Without the White Coat
Minor surgeries
A PRC (Professional Regulatory Commission) ID and license gives the physician the right to practice medicine in this country (my dear Philippines), the right to treat, give medications to his/her patients. As physicians we are trained to deal with the sick and the ill may it be a case of pneumonia to a small case of an ingrown toenail. There was a time when our forefathers or fore bearers in medicine were all called "general practitioners" in which they were able to perform procedures like delivering a baby, doing appendectomy, and the same time prescribing medications. There were times that the "ordinary" "general practitioners" or "physicians" can perform minor surgeries, like excision of breast mass, incision and drainage of an infected wound, suturing of simple and ordinary wounds, or just cleaning and dressing of wounds. Time have move the field of medicine so fast that the practice had become compartmentalized (specialized), the "surgical procedures" may they be minor or "minute" can only be done by a qualified and "true certified" surgeon.
Take the case of an active practicing family physician who booked a minor surgical procedure (an excision biopsy of a small mass less than 5cm) that was approved by the "assistant" hospital director, but was blocked by the surgical department of the said hospital considering it is an "open" hospital. The surgical committee was informed by the surgical resident on duty of the said procedures, but I’m sorry to say it, the "assistant" hospital director gave in to the suggestions of the "surgical committee". If we can all recall, the same situation happened in one of the hospitals in Metro Iloilo even the sign still hangs in the wall of the operating room. (To all ORIANS: no operating room privileges to family medical doctors). The family physician was questioned by the department of surgery on a local and minor procedure he did in the minor operating room for an excision biopsy of a breast mass. The department of Family Medicine of the said medical institution presented the competencies of a family physician when it comes to surgical procedures that the family physician can perform based on the competencies done by the Philippine Academy of Family Physician and the Philippine College of Surgeons. In fact, the Philippine College of Surgeons published a book on surgical procedures that can be performed by primary care physicians. (A copy of the competencies and book are available in the library of the Department of Family Medicine at Iloilo Mission Hospital). It has always been said that the specialty of Family Medicine will have its own boundaries, thus the trained family medicine physician will practice within his/her boundaries and competencies that he/she was trained in.
With the difficulties and hardship of our time, a lot of "us"- doctors and physicians, are just taking up a career change a "U-TURN" for the good of our children and family. As physicians we have lost our "luster" or that "shine" among us doctors, as we are viewed upon by the population-at-large. The community and especially the media had painted a different image for physicians today they had viewed the practice of medicine as a competition between doctors (guina gutom ang iban?), more associated to speed (lost of a relationship between the doctor and the patient, the compassionate physician is now gone) and the practice had become too technical and mechanical relying a lot on modern diagnostic equipment. The media had viewed doctors critical, cynical and suspicious.
With the referral system the family physician will always refer his/her surgical patients to the surgeons, may it be a case of appendectomy to an acute abdomen that needed an exploratory laparotomy, but my golly, even with the smallest surgical procedure the surgeons will still bar the family physician from performing such procedures! So what is left for the family physician to do? If we are barred by the surgical community in performing some simple procedures such as excision biopsy to removal of an ingrown toe nail, maybe there will be a time that the only surgical procedures that a family physician can perform is "pedicure and manicure".