Tag Archives: doctor

What Ails You?

Recently the following article is being circulated in the social media about the dilemmas that a practicing doctor in America is facing with regards to healthcare and how politics is wrecking havoc on them. Such is the sorry state of heath care providers here and abroad.

And it seems that this problem is not something new, as the following article entitled “A Fighting Chance” by Dr. Michael Hussin Muin written almost a decade ago in the Pinoy MD forums, still ring true to this day.

what's your diagnosis?

what’s your diagnosis?

The ‘Sell Out’ stigma has since died down. It is now a footnote in the obscure pages of Philippine medical history. But the exodus continues and the situation is a fierce topic in conferences. Even business schools have taken up the issue and debated on the reasons of the plight and flight of doctors and the effects on the public administration of health care. And the conclusion has taken a gentler form. No, they now agree, doctors didn’t sell out, they just gave up fighting.

And what are they fighting for? Among other things, doctors—and other health workers—fight for better pay and better working conditions. They fight for protection from bogus health companies and quacks in government. They fight for stronger organizational leadership. They fight for a better government. They fight for their patients. They fight for their families.

It is a sad fact that bank tellers and call center agents get better pay than general physicians in HMOs and residents in training. Bank tellers may get as much as P15,000 per month while GPs get P9,000-P12,000. Call center agents get as much as P21,000 per month while residents in private hospitals are lucky to get anything over P10,000. People who handle money and customer service get better wages than those who handle lives. This says much about industry standards, whatever that means.

But isn’t it true that all Filipinos are fighting for higher wages? Yes, but the fight is done in different ways and have different effects. When factory workers stop working, production goes down. When jeepney drivers wage a strike, transportation grinds to a halt. But when doctors go on strike, patients die.

I have seen doctors fight for a collective cause. They threatened work stoppage at a small private hospital unless conditions for better pay were met. They gathered just outside the emergency room and carried placards and signs. But the whispers and conversations within carried in them the futility of their efforts.

Tawagin mo ako pag may dumating na pasyente.’

Akyat muna ako at mag-a-assist ako sa OR.’

Sandali lang, andyan na yung follow-up ko.’

These are phrases uttered by the doctors on strike. Even the venue of the strike is crucial. They to sit it out in front of the emergency room and scramble in when an emergency case arrives. Once the patient is stabilized and brought up to the floors, they then trickle back into the strike area, anxious and ready for another case.

Doctors are not immune to the effects of graft, corruption and poverty. Some doctors are unemployed, while others take double or triple jobs. Many doctors look outside the field of clinical medicine for extra income. Some are into related fields like academics and research, while others go beyond medicine and venture into medical transcription, nursing, information technology and selling jewelry and health insurance.

Not everyone has government officials and actors for patients. In Batangas, moonlighting specialists settle for P1,000 for normal deliveries and P3,000 for caesarian sections. In the provinces, doctors are often faced with poor patients—and rather than exacting consultation fees, most instruct the patients to just buy the prescribed meds with what is left of their money.

Doctors are pinned to the wall. If they fight back, people die. But if they don’t fight back—well, they go home tired and weary. In any case, the health of Philippine society hinges on the Filipino doctors’ sense of decency—the decency to put the patient first—above anything and everything, even their own needs.

Hospitals and managed health companies exploit this sense of decency to a fault. They know doctors will not abandon patients. Yes, some paper work will be delayed if work stops, but they have administrative clerks for that. Patients will still be treated, surgeries will still be performed, follow-ups will still be done.

So, how will doctors fight back without hurting their patients? How will they go to the streets and protest unjust compensation? How will doctors fight unseen ghosts and forces that threaten to push them to acts of indecency and selfishness?

By bringing the fight closer to home. Everywhere doctors are questioning the choices that lay before them. While society continues to flourish in the notion that doctors get full satisfaction from public service, doctors struggle to face the harsh reality that life is full of syet. There are no right choices, just promises and responsibilities to keep. There are no wrong decisions, just consequences and the courage to live with them.

The fight to leave or stay—and yes, it is a fight—is not found in the loud voices on the streets and the echoing chants in demonstrations, but in the grave discussions at dinner tables and the whispered conversations when the children are asleep. Because doctors are slowly finding out that living—and leaving—for one’s family is a battle worth fighting for.

For some, it has come down to choosing between loneliness and poverty. Some choose to be lonely, while others choose to be poor. Doctors are not leaving, they are driven away. And these doctors carry their own personal battles in foreign lands, where they fight extreme depths of loneliness and immense levels of uncertainty. Those who stay fight their own battles of survival, where each day is a search for some sense of meaning in the care of other people’s lives.

In the gloom spreading all over the country, people are asking for a chance to get past poverty, a chance to make a difference, a chance to rise above the muck of helplessness. In the current state of desperation, people are looking for a fighting chance. And everybody deserves a fighting chance—even doctors.

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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.

Photo credits: http://www.backfixer1.com

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Weathering the Storm

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Image from the author’s original post

I woke up yesterday to the sound of rain outside my window and news that school and work had been cancelled. It had been raining since last weekend and parts of Manila were under water. I literally had to drag myself out of bed because we still had to go to the hospital. We still had patients to see and take care of at the Philippine General Hospital.

While a tropical storm above the northeastern waters of the country was enhancing the southwest monsoon and bringing heavy rainfall over Luzon, another storm was brewing.

My first patient for the day was Gibb, an 8-year old child who underwent brain surgery for a malignant tumor in his cerebellar region. He was scheduled for an MRI of his head and whole spine.

I saw his mother, Precy, hunched over in prayer, her fingers nimbly going through one rosary bead at a time. I began chatting with her about her son.

Gibb began exhibiting symptoms last year when his family noted that he was becoming cross-eyed. This eventually progressed until the little boy couldn’t stand or walk straight. They brought him to a private hospital in Cavite but decided to transfer him to PGH because of financial constraints. Something we usually hear from a lot of our patients.

Gibb soon underwent the operation he needed. Precy told me they had to use all of their savings and money given to them by her sibling for the surgical procedure. She used to work in manufacturing but had to stop. Her husband, Antonio, currently works as a regular contractual waiter in one of the restaurants in Manila. Both paid taxes. Both had very little. She said it cost them around 60 thousand pesos.

For the craniospinal MRI, Precy shared that she was able to get money from other relatives and from people in her baranggay. She said it wasn’t easy, but she was glad that they were able to come up with the money. I saw the sense of relief in their eyes when Gibb was wheeled into the MRI complex. It was another step towards getting better. Another hurdle passed. It cost them around 18 thousand pesos.

Like most cancer patients, Gibb and his parents were advised chemotherapy. For this, Precy had to approach people in government for help. And as people in healthcare know, it’s no easy task. The 34-year old mother had to secure requirements, papers, and had to take several trips to a number of government agencies and offices. It took her a number of weeks. Precy then began enumerating the Guarantee Letters she was able to secure: P10 thousand from Senator Pia Cayetano, P5 thousand each from Senators Recto, Marcos, and Trillanes, and P2 thousand from Senator Enrile. She also received financial help from her congressman, mayor, and vice governor. All of these, she said, will go to Gibb’s chemotherapy.

Aside from that, Gibb will also have to undergo radiation therapy. The young mother shared that for this, they had planned to sell some of their possessions like inherited jewelry. Papers for aid from PCSO and help from their governor were also being processed.

She sounded hopeful. She admitted that they didn’t expect to end up where they were right now. The whole process of giving their son the appropriate medical and surgical treatment he needed was long and arduous. She said they were tired. There were times she felt defeated. “Para ho kaming nanglilimos,’ she said.

Recently, Janet-Lim Napoles and the P10-billion pork barrel fund scam hit the headlines. I felt bothered, disturbed, and angry. As a tax payer, if things people have been saying are true, I am appalled with how my hard-earned money was ill-spent and allegedly stolen. As a Filipino, I am deeply bothered. I weep for my beloved nation.

If all of the allegations are true, I hope Napoles, her family, and all the other people involved can live a day in the life of our patients. Walk in their shoes. And see how difficult things are for most Filipinos, especially the marginalized ones. I hope they experience the panic and hopelessness our patients face when they are given huge hospital bills prior to a procedure. Or the discomfort of sleeping under the patient’s bed on cardboard mattresses. Or being confined in one of our wards instead of a luxurious suite, where privacy is almost non-existent and where every cough, cry, and sneeze is shared by at least 40 other people in the room.

There is now a movement calling for the abolition of the pork barrel fund. While I am for it, Precy’s and Gibb’s story reminds us of where part of our taxes go and the good that can be done if our financial resources are managed correctly.

Some people have been saying that P10 billion could have bought us new roads and bridges, built new school houses or railroad tracks, paid for badly-needed education or healthcare for thousands of Filipinos. I think that absurdly huge amount of money could have given us something equally important – hope. Hope that the government is investing in its people. That Big Brother has your back during your time of need. That politicians can put the interest of the majority before theirs. That things can get better – not just for some, but for all of us.

I usually just go about my business everyday, reading the headlines. Sure, I get bothered by the troubling things I see on the news. Predictably, I complain with my coworkers over lunch about how our country is going to the dogs, like a couple of rants on Facebook, and then eventually shrug things off. Like the pseudo-couch activist that I am. However, things resonate differently within me now. I’ve decided I’ve had enough and I feel I should do something, even if it’s a small thing. I asked Precy if I could share her story to which she agreed.

On August 26, Monday, people will gather in Luneta asking for an explanation from our government. I hope to be there. Things may not change and we may never uncover the truth. But I hope our voices will be heard. And hope, is hope.

Today, Tuesday, I woke up to the sound of rain outside my window. And while I prepare to go to work, I think about our countless patients like Precy, Antonio, and Gibb and the long journey they still have to take.

It’s still dark outside. A storm is brewing.

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About the author:

Toto Carandang, M.D. is a graduate of UERMMMC Medicine Class of 2003 and is currently pursuing post graduate training at UP PGH. Our heartfelt thanks to him for allowing us to post his article on this blog.


Doctor as Patient

[NB: The following is the editorial reproduced in full from the Philippine Journal of Internal Medicine Vol. 50 No. 1 January – March 2012 issue, it was written byDr. Margarita Cayco. All copyrights remain with their respective authors and the Philippine College of Physicians]

I am the primary example of a doctor cast in the role of a patient.

This editorial is not a scientific or theoretical one but is my way of educating internists on another facet of medical care. To my medical students, may this article highlight to them that knowledge of the principles of medicine is not enough to practice medicine. It is also important to practice medicine in a humane way.

This article is the first time that I have put down in words my experience and my feelings about what happened to me. I hope the readers of this journal will allow me leeway in my choice of topic for this editorial.

I was hospitalized in late 2007 because of encephalitis, etiology unknown. I do not recall my symptoms prior to my admission. I was told I was highly febrile and complained of urinary retention. I ended up on a
mechanical ventilator because I was in a coma for several weeks and eventually got a tracheostomy, percutaneous endoscopic gastrostomy, a urinary cystostomy and had the requisite central lines. I had to undergo multiple lumbar punctures, phlebotomies and even blood transfusions. My case was a real meeting of minds which knew no boundaries or rivalries among graduates of different Filipino medical schools, just like my marriage to a UERM graduate (my being a graduate of UST medicine). My doctors were from UP-PGH, UST and UERM.

I was comatose for at least two months and thankfully I dot not remember anything that occurred in the intensive care unit. When I woke up I had to undergo rehabilitation (physical therapy and visual rehabilitation) for several months.

I owe my life to all my doctors, the residents, nurses and therapists and of course to my family, classmates, colleagues, friends and medical societies.

Being a patient made me realize what my own patients go through and gave me a firsthand glimpse into their sufferings. It made me sympathize and empathize more with them and made me more patient and understanding in my dealings with them. It makes it easier for me to discuss with them whenever the need for a procedure arises, especially a tracheostomy. I just show them my scars and almost always they agree to have the procedure done. I actually have not had a patient refuse a procedure after I talk to them. I tell
them that if I did not have those procedures done I would not be talking and walking now.

My experience as a patient was a humbling experience and hopefully made me a better doctor and teacher.


Chasing Dreams.. Again

[NB: This article was previously published in my other blog as chasing dreams sometime in 2008. This has been slightly modified and updated from the original article for this blog post]

nurturing the dream

While on board a bus in heavy traffic, this thought came into my mind: when we were still kids and the issues of global warming and the environmental concerns were already present, although not yet a tangible reality, we were told to plant seeds in the hope that it will one day become a majestic tree.

Needless to say, that was a long time ago.

Now all grown up, I realized that it was not entirely a lie but it was more of a half-truth if you please. I do not know if it was an oversight of my teachers then, but in hindsight and retrospect, they should have also taught us that it was not enough that you plant a seed and hope that it will grow. It should be nourished, taken cared of and even protected from the harsh elements. Or perhaps they were actually wise in letting us learn that fact of life for ourselves as we grew older. I will never know. What I do know is that seeds are pretty much like our dreams. It’s not enough that we have a dream, it should be protected, nourished, and nurtured until it becomes a reality.

And that’s part of the reason I am writing all of this again now. A good friend of mine once told me that his dreams of becoming a doctor are becoming blurry and his work in the hospital only make matters worse.

It pains me to know about his situation and not be able to do anything about it. He has the intelligence, the skills and most especially the heart and passion needed to be a doctor. Wait, no, a great doctor. All that bars him from being so is a piece of plastic that serve as proof that he has the license to practice.

How 1,200 questions divided among twelve subjects taken in a span of 4 days determines who is “qualified” or not to treat people of their medical ailments is not for me to judge. Why must his his dream of being able to help others through healing of the body and of the spirit so elusive in the first place?

During our freshman medical orientation talk, one of our professors told the story of a young and promising medicine student who wanted to quit his studies because as much as he wanted to become a doctor, he wanted to be a pilot as well. When he told his professor his dilemma, all he was told was “I don’t see anything wrong with that.” Whoever said you could not pursue both dreams? To make the long story short, the young doctor to be did not drop out of school, finished his degree and went on to pursue his other dream. The last time he saw him, our professor said that he maintains his private practice as a doctor while flying for a commercial airline twice weekly.

Likewise, I had the chance once to meet a fellow doctor that not only treats people with pills and prescriptions, but he also heals with the arguably best medicine there is: laughter. And no, he’s not Dr. Patch Adams, although I did have the pleasure of meeting him once when he visited the country. He is Dr. Carlo Jose San Juan creator of the medical comic strip callous comics.

But going back to my friend, he once wrote on his online post, that he was at a crossroad and had asked for a sign. In irony, I had hoped that he failed in getting the promotion so that he can be once again free to chase that dream of his. And I’m still hopeful that his dream will be realized one day.

Our dreams may be grand or otherwise, but what is important is that they are our dreams, not dictated upon us or simply borrowed from others. We may have others who share and support our dreams, but ultimately it is ours to fulfill.


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.


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