Without the White Coat
By Florentino P. Alerta II, M.D.

A big shocker

“All ORIANS, please be reminded that Family Medical Doctors have no O.R. Privileges”—Dept. of Surgery

This note posted on the wall of the operating room of a very prestigious medical institution in Iloilo is a big shocker for the practicing community of Family Physicians (Family Medical Doctor) in this region. The statement will surely raise eyebrows in the medical community. Others may say, “indeed life is getting a little bit harder for some.” Take note some of our medical colleagues had already opted to take nursing to seek and discover greener pastures. The component society of the Philippine Medical Association may not have any idea of this, but surely the poor surgical resident who posted this sign was just under the order of his superior who haven't read the competencies that were set, formulated and agreed by a panel of top physicians of the Philippine Academy of Family Physicians and the Philippine College of Surgeons. (These competencies are available in the office of the Dept of Family Medicine of Iloilo Mission Hospital, and the manual entitled “Surgical Procedures for Primary Care Physicians by the PCS is also available in the said office).

We should remember that only minor surgical procedures like cicumcision, I/D , excision of masses less than 5 c.m. and other minor procedures can be performed by our Family Physicians. It should not be a “racoon-eye” that should tell us about this, if we look deeper the medical institution is already losing some revenues in the form of minor operating fees and supplies, since family physicians will just perform this minor procedures in their offices, the big problem comes when the patient or the folks would request if the minor procedure can be performed in the hospital. Considering the state of economy of this country the medical establishments and institutions are trying hard to make both ends meet. A lot of medical doctors take up nursing and some district hospitals close down due to shortage of nurses and doctors. In our state of medical practice in the Philippines looking at this statements coming from another specialty will surely send some bickering thru the halls of the medical community, I thought we all agreed we would all work as a team shooting and breaking down the barriers of competitions. We can all live a world of referrals and work harmoniously with one another, and I know each Family Physician knows his/her limitation of practice and there is always that high regard for the referral system.

Personally, when I saw the sign, the first thing that came to my mind is “may ginagutom na?” and the second thing that struck me was “ wala na guid sya pasyente haw?”, come to think about it one person is trying to curtail the practice of Family Medicine in this institution. For some surgeons that I have talked to, they found the statement below the belt and had believe that it can further strain the relationship between two societies. For a practicing surgeon what is the difference between doing a circumcision or removal of an ingrown toenail in the doctor's office and doing it in the minor suite of the operating room, your answer is good as mine, “NOTHING!” So how come this top-notch surgeon would like to make a big fuss about it, then your guess is the same as mine… “ginagutom, wala pasyente”. If all the medical institutions will curtail the practice of Family Medicine in this city when it comes to minor surgery so what minor procedures are we allowed to perform in the operating room?... pedicure and manicure? Or if we are not allowed in the operating room at all, then all medical institutions in this city should put up a sign in the operating room door: “NO FAMILY MEDICAL DOCTOR ALLOWED INSIDE THE OPERATING ROOM. (it is just like saying “ NO DOGS ALLOWED”… you may recall my previous article entitled “A Dog-eat-Dog world of medical practice in Metro Iloilo.”)
   
My apologies to my colleagues and fellow practicing doctors and physicians in Metro Iloilo in bringing up this issue. As of this writing this issue had never been addressed upon, I feel it is also my right as a Family Physician, a diplomate to make a stand and try to stop the “push-over” mentality of other societies, thus I will make a firm stand to uphold the competencies agreed upon by the Philippine Academy of Family Physicians and the Philippine College of Surgeons on surgical procedures for primary care physicians. If the former chairperson of the Department of Family and Community Medicine had never lifted or make a stand then I will make it a “fighting battle” on my side.