All’s well that ends well.

Last week, we tackled the controversy which the Philippine Society of Medical Specialists Inc. (PSMSI) had unintentionally created by announcing an accreditation exam for first-time takers and reaccreditation evaluation for all its doctor-members and those who wish to apply for membership.

The PSMSI is composed of more than 7,000 surgeons, internists, pediatricians, obstetricians/gynecologists, anesthesiologists, and other specialists employed in government hospitals and other health facilities nationwide.

It was announced in a meeting called by the Philippine Medical Association (PMA), the mother-organization of all medical societies, that PSMSI officers have reconsidered their position and decided to cancel the planned
accreditation/reaccreditation exams.

We explained in last week’s column that the PSMSI overstepped its competence and mandate in its plan to conduct the accreditation exams for specialists, an undertaking better left off with the eight lead specialty member-organizations of PMA.

More than ever, the medical society needs to show its unity. With the Universal Health Law hanging in the balance, with the uncertainties of its effective implementation weighing heavily, a unified and committed healthcare force is vital to overcome barriers, such as lack of facilities and healthcare personnel in the country.

A fragmented medical and healthcare community dissipates our scarce human resource. This unfortunate fragmentation worsens when each medical group decides impulsively on some major undertaking that could undermine the efforts of other medical groups.

Dialogue

More dialogues and consensus-building are needed to avoid miscommunication and missteps. Good intentions are not enough to rush a major undertaking.

The PMA, as mother organization, should assert its authority on its member societies. There’s no need to involve other organizations. And all the member organizations should respect, cooperate with, and recognize the authority of the PMA.

I’ve always said that the emphasis on specialization and sub-specialization has inevitably resulted in fragmentation of the medical community. Specialization first led to the development of expertise in a cluster of organs such as EENT (eye, ear, nose and throat), then to specific organs—ophthalmologists for the eyes, otorhinolaryngologists for the ear, nose and throat.

Now, some are specialists in specific parts of the organ only—like retina specialists, who are experts in dealing with the retina, the part of the inner eyes which is like a film where images are being “developed” in a fraction of a second so the eyes can visualize the image.

Probably in the future, there’ll be specialists in the left eye and a separate specialist in the right eye.

This sounds like a joke now, but a few of our senior general-practitioner colleagues, who have been practicing since the 1950s, tell us they never expected that specialization would reach this far.

And there’s no telling how far it could go.

Boon or bane?

Are such dynamic advancements a boon or bane for patients? I think both.

It’s a boon because many previously unknown diseases are now documented and can be readily diagnosed with available facilities. There are medical experts for practically any known medical problem, and patients are assured that they will get the best treatment that modern science can offer.

As a particular field of medicine advances, the specialist can readily update or upgrade his knowledge, and be on par with other specialists.

Unfortunately, it can be a bane, too—when several specialists handling a patient don’t act together, and just treat the patient on a per-organ basis.

The heart specialist treats the high blood pressure and blocked arteries of the patient, the pulmonologist treats the emphysema or bronchitis due to heavy smoking, the gastroenterologist treats the ulcer symptoms, the neurologist treats the frequent headaches and dizziness. No one bothers to treat the root cause of the problem, which could be undue work-related stress leading to unhealthy lifestyle.

Worse, each specialist sometimes doesn’t even check what the other specialists have prescribed. Time and again, it’s humbling when we realize that there’s duplication of related drugs, or we’ve prescribed a medicine with some potential serious interactions with the other medicines the patient is taking.

So, a patient seeing several specialists should show each doctor the medicine prescriptions of the other doctors.

For their part, the different specialists seeing the same patient should make an effort to communicate with each other, even with just a short note on what one’s findings are, and what he or she has prescribed the patient.

Each patient should have a notebook, and each specialist can write short notes on it after every visit. I know of pediatricians who are doing it. But doctors treating adult patients don’t.

I think it’s time this was done, too, for all patients, so that different specialists would be on the same page.

After all, the cardinal rule in medicine is Primum non nocere (First, do no harm).