Sunday, November 18, 2012

Clever ways to spend the money you earned in moonlighting (1st of 2 Parts)

To moonlight or not to moonlight, that used to be the question. A number of physicians these days find themselves saying yes to moonlighting, specially that it goes with the promise of a hefty pay. 

Photo by Shing Camps

Medical moonlighting in the Philippine setting basically means working as a doctor for pay, outside the requirements of a training program. Here in the Philippines, moonlighting is usually done by registered physicians, most of whom did not go through residency training yet, although there are also a handful who had a few years of residency under their belt but stopped training for a number of reasons. I personally have nothing against moonlighting. In fact, I am all for it.

I have been through that path myself. I spent four years doing moonlight job in the beautiful island of Bohol, after doing one year of residency training in Internal Medicine in Cebu City.

Physicians who choose the moonlighting pathway may actually have varied reasons for doing so. On top of these reasons is that they may still be undecided on which specialty to train for. Others may want to redeem themselves or their families from the financial pangs brought about by the high cost of medical education. It could also be that they want to build up a comfortable financial cushion before going into residency training. There are some who probably want a more or less relaxed and less stressful lifestyle as a doctor, with "relatively" easy money flowing in, money that is not in anyway associated with the horrors of residency training. The last reason is actually valid because saying that residency has its horrors is actually putting it mildly.

If ever you decide to go moonlighting, I believe there are two things that you should remember.

First and foremost, bear in mind that moonlighting is just a stopover.  

It is not the be-all of your medical career no matter how big the bucks you are raking in from going on 24H-duties everywhere.  Set a limit for yourself,  a duration of time time you would allow yourself to go moonlighting before finally submitting yourself to training.  One year is enough, with two years being the longest.  Do not be blinded by the money.  Residency might force you to tighten your belt a little, but as I have mentioned in my previous entry, just bear in mind that after proper medical training, the money will follow.  That was exactly what my boss in Bohol told me when I told him about my plans of re-entering residency - "Money will follow, Inday." By then you are already a consultant, a recognized expert in the field you have chosen. You would become the master of your own time and you will not anymore be an employee of the medical institution, unlike when you are moonlighting.  The owner of the hospital is not even your boss, but your business partner, because you bring in patients to their hospital thus making their venture prosper.


Friday, November 16, 2012

Another good news for coffee lovers like me: Caffeine found to boost positivity

If you are a coffee lover like me, you might just have to add another reason to your long list of reasons for drinking that taste of heaven in a cup.

A new research done by researchers from Ruhr University in Germany found out that caffeine may boost positivity and save one from the claws of negativity that abounds in this world.

Sixty-six subjects were part of the study, half of which took a lactose placebo pill and the other half took tablets containing 200 milligrams of caffeine, equivalent to about two or three cups of coffee, thirty minutes before the test.  The test comprised of making the subjects identify whether or not a string of letters flashing across a computer screen were real words or not.

The subjects who took in the caffeine pill were able to spot positive words such as "happy" more accurately than the negative or neutral words.  

Looks like this ability of caffeine to boost positivity further supports a study published last year in the Archives of Internal Medicine, which included 50,000 women who are drinkers of two or more cups of coffee daily.  The study found out that  those subjects who drink two or more cups of coffee a day are less likely to get depressed.  

According to the health website, LiveScience, prior studies have shown caffeine probably stimulates the central nervous system by increasing activity of the brain chemical dopamine, which is linked with rewards, creativity, impulsivity and addiction. Since caffeine seemed to boost the positivity advantage, these findings suggest the root of the positivity advantage may rest in dopamine.


How to get through the hell called internship in the Philippine setting

Lately I found myself in the teaching and tipster mode.  I realized that some unknown force have rekindled my love for teaching. 

It’s teaching in the clinics that I have learned to love this time.

I have nothing against teaching in the classroom because that is the foundation of all the basic knowledge we have about almost everything, of course aside from the basic learnings and values being taught to us by our folks at home.

Teaching in the clinics is unique.  We can even teach ourselves and reinforce our knowledge with the wisdom of our senior residents and medical consultants – wisdom that is invaluable because it backed up by experience. 

As for teaching the medical interns, I always try to emphasize that being in the clinics is way different from the environment they have been used to in the classroom.  In the clinics, it’s the real deal – we see patients, we delve deeper into their presenting complaints, we formulate our clinical impressions, and we work them up to arrive at the final and correct diagnosis.  Along the way, we verify our findings in our patients with what is written in our books, thus solidifying our clinical knowledge, and hopefully, sharpening our clinical acumen or what is fondly called the clinical eye.

Let me mark this tipster/teaching mode with a list of tips for the interns on how to get through the hell called internship.  It might be too late now, considering that they are halfway beyond their internship, but I believe these tips will come in handy for incoming interns.  I hope these tips will shed light to an intern who chances to find this entry.  I don’t actually promote my blog, and only a few know that I have one.  If an intern happens to drop by my blog and read this entry, I hope he or she finds it worthy to stumble upon.

1.    First and foremost, accept your situation.  Internship is your fate.  It is your destiny.  Internship is you’re here and now.   You have worked hard for it for three years, and hey, don’t forget to include the three to four years you spent studying for your pre-medical course.  That makes it seven to eight years of toil before finally becoming a medical intern.  A lot of people are actually dying to be in your place right now.  You are actually on your way to fulfilling your dreams (or your parents and relatives’ dreams) of becoming a doctor.  Acceptance is the first key to success.  Accept internship as a blessing.  There is a song that goes, “Count your blessings, name them one by one/ Count your blessings see what God has done.”  Accept and name internship as one of your blessings, and thank God for getting you through the academic part towards internship.

2.    Cultivate diligence and hardwork.  Ward work, scut work, dirty work, those are the tasks laid on your shoulder as an intern.  You are at the bottom of the food chain.  Somebody’s got to start somewhere.  That bigwig consultant was once an intern.  Make that as your inspiration, and focus on the doughnut, not the hole.  

Think of internship as your initiation, your rite of passage, into the medical circle.  While you have the chance to perform procedures, go ahead.  Refrain from complaining, and aim towards achieving mastery in performing procedures like IV insertion, NGT and FBC insertion, etc.  

Read as much as you can about your cases while you are on duty.  You are more likely to sleep when you are not on 24-hour duty so you might as well read what you can, complete whateven paperwork you need to finish while you can and while you are still wide awake. 

Be early.  A Filipino adage goes, “Daig ng maaga ang masipag,“ but of course it would be better if you are both bright and always on time. 

3.    Practice the virtue of patience.  You may want to want each day to spin fast forward to your last month of internship but that will never ever be the case.  Take each day as it comes, and make the most out of each day.  Do what you can while you can still do it.  Aside from the fulfillment of helping to save a life, try to make it a point to have another reason to pat yourself on the back like, a new learning or a new skill or a completed task.    As much as possible avoid procrastination especially in your paperwork.

                Patience is a job requirement in the medical profession.  In almost every step of your career, you will meet a number of characters, and will find yourself in a situation, who will, and where your patience will be tested.  Internship is just the beginning of it all and it does not even come close to the tip of the iceberg.

4.    Get enough rest.  Interns are sleep deprived.  Sleep deprivation is that sinking feeling trying to swim over a sea of thick chocolate.  Take your vitamins.  Eat healthy food.  What you miss out in sleep you make up with intake of a lot of  good and healthy food.  Drink a lot of water. 

5.    Learn to unwind.  You have to find ways to be happy inspite of your situation. 

6.    Maintain an enthusiasm for learning.  Read and do all you can while you’re on duty.  Also, make it a point to have complete medical tools required in your rotation.

7.    Maintain a positive attitude.  Need I say more?  This too shall pass.  A positive attitude will also help you maintain a good rapport and relationship with your superiors and your fellow interns.  Nobody wants to be around someone who’s always grumpy, someone who always complains, and radiates nothing but negative vibes.

8.    Anticipate.  A resident loves an intern who anticipates what’s next to be done and down the line.  A clever intern who’s full of initiative that right after the resident successfully inserts the IV catheter, he would need a plaster to secure it.  It would speak a lot about you as an intern when you wouldn’t even give the resident the chance to ask for something like the plaster because you are handing it already to him.  The resident would know through that that the intern knows what he or she is doing and is not just a mere errand girl or errand boy.  This for me is actually the secret of internship so you wouldn’t be reprimanded or lectured upon by the stressed resident.

9.    Stop keeping track of the tasks you have done for your groupmates.  If there is one sure formula for a group’s downfall and for a group member to be really disliked by the whole group is to keeping count of the tasks you have done for your group.  As much as you can, go out of your way for the group’s sake.  Any task left undone by a groupmate will tarnish the whole group’s reputation.  It would also help that from the start the group agree on a consensus to help each other and cover up for each other’s asses no matter what.

10.   Dress appropriately.  Observe good hygiene.  No matter the situation you are in right now, you are still a doctor, even if you are still one or two steps away from it.  Make it a point to freshen up yourself at least twice a day or as often as you can, especially when you feel that your face is as oily as a frying pan already.  Brush your teeth ever after meals and please, comb your hair, and at least apply deodorant or spray on some fragrant body mist.  Maybe try to disguise with all that scent and aura that you didn’t have the time to take a shower at all .

          Internship is the only way to go.  Take each day as it comes is the favorite mantra.  But as long as you do everything well and according to the rules, you will only be an intern once.  This is only one of the many hurdles of being a doctor.  But once you reach the finish line of internship and finally walk on the graduation aisle, the exhilaration and the sense of fulfillment is beyond words.  You never want to go back to internship again but each time you look back, you dig through a big bag full of happy and maybe some unpleasant memories, and you say proudly to yourself, “I did it!”

Sunday, November 4, 2012

My vision of how medical practice would be like in the future

I was having my meals at the hospital kitchen when I found myself engaged in a conversation with my fellow residents about how medical practice would be like in the future.  Considering the amazing rate at which technological advances are surfacing in the field of communication and information access through the internet, it is not impossible that medical practice will experience ripples from modern technology.

            These days, going through the daily grind at the wards, I think at least one in ten medical interns owns an Ipad (or any tablet for that matter).  Although probably, most of the time, they might use it as an easy access to watch their downloaded movies or television series, they most likely have saved medical electronic books in those gadgets. 

            In this light, I was thinking, that probably in the future, all medical practitioners will own a tablet through which they can access all the data regarding their patients, particularly those who are admitted at the hospital.

            Picture this:  A resident admits a patient under the service of an attending physician.  The resident physician calls the attending about the admission, tells him or her about the presenting complaint of the patient, the resident’s primary clinical impression, and the laboratory tests which the resident plans to order.  The attending physician agrees to the resident’s plans, then before terminating the call, the physician asks the resident to send through text message the name, age, and room number of the patient, and the access code.

            Now what is this access code?

            It will be a code with five characters, which may be composed by numbers or letters or a mix of those, and it will be through this code by which the attending would access the general data of the patient as well as the laboratory results for this admission.  Additional access codes may be requested for hospital records from previous hospitalizations in the same institution.

            The access code will be convenient to both the attending and the resident physician.  The resident would not be bugging the people at the laboratory if the results of the tests are already available.  It will save the resident a lot of time from waiting for the final report to be sent to the ward. Aside from this, the physician could clarify the laboratory results for himself, in case he or she needs to.  

            I was also thinking of access codes so that the attending physician could see the patient through a CCTV installed in the patient’s room.  However I instantly developed aversion to this idea since I think installing a CCTV inside the patient’s room would go beyond the line of patient’s privacy.  

            I could not anymore recall why we started that conversation on how medical practice would be like in the future.  This vision may come true, it may not, but who knows? Now I remember, so crystal clear, that during my childhood days, I used to play telephone and I wished we only had to bring the handset itself - no bulky receivers or tangled telephone wires.  I must have had the first vision, the original idea, that gave birth to the mobile phone.  The mobile companies owe me big time then, if that's the case.  But then your sarcastic laugh brings me back instantly to reality.  It's time to go back to work and go back to the hospital ward.  (My laughter inserted here.)


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