The truth of the matter is, even after 3 years of residency, another year of post-residency and a year of fellowship training; in this profession that I have grown to love and (sometimes hate), I am a newbie. I have just started seeing my 'OWN' patients in the outpatient department just this year. I have met many patients from all walks of life and in various forms, for I am in primary care after all. The mantra of womb-to-tomb, treat the disease AND the illness, the family is my greatest ally in patient care, etcetera - all that, I believe that I have learned by heart.
Even if I have my own share booboos; I still like to think that I don't have any problems with asking help from the other doctors about certain things or accepting my own limitations and mistakes in some aspects of disease management.
There is this adult patient who came in with a long-standing skin lesions, that I referred to Dr.GNG - only to find out that, if I had asked if a skin biopsy was done before, I would have known then that it is leprosy. There is this 19-year old, with amenorrhea, if I had been more specific in my abdominal exam, I would have known that she is pregnant even without a test. The list can go on, and it's just been 45 days!!!!
Family would often think that being a doctor would make me automatically financially rich especially now that I have finished my diplomate exam and fellowship training. I have also been invited to join the faculty of the medical school. "Consultant." Nice to hear. I am quite proud of what I have achieved but right now it did not do much in improving my bank account. Nope, I am not forgetting that money is certainly, not everything. But it would be nice if it will help me afford some of life's luxuries.
In the current state that I am in, I feel that my capacity to practice what I have trained for and apply what I have learned is limited by the same (some) people who were once my mentors and by the bureaucracy that I am a part of.
It can be tiring when almost everyday, I try to let other doctors and the staff understand what are my competencies. It seems that the certifications that I have earned through years of toil are not enough for me to be granted that admitting/clinic privileges.
In my understanding, this is how the system is working- we have the EXECOM composed of department heads who convene to decide on whether or not one gets to have the clinic space or the admitting privileges. From the information that I have gathered, there seems to be the hesitancy in granting me that privilege because of my being a Family Medicine specialist and that I therefore belong to the OPD only plus, I might usurp patients! These are perennial issues and it would be such a waste of time and effort if I go around educating every single consultant what the specialty is about.
I would be doing a great injustice to patients and their families if I will treat them for something that I know so little about. This is just one of the reasons why a specialty society has a set of competencies that needs to be mastered before becoming certified (well, at least, in PAFP).
In a resolution submitted by Sen. Manny Villar during the 14th Congress (http://www.senate.gov.ph/lisdata/80747294!.pdf), he made mention that the doctor:patient ratio was at 1:28,000 when the WHO placed the ideal ratio at 1:10,000. How could I possibly usurp patients with this statistics?!
Do I need to emphasize that I am responsible and capable of providing comprehensive health care to every individual seeking medical care, and that I can arrange for other health personnel to provide services when necessary; that I can accept everyone seeking care whereas other health providers limit access to their services on the basis of age, sex and/or diagnosis; that I care for the individual in the context of the family, and the family in the context of the community, irrespective of race, culture or social class; and that I take personal responsibility for providing comprehensive and continuing care for my patients. (http://www.globalfamilydoctor.com/publications/Role_GP.pdf) Do I have to, really?
I feel lost. I need to take a stand and treat matters more aggressively. I need to make my domain known. There is much to learn for a newbie like me and the whole world to explore.
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We cannot allow efficiency, bureaucracy, competition, or technology to divert us from keeping our covenant to be there for our patients from first contact to last resort. Advocacy for our patients and for our unique role is central to the future we share with our patients. (http://www.stfm.org/fmhub/FULLPDF/APRIL01/2001-33-4-273-277.pdf)
