What do we have to offer our doctors?

I have written in this column about doctors migrating to foreign lands as nurses, about diploma mills masquerading as medical schools and lowering training standards for doctors and even about the unease of the local medical community towards instituting a working peer review system to handle malpractice cases. I grew up in a family of doctors and those issues are normal dinner table fare. I just believe these issues deserve wider discussion.

On the other hand, I also think that sometimes, we expect too much of our doctors. We look at them as superhuman miracle workers, with little of the needs ordinary mortals have. Maybe in a sense, it takes some superhuman qualities to become a doctor. The Hippocratic oath is a heavy burden to carry for a lifetime.

I want to use today’s column to hear from Dr. Michael Hussin B. Muin, who is founder and editor-in-chief of Pinoy.MD and a professor of Clinical Anatomy and Medical Informatics in Pangasinan. A "Doctor Lilian" forwarded to me his article in Pinoy.MD and I thought every Pinoy should read it. It also reminded me of the medical practice of my late mother in Paco, Manila.

Now, here’s Dr. Muin writing for Pinoy.MD:

By now, everybody knows of Elmer Jacinto–the February medical boards topnotcher who publicly announced his plans to work in the US as a nurse. I was in Zamboanga City visiting my parents when that news broke out. A topnotcher from Lamitan, Basilan hit close to home and I showed the article to my brother. His only question was, "Why? Doesn’t he have any offers?" I could only laugh and muster a short, "No, I don’t think so."

Elmer Jacinto’s situation and the reactions from various sectors are both funny and sad. I can only think of my brother’s question and wonder: What can the country offer its best and brightest in the medical profession?

The short answer is none.

Unlike the legal profession, of which the medical profession is often compared to, there are no offers made to topnotchers. We’ve read news of bar topnotchers invited to join prestigious law firms. Top law graduates are employed even before the bar results are released, while some receive hefty signing bonuses from happy employers.

Medical board topnotchers are not that lucky. After a day or two in the light of fame, most fall back to the shadows of anonymity–their achievements a mere footnote in their résumé. We hardly remember the board topnotchers of the previous years. How many of them are practicing in the provinces, much less in the country? Can you just imagine the public outcry if we found out only a few stayed?

Therein lies the problem–the public outcry. Why is the public so pent up about doctors going abroad as doctors or nurses or caregivers or whatever? Because my short answer is not exactly correct. The country does have something to offer the graduates of the most noble profession: The poor and sick of the Philippines. Physicians, especially new ones, are expected to grab the opportunity to serve–for a pittance of a fee, or even for free.

I tried my hand in volunteerism once when I was "in between jobs"–or, in short, unemployed. Living a few blocks from the Malate parish, I volunteered my services to their social services division for one day a week. I scoured the streets of Manila for jobs on Mondays to Thursdays, while I devoted Fridays to the urban poor of Malate. They gave me an old desk in the small office at the back of the church. The social worker announced my presence to community leaders, and, in no time, I was seeing 10-15 patients a session, which isn’t exactly heavy.

It was a fun experience. A patient wanted me to give him a medical certificate stating that he should sleep on cement benches because it was good for his back. He was supposed to show this document to police officers of Luneta where he spent his nights. Another patient, a jolly 80/M, went to see me not for a check up but to show off that he was in perfect physical health. He would do jumping jacks and push ups in front of me.

It was also a time of desperation. A stroke patient, with half her body paralyzed, persistently showed up every Friday, limping her way through Manila traffic. She continued to have a BP of 200/140. Another patient had a resting systolic BP of 220-240. The list goes on. And I could do nothing but prescribe the cheapest anti-hypertensive. But they all had the same excuse: they didn’t have the money to buy the drugs.

Not willing to lose a battle, I wrote the parish for some support, financial or otherwise. I was asking for some drugs, about P800 worth, and a P500 money pool, in cases of emergency. And they replied that they couldn’t contribute at the moment since they were finishing the wing for the missionaries, putting in a library and air conditioning. I kid you not! I wrote a short letter to the city government, but they said all health support should go to the local health center.

One Sunday after mass, the parish social worker informed me that the Rotary Club of Manila was conducting an outreach program. I went with her and talked with the president of the club. They agreed with the whole package, insisting only that I submit proper accounting reports every month for their newsletter. I can’t say it was smooth sailing from then on. It definitely helped me with some of my patients’ monitoring for drug response rather than just looking on helplessly.

My experience is not unique. Volunteerism doesn’t have to be so obvious. Surgeons forego professional fees after operations, internists accept P20 for consultation fees, pediatricians charge break-even for immunizations, and general practitioners accept eggs and chickens in exchange of services. These may be small acts, but they are by no means less heroic.

There are, of course, doctors who work with the poorest of the poor. Volunteer doctors to the war-torn parts of Mindanao would have different stories: their experience more colorful, their desperation more intense, their helplessness more personal. Their dedication is a strong testament to their character. These doctors who work with the poor often become poor themselves, and I have nothing but the utmost respect and admiration for them.

In all these cases, doctors are found in the frontlines of poverty. They work with almost no logistics and financial support. They carry the burden of salvation for their countrymen, with little or no compensation, with little or no thought of self. But the fact remains that mere presence can only do so much. What can a doctor give if he has nothing more than compassion and care? Is that really enough?

It’s ludicrous how the public expects too much of a sacrifice from Filipino doctors, when it expects too little from its government officials. The fight for better health is a fight against poverty. It is not won by doctors becoming poor themselves, but by government officials becoming the leaders they need to be. Doctors do not make laws, allocate resources, handle budgets, public officials do. Doctors do not get kickbacks, destroy public trust, and plunder taxpayer’s money, government scalawags do. So, when did doctors become sacrificial lambs for the ineptitudes of Philippine government?

The public flogs physicians, living on P10,000 a month, who pack up and go to the US as nurses, when they pay no mind to regional directors, earning P22,000 a month, who go abroad as tourists for weeks at a time. People look suspiciously at doctors driving a brand new Toyota Corolla after five years of practice, when they find nothing wrong with mayors sporting shiny Ford Expeditions after six months in office.

If we should mourn for doctors who leave, let us grieve more for corrupt officials who stay. We shouldn’t complain of doctors who dream of a decent living. Let us object more of unscrupulous government employees who lead obscene lives. Wounded souls search for healing in other countries, but there is no cure for callous hearts.

A mayor once asked me to join a free medical mission he sponsored. I humbly asked if there was any payment involved for my services. "Ah, eh, wala. Pero libre naman ang pagkain. Tapos ipapahiram ko naman yung Pajero ko at isa kong Starex para libre na rin yung transpo."

I wanted to bitch-slap him until his lips bled.

On Call

Now, let’s hear from Dr. Ernie E.

The doctor had just been buried. The last words of the service over, his friends and family started toward their cars. However, they stopped because a strange, eerie sound suddenly was heard from the grave.

As the guests looked around, a colleague of the deceased said, "It’s nothing... just his beeper."

BOO CHANCO’s e-mail address is [email protected]