AT THE CLINIC ; DEALING WITH CARDIAC CHECKUPS

This week, I had to offer a second opinion for an Indonesian maid who was seeking employment. On the prelim medical checkup with a GP, her CXR showed an enlarged heart. A second CXR showed a normal size heart and the employer brought the maid for a cardiological opinion for a ?enlarge heart and ?heart disease. I was very uncomfortable taking a history from the maid in the presence of the employer. Of course, the maid did not mind and gave consent ( as if she had a choice ), but I have never practise disclosing patient information to 3rd party payers. In the course of history taking, it became obvious that the maid had no CVS symptoms or previous heart disease, but she probably have a previous record of emotional problems and ?gynae problems. After examining her, I concluded that she had a normal CVS system and I do not see the need for an echocardiogram, although the licensing body had asked that I perform an echocardiogram. I wanted to highlight the problem that medicine is now changing. Doctors do find that their sanctity of their traditional domain is being invaded by third party payers who insist on test being done, and who also cause you to trespass and gave up patient confidentiality. I am not sure what the answer is, but we are seeing more and more of these. Those of us who are a bit more traditional ( read old fashion ), find it disconcerting and hard to give up, but obviously medicine has moved along into the 21st century. The 'Hippocratic oaths" and traditional medical values may have to be modified to fit life in the 21st century. BUT the laws at the moment are still in the limbo, asking us to be traditonal doctors in our core values, yet mandating us to allow 3rd party payers to invade the sacred areas of our practice. Soon, we will all be a little schizophrenic.