• Date of Medical Observation: February 2008

A 39 year old male had on and off epigastric pain.  He sought consult to a private physician and was treated as Peptic Ulcer Disease, prescribed with Ranitidine.  However, pain did not resolve which prompted his consult to various physicians but was treated the same.  After about 3 weeks of suffering this condition, he was losing hope and was having doubts on the capabilities of physicians, until he came along a surgeon who suggested to have an ultrasound.  The Ultrasound report allegedly showed presence of stones in the gallbladder which would need emergency operation.  According to the surgeon his operation would cost him about sixty to seventy thousand pesos.  Due to the financial burden this situation holds, and with slight relief of his epigastric pain, patient became reluctant to proceed with the operation.  Instead, he consulted me.  Upon review of the ultrasound result, findings turned out that there was no gallbladder stone. There was a  hypoechoic mass seen on the left lobe of the liver. These brought me into confusion. Who was telling the truth? I myself, can not accept that idea that my colleagues especially surgeons would lie to patients in exchange of monetary benefits. It is very unethical. In fairness to the other  surgeon, may be I would think that this patient wasn’t able to understand fully his condition. May be there was some sort of misunderstanding. But where this idea of emergency operation came from? With this in mind, I just told him that an emergency operation was not mandatory at that very moment and that he has to undergo some work-up to further investigate his illness.  In relation to what the other surgeon advised him, I just told him that sometimes different physicians have different approaches in managing their patients. I can not meddle with the management other physicians have with their patients. It is a sign of disrespect. I always believe that physicians would not do harm to his patients.

INSIGHTS

(Physical, Psychosocial, Ethical)(Discovery, Stimulus, Reinforcement)

The Modern Hippocratic oath says..

“I will respect the hard-won scientific gains of those physicians in whose steps I walk…”

 I have been a witness to conflicts and quarrels between physicians back to my home town. As I see it, it is very much unprofessional and a show of disrespect to our profession.

Physicians should not allow a conflict of interest to influence medical judgment. In some cases, conflicts are hard to avoid, and doctors have a responsibility to avoid entering such situations.