Cast & Curious

Blog

  • Changing times and changing my blog

    Over a span of several years, I’ve been blogging about almost everything related to my practice. That same time I “grew up” from a “grunt” blogger to one that takes positive insights to every bit of challenge hurled in front of me, medicine related or otherwise. This blog also “expanded”  its horizons from just relating personal experiences to some “serious” stuff about healthcare.

    the current blog theme

    Physicians still has the “authority” over medicine, but not without silent criticisms from “internet powered” patient. Patients gets medical information, validated or not, from the internet. That was years ago. The broad definition of internet sources it seems, is not limited to peer reviewed journals and strict professional medical organizations’ websites. Social media entered the picture and  is becoming a source of medical information. In fact social media, has been pushing boundaries and game changing healthcare as we knew. Healthcare couldn’t just shrug off social media nowadays.

    Thus most of the time, physicians just parry questions left and right, answering “yes that’s right mister” or “No mam that study you read on the internet is not accurate!”. In fact, physicians sometimes get into embarrassing moments when patients volunteer information from the internet none of us came across that data (because maybe, we are busy with doctoring and everything else other than googling). (Here’s one good guide on how to deal with the patients who surf the net made by Dr. Iris Tan)

    Healthcare it seems, is playing catch up on social media.

    In this set up, I began to rethink about this blog evolving role in social-media-healthcare-catch-up sort of thing. Five years into blogging, there still not that many physicians grabbing the opportunity of using social media as a healthcare tool. In the business sense, a social media strategy to aid in his practice or just healthcare for that matter.

    [pullquote]I may not have campaigned, but the real score probably is this- we’re damn too busy. If we have break, we surely don’t want to bring up healthcare issues right in the coffee table, much worse online. It’s just taboo.[/pullquote]

    I thought of providing information about orthopedics or general medicine. But over the years providing such scientific informations per se are better done  by sites related to professional medical organizations and peer reviewed journals.

    Which brings me to what I’m probably changing a bit about the tone of this blog.

    I like writing on a more personal level, presenting an information and then nitpick an idea to go deeper into how I’d be able understand it. It’s more of summarizing, injecting personal thoughts and giving a whole lot of personal touch to understanding medical information. There’s more of trying to reconcile experiences with whats the journals says. Most of the time, it’s the “bone of contention” or the question/ dilemma that needs to be decided or answered  which keeps the information interesting and the interaction lively.

    Thus, I’m gunning for a more personal, meaty content, on health care.

    Note the blog theme is changing. Minimalist. More on content. And the title.,

    My bone of contention…

  • Blogging up there, somewhere.

    I’m publishing this blog post a bit late. I can’t stand not writing about a blogger friend and defy her preference for “slipping away” silently.

    Goodbye blogger friend. We will miss your blog posts, your writing and your knack for demystifying music to us, cold souls.

    Goodbye fellow bone doc. Even if we rarely had a chance of actually doing bone surgeries together, we shared the same tenacity for fishing out the medical absurdities of our work.

    I hope you did take the “wave and smile” I made during your induction to the fellows fold a warm welcome and congratulations.

    Not a farewell, I hope.

    By for now blogger, fellow bone doc.

  • Prison break

    Today, one of the longest overstaying patient I had finally went out of the hospital.

    Everyone gonna miss this jolly, friendly guy for sure.

    But he seem not happy.

    He’s being escorted out of the hospital and into a jail, for a crime he committed before he was admitted.

    Guess, he liked the ambiance of this hospital than the place he’s going to live in for some time.

    If I was in his place, I’d be sad too.

     

  • Six years after orthopedic residency

    I just came back from an orthopedic fellow’s convention and the Ruby Anniversary (40th) celebration of my former orthopedic training institution. Aside from the maxed out celebration with former (tor)mentors and alumni, I got one serious question unanswered afterwards- What now?

    Seeing the glorious past of an iconic institution, and sensing the current status of a top notch residency program, I am reminded by the vision and mission the department. The same vision and mission somehow answered the very question thrown on me by an alumni and mentor.

    Where are you now in your orthopedic practice? Are you in pursuit of our department’s pillars of leadership and excellence  in training, research, and service?

    A very had question to answer and I can swear I had to think deep enough into the recesses of my orthopedic practice to assemble my answer. There is no doubt in my mind the department’s alumni are in the forefront orthopedic’s training and service in Philippine orthopedics. What I saw and heard during our Ruby Anniversary partly reaffirmed this.  Well, I  “rubbed elbows” and chit chatted with famous/celebrity/controversial orthopedic surgeons in the Philippines I listened to stories of alumni who practiced unknown territories where no other Filipino orthopod dare went into. In fact, almost every nook of Philippine orthopedics nowadays is led or being push up front by no less than the graduates of our institution, be it for excellence or some other things.

    Research on the other hand, lags behind among these pillars that the department is excelling at. Such was an assessment by some former mentors and alumni, if we are to base it on the number of quality, evidenced based researches published on peer reviewed journals here or abroad. Sadly, such also applies to me. The last orthopedic related research I’ve done was six years ago and thats was during my residency training. In a community practice outside a training institution, the chances of you doing orthopedic research is practically nil. I blame it on nobody, but myself. During residency, we had this one common “Limitations of the Study” written in almost all our orthopedic research. It says “not enough study population”. Today, in my practice, that would still be a limitation. But many of former mentors mention this one reason:

    “Many of our graduates outside a training institution don’t do orthopedic research anymore because research don’t feed mouths. Instead of providing money, you need money to do research. Research entails a great deal of commitment in terms of time, money  and effort. Commitment who couldn’t compete with the drive to earn money for living, comfortably”

    Yes. I’m guilty too and these was an aye opener. At least now, I can set a direction to where my practice could focus more to improve service. Perhaps one day I can still live up to the expectations of my department’s vision and mission.  No it’s never late. Like what many have said, there’s so many areas to learn and research on Philippine orthopedics. Not many formal and evidence based researches have been done. Not many got published. That makes Philippine orthopedics still a fertile ground for research.

  • Of headaches and coughs

    Once in a while I get a break from purely orthopedic stuff and wield a stethoscope as a “general practitioner”. I used to like the general medicine as a student but when clerkship bombarded me at least fifty patients a day giving nothing but prescriptions and prayers as “medicines”, I resigned myself to cutting it out in the surgical field.  In my place of practice though, there are times when you’re the only doctor within 1 kilometer of a medical emergency and every other medical practitioner is busy handling other medical emergencies somewhere else. God knows what happens if the patient’s relatives find out you don’t know what atrial fibrillation looks on ECG. So when push comes to shove,  I welcome instances where I can re-learn my rustic general medical skills. Or at least mount an attempt to re-learn.

    Two days ago I started seeing patients for routine medical physical examination. The sheer volume of patients made me think I’d get bored or get tired sooner. Surprisingly, I found myself enjoying the “routine” job simply because its something not routine for orthopods like me. “A break in the monotony of bone breaking, hammering and screwing..” perhaps.  The same fun feeling and excitement when you had your first few patients as a medical student. This routine physical examination also gives me the opportunity to look at the depth and effectiveness of my patient communication skills, especially in medical topics way beyond the orthopedic cram space.

    The sheer volume of patients also brought in funny experiences and encounters you’d probably die of laughing out loud in the washroom.

    Here are some of my (funny) encounters;

    Patients chart says: Chief complaint: “occasional headaches”.
    Me: “Masakit po ba ulo ninyo ngayun?” (Do you have a headache now?)
    Patient: “Wala po”. (None)
    Me to self: (Right, this encounter must not be an occasion for his headache to come out)

    Here’s another:

    Me: “May “cough” po ba kayo ngayon??” (Do you have coughs right now?)
    Patient: “Wala po. Ubo meron” (None, but coughs I have.)

    and another:

    Me:” Sino po ba nag bigay reseta ng “salbutamol” sa inyo?”(Who gave the prescription for your medicine, Salbutamol?)
    Patient: “Tatay ko po” (My dad.)
    Me: “Doctor po ba cya?”(Is he a doctor?)
    Patient: “Opo, doctor po apilyedo nya!” (Yes, this patient’s last name is “Doctor”)

    You couldn’t hide snickers whenever a patient answered like this:

    Me: “Kelan po ba sumasakit ulo nyo?” (When does your headache usually occur?)
    Patient: “Tuwing nag tatanggal kami ng damo sa school” (Everytime we’re tasked to weed out grass in the school grounds!)

    Believe me I couldn’t contain my heart laughing out loud during these light moments. I don’t know if its because of the many misunderstood and trivial complaints you get whenever its an ambulatory clinic you’re conducting (or that I was just too confined with more serious, trauma patients). One thing though,  we all needed the laugh just so we can finish some two hundred plus patients each day.

    Who said my specialist life is too constricted and boring? If there are instances like this where you can find time to re learn your medical skills as a general practitioner, why not? Especially, when there are plentiful of laughs you can make out of the “routine-ss” of the situation. I can surely wield some stethoscope.