accountability and the strengthening of the medical services sector. Let us discuss this in a more holistic manner that encourages the various professions/disciplines in the country to develop in a competent and HUMANIST manner.

1 comment:

livingplanet said...

Regarding your medical "notes", my take on the appropriate regulatory
body would be one comprised of a jury of medical practitioners,
inclusive fo Philippine born doctors based abroad. This would be similar to the INt'l Court at the Hague and would serve as an arbiter and filter of malpractice cases.

Structurally, it would define the role of the body, wherein cases would spend a defined and limited time in screening, interpellation, analysis and decision. The purpose of having expat doctors in the body would be to ensure that technologically, technically and perspective-wise, the body would have all the necessary ingredients in making a well-informed decision with the global stage as its foundation.

This would allow us to benchmark decisions, analysis and cases on
international standards as well as appreciate societal norms around the world.