Yesterday I started a survey  asking healthcare professionals (physicians, nurses and allied medical professionals) if their healthcare institutions have a social media usage policy. (If you’re a healthcare professional you can still vote and comment in that post. ) Now its time to ask our clients, the Filipino patients:

Do you want your healthcare professionals (physicians, nurses allied medical personnel) and /or healthcare institutions (hospitals, clinics) to have a social media policy?

Philippines, the social media capital of the world!

This question is important and highly relevant. Why? Philippines is the social media capital of the world and there’s a surge of content sharing in these social networks. That is according to this report by the Global Web Index. Sharing health related patient information on these social networks threads dangerously on an already greyed (if there is/was) privacy and health information laws here in the Philippines. Without enforced laws or governing policies, a breach of patient’s privacy and confidential information have consequences that pose a threat to the mutual trust between patients and his/her physician or that of his/her healthcare institution.

The other reason is about enhancing patient communication. Social media is  an alternative, revolutionary way in which healthcare professionals or institutions communicate or interact with their patients.  Social media (though research data is lacking on this) could be  a venue for positive reinforcement of actual clinical consults and follow ups. A recent survey also shows that social media is now gaining ground as source of health information in first world countries. The absence of policies regarding its use defaults the interaction to a “free for all” and often negatively affect the overall outcome of these patient-physician  or patient-healthcare institution interactions.

So again, I’m asking you, Filipino patients, or anyone since obviously you are the ones will be ultimately affected by this policy.

Do you want your healthcare professional or healthcare institution to have a social media policy use?

Please vote below and comment (in the comments section) if you wanted to explain your answer. Should you want to maintain anonymous, just email me privately thru this contact page and I will assure you of your confidentiality)

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Copyright secured by Digiprove © 2011 Remo Aguilar

I’m amazed at how surgeons in provinces surpass the seemingly insurmountable odds besetting their practice. I’ve heard of horrifying stories regarding provincial practice during my training, that I sometimes wince at the thought that me too shall join their ranks soon when I get back to my hometown.  Then I got the first hand “feel” of what its to be like a surgeon from the provinces.

In my first year of practice I remember managing one patient who sustained multiple closed fractures of the ankle and that of the leg. On treatment appraisal I found out the guy can afford an operative procedure for the (bimalleolar) ankle fracture but not that of the leg fracture. I was in a dilemma at that time since current evidence only supports good overall functional results if both fractures will be treated operatively at the same time. Treating the two fractures differently or separately will result to a less than good outcome the review further noted. I racked my brains out for a middle ground solution. I can find none more than speculative statistics. I presented this dilemma to the patient and let him decide based on the ‘literature” and statistics I was explaining. I was dumbfounded with what he told me after my lengthy explanation. “Do what you think is best doc”.

Not only that.  I  told the patient that because we don’t have intra-op x-rays in that institution, it’s either we risk infection bringing out the patient to the x-ray room during operation to check for fracture reduction or just feel out reduction and accept whatever comes out after surgery. His only answer was “do what you think is best doc”.

Inside OR, there were so many other things that are less than ideal and often “damning’ to surgeons. I’m pushed to use a manual drill because we don’t have a sterilizer fit for my power drill. No pneumatic torniquets. No reduction clamps nor suitable retractors. And did I say before we don’t have a c-arm or an intra-operative xray machine? None of the nurse assists is comfortable with my orthopedic instruments. If this surgery turned horribly wrong, I wouldn’t be surprised. So I made sure the patient knew exactly what are our risk and he too wouldn’t be surprised if this surgery go bonkers.

I don’t know how the patient’s surgery went well despite these never ending list of “have nots. He went through the surgery knowing all of these and it went well, save for the surgeons’ anxiety and stress. I couldn’t sleep before and after the surgery knowing the odds we’re getting through. Frankly, I’m scared more than the patient but choice is something limited for us during those times. The need outweighs the risk.

Nowadays, I stil encounter a few of these have nots in most of my ORs, and I’m just as scared as before. I always talk these oddities to my patients and secure their approval before performing any surgery on them under these situations. This doesn’t lessen my anxiety and stress level though. It just pushes me beyond my comfort zone trying out new things “unorthodox”  that are anchored on a logical framework I’m taught during training. Ultimately, need is such an impetus for innovation.

So I wonder, does these insurmountable odds make us- the”provincial” cutters, less of a surgeon?

Copyright secured by Digiprove © 2011 Remo Aguilar

In my last post, I presented a research that summarizes the current internet usage of physicians, in the US, Europe, Australia and South Korea. It was a ” backgrounder” really, in my attempt to determine how many physicians in the Philippines use the internet and social media in their practice.

But this data is really difficult to find or is perhaps not available yet.  To give an approximate of how much social media (such as Facebook) has penetrated the Filipino online market, let me show an interesting graphic summary (of facts) about Facebook and its Philippines “market”. This was based on the data compiled by socialbakers.com and graphically summarized by the Yehey digital group. I’ll leave you to draw out your own conclusions.

Philippines and Facebook facts

How many percent of this Philippine market are physicians or patients using FB for their practice or in search of medical information? If you have an idea, leave your comment below and let’s start some discussion!

Recently, I’ve been receiving   complaints from patients regarding some attending physician’s “quality” of service. Complaints like, “the doc saw me late already” or “my waiting time is far longer than my physician encounter time“  or “this was not explained to me” or  the difficulty of some patients (or relatives) to talk to their physicians. In most cases, the attending physician’s technical competence is unquestionable, but the patients or relatives sometimes felt they still didn’t receive adequate care or service from their physicians. What must they do?

a patient unhappy with the physician services rendered to him (Photo credits from http://www.art-of-patient-care.com/doctor-patient.html)

I always tell these “complainants’ that any doctor-patient relationship is contractual by nature. Meaning both parties has to agree and deliver their end of the deal to consummate the “contract”. The contract is of course the delivery of health services required by the patient’s current health needs.(Read my perspective of this here.) This may sound simplistic but for purposes of discussion, this “understanding” of a contract should suffice. If one party, does not agree or adhere to the contract, then the relationship could be terminated after due process.

In non- emergent situation,  and if the service is available, patients have the choice on who will be their doctor or what type of service they could avail. That by choosing or agreeing to be under the service of a particular physician, the patient also has the responsibility of paying the services of that physician. That is the contract, no matter how business like it sounds.   In cases where one party felt that other party did not deliver the expected service , he or she may choose to end the contract after duly informing and after paying the services rendered by the physician. (By the way, the physician under certain circumstances and on valid grounds, may opt to terminate a patient-physician relationship too but let’s leave that discussion in my future posts.)  In my practice, I always offer this option to all my patients even prior to our patient-physician relationship.

Problem comes in when patients just change physician services without adequately informing their previous and frequently, their succeeding physicians. Far worse is the situation  wherein patients  “leave” their previous physicians without paying their bills on the pretext of a “bad” service.  This is not good practice either and probably will only harm patient’s reputation also.  In the first place and except in emergency situations or some government health training facilities,  the choice of  any physician is really the patient’s responsibility. Health is the business not just of the physicians and institutions but of the patients as well. If you don’t know any of your physicians in the community, then you cannot blame someone else for receiving a bad service. Remember, that physician  gave his or her professional service and in the context of a contractual form of relationship, that has to be duly paid even if you’ll change physicians.

Patient doctor relationship is based on trust (photo from http://harvardmedicine.hms.harvard.edu/doctoring/patient-doctor/index.php)

So if you want to change your attending physicians for a valid reason, inform your physician of the transfer. Pay your end of the  contract, meaning the services rendered. Cultivate the habit on talking to your doctors. Pour in your concerns on them and seek necessary answers to lingering questions.   But don’t forget to inform the physician if there’s something good also about his or her service that you liked. I always believe no doctor would want any patient to feel bad about their brand of service. Just be honest. If those physicians do not change for whatever reason, that’s their catch. Remember that health community is far more sensitive than we thought on issues like this. These type of service screw ups always catches up someone else ears. If you don’t like them, then do not patronize them. That way, you won’t complain at the end of your contract. That simple.

Or is it? What do you think?

“The essential quality of the clinician is an interest
in humanity, for the secret of the care of the patient is in caring
for the patient.”- Francis Peabody Class of 1907, Harvard Medicine

Amongst professionals around, physicians are slow in adopting to change. By change I mean adapting  innovative ideas to handle cases, concerns and issues. In our aim to effect innovative administrative policies and changes, I’m trying to understand the behavioral reason behind this “reluctance” to adapt among physicians.

Many physicians are not inclined on taking risks, especially when the issue on hand concerns them, their patients or their practice. An admirable trait perhaps that evolved primarily to safeguard patient’s safety and is ingrained in the professions’ dictum- “Primum non nocere“. First do no harm.

When taking to the extreme, and coupled with an obsession towards handling ALL (medical or otherwise)  tasks as a matter of life and death, breakthroughs for innovations rarely push beyond the research stage. A physician will stick to whatever will sustain life from his or her experience. Thus, whenever an innovative solution for improvement quality of care is implemented, changing perceptions and attitudes will be a bloody issue to tackle.

One other reason is the lack of  (new) knowledge and skills needed to adapt to change. For whatever reason we have, without the necessary new knowledge and skills, no physician will dare venture into any “unfamiliar” tasks. A seemingly slow adaptation is seen among physicians.

It’s quite obvious then that to effect a change in perception or hasten adaptation of any new policies, innovations, or new ways of treating a particular disease, knowledge, attitude, values and skills (KAVS) should be initiated first. That way adaptation to  innovations and policy changes will be a bit faster than what we usually observe today.