Reflective Practice Essays on physician identity, sustainability, uncertainty, practice, and professional evolution.

The Pursuit of Happiness in the Healthcare Workplace

Healthcare burnout is often discussed as a systems problem. But behind the policies and solutions is a quieter question many healthcare workers face every day — how do we continue finding meaning while working inside systems that are still trying to change?

“Mam, where’s our patient?”

The operating room nurse calmly explained the reasons why our patient was not yet on the table as scheduled.

I could feel the frustration building.

“Excuse me,” I said.

I quietly walked back to the empty OR dressing room. I threw a one-two punch and a high kick into the air, closed my eyes, took a deep breath, and sat there for a moment.

Then I grabbed my hospital coat.

I went to the patient’s room, talked with the patient, and tried to fix whatever I could so the procedure could still happen later.

I did all of that with the warmest smile I could manage.

Inside, I was looking for answers.

Am I still happy doing this despite everything that comes with it?

Stories about burnout, declining mental health, and dissatisfaction among healthcare workers have become increasingly common.

Burnout is not simply being tired after a difficult day. The World Health Organization describes it as a consequence of chronic workplace stress that has not been successfully managed — involving exhaustion, increasing distance or cynicism toward work, and a reduced sense of professional effectiveness.

For many healthcare workers, this definition feels familiar.

But burnout is rarely just an individual problem.

Healthcare workers do not practice in isolation. We work inside complicated systems — hospitals, policies, workflows, financial limitations, administrative demands, and human expectations.

The system we work in eventually affects how we work, how we think, and sometimes how we feel about the profession

I am not ignoring the larger problems affecting healthcare.

Many causes of burnout are structural. Healthcare needs systemic solutions, and we probably needed many of those solutions years ago.

But while organizations and leaders work toward those changes, healthcare workers still return to the wards, clinics, operating rooms, and emergency departments every day.

We are left with a more immediate question:

How do we continue doing meaningful work inside imperfect systems?

A colleague once asked me:

“How do you find happiness in this kind of workplace?”

It sounded cynical.

But hidden inside that frustration was still a search for something better.

Finding happiness at work is not about ignoring the problems around us. It is about finding enough meaning to continue working while trying to improve them.

Sometimes it means noticing the few moments that remind us why we still show up.

A patient conversation.

A difficult case completed.

A colleague who helps.

A moment where the work still feels connected to why we started.

System changes matter. Healthcare leaders need to address the conditions that make good people exhausted, disconnected, and eventually leave.

But until those changes reach the people doing the work every day, many healthcare professionals continue searching for ways to protect meaning inside the profession they chose.

Maybe that search itself is important.

Because the people trying to improve healthcare are also the same people trying to survive working within it.

References:

  • National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.
  • Shanafelt TD , Balch CM ,  Bechamps GJ , et al . 2009. Burnout and career satisfaction among American surgeons. ASurg 2009;250:107 15. doi:10.1097/SLA.0b013e3181ac4dfd
  • Rosales, Rheajane & Labrague, Leodoro & Rosales, Gilbey. (2013). Nurses’ Job satisfaction and Burnout: Is there a Correction?. International Journal of Advanced Nursing Studies. 2. 10.14419/ijans.v2i1.583.
  • Jabonete, Fritz Gerald & Dayrit, Aubrey. (2018). Reported Work-related Stressors among Staff Nurses in Metro Manila, Philippines.
  • #HCLDR. (2019, December 5). Reconnecting To Joy in Work [Blog post]. Retrieved from <https://hcldr.wordpress.com/2019/12/05/reconecting-to-joy-in-work/>
  • Credit: Image by Halcyon Marine Healthcare Systems from Pixabay

By • December 13, 2019

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A Doctor in the Family

We often assume that having a physician in the family makes illness easier to face. Experience teaches a more complicated reality — that medical knowledge can guide decisions, but it does not separate a doctor from the fears and responsibilities of being family.

I believe having a physician in the family offers some distinct advantages.

The most obvious one is access. Medical information, advice, prescriptions when appropriate, and connections within the healthcare system become easier to obtain. With a physician relative, navigating the maze of a complex healthcare system becomes a little more bearable for the average patient.

But these advantages come with their own complications.

Family dynamics can interfere with a physician’s ability to remain objective. This is why many doctors choose to entrust the treatment of their own family members to colleagues. In these situations, the physician in the family often assumes a different role — not as the primary doctor, but as a healthcare facilitator.

The physician becomes the person who helps navigate the system, coordinates care, explains procedures, and translates medical information into something understandable for everyone else.

In bureaucratic terms, maybe we become a kind of “fixer.”

Not exactly the most flattering title for someone with several letters after their name, but in many ways, that is what we do when someone we love gets sick.

Some physicians still choose to manage their own family members despite the potential bias. It is possible, but it is never easy. Sometimes it takes a personal toll.

I squirm at the sight of my mother being stung by needles. If she winces in pain, I wince too. I feel terrible whenever she complains about swallowing several pills, even when I know those medications are necessary.

When she asks me, “Are you going to cut me again?” my heart melts.

In those moments, I hate being the doctor in the family.

Nobody likes causing pain to someone they love with the promise that it will eventually help them get better.

Is it easier, then, for physicians to manage a sick family member?

No. It isn’t.

I do not find conversations about illness within the family any less painful. Simplifying medical information is challenging. Even when aiming for shared decision-making, you often end up carrying much of the responsibility because everyone sees you as the one who understands the situation best.

And sometimes, not making a decision is also a decision.

There is an unavoidable reality that families with doctors are not exempt from the same problems every other family faces. The cost of healthcare, the complexity of the system, family expectations, fear, and uncertainty do not disappear simply because someone owns a stethoscope.

The hardest part may be carrying the responsibility when medical knowledge reaches its limits.

I have rarely met physicians who proudly claim they “healed” their own family members. But I have met doctors who quietly carry the burden of wondering if they could have done more.

So is having a physician in the family truly an advantage?

As both a physician and a son, I am not always sure.

Let me hear what you think.

By • July 17, 2013

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Balancing Act: Community and Tertiary Care Orthopedic Practice

Early in practice, choosing where and how to work is not only a professional decision. It also shapes how physicians learn, teach, serve their communities, and build a sustainable life around medicine.

Barely five years into private medical-surgical practice, some people have asked how I am “doing” with my kind of orthopedic practice.

By orthopedic practice, I mean the working environment of an orthopedic surgeon — the type of patients and cases handled, the time, effort, and resources invested, and the returns, monetary or otherwise, gained from this professional career.

This is a simple definition, maybe even a business-oriented one, but it approximates what medical-surgical practice looks like in the real Philippine healthcare setting. The definition becomes even more complicated because of different practice styles and the way many orthopedic surgeons mix and match these approaches.

Before explaining my own practice, let me describe what I think are two ends of the spectrum: community-based general orthopedic practice and tertiary-level academic orthopedic practice.

A community orthopedic practice usually handles general orthopedic problems and extremity trauma such as fractures. It is often the first line of orthopedic care in the provinces. Patients are usually admitted to primary or secondary-level healthcare institutions within the surgeon’s community.

Academic orthopedic practice, on the other hand, is usually based in tertiary hospitals or trauma centers. It deals with more specialized and complicated orthopedic problems such as arthroplasty, spine cases, or cases requiring advanced facilities and support systems. This practice is often combined with teaching and training orthopedic residents. Some institutions also involve surgeons in administrative responsibilities.

The difference between these two types of practice is often seen in the amount of time, effort, and resources invested in each case.

Specialized academic orthopedics is generally considered more intensive in terms of learning, preparation, and complexity. It is also often perceived as more rewarding financially and professionally.

Of course, there are exceptions.

The separation between learning in urban centers and learning in the provinces is becoming less distinct because of easier access to information and technology. But for simplicity, these two models represent different ends of the spectrum.

So why differentiate between them?

Because somewhere between these two approaches is what I consider the desirable middle ground.

A balanced orthopedic practice, at least for me, involves continuous learning while maintaining a working environment focused on delivering quality orthopedic care within a community.

Many surgeons believe this balance is difficult to find or sustain.

Orthopedics naturally depends on implants, technology, specialized equipment, and hospital infrastructure. Because of this, many orthopedic surgeons continue to concentrate in urban centers and tertiary hospitals.

However, with improving information technology and better availability of orthopedic resources, community orthopedic practice is slowly becoming more feasible.

A former mentor once asked me if I was happy with this dual type of orthopedic practice.

I answered yes.

But I immediately added:

“With some necessary lifestyle and living adjustments.”

Personally, I find that these two forms of practice complement each other.

A community practice without continuous learning can become limiting.

Teaching orthopedics without actually practicing what you teach also feels incomplete.

Somewhere between these two worlds is a compromise — the balancing act.

But what about the lifestyle adjustments?

For me, I chose this balance because it fits my lifestyle.

Compared with a high-volume urban practice, I prefer the relatively quieter working environment of community practice.

At the same time, I cannot let go of the opportunities for learning that academic institutions provide.

Besides, I love teaching.

Teaching might have been my career if I had not discovered medicine. As one mentor said:

“There is no better way of learning than helping others learn.”

A community practice may rarely make you rich, but it can provide a good life. More importantly, it can provide something else — time with the people who matter.

In the end, I think it depends on what fits your lifestyle and priorities.

Mine just happens to be close to the kind of life I imagined years before I became a doctor.

So which would you prefer?

Community practice?

Academic practice?

Or a little of both?

By • September 5, 2010

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Going Under a Knife to Mold a Surgeon

Medical training teaches surgeons how to stay calm during difficult moments. But when someone you love becomes the patient, the experience changes. Sometimes understanding what it means to care for others begins by standing on the other side of the operating room door.

I must admit, I become a bit compulsive and anxious whenever someone close to me gets sick or needs to undergo a surgical procedure.

In our family, I am the only medically knowledgeable person. Being “the medical guy” in the family carries a tremendous amount of responsibility. Yes, it does.

The surgeries my mom and sister went through, along with the countless times other family members became sick, have taken a heavy toll on my stress reserves. Of course, medical training helps — especially the part where you learn to put on an emotionless face and maintain a calm composure. As surgeons, we need steady hands. Calm hands. Hands that can heal.

But this time, not even my medical training could completely hide the stress. Ironically, being a doctor can make things harder. Medical training fine-tunes your senses and pushes you to become more compulsive about every small detail when someone you love becomes the patient.

Why?

Frankly, I don’t know.

As one good surgeon mentor once told me:

“You can never be a real surgeon unless you go through the knife yourself.”

Then it suddenly made sense. The closest thing for me to personally going under the knife was watching someone closest to me go through it.

And now, for another time, my mom was about to undergo surgery.

Her previous surgeries were emergencies. The decisions were urgent. Preparation time was short. Options were limited. You make the best decision available and pray everything turns out well.

So you might think cataract surgery is minor.

But if you have seen an almost blind elderly patient being guided toward the operating room, you might think differently.

Better preparation, more choices, and lower risks? Maybe. But having more time also brings more responsibility. It means having more chances to check every detail and making sure nothing is missed.

After everything is prepared, it is still surgery.

And when your mother is the one on the operating table, nothing feels minor.

Never mind that my mom is diabetic with beginning retinopathy. Never mind that she has already survived several major surgeries and hospital admissions before.

When someone you love is the patient, every surgery carries weight.

Especially when your mom is the one receiving the surgeon’s knife.

So I continue with my usual attention to detail — the repeated reminders, the extra questions, and the things some people might consider unnecessary.

Maybe it is excessive.

But if I were the patient, I would want my surgeon to do the same thing for me.

Take the extra step.

That additional effort gives me confidence that my surgeon cares about me, not only my disease.

This is one of the lessons I learned from my mother’s surgeries: feel for your patients, put yourself in their situation, and imagine what kind of care you would want if you were the person lying on the operating table.

I try to apply this with my patients. I teach this to my residents.

Stressful? Yes.

But who said the life of a surgeon was easy?

So thank you, Mom.

For going under the knife for me.

You helped mold a better surgeon.

Update: I know my mom’s surgeon probably will not read this, but I have nothing but praise for him. He did not just make an extra effort for my mom. Everything he did reflected his skill and care.

Thank you.

By • September 20, 2009

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