Cast & Curious

Author: Remo Aguilar

  • Remembering and Honoring Lives Lost, To Heal the Living.

    Remembering and Honoring Lives Lost, To Heal the Living.

    On the evening of October 31, as we approached All Saints’ Day, my family and I gathered at the memorial park to celebrate my mom’s life on her third death anniversary. We held a simple Bible service, and the layperson leading the ceremony praised us for honoring our loved ones by visiting, praying, and caring for their resting places. He noted how some people seem to have lost the essence of this day, turning it into an occasion for socializing, rather than for reflection and remembrance. That observation stayed with me.

    In previous years, I’ve marked this time by traveling or hiking—finding solace in quiet places to remember family members who have passed. This personal ritual has been a way for me to reflect, especially as I continue my journey in medicine. I’ve come to see this as part of my process for managing loss—not only of loved ones but also of patients.

    As we come together on All Souls’ Day to honor those we’ve lost, I invite healthcare colleagues to reflect on the personal ways we remember our patients and cope with loss in our profession. Here are some questions we’ll explore during our #Healthxph chat on November 4, Saturday at 9 PM (Manila Time).

    T1. Was there a time in your medical career when you struggled to cope with the death of a patient?

    Death is something healthcare workers face regularly, yet it never becomes easy. Each loss is significant, and it can be challenging to process while continuing to provide compassionate, respectful care. There are moments when the emotional weight feels overwhelming, and we have to find ways to grieve—whether quietly in a call room, through shared stories, or in private moments of reflection.

    Like many, I have had moments of sadness and tears even years later, remembering some of the patients I felt closest to, especially my mom.

    T2. What practices, rituals, or personal traditions help you honor and remember deceased patients?

    Over my years in medicine, I’ve seen many colleagues and institutions adopt meaningful ways to remember patients. I recall a patient, a 60-year-old woman in a charity ward with metastatic cancer. Her family couldn’t afford a ventilator, so her grandson and I took turns manually bagging her. On her last night, I held her hand one final time before stepping back to let her family grieve. Afterward, I returned to the call room to collect myself, still teary, and wrote a note of condolence for her family. These small acts help us to honor our patients, even as we move on to care for others.

    T3. Have these practices helped you in your journey as a healthcare professional?

    While we gain skills and knowledge from each patient, it’s the personal moments—the ones we carry with us—that help us cope with the mental and emotional demands of this work. For many of us, honoring our patients offers a way to remember them and manage our feelings, even if it doesn’t completely ease the sadness.

    Please join us on November 2, Saturday at 9 PM (Manila Time) for this #Healthxph chat to share, reflect, and remember together. We look forward to hearing your stories and insights.

  • Navigating Ethical Dilemmas in Medicine: Right vs. Right Decisions

    Navigating Ethical Dilemmas in Medicine: Right vs. Right Decisions

    In medicine, ethical issues are often seen as clear-cut choices between right and wrong. However, in reality, they are frequently far more complex, especially when multiple legitimate solutions exist for the same problem. Joseph L. Badaracco, a distinguished professor at Harvard Business School, introduced the concept of “Right vs. Right” decisions—situations where conflicting values or duties create ethical dilemmas without an obvious answer. These “Right vs. Right” dilemmas are a common occurrence in medicine, challenging both physicians and patients nearly every day.

    Consider the following scenarios:

    • An obstetrician is treating a pregnant patient whose life is at serious risk due to her pregnancy, but the patient refuses to consent to a termination that could save her life.
    • An orthopedic surgeon recommends amputating a gangrenous limb to prevent life-threatening sepsis, yet the patient declines the procedure.
    • An oncologist advises a patient with an early-stage cancer to begin chemotherapy to prevent further spread, but the patient chooses to pursue an unproven alternative treatment instead.

    In each case, both the patient’s autonomy and the physician’s duty to preserve life clash, leading to ethical dilemmas where both choices can be viewed as “right” from different perspectives. So, what should physicians do when confronted with such dilemmas?

    The Digital Age: Adding Complexity to Ethical Decision-Making

    Today, the digital landscape has only amplified the complexity of medical ethics. With unprecedented access to information, alternative healers, and aggressive marketing—sometimes promoting unproven or even harmful treatments—ethical principles can feel more prescriptive than practical.

    The issue isn’t that healthcare professionals don’t understand ethical frameworks. The real challenge lies in applying these principles in a world that is increasingly dynamic, unpredictable, and digital. The real question isn’t just what the ethical principles are, but how and why they should be applied in the context of evolving patient behaviors, informed (or misinformed) by online sources.

    In this discussion, we’ll explore how physicians can navigate “Right vs. Right” decisions in their daily practice.

    Here are the guiding questions for our chat:

    T1. Have you encountered a “Right vs. Right” ethical dilemma in your practice? How did you resolve it?

    T2. What was your primary challenge in resolving such a dilemma?

    T3. In today’s digital world, what ethical framework would you recommend for resolving “Right vs. Right” dilemmas?

    Don’t forget to use #HealthXPH in all your tweets. See you this Saturday, October 5, 2024, at 9 PM (Manila time)!

  • Breaking the Irony: Healthcare Professionals, Sports, and Fitness – Let’s Get Real!

    Breaking the Irony: Healthcare Professionals, Sports, and Fitness – Let’s Get Real!

    Ah yes, sports and fitness… again?! I know, it’s the last thing many of us healthcare professionals want to talk about. We’re busy saving lives, managing stress, and battling the daily grind. But this topic just too important to ignore. So, let’s dive in.

    Seriously though, how many of us, despite knowing the undeniable benefits, consistently engage in sports or fitness activities? The key word here is consistent. Yes, we tell our patients to “exercise regularly” but, let’s be honest, how many of us actually practice what we preach? Personally, I’ve struggled with this myself, and I know I’m not alone. Even athletes—those fitness gods—have their ups and downs. But unlike them, sports and fitness are not our profession.

    For us mortals—busy, overworked healthcare professionals—finding time and energy for fitness feels like climbing a mountain. But here’s the kicker: we, of all people, should be leading by example. Yet, many of us are trapped in a cycle of inconsistency, letting our mental and physical health slip.

    The Moment of Realization

    I had my wake-up call just six months ago when I caught a glimpse of myself in the mirror. There I was, staring at a pot-bellied version of myself, wondering how long before my clothes would burst at the seams. The weighing scale wasn’t kind either. Then, I noticed a colleague stacking up maintenance meds like they were vitamins—some even taking five different pills a day. It made me wonder: am I the odd one out for not being on medication yet?

    To add salt to the wound, my patient went to someone else for weight loss advice after consulting me. Ouch. That was the final push I needed to realize that something had to change.

    Let’s Skip the Basics and Get Real

    We already know the benefits of physical activity—let’s not waste time repeating them. The real conversation we need to have is about the barriers. Why aren’t we, as healthcare professionals, engaging in consistent sports and fitness activities? What’s holding us back, and more importantly, how can we overcome these barriers?

    This Saturday at 9PM Manila time, during our #HealthXPH Twitter/X chat, we’ll tackle these questions head-on.

    T1: What are the common barriers for healthcare professionals to consistently engage in sports and fitness activities?

    T2: What is your compelling motivation to consistently engage in sports and fitness activities? And if you’re not into fitness yet, what could motivate you?

    T3: What tips or strategies have helped you stay consistent with sports and fitness?

    I won’t give away my thoughts just yet. I want to hear from all of you—your experiences, your struggles, and your solutions. Afterward, I’ll follow up with a post summing up the best advice and tips from our collective wisdom.

    In the meantime, start warming up! Get those fingers ready to tweet and, more importantly, stretch those hands and bodies before and after our hour-long chat. See you Saturday at #HealthXPH, and let’s move towards better health together!

    P.S. If you’re already feeling inspired (or guilty, like I was), why not take a few minutes to schedule that long-overdue workout? You deserve it—your patients, your family, and most importantly, your future self will thank you.

    Image by freepik

    Disclosure: This post was edited with the help of a writing AI.

  • How should healthcare professionals act on social media, nowadays ?

    How should healthcare professionals act on social media, nowadays ?

    Revisiting the ethical social media principles then and applying it now.

    The recent social media controversy that irked many in the Philippine medical community is this- a student nurse posting a video of a healthcare worker doing a medical procedure, on tiktok. While this, arguably constitute a breach of privacy and confidentiality and the ethical ramifications are quite disturbing, I wonder why the student nurse failed to grasps an established social media and medical etiquette? Did we somehow missed something when crafted the social media guidelines before for future generations? Maybe it’s time to revisit this.

    The #Healthxph was founded as a community of healthcare social media practitioners, laying down the foundations of the ethical use of social media to achieve common good in healthcare. We even have our signed manifesto accepted by the different medical associations in the country. I and many of #healthxph team talked about ethical and good use of social media in healthcare and even came up with actual conferences about it. That was ten years ago. Now, we are seeing a resurgence in privacy and confidentiality breaches in healthcare with the use of social media. Again, did we miss something here? Implementation? Commitments? This will be the topic of our chat today.

    T1. Do you see a resurgence in healthcare privacy and confidentiality breaches with the use of social media?

    T2. Is the healthcare community effective in preventing privacy and confidentiality breaches on social media?

    T3. Recommend three ways of preventing preventing privacy and confidentiality breaches on social media.

    I’d like to share my previous talk on How should nurses act on social media platforms. This was part of my speech during the Annual Convention of the Philippine Nurses Association in Davao City. I knew this student is not yet a full fledged nurse, but it may be good to start early. What do you think?

    Join #healthXPh chat on this topic this Saturday Aug 10 9PM Manila time. See you all!

  • Balancing Health and Career as a Physician

    Balancing Health and Career as a Physician

    [su_dropcap]A[/su_dropcap]s healthcare professionals, we dedicate our lives to the health and well-being of others. Yet, amidst demanding schedules, long hours at work, and constant emotional and physical toll, we still think our body will handle itself, without us “helping” or investing time and effort on our overall well being.

    [su_box title=”Stories from the Clinics”] A patient sought consult for a low back pain and tingling sensation down his legs. He is overweight and his random blood sugar was elevated on testing. Both his parents were diabetic. I asked if he consulted an internist or endocrinologist. “Not yet, but I will” he said. After doing a physical examination, additional diagnostics, preliminary diagnosis and strategy for managing his concerns, he asked me this question “what is your physical activity and how do you avoid obesity? This patient obviously noticed my “not so healthy physique” but courteously waited for my advice. So as an orthopedic surgeon, I advised him what I know about the (theoretical) benefits of physical activity and proper nutrition to his overall well being. Then he followed up with – “How”? I paused for a moment and replied, ” I try fitting all that into my busy schedule. My answer confused him even more. I doubt he’d follow my concoction of advice, seeing that I, a physician, was obviously out of shape. [/su_box]

    This clinical encounter flashed backed months ago, when I saw my physique on a mirror. I am out of shape! Last year alone, I saw two colleagues my age succumbed to lifestyle disease-related complications. Another one took his own life. I got so scared I started researching physical and nutritional health, again. I did the same research, activity and dieting, several times in the past. I even went on organic farming to support these effort but well, failed. So not this time I promised. I also delve into specifics of incorporating such healthy physical and nutritional lifestyle into a busy physician life. Is it even possible?

    Share Your Insights

    For this conversation, I wanted to learn how healthcare professionals maintain well-being while delivering the best care possible. I want to reach out and gain insights from colleagues’ experiences. Your experiences and strategies can provide invaluable guidance and support to fellow physicians navigating similar challenges. Here are three main questions I’d love for you to answer:

    T1. How Do You Manage Stress and Prevent Burnout?

    Burnout, characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, is a prevalent issue among physicians. There’s no published local data yet, but according to a study published in the Journal of the American Medical Association (JAMA), more than half of U.S. physicians experience substantial symptoms of burnout (Shanafelt et al., 2015). How do you manage stress and prevent burnout in such a high-pressure environment? Are there specific strategies, routines, or practices you follow?

    T2. How Do You Prioritize Your Physical Health?

    Given the irregular hours and intense workload, maintaining physical health can be challenging for healthcare professionals. Regular exercise, a balanced diet, and sufficient sleep are fundamental to overall well-being but are often compromised. An 2018 FNRI study showed 37.2 % of Filipinos adults are obese. Since 1993 to 2018, fasting blood glucose is increasingly elevated in adults. Approximately 40% of Filipino adults are also physically inactive. While these figures do not single out healthcare professionals, it doesn’t exempt us either. According to the American Medical Association, a significant number of physicians report insufficient sleep, which can impair cognitive function and overall health (American Medical Association, 2017). How do you ensure you get enough sleep, exercise regularly, and maintain a healthy diet? What tips and tricks do you have for balancing these aspects amidst your busy schedule?

    T3. How Do You Sustain Mental and Emotional Well-being?

    The emotional demands of being a physician are immense. I witness doctors quit training because “they couldn’t handle the pressure”. I talked to a colleague shifting into an outpatient only practice because in patients took much of his night time sleeps. Dealing with patients’ suffering, making critical decisions, and managing complex relationships can take a toll on your mental health. The National Academy of Medicine highlights that mental health issues among physicians are often underreported and undertreated (National Academy of Medicine, 2019). How do you take care of your mental and emotional well-being? Are there support systems, hobbies, or mindfulness practices that you find particularly helpful?

    [su_box title=”Key Takeaways”]Healthcare professionals should balance their physical and mental well being while taking care of their patients and their families. The best way to do this is to invest time and effort on physical and mental activities, incorporating these into our daily life/work routines.[/su_box]

    “If you don’t make time for exercise, you’ll probably have to make time for illness.”

    Robin Sharma

    Looking Back

    Will that patient follow my advice when he sees my physique now? Will my improve physical and mental well being impact my work as a physician? Please share your insights in the chat with the guide questions above . Kindly append your answers with #healthxph hashtag. Your insights should help foster a community of well-being and resilience among colleagues.

    Image by freepik

    References

    1. Shanafelt, T. D., Hasan, O., Dyrbye, L. N., et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. JAMA, 314(22), 2334-2343. doi:10.1001/jama.2015.13971
    2. American Medical Association. (2017). Addressing physician burnout: The way forward. Retrieved from https://www.ama-assn.org
    3. National Academy of Medicine. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Retrieved from https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional