Tag Archives: doctors

Living, Learning, Earning and Leaving

mch

helping the sick get better.. that’s my job

“One day I’ll be missing this place”

I read these words from a former staff nurse as a comment to a picture of the hospital where I am both a visiting consultant and a volunteer doctor. And I can’t blame them really, with the economic turmoil and the harsh reality of the nursing profession. Sometimes I myself am asked why I continue to stay despite the difficulties of medical practice and I tell them the story of one patient in particular who helped me place things in perspective.

I went to see this particular patient because she was referred to me for cardiopulmonary risk evaluation prior to a planned open cholecystectomy procedure, nothing out of the ordinary at first but when I looked briefly at her chart, I noted that she came from a far off town, at least two to three hours away. I confirmed this with the patient when I did my rounds and she told me that they even had to take a boat as part of the commute. I recall being to that town before on a medical mission at a friend’s invitation, so I know that it’s really a long way. When I asked how come they happened to be admitted at this particular hospital, she told me, and this would not be the first time, that her National Health Insurance Program (PhilHealth) payments were not up to date and hence, were not eligible for the program.

But the patient continued with her story and told me that she was not looking for a free accommodation and hospital services but rather, where the rates were lower, at least in more affordable compared to the private hospital where she first sought consult and later upon knowing the amount she had to pay, just opted to go back home despite the pain and discomfort she was feeling at that time, simply because she could not afford it. She tells me she has some money with her, but not enough she reckons for the expenses after the surgery; so that is why she will be asking for financial aid from the local politicians, a common practice I observed. She does not want to be begging for alms, but what can she do? She really wants to get well, to be relieved of the pain and suffering she told me. I finished my examination and promised her to help her in the best way that I could medically. I excused myself to make notes and place my written evaluation. The medical assessment would be the easy part; it’s all based on objective and sound scientific and medical data that’s readily available. It’s the human aspect of the healing process that’s a little tricky. The part where our mentors would say the art of medicine comes in, making that human connection and not just treating the patient as a compilation of lab results and imaging studies. In a way I’m thankful that she chose to go to this quaint hospital where it may be a little out of the way, not have the most advanced equipment, and sometimes where things just don’t go the way we plan them to be; but its doors are always open to those who seek medical aid, regardless of creed, race or stature in life. Likewise, the doctors who choose to serve here are more than willing to help out, despite the hurdles and insurmountable odds they have to face. And maybe that’s one of the reasons I choose to stay, because more than just a job, it’s a calling if you may, where I can practice my profession and give back something in return. Besides, here I can be an agent of change and there will always be something new to learn; mostly in the practice of medicine and sometimes, life in general.

In the words of the Blessed Mother Teresa: “Stay where you are. Find your own Calcutta. Find the sick, the suffering and the lonely right there where you are – in your own home and in your own families, in your work places and in your schools.. You can find Calcutta all over the world if you have the eyes to see. Everywhere, wherever you go, find people who are unwanted, unloved, uncared for, just rejected by society – completely forgotten, completely left alone.”

This article uploaded in response to today’s daily prompt

Advertisements

Hearts, Doctors, Love

20130719_161134

lub dup.. lub dup..

Out of breath? Palpitations? Skip beats? It could be signs of heart problems.. That or you could just be in love. Either way, have a date with your doctor today and find out. Happy Healthy Hearts’ Day everyone!


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.

______________________________________________

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


Prescriptions & Prejudice

rxpad

kindly include prayers as needed..

Part of what I do as an In-House physician in the hemodialysis center where I work is to review the patient’s list of medications and if needed, refill prescriptions for the said medicines, as we often limit them to a month’s worth as they may have to be changed later based on their response to the said medications. One time, the husband of a patient came to me asking if I could make three identical copies of his wife’s prescription. When I asked why, he reasoned that he was going to ask three different entities, namely, the City Health Service of the City of Angeles, the Philippine Charity Sweepstakes Office and the Office of the Governor, for the said medicines. Further reasoning that if all three gave him, he would have at least been assured of 3 months worth of meds, if not, he will just buy them instead. I pause and give a short sigh, but remember having read this letter from a woman who experienced prejudice firsthand, I would think twice before passing judgment.

Going back to the said letter, I was drawn to another website where it was also featured not to the article itself but the commentaries of the people who have read it. Some of them pointed out that true, there may be people who are actually in need of this kind of aid from the government, there are still those who abuse these kinds of things as well. Government aid, they argued, can be a bane or a boon depending on how we look at it and from whose perspective. Given the ongoing talks about misused funds and taxpayers money, I heave yet another sigh.

I remember when I was still a Junior Intern (or Clinical Clerk as they are known in some other institutions) during my rotation at the Out Patient Services, Charity Division of the hospital my then OPD resident told me to assist a patient to the Social Services office prior to their admission. The patient was a male in his early 20’s and with him was his father. Based on the planned surgery, he would be needing titanium plates and these would cost money of course. The question would be: will the hospital shoulder some or all of the medical expenses, given that this was a charity case. At the Social Service office he was asked routine questions about their family and the patient: Where they lived, source of income, etc. I was there so I know for a fact that the father claimed that he had no stable source of income, when lucky he would ply the streets as a tricycle driver. That they were living with relatives in Manila just for the time until the surgery can be done. He presented some documents for scrutiny, and after several minutes had his admission stamped with “class D” – meaning he was from the lower income bracket and was indeed qualified to avail of the hospital’s charity services.

So what has the above story connect with the first? It was only later when I went to see how the patient was doing when I accidentally overheard the father of the patient talking to another relative in the ward. He said, or rather boasting, that he wasn’t really poor at all, that they had just been from Hong Kong the month before, and that he just wanted to save the money he would have otherwise spent on the titanium plates had they known his real status in life. We have to be wise about these things he said with a laugh. I cringed. We all have been fooled, the people who just wanted to help, by some people who deliberately choose to deceive and get the upper hand.

What is disheartening most about this is not the fact that part of what was used to pay this particular patient’s hospital expenses came from our tuition fee as medical students, but that the same treatment could have been given to someone who actually did deserve and needed it. This happened several years ago, but with today’s current issues at hand foremost the circus that is the pork barrel scam still to find a resolution, I choose to abide by the oath that I have taken as a physician, and rather than be a critic, to just do what it is we hope to do best: to be a healer to the sick and afflicted no matter their race, creed or stature in life and hopefully in our own little way, be a catalyst for the change that we yearn for.


Old Methods, New Learnings

[NB: The following appeared on the opinions pages of the Philippine Daily Inquirer  the online version can be found here. The article was written by Dr. Leonardo L. Leonidas who retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1986 graduate of the UP College of Medicine. All copyrights remain with their respective authors and the Philippine Daily Inquirer]

med_school_591

medicine.. lifelong learning

About 17 years ago, Bethany, a former patient of mine, asked if she could shadow me for three months at my office. She had just finished her premed course at the University of Maine. She wanted to apply to a medical school.

In the first couple of weeks, she just observed what I was doing. Then I let her listen to the chest and heart of my patients and, in time, to use the otoscope to look at the eardrum. Soon she was palpating the abdomen of babies and checking the hips for dislocation.

After about a month of Bethany’s observing and listening to how I took the clinical history of children with ear and throat infections, I would leave her to interview the parents and write the history herself. When I would return to the examination room, I would find the history and details of the physical exam already done in the computer.

Near the end of her three-month “training,” Bethany was writing prescriptions for the most common antibiotics for ear and throat infections as well as pneumonia.

A couple of years later, my son, Len, completed his course in biology at the same university that Bethany went to. He wanted to take a year off before applying to medical schools, and he volunteered to help at my office. Like Bethany, he shadowed me and learned how to take a patient’s clinical history and conduct a physical examination.

Neither Bethany nor Len attended formal lectures in basic medical subjects like anatomy and physiology. Because my office was busy, I just told them the main features of a disease to make a diagnosis. I advised them to read about pneumonia, asthma, ear infections, strep throat, appendicitis, migraine, etc. after office hours.

Len shadowed me for about 11 months, and I treated him like a third year med student. And during that time, aside from diagnosing the most common illnesses in children, he was able to suspect appendicitis in two cases—and the surgical reports confirmed it. Just after about three months, I left Len alone with my patients and their parents, and he independently wrote the histories and physical examinations, made diagnoses, and wrote prescriptions. I reviewed what he had done and signed the Rx. In the vast majority of patients, his diagnoses were on target.

Now why am I telling you about Bethany and Len? With the advent of the iPad, tablets, smartphones, and laptops, I think we can drastically change how we educate our medical students, in a better and faster way, with less of the stress that may lead them to depression or suicide.

The only lecture-based topics that medical students need are: how to take a history, to do a physical examination, to make a differential diagnosis, and to request the most common lab and imaging procedures. These can be done in the first six months of med school. Then they should be exposed to patients as early as the second half of the first year. The “basic sciences” standard lectures should be reduced by 80 percent; they should be allowed to study independently outside the lecture room using video lectures by the best teachers, which are available 24/7.

During the bedside interview with the patient, using an iPad or tablet, students can easily look for the common signs and symptoms, pertinent physical exam, and patho-physiology procedure needed to figure out the diagnosis. With a resident guiding or demonstrating to them the steps in making a diagnosis, students will learn clinical medicine faster than in the traditional lecture-based education which, from my experience, was stressful because of tons of memorization.

Armed with an iPad, tablet, or laptop, students can make an electronic patient portfolio file (EPPF) that they have to keep from first to fourth year. Their graduation will be based on this EPPF. However, they will have to see a minimum number of patients afflicted with asthma, migraine, diabetes, pneumonia, heart failure, meningitis, depression, head injury, fracture, appendicitis, etc. The EPPF will carry complete histories, physical exams, differential diagnoses, work-ups, discussions, and evidence-based medicine references (if available).

The EPPF will be designed to include a self-assessment test after each case; a student should be expected to answer and pass this test by at least 90 percent. The questions will be almost the same as what are being asked in the national board exams.

Students’ EPPFs can be easily reviewed by senior residents, mentors, or consultants without them leaving the comfort of their office or living room. A patient may also access an EPPF if he/she desires to do so, and correct or add new information. If the patient has an e-mail or Facebook account, a student can do follow-up work and an outcome study. Those who are interested in teaching, even if not part of the faculty, may volunteer to be e-mentors. With this pool of talent and experience, learning can be more personal and global.

About 10 years ago, I hosted an e-learning case-based problem-solving session with third year students of the University of the Philippines College of Medicine. It was fun, and one of my e-students commented that he learned from my e-mails much more than in the six-week rotation at the Department of Pediatrics. This student has just completed his gastrointestinal fellowship at Mayo Clinic.

Bethany is now a cardiovascular surgeon, and Len an internist-pediatrician.

————————————

We would like to acknowledge the author for giving us permission to repost his article in this blog and saying that he might contribute here as well.


Doctor, Doctor.. you are sick?

It’s like saying that doctors are people too.. sometimes we tend to forget that as well.

music and musings blog

In an ideal world, all doctors are healthy and lives healthy. Unfortunately, that is not the case. Sad to say we don’t follow our own brand of medicine so to speak. Another thing is that we tend to diagnose ourselves and subsequently treat ourselves. Of course, this is just for small aches and pains. The “bigger” diagnoses, depending on the person, we either refer ourselves to our colleagues or well… we procrastinate. Much like any other person I suppose.

Another issue when doctors get sick is we lose time with patients. More to the point, we lose monetary means especially when you’re strictly in private practice. A day out of your clinic can be a big loss. Good thing for me I work part time in a government hospital. Now even absence from that gets me anxious because at times no one will cover for me. Good thing on my…

View original post 374 more words


Beyond Medicines

striking a balance

striking a balance

Looking for inspiration on what to write about, I found this written on a piece of paper while cleaning my room. I recall reading this in a daily broadsheet once and having been moved by the words, wrote it down and eventually forgotten, until now. Happy Holidays everyone!

———————————————————————————————————————-

“Respect and balance” was what Dr. Samuel Bernal said when he was asked to choose keywords to best describe his medical credo.

He continues by saying “one must respect the individuality of a person, and how every RNA, the edited version of genes of DNA, is expressed. Every gene expresses itself uniquely in every individual.”

“Balance – this isn’t just physical, it is all of mind and spirit, too. When working at one’s health, the personal state of mind and heart is an integral part of the totality of being.”


%d bloggers like this: