Response to Dr. Tiongco: Why online medical education can still work in PH:

Thank you, Dr. Ida M. Tiongco, for your Letter to the Editor, “Online medical education will not work in the Philippines” (3/15/2022), in response to my piece, “New way to educate a medical student” (3 / 7/2022).

Even more than 50 years ago, all of us from Class 1968 of UP College of Medicine did not practice soon after graduation. All of us finished medical and surgical residencies, and some even went for fellowships, which is another three to five years of more training. Few physicians now practice soon after getting their diplomas. So your chance of being examined by a physician with only two years of training is zero or slim at best.

Yes, there will be some high school students who will probably start learning medicine while they are in high school if they can find a mentor. They are the ones who have been dreaming to be physicians since they were in elementary school. They are the lucky ones who will escape burnout, depression, or suicide.

The vast majority of patients would allow a medical student to be interviewed and examined. In my 37 years of practice, I cannot remember a patient who did not allow my student to examine them.

At present, you are right that internet connection in rural areas is slow and expensive. But in the near future, the internet will be available almost instantly from any part of the world, rural or urban, and maybe at a lower cost when millions of Starlink users are onboard.

Mr. Elon Musk will deploy about 42,000 mini-refrigerators-size low-flying satellites called Starlink. Currently, there are already 2,000 Starlink satellites hovering at 550 kilometers above the earth, sending back Wi-Fi signals to a special disk and router on the ground.

The vast majority of diseases, about 75 percent to 80 percent, are diagnosed by clinical history alone. Dr. Tiongco’s concern that students will not be able to palpate the abdomen online is valid. However, during internship and residency, they will palpate hundreds of abdomens.

Some physicians do physical examinations because insurance requires it for a certain level of payment. My primary care physician in Maine did not automatically do a physical examination when I visited him. If my complaint and present history tell him that I need a physical examination, he does one.

Yes, it is important to talk to a clinician and see them face-to-face. But as we’ve experienced during the pandemic, thousands of patients got better by getting their prescriptions and advice over the phone or Skype, at a lesser cost to and safer for the patient. In the United States, clinicians can be paid for five to 10 minutes of telephone consultation with the CPT code 99441.

The top reason I am proposing a different way of educating medical students is my concern that physicians are committing 5 percent to 15 percent wrong diagnosis. If these were happening in other industries like aviation or banking, people would be in the streets demanding for change.

Another reason is there are many poor families in rural areas with smart children who are qualified to be physicians, but tuition and travel costs are huge barriers for them. Online education can be a simple solution for them.

In the near future, wrong diagnosis will be reduced to lower than 5 percent because traditional medical schools will teach diagnosis, mostly from first year until graduation. Plus, a universal handheld app will guide a clinician to the right diagnosis. And this will be the best tool, not the stethoscope, to make a right diagnosis.

With these two changes, injuries and deaths in hospitals and clinics will go down, and medical costs will also plummet.

Leonardo Leonidas, MD, assistant clinical professor,[email protected]

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