‘Physician, heal thyself’

“Medice, cura te ipsum” is the Latin form of an ancient proverb from the book of Luke chapter 4:23 where Jesus is quoted as saying, “Ye will surely say unto me this proverb: ‘Physician, heal thyself, what we heard you do in Capernaum, do also here in your country.’” (Wikipedia)

Who would have imagined that one day, physicians in the Philippines would find themselves at the receiving end of such a phrase? With allegations and accusations stirred up because of an alleged multi-level marketing scheme for prescription medicines, many doctors are concerned with becoming collateral damage in terms of patient trust and integrity.

As expected, it is the majority of innocent and trustworthy physicians who are standing up for the profession and declaring they are without sin. I have received reactions from young doctors who have pushed back against the suggestion that they are more likely to fall or be misled by unscrupulous vendors because their generation is better informed.

But in the same breath they do complain about delayed payments or reimbursements from hospitals as well as the larger cut of HMOs than what doctors get for treating patients. A doctor in a hospital in Parañaque gets P300 for a consult while a doctor at the BGC charged P15K for a three-minute consult.

It is of course a normal reaction to defend and clear one’s self of any wrongdoing if you’re not guilty, but it is unnecessary and ineffective. Those who know you, know, and those who don’t know you will never believe you or will reserve judgment. What helps is to speak out against wrongdoing or ethical violations. Unfortunately, those who speak out for themselves fear to speak out against others causing the damage.

This is what older, more senior practitioners have been doing lately. They have talked to their relatives, friends, etc. and have shared their observations about the “lavish lifestyle” of those who are suspect. They have turned the screws a little, they are naming names, sending photos and naming brands. Why wouldn’t they, considering the many sacrifices they made in order to attain a position of respect and expertise?

It is not every day that you would hear top surgeons suggest that the Bureau of Internal Revenue should conduct audits or lifestyle check or even trace ownership and purchases for cars, bags and watches, etc. That of course might open a can of worms, given how the parking lot at the House of Representatives often looks like a luxury car dealership while some senators and congressmen have been scandalized and branded on social media as walking billboards for million-peso watches.

Here are some sentiments shared by respected physicians:

#1 “It’s all FINANCIAL GAIN. Point of care no longer patients but MONEY. Character, ethics is gone. More on personality ethics. My parents and mentors taught me one very valuable lesson: whatever I do, make sure I am the last to benefit.”

#2 “It is sad and appalling. But again, evil has permeated so many institutions, even those supposedly meant to serve with utmost integrity and compassion.”

Even the Philippine Medical Association president recently issued a statement on the subject: “Maintaining integrity and ethical practice in interactions with the pharmaceutical industry.

“Integrity is the bedrock upon which our professional duties rest. It is what fosters trust between us and the patients we serve. This trust is critical, not just for the efficacy of our treatments, but for maintaining the sanctity of the doctor-patient relationship.
“The trust that our patients place in us is the cornerstone of the physician-patient relationship. To preserve this trust, it is crucial that we maintain an unwavering commitment to moral conduct, particularly when dealing with the pharmaceutical industry. Our decisions must always be guided by the best interests of our patients rather than the influences of external entities.

“The Philippine Medical Association therefore encourages all physicians to engage in:
1. Active disclosure of any financial relationships or conflicts of interest with pharmaceutical companies is essential. Such transparency ensures that our clinical decisions remain unbiased and patient-focused.

2. Commit to evidence-based medicine and promote the highest standard of care for our patients. We must base our prescribing patterns and treatment recommendations on the best available evidence rather than on promotional materials or incentives from the pharmaceutical industry.

3. Seek out independent sources of continuing medical education to complement industry-sponsored learning. Critically evaluate the information presented, ensuring it is both unbiased and scientifically sound.

4. Uphold ethical guidelines when entering into partnerships with the pharmaceutical industry. This includes being wary of accepting gifts or incentives that could influence clinical judgment.

5. Advocate for practices and policies that prioritize patient welfare and the integrity of the medical profession over the interests of any third party, including the pharmaceutical industry.

Remember, when you do not appear vulnerable, gullible and greedy, opportunists will not even approach you nor prey on you. When in doubt about any possible conflict of interest, decide as if there is.”

The PMA statement is a strong reminder to physicians, but are the guilty being punished? I am sure that many pharmaceutical companies, particularly those covered by punitive laws on corrupt practices and ethical standards, will take offense at the generic tone or generalization of the message. Many doctors and one pharma are responsible, not all.

One rotten apple spoils the bunch but failure of government, regulators and gatekeepers to directly address the actual violations and violators and single out the guilty does not solve the problem. Remove the rotten, reduce the talk.

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