Monthly Archives: September 2012

hu u?

Image

“Doctor me, hu u?”

Duktor ako.”

It’s a line that I have heard so many times as a way to end a discussion.

Duktor ako.”

It’s also the line used to get additional privileges, like being excused from traffic violations, being placed in front of a long line, and being relieved from all suspicions on any crime or unpleasant incident.

Duktor ako.”

I have heard it being spoken by males who wanted to impress a woman they have just met, as if being a physician is an absolute guarantee of faithfulness, joy, and love. (Note: Sometimes the line works if the woman is gullible or shallow.)

I remember what one of my favourite professors in medical school said to us during one of our classes – Doctors are beings placed in a plane above ordinary mortals. I know some people who took it to their heads and demanded the bigger share of everything because they’re doctors. I also know others who took it by the heart too, but interpreted it the way Spider-man interpreted his dying uncle’s advice: that with great powers come great responsibilities.

For me, I came to interpret what my old professor said a;this: that being a doctor gives a person enormous responsibility that it does not seem human at all. Doctors are given the Knowledge and Wisdom to do something that not any person – no matter their statuses in life may be – could do at all. In their hands, a person’s life is directly placed, and with that life, a future could be shaped or destroyed.

Teachers would rear children to become good and responsible people. Engineers would build something that may a thousand years. Lawyers are people who have the burden of spreading and keeping justice.

Doctors, on the other hand, have different functions. Psychiatrists could guide a person to get himself together and put his life on track. Paediatricians take care of children from the moment they get out of their mother’s womb until they turn into young men or women (and some keep their paediatricians as their primary physicians despite already being adults). Surgeons take out any body part that makes a person sick or correct any lesion in a person’s body. Obstetricians and gynaecologists help a woman deliver her child safely as well as ensure that the bearers of the next generation of human beings are healthy. Internists balance the function of the body through medications and sound advice. All of these are done to give people a second (or third, or fourth) chance in life – to correct their mistakes, to appreciate life even better, or maybe just to spend a longer and better time with their loved ones.

To be honest, I don’t think a lot of physicians have come to understand that.

My line of work is not in the clinical or hospital setting anymore, but still, it’s a doctor’s work. It involves evaluating another physician’s work and providing as much support as he or she needed. I have come across so many physicians who would cause me to raise my eyebrows with the way they would manage their patients. Of course, they are more the exceptions to the rule (thank goodness), but since I get to handle medical-legal cases, I get to face these exceptions more often than not.

I have met physicians who would insist on continuing a certain treatment on a patient despite the patient’s symptoms getting worse with it. I have met physicians who would refer patients with simple neck pain to other providers to undergo rather questionable treatment modalities only to return to their offices five to six months later still with neck pain but that that time already with associated weakness and numbness radiating to one or two arms.

In my recent employment, I get to identify physicians who would provide diagnoses like “Pain,” “Crying,” and “Fever” along with a bill amounting to several thousand pesos for a gamut of treatment modalities done in the emergency room.

To justify their medical judgment, they would bring up that familiar line. “Duktor ako.”

In restaurants and buffets, I have come across people who would deliberately cut the line, and when the other people confront them, they would reply, “Duktor ako.”

I also personally know people who, at the opening of any conversation, would never fail that they would introduce themselves as “Duktor ako.”

To these I would reply, “Hu u,” like that ultra-polite response some people would give whenever an unregistered number sends them a message in their mobile phones and they really don’t have the time to play around.

It is not uncommon for people to criticize government officials about their excessive and frequently unnecessary spending of the tax money. In Metro Manila, it’s not uncommon to see light posts, waiting sheds, and other public structures designed with the incumbent mayor’s name or initials – all stylized in symbols to make it prettier and almost necessary for the structure (not really). In streamers and ambulances, the initials or abbreviations of the names of programs and services are forcibly fitted to form the serving politician’s name. We get annoyed whenever we see public executives on TV taking advantage of disasters and urgent events to do photo opportunities and get some exposure to make the public see them “in action.” Prior to the time of the current president, it was not infrequent to hear police and/or ambulance sirens blaring across the streets, only to find them escorting a car with a single-numbered plate travel at past two in the morning (and no, congress sessions rarely finish at that time of the night).

It’s actually what we have come to know as the “Wangwang Mentality” – that mindset that given that position, these people would come to feel that they are indeed beings placed above ordinary mortals – that they could not be bothered, inconvenienced, or – to put it rather bluntly – made to feel like another human being because they are God’s gift to humanity.

As much as I feel that some politicians have lost touch with the reality about who they really are and what they are supposed to be doing, I have also come to feel the same way about some physicians. The “Wangwang Mentality” has simply been altered with the “Duktor Ako Mentality” as if it were the ultimate answer to the questions that are raised.

When I was a child, I have always had this sense of reverence for physicians that is equalled only by my reverence for priests, pastors, and imams. More than any person who I would encounter, it is they who I would look up to and say to myself, “I want to be like him/her.” Maybe it’s the white coat. Maybe it’s the selfless dedication to make their profession obsolete (as I don’t know any other profession that works to make themselves unnecessary to other people after they have solved their problems). Maybe it’s the ability to keep smiling and talk respectfully despite the long hours they spend in the hospitals – and to be honest, the small salary that they receive.

Ah, but those were the good ones! Maybe I was blessed to have been exposed to my parent’s doctor-friends and physicians in private hospitals who, I would later learn, were actually trained to keep smiling and to stay polite because they are being paid by the patients and their families to smile and be polite (I learned about it when I myself practiced in a large hospital that is more of a corporation rather than a hospice). Except on one occasion, I did not get to experience rude physicians when I was younger.

Now that I’m a physician myself (but admittedly still penniless), I would deliberately seek consultations with doctors who are reputably mean and rude. Sometimes it’s a way for me to evaluate their performances and to verify patient complaints, and sometimes I just enjoy the pain. I never volunteer the information that I am a physician, and I believe that my Academy Award-winning performances are able to convince them that I belong in a plane below them. It works every time – they would tell me what I need to do after they examine me and would not even ask for my name. They would then act surprised and change the tone of their voice and manner of speaking after they find out that I am a physician too. Suddenly I become only half a plane below them (because still, I am seeking their sage-like wisdom to treat me), but it’s a considerable promotion for me.

To be quite brutal, I do enjoy getting into arguments with people who use the line “Duktor ako” to put themselves above the argument. I would reply to them, “So what? I’m a doctor too, and our profession does not make us automatically correct in every argument.” Sometimes, I would fantasize being able to finally say “I’m a doctor too, and a lawyer as well, so f#%$ you,” just to spite them and put them back to reality. I thought saying to them “f#%$ you” is the part of any argument that is way much sweeter than “Duktor ako.” Then again, “f#%$ you” is that part of any argument that is way much sweeter than any of its point.

As I said, I subscribe to what my old professor taught me back in my medical school days, but the state of being in a plane above ordinary mortals is more about the responsibilities rather than the privileges. The privileges would be there, I believe, once we demonstrate that we are above ordinary mortals. The key is always Humility, as beings above ordinary mortals already know that they are above the pettiness of labels and titles, because they already are assured of who they are and what they could do. They do not have to whine and scream like little kids who had been told that they could not have everything that they want in the flick of a wrist.

Personally, I always let doctors go first in line in restaurants and canteens inside hospitals. That’s a way for me to let them feel that I revere them and I understand that they are there for a break from their demanding schedules, but I would never let them cut the line in groceries, department stores, or anywhere else just because they are doctors.

Of course, that argument places me at risk of not receiving any medical attention because some smart doctors would reply “you go to the hospital or clinic for me to take care of you, and not here” once they see me clutching my chest and fighting for a breath while in a public, non-hospital or clinic place.

Still, I would rather be dead than be taken care of physicians with no common sense or stupid pride. To them I would still say with a dying breath, “Hu u” or better yet, “F#%$ you,” to end the argument.


At the End of the Day

[NB: the following is an original article posted in the Pinoy.MD community boards in May 5, 2004. We would like to thank the author for giving us permission to post the article  in this blog, with some minor modifications to the original text. ]

The more letters we add after our name, the more we realize how much we still need to know

Doctors are leaving. We’ve read the bitter reviews, the harsh editorials and the sensational news. Filipino doctors are packing their bags and taking the next flight out of the country. It doesn’t matter where or as what. The bottom line is that they’re out of here—and Philippine society is angry.

It’s easy to lump individuals into professional categories: doctors, specialists, general practitioners. When headlines shout “Doctors are leaving”, it conjures an image of a crowd in a cinema running and fighting their way to the exit as if a fire just occurred. In this instance, it doesn’t matter where you end up as long as you don’t end up dead. Anywhere but here, as an old saying goes.

Is this far from the truth? I honestly don’t know. I only know that there are familiar faces in the crowd: classmates, friends, teachers and mentors. And they are not running. They are sitting silently in the corner, deep in thought but ready to make their next move.

My friend told me a story once. He was in a Florida club with a white female friend. This was just after he passed the local boards. A white dude came up to him and insulted him with racist remarks. His female companion defended him, saying he was a Filipino doctor. The dude just had one thing to say to my friend, “So, what does that make you HERE?” My friend replied, “Nothing. That makes me nothing at all.”

It is a true story. Sad, but true. It also drives the point that some doctors, when they leave for other countries, may also be leaving their hard-earned degrees. Ten years of sleepless nights, stressful days and neck-breaking hours in between—all down the drain.

Only a few understand the rigors of medical training. The prized M.D. degree consumes almost 10 years of a person’s life. If you add residency training, by the time the new specialists graduate, they’d have spent half of their lives going after a goal—to be a doctor.

But beyond the time and the labor, fewer people understand the support behind every medical student or resident physician. For many, medicine is not an individual goal; it is a collective dream—nourished by fathers and mothers way before medical school. Nobody survives medical school or residency training without moral and financial support.

We know the stories: an OFW in Saudi cannot go home until his daughter becomes a doctor; a caregiver in Canada continually sends half her income to pay tuition for her brother in med school; a government employee foregoes retirement to fund materials and equipment for her son in residency training. There is no dearth of stories, as each will have his own. Behind one doctor’s dream is a collection of family sacrifices—family sacrifices that may have to be paid in full.

It’s not surprising new physicians or specialist are running up and about, ready to put all their training to use. They need to earn. Let me repeat that, they need to earn. With a certificate in one hand and some idealism in the other, they stand at a crossroads.

Doctors practice their trade wherever and whenever they can. Some go home to their provinces, while some try their luck in urban centers. Some take up additional training, while some set up small clinics. Some apply for admitting privileges in hospitals, while some get affiliations from HMOs. Working hours may start as early as 5 am and may end as late as midnight.

But at the end of the day, in the confines of their own homes, they hang up their stethoscopes and tuck away their degrees. They watch the news and eat stale dinners like everyone else. They play with their kids and put them to sleep like everyone else. They go to bed tired and weary like everyone else. Because at the end of the day, these doctors are not doctors. They are fathers and mothers, sons and daughters, husband and wives. And much like everyone else, they worry about their future and their family’s future.

As the exodus continues, Philippine society will see doctors leaving careers and patients behind. But in the confines of homes in different parts of the country, we see fathers and mothers leaving families behind, sons and daughters saying goodbyes, and husbands and wives praying for a bright future. At the end of the day, we are not losing doctors, we are losing loved ones.

Almost a year ago, my good friend told me he was leaving for Trinidad and Tobago as a UN Volunteer Doctor. I didn’t ask about his career, his degree or his plans. The only question I asked was “Paano anak mo, asawa mo?” (What about your child, your wife?) And with a long sigh and a short smile, he answered, “Para sa kanila naman ito.” (I’m doing this is for them.)

And that is where many doctors find themselves at. With a plane ticket in one hand and a good dose of reality in the other, they stand at a new crossroads—where paths lead to faraway places and foreign countries, where the only things they can bring are what they can fit in their hearts, and possibly some pictures in their wallet.

I may soon find myself standing at that crossroads—falling in line and holding that crisp boarding pass in my hand. But I don’t dread the day some white dude would walk up to me and say, “So, what does that make you HERE?”.

It makes me a father. At the end of the day, in the confines of my rented space in a foreign land, my son is more important to me than a piece of paper hanging on a wall.

———————

About the author:

Michael Hussin B. Muin, M.D. is the Founder and Editor-in-Chief of Pinoy.MD – The Website for Filipino Doctors. He is a professor of Clinical Anatomy and Medical Informatics in Pangasinan.


On God, Doctors and Nurses

I’d like to think that we work better together

I was still a resident in training when this particular incident happened while doing our morning rounds: one of the patient’s relatives approached us and asked what time a certain surgeon will do his rounds, politely we informed him that we are not surgery residents and maybe he should ask the assistance of the ward nurses. So in a not so subtle voice he proceeded to ask within hear shot of everyone around, “Who is the nurse in charge? Yung alalay niya? ” to quote him verbatim. Loosely translated, he was looking for the “aide”, absurd at it may be, as nurses are professional as well. Anyway, his reason for wanting to see the surgeon was that he wanted to talk to him before seeing the patient and telling her about the biopsy results. According to the relative, since he’s “just” a doctor (“doctor lang siya”), he wouldn’t understand the patient’s needs and emotional state and just give the medical mumbo jumbo of the disease and would nary a care about how the patient feels. I’ve heard enough. I went to proceed with the morning rounds thinking, is this just an outlier or do all other patient relatives feel the same way? I rather hope not, but if that is the way that they do see doctors in general, then that means as a doctor myself, this should be a wake-up call. As all the medical science I have learned in residency training will have boiled down to nothing if I forget the basic tenet of why we are here in the first place: to treat the patient and not the disease, if not cure him of his illness in the very least alleviate him of his sufferings.

The other issue here that I would like to raise is how the relative have belittled our colleagues in the medical profession, namely the nurses. Here we clearly see that the relative downgraded the nursing profession to co-equals in treating the patient to simple being a doctor’s assistant. The world is far from perfect, but it would be so much more a better place if we could set aside our own prejudice and stereotypes of what people are and what they are capable of doing. Nurses are our allies in making sure that our patients get better, and most of the time they do most of the work even if they are understaffed, underpaid and worse, unappreciated. Just to repeat the point, nurses are not our aides, they are our partners in healthcare. And for some us lofty doctors, this story should serve us well to be reminded that our profession is that of humble service. In good days, when we have accolades and praises when we do our job right, should just be viewed as a reward for a job well done. Same way as when we did all we could but things didn’t turn out for the better. We may strive to be, but we are not God to begin with, only his instruments in doing his will. Take it in stride, tomorrow is another day.


Crabs and Kindness

This now brings new meaning to the term crab mentality

Pediatrics was my first tour of duty as a post graduate intern at JBLMRH, a tertiary level government hospital that also served as a referral center and training institution. I was already about to end my pediatrics rotation then, I pause for a while and think, is it all worth it? Was I ready for more sleepless nights, the endless harassments, the unkind words and the harsh treatments? Should I have taken the chance to transfer to another hospital where the conditions may not be that much better, but at least I will be among friends who will act as my support group? Looking back, I honestly did not know how  I managed to keep up with the kind of treatment, then I remember at least one saving grace to all the madness.

It was during my tour of duty at the out patient department. As always we were packed to the rafters as an endless sea of sick kids brought in by their parents came in droves for a chance that a remedy to their ailments was at hand.

I was all alone that day as my senior resident told me that I could handle the remaining cases for the day. Either she had complete faith in my abilities or she was also taking some time off for herself, I wouldn’t know for sure. It was taxing doing everything yourself. I was just about to give up. Realizing that I would also be on duty at the emergency room later did not help. I just wanted the day to end. Then, miraculously I was down to the last patient for the day, a follow up consult. It was a child swathed in the all too familiar white cloth. He came in accompanied by both parents. Nothing unusual so to speak. But what caught me off guard was when they were suddenly thanking me profusely for taking good care of their sick child while he was still admitted in the wards. I can barely remember what I did for them that seemed so important, but apparently to them I was definitely not forgotten. It was then that they handed me a plastic bag containing a singular crab. It was a large one by any standard and I stupidly asked them what it was for. It was a gift they said. It was their way to show their thanks. Initially I didn’t want to accept it, telling them that they needed it more than I did, knowing quite well that the population we serve here at the hospital are the lower income bracket, or simply put those who could not afford better equipped hospitals who charge by the visit. But they insisted that I take it, it was just a catch from the fishpond they said. Then I remembered something I was often told about the rich and poor. The rich give to others what they have in excess, but the poor give all that they have. I did not want to insult their generosity so I accepted their gift and fervently hoped for their good health.

This story could have happened to anybody else in my profession, you probably already heard a similar story from someone else, but at the end of the day, this is my story.

Many times I’m asked if being a doctor is worth all the hard work and the sacrifices that we do. Looking back at this story I can tell you, it is.


Lifelong Learning

Like birds, we look to the sky and dream of flying high

Today has handed me some refresher courses in life lesson 101. It may be an overused cliché already but truly when a door closes on you, another window of opportunity opens. It happened as I was getting ready to submit my credentials in a private hospital so that I can have admitting privileges and hopefully, some clinic space. But fate, or in this particular case, the medical director’s secretary would not look into my prayers favorably.  It wasn’t even subtle, but an outright rejection, her very words being “just come back when you have all the requirements ready” I didn’t argue anymore nor did I ask for consideration as she handed my papers back to me. She was right, I just took the chance that they might consider. I will just have to work to earn my Certificate of Training then. My ego has been bruised and deflated, but I was still alive nonetheless. Besides, she was just doing her job, and I’ve still some errands to do. Let the door be closed, for now.

My window of opportunity opened as I was waiting for my turn in paying my taxes at the bank. My phone rang and the caller on the other end was the community hospital which has just recently accepted me with open arms as a member of the medical staff, I had a patient admitted there so I thought they were just calling to update me on my patient. Imagine my surprise when they told me that I had a referral in the surgery ward for cardiopulmonary evaluation and co-management of the diabetes. Wow, my first ever referral from another doctor. I used to be a scout when I was younger and the motto was “laging handa” (always ready) and so right after paying my taxes I went back to the hospital and saw to the patient. I wrote down my notes and suggestions, they reached about 3 pages back to back. Unofficially, I had the single longest order for any doctor for the day. The fledging doctor has begun to spread his wings, it doesn’t mean he can fly and soar over the horizon already, but it’s a start.

 I’ve still a lot to learn in my chosen profession, like what they told me back in med school, the more letters you add to your name, the more you realize how much more you need to know. Right now, there may be just two letters after my name – MD – and with those two letters I have earned the right to be a lifelong learner, and the privilege to be of service to others.

 

 

 


Children of the Moon

Wheter real or not, there is always something mystical when one gazes at the full moon..

I remember that there was a time during my Psych rotation when I spent a good number of hours listening to people who claim hear voices that vary from mumblings to eloquent conversations with beings seen only by them, sometimes causing them to have sleepless nights and grumpy mornings. Sometimes it even gets worse and they as let the voices in their heads take control of their lives.

Of course they are a whole better lot than the encountering people who scream at the top of their lungs “I don’t know why I’m here, I’m not the one who’s sick, it’s you, you! YOU!! who needs help!!” kind of people.
Then again there’s also the handful few who have seemingly made a solemn vow of sheer deafening silence and have contained themselves in an impenetrable albeit invisible force field, with nary a care in the world.

Welcome to the world of the unreal and fantasy become the norm, and sanity has been left at the door. Here I have close and sometimes unforgettable encounters with the sons and daughters of Luna, sometimes a little too close and more personal for comfort.

In keeping with patient doctor confidentiality, I shall not disclose their real identities, but allow me to share in some of the thoughts running in my own, hopefully still sane at the time of consultation.

There was for example the time when I was seeing a patient and was asked her companion to confirmation of facts she stated. All went well, the patient was apparently stable and I advised the patient on what to do until the next visit. Imagine my surprise though when I called up the next patient… it was my previous patient’s companion! Apparently he was also there for his follow up consult. He didn’t even want to stay still, “just give me my prescription for my shot so I can leave” he asked, nope, ordered me. And being the good doctor that I am, I was only too willing to oblige.

Eventually I learned to handle these situations and politely ask them to sit down so that we can finish the consultation with neither of us needing surgical consults. It’s also a good thing that the last doctor who rotated kept good notes, he was stable according to her assessment of the patient, then again, it’s been a while since their last consult and a lot of things can or could have happened.

At the end of the half day session, I realized why we don’t do this the whole day: any more and I myself would probably be in need of those nifty white long sleeved jackets that seem so in fashion with these patients.

 [Originally Posted on 12.4.2005 at 11:58 PM at inkblot.easyjournal.com; slightly modified and updated for this blog post]


What We Say.. What We Mean

I just told some friends who were interested in your case

Just in case you get the notion that medicine is all serious stuff and that’s all you will get to read from this blog, well, most of the time probably, at other times we’ll feature some stuff on the other end of the spectrum. The following was sent to me years back via email, so my apologies to the original sender whom I cannot acknowledge anymore. Anyway, it’s supposed to be about interpreting what we really mean when we say the following during your visit. Happy reading!

___________________________________________________________

"Well, what have we here...?"
He has no idea and is hoping you'll give him a clue.

"Well, we're not feeling so well today, are we...?"
I'm stalling for time.

"If it doesn't clear up in a week, give me a call."
I don't know what it is. Maybe it will go away by itself.

"Let me check your medical history."
I want to see if you've paid your last bill before spending anymore time with you.

"Well, now, we have some good news and some bad news."
The good news is, I'm going to buy that new BMW. The bad news is, you're going to pay for it.

"This should be taken care of right away."
I'd planned a trip to Hawaii next month but this is so easy and profitable that I want to fix it before it cures itself.

"Let me schedule you for some lab tests."
I have a forty percent interest in the lab.

"Let's see how it develops."
Maybe in a few days it will grow into something that really needs to be cured.

"I'd like to prescribe a new drug."
I'm writing a paper and would like to use you for a guinea pig.

"That's quite a nasty looking wound."
I think I'm going to throw up.

"This may smart a little."
Last week two patients almost bit off their tongues.

"This should fix you up."
The drug company slipped me some big bucks to prescribe this stuff. Hope it works...

"Everything seems to be normal."
Rats! I guess I can't buy that new beach condo after all.

"I'd like to run some more tests."
I can't figure out what's wrong. Maybe the kid in the lab can solve this one.


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