.PARALLEL UNIVERSES.

Change of Shift, Vol. 2, No. 23

2008-05-15T17:34:00.004+08:00

Welcome to Change of Shift, a regular rounds of the best posts in the Nursing blogosphere! It is an honor to be the third physician moderator of this grand gathering. This carnival of posts comes to you live from Asia, in the Philippines!

I have always held nurses in high esteem even when I was a medical student. Sure, doctors do all the critical medical decision-making, but the nurses play critical roles in making sure that all the important clinical decisions happen. Without nurses, a doctor's life would be empty and crippled.

So, on with the show......

EDITOR's Choice Post - Do you have anything there to wipe off my tears? Blue. This is truly a heart-breaking post from MonkeyGirl.

Purely Nursing

As one goes up in the career ladder of nursing and becomes a manager, life does not become easy. Nurse Kathy of NurseConnect discovers the woes of "other duties assigned." She also promotes the need for healthcare organizations to adopt certain practices in their organization related to Relationship and Results Oriented Healthcare to improve practice, patient and physician satisfaction.

Nursing work and duties can be exasperating at times. This leads to disillusionment and Nurse Laura, also from NurseConnect offers the solution of role models to relieve the seemingly overwhelming problem.

Are nursing orientations only about getting paid for sitting, studying, and reviewing? Miss-elaine-ious has beautiful thoughts on the matter.

Where do nurses come from? From equally good mother nurses, of course! Nurse Bear pays tribute to all the wonderful Mama Nurses.

Kim, my wonderful nurse-blogger friend who made this hosting possible, offers some excellent nursing pearls for the next generation of nurses.

Nursing Relaxation

Almost always, nurses and doctors are always stressed, and it is not easy to relax even someone told them to. What to do? Take the awesome advice of Mother Jones as she discovers the wonders of needles. I will surely try this one of these days!

And to complete our relaxation and rejuvenation process, try the healing benefits of Reiki, too! The mantra is this:

Just for today, do not anger
Just for today, do not worry

Other Concerns

History and Cheek Biting - sarcastic and witty post from Max E Nurse.

Electromagnetic Fields and Preemies - is there a link? Not true. Not true. Nurse Sandy tells why.

Sleeping Pill Risks - another great post from TherapyDoc. I agree more with the alternatives like exercise and avoiding caffeinated drinks.

Brain Advice - that organ needs some form of exercise, too!

Water Woes - yes, water. The precious liquid. Student nurse Faith ranted a mouthful and it's worth reading. I experienced this one time, too.

Heal Your Prostate - a natural recipe for men having troubles.

Web 2.0 + Medicine - is a marriage possible? Or will it end up in divorce?

_______________

That's it for this round! I hope you get to read all the posts. They're all informative and eye-opening.

It was great hosting Change of Shift! Special thanks to Kim for making this possible.

The next edition will be hosted on May 29th over at Miss-Elaine-ious RN. Be sure to send your choice posts to her.

$500 a Month Lying in Bed?

2008-05-13T04:11:00.002+08:00

It's not a joke. NASA is said to be offering that kind of compensation for qualified individuals willing to undergo its Bed Rest Study.

Be sure to fill the application form if you are interested. Read the FAQ first.

If you complete the test, you'll get more than $15,000.00 as salary.

I just hope they cover you for possible bedsores and stimulate you enough to cure your boredom.

Mothers' Day

2008-05-11T05:05:00.000+08:00

"A mother's arms are made of tenderness
and children sleep soundly in them."
~Victor Hugo

TBR-8: Do We Practice What We Preach?

2008-05-06T04:30:00.007+08:00

Welcome to the 8th episode of The Blog Rounds, a compendium of select posts from medical bloggers of the Philippines. For this edition, I thought of asking THE one question which patients may be very curious about, but were hesitant to ask their respective doctors. Last week, I wondered if doctors follow and take their own dose of healthy advice. As they say, talk is cheap. Most of the time, what matters most is if we do believe and adhere to the things we often enjoin our patients to follow.

In the Philippines, aside from local town fiestas and Santacruzans, the merry month of May is also a month of annual medical conventions. Even as I type this, the Philippine College of Physicians is meeting once more for the 38th time at the SMX near the Mall of Asia. This gave me an idea of making this episode of The Blog Rounds unique. Imagine a plenary session of local medical bloggers and their patients. There's a row of chairs in the stage, and all the medbloggers are present. Now, instead of punishing their patient-audience with the drivel of boring lectures, visualize that the ongoing conversation is of the simple interview type.

Patients are asking questions.....and our local medbloggers are answering.....

Question: Do you also have a regular form of exercise or physical activity like you always tell us? How are you in losing the unwanted poundage in your bodies?

Dr. Claire: I have had periods in my life when I've had regular exercise --- but this period in my life is not one of them. I would love to swim regularly, but there aren't any pools anywhere near my house. Everything else is a no-no because I don't like to sweat and because anything that has to do with athletics makes me feel as graceful as a pregnant elephant.

JA: I don't exercise regularly. As a medical doctor, it's something I'm a little reluctant to actually admit. I have never set foot in a gym, and neither do I plan to in the future. I am already living such a tight schedule in my first year of residency and attending to other family and social obligations that this has been at the end of my set of priorities.

How about smoking? Do doctors smoke? Isn't that an amusing example of an oxymoron?

Dr. Gigi: I stopped smoking cold turkey 5 months ago, and I have not lit a stick ever since. I made the decision to drop the habit so that it will be less difficult for me to tell someone in the house that smoking will do more harm than good to his mechanically-impaired heart.

Dr. Claire: I don't smoke. I've never touched the stuff in my life, and I never plan to.

I was always teased being a couch potato. Being doctors, have you ever experienced being a couch potato?

Geekydoc: I got away with being a couch potato in early adulthood because I had little money and what little money I had, I used to buy books. I played sports when I could. I ate just enough to stave the hunger. Fast forward a decade later. I’m still a couch potato. I have more money but less time to read. What little free time I have, I spend sleeping or eating. Food, I’ve discovered, relieves stress.

Food relieves stress? What do doctors eat?

Pinay MegaMom: I still do eat sweets, drink wine, eat some fatty foods. My body needs a little bit of all of these, but in moderation. I have learned to ‘listen to my body’, by knowing when to stop when I am full, and not just because there’s still a piece of cake left or lechon at the buffet. [Pinay MegaMom also has an excellent 5-point program which you might want to emulate to change your BMI back to normal].

Dr. Ness: My word: Don't eat the oysters that are sold in the flat bottles. Best to eat the oysters direct from the shell (after it's been cooked), at least you know how clean your hands are! And don't eat the oysters on an empty stomach. I did that once and I vow never to do it again.

Oysters? Now, how about alcohol? Do you drink occasionally or are you on the verge of being termed an alcoholic?

Dr.Dorothy: .....more often than not, as long as I am not on duty, I am out --- on a "gimmick!" Of course, associated with that kind of lifestyle are the unhealthy activities that come with it – sleepless nights, drinking, smoking, drinking, eating fatty greasy food, and more drinking! (I was drinking alcohol like a fish! … Wednesdays in Greenbelt, Thursdays in Yaku, Fridays in Ponti and Saturdays in Capones! Haaaay. Those were the days…)

Can you tell us why as doctors you sometimes do not follow your own rules?

Bubbleman: In medical school I saw that doctors are not any different from the ordinary person. Having an M.D. does not place you on a moral high ground, nor does it enable you to preach.

Doc Louell: (just between you-and-me, ok?)I know a lot of diabetic internists who are still fond of pastries and a bunch of surgeons who can't seem to control their drinking spree.

That's it?!? You're saying that since you are no different from us, you can also commit the same mistakes? But you're all doctors! We look up to you as role-models. What can we learn from you?

Prudence,M.D.: My point is this: being able to follow one’s own preaching doesn’t necessarily mean that one is a better doctor. I think these all boil down to one word, CHOICES.

PDI: Now, the other big reason why we don't practice what we preach is that the medical profession is a TOXIC profession, the only profession that directly and mainly deals with something that is as sacred as life. I think it's life itself. Hehehe.

Bubbleman: If I'm not able to follow my own advice, I don't use the authoritative tone that we are expected to utilize in "educating" (or, more appropriately, scaring) our patients. I change into citation mode.

BoneMD: Sticking it out with "practicing what I preach" creates a "positive" impact on my patients and practice. But we all knew that, of course. In a provincial setting and in a community so keen on nitpicking physicians for their lifestyles, vices, and personal lives, I have to be on my toes always. Or I'll lose my job.

Dr. Em Dy: You all need to read the lessons under my Stress Management 101!

Martin Bautista, MD: If we should preach any particular message, it is that we neither live nor die for ourselves alone.

Joey MD: Maybe you should all try to take this "quiz" I made. It might help you decide what to do. Tell me what scores you got, ok?

Dr.Tes: Oh, give us a break!! Do we practice what we preach? I challenge you to tell me the answer yourselves by looking at these pictures.

____________________

Ok. Time is up! That concludes our blog rounds this week. I hope everyone now sees that doctors are human, too. We have our own set of flaws, and we get tempted too, as often as anyone else. Our medical degrees and licenses do not exempt us from "sinning." Far from it.

When we give our medical advice to patients to reform their unhealthy habits, we say that because we want to help them realize that there is an answer to THEIR ailments and there is a solution to THEIR medical problems. The keyword is "their," because as any well-meaning 'preacher' knows, it is easier to dish out great advice to other people. Following one's advice, however, is another story. Besides, doctors are sought not because we are paragons of healthy living (of course, we all wish we can be!), but because we are sworn to do so.

Listen to what we say, but don't do as we do....especially when you see us do the 'sinful' stuff.

Sure, we are old and knowledgeable enough to know that we should also avoid those dreadful trans-fats and that addictive nicotine. But like you, it is a challenge for us. Rather than look at this negatively, I think patients must realize that their doctors have their own share of demons. We also fight our battles. We get sick too, and we get afraid of injections and needles as we learned from Dr.Tes' hosting of TBR-4. It is my opinion that patients should never use their doctors' own bad habits as excuse for not following the 'healthy' orders prescribed to them.

Healing has always been a complex process. It is best to think that patients and doctors are learning from each other's interactions. We learn to empathize more with our patients' hardships and become more sympathetic of their plights. It helps us see the torment a patient undergoes when he/she tries to diet, to exercise, and to quit smoking. In the process, we want to learn more from each other and hope to end up both as winners in our quest to adopt a healthy lifestyle. Doctors learn a lot from their patients, and for this, we are always thankful.

Please tune in again next week for TBR-9: Mentors, Tormentors to be hosted by Pinay Megamom. Please check out the details here.

Thanks to all of those who participated here. It was an honor to host you all! I want to do this again in the future.

An Invitation: Do We Practice What We Preach?

2008-04-29T01:29:00.009+08:00

"Avoid eating large amounts of fatty foods like lechon and kare-kare."

"Exercise regularly."

"Stop smoking."

"Avoid salty food
items."

"Stop smoking already."

"If you're a diabetic, learn to avoid eating sweets ---
yes, that includes drinking sodas and iced tea."

"Please stop smoking now."

"No, watching TV and playing
video games are not forms of exercise."

"Avoid eating junk food."

"Can you take your medicines religiously?"

"Why haven't you
stopped smoking yet?"

"Consult your doctor regularly or at least once a
year."

"Sleep early and sleep at least 8 hours every night."

"How many times have you undergone an executive check-up?"

"What medications do you take?"

"Smoking kills. It has been documented and proven in studies. Doesn't that scare you?"

To my fellow medbloggers, friend nurses, and those others in the allied medical professions who blog --- I am sure you are all familiar with the statements and questions mentioned above. At one point, you must have heard yourself say and ask those things to your dear patients.

I will be hosting TBR-8 next week, on May 6, 2008 (methinks this year's annual PCP convention will coincide with this date), and the theme is:

I am inviting all of you to elaborate or to share particular stories and experiences why you practice or why you don't practice what we preach our patients.

Show where you stand, and do not be too shy about it. It is about time our patients knew if we practice what we preach.

Do we really lead healthy lives? If so, how healthy are we?

Describe your normal 'healthy' day.

What do you eat? What do doctors eat?

How do we exercise? Do we exercise regularly?

Do doctors smoke? Do smoking doctors find it difficult to quit? Do we even consider quitting? Why or why not?

How often do we have our own regular laboratory work-ups?

It is said that experience is the best teacher, and that the best way to teach is to lead by example.

How true is this in our case? Are we leading our patients by example?

Let me know by submitting your post links to me at doc[dot]emer[at]gmail[dot]com on or before 11:00PM of May 5, 2008. Please put TBR-8 Submission in the subject heading.

Thank you, and I hope to see you all here next week.

Top 3 Reasons Why I Love The Philippines

2008-04-28T23:26:00.008+08:00

Because I am deeply rooted here. Ako po ay totoong Batangueño [I am a true Batangueño]. My eyes are chinky, and in travels abroad, even foreigners mistake me for being a Chinese, Japanese, or a Korean. I always end up correcting them with a proud clarification --- I am a Filipino! I grew up in a once rustic town in Batangas, about 110 kilometers away from metropolitan Manila. It was a town where you can picture all the characters and events Camilo Osias wrote in his Barrio Life books, and where you can see in true color the details of what Fernando Amorsolo painted in his works. I spent my childhood and adolescence in the province. I played patintero, taguan, sipa, sungka, trumpo, and siato with classmates and childhood friends even when it was raining hard outside. There was no acid rain back then. LOL! I even swam in nearby rivers. While a good portion of what I knew then has now been replaced with buildings and restaurants, my good memories of how beautiful it was remains with me. Whenever I go back, old friends greet me like family.

Because I do not think our heroes were fools. Rizal, Bonifacio, Jacinto, Abad Santos, Magsaysay, Aquino and a host of other famous people we call "heroes" did not sacrifice their lives to see a horrible future for this country. These were intelligent people who saw the value and beauty of the Philippines. Their sacrifices shouldn't be wasted. They saw something worth dying for, and I believe that as a true Filipino, I should endeavor to give something back to honor what the heroes died for...even in my own little ways.

Because the 3Fs are here. The 3Fs are family, friends, and food. In the US and Europe, if you wanted rice or calamansi or patis or bagoong, you still have to go to an Asian store or Filipino store to get these items. You will always be surprised also how expensive they are there. Here, as long as people know you, they treat you like family. In case you have not noticed it yet, Filipinos are very personal on all matters, because of its family-oriented society. Once someone is a friend, he/she automatically becomes a Tito, Tita, Ate, Kuya, Nanay and Tatay --- all terms of endearment addressed to family members. Here, laws are not enforced fully because everyone thinks that since we are one big family, there's no need to be so serious about enforcing it. Hence, one can always cross the street even if there's no pedestrian lane, or one can always park anywhere even if there's a No Parking sign planted nearby. There are negative consequences, of course, and all of us know all about them, but as long as they do not immediately endanger any person, most of these are ignored and charged to a simple, "Ganyan dito, eh. Pilipinas ito." [It is like this here. This is the Philippines.] Then, this is either followed an authentic Filipino joke, and everone who hears it end up laughing. Another Filipino trait -- we have a unique kind of humor that makes every burden and heartache seem light.

I must admit there is a need --- no, make that a great need --- to improve. We do still lag behind our neighbors. We have soooo many problems. But progress here is defined in another way unlike how the rest of the world defines it. It is difficult to explain this to a non-Filipino, but for a Filipino like me, it is easy to digest. We are one big family. Sure, we have problems. But we manage, and we always try our best to survive.

On The Cebu Hospital Scandal

2008-04-25T05:07:00.008+08:00

The hype has not died down yet. The disgraceful incident is still seen on the nightly TV news, and still fills up the radio airwaves as well as the frontpages of the major dailies. The ways it has been referred to and described are assorted and numerous --- Surgery Scandal, YouTube Surgery Scandal, YouTube Doctors Scandal, Vicente Sotto Hospital Scandal, Cebu Hospital Scandal, YouTube Rectum or Rectal Scandal, Cannister Scandal, etc.

I have not seen the controversial video. But from news reports, it is said that the scandal involves the uploading of a video in YouTube showing doctors and nurses "laughing, giggling and cheering in the operating room."

Here are my unsolicited thoughts on the matter:

Teaching Hospital - the hospital involved in the case, the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu is a teaching hospital. Because I am also a product of a teaching hospital, I can now understand why there were so many people inside the operating room while the surgical procedure went on. As part of the teaching and learning process, senior doctors usually allow student doctors (medical clerks or interns) and student nurses to observe surgical operations. Most teaching hospitals in the Philippines are not equipped with a viewing gallery, where student observers can stay separated from the actual operation setting. So, what senior doctors do is allow the students inside to observe.

Unusual Case - having a patient come to you complaining of a 15-centimeter long cannister of perfume spray stuck inside his rectum qualifies as an unusual surgical case. It does not happen every day. Because of this, I suspect that the primary surgeon wanted this case presented in their weekly surgical conference. This is done with the consent of the patient, and I am quite certain that the patient must have signed a consent form prior to the operation. Hence, it is not surprising that an official video recording of the whole procedure might have been taken. The video uploaded in YouTube, however, came from a cellphone-camera. This means that, someone, other than the official video recorder, might have recorded the whole procedure using his/her cellphone.

Of course, it was wrong! Where can you find doctors that would allow photos to be taken that violate a patient's confidentiality? Regardless of whom you did it to, it was very bad." ~ DOH Sec. Duque

What Went Wrong - poor crowd control (there must be a limited number of observers inside the O.R.), and no clear enforced rules and hospital policies on unofficial and unauthorized recordings of surgical operations, whether an unusual case or not (I still wonder if each of those student observers knew how important it is to protect and respect patient's privacy). Clearly, whoever uploaded the salacious video did not know what "sacred trust" meant.

"Sacred Trust" - this is clearly stated in Article II, Section 6 of the Code of Ethics of the Medical Professionals in the Philippines. Every doctor, aspiring doctor, and even student nurses must take this wise guideline into heart. The sick patient is already in pain and suffering when he seeks medical help. Doctors and other medical personnel must not add nor contribute to the emotional anguish of the patient.

Art.II, Sec 6. --- The medical practitioner should guard as a sacred trust anything that is confidential or private in nature that he may discover or that may be communicated to him in his professional relation with his patients, even after their death. He should never divulge this confidential information, or anything that may reflect upon the moral character of the person involved, except when it is required in the interest of justice, public health, or public safety. ~ Code of Ethics of Medical Professionals

Who is to Blame? - a Catholic priest from Cebu insists that the surgical team shouldn't get all the flak from the unfortunate incident, "but it should be the person responsible for the indecent incident." Meaning? We should all castigate the patient instead? Hasn't he suffered enough? Before we point fingers, I suggest we wait until all the investigating teams have finished their work. Someone clearly erred in this controversy, but let us not commit another error by giving half-baked conclusions.

Filipino Humor and Homosexuals - Let's face it.....gays are still ridiculed in our society. Dolphy, the so-called King of Comedy, achieved this feat by playing various homosexual roles on film. I think he, along with a host of other comedians after him, helped a lot to perpetuate the way our society treats people of a different sexual orientation. Whether willfully or not, and given the Filipino's propensity to create homosexual jokes, I suspect many of those observing inside that O.R. were thinking a number of funny thoughts. When the perfume spray cannister was finally extracted, it was not surprising to see why so many of them laughed, and did it vociferously. It might be human nature to laugh, but it becomes very disrespectful when it is done at the expense of a poor, suffering patient.

Benefit of the Doubt - I have given it some thought that the boisterous laughter might not have been mocking in nature, but more of an expression of relief and achieving success after what would probably be a difficult surgical extraction of a large foreign object. It might be a case of misunderstanding, too. Surgeons are one of the most highly stressed among medical personnel, and surely, if they yelled as an expression of triumph after a tedious operation, certainly, there can be little fault in that. But hey, that's just me and my theories. The cat is already out of the bag and I bet many will not agree with me.

Shooting Our Foot - DOH Secretary Duque said the whole thing would have been "praise-worthy," hadn't we shot ourselves in the foot. I couldn't agree more. Remember the much-ballyhooed Teri Hatcher joke last year? Don't be too surprised now when you see or hear that kind of joke flourishing into more colorful versions. I bet it will! Let's hope the trigger-happy and sensitive ones among us do not pounce on her again when she does it. Foreigners have a different way of showing their amusement and humor. Besides, we have brought this latest incident upon ourselves, anyway.

P6M in Total Damages - this is what the victim is asking those whom he felt offended him. I have always believed that a person's reputation is priceless. If it gets damaged, it might be lost forever. My prayer is if ever he gets to win this case and collects the money, let the real issues not be forgotten. Collecting money is not the issue here; protecting patient confidentiality is. Everyone involved must learn and remember this always.

Jan-Jan, the patient, is asking P1 million in moral damages and P5 million in exemplary damages. He filed yesterday a supplemental affidavit to his complaint with the Office of the Ombudsman-Visayas. - Sun Star Cebu

Code of Ethics - How many physicians make it a point to review and read this guideline on a regular basis? I suggest that all hospital administrators begin posting this on every operating room for the ready reference of concerned parties. Also, for medical schools, make sure that medical students learn the importance of truly caring for the patient's needs and wants. It is never a fault to over-emphasize an important code of conduct, especially if it means avoiding another dreadful incident in the future.

Diagnosing Philippine Healthcare: When Dying Becomes The Better Option

2008-04-22T04:05:00.001+08:00

Bakit hindi lahat ng Filipino na may sakit o gustong magpatingin sa doktor ay natitignan ng doktor? [Why is it that not all sick Filipinos or those who want to see a doctor are not attended by a doctor?]

Ano ang bulok o MALI sa sistema --- kung may sistema man? [What is wrong with the system --- if such a system exists?]

Where is the GAP? Is it the health budget? Our politicians or legislators? Is this government incapacitating us to deliver basic health services to every Filipino?

Or maybe, there is also something wrong among us medical practitioners? Those physicians who treat their pockets more than they treat their patients illness? On the other end of the spectrum, do we have overworked, underpaid health care workers, who in turn, can't give ideal health service? What about the Philippine Medical Association? Yeah, what is its role in all of these?

What about our patients? Is it really just about the extreme poverty in this country that prevents our patients from seeking health services or is it MORE than that? Like skewed priorities? ~ MerryCherry, MD

Every Filipino has an answer what ails Philippine healthcare (yes, I'm one of those medbloggers who simply can't agree there is a 'system' that exists).

Ask them and they will certainly answer any or all of the following: no money, low budget, low salary, graft and corruption, no doctors, no medicines, no facilities, poverty, overpopulation, no efficient family planning method, expensive hospitalization, expensive medications, ignorance, etc, etc. True enough, every answer is correct. Worse, two or more of the said factors may be present in one place, and may all be contributing to the horrible health situation.

In Medicine, we use stages to describe the severity of a medical condition. Stage I is the mild stage while Stage IV or Stage V usually connotes a dire clinical condition. To use the analogy, I'd say Philippine healthcare is hovering somewhere between Stage III and Stage IV.

If I were the attending physician of this 'patient' called Philippine healthcare, I think the condition is not that hopeless yet, but as social problems pile one on top of the other, or as surprise epidemics and unexpected calamities occur and join the fray, I am very, very bothered about how my patient teethers on the brink of death everytime.

Another source of my extreme bewilderment is WHY the 'patient' isn't being moved to the ICU (intensive care unit) yet?

Why the seemingly cool nonchalance by almost everyone?

Everyone says there is something wrong. Everyone knows there IS something wrong. Everyone agrees something must be done. Yet, nothing we can describe as a "great solution" or a "curative approach" is being implemented as soon as possible.

To illustrate, I'd like to ask the following questions:

1. What has happened to the Cheap Medicines Bill? - every hour or every day that passes without this law means thousands of sick Filipinos suffering from lack of needed medication. Lack of medication = poor clinical outcome. One need not be a doctor to realize this, right???

2. Is the Senior Citizen Law being strictly enforced? - every doctor knows that geriatric patients constantly need a steady, uninterrupted supply of maintenance medication for their varied medical conditions. Clinical management especially for outpatients become problematic when old patients come to us and complain that big and small pharmacies only extend senior citizen discounts on pharma products on a limited basis (once a week or twice a month ONLY!). Nowhere is it enumerated in RA 9527 that there will be limited offers of senior citizen benefits.

3. Is the Tobacco Regulation Law being strictly enforced?- the premise has always been that most diseases are preventable. If we prevent one vital risk factor like smoking, there is a great chance that we can see less people getting sick.

4. Before we embark to promote massive medical tourism, why not show the world first that we can take care of ALL our people by providing them with world-class quality healthcare? - 'Just asking. I'm not really against medical tourism. I would just like to know why we can't prioritize our people first before our visitors? I think it will be good marketing for tourists if they see how well we take good care of our own.

Another analysis I would like to pursue is to analyze the behavior of the main cast of characters involved in this never-ending problem of Philippine healthcare:

1. Government - always blamed but because it is working with a very limited budget on health, whatever the DOH is doing is not enough to correct all the problems present. Its poverty-alleviation projects focus more on dole-outs rather than self-sufficiency. As a result, people are conditioned to be always dependent on government help.

2. Government Physicians - feeling they are not taken care of, choose to leave their posts and work abroad as nurses. While these doctors can't be blamed, it also means no one capable or trustworthy will be manning the provincial hospitals anymore.

3. Private Physicians - most charge sky-high professional fees for their quality care extended to patients. Discounts and free services are strictly reserved for close family relatives and best friends only.

4. Pharma Companies and Pharmacies - no move to drastically reduce drug prices (it's a business, after all). Sure, there are discounts, but still, most Filipinos still cannot afford to even complete a full-course schedule of antibiotics or be on an uninterrupted supply of maintenance medications.

5. Hospitals - private hospitalization is still better quality-wise than being confined in a charity ward of a government hospital. 'Problem is, it is also VERY, VERY expensive. So expensive, one can end up being discharged cure of his ailment but with a mountain of debt problems or worse, bankruptcy. Both government and hospital administrators have not really moved to improve the quality of health services in the charity sections. Why? There's no income there.

6. Patients - the unwitting victim of #1 to #5. It is not only the poorest of the poor who die without the benefits of hospitalization. I have witnessed very sick middle-class patients opting TO DIE instead of being hospitalized or be seen by a private doctor. Their relatives agree and sometimes even decide with a heavy heart to go with the fatal option rather than suffer a lifetime of debt or debt servicing. It is often a sad --- terribly sad scenario.

The alarming reality is that quality healthcare in the country exists, but they are reserved for the select few who have extra money to burn. The middle-class, the poor, and the very poor --- who comprise the bulk of the population --- must content themselves to half-quality service or NO service at all. Former Health Secretary Juan Flavier used to say, "Bawal magkasakit!" [It is forbidden to get sick] in one of his TV commercials. For most sick Filipinos, this admonition takes a different color. It becomes a rule and law for them. Because if they get sick, their options become very limited --- either they get better or they choose to die as quickly as possible to prevent expense and more worry for their loved ones.

The more alarming reality and diagnosis is the growing apathy about the whole situation. Everyone seems to accept that this is fast becoming the new norm.

BPA in Plastic Baby Bottles

2008-04-19T11:51:00.003+08:00

Overreaction or a prudent decision?

The Canadian government moved Friday to ban polycarbonate infant bottles, the most popular variety on the market, after it officially declared one of their chemical ingredients toxic.

The action, by the departments of health and environment, is the first taken by any government against bisphenol-a, or BPA, a widely used chemical that mimics a human hormone. It has induced long-term changes in animals exposed to it through tests.

[New York Times, 19 April 2008]

BPA, or Bisphenol-A is a compound used to make polycarbonate plastic and epoxy resin materials. Because it is tansparent, clear, and almost shatter-proof, polycarbonate plastic is used to make a variety of products like baby and water bottles. The problem is, according to a published report last February 2008:

When the bottles were heated to 175 degrees F (80 degrees C), every one of them leached bisphenol A at about 5 to 7 parts per billion. The report also suggested that because of the chemical makeup of bisphenol A, it may leach more in fatty or acidic liquids, such as milk or apple juice, than in water. [TIME, 08 Feb 2008]

The concern arises because BPA, even at low dose exposures, can mimic the hormone estrogen, and induce a number of hormone-related effects like early puberty, miscarriage, breast and prostate cancer, immune system changes, and low sperm counts.

There's an ongoing debate on its safety, however, because some scientific reports give conflicting findings:

In a 2006 summary explaining its review of bisphenol A safety, the European Food Safety Authority argued that animal trials of the chemical simply don't tell us very much about humans. For one thing, when humans ingest the compound, it's quickly excreted through the urine; when rats and mice eat it, it's released into the bloodstream and remains in the body much longer --- with much more time to throw off the body's sex-hormone balance, causing nasty effects. [TIME, 08 Feb 2008]

Meanwhile, Canada is not waiting for any more debates. Toxic or not, it is banning the plastic baby bottles.

TBR 5: Memorable Summers

2008-04-18T07:52:00.004+08:00

My choice cuts are Remembrances of Summers Past by Pinay MegaMom, Baptism of Fire by BoneDoc, and like the host, A Summer Like No Other by Dra. Mona is an eye-opener for all doctors starting their colorful careers.

Head on to Dra. Ness' site as she hosts TBR 5: Memorable Summers of Filipino Doctors.

"The Sarkozy Effect"

2008-04-15T05:30:00.002+08:00

Alpha male or not, I'm sure most men will say that even at 39, Carla Bruni is one of God's finest female creations. So beautiful, that alleged alpha males like French President Nicolas Sarkozy would die for.

While in France late last year, I was surprised that the French leader divorced his wife and later on was seen dating the beautiful supermodel Carla Bruni. On February this year, the two tied the knot in Paris. She is now France's First Lady.

In the past, Ms. Bruni was quoted saying the following:

"I'm monogamous from time to time, but I prefer polygamy and polyandry."

and

"I want a man with nuclear power."

Are alpha males attracted to women with bold beliefs? I still do not know how much "nuclear power" Sarkozy has left inside of him (LOL!) but I thought he made a colossal leap of faith when he decided to marry Bruni. How long will this marriage last? And I'm not even asking because I'm a pessimist, ok? I'm simply still flabbergasted by the rapid turn of events.

Now, before you begin espousing suspicions that I have shifted from health to rumor-mongering, let me bring you to an excerpt of an article I read in the Telegraph recently:

Surgeons at a Harley Street clinic say more and more "alpha males", particularly those who are marrying younger women, are going under the knife, with Botox and male breast reduction top of the list.

They have called the trend "The Sarkozy Effect", after the French President Nicolas Sarkozy, who last year married Carla Bruni, a former supermodel 13 years his junior.

The Harley Medical Group says 50 per cent more men aged between 35 and 55 had Botox injections to reduce wrinkles so far this year, compared with the same period in 2007.

Chin lifts, blepharoplasty --- the removal of eye bags --- and face lifts are also more popular than ever among what surgeons call FAMs --- forty or fifty-year-old alpha males. [Telegraph, 14 April 2008]

How far would aging men--- FAMs, as they are called in Europe --- go in order to please and win the affection of younger women? Do FAMs go through all the trouble of having multiple surgical corrections because they are madly in love, or because they want to validate that aging does not affect their zest for winning the loveliest and the most beautiful? Or is it both?

The cosmetic and plastic surgeons are all happy, of course. This is good business for them.

Discriminating Obese People

2008-04-13T06:00:00.003+08:00

As obesity rates continue to rise in the U.S., so might our acceptance of those who are overweight. But a new study from Yale University suggests the converse trend: rather than feeling tolerance in our society, the overweight and obese say they feel more heavily discriminated against now than they did a decade ago.

"If a person perceives he is being discriminated against," Andreyeva says [lead author of the study], "it might have significant consequences for his or her health and mental health. Even the perception of discrimination can be important because it is self-perpetuating." And if rates of weight discrimination are indeed on the rise, say the authors, then it's up to society to mandate legal protections for those who are overweight, just as laws protect people from discrimination by race, gender, disability and age. [TIME, 11 April 2008]

It can't be helped, I guess. Those who are different and those who often discriminate can't live harmoniously together. Cultivating a behavior of tolerance and respect for all always requires a certain level of maturity on people. And maturity varies from person to person. Discrimination exists everywhere. It can begin as early as the primary years in school. How many times have fat kids ran away crying from too much teasing by classmates? When they grow up, the same thing happens in the work place. It is mentally and emotionally agonizing indeed.

Legal protection? Will that work? Will society even pass a law making discrimination of fat people a crime?

BatJay's Mga Kwento ng Batang Kaning Lamig: A Healthy Book!

2008-04-10T19:00:00.002+08:00

BatJay, our homegrown prolific and award-winning blogger, has come up with another superb follow-up to his first bestseller Kwentong Tambay. Still yellow, it now has the spoofed caricature of one of my favorite superheroes swinging into action in its front cover. Now that there is talk of either a real or imagined rice shortage looming upon us, I think BatJay must have been some kind of clairvoyant for having perfect timing.

Inside info: BatJay now recommends food tripping on veggies and using them as excellent substitute for rice. Great and healthy idea, right? If one still prefers eating rice over veggies, he endorses cooking and eating brown rice instead. 'Still a good idea because most Filipinos still prefer white rice. Surely, shortage of brown rice remains a remote possibility.

Now, why I am I reviewing his book? Isn't this a health and medical blog?

Well, I, myself, was surprised to find out that BatJay's second book is also health and medically related. No, I am not pulling your leg. It is true! In the book, he offers unconventional health advice on matters people seldom talk about:

he offers an excellent tip on how to prevent premature ejaculation

he tells you the right way to clean your nose

he relates a story how love can help get rid of body odor (yes, it can!)

he reveals in a poem what food items to avoid if you suffer from gouty arthritis

In addition, he expounds on his own health experiences on the benefits of exercise and walking, taking good care of one's teeth, watching what one eats, and lastly, why one should stop smoking.

As a doctor, it is sometimes (very) difficult to exhort patients to quit smoking and begin changing their harmful lifestyle habits. This is particularly true in the Philippine setting. As I have related in a previous post, Filipino patients agree with their doctors inside clinics and hospitals. But once they step outside, it is a different ballgame. They seldom follow what their doctor told them. Filipinos, in general, do not believe in the virtues of prevention. They prefer to live life to the fullest no matter what the consequences are. What do they always say? "'Tis better to die full and satisfied, than to die hungry and with a horrible frown on your face!"

That is why BatJay's second book serving is truly a welcome development. He tells the benefits of staying healthy from a layperson's point of view. This is a great way to communicate with those patients who still hesitate in changing their harmful lifestyle habits. Another great thing is that one can finish reading BatJay's book in one sitting. It is never boring and time-consuming.
I highly recommend this book!

Like the first book, it gives the added perks of a detailed and comprehensive picture of how a Filipino overseas worker acclimatizes to foreign culture. It gives many other useful tips from paying taxes to buying your own house. Loneliness still remains as the greatest obstacle, but Filipino humor is constantly there to balance things and make everything run smoothly.

Mga Kwento ng Batang Kaning Lamig is now available at P120 each in the following local book shops: Bound, Popular Bookstore, Jade Bookstore, Precious, and Schoolzone. Next month, it will be available in National Book Store, Fully Booked, and Powerbooks.

On April 14, this coming Monday, at 4pm, BatJay will personally launch his book and sign copies from readers at Fully Booked in Bonifacio Global City. Go there to see and talk to him personally and say hello.

4th TBR: The Sick Doctor

2008-04-10T00:26:00.004+08:00

Everyone gets sick. "No one is exempted!" Even your doctor gets sick. But he is one of the most difficult patients to treat. Why? Because as a doctor, he cannot imagine a life as a patient. He is sometimes in a state of constant denial. He can sometimes have this silly notion that just as he can heal others, so can he heal himself, too. Therefore, he does not need any outside help to take care of his own sickness. That might be true sometimes, but certainly not all the time.

Some other revelations:

Like most patients, some doctors are also scared of needles. They abhor injections and blood extractions.

Most doctors, when sick, deny they are sick.

Some doctors think that they have this "unconscious pact" with God that because they care for the sick, God will guarantee them good health as long as they live.

"Only unrelenting pain, great weight loss, or catastrophic bleeding confirmed by the evidence of radiography or endoscopy awaken them to the reality that they have become patients." [AIM, 15 Jan 1998 | Vol 128 Iss 2 | Pp152-154]

"Sick doctors are lonely patients, isolated but on watch, vigilant against error" [AIM, 15 Jan 1998 | Vol 128 Iss 2 | Pp152-154]

Check out the 4th Philippine Blog Rounds brought to you this week by An Eye Doctor in a Third World Country.

Poisoned By Pancit!

2008-04-08T00:54:00.006+08:00

It was one of those nights. I arrived home late, hungry, and craving for Pancit. Sure, I could've stopped for fried chicken, or nuggets, or burgers, or even spaghetti on the many fastfood outlets I passed by on my way home. But after a hard day's work, a tired man sometimes wants more than the usual offerings --- and don't laugh --- for me, the 'extraordinary' means a dinner of hot, delicious Pancit. Only two types of pancit can relieve my hunger --- the miki guisado type and the famous Pancit Malabon. On that fateful night, there was no more miki guisado available and the nearest Pancit Malabon outlet was about to close, and I was only lucky to be granted the last order for home delivery.

When it arrived, I spent no time in devouring my favorite food. I think I almost finished half of the small bilao I ordered.

Minutes passed, and I began to feel a slight abdominal pain. I ignored it thinking it was only a mild gas pain. After more than one hour of lying in bed trying to sleep, the abdominal pain became worse. I started trying out different bed positions to relieve the gnawing pain but nothing worked. Nothing worked! The pain became both irritating and untolerable as I moved.

Then, it dawned on me.

"The Pancit Malabon!" I thought.

The doctor in me was yelling, "Food poisoning! Food poisoning!"

I should go to the nearest Emergency Room for treatment. The nearest hospital is less than 5 minutes away from my place. But I was both stubborn and torn. One part of me said I should get help immediately. Another part of me insisted that I can heal myself. It was a tug-of-war between two choices amidst a very irksome affliction. I felt stabbed by a long dagger. Not satisfied, whoever did it was also taking satisfaction twisting the dagger ever so slowly so I can feel every centimeter of movement. It was a terrible, terrible pain!

"How can I heal myself?!? I can't think straight with the growing unbearable pain."

I tried sitting down, standing up, bending, and lying down again, all with the ridiculous theory that I can drive the pesky gas to move out of my stomach.

"Darn! It isn't just gas! It is food poisoning!!! Go to the hospital...NOW!!!" admonished the doctor in me again.

"NO, I can do this. No hospitals! Breath in, breath out. Arggggh!! 'Can't think straight..." I felt as if my insides were being squeezed and shaken simultaneously in a slow, truly gut-wrenching manner. By this time, I can already feel the cold sweat in my forehead. My face had become nothing but a solidified frown.

"Get up!" I told myself. I went downstairs gently. I was like a terribly wounded soldier walking. On my way down, as I was almost getting convinced of going to the nearest ER, I spotted a bottle of antacid lying near my study table.

"There! Take 2 tablespoons of that, and see what happens..." advised the troubled doctor in me.

Minutes after taking the antacid, a certain calm enveloped my troubled stomach... only to be jolted later by the sudden onset of nausea and followed by explosive vomiting. That night, I knew first-hand what explosive vomiting meant. I threw up!!! Everything I ate came out. The sour stench of my gastric acids filled the air. This lasted for about two minutes.

"Goodbye, poisonous pancit! Good riddance!" I happily thought.

After that, there was complete relief. The stomach pain went away as if it didn't even happen. I was at peace once more. I was well again! My reasoning mind had its last words....."Emer, poisoning is easy to manage IF you get the poison out of the system!"

And I did. The explosive vomiting did the trick. But was it my management that helped? Or was it the normal physiologic reaction of my stomach to thwart and kick out unwelcome elements in my system? Was I just lucky to be alive again?

One thing I'm sure of --- it is always very difficult when a doctor gets sick.

Medical Grand Rounds - Philippine Edition

2008-04-02T23:54:00.001+08:00

es! You read that right! And no, that is not some belated form of April Fools' prank. The Philippine Medical Blogosphere exists, and is powered by many talented Filipino medical bloggers. Patterned after Blogborygmi.com's Medical Grand Rounds (hello, Dr. Nick!), the Philippine edition was born on March 11, 2008, initiated by the pioneering leadership of the Bone Doctor (just call him, BoneMD).

For the uninitiated, Grand Rounds is a weekly anthology of the best posts of medical bloggers. It can be about anything medical and health-related. It can be factual or based on experience. Usually, an editor/host is assigned to sift through a gamut of submitted post links, and from there, select posts for the weekly edition. Sometimes, a theme is imposed, and on other times, the host can accept everything he gets from the email submissions. Either way, the objective is to communicate to everyone the inside world of practicing the difficult art of medicine.

Like my fellow medical bloggers, I am excited to be a part of this local weekly get-together of ideas and experiences. I have hosted Dr. Nick Genes' GR four times already (1, 2, 3, and 4) and I was its first international host way back in 2004. God knows how much I wanted to start one like what is happening now, but my schedule always interferes. I'm sure you know what I mean. That is why I am so thankful that BoneMD was able to begin one we can all call OUR own.

Thank you, BoneMD!!! Keep it up!

So, what are you waiting for? The Blog Rounds, or TBR, is now on its 3rd episode, and is up and running over at Dr. Clairebear's Middle of Nowhere. Come and visit, and see what Filipino medical bloggers are talking about this week.

For guidelines, updates, and other information on how to join, please click here.