25 April 2008

On The Cebu Hospital Scandal

The hype has not died down yet. The disgraceful incident is still seen on the nightly TV news, and still fills up the radio airwaves as well as the frontpages of the major dailies. The ways it has been referred to and described are assorted and numerous --- Surgery Scandal, YouTube Surgery Scandal, YouTube Doctors Scandal, Vicente Sotto Hospital Scandal, Cebu Hospital Scandal, YouTube Rectum or Rectal Scandal, Cannister Scandal, etc.

I have not seen the controversial video. But from news reports, it is said that the scandal involves the uploading of a video in YouTube showing doctors and nurses "laughing, giggling and cheering in the operating room."

Here are my unsolicited thoughts on the matter:
  1. Teaching Hospital - the hospital involved in the case, the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu is a teaching hospital. Because I am also a product of a teaching hospital, I can now understand why there were so many people inside the operating room while the surgical procedure went on. As part of the teaching and learning process, senior doctors usually allow student doctors (medical clerks or interns) and student nurses to observe surgical operations. Most teaching hospitals in the Philippines are not equipped with a viewing gallery, where student observers can stay separated from the actual operation setting. So, what senior doctors do is allow the students inside to observe.

  2. Unusual Case - having a patient come to you complaining of a 15-centimeter long cannister of perfume spray stuck inside his rectum qualifies as an unusual surgical case. It does not happen every day. Because of this, I suspect that the primary surgeon wanted this case presented in their weekly surgical conference. This is done with the consent of the patient, and I am quite certain that the patient must have signed a consent form prior to the operation. Hence, it is not surprising that an official video recording of the whole procedure might have been taken. The video uploaded in YouTube, however, came from a cellphone-camera. This means that, someone, other than the official video recorder, might have recorded the whole procedure using his/her cellphone.

  3. Of course, it was wrong! Where can you find doctors that would allow photos to be taken that violate a patient's confidentiality? Regardless of whom you did it to, it was very bad." ~ DOH Sec. Duque

  4. What Went Wrong - poor crowd control (there must be a limited number of observers inside the O.R.), and no clear enforced rules and hospital policies on unofficial and unauthorized recordings of surgical operations, whether an unusual case or not (I still wonder if each of those student observers knew how important it is to protect and respect patient's privacy). Clearly, whoever uploaded the salacious video did not know what "sacred trust" meant.

  5. "Sacred Trust" - this is clearly stated in Article II, Section 6 of the Code of Ethics of the Medical Professionals in the Philippines. Every doctor, aspiring doctor, and even student nurses must take this wise guideline into heart. The sick patient is already in pain and suffering when he seeks medical help. Doctors and other medical personnel must not add nor contribute to the emotional anguish of the patient.
  6. Art.II, Sec 6. --- The medical practitioner should guard as a sacred trust anything that is confidential or private in nature that he may discover or that may be communicated to him in his professional relation with his patients, even after their death. He should never divulge this confidential information, or anything that may reflect upon the moral character of the person involved, except when it is required in the interest of justice, public health, or public safety. ~ Code of Ethics of Medical Professionals

  7. Who is to Blame? - a Catholic priest from Cebu insists that the surgical team shouldn't get all the flak from the unfortunate incident, "but it should be the person responsible for the indecent incident." Meaning? We should all castigate the patient instead? Hasn't he suffered enough? Before we point fingers, I suggest we wait until all the investigating teams have finished their work. Someone clearly erred in this controversy, but let us not commit another error by giving half-baked conclusions.

  8. Filipino Humor and Homosexuals - Let's face it.....gays are still ridiculed in our society. Dolphy, the so-called King of Comedy, achieved this feat by playing various homosexual roles on film. I think he, along with a host of other comedians after him, helped a lot to perpetuate the way our society treats people of a different sexual orientation. Whether willfully or not, and given the Filipino's propensity to create homosexual jokes, I suspect many of those observing inside that O.R. were thinking a number of funny thoughts. When the perfume spray cannister was finally extracted, it was not surprising to see why so many of them laughed, and did it vociferously. It might be human nature to laugh, but it becomes very disrespectful when it is done at the expense of a poor, suffering patient.

  9. Benefit of the Doubt - I have given it some thought that the boisterous laughter might not have been mocking in nature, but more of an expression of relief and achieving success after what would probably be a difficult surgical extraction of a large foreign object. It might be a case of misunderstanding, too. Surgeons are one of the most highly stressed among medical personnel, and surely, if they yelled as an expression of triumph after a tedious operation, certainly, there can be little fault in that. But hey, that's just me and my theories. The cat is already out of the bag and I bet many will not agree with me.

  10. Shooting Our Foot - DOH Secretary Duque said the whole thing would have been "praise-worthy," hadn't we shot ourselves in the foot. I couldn't agree more. Remember the much-ballyhooed Teri Hatcher joke last year? Don't be too surprised now when you see or hear that kind of joke flourishing into more colorful versions. I bet it will! Let's hope the trigger-happy and sensitive ones among us do not pounce on her again when she does it. Foreigners have a different way of showing their amusement and humor. Besides, we have brought this latest incident upon ourselves, anyway.

  11. P6M in Total Damages - this is what the victim is asking those whom he felt offended him. I have always believed that a person's reputation is priceless. If it gets damaged, it might be lost forever. My prayer is if ever he gets to win this case and collects the money, let the real issues not be forgotten. Collecting money is not the issue here; protecting patient confidentiality is. Everyone involved must learn and remember this always.
  12. Jan-Jan, the patient, is asking P1 million in moral damages and P5 million in exemplary damages. He filed yesterday a supplemental affidavit to his complaint with the Office of the Ombudsman-Visayas. - Sun Star Cebu

  13. Code of Ethics - How many physicians make it a point to review and read this guideline on a regular basis? I suggest that all hospital administrators begin posting this on every operating room for the ready reference of concerned parties. Also, for medical schools, make sure that medical students learn the importance of truly caring for the patient's needs and wants. It is never a fault to over-emphasize an important code of conduct, especially if it means avoiding another dreadful incident in the future.

20 reactions:

geekydoc said...

Bravo. A better post on the matter, I think. Not satisfied the way other foreign bloggers wrote about it. Especially Kevin, MD.

Technograph said...

For us, the most important aspect of this issue was the violation of trust. Like you said, it's a sacred one. Let's hope that this doesn't keep people from seeking the medical help they need, no matter how embarrassing it will be.

mesiamd said...

Doc E, nice reading you again! Your insightful piece covered a good deal of the issue.

In USA, most hospitals put those reminders you mentioned on doorways and elevators.

Patient's Bill of Rights are on walls in every hospital floor. Reminders of not talking about a case in the corridor are redundantly common.

Hospital workers spend a few hours each year on seminars that deal with improving patient care. And patients receive surveys asking about their best and worst experiences during their hospital stay. They're asked to grade their doctors, nurses, lab techs, up-keep personnel, receptionists, and nutrition services. These appreciably lessen the chance that hospital workers would forget about ethical treatment of human beings.

The hospital environment is quite litiginous and a case like this is a boon to the lawyers.

BTW, may I invite you and your readers to take a peek on the UP Ibalon Bicol Blog where my next post is about the same topic.

mesiamd said...

Doc E and fellow readers,

I forgot to give you the address:

"Hippocrates, Maimonides and the Perfume Canister Incident"


Anonymous said...

i have seen the video, and i myself was shocked too. it was really an unusual thing to witness but i think the staff have been too insensitive with their reactions. though the patient is unconcious, they should have respected him more. we all have our own share of dark secrets anyways!

just dropped by.thanks!

Dr. Emer said...

GEEKYDOC - Thanks. Everyone has an opinion when it comes to sensationalized cases like this one.

TECHNOGRAPH - As it is, with or without a violation of that sacred trust, most Filipinos would rather not see a doctor for consultation. It's usually due to financial reasons.

MESIAMD - That's also the reason why, sometimes, it is better to practice in the Philippines than in the US. In the US, doctors are always wary of a possible legal problem raised by the patient or his relatives. Here, as you know, patients seldom ask, and usually trust everything to their doctors without the threat of legal problems. While conducive to medical practice, this can also be subject to abuse.

KURISUJAE - there's more to this story than meets the eye. Let's wait for the results of the investigations.

Anonymous said...

hi doc, i just saw the YT video this morning. i really feel sorry for the patient. this incident should not have happened in the first place had the doctors and all those who bore witness to the operation acted professionally.

Panaderos said...

I fully support the patient's suit against the hospital. His rights and personal dignity were clearly violated.

mesiamd said...

Doc E:

You struck gold in saying Filipino patients are so trusting. It's for their trust and their being helplessly poor that they deserve respect.

The image of Jesus summoning the children to his lap comes to mind...

I hope this ignominious Cebu incident serves as a classic lesson for all of us.

bayi said...

Dr Emer

I am a latecomer to the discussion. Someone in the group violated the trust placed on him or her and this is going to have a negative effect on all the teaching hospitals in the way operations are allowed to be filmed or observed. At the end of the day, it does not just impact on the teaching of student doctors alone but our society.

But I am a positive person, believeing in salvaging some good out of a possibly negative incident which has already happened and which we no longer can reverse.

As you have so rightly put it, let the investigating team finish their work and then they can make some recommendations. Jumping the gun to offer "conclusions" is hardly any help.

Ethics is something that must be ingrained in all professionals, no matter what field they are in.

I am following the case with great interest.

edgar said...

The problem in philippines is the attitude,even professionals,politicians businessmen etc. treated everything like its an open market,you go to city hall or any government offices to process papers,you will bargain or argue your way to settle things out,you go to our embassies abroad they will treat your case like the way they're conducting business in the "talipapa", and yes even in our hospitals,look at that VSMMC they treated the poor guy like they are butchering a pig in a butcher shop.Where are the so called well mannered educated people now a days,are they still out there?

Aice Nice Concepts said...

Lately, there has been very bad news on television and even on TV series about Filipino doctors... have they NOT learned the lessons yet???

Hospitals and medical schools should be alarmed but what is happening?

I was really surprise on how the student doctors and even the surgeon in charge reacted, they are professionals and should act like one...

I felt bad for the patient am praying that he will win this case!

and please don't point fingers because of homosexuality that is never the issue here, I agree with you Dr. Emer it is the "Sacred trust" that is involve.

toni said...

Thank you for sharing your thoughts on this! I wanted to know what other doctors thought.

I've chosen not to watch the video. I just find it disgusting that people had the nerve to record it and post it on YouTube. Makarma sana sila.

Emilie said...

@Toni - me too, I opted not to watch the video.What I've heard on the news is already enough.Parusahan ang dapat parusahan.

@Doc Emer - tnx for posting the search strings used in youtube. I did flag them all, hopefully youtube will put into consideration to delete those videos.

ms firefly said...

hi doc E! hopped in from toni's!

i actually watched the video from youTube, and while everything is dark and blurry, you cannot mistake the loud and boisterous crowd on the background.

i think this incident is a lesson to be learned for people in the medical profession as a whole, because honestly, i do sometimes feel intimidated while going through my annual physical exams. i don't know, but some people just have the knack of annoying me.

Dr. Emer said...

MARI -- Beyond professionalism, extra care should have been practiced to limit the number of observers who cared enough to know how delicate and unusual that particular operation was.

PANADEROS -- With all the media hype, I think most people are now behind the victim versus all those doctors and medical personnel involved.

MESIAMD -- A truly classic lesson? Indeed, it is. It is just lamentable we learn our lessons late.

BAYI -- Terima kasi, my friend! As always, you are more Filipino that most Filipinos I know. Thank you for not losing hope.

EDGAR -- Amen to your analysis. There are still exceptions, of course. But those that sell newspapers are usually the bad news. Every journalist knows this.

AICE -- Let us wait and hope that they come up with the results soon enough!

TONI -- Coming from you, strong words yan. When a gentle soul gets angry, it is frightening.

EMILIE -- Thanks for visiting.

MS. FIREFLY -- Thank you also for visiting. Yes, this is another black-eye for local medical professionals. As a result, the already hesitant patients will probably have one more reason not to consult their doctors. Arrgggh. I have to assure you, that this is one of the isolated cases. Most doctors, I would like to believe, still uphold the code of ethics.

Θεμις Μαντζαβινος said...
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Jet said...

I am, by nature of my profession, a patient's advocate and I strongly believe that there is no hope for the doctors and nurses involved if they even have the audacity to defend themselves. What they did is wrong, plain and simple, and there is no need to complicate that truth. For even without a code of ethics, even without the patient's bill of rights, to make fun of a person is inflicting emotional and psychological harm on him and doing so when he is unable to protect himself is abuse and is, by law, damnable.

J.A. said...

Hi! A very late post, from someone who has actually spent a couple of months rotating as a senior clerk in VSMMC a few years back.
I have been always uncomfortable with the way some of the staff treat the patients there i.e. one of my patients was berated and called a lot of unspeakable names when she decided not to sign a consent for a bilateral tubal ligation. In the end, we do have to respect the person's right to decide on what should be done to his/her body!
Sadly, a lot of us in the medical profession still think, and I actually quote one of my classmates then: "Ethics is relative." Does that mean that we can always subjectively manipulate the rules just because we are licensed physicians?
I believe that we all have to treat patients with a lot of understanding and respect, and everyday in my residency training, I'm trying to do just that while I perform some very uncomfortable diagnostic procedures on them.
I believe that humiliating the patient with posting the video and making a mockery out of the procedure was quite wrong. We should always respect the right to privacy of patients. Still, I can't help but wonder why in the world none of us know the identity of the person who did this to Jan-jan in the first place. How come he isn't filing physical injury charges against him at the least? Just a thought...

Anonymous said...

Doc E.
Am a late contributor to your article, you've said enough and it is worth reading. Those doctors and nurses involved in the scandal should receive the punishment they deserved. dapat lang silang parusahan. I'm in the medical profession and too shameful for what these med. practitioners have done to the poor patient.i hope that the designated people in our gov't will solve this fastforward to put these people in barred rooms.