Defining, Defending, Extolling the Nobility

Dr. Calleja's In Defense of the Physician mixes a healthy dose of medical history and current events with political and ethical issues involving the medical profession

By Lucio Victor Jr.

When cardiologist and four-term Philippine Medical Association president Dr. Homobono Calleja takes to the quill, he plunges into an odyssey of sorts and pulls his readers into a maelstrom.

    His book In Defense of the Physician (Raintree Publishing, 1999) is a compilation of speeches, essays, versified statements, and letters woven into a quilt of the physician's realm.

    Many of the essays give a generous serving of medical history, discussions on the nature and practice of medicine, a witty analogy of physiologic processes with situations concerning physicians today.

    A great deal of the book tackles ethical and controversial issues such as health maintenance and managed care organizations, the Generics Act, alternative medicine, medical malpractice, intellectual honesty. Although the title somehow gives the reader a feeling the book is all a defensive ploy and a rebuttal to criticisms against the medical community, it does not come close to such. In fact, some of the essays are written specifically to remind the health care provider of the kind of service expected of him.

Primum non Nocere

    Some essays in the book remind one of man's mortality and fallibility. Dr. Calleja says every physician is there to help people get a fighting chance at life when stricken down with disease.

    But he reminds physicians that they do not take the place of God. "The physician," he writes, " is never an agent of death." In cases where death is inevitable, he steadfastly reminds physicians their role is to make their patient go to God gracefully and with dignity.

    Dr. Calleja also points out that physicians make mistakes just like any mortal being. However, he stresses that even if no mortal will ever be perfect, doctors should not be satisfied with the status quo. They should continue to learn and improve their craft.

    He feels that physicians should not use their humanness as an excuse to fall into errors whether by commission or by omission. Rather it should guide them in dealing with their patients so that they "treat the person and not just the disease." He encourages physicians to keep growing.

    Comparing a physician's growth to that of a plant, he quotes Hippocrates: "Character is the soil, the master's precepts is the seed, education is the sowing of the seeds in season, the circumstances of teaching is the climate that controls the growth of the plant, and industrious toil and the passage of time [are factors that] strengthen the plant and bring it to maturity."

    Dr. Calleja notes that physicians also have a role to console patients and their families and in part serve as a source of emotional and psychological strength. "Carefully chosen words of sympathy and compassion can go a long way to ease and alleviate the suffering of the patient and the impending grief of the family," reminds the esteemed cardiologist. True enough, if topical preparations are soothing for a patient's burns and scalds, kind words and moral support from the physician would be salve for the soul.

    Dr. Calleja writes: "A physician is basically a human being, educated and trained to serve the sick of mankind, guided by the Hippocratic Oath and Code of Ethics of the profession, who has earned the trust and confidence of society not by force, legislation, or commerce of man, but by the simple act of service to the sick." He adds that physicians must take into heart that the profession they are in calls for them to "serve beyond self, to give of our self, and to heal by sharing."

Finding Answers

    Dr. Calleja encourages intellectual honesty among colleagues and respect for the efforts of peers. Citing the history of the discovery of Renin and Angiotensin, and the establishment of the Renin-Angiotensin System, Dr. Calleja says that colleagues can share discoveries and knowledge while giving due credit to efforts of all persons concerned in the quest of uplifting health care.

    He holds that research and discoveries should not be used primarily to forward one's own career and seek fame, but to improve the state of health care, find solutions for illness and generate cures when necessary.

    Great physicians like Willem Einthoven, for instance, shared their knowledge of the heart's electrical activity not for profit but for the common good. The result is the ECG, now an indispensable tool used to record the heart's electrical activity to help in the diagnosis, treatment, and monitoring of cardiac diseases.

    The discovery of X-rays by Roentgen and the DNA by Watson and Crick have opened the doors for various tools that today's physicians use for diagnosis and treatment.

    X-rays have come a long way since their discovery. X-ray technology is used not only for diagnosis but also for treatment. Now there are linear and spiral CT scans that can more than "see through" human flesh to search for neoplastic lesions or pathologic changes in the cranium. X-rays have also become indispensable in radiotherapy for various malignancies.

    Genetics and DNA technology have led to the discovery of genetically predisposed illnesses from Down's syndrome to diabetes. From a simple family history, couples can now be warned of the possible illnesses of children. People at high risk for a familial disease can also be guided on precautions to take to keep at bay any illness they may be predisposed to.

    Had scientists like Roentgen, Watson, and Crick sought royalties for their discoveries, they would not have benefited as many people as they have. And good health care might have remained affordable only for the moneyed few. And as Dr. Calleja firmly believes, quality health care should be available to everyone. If a patient cannot afford a physician's professional fees, then an amicable compromise can be met. A physician, he reiterates, is not supposed to leave a patient out cold-not at any cost.

Putting a Price on Health Care

    Waging a war against health maintenance organizations (HMOs) and managed care organizations (MCOs), Dr. Calleja lashes out at them and enumerates the woes they bring about. Taking note of the US experience, Dr. Calleja says HMOs have not managed to make healthcare more available and affordable to the vast majority. Instead, they have done the opposite and in some cases even shortchanged patients of what they paid for the service. They limit, for example, certain diagnostic examinations, in the process hindering a physician's quest for the correct diagnosis.

    Dr. Calleja speaks vehemently against the Generics Law, arguing that instead of pushing drug prices down, it might, in reality, do more harm than good.

    He notes that the law empowers patients to choose cheaper versions of a drug prescribed for their illness. But he argues that cheaper does not necessarily mean always better. He says that the law has even encouraged the proliferation of fly-by-night drug companies that market substandard medicines.

    Turning to the pharmaceutical industry, Dr. Calleja encourages research and development in the hope that newer drugs could be discovered for diseases that up to now still have no cure. But as a physician, he expects only the best quality from the industry and feels disgusted at the way some companies have put profit before service by producing adulterated and low quality drugs.

    At the same time, he rallies against the use of herbal medicine. Although he does admit that many modern drugs began as herbal concoctions, he points out that the active ingredient in these herbal concoctions have been purified and their measure standardized in the laboratory to arrive at the proper dose that generates the beneficial response from patients.

    With herbal concoctions, he says impurities are not removed, potentially harmful substances still remain, and the amount of active ingredient might be too much or too little. Thus, cure might be protracted, or toxicity introduced. He therefore encourages scientific research on medicinal plants to ensure their safety and potency.

In Denouement

    Contrary to what its title suggests, In Defense of the Physician is not meant to defend the doctor against denunciation or assault to their profession, especially at a time when talks about malpractice hog the headlines.

    The book is a good read especially for those in the profession. It mixes a healthy dose of medical history and current events with political and ethical issues involving the medical profession. Not all readers may agree with Dr. Calleja's views, but it would be refreshing to get into the mind of one of the country's distinguished physicians.

    The book does not aim to shove the author's viewpoints and opinions down one's throat. All it does is paint a clearer picture of the medical profession for those who are not in it and remind doctors of their responsibility to humankind. It also presents in humorous, serious, and intellectual tones the various health care problems that add to the burdens of our already ailing nation.

    Since the book is a compilation, it fits persons who would prefer to read only topics of interest to them or who are so busy they can read only one article at a time.

    Interesting, serious, educational, funny, provocative, and slightly argumentative, In Defense of the Physician is not one of your run-of-the-mill books. It can light up a fire in you, make you laugh, feel sorry for the world, and yet in the end know that humanity is not lost in all the hustle and bustle of this world.