I remembered few years back when my brother told me that one of the major hospital in the city here in Cebu was threatened by an immediate drop in hospital admissions. Something very unusual for them since they are always flooded with patients at any given time. All of a sudden, as what my brother described the phenomenon, the emergency receiving area became a “ghost town”. Orderlies are lining up outside waiting for patients!

What brought about this phenomenon? As it turns out, many of their hospital doctors has somewhat “unionized” and started referring their patients to other hospitals of their affiliation. What sparked the sudden outrage of these doctors was due to the hospital’s initiative to adopt JCAHO practices. As a consequence, other hospitals within the city suddenly had an unexpected surge of patients while the said hospital had very few. So what is JCAHO? Why are doctors in that hospital intimidated and even caused outrage to move their patients out?

JCAHO is an independent, not-for-profit organization, The Joint Commission accredits and certifies more than 15,000 health care organizations and programs in the United States alone. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

What is JCAHO’s Mission?
To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations.

What is the scope of JCAHO?
The accreditation programs of JCAHO includes: Ambulatory Care, Assisted Living, Behavioral Healthcare, Critical Access Hospitals, Home Care, Hospitals, Laboratory Services, Long Term Care, Networks, and Office-Based Surgery.

Isn’t this good for all of us?
The answer is a resounding yes! However, (in my opinion) doctors are threatened because of the following reasons:

1. Standards: When doctors work in a JCAHO accredited hospitals, part of the policies that they are expected to adhere is the set standards by JCAHO. This means that doctors cannot just confine patients, request lab workups or procedures unnecessarily. Thereby, controlling healthcare cost incurred by he patients. This significantly controls the doctor from having malicious agenda of giving so many procedures and confining them unnecessarily just to earn more. This is true and this is rampant.

2. Peer Review: This time around, doctors practices are meticulously reviewed for proper patient management. They are under a watchful eye of hospital appointed committee (like the “Big Brother”) and reprimand if any violations are made, be it procedurally or behaviorally.

3. Performance Evaluation: With our current healthcare practice, who determines if the doctor is effective in patient management? Does the doctor himself even know he/she is efficient and effective in delivering healthcare? I bet he doesn’t. We consider doctors as modern day Shamans and would want to remain that way! JCAHO has toolkit for medical practitioners in the form of performance indicators. It is performance metrics program where all their patient management activities are measured, quantified and analyzed. The output of the report provides a grade. Just like how hospitals under JCAHO are graded from 0 to 100.

4. Full disclosure: Doctors are also expected to fully inform and disclose all activities that will be done to the patient, its outcome, and medical errors (if any) – blag! Doctors are human and they commit mistakes but they are not honest enough to tell you they made a mistake for fear of litigation.

My thoughts:
We don’t anymore live in the middle ages where the Shamans are the only people in the know and not even question their authority. Doctors have enjoyed that position for a long time and at most at the expense of patient safety. JCAHO’s basic tenet is patient’s safety. Nothing more and there are no hidden agenda to this. Bottom line here is, doctors don’t want to be controlled or a “big brother” watching over their shoulders. It just annoys them to think that they can be kicked-out of the JCAHO accredited hospitals or worse, sued for medical errors by their patients.

Quality healthcare is one of the very basic benefit every Filipino should and always have. Yet, even those who have and can afford, cannot truly appreciate health care in its true sense of the word. I’d say, much of the problems in service delivery  lies entirely not our government or the system but from the principal drivers of health care – the doctors.

I have listed some common and very annoying habits that doctors do or doesn’t do in the practice of their profession and what med schools should teach to our young graduates.

1. Respect other people’s time.

Have you ever seen a doctor who came in for work on time? Probably there are but in my experience 9 out of 10 doctors never make it on time. What’s even more disheartening is the fact that people graciously accept doctors’ tardiness. No one expresses anger or disappointment whenever the doctor come in late for work. Instead, they are greeted with respect and reverence much like greeting a priest in a confessional. Also, our chronically tardy doctors were given ‘safe passes’ or ‘blanket’ acceptance for such socially unacceptable behavior. It’s high time that we should express to our doctors that our time is equally important as their time and that there are no excuse good enough for disrespecting our covenant of properly keeping time.

2. Always consider patient’s financial capacity.

The cost of health care including diagnostic tests and medicines are steep these days most specially with the advancement of very modern medical technology. Ever wonder why doctors prescribe too many lab tests and not even ask if we can afford to pay for it? In retrospect, doctors should always qualify the financial capacity of the patient to pay for medical bills and that procedures should be conservative and given in accordance to patients’ economic status. In other words, before an expensive procedure is to be given to a patient, a low cost alternative must first be considered unless extremely necessary.

If it may help to understand, doctors get as much as 15% to 30% percent (commission) for every laboratory referrals they make to private laboratories. The more referrals they make, the more income they generate – that is how the ‘game’ is played. Sad but true, there are no prevailing health care standards placed by our Government to better monitor and manage medical practice, much like an ISO for the manufacturing industry, and so doctors are left to do basically anything they want without being accountable for anything.

3. Give what is due to the Government.

Doctors make poor businessmen. A dishonest businessmen at that. In fact, they don’t consider their practice a business at all; probably another excuse not to give official receipts and being chronically tardy. Doctors don’t declare how much patients and money they earn for medical consultations. Doctors don’t declare their commissions or referral fees they get from private laboratories and hospitals. Doctors don’t declare cash gifts and bonuses. And, doctor’s refuse to deduct taxes from services rendered to insurance holders. Well, if there is anything these doctors want to deduct from, it probably is their obligation of service and charity to their countrymen.

4. Stop asking favors.

We are in the business of health care and, part from being that, we hire doctors to manage our clinics. If there is truth to what our medical director once said that: “doctors need medical reps for conference sponsorships“. Is it really a need or just merely a want? I pity the medical reps these days for they are reduced by these doctors to become their personal sponsors for conferences and even their dinner parties. This is one major reason why our medicines are among the most expensive in Asia because of the representation costs incurred by drug companies to these doctors. Yes, your doctor is the reason why they are expensive.

5. Work with the system.

Many doctors always seems to feel that they are always a cut above the rest. This probably stemmed from long and expensive education that they feel they should be given special treatment. Thus, being socially placed above the pedestal, they feel that they can work their best if there are less rules to follow. Rules that particularly govern their professional practice.

I can vividly remember when we first installed our first medical director to our chain of medical clinics and discussed on house rules and policies, they (the doctors) started feeling very uncomfortable.

The practice of medicine has changed dramatically over the years most specially with the advent of modern medical technology. We were able to probe deeper and understand primary causes of diseases and how we can protect ourselves from them. But, despite all the advancements, some basic yet very important things hasn’t changed and that is how our modern shamans (doctors) practice their profession for the sake of science?