01 May 2007

On Trusting Your Doctor

"Do you trust your doctor?" was what my friend, the Sassy Lawyer asked last week. I was too busy to post a reply and since almost a week has passed, I am instead writing my thoughts here.

Well? What do you think? Do you trust your doctor? If not, why so?

Some of the reasons why I think a patient will not trust his/her doctor:

  • Competence - a doctor has difficulty diagnosing what's wrong with the patient. Worse, he might often give you a wrong diagnosis and begin treating you with the wrong medications. Worst case is when you begin developing new ailments courtesy of the side-effects of the wrong meds given to you.

  • Awesome Professional Fees- for merely five or so minutes of asking you questions and barely touching your body with his stethoscope, his secretary charges you more than a thousand bucks when you walk out of his clinic. Another variation are in-hospital patients (those who are confined) who can't remember a single moment they were visited by their doctor, but are similarly surprised to find out the stupendous fees a particular doctor has charged them on the end of their hospital stay.

  • Corruption Issues - this is the reason of many well-informed patients and also what constitutes majority of what the Sassy Lawyer griped about: "Yeah, it is about the practice of doctors of accepting gifts, payments and other freebies from pharmaceutical companies. A study says that some fields of specializations are more prone to the corruption than others. Oh, yes, it is corruption and corruption is a relationship --- one party corrupts another party who is willing to be corrupted."

  • Aversion to Scientific Methods - let's face it, in this modern age, there is a growing number of patients out there who simply do not trust medicine and its practitioners. There are those who still think they get sick because God or a higher being is punishing them. Therefore, the only way they can be treated is by spiritual means, or by drinking concoctions of boiled leaves of some herbal plant. Don't get me wrong, ok? I believe some herbal plants do really alleviate some disease symptoms, but I still prefer a scientific explanation and solution to diseases. This particular group of patients would rather stay home and probably pray or seek the help of an alternative health practitioner than go to a hospital or see a doctor.

  • Punctuality Issues - many doctors are guilty of being late in their clinics. Their clinic hours say 9:00am to 12noon. But because of supposedly-important reasons like "being on hospital rounds," "having an emergency operation," "having an emergency consultation," "having an important meeting with other doctors," to the downright overused "being caught in a traffic jam," doctors usually arrive 1 or 2 hours late of their advertised clinic hours. A well-respected pundit once said that unfaithfulness in keeping appointments is an act of clear dishonesty, and it is!

A patient distrusts his doctor because of any one or a combination of the reasons above. Often, the real cause of loss of trust is the doctor himself.

In the study mentioned by the Sassy Lawyer, ninety-four percent (94%) of more than 3,100 physicians surveyed mentioned some type of relationship with the pharmaceutical industry. Asked to describe the ralationship, eighty-three percent (83%) of the physicians said it involved receiving food in the workplace, while seventy-eight percent (78%) said it involved receiving drug samples. Thirty-five percent (35%) of the doctors received reimbursement fees for costs associated with professional meetings or continuing medical education, and twenty-eight percent (28%)received payments for consulting, giving lectures, or enrolling patients in clinical trials. The table below summarizes the results of the study:

Cardiologists were reported by the same study to be more than twice as likely as family physicians to receive the said payments.

Here in Metro Manila, in one of those hot days in May, if you happen to drop by one of the famous 5-star hotels where a medical convention is being held, the images below are familiar scenes:

Hotel personnel are constantly busy assisting physicians in their pharmaceutical "shopping sprees" to collect what is known among all doctors here as "goodies," mainly pens, prescription pads, plastic cups and mugs, towels, food items, computer accessories, office and clinic supplies --- all distinctly inscribed with brand names of a smorgasbord of medications. Come to think of it, I think the situation gets worse every year. I am beginning to think doctors attend these medical conventions not to learn anymore, but to collect as many "goodies" as they can.

Now, is there anything wrong with receiving food, drug samples, payments for lectures, tickets to entertainment and recreational events like concerts, out-of-town trips, and golfing matches?

There is something wrong when these practices DO NOT primarily benefit patients and enhance the practice of medicine.

In 2002 and 2004, the American Medical Association and the American College of Physicians, as well as the Pharmaceutical Research and Manufacturers of America(PhRMA) implemented codes of conduct governing physician–pharmacy industry relationships to be observed by all people concerned. Read it in detail here.

In the Philippines --- correct me if I'm mistaken --- I do not know of any similar codes of conduct issued by any medical organization or pharmaceutical association. Each doctor has his own code of conduct to resist the many temptations constantly dangled to him by the pharmaceutical companies. In my case, I accept the gifts but I also tell the medical representatives that I prescribe only the medications which will benefit my patients. That has been my motto ever since. Maybe that is also the reason why I think I receive fewer "goodies" than other doctors. *LOL* Don't worry, I am not complaining. 

Nanette Newman, an English actress and author, is credited with saying that, "a good marriage is at least 80 percent good luck in finding the right person at the right time; the rest is trust." I believe it is the same with the doctor-patient relationship. If one is lucky enough to have a doctor who is a family relative, then the trust issue becomes a non-argument. But the reality is that many of us have no doctors in the family. It is always a matter of chance if we find a good doctor we can trust. Therefore, in the absence of extablished code of conducts, I think doctors should have their own set of rules. This set of rules should always place the
welfare of patients first, above anything else. That is the only way in which doctors can win the patient's trust.

10 reactions:

duke said...

when I was still working in one of the hotels in Manila, pharma companies normally have these lavish dinners and luncheons for doctors depending on their area of specialty. It is indeed amazing how the doctors get to take home all those goody bags. Some of them even get free room vouchers of buffet vouchers depending on the company.

I still trust my doctors though. I have this certain "trusting" feel on most of them. I hope I am right :D

Pete said...

Dont trust anybody blindly. Reasearch about your illness in the internet and if not satisfied with your doctor's advice, dont think twice about getting another opinion from other physicians.

Connie said...

That's what I like about you. You don't subscribe to the "we protect our own" policy. May your breed propagate.

Anonymous said...

I have an officemate (we are government employees)who once treated our boss and two officemates to lunch because it was her (my officemate's) birthday. Also present was her young husband who is a military doctor (a cardiologist) and with him was a sales rep of a pharma co. Sinong nagbayad? Yung sales rep. Earlier while they were waiting for the bill, may nag-alok ng bracelets at kumuha si officemate for our boss and officemates. Pati yun binayaran ng sales rep. And my officemate is mighty proud that her husband gets some sort of regular "incentives" from sales reps, and this include trips abroad with the whole family. Ok na rin siguro ganyang set-up para hindi mag-nurse ang mga doctors natin? So sad.

john said...

to anonymous, that is nothing wait tell your friend's husband becomes the surgeon general of the armed forces. even the tuition fee of his kids might be shouldered by the pharma company in exchange for being the exclusive supplier of drugs to the poor soldiers, Also , do you know that some of the pharma company spends millions sponsoring the renovations/constructions of a partion of some of the prominent hospitals in the country.

drytears said...

Actually for me the one doctor... (wait it was actually a NP) that I trusted the most was the one who perscribed meds and treatments that never worked and never found out what was wrong with be, yet I trusted her the most.

Anonymous said...

John, is that true? pharma companies spending for hospital renovations/ constructions? Is this a normal practice? No wonder, my medicine is soooo expensive. Do you know what percentage of the med's price goes to expenses incurred by pharma cos in taking care of the doctors' and hospitals' "needs"?

nikki said...

Doc Emer, natawa naman ako dun sa picture mo. Pareho pala tayo, ganyan din sa mga conventions namin. Some even fight over those goodies. Nakakatawa minsan.

Ako I admit to getting help from reps for payment sa mga convention fees but only from reps whose drugs I really use because I believe in the drug. The drug samples I get, I either give to my sister-in-law for my niece's use, give to my patients (for free) or give to a convent in Mindanao for use in their out-reach programs.

jher said...

the pharma companies, instead of spending millions for the "freebies" and "goodies" for the doctors, should use their funds to make their products more affordable. the drugs in the philippines are so expensive because all the marketing expenses are included in the costing of these drugs. so sad.

bayi said...

You are absolutely right, Dr Emer. And I must say that if I don't know you better, I would be surprised by your candor. But you have always advocated transparency and a long term approach that would be good for both the medical fraternity and the patients.This is quite evident in your post.

I don't like doctors who are arrogant and this can sometimes develop into a distrust for the doctor. Some doctors are adverse to touching patients and some don't entertain questions from their patients, adopting the attitude that the patients have no right to question them. This patronizing attitude always gets to me.

Generally I trust doctors and would follow their advise. If in doubt, I seek the opinion of another doctor without informing him first that I am seeking a second opinion.