Filipinos in general,  have some peculiar, health and physician consulting habits  It’s an observation many of us (physicians) noticed even before my generation of medical professionals. Surprisingly, we somehow developed  an adaptive, physician-patient working environment that is “attuned” to such behavioral peculiarities. Even if sometimes, they are as annoying as fascinating as they can be!

Some words of caution though and a bit of a “disclaimer”. I’m pretty sure these are not unique to my set of patients nor to my field of specialty. Also, I am not saying these habits are trademarks or are unique to every Filipino patient out there. There are plentiful of exceptions and there are probably a hundred more similarities with another nationality. Certainly, I don’t want to stigmatize Filipinos but I’m sharing across a set of unique habits that sometimes hinder delivery of health care.I am not passing any judgment on these also, since I believe, talking and working these out with your personal physician is best in curbing some of these peculiar habits.  Let’s do away with those and read on my observations. Feel free to agree or disagree by commenting afterward.

1. A lot of patients seek consult about their health problems late in the stages of their disease. Pag malala na saka pa lang ipakonsulta.
2. Many seek physician consult as a last resort. They go through the rigodon of first seeking the opinions of these people : neighbors, friends, albularyos and then finally a physician. I still get patients who have their x-rays taken because a bone setter told them to do so. Rarely, I get referrals from them, with x-rays already!
3. Some patients really like to switch the urgency of their diseases on their own- an emergent problem needing immediate physician attention to a non emergent problem and vice versa. Pag emergency ang kaso, palipasin muna ang ilang araw bago dalhin sa hospital. Pag di emergency naman sa Emergency Room agad ang punta at nag aapurang makita ng duktor.
4. Most patients love watches but hated time. They’re in the habit of seeking consult outside the physician’s clinic schedule. A plethora of excuses may come your way, ranging from the death of some relative, to the death of someone elses’ dogs.
5. A lot of patients do listen, but rarely ask questions or clarify their health problems. They leave your clinic nodding and then call their docs when they get home. The usual question? Anu nga ba yung gamot na iinumin ko doc?
6. Some patients do not want to wait in line for consultation. So they employ all sorts of maneuvers to go inside the clinic first only to remember they haven’t got their lab exam results yet!
7. “Kaw na bahala doc, kung anu yung pinaka maganda na gagawin sa akin “-Is the most common response  I get whenever I ask patients what’s their decision on the options of treatment I just lengthily explained to them.
8. Most patients do not know what medications they’re taking or for how long they’re taking it already. Others skip medications and drink only on as per liking basis. Despite, take note, despite their docs telling them about it and giving them prescriptions.
9. It’s not unusual to see a patient taking an antibiotic for a month thinking it was some sort of vitamins. And they think antibiotics are as harmless as candies.
10. Some patients ask for medical advice that they rarely follow or worst, do the exact opposite. There’s always the physician to blame for unclear instructions.
11. Frugality aside, most pinoys give less priority to their health than things like a new dress, eating in a restaurant, malling, alcohol, loaded diet and all other things except the word health.
12. Vitamins is the most sought after “drug”. Second is an albularyo. They are not drugs and many don’t need any of them anyway.
13. The macho guy patient is the cry baby. Ask the nurses who give skin testing for drug medications in the ER.
14. So far, the best and effective form of advice I gave is, surgery. If you tell a patient you would operate on him if he won’t follow the medical treatment you give, 90% of a time, he’ll do the medical advice. Works wonders for me.
15. Many still think that unhealthy diet, obesity and lack of exercise can only kill patients other than themselves. So party living in the meantime is necessary, until it gets worse.
16. Those who swear in front of their physicians,  are most likely the first to break them.
17. Most have this habit of comparing their disease to other diseases of another person, even if the two entities are kilometers in difference. Then they worry about someone else sickness and not theirs.
18. Some patients do pop out like mushrooms on rainy days, and disappear suddenly like thin air on good days. Nobody follows up when they feel good up front despite the careful advice of a close follow up.
19. Many prefer to have their children seen at the slightest fever, rather than themselves when they are spitting out blood.
20. The last but certainly not the least annoying is, patients believe and only follow the medical advice that they like. This selective understanding is often used to support an unfounded belief and realigned to suit a particular socio-cultural belief and tradition.
21. (Updated) The bantay (guardian) system. On the positive side, we rely on bantays to assist us in providing personal care of the patient. But sometimes, some Pinoy bantays are really just mirons (kibitzers) and just meddle on issues for the sake of gossiping. Whew!

So, these are all I can think of for now. I’m sure there’s a lot more to tell but well, I’ll leave the others to my colleagues! So which among these traits or habits do you have as a patient? Leave a comment to reply!
(Update: After I wrote this article, I stumbled upon Doc Emer’s posts some 2 years ago about the same topic. We have strikingly similar observations in not a few instances! Here , have a good read on his post)
Photo credits: Photo taken from here

Copyright secured by Digiprove © 2011 Remo Aguilar

Here is one concise analysis of the UP-PGH Directorship issue from the former dean of the UP College of Law, Raul Pangalangan. Original article can be read here in his column in the inquirer.net.

Unceremonious unseating of UP PGH director
By Raul Pangalangan
Philippine Daily Inquirer
First Posted 22:39:00 03/04/2010
I AVOID writing about faculty intramurals in the University of the Philippines, preferring to talk instead about the more benign politics of murders, massacres and wars. However, the recent unceremonious ouster of a sitting hospital director smacks too much of Malacañang-style politics that writing about it, come to think of it, is just like writing about President Macapagal-Arroyo.
On Dec. 18, 2009, the university’s Board of Regents appointed Dr. Jose Gonzalez as the new director of the UP Philippine General Hospital. I do not know Gonzalez, have never met him, have never spoken to him. I also do not claim to evaluate his qualifications or platform. I write solely about the sheer brazenness of his ouster.
The university is governed by the 11-member BOR, consisting of two co-chairs (the Commission on Higher Education chair and the UP president), two seats for Congress (one each from the House and Senate), four organic members each chosen respectively by the faculty, students, staff and alumni (“organic” in the Gramscian sense), and three non-organic members or as the Philippine Collegian loves to call them, “the Malacañang appointees” (a four-letter word in Diliman’s lexicon, as you can imagine). Gonzalez won by a 5-4 vote. He got the vote of all the four organic regents plus the tie-breaker by the CHEd chair.
On Jan. 4, 2010, the first working day after the long Christmas holidays, the BOR officially announced Gonzalez’s appointment. This is where the story starts to get exciting. The next day, at around noon, UP president Emerlinda Roman announced that one of the non-organic regents, former Supreme Court Justice Abraham Sarmiento, had filed a protest letter to strike out the vote of the student regent, Charisse Bañez, on the ground that she did not enroll for the second semester. On that basis, Roman appointed an officer-in-charge for PGH, which provoked opposition. On Jan. 7, the long-delayed formal appointment of Gonzalez as PGH director was finally released and on that same day, he took his oath.
In its January meeting, the BOR upheld Sarmiento’s motion to declare the seat of the student regent vacant and to nullify her vote in the earlier decisions. The organic regents walked out: faculty regent professor Judy Taguiwalo, staff regent Clodualdo Cabrera, and Charisse. Alumni regent Alfredo Pascual, president of the UP Alumni Association, did not participate in the vote.
In its February meeting, the BOR nullified the appointment of Gonzalez and elected Dr. Rolando Domingo as the new PGH director.
To start with, why the tangled legal attempts to block Gonzalez? Why try to appoint an OIC when there was no vacancy? How can the vote of a collegial body be set aside without a collegial decision, and on the basis of a letter by one regent? Is there such a thing as a super-regent whose solitary vote overrides those of his colleagues?
Gonzalez is entitled to hold office for the duration of his term. In the archaic language of the law of public officers, the “termination of official relations” occurs only upon death or disability, retirement, resignation, expiry of term of office, abandonment, abolition of office, recall or removal for cause. Not a single ground is present in this case.
The entire ouster of Gonzalez was actually carried out by first ousting yet another person, Charisse Bañez. Indeed Charisse wasn’t enrolled, but there are two important issues here. One, when her vote was counted in favor of Gonzalez on Dec. 18, the BOR fully debated her enrollment issue (even asked her to step out then) and decided that she could vote. I recall the joke during martial law. Marcos was complaining: Filipinos are so demanding—I already let them vote, now they want their votes to be counted! The BOR must respect its own decisions, and not reverse it only after they discovered that Charisse voted for Gonzalez.
Two, Charisse has a pending application for residency as a student, which is routinely approved for others but which has been kept hanging for Charisse who, not surprisingly, has been harassed by a series of disciplinary cases filed for her activist work. Again, I do not know where she stands ideologically—and I have my own criticisms of the dogmatic and doctrinaire—but the students have chosen her as their regent and the school administration cannot frustrate the students’ choice by harassing her with disciplinary cases.
Irony of ironies, it now turns out that the three Malacañang appointees all have expired appointments. President Arroyo appointed them merely as “Acting Member, Board of Regents.” However, the Administrative Code, Executive Order 292, provides that “in no case shall a temporary designation exceed one year.” All three had exceeded one year. Sarmiento himself was appointed on Sept. 29, 2008. They were all essentially impostors on Dec. 18, trying to oust the student regent who enjoyed an authentic mandate.
The BOR has pooh-poohed that argument, saying that “acting” is different from “temporary.” In what way, I ask? That is a cockamamie legal distinction. I ask the BOR: What is the difference between an “acting” regent and a “temporary” regent? The “acting” designation is as temporary as it gets.
What I have chronicled here is familiar to us by now: the Machiavellian manipulation of technicalities to justify just about anything and to maneuver events to get precisely the desired result. It is a mindset, a way of life, that I identify with the Arroyo administration, and I am saddened when I see it practiced in a university that has become a part of my life since I entered as a freshman 36 years ago.
Originally published here: http://opinion.inquirer.net/inquireropinion/columns/view/20100304-256678/Unceremonious-unseating-of-UP-PGH-director

(Permissions taken from the author)

RESOLUTION OF THE COLLEGE COUNCIL OF THE UP COLLEGE OF MEDICINE ON THE APPOINTMENT OF THE DIRECTOR OF THE PHILIPPINE GENERAL HOSPITAL UNIVERSITY OF THE PHILIPPINES MANILA

• Whereas the University of the Philippines Board of Regents in its 1252nd meeting on December 18, 2009, appointed Dr. Jose Castillo Gonzales as Director, Philippine General Hospital, University of the Philippines Manila from January 1, 2010 to December 31, 2012;

• Whereas Dr Jose Gonzales took his oath of office as Director of Philippine General Hospital, University of the Philippines Manila before the BOR Chair on December 21, 2009 and before the UP Manila Chancellor on January 7, 2010;

• Whereas Dr. Jose Gonzales has already served as PGH director and has performed responsibly since January 4, 2010 with honor , integrity and transparency;

• Whereas under Civil Service Laws, Dr. Jose Gonzales can only be removed as PGH Director for due cause;

• Whereas the removal of Dr. Jose Gonzales as PGH Director is unjust and arbitrary, he should therefore continue to perform his duties and functions as Director of PGH for the welfare of the Filipino people;

• Whereas the College Council of the UP College of Medicine upholds Academic Freedom, human rights, due processes and the protection of its constituents under the Civil Service Law;

We, the members of the College Council of the UP College of Medicine resolve, as it is hereby resolved:
That we recognize and support Dr. Jose Gonzalez as the duly appointed UP PGH director from January 1, 2010 to December 31, 2012 in accordance with his original appointment.

Approved on the 2nd day of March 2010 at the Class 64 lecture room, UP College of Medicine, 547 Pedro Gil St, Ermita, Manila.

The PGH Director controversy continues to heat up with sudden twist and turn of events that will for the first time in so many years, fire up into a UP Manila/ UP-PGH wide constituency (Laban-PGH Movement) barricade tomorrow morning, March 1, 2010.  I’m publishing a copy of this Indignation Statement here verbatim. Chronology of events that led to this controversy will also be published in my succeeding posts.

On the historic day of Feb 25 and the 24th anniversary of the People’s Power Revolution, the UP Board of Regents under the dark clouds of a walk out by the student, alumni, faculty and staff regents and a dismissed temporary restraining order against a decision to remove the student regent Chari Banez, declared null and void a board decision that appointed an already functioning PGH Director in Dr. Jose “Joegon” Gonzales.

A grave abuse of power that has been done in the State University where we were taught the importance of dissent and critical thinking and where we learned to love democratic principles and idealism. Spearheaded by UP President Emerlinda Roman, supported by the three other GMA appointed regents, Congresswoman Cynthia Villar and CHED Chairman Manny Angeles ( CHED Chair Angeles voted in favor of Joegon in the December 18, 2009 BOR meeting, made a sudden and very suspicious turn around by now following the lead of GMA’s BOR appointees in January 2010). They have oppressed a UPCM faculty member and employee of the UP-PGH by arbitrarily removing Joegon a legally appointed, sworn in and functioning PGH Director under very extra-ordinary and highly suspicious circumstances. Civil servants are protected by law from such arbitrary actions even by the highest governing body of any institution in the Philippines. To make matters worse, his replacement by Dr. Eric Domingo a known political ally of GMA, was removed from the list of nominees for PGH Director in December 2009 because of his lack tenure being a part time employee of PGH.

It is time to wake up from our apathy and fight not just for Joegon but also for what he represent and for what our conscience deems as just and right. Many have maligned him for his unambiguous stand on controversial issues in PGH and foremost is the disadvantageous deal made between UP’s BOR and the Daniel Mercado Medical Center that will soon operate a private laboratory, diagnostics, pharmacy and outpatient clinic within PGH itself. He has been singled out as the main stumbling block to the estimated hundreds of millions of pesos in profit that is grossly slanted to favor only a non-PGH entity.

Therefore on Monday, the first day of March at seven in the morning, we the LABAN UP-PGH Movement and all our allies will barricade the PGH Director’s office to protect Director Joegon and rightfully keep his position as PGH Director. The All UP Worker’s Union have already committed to join us. UP students from Diliman, Manila and other units are rallying their constituents to join this barricade. We are counting on the PGH Faculty, the UP Medical Students and UP Medicine Alumni to be there. Anyone who cares for UP and PGH should be there physically or in spirit. We need all the help we can get. We can no longer afford to sit on the fence or watch from the sidelines. We need to act now and we need to act fast.

OUR STATEMENT

Respect the civil service law protecting the tenure of all government employees including the Director of UP-PGH. The arbitrary attempt to remove and replace Director Jose Gonzales under suspicious and extra-ordinary circumstances is unjust, oppressive, illegal and immoral.

Kung ginawa ito kay Director Joegon maari din itong gawin sa lahat ng empleyado ng UP at PGH

Ituwid ang baluktot, itama ang mali.
Kung Di ngayon kailan pa
Kung Di tayo sino pa.
Si Joegon na Tama na.

LABAN UP-PGH MOVEMENT

A copy of the indignation statement can also be found on Facebook, here. Pictures of previous indignation rallies can also be found, here

The legal, ethical and aged (almost wise, but not quite) captain of the ship medical adage always stand true in any physician led health team. This autocracy is no more apparent anywhere else than that inside a surgical theater orchestrated by a feel god surgeon. I will not contest that Machiavellian theater governance (will write another post for that) but focus instead one ghastly annoyance that hound surgeons both inside and outside the OR once in a while. This:

You are always the captain of your ship but oftentimes, you need to be a bosun too!

I’m not sure if this is unique to any not so lovely practice environment but often something has to be done (short of putting a gun inside your mouth)  un-captainly in order to stop a captain’s sinking vessel.

Take this one anecdote shared by another surgeon in one far flung province here.

It was ten PM then when I receive a hospital call informing me of a VA victim who sustained open injuries to his right lower extremity. Already sleepy and tired from a surgery an hour earlier, I reluctantly hurled my ass to the ER and evaluate the patient around 10minutes after. While our hospital have 24 hour, “resident” staff physicians to attend to these emergencies, I rarely see one who makes an approximate diagnosis and institute an measures expected of a trained physician. So I need to go to the ER as soon as possible, if I need a better assessment of the patients status and institute immediate treatment myself less I get sued for malpractice for someone else’s missed steps.

Anyhow, I came in 10 minutes late and was horrified  that I neither have an x-ray of the patients injured extremity (he has skull, chest and abdominal x-rays that are all significantly insignificant somehow) nor a splint stabilizing his grossly deformed extremity. I asked the nurses (couldn’t find the resident inside the ER) why this procedures wasn’t done earlier (or even prior to calling me up) and they unanimously said none has been ordered at the time patient was brought to the x-ray room. The gaping wound plus the bleeding “fracture” is repulsive prompting them not to do anything but plug the wound with tens of OS and tens more of leukoplast. In the meantime, the patient is wriggling in excruciating pain (an NSAID was already given IM earlier though) as they waited for me to appear in the ER’s doorstep. Not interested in witch hunting at the moment  and keeping my composure “respectable”, I asked for sterile gloves so I can examine the wound, pack the bleeding properly  and then put some form of splint before bringing the patient to the OR. One nurse went scurrying for something immediately, which made me sigh in hope. But this was short lived as I soon discovered, he just actually made a prescription for sterile gloves! I said, “you gotta be kidding me! If this is not for my patient, I (and the patient possibly) could have walked away in sheer disgust over the incredulous situation I am with! But we have no choice but to make sanity out of this proverbial serendipity (composure some more). I took some moment to breathe. I went to the CR and peed while waiting for God to bring in sanity to this ominous chaos.And the sterile gloves.

On my way back to the ER I grabbed one pair of clean gloves and abdominal pack  from the sterilizing room, snatched a wooden handle from broom stick lying around, grabbed a newspaper and went back to the ER to do what I’m supposed to do. Then I waited for two more hours just so the patient can be cleared for OR. And I was ten minutes late?!!!

In the OR theater, the same operational amnesia goes on unabated. No available sutures, inadequate or barely working instruments, robotic assists with pillar like extremity dexterity and blurry dioptic visions. I get lots of stymied fans standing all around me doing everything except being helpful to the ongoing surgical orchestra. I cannot describe how I moved assess and turned OR cabinets to look for this and that but we managed to produced the needed stuff anyway.I bring a back up OR stash anyway for frequent detours like this. It was however, brutally exhausting and tension filled voices and breathing almost always kill the fun inside the OR. Luckily, the patient survived the procedure well and went back to his normal (drunk driving) life again despite the chaotic serendipity. Now, I know some hospitals are ill equipped and manpower deficient most of the time, but occasional like these are totally unacceptable if we want better service for our patients!

The poor surgeon obviously was holding himself in one piece and acted magnificently composed despite his horrific ER/OR encounter. For some, this incident is rather minor and might not constitute an annoying occurrence. Me however, in my zaniest complaining attitude, will whine in sheer frustration. Not this surgeon I guess. He simply went on doing some “extraordinary” stuff to fill in gaps in the proper delivery of health care service. We are abused in our training to do more than being just the surgeon. Who couldn’t forget having to buy sutures for your patients or pleading another patient’s extra OR needs during residency? Un-surgeon-ly? In our day to day encounters as a medical and surgical professional, we might find ourselves in similar situations and do one un-captain-ly act  for patient to recover uneventfully. You might  need to be as a resourceful and quick thinking para medic just so you’ll salvaged a patient. Or your career…