Cast & Curious

Blog

  • Streamlining our OPD services (Orthopedics)

    We’re streamlining our Orthopedic outpatient services. And this is all to strengthen our out services especially to the indigent ones. The proposal will try to achieve the following

    1. Provide a better, quality and cost efficient outpatient service for patients.
    2. Better case documentation and improved follow up of patients.
    3. Improve our residents’ training program with better documentation of cases and outpatient follow up.
    4. De congest the outpatient department with unnecessary follow up and costly diagnostic procedures such as x-rays.

    Hopefully, this will alleviate some of the service concern of our patients.

  • Training Perspectives Part I: Dummies guide to surviving an Orthopedic pre-operative case conference

    It’s never a pleasant experience for me, as an attending, to see a resident tremble in front of the consultant staff, his pre- op case vanishing in room air and his morale at the level of the floor mat. I was in the same undesirable instances before, as any resident would be, not a long time ago. Often, the deja vu, nauseates my academic appetite. Ironically some of the best lessons I learned in my training came from such spectacular display of “enlightenment”.

    I am in the opposite sitting arrangement now, as an attending, throwing the same bullish questions I lovingly evade before. But then again, if you are a resident and you accept your status as it is, this might be the best way of freeing yourself from such lowly self esteem!

    A word of caution though. This is not Us, The attending vs You The Residents sort of set up. As Someonetc said, were all in these together. Nethier you or us nor the patients should lose. We all learn from it.

    The common question from the frustrated resident is “How will I ever satisfy this ever critical attending? I’m always wrong to him!”So our residents will ask me, “how can I ever avoid such hell questions during pre-op?” In the short time I’ve been an attending (and the long time hibernation as a resident) these are the “attributes” I look for and emphasize during rounds and pre-op. In this particular order.

    1. Present the case for your patient. Know your patient, examine him well, take care of him, and decide according to his realities and situation. Put him in the top of your indication list. Err on his side. Overdo things for his welfare. I cannot emphasize more. Nothing irritates us more when the patient is not on your number one list or if you forgo the patient’s welfare just because you were busy with something else.It is always wrong to reason out that way!
    2. Never lie or bluff your way out. We will be sending you to vacationland for good or force you to jump-off training. Believe me.
    3. It’s the decision making process that I look in more. The logic behind why you do the labs, why did you decide to do the the surgery or not. This separates you from as a scientist and surgeon to a technician. Treatment protocols may vary, gold standard of treatment will change in the future, but logic and decision making attributes remain the same.
    4. Read for your case. Read voraciously what is relevant to your patient and case at hand. Hit your ortho books but new relevant studies will always grab our interest. Never come unprepared to the pre -op. No patient (not even you as a resident) would want a surgeon who doesn’t know what hes doing, to operate on him
    5. Accept mistakes and make good at your promise to do well next time. The attending will always remember the next time.
    6. Talk to your attending or consultant after the conference (and the patient) to make sure you got what they advised you.Its always a mark of a dignified resident to clarify his lessons and make sure he understands them well.

    Again, we’re all in these together, you residents, us the consultant staff and the patients. I still believe no consultant is in there to personally destroy a residents career. Most of us are there to help you learn, learn the right way for you“-free of charge. Perhaps, thats the best assurance you can get from us.

  • Filipino MDs in the blogosphere: "Duktor Ko"!

    These Filipino docs may have a very busy clinic or duty days, but blogging is part of their routines. Blogging may be after all, one of their stress reduction prescription- Pinoy style!

    Em Dy of Pulse have compiled blogs of Filipino MDs in the blogosphere including some (Martin B. of On My Way Home, Doc Emer of Parallel Universes, Prudence MD by Tess R. and yes Em Dy‘s Pulse ) of the well known personalities in the medical blogosphere, and some ‘Juan-came-lately” newbie blogger doc (like me).

    So perhaps, Pinoy MDs are taking more active “utilization” of this form of social media after all!Blogs may not be medically related, but they are as interesting as the docs themselves!

    Here is the list and the complete descriptions of the blogs by Em Dy of Pulse. I can’t think of better descriptions of the blogs than what Em Dy has wrote. So I’m lifting it here verbatim!

    • On My Way Home. This is the blog of Dr. Martin Bautista who is perhaps the most popular among the Filipino doctor bloggers. His fame is not so much due to his blogging but because of his attempt to run for a Senate seat. Although unsuccessful in his bid, the votes that he garnered is testament that the Filipinos are ready for change.
    • Prudence and Madness. Tess Termulo is a well-known figure in the Philippine blogosphere. She talks about medicine, personal and socially relevant issues and even shares her dreams.
    • Parallel Universes. Also well-known among Pinoy bloggers, Doc Emer writes mostly about medicine but occasionally ventures into posts very distinct from medicine.
    • Finestkind Clinic and Fish Market. Retired physician Dr. Nancy Reyes dispenses her thoughts on medicine, culture and the joys of cooking pancit.
    • No Special Effects. The doctor who runs this blog, Manggy, is addicted to dessert.
    • Feeding the Boys. A dermatologist now living in Canada, CTL shares her adventures in the kitchen.
    • My Little Space. This is Dr. Gita Asuncion’s home on the web. Here, she shares her life, what she’s seen, felt and heard, where she’s been and more.
    • Super Dok. Amelyn R. Rafael, MD wears many hats, those of a mom, practicing physician, teacher, wife, etc. With all that multi-tasking, she’s definitely super.
    • Shouting My Whispers to the Universe. This is the personal blog of a female Filipino doctor who calls herself Midnight Rainbow.
    • MegaLife. Written by MegaMom, this blog is a collection of posts about food, wine, coffee, books, music, art, movies, health, family, altruism, everything but bowling. Now blogging at Pinay MegaMom.
    • Notes of an Anesthesioboist. I found Dr. T. Legarda from a comment in MarketManila. She was born in Manila and now engages in anesthesiology (private practice) in Boston since the move to the US in 1981.
    • My Life and My Scrapbooking. Dr. Rita Marie S. Vergara is a pediatric pulmonologist and is a certified scrapaholic.
    • The Doctor is a Photographer. Dr. Antonio C. Comia shows us that his photographic eye is as good as his clinical eye.
    • Ripples from the River of my Thoughts. A physician from Cebu, JA also likes to dabble in creative writing.
    • Payb-Pifty Lang Po. This is Doc Broks’ funny blog.
    • Samu’t Sari. A personal blog with interesting takes on theater, dance and travel, Samu’t Sari is all that and much more.
    • Differentials. Another personal blog, this time by a female physician on her way to becoming an internist.
    • Sympathomimesis. Dr. Rosseau, another would be internist, channels his thoughts in this site.
    • Aloyloy. Probably, the strangest name among the blogs listed, this one focuses on politics and pop.
    • Lifeline. Reeza is a doctor from Lipa who has only recently started blogging.
    • So Far, So Good. Dr. Christian Gomez describes himself as multi-faceted. His blog is similarly so.
    • Life Journal of an Integrative Medical Doctor. A ger
      iatrician who calls himself XyberDoc talks about his life and medical practice.
    • Pepper Says. A newly licensed doctor in transition from school to work blogs about her universe.
    • It’s Me! Raphael. This doctor from Cebu talks about family, medicine, technology and religion.
    • Mah Lyf. Norwin Detalla is another doctor blogger from Cebu.
    • The Last Frontier. This is the blog of Raul Espinoza Ramos, a doctor who’s also a nurse.
    • Chronicles from the Middle of Nowhere. Dr. Clairebear describes herself as a young doctor in quarter-life crisis, wandering through life for the first time without a map.
    • My Sanctuary. Doc Mai is a Filipino doctor based in Mindanao who once dreamed of a Palance award. She rekindles her love for writing in this blog.
    • Merry Cherry. Merry Cherry is a doctor to the barrios who blog about her adventures both in the city and in the country.
    • Checking In. This is the blog of Dr. Geena Macalua, an internist-oncologist. Here she talks about medicine and life in general.
    • Sison of Love. It’s obvious that Doc Cristina loves two things: music and love.
    • www.thekid.tk. TK is an internist/medical officer whose mission in life is to make good memories with his children.
    • Doralicious. Another doctor who wears many hats, Dorothy is a psychologist turned physician turned public servant.
    • At Random Ness. Based in Dumaguete, Ness blogs about medicine, family and friends.
    • The Orthopedic Logbook. Bone MD writes about issues affecting his daily medical and orthopedic practice.
    • Okasaneko Chronicles. This is the blog of KittyMama, a doctor whose passions in life include autism and Hello Kitty.

    Thanks again Em Dy. And to those interested we can form a blog carnival of Filipino MDs. Please don’t hesitate to contact me (email) or leave a comment here!

  • SurgExperience: "Surgeries" in the blogosphere

    Perhaps the best thing that ever happened to surgery in the blogosphere, SurgExperience is cut throat “operation”. Imagine the razor sharp wits and stories of the surgeons, anesthesiologists and the whole surgical team, brought into life via the blogosphere and compiled into one for everyones’ reading feast. And you don’t need to scrub yourself nor don an OR suit. Just your wit dude, just your zanny wit…

    A compilation of the best surgical (and anyone else proud enough to keep one) blogs in the net today, SurgExperience was originally conceived by Jeffrey Leow of Monash Medical Student Blog and is on its 14th edition now. This will be hosted on “Notes of an Anesthesiologist” come Feb 3. Previous compilations as well as the upcoming schedule can be seen here.

    So maybe, there is “cutting and nailing and implants” in the blogs after all. Not the literal type, but just as visual, and glorious (or worse) moments in our surgical life! Read on their posts, the operating theater is as open as you can squeeze in!

    (Note: The Orthopedic Logbook, together with other Bone heads in the blogosphere, has recently been added to the roll. Hope I can contribute soonest or host the SurgExperience!)

  • Cheaper Medicine Bill Part II: Not cheap at all!

    The dizzying melee over the Lower House version of the Cheaper Medicine bill has brought out some disconcerting and ironically “costly” issues to the medical community and the current Philippine healthcare industry. And these almost intangible yet paralyzing and costly “side effects” are beginning to wreck havoc and are not cheap at all!

    Even before the passage of the bill by the congress and senate bicameral committee, the Quality and Affordable Medicine Bill (which is supposed to lower the high cost of medicines in the Philippines) already took its toll on the very parties it primarily aimed to help- the Filipino patients and their MDs. Imagine these:

    1. The discussions and bickering had succeeded, in some way, of polarizing two of the primary parties to the bill. The doctors has been “demonized” ( to use Prudence’ term) as anti-poor and greedy because of their alleged ” incentive” driven practice of prescribing “branded” drugs . The PMA loudly declares “MDs are for the patient’s welfare” not some drug companies! The patients on the other hand, thought to be less informed and knowledgeable about their sickness, is deluded by unscrupulous politicians of the promise that a cheaper generic drug will heal all their illness. Imagine the mistrust (between these two parties) that emanates from this polarization! I am totally scared to even think of a doctor patient-relationship that is based on mistrust.
    2. A landmark study about the therapeutic equivalence and safety profile of generic drugs in the Philippines (compared to its branded counterpart) has yet to be heralded by someone. This is perhaps the gist of The Physicians’ arguments against some (generics only prescriptions) provisions of the cheaper medicine bill, and remains a major stumbling block towards MD’s accepting some generics drugs as a good alternative. But such studies is costly, and not even BFAD (who wallows in its funding mediocrity) nor some low cost generics drug company, will willingly spare any cent at all.
    3. That the general perception of doctors receiving “incentives” from the pharmaceutical companies (in any form) and that these incentives influences his prescribing objectivity, is a costly blow to the medical profession. Even the PMA President acknowledges that a few MDs practice such “incentive driven drug prescribing habits”, but this form of “bribery” is not unique to the medical profession. Nevertheless, such practice is totally unacceptable and is a shame to medical community. The noblest profession on earth couldn’t afford such stain to its integrity.
    4. BFAD accepted its inadequacies in implementing stringent rules on the testing, approval, monitoring and policing all (not just the generic but also branded) drugs in the market. This confession made us wonder how on the earth did the current drugs went into market after all? Are we having less or subpar medicines in the market?If BFAD is inutile, then the doctors were left with their expertise and preferences in prescribing their drugs after all! BFAD therefore needs some sort of “medicine” to take care of its ailing “status” of de facto licensing and drug regulatory agency. And in this government, where health is of lesser priority, surely it has a long way to go.
    5. The “BFAD inadequacy” thus lead to another costly move for some of exhibitionist politicians to jump gun on the MDs directly. “Screw the BFAD rehab for now (we need more of our pork barrels instead), lets police the doctors and coerce them to give only the cheapest generic drugs! More ever, lets allow the hapless pharmacist (if your lucky to face one in the drug stores) to guide the patient in choosing one of the 3 or so generics in the drug store“! Anyway, it is the doctor who will be held liable if this drug wouldn’t get its desired effects. Tell me I am all wrong but this is another costly pursuit for any parties involved, the patient or the doctor-litigation for a malpractice suit!

    Nobody wants an expensive medicine, not even the doctors. In fact, everyone is for lowering the cost of medicines here in the Philippines. Even the pharmaceutical companies themselves wants their medicines be affordable to the masses. If nobody can afford their medicines, how can they reap their profits?And if the doctors prescribe exorbitant drugs and the patients didn’t get well because he/she can afford it, will the doctors make a living?

    As Prudence has said, “lets not loose our guard in this discussion”. Because after all the hullabaloos in the race for “enacting the Cheaper Medicine Bill”, we might have been deceived at seeing the real cost of our incessant political exhibitionism.