WITHOUT THE WHITE COAT
By Dr. Florentino P. Alerta II

Notify the physician… a matter of respect and courtesy

I never taught that in my years of practicing Medicine and teaching it to the medical students I have to write this eye opener article and opinion with regard to some medical institutions' “protocols” or “SOP” (standard operating procedure) on notifying “common” doctors if they have patients in the emergency rooms when they are not among the active or visiting staff of that medical institution.

One morning a delivery boy from a fast food chain had skid off the street and had suffered an injury on his left knee (an abrasion), the poor person was thus rushed to the emergency room facility of a religious medical institution on Luna Street . Not suffering from any life threatening injuries, the patient was ambulatory and very much conscious (GCS 15 with no loss of consciousness or vomiting noted.) The triage nurse of the emergency room department referred the poor patient to a consultant who is occupying the second floor of the medical complex, according to the triage nurse that was the emergency room “protocol” of that religious institution. (Never in my life working in the US that an ER patient is referred to a medical office, in the first place the patient sought medical attention in the Emergency Room, what happened to the surgical resident that is on duty in the emergency room?) One very important aspect that I wanted to bring out and also an eye opener to the administrators of this medical institution: always remember that there is an existence of what we call a medical retainer or plainly a “company physician”. This medical practitioners or doctors are paid by the company that retain their services, and most of this doctors are qualified to practice Industrial and Occupational Medicine being bonafide members of the Philippine College of Occupational Medicine as required by the Bureau of Working Standards under Article # 160 (Occupational Health and Safety) of the Labor Code of the Philippines (Department of Labor and Employment). It is “just” a matter of courtesy and respect on the part of that physician to be notified that he/she has a patient in the emergency room even though he/she “does not” have any “visiting or admitting privileges” in that medical institution, especially in cases that the patients strongly and aggressively tells the ER resident or nurse that they have a company physician or medical retainer, because it is the company physician that will do the follow-up on that patient once he gets that needed treatment, is there fairness in this issue and situation? Since most of our emergency rooms are operated as a commando outpost by some “vultures” in the medical practice utilizing some “triage personnel” as their agents. (Can you smell a racket going on here? isn't it time that these individuals will be ashamed of themselves… if they have one.)

My patient was seen by a doctor on the second floor of the hospital complex and was charged 250 pesos and requested him to have his knee “X-rayed” and was prescribed one of the most expensive COX2 medications in the market, come to think about it that the patient was just meagerly earning a poor man's salary. Come to think about it that we are trained professionals who were given a bigger brain matter that this patient needs a good pharmaco-economic intervention or simply a better and cheaper alternative. (A choice of medicine in which the patient's pocket can afford, unless he /she is under some agreement with the pharmaceutical company).

It may be some battle cry for some furious medical practitioners who just wanted to be simply notified once their patient is seen or admitted to the emergency room, is it too hard for the emergency room physician to notify the physician or they will just have the free hand to deck that physician's patient as a house case to the physician on deck or just plainly admit the patient to his/her favorite consultant. (Is this happening in your medical institution?) The basic and elementary problems in this medical institution's emergency room is that the emergency room residents or triage nurses will never notify the physician or doctor that the patient requested or have chosen as his/her doctor because his/her doctor of choice is not on the active or visiting staff roster of the hospital, convincing the patient to accept the house physician hook, line, and sinker, the patient doesn't even know the physician. (She'll/he'll be in shock of his/her life if he/she will later find out that the house physician he/she was luckily decked under was just a plain “vulture” dressed in a white coat disguising himself as religious Samaritan). Some admitting consultants (physician on deck/house doctors) in a religious medical institution knowing that the patient is under or belongs to the care of a medical retainer or company physician will still go ahead and admit the patient under their services. (Where is medical ethics here? Or just plain respect and courtesy to your fellow colleague or physician, did this “good” consultants know that the patient have to go back to work and eventually will be followed up by the company retainer or physician?) Let us face it, medical practice in Metro Iloilo is getting tougher and tougher (dog eat dog medical practice) everyday and a lot of this medical consultants are getting greedier and rude everyday. (Remember they have a lot of “obligations” to be covered-up). If we can all make it a point to notify all physicians (lawfully and legally practicing doctors, recognized by PRC) even though they are not in the roster of active and visiting staff of our medical institution is rendering courtesy and respect to our colleague in the medical practice. (For the emergency room resident or triage nurse, is it so hard to pick up the phone to notify the patient's choice of a doctor or you're just following some “protocols” set aside by the slickters in medical practice?)