When Things Go Wrong

Would life be better if all the things that I wanted is always served in a silver platter? Would I be saved from crying bitter tears, from the frustration or from heartache? 

So, What Now?

I have been sad borderline frustrated about how the Team is handling my case. They are still "talking" about my application for admitting privileges. They asked the Department of Family Medicine to furnish them with an guidelines for admissions, for which I helped in drafting.  I can only guess about their perception of Family Medicine. Is this about patient turfing? I don't know, because I feel its too lame to be used as an excuse. After all, it is a specialty both here and abroad, even qualified to be gatekeepers of health care in Europe. Patience is a virtue.

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I received two significant emails today that got me excited; which I am taking as one of the unique ways God is encouraging me to pursue what He has prepared for me. 

1.   A patient with chronic pain from the United States inquired through the Filipino Doctor for a physician who could help him with his pain as he is preparing to spend his retirement in Dumaguete City. I hope I will be able to practice what I have learned from my fellowship on pain management. Most importantly, that I can make a difference in the life of this patient and his family.

2. The most exciting of it all, is knowing that a Sillimanian based abroad, is interested in starting a community palliative care program. I have committed to help her in this endeavour. Based on this first exchange, she wanted to start by educating the students and the Silliman community about what palliative care is and its goals. 

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Julius and I are currently in the "medical process" of finding out if we can have children or not. We have been married for almost three years and there is no sign of a baby yet. Hopeful.

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People and circumstances may delay it but truly they could not stop it.

Clinic Hours

My husband would have preferred for me to have the usual out-patient clinic hours that other physicians keep -  the nine to five thing with lunch break in between and the occasional after office hours consultations. Instead, I am keeping a twelve noon to nine in the evening clinic from Monday to Saturday. It is unconventional but it does serve its purpose(s).

The hospital I am affiliated with is trying to up-build her emergency and ambulatory care services. Based on the patient census, this is the time wherein most patients and their families would come to the ER for consultations; and they are not necessarily emergency cases. Most of the time, its either their preferred physicians are no longer holding clinic for the day or has reached a limit in the number of patients to be seen for the day. Or they just do not want to wait, period. The "OPD-ER Extension Clinic" will decongest the ER of the non-emergency cases- somehow discipline the clients about emergency cases vs ambulatory cases. 

This schedule has also allowed me to have late mornings, spending it with my husband over brunch in most days of the week. I can also schedule errands/other appointments in the morning;  and starting this June, I can hold classes in the medical school in the morning. The morning is also spent catching up with other administrative work for the residency training program.

Since I have always believed that there is always a time and a season for everything, I am pretty sure that there will be more reasons for me to keep this schedule in the days to come. And yes, my husband has come to accept this schedule and has also found ways to "complement" my schedule.  

 

definitions

Palagaylay - is a term that I first came to understand when I started my post-graduate training at Silliman University Medical Center in Dumaguete City. It could mean dilly-dallying, dragging your feet or delaying.

And it is something I wanted to do after a week of hospital work. ",)

The TroubLe with Being A NewBie

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)

Shout Out for 2012: Joshua 1:9

"Have I not commanded you? Be strong and courageous. Do not be terrified; do not be discouraged, for the Lord your God will be with you wherever you go."

 Thank you to the Silliman University Church Service today for this reminder. I am truly blessed.

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 The year 2012 started with a challenge - how to pack all the materials things that I have accumulated during my fellowship year in Manila without earning the ire of my patient husband - and I failed. I had to pay a considerable amount of money to Cebu Pacific for the excess baggage. Countless times has my reminded me to send some of these things ahead of time but I procrastinated. Yes, I have to admit that I really am a Hoarder and I hope to make every effort to improve.

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I have been told by those who have come before me that I will face the considerable task of making palliative care be known, understood and accepted in Dumaguete City. I had to prepare myself; and I knew, even at the beginning, that could not do it possibly do it alone. It is in the moments of hesitation that I became more conscious of the people and circumstances that God has presented to me. 

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 The most basic virtues still apply - patience and perseverance, humility and love.