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Korean J Fam Med > Volume 44(1); 2023 > Article
Cordero Jr.: In Doctors We Trust! Addressing Trust Issues for an Enhanced Continuity of Care

To the Editor

In a recent editorial published in the Korean Journal of Family Medicine, the author highlighted the role of continuity of care in managing chronic diseases. He rightfully emphasized that the factors affecting the continuity of care might vary depending on the country’s environment or medical system [1]. I agree with this point since it is evident that the healthcare systems of First World countries are far more advanced than those of developing ones, especially regarding resources and technological advancement. However, I feel the need to emphasize another indispensable factor, the behavioral aspect—trust issues. Here, I have elaborated on this point by sharing the situation in the Philippines.
Continuity of care is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing healthcare management toward the shared goal of high-quality, cost-effective medical care [2]. It is essential, especially for chronic diseases, since evidence suggests that continuity of care for patients prevents hospitalizations, reduces health care costs, and may prolong life in some populations [3]. While the level of continuity of care differs worldwide generally because of the abovementioned factors, the behavioral aspect vested in healthcare providers, such as family doctors, general practitioners, specialists, and health government officials, also matters greatly. In case of trust issue or lack of confidence due to inappropriate practices or any unusual behavior, Filipino patients usually sever their relationship with their family doctors. One example of malpractice is the unreasonable professional fees collected by doctors during the current coronavirus disease 2019 pandemic. Despite the difficult financial situation during this crisis, some doctors collect additional fees, namely “pandemic fee,” even if the patient is a member of a particular health maintenance organization or has active medical insurance. Moreover, some private hospitals also charge patients excessively [4]. The current National Health Insurance Program (NHIP) benefit scheme in the Philippines offers benefits on a fee-for-service basis up to a fixed ceiling. However, NHIP beneficiaries are also not entirely free from the financial risk of having to make potentially large outof-pocket payments for inpatient care [5]. Another “trust issue” is some malpractices committed by healthcare personnel. Recently, four doctors and two staff members in hospitals run by the Negros Occidental provincial government are being investigated for alleged medical infractions. The complaints filed at the Department of Health (DOH) involved medical malpractice such as selling medicines in hospitals [6]. In another case, the Court of Appeals upheld the decision of a lower court in Cebu ordering two physicians and a community hospital to pay over PhP2 million in damages to an appendectomy patient whose heart stopped during surgery [7]. Furthermore, health government officials were also involved in huge controversies that disappointed many Filipinos, resulting in lack of confidence towards medical professionals. An example is the DOH authorized administration of Dengvaxia to schoolchildren. Approximately 2 years after the campaign started, Sanofi, the manufacturer, announced that the vaccine might cause “more severe disease” in those who have not had previous dengue infection. However, by then, over 800,000 Filipino schoolchildren had been inoculated [8].
Given these circumstances involving patients’ “trust issues” in their health professionals, a higher level of continuity of care is difficult to maintain since a deeper relationship between both parties is not established. Thus, some interventions are needed to recover the trust and to strengthen the bond between patients and health professionals. However, it is imperative that both parties start from the basics, which is fulfilling their respective responsibility. Doctors are responsible for record-keeping, knowing patients’ history, recalling accumulated knowledge, and maintaining confidentiality. Meanwhile, patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors), and trusting their doctors [9]. Both the parties are equally benefitting when they are faithful to their responsibilities. In addition, it is essential to note that the government (or national health insurance) as a policymaker plays a critical role in maintaining the trust between patients and providers in the country. The health policy or system protects the interests of patients while simultaneously promoting their full cooperation with the health providers for a harmonious relationship.



No potential conflict of interest relevant to this article was reported.


1. Oh SW. The role of continuity of care in the management of chronic disease. Korean J Fam Med 2022;43:207-8.
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2. American Academy of Family Physicians. Continuity of care, definition of [Internet]. Leawood (KS): American Academy of Family Physicians; 2020 [cited 2022 Jul 29]. Available from: https://www.aafp.org/about/policies/all/continuity-of-care-definition.html

3. Ladapo J, Chokshi DA. Continuity of care for chronic conditions: threats, opportunities, and policy. Health Affairs [Internet]. 2014 Nov 18 [cited 2022 Jul 29]. Available from https://www.healthaffairs.org/do/10.1377/forefront.20141118.042672

4. Micua L. Official slams private hospital for excessive billing. PNA [Internet]. 2017 Nov 27 [cited 2022 Jul 30]. Available from: https://www.pna.gov.ph/index.php/articles/1017218

5. Tobe M, Stickley A, del Rosario RB Jr, Shibuya K. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines. Health Policy Plan 2013;28:536-48.
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6. Gomez C. 4 Doctors, 2 health workers in Negros Occidental face malpractice probe. Inquirer [Internet]. 2022 May 30 [cited 2022 Jul 30]. Available from: https://newsinfo.inquirer.net/1604034/4-doctors-2-health-workers-in-negros-occidental-face-probe-for-malpractice

7. Pulta B. CA affirms P2-M damage suit vs. Cebu doctors over negligence. PNA [Internet]. 2020 Aug 12 [cited 2022 Jul 30]. Available from: https://www.pna.gov.ph/articles/1112011

8. Lasco G, Yu VG. Communicating COVID-19 vaccines: lessons from the dengue vaccine controversy in the Philippines. BMJ Glob Health 2021;6:e005422.
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9. Crooks VA, Agarwal G. What are the roles involved in establishing and maintaining informational continuity of care within family practice?: a systematic review. BMC Fam Pract 2008;9:65.
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