Indexing Title:

ROJOSON’s Medical Anecdotal Report [05-07] 

MAR Title: Weekly Electrocardiogram 

Date of Observation: August, 2005 

Narration: 

A 45-year-old female consulted me for her breast pain.  Clinical evaluation showed no evident physical abnormality on the breasts.  Thus, I advised her on a diagnosis of nonspecific mastalgia, allayed her anxiety, and recommended a check-up in one month’s time for assurance purpose.  During our conversation, the patient volunteered she had been seeing another physician, a general practitioner, prior to seeing me for second opinion.  For her breast problem, she was given analgesics, anti-inflammatory agents, and antibiotics and was asked to return to the physician weekly for follow-up.  I was not surprised when I heard of  the usual regimen of triple therapy being prescribed to patients with mastalgia by general practitioners.  This is a rampant practice up to now. What shocked me, however, was when the patient was asked to undergo electrocardiogram (ECG) in the general practitioner’s clinic every time she visited him, that was a weekly ECG and 3 ECGs in 3 weeks.  The ECG tracings would be read by the general practitioner and patient would be charged PhP 400.00 for each ECG. The patient said that practically all patients who consulted this general practitioner were made to have ECG in every visit.

INSIGHT: (Discovery, Stimulus, Reinforcements) (Physical, Psychosocial, Ethical) 

The weekly ECG is definitely an unethical practice on the part of the aforementioned general physician.  It is not anymore a case of ignorance on the use of diagnostic procedure. It is a premeditated money-making scheme.   

Time and again, we have been advised during our bioethics courses and fora that we should be ethical in our practice of medicine.  We should be truthful to our patients.  We should avoid conflict of interest.  We should not take advantage of our patients’ ignorance. 

Definitely, the rational of an existing law that prohibits physicians from dispensing drugs consists of avoiding a conflict of interest.  Physicians will tend to over prescribe drugs when they own a pharmacy.  The same situation of potential abuse exists when they own diagnostic equipment.  They tend to do diagnostic procedures even when not indicated.   

Such situations of conflict of interest among practicing physicians are prevalent in our community.  We have to avoid them to be able to maintain our ethical practice of  medicine.