Author Archives: Rey

About Rey

Analyst by day, writer by night, physician at heart.

Departures

Passport

The reunion was like any other: it would not involve anyone else but instead only those who would make the gargantuan effort to just be there. The wives had been gracious and understanding enough to give the boys the “day pass” to become boys again – after all, love is a matter of trust, and given the company that they would be in for the day, the worst that they could expect is that more than enough would be spent on nonsense things like comic books, arcade tokens, and more food. That’s why as the budget enforcers (and guardians of the waistlines), they gave their husbands only enough money for food and maybe a small cup of coffee afterwards.

Despite the years that passed, the conversations remained the same, although those who have children have more updated information about the latest cartoons and toys. The other single men were not really outdated: one has two nieces and a nephew that require him to be at least aware if not knowledgeable about the latest kid stuffs, while the other has an enviable job as an animator for the empire of some famous rodent to be able to even brag about its up-and-coming products (except that he would not give any details or confirmation, lest he would have to kill us).

The topic shifted to another part that made them realized how old they have become: it was about money this time, and not really about them lacking it. In their high school days, it was actually a common topic especially when one has to go on a date and he has no budget and he would be asking those who have extra to maybe lend him some. This time it was about their kids’ tuition fees, expenses for maintaining a home, and investments. Yes, investments – as in possible business decisions (but not including the selling of insurance plans or recruiting members for some actual or imaginary products). Discussions on the cost of franchises, creating partnerships, and differentiating mutual funds versus index funds (and which ones to invest to) were brought up, until the elephant in the room was brought up.

“Why don’t you try going with us? We made it there, we know that you can make it there too.” Of the four people who were there, two were already successful expatriates in that country. One revealed that he was about to leave to try his luck there – not that he was earning poorly here: he’s actually working in the IT industry with a rather handsome salary. He decided that he had already had enough cow dung in the Philippines that he wanted to be in a place where his taxes are actually put in the service of the people and his promotion or non-promotion would be because of his achievements at work and not because of who he knows.

“I’m planning to get back to the Practice here. I’m just making my preparations. Thank you,” I replied, myself not even convinced of what I just said.

“Nonsense. You can get into the insurance industry there too and earn more than what you are currently earning here. You already know how to hustle. You only need the opportunity, bro.”

It was not the first time that I have been offered to go there: my former college roommate who used to work in a neighboring country had also gone there with his wife, who in turn left her practice as an emergency room physician to practice there instead. A former co-worker who worked in Dubai in an insurance company, had been planning to return there. Another high school friend, who moved to a South Pacific island, has established a successful practice as a professor in Pathology in a medical school there. All have asked me to go with them and try my luck there. They all have said that having known me all this time, they knew that I would make it there too.

I looked at my previous missed opportunities and pondered if this latest offer is actually the sign for me to finally leave the country and maybe reinvent myself again – if not as a physician then as someone who’s still working close with the medical industry. After a series of events in both my personal and professional life in the past year and early this year, I have come to realize how much I miss the Practice and I had been yearning to see patients again. After all, physicians are in demand there, and I do have several acquaintances who have moved their Practices there.

I remember my medical school days and I remember one particular conversation that I had with my bestfriend Allen. We had the same mutual interest about going to the barrios and practicing there – minus the flair and the elegance of high-tech medical equipment and the vacuum-and-polished floors of “internationally-accredited” hospitals. We would still be wearing white coats – or at least blazers – but instead of tailored pants and Italian shoes we would be wearing blue jeans and rubber shoes to make us move more comfortably. Instead of the well-lit air-conditioned halls of large hospitals, we would be walking on muddy trails of far-flung areas of the country. Instead of spoiled brat pediatric patients and people pretending to be sick and just wanting to have a medical certificate to get a night off work, we would actually be fighting tuberculosis, intestinal worms, and malnutrition in people who have no real access to decent medications.

Yes, in some way, we had been influenced by the late Senator Juan Flavier. At the back of our minds, we thought, if he could do (“DOH”!) it, we can do it even better!

Fast forward to the present. The dreaming is over, and we are where we currently are. My bestfriend and I rarely communicate as we used to anymore, but I have had the privilege to become his bestman on his wedding (and I made him swear to me that he will be my bestman on my future wedding). When we do get to converse, I would love hearing about his patients. Medical confidentiality would of course be observed, but more than the daily rounds, diagnoses, and courses of treatment, we would be discussing the things about Life (not just “life”) that we learn from our patients. I created my own term for it – “Evening Rounds,” as doctors’ visits are usually only made during daytime (unless the doctor had been very busy), and only relatives and people close to them get to be with them at night. Being alone again and being in the middle of the night somehow bring out the sentimentality of people, and they tend to be more open about talking about their lives at that time – and be more receptive to medical advice compared with formal hospital visits. Professionally speaking, besides establishing a better rapport with the patient, it also helped ensure their compliance to management, especially for those that involve lifestyle changes instead of just intake of pharmaceutical products. More than those, I would learn so many things from their points-of-view, which make me appreciate more the Beauty of Life.

Neither my bestfriend nor I have become barrio doctors, but he is in the province and he is serving the people – still close to our younger dream. At times, he would forego getting his professional fee and rely instead on the designated payment that PhilHealth had provided for the particular disease that he had just treated (and admittedly, it is usually too small) to help those less-financially-privileged to keep their money for buying their take-home or maintenance medicines. As a specialist, he acquired a better knowledge on diseases and this helped him become a better doctor.

I had not gone shabby myself. I have come to work for a company where I felt valued and – modesty aside – had provided me not just the financial stability that I wanted but also the opportunity to be with doctors and evaluate medical cases more thoroughly. More than that, additional privileges had been given to me – and extended to my loved ones. Still, there had been something deep within me that told me that there could be more to Life than what I already have.

Enter now this offer from my high school buddies. One had offered me his flat for me to stay on to for free until I find my own flat. The other promised to get me familiarized and street smart – as well as introduce me to his friends there. The only thing that I had to worry about is getting the tickets to get there, as well as my updated résumé. The one who was about to leave had offered me his agent (a friend of his wife), who could assist me in getting a new job and negotiating my desired salary.

I promised them that I would very heavily think about it, and despite their protests and playful (but still stinging) mocking of me letting the opportunity pass (especially with me being single and without having to think about leaving anybody here), I think they understood where I was coming from. I have never really thought about leaving the country, except to visit the Vatican or to make a pilgrimage in Israel. Those were ordinary desires wherein I would only be a tourist and be gone for maybe a week or two – not really a way of life that I would have. My work is at a semi-government corporation, and while it is far from my dream of directly serving the people – those who could not afford medical services, I have come to realize that my work still involves that – providing affordable healthcare and access to top-caliber physicians to people who otherwise could not afford them. Of course there would be limitations and exclusions as after all, the medical services provided would be determined by the employer, and my job would be to ensure that the services that had been guaranteed to the patients as needed would be delivered and they are able to utilize it correctly and efficiently.

Still, there is discontentment.

At the back of my mind, I thought about my desire to earn more – to be able to buy a huge house in an exclusive subdivision, a brand-new expensive car that would turn people’s heads when I pass by, buy all the stuff that my (future) wife would love to have, and send our (future) children to expensive schools. I could buy an iPhone on a whim and maybe that large-screen LED TV that I had been drooling about.

Then again, I thought about my younger dreams. Of course it is important to have my own house and to have my own means of traveling. Of course I want to spoil my wife and send my children to the same schools that my parents have sent me and my siblings, but do I really need to have a luxurious and extravagant lifestyle?

Do i really need to get out of the country to be able to afford the bare necessities and realize my younger dreams?

I remember what Pope Francis had said about Greed – that so much blessings are poured by God to our cups but instead of letting it overflow from us and on to others, our Greed tends to magically increase the size of that cup such that despite so much blessings pouring down, it would still not be enough to satisfy us.

Have I become like that – unsatisfied by what I have already have and still saying (screaming): it’s not enough! I want more! I deserve more!

For the week after our reunion, the unofficial updated lyrics of “UP Naming Mahal” kept playing inside my brain (yes, I took my pre-med course at UP). The lyrics go: “Malayong lupain di kailangang marating / Dito maglilingkod sa bayan natin / Dito maglilingkod sa bayan natin.” I then remembered the speech that Prof. Solita Monsod delivered to one of her classes about the cost of education and how much my country had shouldered mine: if Ateneo and La Salle (which, according to her, are the second and third best universities in the country, respectively) are charging so much for their education, how much more should UP charge, being the best university in the country?

More than that is the sense of social responsibility that I feel that I should have – not for anything else but because of the too many blessings that have been poured down on me: blessings that I may have overlooked because of my desire for something more, which I believe the world owes me.

My new passport had arrived and getting a ticket is just a click away. My résumé’s been updated and a resignation letter is too easy to write. It will be a new beginning for me, but I know that transplanting myself to another country would not be easy. Being a Filipino is already difficult in the Philippines, what more in a foreign land?

Will practicing as a doctor in another country compensate for my non-practice here? Would i finally become satisfied with Life?

In a recent conversation in Viber, my friend gave me some consoling words: “You might find her here.”

I laughed.

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A Doctor’s Lamentation

"It is such a mysterious place, the land of tears." - Antoine de Saint Exupery, "The Little Prince" (Photo taken from Pixgood.com)

“It is such a mysterious place, the land of tears.”
– Antoine de Saint Exupery, “The Little Prince”
(Photo taken from Pixgood.com)

I came into his office a cynic. In my mind I was expecting another series of complaints about not getting paid what he thought ought to be paid to him given his stature and his tenure as physician. He was, after all, one of the oldest physicians in that hospital and he had been a great help in establishing our line of work not just in that hospital but in the entire province as well. I traveled to the south of the country from the urban jungle of Makati to establish rapport with the doctor and rejuvenate the company’s relationship with him. I had prepared to receive verbal abuse and maybe a few profanities, but instead I was greeted with a firm handshake and a smile.

I readied my “physician force field” – that mysterious, powerful energy I was trained to create during my internship that filters any transference of emotion from the person I was conversing with for me to remain objective and “professional.” I was telling myself that in case he’s angry, he’s not really angry at me but rather on certain… things and aspects. On the days prior to that meeting, I reviewed my old style of establishing rapport with a complete stranger using the weird combination of pathetic corny jokes (trust me – they actually work positively) and genuine concern about their plight, hoping that I had packed enough to diffuse the entire situation.

We discussed the success that his hospital had achieved, and how quickly it was expanding. I mentioned how it was pretty much at par with – and even better than – many of the hospitals in Metro Manila. He gave me a hesitant smile, but there was just this palpable loneliness in his eyes. We conversed about professional matters that I need not write about, but I could not help myself from asking him.

“Are you all right, doctor?”

“This… this has nothing to do with our relationship as physician and HMO, OK? I understand that you are a doctor too, aren’t you? I just need to get this off my chest,” he said to me as he looked at the pictures on the small cabinet near me.

I smiled at him and assured him that our conversation would just be between two men, nothing less.

“You know, I’m disappointed about the whole thing. I’m regretting this.”

“Doc… I-uh… I don’t understand.”

He was practicing in the biggest and most prestigious hospital in that province, and he was practically its top dog. Recently, the hospital went into a partnership with one of the biggest business groups in the country, and there was really nowhere for it to go but up. As I said, the hospital was expanding, and aside from the prestige, there would also be an expected financial success to go with it.

“Tell me: why did you become a doctor,” he asked me.

I had to point out to him that I was not in the practice – that I was “just” an employee earning a fixed amount every month. Still, I gave him my reason when I decided to become a doctor when I was young. It sounded too idealistic as I look back to it now, but I could not lie to him.

“You know, this hospital only started as an extension of our house,” he said. “My dad converted part of our house into a clinic, and he would see his patients there.”

“Well, doc. Look how far your father has gone,” I smiled. I was to tell him that he had brought his father’s hospital to greater heights, and they have become pretty much a formidable entity in the region when he interrupted me.

“No, no, no,” he shook his head. “You know, most of the time, people didn’t have anything to pay him that time, and he was all right with that.

“He was happy. He was practicing Medicine because it was his passion. The payment did not really matter to him, but still he was able to send us his children to good schools. I even became a doctor like him.”

I stayed quiet – waiting for him to just let everything out from his chest.

“To be honest, this hospital was still doing well before we entered into a partnership with the big business group. We were told that we could help more people with the partnership.

Right now, yes, business is booming and we are expanding, but at what expense?”

“You are not happy with that, doc?” I queried.

“Where are the poor patients now? Now, they could not afford being seen here. They have to pay for everything.

“My father’s legacy is that he would not turn away patients, especially those who are in need. That was his joy. He would often tell me that he would prefer those that could not afford to pay him because then he could charge it to Him,” he said as he pointed upward, pertaining to God.

I then told him about this hospital in Metro Manila that used to be run by nuns. A business group had to eventually drive those nuns away because the hospital operated at a loss. An investigation later revealed that they would frequently just ask the patients to pay whatever they could afford if they could not settle the actual bills. There were several rooms filled with crutches, wheelchairs, and other worthless personal effects that the patients gave in payment for their bills.

“Exactly. You know, my father and I used to do that here too. We also had nuns operating this hospital, and we would distract them and let the patients abscond when they’re well.” He let out a mischievous smile as he recalled.

“I’m sure that they were good nuns, but we have to face the reality, doc,” I said. “Without money, you can’t pay for the hospital’s other expenses. You can’t buy medical supplies and equipment with crutches and wheelchairs, and you can’t tell your nurses and hospital staff that you’d just pray for them.”

“I know, I know,” he said. “I just wish I could do more.

“I just wish I could turn back the deal and just get back to healing people instead of conducting a business.”

He then turned quiet as he got lost in his thoughts.

“I really wonder what Dad would say to me when we meet again.”

He paused again as he looked at the black-and-white picture of his father on his table.

“What’s that saying again? ‘What profits a man…‘”

“‘What good is it for someone to gain the whole world, yet forfeit their soul?‘” I quoted.

“So, what good is having the biggest hospital, if I lose the meaning of being a physician?”

From my seat, I noticed a glint on the side of his left eye.

“You know, it’s not really fear that feel when I think about the day that we would see each other again. It’s embarrassment. I’m sure he would ask me, ‘My son, what have you done?

“I’m an old man now, and everyday that’s what I think about. I’m embarrassed to see Dad again and tell him what I have done to his legacy.”

I tried to comfort him, but most of the time I remained quiet. It was a mysterious place, the land of tears, and part of me was wondering why he was telling me all these. Perhaps because I listened to him and did not dismiss the idealism that remained in him that I have come to realize as lost in many if not most of the doctors I get to interact and communicate with often. Don’t get me wrong – I’m still blessed enough to meet so many of these doctors – some of them are even my colleagues in medical school, but in several moments, it’s all about the money, even if we’re already speaking as two normal human beings talking about our lives.

I remembered the reply I gave him when he asked me why I wanted to become a doctor, and as I left the hospital, I thought about the conversation that my present-day self would have had with the young child that wanted to become a doctor back then. The old doctor was embarrassed to see his father again and explain what he had done to his legacy – but still, he did the best that he could. I was fearful about seeing my younger self again and explain why I lost his idealism.


Choices

Closed Sign by Artur84

Common signs seen during holidays… except in many private clinics and most hospitals. Illustration by Artur84/Freedigitalphotos.net

I have since deactivated my social media accounts – including that in WordPress – except for Google Plus, but that’s only because I play video games in Android and to get some freebies, the user would need to have a particular account. I do not post anything anymore, but I will try to continue writing for the White Coat Chronicles as much as I could.

The last two weeks of the year is quite a haven for many people. Of course, students do not really feel it because sometimes their schools take their Christmas break as early as the 16th of December. December 24th and 25th are holidays because of Christmas Eve and Christmas, respectively; December 30th is Rizal Day, and December 31st and January 1st are holidays because of New Year’s Eve (or “Bank Holiday”) and New Year’s Day. For 2014 however, there were a couple of additional special holidays included: December 26th and January 2nd were sandwiched between the holidays and the weekends. The only “unlucky” day was December 29th, but several people have already filed their leaves on that day. Honestly speaking, it would not be too bold to say that most of those who actually went to work on the 29th only did so to hang out and chat with their coworkers. Including the 29th, that would make a 12-day vacation for most of us.

During my social media days, I would often encounter posts by doctors during long holidays feeling bad about not being able to take a vacation during this time at all. Holidays are just another day for them to go to their clinics and see patients. One clever physician even said that diseases do not recognize holidays and so doctors could not go on holidays as well. It is also not uncommon to read a post by a young physician during this time where he or she would say something about feeling sorry for him/herself about going to the clinic or hospital while everyone else gets to enjoy the break to be with their families and loved ones. There would be those who would post about patients who only go to the emergency room to get a medical certificate so that he or she could take the day or the night off work.The lamentations would go on, and the doctors would say that they would continue to be persecuted for taxes and they would have face patients who are too drunk and/or too stupid to understand that their medical conditions do not go on vacation and so drinking heavily, eating too much, or partying too hard could still take its toll on their bodies. Someone said that unlike employees, doctors do not get a 13th month pay or a Christmas bonus. Doctors also could not go on paid vacation or sick leaves, and it is so unfair to them, especially since their work involves saving lives and making people well enough to return to work.

Reading these posts somewhat evoke an ambiguous feeling for me. On one hand, I do understand the difficulty of the practice –  how the principle of “no work, no pay” very much applies to them. But this also applies to other contractual employees. There is no hazard pay, no insurance coverage, and no other benefit. They only get their daily payment with the taxes deducted as per the law. The difference perhaps is the salary: contractual employees usually receive only the minimum or slightly above the minimum wage per month while physicians definitely earn something more.

While it is true that doctors do not receive particular bonuses as much as employees, they are not confined to a fixed amount of salary per month. Employees receive a specific payment depending on their position in the company. Physicians, on the other hand, depend on the number of patients that they see in a day to determine the amount of money they take home. Specialists under health maintenance organizations (HMOs) are paid a fixed amount per consultation, while general practitioners earn a little less than that. Those who are not under HMOs can charge however much they wanted. Those who have a contract with clinics are paid a fixed amount of salary per day, but the contract only binds them to a particular length of time (usually about four hours a day) and they are allowed to take additional work depending on their schedule. While some may be allowed to take a second job by their employers, most employees are bound to work for a particular company due to the possibility of conflict of interest.

Employees are also tasked to work only at particular times of the day, and most are required to work 40 hours a week. The most usual shift is the 8-to-5 shift, with a one-hour break in between and another 15-minute break sometime in the morning or in the afternoon. There are also those who are in shifting duties (6am to 2pm; 2pm to 10pm; and 10pm to 6am, or their variations). The work is usually Mondays to Fridays or Tuesdays to Saturdays. Most physicians are able to determine the length of time and the day/s that they can hold their clinics.

Working on a holiday is not just a physician’s obligation. Nurses, medical technologists, police, firefighters, security personnel, and several key employees of certain establishments also need to go to work to ensure that peace and order is maintained and that workplace operations would continue to run smoothly by the time everybody returns to work. These people, like physicians, are also selfless souls who make sure that the world continues to turn and that there would be those who would care and give a damn in case something goes wrong. Also, like physicians, they do receive additional benefits: for special holidays, there is a 30% additional payment and for special holidays, they receive double payment. Of course, depending on the contract, some doctors receive only 30% additional payment whether it is a special or a regular holiday. Still, it points out the fact that doctors are not the only persons who need to work during the holidays.

Do not get me wrong: I admire those physicians who work hard everyday to ensure that they can provide for themselves and their families, but this admiration is just the same as that I feel for any hardworking person who takes on any type of job – whether that person is in an office, in the streets, or in the sewers. As long as it is an honest job, I look up to that person even if their salary is significantly lower than that of a company CEO or even if their job involves literally getting dirty to be able to do it properly.

The thing is, we all make choices: there are those who choose to work in the corporate setting, and there are those who chose to go to work on holidays. There is no need to grumble and be grumpy just because one “needs” to still get up early when everybody else is still at bed at eight in the morning. We all have our roles and tasks, and most of the time we choose where and how we are going to be. If the holiday cheer bothers that physician – or anybody else who had been tasked to work on these supposed-to-be-vacation days – then there is the choice to just walk out and join the other side.

Happy New Year, folks!


Salvation in a Bottle

The man wearing this fancy yellow long-sleeved polo and navy blue pants was on fire. His face was drenched with his sweat as well as the excessive hair gel that failed in its duty to hold his hair together. He reached out his left fist as he shouted, “Do you want to be prosperous? Do you want to solve all your problems and worries? Do you want to be healthy and at the same time wealthy and free from the burden of your financial obligations?”

Another man, with the design of his green t-shirt hidden by the dirtied white blazer bearing the logo of a government hospital, extended his arms to the air as he closed his eyes as he became emotional with his reply, “Yes, yes! I want to be prosperous! I want to be stable! Yayaman na ako!” Everyone else around him was doing the same thing – some were even jumping up and down while the others had their faces wet with their tears and sweats.

No, I was not in some Christian church that was having its fellowship.

I was at the presentation of an organization promoting its line of healthy products.

 

It was not the first time I have attended such a “presentation” – and certainly this would not be the last time. In some, I had been duped into going because I was told that my opinion as someone who has medical background would be needed, while in some I willingly went out of courtesy to the person inviting me.

I know the routine already: it would involve an audiovisual presentation of how the world is already falling apart and that the people are putting their lives at risk because of their unhealthy living. It will also show how people are getting poor because they do not know that they should be prioritizing their health, and instead of spending their hard-earned money on being healthy, they were spending it on things that would not matter in the long run. Some statistics would be cited as to how health products are only starting to be the rage and how investing on them now would mean a bigger share of the market in the future. It will be followed by a testament by the host, who would introduce a few people who were wise enough to have invested – those who belong in certain echelon of their organization because of how much they have already sold (this will include a mention of how much they were earning in a month). They will then tell the participants that they were “lucky” that one of those in the upper echelon was able to squeeze his or her time (which was supposed to be spent in talks or a vacation abroad) to give a testimony of how the product has changed his or her life.

This upper echelon person will then stand up amidst the cheer of everyone, and he would go on stage like a shining professional wrestler who was acknowledging his fans. He would introduce himself and would not fail to mention that he was a graduate of this or that course and that he did not make it in the board exams, and then say something about the hardship of his pre-health product-selling life: how he would spend countless hours in the office laboring pointlessly but never earning much to even buy himself a car, how he wanted to buy an expensive and branded gadget but he could never afford one, and how he wanted to earn enough for his family so that he could give his parents the comfort that they have always deserved but never gotten. He will then testify how much he sacrificed to start up, including what he sold or gave up to invest. Of course, it will end with a happy ending – that he was now earning almost half a million pesos a month and how miserable he is now that he does not know what else to spend on, as he already has a beautiful house, a sports car, and he could buy anything that he or his loved ones wanted.

By the way, more importantly, he was able to help make the world a healthier place. Not bad.

Of course, there is no force-selling those health products. The presentation, after all, is just to expose the invitee to the potential of earning huge money – and half a million pesos a month is not just a pretty penny even to the CEO of a small business. If you’re interested, just approach one of their “coaches” who will help you become a member, purchase their products, and maybe give you a pointer or two on the art of selling.

 

Now what is the point of all of this? The keyword was already right there – “health.” The product is about making everyone healthier and the seller prosperous. This is where physicians go in the picture.

After the presentation, I was introduced to my inviter’s other friends. They were from several different backgrounds: some were office workers who wanted to earn more, others were hardcore business people who were looking to expand their profits, and most of the rest were a mixture of eager students, bored housewives, or fresh (and not-so-fresh) graduates who were looking for work. One of my inviter’s friends left a bigger impression on me than the others.

He actually did not need to introduce himself to me, after all, his name and the capitals “M” and “D” that followed it were embroidered in dark blue above the breast pocket of his dirtied white blazer. I am not sure, however, if he were still affiliated with the hospital whose logo patch was still on his blazer, but as far as I know, residents and consultants usually have their respective fields also embroidered below their names. Seeing he has none, it was not unsafe to assume that he was a general practitioner who went to that hospital for his internship and did not bother to remove the logo anymore when he started his own practice.

Para sa atin, ‘tol. Kayang kaya natin kitain ito,” he said rather confidently. “Ang dali lang, di ba?

Yes, he was the same person who had his eyes closed, head bowed down, and arms extended upwards during the presentation. At that time he looked like a grave sinner whose sins had been mercifully forgiven by God and he had been delivered from eternal damnation by the speaker.

Pare, ilagay mo lang sa reseta mo yan tapos sabihin mo sa pasyente mo na hindi pa available sa Mercury iyan, pero meron ka sa clinic mo. O e di tapos!” He smiled and clapped as he said “tapos” as if it were the solution to the dilemma I was having.

It made sense though: putting it on prescription definitely makes it a “must buy” for the patient. After all, as one commercial said, “magrereseta ba si Doc ng masama sa iyo?

 

I decided to defer jumping in the bandwagon, as I prefer making my own investigations on the products. In another presentation, it was emphasized that their products were already in the latest issues of MIMS Philippines as well as Physician Desk Advisor. This, according to them, makes their products legitimate for prescription. But these publications also include milk formulas, nutritional products, vitamins and minerals, and other health supplements too – and while helpful, these do not guarantee that the health products being sold are indeed therapeutic. Unless these had been approved by the Food and Drug Administration (FDA) as treatment medications, they ought not to be advertised as treatments or health solutions. The label “No Approved Therapeutic Effects” should be emphasized. Better yet, maybe the label ought to be bilingual, and in Filipino it should state “Hindi Pa Talaga Napatutunayan Na Nakagagaling.”

The problem really is not just the labeling, but rather with the aggressive marketing that they are having. Of course, a patient who is coming in with a disease or medical condition that is bothering him or her or a loved one would expect the doctor to give something that would make them feel better – a drug or an antibiotic that will lessen if not totally remove their symptoms. What would be a better way to sell the product than by prescribing it?

I am not in the practice, but it is not unusual for me to be approached by acquaintances and friends who would ask me about their condition. Not a few of them would tell me that their medications are so expensive that they do not know how else to budget their finances. One acquaintance once told me that her child was diagnosed with a respiratory disease, and she could not bear the expenses for the treatment. I mentioned to her that medications for her child are relatively affordable, as the disease is one of the priority diseases of the government. She showed me the prescription and said that all in all, she would spend almost two thousand pesos every two weeks for her child’s treatment.

The health supplements were placed on “number one” and “number two” on the prescription, and the actual medications for the disease were numbers three, four, and five. As the two medications were more expensive outside, they would buy them from their doctor and the other meds from a pharmacy.

I do not want to make accusations, but it seemed that her prescribing doctor made sure that the health supplements would be bought first before the actual medications.

The sad part about it is that there is nothing wrong about that. Well, technically, there was nothing wrong with how the prescription was written.

 

Hippocrates once said, “primum nil nocere,” which in English means “First, do no harm.” Of course, Hippocrates is not a licensed medical practitioner and he probably did not have fancy cars, several houses, and state-of-the-art electrical gadgets as proof of a successful medical practice, and so his teachings – while important in passing worthless subjects in medical school such as “Medical Ethics” – are not really emphasized anymore once a person finishes medical school and passes the physician board exams. Maybe this is why a lot of physicians would make prescriptions of products that they do not really know about. Maybe this is why a lot of patients would go from one doctor to another to find someone who would actually help them make their lives better. Maybe this is one of the reasons why, when physicians had been subjected to an embarrassing advertisement by the government, most of the people cheered and even made exaggerations on physicians in the web.

One of the common arguments I have heard about prescribing health supplements is that it is usually covered by health maintenance organizations (HMOs) anyway. If given during their hospital stay, HMOs would be the ones paying for them anyway, so what was the big deal? In some companies, employees are given medical allowances for their medicines, and so it will be covered as well. The doctors who would prescribe the health supplements would earn extra money that they deserve, the patient will be “healthier” because of the rich components of their health supplements, and it will be carried over by people (or organizations) that are not them. Again, what was the big deal?

The big deal perhaps is not really the coverage – after all, HMOs are huge evil corporations ought to screw people from their hard-earned cash – but rather it’s about missing the point of Medicine – that of making people’s lives better. More so, it involves doing no harm in the first place. It is good if these health supplements are useless and would just be passed out as urine or fecal material, but more often than not, they are not. Health supplements are health supplements and not medicines for a reason, and it is not because of the conspiracy of huge pharmaceutical industries that want to keep healthcare exclusive to themselves. Rather, it is because health supplements are not yet fully proven to be effective and their side effects are not completely known at the time.

Of course, who will stop them? There are no laws stating that health supplements should be prescribed on a limited bulk. There is no memo among specialty societies saying that health supplements ought to be prescribed on a separate prescription pad and the patient instructed that these should take a backseat to medicines and antibiotics prescribed to actually treat their conditions. There is very few if any healthy discussion of these health supplements during medical conventions. Maybe because health supplements can afford to sponsor the conventions in cool venues such as Boracay and Camarines Sur?

The image of the doctor with the closed eyes, bowed head, and outstretched hand saying “yayaman na ako” will forever stay in my mind – much worse, his not uncommon or unusual solution of prescribing the health supplement to his every patient will haunt me and hurt me not just as a medical professional but as a human being who is genuinely concerned about his fellow human beings. I don’t know where he is now, but I have directly and indirectly encountered quite a number of doctors who use the same strategy and who try to convince me to do the same.

Forget Hippocrates and his ethics, there is salvation in a bottle.


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.


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