Medical schools need strict regulation

I didn’t realize my recent columns on medical education caught the interest of Pinoy doctors here and abroad. I picked the subject, not typical in the lay press, because of a personal interest in it, being the son of a long time professor of medicine. In fact, many of the e-mails reacting to my columns are from former students of my Dad. But doctors are shy about going public with their views. Such is the medical fraternity here.

One former student of my Dad wrote to say that our present situation "is scary, because conventional wisdom tells us that a medical education is a very demanding course intellectually and to bow to the economic needs of medical schools is short of incredible."

My Dad’s former student said "attitude adjustment is more appropriate than curriculum change. No system will improve the local education, if it does not incorporate the evolutionary technological advances of the recent past. We (as well as the brochure on PBL) wrote on EVIDENCE-BASED medicine."

This former student of my Dad is pretty emphatic. "Evidence-based medicine is mostly technology-based. Equipment must be TRUE state of the art (at least at the training centers) and the professors in these fields must be truly QUALIFIED. The fact, that the country cannot afford these machines and essentially bar qualified professionals from abroad (ref-Dr Nolledo, whose e-mail was featured in an earlier column) to train locals is no excuse for local MD-professors trying to marginalize and/or trivialize the value of evidenced-based medicine."

Actually, the problem is more basic and the situation is worse than he thought. I understand that a number of med schools in this country are accepting students that are less than qualified. They have lowered the cutoff NMAT scores for applicants to med schools. NMAT stands for National Medical Aptitude Test, a kind of entrance exam for aspiring medical school students.

In the past, the Association of Philippine Medical Colleges has set the cutoff at 45 percent (percentile). But when some schools complained (for lack of students) and this was then deregulated, the only requirement is that one should have taken the NMAT and may apply and get accepted with three percent or five percent or even negative scores.

The proliferation of diploma mills masquerading as medical schools makes it important to set up a system of accrediting medical schools that is internationally accepted. This is based on the principle that a human body is the same anywhere and as such, doctors must have the same competence in America or in the Philippines. It should be possible for our medical schools to get themselves accredited with a system in the United States so that the public has a way of judging their standards. I understand that so far, only UP and UERM have applied to be so accredited.

Because the private sector can’t seem to put the interest of public health above their business objectives, we need government to come in strongly. I get the sense that right now, no one is in charge of monitoring our medical schools. It would be nice to see CHED taking a more active role. CHED should set the necessary rules and regulations to maintain quality medical education.

For example, it should be simple enough for CHED to evaluate the medical schools based on the performance of their graduates in the medical board exams. Schools that register three successive ratings below the national passing average, should be placed on probation. And I guess any med school should be shut down if its graduates fail to meet accepted standards of competence.

My Dad’s former student observed that the qualifying exams to practice medicine in the United States are evidence based. This is why, he surmised, our local graduates find it difficult to pass these exams. Maybe, we are left with no choice but to establish a kind of third world medicine something we could call "barrio" medical education. But I wonder if this would mean, having second class doctors, yung puede na, pero hindi world class. I find the concept unacceptable.

Maybe, what we can do is introduce a new type of medical professional known in the US as Physician Assistants or PAs. At least it is clear that they are not Physicians but are trained to handle some common ailments. Many rural communities in the USA are serviced by physician assistants(PA’s). Training to be a PA is shorter and less expensive. It can center on our forte, clinic-based medicine.

We are a poor nation and maybe even poorer in the foreseeable future. Maybe we have no choice but to accept reality and do something for our communities. But the thought that our younger doctors are less qualified than those abroad worries me. Let us reserve the title "doctor" to one who is properly trained and qualified to be a doctor as we traditionally know what a doctor is. The quality and the integrity of the Medical board examinations must also be protected at all times.

Finally, maybe Congress should review the present law governing the practice of Medicine in this country. There may be amendments to the law that are appropriate to our current situation.

I wonder why the physicians in Congress, like Dr. Flavier, didn’t give this problem much attention. Well, the next Congress should. It is the health of the Filipinos at stake and it should be a priority.

Pinoy diaspora

I received this e-mail from Ronald Tolentino, one of the many Pinoys now living abroad. Here are excerpts.

I was an ordinary Filipino salaried man (my family are now Australians, I am sorry to say) and perhaps represented a big segment of our population so I might just as well take the chance to voice out my opinion. I am absolutely without confidence in the way our country is run and that’s why we fled it at the first opportunity and now living in a better managed one (Australia).

But looking back I realized that aside from my own experiences, the one that prompted us the most to migrate were the constant warnings by newspapers that IN THE NEAR FUTURE the Philippines will surely suffer CATASTROPHIC ECONOMICAL and POLITICAL disaster.

In short, I was scared into fleeing the country. Of course like the million others who did migrate, our families are now facing a much better future. I believe I did my part however small it was. I was among the first few people at the original EDSA and then was there again during the impeachment of ERAP. I paid my taxes and was a peaceful citizen. I even did my tour of duty as a Saudi Arabia OFW for two years.

But I felt betrayed by our politicians. They treated us like idiots. They know they can ignore us because they get elected anyway by cheating and getting the votes of the less educated Pinoys. And when you see them on TV, they try to sound and look so important.

It came to a point when I realized all politicians are the same. They are all up to no good! Oo nga naman! may maganda bang hangarin itong mga ito na pumasok sa isang trabaho na ang baba ng sweldo pero handang gumastos ng limpak-limpak na salapi para makuha ito?

I felt bad having to surrender a big chunk of my salary to taxes while the others who can really afford to pay more do not pay proper taxes at all. And these politicians again who treat the public money as their own. Naku! tama na nga Mr. Chanco kundi ay di ako matatapos. Ipagpatuloy mo ang mga sinusulat mo at baka sakali may mangyari. I always look forward to Mondays, Wednesdays and Fridays.

Tax time

It is that time of the year. Dr. Ernie E has something for that too.

Father O’Malley answers the phone.

"Hello, is this Father O’Malley?"

"It is."

"This is the IRS. Can you help us?"

"I can."

"Do you know a Ted Houlihan?"

"I do."

"Is he a member of your congregation?"

"He is."

"Did he donate $10,000 to the church?"

"He will."

Boo Chanco’s e-mail address is [email protected]