The PAO Newsletter has been around for 25 years and numerous eloquently written articles that showcased the Ophthalmology Community -- its values and activities – were published. Some of these articles remain relevant to this day and, thus, through FLASHBACK we look back and revisit the lessons we have learned in the past to guide our path to the future.

We Have Failed

by Carlos G. Naval, MD

To read the article in the original issue: http://efocalpoint.pao.org.ph/v2n3/message.php

The PAO does not have the teeth to go after erring members participating in egregious schemes with the intention of getting rich quick from PHIC reimbursements. The PAO cannot control wanton medical missions striking wherever they like, sometimes several times a year. The PAO is powerless in helping non-Board certified members from being barred from compensation from the PHIC for surgeries exceeding the equivalent of 80 RVUs. Yes, it seems like we have failed. Let’s analyze those failures.

I believe that the PAO should not have police powers and treat members with punitive sanctions except under special circumstances. Enforcing a change in behavior by punishing errant members, while it satisfies a sense of justice, does not produce long-lasting effects. What it does is it makes the perpetrator better at hiding his misbehavior. And, when the enforcer is not around, the bad behavior returns. Besides, taking out the person from a system that is faulty, that allows the behavior to occur, is not the best solution. The better solution would be to fix the system. So, for example, while the PAO steadfastly defends its members from the prosecuting powers of PHIC, it also works with PHIC to help plug the loopholes that produced the problem in the first place.

The PAO has no authority to ban medical missions. Instead, we try to influence the mission goers to go to places that are truly in need, and, dissuade them from trekking on their own to areas where there are local practitioners already. We have been able to produce some degree of coordination of these missions with the members in the place of interest through the Mission Guidelines. And, what we cannot enforce by fiat, we try to settle by dialogue. At the same time, we strongly support local chapter and local government efforts to create their own solutions to the problem of blindness in their community.

Many of the graduates of residency programs do not take the Board exams or do not try again once they’ve failed. They are free to practice and do cataract surgery anyway, some reason. As an ex-officio member of the Philippine Board of Ophthalmology, we try to influence the Board to create better systems, and, to professionalize operations. We know that with these improvements, residency programs will be better guided and the passing rates should go up. In the meantime, we worked for a delay in the implementation of the PHIC Resolution and got a moratorium of 3 years.

We also continue to support CME activities that elevate the practice and heighten the professionalism of our members. Constant repetition of the tenets of ethical practice and professionalism during residency courses should create a better culture in the future.

Naturally, these approaches will take time, and, only time will tell how much impact they will have on our practices. Should our collective membership be better off in the next few years in all these aspects, only then can we declare that we have succeeded.


About The Author

Carlos G. Naval, MD
Secretary, PAO
Past President