Prudence I Write

Not so few medical schools and hospital training programs have closed because of the dramatic decrease in applicants. Only those medical schools, usually the long-established and big ones, can attain its yearly quota of enrollees. This is an indicator that a battle for survival has begun. As often the case, the strongest and the best adapted will survive. In smaller hospitals, junior consultants and “moonlighting” general practitioners go on 24-hour duties because of lack of residents-in-training. And in bigger hospitals, residents’ training year would begin with complete set of residents, only to depleted by midyear. One by one, they were dropping out of the training program in favor of a better job offer in private clinics, locally or abroad, or even job offers not in the medical field, such as call centers. Others would rather pursue a master’s degree in a different field; others study nursing, after which they leave the country.

So, why not dwell in a career that took almost half a lifetime to build? Why rather be anything but a doctor nowadays?

Work Not Satisfactorily Compensated

First of all, people have this erroneous notion of doctors being overwhelmingly wealthy. Driving around with luxury cars, wearing designer clothes, or globetrotting. This may be true for a handful but, what most people fail (and refuse) to know is that this image of the wealthy medical doctors should be treated obsolete. Most of the few remaining doctors who may be considered rich are those who have either come from wealthy families or have acquired their wealth through long, long years of stable medical practice or through businesses.

So, what about the other doctors? Doctors that have to compete for patients with several thousand others in the cities?

To setup a practice isn’t so easy, as one would think. No doctor could just admit his patients in any hospital. He has to pay for clinic space where he wants to practice and this could amount to anywhere from P300,000-P1,000,000 (in really “high-class” hospitals). Then he has to buy medical equipment necessary for his clinic, which could be from P15,000-P100,000.

So, how can a doctor, with all these expenses, gain back his investments with only a handful of patients per day?

Most people can’t simply imagine how a doctor, with long line of patients waiting outside his clinic, be anything but out of money. What people don’t know is that most of these patients consulted either for free, because being referred by a relative or friend, or with a discount on the professional fee (most of the patients, by the way, do ask for discounts in the professional fees). What is even more troubling is that, because people think doctors are rich, they continually beg for discounts on just about everything, thinking it wouldn’t really hurt the doctor. But the cumulative effect is that it does hurt, especially when everybody else will refuse to pay the amount that is rightfully due for his services rendered. People just fail to consider that the service they’ve been given took several years of study in the hell of medical school and hospital clerkship and internship and specialty training, not to mention the several hundred thousand bucks spent by hardworking parents.

It is sometimes so disappointing and disenchanting to hear some patients haggling doctor’s fees, as if they are in the market buying vegetables and meat, that it almost leaves a bitter taste in the mouth afterwards.

Patients’ Growing Mistrust of Doctors

I’d say this is a direct consequence of ordinary people being bombarded everyday with television and printed news of “bad” doctors and “bad” hospitals, not realizing that most of these stories are either incomplete or biased (after all, journalists aren’t forced to present both sides of the issues).

Several questions run in the minds of patients whenever they consult doctors. Is he competent enough? Can he diagnose my problem? Is he going to overcharge me?

And when the doctor begins probing their schedule of medications, habits, and diet, patients suddenly turn defensive: Is he trying to pin the blame on me? Is he telling me I’m not compliant with my medications? Is he telling me I’m not eating properly? Is he telling me my vices led me to my illness? No, no, no!

And thus, the denial of one’s responsibility for one’s actions ever increases.

As the TV character, Dr. House, succinctly puts it, patients lie. And they lie to cover up details of themselves deemed too intimate or too incriminating. The doctors’ job becomes all the more difficult with this lack of cooperation, stemming from mistrust. It’s like trying to feed a stubborn, obnoxious toddler with his healthy dose of leafy greens for the day: the more you insist, the more they resist. Waiting for the patient to willingly divulge that information (or try beating around the bush for eons) or consent to a diagnostic procedure is just like waiting for the stubborn child to finally open his mouth to take in that spoonful of food. One can understand such behavior in a child, but not in the adult patient.

Another disturbing observation is that patients have developed the attitude that doctors should always be there for them, as needed and as wanted. Patients come to the emergency room to be treated as an emergency case, even if their problem isn’t an emergency at all, and then get mad if left suddenly unattended because a real emergency case arrived and needed the attention of all the doctors and E.R. staff. Patients come at the outpatient clinic during lunchbreak, demanding to be seen immediately. And if asked if they could wait for a while longer because everybody is on a lunch break, they’ll give outbursts that they couldn’t because they don’t have the “time” to wait. And then, they’ll fling obscenities at doctors in the E.R. because they think they aren’t attended to completely enough. When they find out that they’re making a fuss about nothing at all, they would defend their bad behavior by saying they got emotional, angry, and panicky, and they have the right to because they are “patients”. For them, they need not to be civil with doctors because doctors aren’t human beings, with no right to hurt feelings or suffering undue psychological and physical stress. And to top it all off, adding more insult to injury, doctors working for 24-hours (the kind of doctors who most often encounter these ungrateful patients and who suffer most from the above-mentioned assaults) get paid P100 or less per hour.

After all those years of hardwork in medical school, the hundreds and thousands of pesos spent by parents, wishful for the day when they’d be called lucky fathers and mothers of doctors, the two-year long hell of being clerks (glorified term for the lowest form of animal in the hospital) and then interns (glorified term for the second to the lowest form of animal in the hospital) and the months of grueling study for the medical board exam, of which result will dictate the life or death of a budding career, we get paid a measly fee? And then, patients, when feeling slighted,come up threatening to take away our licenses as if they own it?

The doctor-patient relationship’s foundation, like any other professional relationships, is trust. Patients should trust that doctors will, firstly, do no harm (this is what we have sworn when we swore the Hippocratic oath) and will do his best for their greatest benefit. Doctors should be able to trust patients giving them correct information that would be a big factor in the treatment of their disease. But if patients have no trust in their doctors, then what’s the point of the whole doctor-patient relationship?

Why Should Doctors Leave

A recent eyeopener was an article I read in the Philippine Daily Inquirer last January 13. It was written by a young medical doctor who is part of DOH Doctor to the Barrios program and works in underserved areas of the country. She described the fulfillment she gets, being able to help people receive the medical attention that they need. She said that people around her have thought her crazy for not wanting to work abroad. A simple life is all she wants, it seems.

Maybe the life she has is enough for her. For now. But how about later if she decides to raise a family? Would she settle for raising her kids in the province where the nearest hospital could be miles away? Would she settle down in one area or go from barrio to barrio, her family tagging along with her?

There is no doubt that her deed is a noble act and that she renders the country great service. However, nobility do not require selflessness all the time. Noble is he who performs his work well for the sake of working and seeks his rightful fulfillment, be it monetary, in career, family, or spiritual.

But what if he cannot find fulfillment in work here? Where will he go? Obviously, the person in search for fulfillment will go somewhere where his efforts are appreciated and given worth.

The problem is, however, people here in this country expected all doctors to be sacrificial lambs to the great deity called “Patriotism”. But isn’t that behind this “deity” hides the self-righteous people who perpetually ask others to make sacrifices for them? Aren’t these the kind of people who perpetuate a justice based on mendicancy?

As a doctor, I continually ask myself the question: am I receiving my worth? For the duration of my practice, I’ve let myself work and be underpaid for it and still it’s okay. After all, it is “service”. But for how long can I stay this way? How about my parents whom I have to support? How can I support them if other people will expect me not to receive my worth for their sake? So that I could heal them and guide them to living healthy lives and then threaten to take away my right to practice if, in as much I try to defend myself from those who abuse me?

So many are clamoring for patients’ rights, claiming that doctors are out to victimize patients. But have you ever heard of anyone defending the doctors from patients who not only abuse their service, but take away their right to be humans? None. Because not everyone believes that doctors are human beings, too, and they work for survival, just like everybody else.

To my fellow doctors, my message is: Let us leave this place, if we can and while we still can. Let us not let ourselves believe that we shouldn’t receive any less than what we have earnestly worked for. Let us not let them tell us how and why to practice. Let us live for ourselves. By knowing our real worth can we all be of true service to our country. In time, when people have learned that one man do not live for the sake of another man, we could come back. Let us live by this mantra, taken from Ayn Rand’s novel, Atlas Shrugged:

“I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine.”

To the people, do not expect us doctors to bleed dry for unthankful, unappreciative fools who think we owe our lives and our licenses to them. Do not expect us to live when you are trying to kill us. Give us the worth of our work and we will live, not for you, but because it is our right as we worked hard for it. When you have learned, we will, no doubt, come back.

But for now, M.D.’s are leaving. We are on strike.

I’m already 2 years old, by Blogosphere reckoning, but I haven’t
attended a gathering of those who are so much into blogging (read: blog
addicts) like me. For the life of me, I don’t know why I haven’t
thought of meeting up, even with a few bloggers I’ve encountered by
bloghopping or by having them visit my site.

Who says bloggers
are geeky, reclusive introverts who just wanted to connect with hard,
cold computer machines? Of course not! We read blogs because we want to
get to know more people. We post comments because we want that other
person and other people who’ve commented to know our presence in the
Blogosphere. We leave messages in their chatboxes because we want to
know our fellow bloggers we’ve thought of them, at least once, during
the day. We discuss, argue, fling hot words at one another, and
eventually simmer down enough to keep the argument at bay because we
want to know we’re alive, even in Cyberspace. We want social
interaction, be it online or offline. That’s why bloggers blog.

So,
my fellow bloggers, it’s time to party! The chance is here to finally
meet up with those fellas you’ve been chatting with in the shoutbox or
whose sites you’ve been bloghopping into for months.

Blog Parteeh! 2007 is, as the site claims, the biggest ever blogger meet-up organized by bloggers for bloggers.  Here are the main details:

What: Blog Parteeh! 2007
When: January 27, 2006 2:00 p.m. to 8:00 p.m.
Where: 6th Floor (Poolside Area), Classica Tower 2 Condominium, HV dela Costa St., Salcedo Village, Makati City 1200

So, how can you get yourself invited to this party?  Just blog about it!  Check out the site for more details!

This event is sponsored by: Sheero Media Solutions, MyJournal Philippines, FeedText, Inc., Migs Paraz, A Bugged Life, The Blog Herald, b5media blog network, About My Recovery, Pinoy.Tech.Blog, Enthropia, Inc., Krispy Kreme Philippines, GMA New Media, Awesome Philippines, Codamon.com, Boracay.com.ph, Recipes.com.ph, WebMaster.com.ph, Bouncing Red Ball, Bo Sanchez, Microwarehouse Inc.

Hope to see y’all bloggers (myself included!) in the party! 

P.S.
I’ve just recently registered a new domain and I’ll be transferring my
site soon. So please do standby for the launching of my new domain, tesstermulo.com

Born:  June 2000
Died:  January 18, 2007

My little angel sunshine,
For you, I’ll believe in Heaven.
I love you.
May you rest in peace…

See you when I get there.

Today, despite differences in cultural backgrounds and social status,
we move in a society where certain courtesies are expected. We follow
traffic rules out of courtesy for other motorists and for the safety of
everyone on the road. We walk on the right side of a two-way corridor,
stairs, or any walkway out of courtesy to other people passing us by
from the opposite direction. We say "excuse me" when we bump
accidentally onto other people. These are simple rules we follow that
we have come to imbibe in our lives due to innumerable repetitions
enforced upon us by our parents, guardians, teachers, and elders since
we’ve learned how to walk and talk.

With these realizations, I
just simply can’t understand why some people need to be rude, when
following simple rules expected of us can make life more pleasant for
everyone.

At the HMO clinic earlier today, I was using the
patient’s toilet room because the one for the doctors was being cleaned
up. I was washing my face when I heard someone trying to turn the knob.
The other person obviously wouldn’t be able to because I had it locked
so I told the person outside that I was still inside. The person
continued turning the knob and even thumped the door loudly three
times. Though starting to get irritated, I continued washing my face
and brushing my teeth. After a short while, I heard another series of
knocks on the door, still as loud as the previous knocks but more
urgent.

When I was done, I stepped outside, irritably wondering
who the hell does this person think she is to keep on rapping on the
door like that. I discovered she was this almost elderly woman with
fake blonde hair, fake pearls, and an air about her that speaks of
haughtiness and feeling of superiority. I wasn’t wearing my white coat
then, so she must have thought of me as a kid who’s been using the
bathroom for too long (in her opinion) and just rushed past me into the
bathroom, nose in the air. No apologies whatsoever.

I would have
accepted an excuse such as that she can’t hold her urine any longer
(after all, she’s elderly already). But she didn’t even offer any
apologies at all. It was as if it’s her right to kick someone out of
the bathroom when she needs to use it.

Actually, I wasn’t
offended because I’m a doctor whom she tried to kick out of the
bathroom. I was offended because I’m another human being who doesn’t
deserve such discourtesy. She seemed an educated woman but why can’t
she be civilized enough to respect my right to use the bathroom,
especially if I was the one there before her? Did she think she has the
right to disregard my right just because she’s older?

That is
the problem with some old folks these days. Older people often complain
that the younger generation has yet to learn discipline and respect.
But older people, too, seemed to have been losing their manners. They
demand that their needs be placed above others simply based on
seniority. They demand that they be respected, even if by their virtue
they don’t earn it.

I still do hold respect for older people.
And so I held my tongue at that time. But I wished she was in line for
consult in my clinic so when she sees me, she’d realize she tried to
kick out of the bathroom the doctor she’s going to have consultation
with. So that, at least, for a moment, we would be equals, somehow.
Unfortunately, she was in line for consult with another doctor.

So
there she went, with me having done nothing. After all, how does one
reprimand an older woman that she’s lost her manners? She just might
spat on my face for my "disrespect" for her. Filipino elderly people do
not handle such criticisms from the youth. It is as if they are
untouchable by merit of their age.

But then, I remembered age
isn’t necessarily an indicator of wisdom. With the increasing
population of the older age group, I’m beginning to wonder where the
wisdom and the manners had gone to.

The journey through life is like trekking an unknown, uncharted part of
the Woods. You just can’t seem to find a way around it and the
frightening part is it’s the only way out.

But like any other
experiences we had, either those that just breezed past us or were
dearly paid for, the trek to the unknown is consummable knowledge. We
use it for future encounters. We use it as battle scars to be shown
with pride to future generations who might care to learn. We use it to
keep us sane amidst the confusion of trying to live. However, you try
to see it, in the things we do and in those that come as results of our
own actions, we learn. No shortcuts to glory.

And as one who
face the threat of a looming, dangerous adventure such as the unknown
Woods, I did feel frightened, uncertain, insecure, and a bit hopeful
when I faced 2006. And as I’ve gone through it, I think I’ve harvested
enough lessons that can help me last another year of trials, triumphs,
and failures.

So, here are my lessons learned in 2006:

1)  Experience is True Knowledge
I had only few moonlighting duties under my belt when January 2006
came. I was full of uncertainties and insecurities. Though people said
clerkship is glimpse of what real medical practice is, in reality,
nothing can really prepare you for it. The important things is one has
to trust one’s self, one’s knowledge and intuitions because nobody else
will be there to make those decisions for you, which most often are
decisions that could mean life or death.

2)  Money earned gives a sense of self-worth
Since
last January, I was able to buy my Motorola E1 ROKR phone and a bunch
of other personal things (mostly clothes, books, shoes, makeup) and
spent on gimmicks with my own money. Not the dough I get from my
parents. And these money I earned through "moonlighting". My monetary
capacity to spend is nowhere near that of other people my age, who had
begun careers in the corporate world, but one has to be thankful for
small blessings. At least, I’m beginning to see the fruits of my labor
and understand how valuable money is. But, of course, my skill is
really worth more than these. Hopefully this year there will be
improvement in the financial division of my life.

3) The person you love most hurts you most.
When
JP and I started our relationship, I thought he would be my last and I
vowed that I’d do everything in my power to make it last. I refused all
temptations and I set my mind on just loving him, something I haven’t
fully done in my other relationships. The most hurtful thing, though,
was he didn’t reciprocate these efforts. No I fear that I can’t love
that much again. But as a female friend said, I shouldn’t take it
against myself if people I care for do not give me the respect I well
deserve. Yeah, and I should just quit whining. "I will live my life for
myself and not for anyone else anymore," I promised myself. I may not
be able to extricate justice for what JP did to me because he’s too
much of a coward to face up to me and admit his guilt. But living my
life fully and as I want it is more than revenge; it is my right.

4) Don’t protect your loved one from a well-deserved fury because he just might need to get every bit of it.
The
faggot bitch started bothering me sometime January last year. I’ve
written several posts about it. I don’t have regrets in having
text/message/blog brawl with him. I only regret that, at that time, I
did it to protect my ex. My ex might say he never did ask it from me.
But hell, he have the bad habit of saying one thing and yet doing a
different thing entirely and claim he hasn’t done anything wrong (like
telling me he loves me so much then screwing his fubus behind my back,
and then claiming that he really can’t love me…what kind of bull—-
was that?). He fully deserved the faggot’s fury because it could have
taught him a lot of things he should know by now (because he’s already
28, for goodness’ sake! He should be a mature person by now!). What I
did understand from this mishap was the faggot’s anger. He was squeezed
to the last drop of "usefulness" by my ex. The faggot’s got every right
to be mad.

5) Being left for another man by an ex-bf is worse than being left for another woman.
I
was hurt when my gay ex-beau told me that he cannot love me the way I
wanted him to. Then he went off with his new boyfriend who can satisfy
him in bed. And then I found out from his old friend (and old flame)
that he was still sexually attracted to his other ex-gf but not to me.
Those were insults flung head to foot and are still buzzing irritably
around my head like taunting flies. It’s got to be the most insulting
thing I’ve ever had in life.

6) But being left for another woman hurts still.
I
also thought Mike would be my last. He’s a charming man, financially
stable, and had asked me to be his wife. What else could go wrong?
Nothing, I thought. But I was wrong. Five months in the relationship, I
caught him having another "fiancee". The girl claimed it and he
confirmed it. Then he’s gone with no explanations. It still hurt me.
But in his case, I know he loved me; he just didn’t choose me. In my
gay ex-beau’s case, I don’t know if he really did love me or he just
had me for the sake of saving face.

7) Failures are expensive mistakes but better to have tried than not to have tried at all.
In
the last week of February 2006 I took my USMLE Step 1. And I had to
wait for weeks (5 weeks, to be exact) only to see that, well, I didn’t
make it. It was a horrendous, 800 USD-worth of failure. I felt bad
having to let everyone down. But still, at least, I didn’t have to
torment myself with "what ifs". I just remembered the fortune cookie I
had the night prior to the exam. It said "never give up". I wonder what
that means. I guess I should still go for another try. I just hope
another chance comes up.

People have lost respect for the medical profession
I
thought of writing about this as a separate article. But for this post,
suffice to say that, based on my one year of medical practice, I’ve
come to the conclusion that people regard doctors as either
money-hungry, money-grabbing professionals worth only to be treated
like servants/waiters/waitresses in restaurants where the slogan runs,
"customer is always right (no matter how unreasonable they are)" or an
unfeeling, inhuman creature with no right to receive proper conduct
from people they treat. Or maybe both. But the thing is, people have
lost respect for the medical profession. Even with the nurses and other
health care staff whom they treat as if less than househelp. Just
imagine, if they treat doctors and nurses as if they are mere servants,
shouting at them and talking as if they own their lives and licenses,
how worse can they treat their househelp? One would shudder at that
thought.

9) The mind is humankind’s greatest asset so use it!
Atlas
Shrugged, a novel by Ayn Rand, is perhaps the book that has brought the
greatest change in my outlook in life. I regret that I’ve only come
across it late last year. The book is about "the mind on strike" (Ayn
Rand even said it was her working title while writing this novel before
she decided on "Atlas Shrugged"). Central to the novel’s theme and
Rand’s philosophy is the idea that the mind is the motive power of the
world; hinder it or take it away or leave it at the mercy of the people
who believe they can get what they don’t deserve will lead to world’s
destruction. In life, I have encountered a lot of stupid, senseless
people. Most are the kind too blinded by superstitions and "faith". And
for allowing themselves to be blinded, they have risked their lives and
other people’s lives. Tell them there is an explanation to most
phenomena and they’ll wag their finger on your face and say you’ve
become too proud and only God can tell you true things. And, of course,
how can you argue with such persons who base their conclusions upon the
logically unarguable like the virginity of the mother of God or that
those who do not believe in God will perish in hell? How can you
convince a person to be treated if he believes his sickness is a
punishment/test from God that he should endure humbly, even if it will
bring him to early grave? How can you believe that a group of believers
love their God so much that they are more than willing to take other
people’s lives in their God’s name, calling it holy war? How can you
believe that unity in belief in one God can bring peace when they come
out shoving their beliefs in your face and calling you immoral if you
do not believe in it too? Are we to leave the fate of the whole world
to people like these who could bury themselves crazy in beliefs they
have no way of proving true? Religion is a dangerous, dangerous weapon.
I fear it so much. And with the way people have used religion to cast
much evil in the world today, I fear so much what the future might
bring.

These are the lessons that I’ve harvested as I trekked
through the once unknown, uncharted Woods of the year 2006. I got
through, barely surviving. But looking back, I think I did quite well,
if not for a handful of mistakes. Some will say that one shouldn’t
really look back at these mistakes for there shouldn’t be space for
regrets in one’s life. But, I say, it is one’s duty to look back once
in a while. Only by remembering the experiences we’ve had can we only
be properly armed to explore the future.

So, I begin the year
2007 by taking this oath from Ayn Rand’s Atlas Shrugged: "I swear by my
life and my love of it that I will never live for the sake of another
man, nor ask another man to live for mine."

So be it.

Not that I’m having another mental drought. On the contrary, I feel my
brain is almost saturated with so much ideas I just can’t keep up
chasing them around in my head, trying to catch them, process them into
words, and put it up as a blog post. Much like the garden goblins in
the Weasleys’ home garden. Haha.

Scraps of paper containing my
half-finished blog entries are already piling up. Hmmm…I better do
something about this. I’m beginning to hate myself. I don’t like
leaving things unfinished as it is.

To my blog readers, I cry your pardon.  I have been unduly preoccupied and let myself be overpowered by such preoccupation. 

Tomorrow
I will begin posting more substantial entries. For now, I’ll try to fix
this blog as it need a bit of revitalization. After all, it’s a new
year. Again.

Thankee much.