Tag Archives: patient care

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.

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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


Smile Therapy

As doctors sometimes the work that we do becomes routine and mundane, but then something unexpected happens that makes us realize why we do the things that we do. The following is a status update on a colleague’s FB page. Couldn’t help but smile myself. 🙂

“at the clinic earlier, a patient who was biopsied back in 2011 and has seen a couple of nephrologists (and fellows) since comes in. She tells me that I gave her the best explanation regarding her condition ever. She had stopped seeing her doctors since late 2011 because they didn’t explain what they were doing and what they had been looking for in her labs. So yeah, I left the clinic and my smile was *thiiiiiiiiiiiisssssssss* big. hahaha”

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About the author:

Tennille Tan, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is a board certified nephrologist.


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