PAGE TWELVE   By ELINANDO B. CINCO Elinando B. Cinco (This column gives way to a two-part series article by Dr. Ricardo Ledesma M.D., which he describes as “one of his favorite topics to develop and share his thoughts in the practice of medicine in relevance to spiritual value.” The second part will appear in one of the subsequent issues of this column.) We all know that a checkup is a thorough examination, especially a physical or a medical one. I must have performed thousands upon thousands of checkups in my 47-years of medical practice. As a clinician, we undertake fundamental steps to get a good history of the patient—his personal habits and family backgrounds; and to conduct a routine physical examination. In     so doing we use our clinical senses of sight, hearing, touch, and smell. Over the years, the field of medicine has continued to grow. As a traditional clinician, I strongly support, recognize, and even encourage this change in SPECIALTY MEDICINE, greatly appreciating its significant benefits to patients. These modern medical equipment and facilities are, undeniably, gifts from God to be shared and utilized gratefully. However, relying solely on these material gifts is very risky as it can easily corrupt our mind. It is saddening to note that God’s will is mostly disregarded--- if not ignored---in the use of  the attractive and very convincing modern equipment. Our good and successful doctors have become fully occupied with their use, forgetting where these came from as well as God’s imperative role in their life and career. Thus, more than the medical breakthroughs and state-of-the-art technology, new challenges emerged involving both doctors and their patients. It’s evident in the last 20 years that 40% of patients are sent home from the emergency room without getting a ward or room accommodation for financial reasons---because hospitals continue to require a deposit before treatment. The same percentage sadly experiences the following:

1.  Use out-of- the-pocket money to pay doctor’s fees, expenses for medicines and use of basic laboratory facilities in the emergency room.

2. Get treatment for health maintenance organization (HMO)-registered physicians.
3.   Seek confinement in hospice clinics.
4. Those confined in ICU wards are required to have “co-pilot” interventionists to act as prompters on prepared checklist which normally are entrusted to ICU-experienced nurses.

Lastly, the same percentage now experiences only five to ten minutes of consultation and initial routine checkup---shortened by 70%. But that is not all, because nowadays, 60% of patients:

1. Switch to cheaper generic medicines instead of what doctors prescribed.
2. Compliance to both dosage and duration of treatment is not followed.
3. Disregard the use of expensive diagnostic tests, even for leading lifestyle

diseases, such as stroke, diabetes, chronic kidney failure, among others.

4. Refuse DNRO (Do Not Resuscitate Order), even for first cardiac or respiratory arrest or terminally-ill patients.
5.  In the case of those with suspected dementia or cognitive mental disorders, hospitalization costs have quadrupled, resulting in the early discharge of such patients.

These unfortunate situations certainly result in an atmosphere of conflict of interest between  doctor’s responsibility to his patient and patient’s primary needs. With the high investment costs of building modern hospitals and acquisition of the latest technology in medical equipment and facilities, the factor of economic gains has become unavoidable---particularly where doctors are part owners in the investment scheme. This situation could heighten a conflict of interest that could affect a physician’s clinical judgment. (To be continued.)