Wednesday, August 22, 2018

The Crossroads in a Physician's Journey

Replying to one of the emails/comments from one of our readers, Jesselyn, in The Tipster: The Idiot's Guide to Residency.


Good afternoon po Doc. :) I recently passed the board exam (March 2018). And I still can't believe that I am already a licensed doctor. During med school I already had the idea of going to Internal Medicine with an interest in Nutrition and Allergies. But right now, I feel like a blank piece of paper. I don't know what to pursue for residency. It seems like I always doubt myself in pursuing such a busy, stressful and demanding training. I do admit being a sickly person (asthma, allergic rhinitis, menstrual problems, so on and so forth). My place is like a pharmacy bec. I have a lot of medications. Some of my seniors would even ask me why did I enter this field knowing my health condition is quite poor. Being a doctor wasn't really my first choice bec. I was thinking that my health might not be able to cope up with the stressful environment as a physician. But when my late grandfather told me that he wishes me to enter medicine, I took a chance. I made a promise to myself that for every year that I pass med school, I shall continue my craft to be a physician. And so I did. But in between those success in passing are the days and even weeks that I am not feeling well. I even had instances where my allergies flare up during exam days, and I had no choice but to take medications. Sometimes I find myself sleeping during exam. Our Dean would always tell me that I am incapable of being a good doctor and just quit. But for every time I get through these exams and hear the words "thank you" from my patients, it lights up my eagerness to be a doctor. I accidentally found your blog po Doc while I was scrolling down at Google search for what should I do in choosing residency training. I have read a few articles just now and I was really inspired. I hope to hear from you po Doc. God bless po :)
 I have posted it here so it can reach more readers.


Hello Jesselyn!

I am so sorry that it took me quite a long time to finally reply to your comment.

First of all, I would like to thank you for taking time to read my entries. It does not matter that you found this blog serendipitously because that is how most readers found their way here. LOL! What matters is that you have found a companion, a confidante, as you begin your journey as a physician. There is nothing better than touching a person's life and I believe that somehow in my own little way, I have touched your life, and that is more than enough to inspire me to go on nurturing this blog.

Second, allow me to congratulate you for passing the physician licensure boards. Congratulations, Jesselyn! You made it! It is undeniable, it is on paper, and the PRC can give proof that you are a licensed physician! This victory, this triumph, definitely cancels out all the discouragements you have encountered before earning your license. Do not waste time dwelling and fretting about what has been said to you then, those comments might have propelled you to where you are now and that's it, those comments have served their purpose, which is to challenge you so that you can prove them all wrong. So again, congratulations! Our journey as physicians is actually not without trials and frustrations (sorry to break your bubble with that) but those tribulations will only mold us to become better individuals and able physicians who can deliver quality care for our patients. You've surpassed all those hurdles in health, in the people around you, etc., it would not be impossible that you will overcome other trials in the future. Hard but not impossible. Besides, that is life, Jess. We will only stop encountering challenges once we join the flatliners. So congratulations again, and rejoice! Life throws lemons at you because you are alive and it knows you can make lemonade out of it.

I could still remember that very first morning after the night when I knew I passed the medicine boards. The sun emanated an unusually pleasant glow. The meal I ordered at McDonald's tasted differently in a good kind of way, and lastly, I could not hold my smile. That's how victory felt and maybe, tasted.

Now, as we enter this milestone, we are beset with a lot of choices, like multiple decks of cards laid and neatly arranged in front of you, each card almost silently screaming at you to take it.

Well, how do I help you with this. 

This may sound cliche or cheesy but in this aspect, it would make sense - I say follow your heart. If you decide to go into a particular specialty for training, be sure it is the specialty that you see yourself practicing in the future. You have to set your eyes on the doughnut and not the hole. The journey to the finish line will be very challenging, I tell you, ( I found myself crying almost everyday when I was in training) but just think of your goal and your purpose. Just remember that short-term pains will lead to long term gains. However, let me emphasize that as much as possible, avoid setting money or being rich as your primary motivation. Of course, as doctors, we are assured of at least a comfortable life, but it is different when your mindset is, you wanted and indeed you became a doctor because you wanted to be very rich. In my honest opinion, money as a motivation, will easily make you dwindle and wither specially with the harsh reality of this profession - the almost unattainable expectations from your patients, your colleagues, and the workplace in general. This mindset which is mainly centered on money will easily lead you to the thought that anyway, there are other ways to earn big bucks, and even bigger than practicing to be a doctor. In other words, commitment is the key here. A consultant once told me that just do what is right, just give everything your best, and money will follow.

I hope this helped, Jess. God bless you in your journey and who knows, by chance, we would meet somewhere sometime soon in one of our conferences. 

Mabuhay ka!

Thursday, August 2, 2018

What’s your excuse?

The woman in the picture, carrying her newborn child was referred to me for medical clearance for surgical procedure. In the middle of my interview with her, my attention was diverted to the man in the picture, who was sitting at the foot of the bed. He was in fact, her husband. 

I even looked closely (yes,like, literally) to check if I was seeing what I was seeing then. Both of his eyes were blind. His right eye had a dominant opaque lens and it exhibited a right-sided nystagmus. I asked as politely as I can and he told me he has been legally blind on both eyes since the age of six as a complication of measles.

In layman’s term, legally blind would mean he cannot even perceive light on both eyes. Pitch black.

I went on to ask him what he does for a living, and he said he makes cabinets and furniture. I was even amused how he is able to pull that off considering that he has to mark his measurements on wood and cut the wood too. He just smiled and said it may sound unbelievable but that is  what he does and his smile was beaming with pride when he told me that the products he builds and puts on display does not stay idle very long and are sold out after a few days. He also accepts other errands that would give him pay after a day’s work.

What struck me even more was the absence of even the slightest hint of bitterness in this man. He was smiling most of the time when we were talking, not because of embarassment, but simply because he had long accepted his reality and is at peace with it.

He even mentioned something to the effect that his mother probably forgot to have him vaccinated against measles when he was young. He ended that statement with a soft chuckle, giving me the impression that that does not matter a bit at at all. That is small stuff now.

He is at peace, even if he does not run out of trials, to add to his condition. His wife of 22 years just gave birth to their newborn baby boy, their 7th baby (7th heaven?) - adding to the six small mouths he already needs to feed - not including his wife’s and his. 

Amidst all that, he maintained a positive mindset, confident that they will surpass all these trials and that the Almighty will not forget them and forsake them. He was kind of worried though if ever they would need to stay longer in the hospital. A longer hospital stay would mean a loss of opportunity for him to earn for his family. Now that gives us more than a hint of the diligence, perseverance, and sense of responsibility that this man has. 

I may not exactly be super duper pious but I concluded our conversation by blessing him and wishing him well. Here is a man deprived of his sight since childhood but does not consider it as a hindrance to work hard for his family. His disability did not even succeed in crushing his hope for a better life for him and his family.

He may be blind, but his eyes which have long become strangers to light, are radiating with a lot of positivity of the almost blinding kind. 

He is an inspiration.

Now, what’s your excuse? What’s our excuse?

Note: Photo taken with permission. It shows in their smiles, doesn’t it? :D

Thursday, March 8, 2018

To go public, or not?

I was more than delighted to receive an email recently from one of my readers.  I am posting it here hoping to enlighten more doctors, specially the young ones who are finding themselves at a crossroad in their career path.


Good day po, doc.  I have read your blogs regarding residency and I just want to ask you questions lang sana if it's okay.  I just passed the board exam last march 2017. I've been moonlighting na ever since. I plan to go on residency by Jan2019. I'm planning sana to take IM. I wanted to try applying in private hospitals in Manila but medyo takot ako na baka di ko masustain ang mga needs ko with only limited salary. I cannot depend on my family naman. Kaya option ko n rin magpublic hospital para at least bigger ang pay. May I know what residency did you go into? And if private or public hospital ba pinili mo? I just want sana to at least have an idea. Thank you, doc! - Nicole


Hello Nicole!

Thank you for taking time to visit my blog and read my entries. At least, in my own little way, I can be of help specially to budding physicians like you.

I had my residency training in Internal Medicine in Cebu Velez General Hospital in Cebu City. It is actually the base or mother hospital of my alma later, Cebu Institute of Medicine. It is a private hospital, and I admit, the pay is a bit meager compared to that of public medical institutions, therefore I had to make a few adjustments particularly with regards to my expenses.

Actually, my pathway to residency, and to finally completing it, was quite unique in the sense that I went into residency twice.

The first time I went into residency, I was a total newbie, fresh from passing the boards, with barely any savings at all. 

The year was 2006. Still high after nailing the licensure exam and oozing with desire to be independent and to take a load off my parents’ back, I moved out of the apartment I rented when I was a medical student. I knew that my monthly salary of... (drumroll please).....
Php. 12,000.00,  would not be able to support my simple lifestyle (yes, simple, no kidding!) so I chose to avail of the free board and lodging offered by the hospital.

Free lodging meant we had our own rooms at the upper floor of the hospital, free water and electricity - not a bad offer at all, except that the upper floor above ours, was where the owners of the hospital live, and when we went down one level, it was already our workplace, our battle grounds - the wards. Still not bad. No transportation expenses at all in going to the workplace. Those were minor, almost negligible hurdles compared to the challenge called residency. 

Free board meant free food from the hospital dietary - still not bad because we would occasionally have lechon kawali, pork barbecue, freshly-squeezed kalamansi juice (yes, healthy!), and I am a fan of a number of the dishes they serve even if I have been their customer for half a decade. At least I could brag and say, there is such a thing as free lunch.

I finished the first year in residency but decided not to continue to the next level since I decided to try my luck with the USMLE. I spent four years working for my American Dream and during that span of time, I moonlighted in another private hospital in Tagbilaran City in the beautiful island of Bohol. 

It was during my moonlighting stint that I was able to get hold of a relatively large amount of money that I did not encounter in my life - not really in the million levels but pay was never better than I have known since I started my career then. I was able to afford stuff that I wanted, on top of my needs. It was also during that time when I brought for myself my very first investment, a life insurance from Sun Life. I am proud of that achievement and I consider that as one of my remembrance purchases during moonlighting - something that will outlast that gig of mine. When the time came that I had to go back to residency, I had to face the fact that adjustments had to be made once again.

Presently, I am an employee of the Philippine government, since I am affiliated with a DOH-retained hospital in Mindanao. I can say compensation is quite satisfactory.

For you, Nicole and for budding doctors like you, I have enumerated the following points, which I believe are major issues that need to be considered in choosing which hospital to train
-- private or government-owned. "To go public, or not?" -- that is the question that we all hope to answer.

1. Work load -- To establish a baseline idea,residency is like a vampire that only desires to suck out all the life and blood out of you. Do not get me wrong here. I favor residency training as long as your circumstances would allow.  I am not trying to scare you or discourage you from going into training but at least I want to give you an idea of what you will soon be getting into. In my own humble opinion, work load is a little bit - just a teeeeeeeeeeeny weeeeeeny bit - forgiving in the private hospitals. In the government hospitals, aside from your designated job description as resident, you might find yourself also doing a lot of scut work, like pushing wheelchairs, extracting blood specimens yourself, sending specimens to the laboratory, and other stuff like that. I even hear testimonies from fellow physicians that they go as far as buying stuff like IV catheters for their patients using money from their own pockets. Government hospitals, specially the referral centers, are always flooded with patients, it's like there is a party at the Emergency Room every single day. You have to prepare yourself for that reality in case you go for the government hospitals.

2. Compensation -- Dito naman bumabawi ang mga pampublikong ospital. A lot of doctors nowadays are finding themselves in government hospitals because of the very attractive compensation. The government gives 13th and 14th month pay, that's one month of your salary that is tax-free. There is what we also call Philhealth sharing among the hospital
employees, wherein we receive our share of the Philhealth earnings of the hospital. Sharing could be at least Php 5,000.00 every month, that is on top of your monthly salary, monthly laundry allowances, uniform allowances, hazard pay, and many others. I knew all about this when I started working for a government hospital. In this case, all your efforts and sleepless nights actually pay off as you find yourself laughing as you pay a visit to the ATM machine to check on your salary. In the private hospital where I trained we only had the 13th month pay
to look forward to, and a modest love gift from consultants, which both come in December, that's all.

3.  Conducive learning environment -- Now this would not depend on the hospital but this one last issue depends on you, the main player of the game. Just ask yourself, in which environment will you find yourself at the peak of your learning. In which environment would you feel more motivated to work and learn at the same time. Remember that residency is all about learning the ropes before we go into the real world. It is all about learning skills, developing good habits and clinical practices, and sharpening our clinical eye. Which environment will bring out the best in you?

To come up with a decision, consider each issue carefully and just be honest with what you feel about it. Remember, you are at the receiving end of the outcome of this major decision you are going to make. Be kind to yourself first, so that this kindness will radiate on to your patients, whether they find you in a private or a public hospital.

 I wish you all the best and I hope that somehow this has shed some light to your queries.


Keep the e-mails coming, dear readers.

Thank you.

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