Cast & Curious

Category: Uncategorized

  • It’s about time Bonedoc!

    Since I started The Orthopedic Logbook about three and half year ago, I never thought such knee jerk “jump” at this social media will have any impact on  any readers at all.  Health blogging  is at its greatest boom back then and I know my blog would just be one of the thousands targeting the health niche. But grabbing a niche and be popular wasn’t my agenda then. It isn’t,  and will not be up to now.

    Bonedoc, author of this blog, The Orthopedic Logbook

    I’d started blogging about almost everything including health care in order harness my writing skills and share information.  There’s a lot I learned (and I’m still learning) in med school, the hospital and in the lives of every patient physician’s out there. Holding these information to myself will benefit no one. There’s no way but to share it too, to be part of a greater community knowledge and for a better health care. The  influx of information, including those in medicine,  came rapidly and tremendously because sharing of ideas exploded.  This blog contribution to health care, though how minuscule, will go a long way in shaping the minds of wired, health care citizens.

    I’m bringing health and health care information right in front of our wired health citizens out there, Filipinos and globally. Majority of Filipinos are not yet connected to the net, but the increasing trends points to a better scenario in the years to come. That’s inevitable too. Filipinos will surely, later if not sooner. The powers of these new social media in connecting people and providing information is an inescapable paradigm. Either we take advantage of it or we stagnate with health care information.

    So next year, after 167 posts and 108 comments,  The Orthopedic Logbook will

    1. Continue to deliver personalized health and health care ideas right in your desktop.
    2. It will also maximize the other emerging social media to help anchor these ideas to your needs. Facebook and Twitter have invaded the web and health care has yet to capitalize on these growing third media.
    3. Majority of Filipinos are interconnected via cellphone and sms, that should be another good area to explore.
    4. The author will also talk on various social media forums on health care and health care blogging.
    5. I will also try to “create” community for health care readers and health care writers…

    Thank you my dear patrons and readers. Expect a better and simpler Logbook in the years to come! Don’t hesitate to subscribe to this blog, comment on any of my posts or just contact me thru mail for any suggestions to wanted to convey. I promise you I’ll answer them in the soonest possible moment!  Thank you once again and Merry Christmas!

  • Balancing Act: Community and tertiary care orthopedic practice

    Barely five years into a private medical-surgical practice, some people got interested how I’m “doing” with my “kind” of orthopedic practice.  Orthopedic practice refers to an orthopedic surgeon’s working environment, the plethora of patients or cases he handles, the time, effort and money he or she invests on it as well the returns (monetary or otherwise) he gets from this professional career. This is rather a simplistic definition, one that is based on a business model, but roughly what approximates a “medical-surgical practice” in the real Philippine health care settings. This definition is further muddled by “subtypes” of an orthopedic practice as well as the mix and match attitude by most orthopedic surgeons practicing in this country.

    Before I’d shed light on my kind of orthopedics, let me describe what I think is the two extremes in orthopedic practice- the community type, generalist orthopedic practice  and the super specialist tertiary level academic orthopedics.

    A community type of orthopedic practice usually caters to patients with general orthopedics (osteomyelitis) and extremity trauma (fractures) problems and usually the first line of orthopedic care in the provinces. These patients are commonly admitted to a non specialist, primary to secondary level, health care institutions found within the surgeon’s community or area of practice. Academic orthopedics on the other hand,  is basically a tertiary, level I trauma care practice that deals with, specialized or complicated orthopedic problems (e.g. arthroplasty or spine cases) that requires super specialist institutions with supporting facilities (ICUs) . Such specialist type of orthopedic practice is usually coupled with training residents in the orthopedic specialty. Some hospitals add admitting and/or administrative privileges to the surgeon.

    The contrast between these two types of orthopedic practice is probably  apparent in the  amount of time and effort an orthopedic surgeon “invest” on each cases .  A super specialist academic orthopedics is generally thought to be more time, effort and learning  intensive, compared to a community type of orthopedics.  It is also perceived that specialist care are more lucrative, pay and prestige wise.  Of course there will be exceptions to this observation, as the delineation between “learning” in the country side versus the urban centers is gradually grayed by the advent of fast information and the internet. But for our purposes here, let me just simplify definitions to differentiate between the two.

    Why am I differentiating between these two types of practices?  Theoretically speaking, somewhere between these two practices is the middle ground which is for me, the logically desirable type of practice –time, effort and income wise.  Thus, a balanced orthopedic practice (in my opinion) is one that  involves continuous learning and at the same time, offers a “relaxed” environment that caters more to delivering quality orthopedic care in a community setting.

    Many surgeons believe such “balanced orthopedic practice” is not easy “find” , difficult to live with, or is unsustainable. The inherent affinity of the orthopedic practice to orthopedic implants and gadgetry as well as to a tertiary level health care institutions is believed to be the primary reason for such negative perception . While many many orthopedic surgeons still conglomerate on urbanized cities and tertiary level care institutions because of  this logistics necessity, a trend towards community type of orthopedic practice is picking up pace because of improved information technology and delivery of much needed orthopedic implants.

    One former mentor asked me if I’m happy with this dual type of orthopedic practice. I answered ” yes” although I qualified it immediately by saying “.. with some necessary lifestyle and living adjustments” . Personally, I find it natural that this two sub types of practice  complement each other. A community practice without continuous learning is boring. Likewise, teaching orthopedics without actually doing what you teach is too good to be true. Somewhere between these two “extreme” sphere of practices lies a compromise that I felt, will produce the balancing act.

    “But what about lifestyle modifications as you said?” I for one, chose this balancing act, because it fits my lifestyle. Compared to an urban, high volume, city practice, I certainly preferred the relatively relaxed working environment of a community practice. On the other hand, I cannot let go of the many opportunities for learning that these big academic institutions could give. Besides, I love teaching. Teaching could have  been my career if not for the ‘healer” awakening I got in college. Like one mentor said ,  “there’s no better way of learning than to help others learn“.

    Well, a community type of practice will rarely make you rich, but I’m pretty sure you’d be able to put food (or a house and a car perhaps along with some other perks) in your family’s table. A simple living will surely come handy in surviving this dual type of orthopedic practice. But it does pay well in the amount and quality of time you spent with your love ones! I guess it all boils down to what fits your lifestyle and your priorities. Mine just happened to be where I wanted to be years before I became a doctor.

    So which one do you prefer then, the community type of practice? the academe?or both?

  • A Perspective on Non-Compliant Patients and the Contractual Doctor-Patient Relationship

    I have long been an advocate of a no refusal, admit all patients policy for physicians . Any physician is bound by his Hippocratic oath and the law to treat any patient (within the bounds of his skill and expertise) whatever the circumstances of that patient will be. The physician also has the social responsibility of reporting any patient (to proper authorities)  that  may pose danger to any other person or to the society for which the patient belongs.

    Lately however,  I’ve noticed a few non-compliant patients pushing limits of our patience and  resources. My case in point.

    A thirty something male patient brought to the ER (allegedly from another hospital) for a 2 day old gun shot wound. The GSW entry point is at the postero-medial portion of his right leg, with no exit wound noted. He has a comminuted fracture on the middle part his tibia. On examination, the bullet  slug is palpable on the  postero-lateral side of his knee. I noted a wide area of contused skin from the leg, extending to the lateral posterior of his right thigh. Patient is febrile and have an elevated BP. We immediately started IV antibiotics and  scheduled the patient for an emergency debridement and external fixation of the fracture.  Surgery went well and while the skin contusion did grew to a alarming size, the patient eventually recovered and was on his recovery 5 days  after surgery.  The patient ran away from the hospital without proper discharge procedure and without paying his bills. As we learned later, all patient’s data and circumstances were dubious and the patient is nowhere to be found.  My worst fear is the danger of this patient contracting osteomyletis if ever his fracture isn’t followed up carefully.

    If he ever goes back to any hospital, and if you are the physician, what would you do?

    The dilemma is much more difficult in government hospitals. In the Philippines, government hospitals are funded by people’s taxes. Funding that are at less than optimal and is finite. Government physicians sometimes sees patients, that for some reason,are rarely compliant. Most often these patient’s’ non compliance results to complications and prolonged treatment. Prolonged treatment siphons physician and hospital resources that could have been allocated to other patients. This is where the decision making abilities of a physician enters and is very crucial. It can actually make or break his career because litigation and malpractice suits isn’t easy to come by.

    My take on this? I’d still treat the patient according to what his medical problem requires and to what treatment the patients consents to. But I’m going to document it very carefully and protect myself with detailed consents and waivers. I will also get the opinions of  appropriate legal or social services department. Sometimes, its more with communicating with the patient and convincing them of their most beneficial treatment option. This is not easy. But aren’t we surgeons and doctors now if our job is easy?

    I may sound like crap but again, the simple fact remains the same. We are the physicians, the very persons privileged to touch and care for sick people. When we treat patients, we (and the hospital) enter a ‘contract” with that patient. Contract that to an extent, requires both the doctor and the patient to work for the wellness of the patient, for so long as that treatment is not detrimental to others. It all boils down to both parties being aware of their responsibilities in this contract. If one violates this contract, that ceases the existence of the contract and therefore, ceases the doctor- patient relationship.

    If you are a physician in this situation, what would you do? If, you are a patient, what do you think should the physician do?

  • A cliche to settle…

    Barely two weeks ago I got the news that a good friend’s dad died of complications from an untreatable disease. In the few times we interacted, I instantly liked the bare realism of tatay. Tatay, as I fondly call him, reminds me of my dad’s astute stubbornness and brute witticism. The down to earth jolly individual who grew out of the market’s daily grinds, never fails to surprise me with his “i am in control attitude”. He is after all a dad to his children. When the news of his death reached me, I found myself groping with sadness..

    Me, a doctor, a surgeon. Born into the hard life, molded into steel (so my story goes) still…and still, I am groping with sadness.

    When we lost our dad to liver cirrhosis three decades ago, i barely had any idea what grief means. I was only eight years old. I never knew a thing in this world but “play”. When I grew enough to miss my dad, I began to use that missing as a source of inspiration for pursuing my dad’s dreams for us. Together with my mom’s unwavering love, I drew inspiration from that ‘missing” and strength from my dad’s memories. In a way, I never really faced off with sadness before.

    Until again this time, when another semblance of my dad came along…and left.  He reminded me what once my dad’s fondest “cliche” for us.

    Live today as though it will be your last.

    Seek the best in all that you do.

    Never put a thing off for tomorrow what you can do today.

    Dream small, dream big, above all, never fail to dream…

    Yes, they are cliche today. But in my job where I rub elbows with a “dead man walking” almost daily, the only cliches are those “cliches, you need to settle”…

    RIP, tatay. Thank you for reminding me of my dad. Please pass this to him when you guys meet up there: “I love his cliches“

  • Thing(s) that we do outside our clinics…

    One thing I always do whenever I get this “blogger’s-duh-moments” is read what my fellow docs write  or see what they’re up to in their blogs. A kind of stalking yes, but believe me, their stories are pretty inspiring. Busy schedules aside, some write ups and post reveal a lot about their preoccupation outside of their medical careers!

    Hobby-Happy:

    Take Prudence MD‘s Toycon 2010 experience. I did know she liked cosplay but attending  a Toy Convention sans the odors and the bumpy crowd? Your guess is as good as mine. Hooked!  I noticed too she had a new medical site named MROD notes! Rock on senior!

    Gigi, fellow orthopod (who I suspect is a linguist too, a musician perhaps) narrates and critiques a french movie. Seriously I know nothing french except fries and toast, but yeah I wouldn’t wait 40 minutes for a movie. There I said it.  Cause you said so.

    Cooking aside, I missed Manggy’s food post and pictures. Uh, well, how can you resist such yummy food photos? Even if half the time, I don’t know what’s cooking?!

    Medicine outside of the clinics:

    Merry Cherry, the family physician in training is ripping his hearts out with “money matters”, in treating her patients. Welcome to the real world. No, the real, real, medical world where money does matter and all you can do is comfort our patients. Thumbs up for the experience!

    Ugh! Brian‘s Realizations… We have plenty of them indeed. You don’t have to go to craniec or cardio monitoring however. Learn the best from both worlds- books and consultants that is. What I’m sure of is as a resident, you’ll get a hit anytime and anywhere you least expect. But then, it’ll pass. It’ll pass..Five years isn’t that long.

    Extended learning:

    Doc Clairebear, who chronicles from the middle of nowhere, (oo nga, saan nga ba?) started her birthday on a positive note. That of seeing life in a positive light. Well, if you were negatively grounded before, I certainly didn’t noticed. But let’s start your birthday with a drive test that you passed. Positive.

    When one talks of new beginnings in a seemingly tunneled professional life, I turn to this post by Doc Ian. The professor is now a student, again. And he’s excited about it. All I can say Doc is, “did we ever stop being a student?”.  Good luck and I will be reading your posts more often.

    Politics:

    Doc Martin Bautista thanked us all, for all our support even before he walked the path of politics. Even if he hadn’t gain a seat in the senate, he helped fulfill our collective of expression of hope, for a new president. For P. Noy. Mabuhay Dr. Balikbayan.

    Doc Doray, is on her second term as QC councilor. The running councilor is continuing her run for a good city legislative council. The best of luck sis!

    The Bubbleman talked dirty on dirt deep politics. Heart you man. After automated election, maybe we should automate voters education. What’d you say?

    Ligaya should now be happy too. His president is now our president. Mock me, but how she arrived at her presidential choice, is strikingly similar to me. Let’s cross fingers Ligaya, that our president will perform par with our expectations.

    Mommy matters:

    Megamom, mega busy with mega kids, mega cooking and mega pictures. What’s left of that is well, for mega works. I’m waiting for her mega posts hopefully soon…

    Joey, joey, Joey! Why are you so busy? This raket scientist-mom I knew has the best of all worlds -a busy  medical and non-medical career. Her blog is streaming with posts. Yes, supermom. Go!

    Kittymama never fails to bring and infects us with her stories of hope. Her inspiring stories of autism and her love for her child, tells us Yes, there is always hope. Read her post and you’ll know what I’m talking.

    Partying, singing and the like…

    Yes, the Eye Doctor, singing the Eraserheads ultraelectromagnetic pop songs on karoake?? Hey Doc, I love Bob Marley. The knight’s on daily weed, that’s why his songs are kinda, “weedy”.

    And uh, our anesthesiologist online, Dr. Ness, who posted tidbits of her escapades outside the OR theater and the net. She must be very busy getting all those stuff, judging from the signage she’s laughing her heart’s out. And who told you OR people don’t party?

    Travel. More travel:

    So where in the world is Em Dy? Me, I don’t know. But what I’m pretty sure is she’d be posting another thought on her blog from basically anywhere in the world. Hint: She’s not on the go when shes blogging about movies.

    The sign on this blog read “The doctor is out: Beachy“. I won’t bother disturbing.

    Oh, careers:

    Her last shout/ whisper to the universe, should be titled “sunday duty no more“, as her blog url will tell us. One thing I can share about leaving a training program “It damn take as much courage as sacrifices as pursuing it“. So yes, go to where you are happy to. Suportahan ta ka!

    Explaining:

    Talking about heat exhaustion during this hot summer season. The Emeritus doc at Parallel Universe talked about how heat can kill a diabetic, hypertensive patient (let me add to that, a diabetic, hypertensive, politician). But not heat stroke, thank god, but Cerebrovascular Strokes. Certainly media and election hype did a thing to the misconception. So beware..

    Family, or when we ourselves become the patient (or patient’s significant others)

    Don’t give up Doc Abner, there’s always hope. Or something to hope for. Like our patients, all we can do is hope and comfort for our patients. That doesn’t exempt us and our families. God bless you and your family.

    Doc Ducay is happy. Totally overjoyed with the new addition to her family. What a happy new year indeed!

    Stressed now?

    Hop into Doc’s Grace Clinic. Why such blog exudes relaxation and coolness, go check it out. But I have to ask though, what’s in for guys like us doc?

    Well if you missed The Blog Rounds, don’t be surprised to read the most recent most edition here. And I’m greatly indebted to Doc JA for hosting TBR and the contributors, Doc Gigi and Doc Sonia. Thank you to all of you! Yes, I learned that too in Kindergarten.

    Well the last, but my favorite recently, Last Minute Madness. Doc Sonia blogs with totally entertaining and streaming frequency. Some of her diary like stories is almost always fresh from the box, err, the bus. Read her moonlight saga here and get swooned.

    There, all the edema rounds in half a day! Whew, what at read. Now I have so many things to write. Like this post.

    For my fellow MD TBR bloggers, if you have reactions (violent or otherwise) leave your comment here.  Please update your links to this blog also, since I changed url sometime ago!