Central to correcting medical errors is accepting one first, if it did happen. Improvement in healthcare delivery will only happen if we learn from our mistakes and make concrete, active steps to rectify it. This is what we actually do during mortality and morbidity conference- analyze medical events and cases to help improve delivery of healthcare services.

The health care industry accepted the occurrence of medical errors decades ago. But disclosing medical errors publicly is unpopular even in countries where litigation is relatively not so common. Why? No one really knows. In our society however, publicly apologizing for one’s true medical mistakes is akin to killing your medical career. I guess it’s a bit easier to admit moral turpitude publicly than let’s say admitting you misdiagnosed a patient. The acceptance is just too low.

But what can we do? First, we should create an environment of open-mindedness among medical peers and enact laws that will protect disclosures of medical errors publicly. That way, we can freely examine medical errors to institute appropriate corrective actions based on acceptable and evidenced based medical practice.

This is what John Hopkins University Hospital is doing since 2001. Their  Disclosure Policy  protects and actually encourages employees to confess or report medical errors. This is partly the reason why JHUH  litigations have continually decreased ever since the policy has been implemented.  John Hopkins is the top ranked hospital in the US for 20 years already.

Medical errors simply don’t surface over time. For us, providing a “medical whistle blower” law might just be the first step in improving delivery of healthcare services. Don’t you think so?

Copyright secured by Digiprove © 2011 Remo Aguilar

Last Monday, on my way to Davao City,  some hundred and forty kilometers away from my place, we passed by four vehicular accident sites involving motorcycles. In one site, we saw a lifeless body, with still his helmet on, lying on the ground still pinned by the truck’s tire. In another, we saw two motorcycles entwined in the center of the road with broken glass and blood all over and the two drivers were rushed to the hospital. These gory sights shocked even surgeons like me.

A "shredded" motorcycle and its driver.(Photo from this site http://www.vf750fd.com/motorbikes/crashes/accident/motocrash.jpg)

Motorcycles accidents top the list of vehicular accidents in our country today. The same cause of acute traumatic injuries is the runaway winner if we base this on the Trauma Registry of the Philippine Orthopedic Association.

In practice, approximately 60-75% of cases I’ve handled are related in one way or another to motorcycle accidents.  In government health care institutions, more than half of the ward patients are victims of motorcycle accidents. Worst, the type of injuries that these accidents brings are not only complex, but also unique. Such injuries poses great challenge to our surgeons and require costly, repeated operations that exhaust both the patients and health care providers.  I bet if the health care community do a cost analysis of treating motorcycle injuries and the amount at which government spend to save this patients, we’d be all shocked.

So what really cause the rise in motorcycle accidents? Think about these and you’ll get what I’m pointing at.

1. Drunk driving or even driving under the influence of alcohol is rarely enforced in this country.
2. You only need Php 2,000.00 to get and drive your new motorcycle.
3. Anybody knew who’s supposed to be policing and regulating motorcycles? (If you know, please ask them to show up)
4. Some say, in the Philippines, even a blind person can get a driver’s license. And its cheaper to bribe than to bail out of motorcycle violations.
5. Teenagers drive motorcycles and they drive like they drive a bicycle. Just because you know how to balance a bike doesn’t mean you can drive a motorcycle.
6. Some schools even give parking spaces for students with motorcycles.
7. Approximately half of motorcycle drivers nowadays have one violation or two in their motorcycle ” papers”.
8. In the Philippines, if you bump a motorcycle and injure the driver, you ought to finance the drivers health expenses even if it were the motorcycle driver’s fault.
9. Motorcycle injuries in my city dropped when there was a rise in motorcycle theft and deaths.
10. Motorcycle injuries also dropped when the gasoline prices rose sky high.

There I’ve said it. Well, authorities can simply deny all these and more and say we’re all fine. Lack of budget and manpower seem a pretty good excuse I suppose. But the fact still remains, motorcycle related  accidents keeps on rising. Just watch your TV channels evening news and you’ll know what I’m talking!

I have long been an advocate of a no refusal, admit all patients policy for physicians . Any physician is bound by his Hippocratic oath and the law to treat any patient (within the bounds of his skill and expertise) whatever the circumstances of that patient will be. The physician also has the social responsibility of reporting any patient (to proper authorities)  that  may pose danger to any other person or to the society for which the patient belongs.

Lately however,  I’ve noticed a few non-compliant patients pushing limits of our patience and  resources. My case in point.

A thirty something male patient brought to the ER (allegedly from another hospital) for a 2 day old gun shot wound. The GSW entry point is at the postero-medial portion of his right leg, with no exit wound noted. He has a comminuted fracture on the middle part his tibia. On examination, the bullet  slug is palpable on the  postero-lateral side of his knee. I noted a wide area of contused skin from the leg, extending to the lateral posterior of his right thigh. Patient is febrile and have an elevated BP. We immediately started IV antibiotics and  scheduled the patient for an emergency debridement and external fixation of the fracture.  Surgery went well and while the skin contusion did grew to a alarming size, the patient eventually recovered and was on his recovery 5 days  after surgery.  The patient ran away from the hospital without proper discharge procedure and without paying his bills. As we learned later, all patient’s data and circumstances were dubious and the patient is nowhere to be found.  My worst fear is the danger of this patient contracting osteomyletis if ever his fracture isn’t followed up carefully.

If he ever goes back to any hospital, and if you are the physician, what would you do?

The dilemma is much more difficult in government hospitals. In the Philippines, government hospitals are funded by people’s taxes. Funding that are at less than optimal and is finite. Government physicians sometimes sees patients, that for some reason,are rarely compliant. Most often these patient’s’ non compliance results to complications and prolonged treatment. Prolonged treatment siphons physician and hospital resources that could have been allocated to other patients. This is where the decision making abilities of a physician enters and is very crucial. It can actually make or break his career because litigation and malpractice suits isn’t easy to come by.

My take on this? I’d still treat the patient according to what his medical problem requires and to what treatment the patients consents to. But I’m going to document it very carefully and protect myself with detailed consents and waivers. I will also get the opinions of  appropriate legal or social services department. Sometimes, its more with communicating with the patient and convincing them of their most beneficial treatment option. This is not easy. But aren’t we surgeons and doctors now if our job is easy?

I may sound like crap but again, the simple fact remains the same. We are the physicians, the very persons privileged to touch and care for sick people. When we treat patients, we (and the hospital) enter a ‘contract” with that patient. Contract that to an extent, requires both the doctor and the patient to work for the wellness of the patient, for so long as that treatment is not detrimental to others. It all boils down to both parties being aware of their responsibilities in this contract. If one violates this contract, that ceases the existence of the contract and therefore, ceases the doctor- patient relationship.

If you are a physician in this situation, what would you do? If, you are a patient, what do you think should the physician do?

I had mixed feelings after reading the text of  your recent State of the Nation Address (SONA) Mr. President.

On one part, I got excited when you detailed some of what many of  your countryman (which you gracefully called your Boss) knew years ago- corruption is rampant among many of the government agencies. That however, is old story to us Mr. President. My eardrums has thickened hearing all those  exposes that ended up in the waste can for “lack of evidence” and so many legalese gobbledygook. Put the corrupt officials behind bars and recover the peoples money and we will be all excited and happy. Including my eardrums.

The other part of me had this bad feeling about what might happen to your other priorities mentioned in your campaign. Your tone on corruption is very much aligned with your campaign tag line, but you spoke less on health and education. Where are they now in your priorities Mr. President?

Yes, the statistics on Philhealth coverage is confusing. But so is our health care system. You mentioned correcting the coverage statistics and expanding Philhealth coverage  to every Pinoy. It sounds good on our ears but personally Mr. President, its not enough to heal the woes of our health care system. Many of your Boss, cannot survive Philippines with Philhealth coverage alone.

And education? I can barely make anything of what you mentioned, yet. Frankly,I spent half of my lifetime in school and yet I barely can put food in my table. That’s why i doubt prolonging  years in school actually translate to a quality life.

I understand you’re trying to paint a picture of a negative starting point for your term. (Give thanks to the previous administration by the way, they made that painting an easy task for you with all those nauseating scandals). But that is the same reason we put you in charge now Mr. President. We believe you can be a good president even if you start from a negative starting point. We believe you can save us,  your boss,  from lingering in the kamote fields.

You asked for our support. If you noticed, there are many uprisings we supported in one way or another-rebellions, coups, edsa and even green revolutions. The people have shown their support to the presidency in so many times already. The people rallied to support so many crusaders but most of them failed us in many respect. Look at us now, we’re back to square negative. Maybe its high time you give us results already. You are the president. You weave power enough to do all of these reforms. Results is all we’re after now.

In all of this Mr. President, my prayers is with still with you. Give back health and education to the people .  Make them your priorities. And give us results.

You cannot fail us. We forbid you.

What are our healthcare priorities?

Health care issues that have been there before he ascended into office. Pres. Benigno Aquino III, my president, if health is one of your top two (other is education) thrust for governance, these are the issues that needed your immediate attention and resolution.

1. Realistic, workable and universal health care reform policy that covers ALL the stakeholders in it.
2. Control population growth explosion vis a vis the reproductive health care law implementation.
3. An national health insurance system that is expanded and will benefit not just patients but to health care providers as well.
4. Implementation of Magna carta’s for patients, magna carta for health workers, including the freedom of the “Morong 43″.
5. Restructuring of the medical education act and the policies governing education of our health care workers.

Too much?Impossible? Hard definitely. But not impossible. Six years enough?I took Ninoy his life to give us our freedom. Whether you like it or not, that will be our standards for your performance.