Trust your doctors: ethical dilemmas in remote medical consults

A 35 year-old female came in at Afable Medical Center, with severe 10/10 (NAS) hypogastric pain of sudden duration. Palpation revealed a tender abdomen to deep palapation at the left lower quadrant. There was no fever and no relief to Mefenamic Acid, an over the counter analgesic.

Initial Assesment was a possible Nephrolithiasis. CBC and Urinalysis were normal except for 2-4 WBC on the urine sample. No crystals were seen. Tramadol and Buscopan per IV were given to the patient with substantial relief. Admission was offered for observation and to prep for an ultrasound. A referral to a urologist was recommended.

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The patient agreed and was admitted.

It was a Sunday and, since Olongapo City was short of medical practitioners, I had to wait for an available urologist to examine my patient. For temporizing measure, I gave Tramadol and Cefuroxime (a broad spectrum antibiotic). I also have to wait until a sonologist would have to be available for an ultrasound.

All my management was sound and under protocol.

After a few hours, she bursts out in anger.

“Uuwi na po ako; wala daw po ako sakit. [Trans. I’m going home, they told me I have no illness]

“Who told you?” I asked.

She gave me her cellphone and I talked to a Dermatologist who was very angry that I admitted her sister-in-law with 2-4 WBC.

I told her that I saw the patient in severe pain and that she had to undertake more tests.

She told me that I was an ingrate and that I know nothing about her sister-in-law’s condition.

She dropped the phone. I asked my patient for the doctor’s name and she refused. She paid for the bill after signing a HAMA agreement.

This was four years ago and I regret I did not sue. The attending physician, or the one that is actually present, has precedence over a medical case. Medical opinions outside of the case are just that, medical opinions. Having a board certified specialty training in Dermatology doesn’t make you an expert over matters you cannot see. You can have a triple specialty or subspecialty but if you do not oversee the case, you shouldn’t make inferences that can damage the reputation of the attending.

The dermatologist violated the PMA Code of Ethics and is liable for slander. My story is one of many I have encountered in clinical practice. I have met patients time after time asking for a second opinion hoping to discredit the previous doctor in their care. I always tell the patients about differences in practices and that their previous doctor was doing the best he can. I do not wish to stain anybody’s reputation but time after time, I hear my own patients telling me that some specialty consultant said something bad about me, or that another patient I knew, is spreading a nasty rumor after his/her kid is not feeling well despite the meds I gave. Each of us doctors graduated with a degree of Medicine and sworn to uphold an oath. Each one had a different set of teachers and a different set of values. In a time when teamwork is needed, I see a crab-mentality issue going on.

“Hindi yan magaling… [Trans. That doctor is no good…]

I actually heard this comment coming from another doctor. The doctor he was referring to was a specialist that has serviced the community for more than 20 years and has done a ton of charity work. I actually found out that the commenter had a daughter who has graduated with the same specialty as the victim and needed a recommendation of patients to see.

This has got to stop! This is bad practice. This is unethical practice. Medical Doctors are becoming scarce and the remaining Filipino doctors are discriminating each other.

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