Cast & Curious

Tag: #HealthXPh

  • Deflection Bias in Practice: Between Constraint and Choice

    Deflection Bias in Practice: Between Constraint and Choice

    We work in systems where ideal diagnostics are not always available.
    That’s not new. It’s the reality most of us have adapted to.

    Decisions get made with incomplete data.
    Sometimes that’s the best that can be done.

    But over time, I’ve started to notice something less obvious—
    not just in the system, but in how I think within it.

    When does necessary adaptation become explanation?
    And when does explanation start to feel like justification?

    One way I’ve been trying to frame this is through what I’d call deflection bias:

    the tendency to externalize responsibility for clinical uncertainty—attributing decisions to system constraints—thereby reducing internal accountability and limiting reflection.

    Not always incorrect.
    But not always examined either.

    A recent case brought this into focus for me.

    A patient presented with a small, hard, non-tender mass over the anterior distal leg.
    Pain occurred only with strenuous weight-bearing, without systemic symptoms.

    Radiographs showed well-defined lytic lesions without cortical break or sequestrum.
    Advanced imaging—CT, MRI, nuclear scans—was not available.

    The working impression leaned toward a benign tumor, though infection remained in the differential.
    Surgery proceeded.

    Intraoperatively, the lesion was consistent with chronic osteomyelitis with abscess formation not evident on plain films.

    Cases like this are familiar in our setting.
    What I’m less certain about is how often we examine the reasoning around them.

    Because in environments like ours, system limitations don’t just shape what we can do—
    they can also shape how we explain what we do.

    And sometimes, that explanation becomes a way to settle uncertainty a little too quickly.

    The literature is consistent on one point:
    clinical outcomes are shaped by both system constraints and cognitive processes—they interact, not compete (Croskerry, 2003; Graber et al., 2005; WHO, 2020).

    Which makes the question less about blame, and more about awareness.

    Even within constraint, how we think still influences what happens next.

    So I’m putting this out to colleagues in #Healthxph—not as a conclusion, but as a point for reflection:

    1. T1. When do system constraints appropriately guide our decisions—and when do they begin shaping how we justify them?
    2. T2. How often do we revisit decisions initially attributed to “limitations” and re-examine our clinical reasoning?
    3. T3. In a constrained system, what does accountable decision-making actually look like in practice?

    No clear answers on my end yet.
    Just a growing sense that this is worth looking at more closely.

    Inviting everyone to the #HealthXPh Chat this Saturday, March 21, 2026, 9–10 PM MlaTime. Let’s have the conversation medicine rarely makes space for.

  • What Filipino Physicians Really Think About AI: Insights From Our Community Chat

    What Filipino Physicians Really Think About AI: Insights From Our Community Chat

    Last week, we launched a #healthxph conversation on Bluesky about the three biggest challenges Filipino physicians face with the rise of artificial intelligence. The response was thoughtful, and surprisingly candid. Physicians from across private practice, training institutions, and government hospitals—shared their experiences and fears, as well as their hopes for AI’s role in healthcare.

    Here’s a synthesis of the insights that surfaced from the discussion.

    1. The Skill Gap: We Want AI Training—But It Must Be Practical, Local, and Clinically Relevant

    The overwhelming consensus:
    Filipino physicians are willing to learn AI, but we need structured training that fits our realities.

    Many admitted they feel “curious but cautious,” and several pointed out that most available courses are too technical or too focused on foreign healthcare systems.

    Common points raised:

    • “Show me AI that helps me in become more efficient in the clinics—so I have more time for my patients.”
    • “We need case-based, specialty-specific examples that are based on local, relevant data sets.”
    • “Train us in what’s safe, what’s allowed, and what’s actually useful.”

    A recurring theme was the gap between hype and practicality. Doctors want AI literacy, but they want it delivered in digestible, clinically anchored modules—ideally endorsed or facilitated by medical societies.

    Dr. Iris Isip Tan is already “launching an improved version of my AI workshop for medical educators in 2026. It will be aligned to the Unesco competencies below:

    Community Insight:
    AI education for Filipino doctors must be simplified, contextualized, and integrated into specialty training and CME.

    2. The Trust Dilemma: Accuracy Matters—But Accountability Matters Even More

    When asked what would make them trust (or distrust) AI, Filipino physicians gave two dominant answers:

    A. Trust rises with transparency.

    Doctors want to know:

    • Where the model was trained
    • Whether Filipino data was included
    • How often it makes errors
    • Who audits it
    • What the fallback is when the AI is wrong

    B. Trust collapses without accountability.

    The clearest insight from the chat:

    “We need clinical validation and FDA approval”

    This reflects a major gap in the Philippines:
    We have no formal guidelines on liability when AI is used in diagnosis, documentation, or decision support.

    Until this is addressed, many physicians said they will use AI—but “only for drafts, never for final decisions.”

    Community Insight:
    Filipino physicians trust AI only when its limitations, sources, and accountability structures are clearly defined.

    3. The Identity Shift: Filipino Physicians Believe AI Should Amplify—Not Replace—Our Humanity

    The most meaningful part of the conversation centered on how AI may reshape the physician–patient relationship.

    Doctors shared two major reflections:

    A. AI can free up time for what matters.

    Many said:

    • “If AI can reduce clerical work, I can finally talk to my patient.”
    • “Let AI draft, I’ll add the humane part.”

    Physicians emphasized that Filipino patients value kwentuhan, relational trust, and face-to-face reassurance—things AI cannot replace.

    B. But AI will push us to redefine our roles.

    Some were concerned that patients increasingly come with AI-generated diagnoses.

    A memorable comment came from a specialist:

    “AI will push us to become better educators, not just prescribers.”

    This sentiment echoed through the thread. The future Filipino physician may be:

    • A translator of complex data such as in public facing patient materials.
    • A curator of high-quality information as in research
    • A guide through uncertainty although this still “needs a human in the loop”.
    • A protector against misinformation

    Community Insight:
    AI won’t make us less relevant. It will require us to become more human, more communicative, and more relational.

    What This Discussion Taught Us

    This chat revealed a shared truth among Filipino doctors:
    We are not afraid of AI. We are afraid of being unprepared for it.

    Physicians want:

    • Clear training
    • Ethical safeguards
    • Practical tools
    • Better patient communication frameworks
    • Policies that protect both doctor and patient

    More importantly, we want to shape AI adoption on our own terms—guided by Filipino realities, Filipino patient needs, and Filipino clinical culture.

    Where We Go From Here

    Based on your insights, the next steps are clear:

    1. Create a “Practical AI for Filipino Clinicians” mini-course

    Short, case-based, specialty-relevant.

    2. Draft a community-led “AI Use in Clinical Practice” guideline

    To address safety, transparency, and liability.

    3. Continue these monthly discussions

    Because the landscape is evolving faster than any single physician can keep up with.

    If you’d like the next #healthxph conversation to focus on AI in diagnostics, workflow automation, documentation, or medical education, just let us know—we’re prepping for part two of this convo..

    For now, thank you for lending your insights.
    This is how Filipino medicine moves forward: together, reflective, and proactive.

  • Effective healthcare campaigns in changing digital media environment- From “You do it” to “Let’s do it!

    Vaccination and measles outbreak flooded our social media feeds recently. The sad news is we thought we eradicated measles decades ago. Measles however, only hogged the media limelight after an outbreak happened. “What went wrong with the measles campaign?” many asked. There’s no shortage of blaming on what many called “a failure” to counter an “avalanche of online misinformation” about vaccination and vaccines. Measles and vaccinations are just two of the many health campaigns that took centerstage after an “outbreak” happened. Heard of health supplements? Alternative cancer treatments? Dengue? Flu? Smoking? Vaping? Diabetes? Kidney diseases? We din’t notice until something alarming happened. We blame the new media and the people who use it for their own purposes-good or bad. Then we rush to using the same new media to counter such online misinformation. We fail and wonder. How come?

    First allow me to narrow the discussion to health campaigns on social media. Successful health campaigns are not solely because of an effective media strategy let alone a savvy social media leader. The whole caboodles of political, economic, logistical and support systems should be in place before we can even talk of launching it on social media. Having said that, and for the sake of our discussion, lets assume we all have those factors sorted out in place and we’re left with an effective social media campaign strategy to go with the health advocacy.

    In the past we had leaders adept in using media to implement effective healthcare campaigns. Think Dr. Juan Flavier and his much loved health news, radio and TV campaigns. He and his health campaigns were blockbusters, to his avid followers and critics alike. The charismatic secretary seemed to have mastered old media messaging and signalling and was very effective in mobilizing the crowd. He is interested in empowering the public, not himself nor his organization- a novel, laudable new media value. This cascading top to bottom healthcare campaign strategy worked for old media- newspapers, radio and TV. Will it work for the new media?

    T1. What old media health campaign strategies work in social media?

    Internet and social media showed much promise for advocacies and campaigns. Twitter had been instrumental in monitoring or reporting disease outbreaks for CDC and WHO. Healthcare organizations employed social media platforms to pressure health policy changes in some countries, and won. Social media campaigns played a huge part in the passage of Sin Tax Law and the Universal Healthcare Law in the Philippines. Incremental wins some may call it but a win nonetheless. Let’s not forget, the millions of money that poured in to health advocacy groups because of memes such as the “Ice bucket Challenge”. Why some organisations are successful in using social media to meet the objectives of their healthcare campaigns (and others, do not) remains a mystery to many.

    Internet and social media comprise the “new media”. Internet gatekeepers and social media platforms keep changing its policies, algorithm and strategies to achieve its bottomline- profit for its owners and shareholders. That’s not altogether bad given the social media platforms who succeeded in providing desirable value to the general public while maintaining a profitable and sustainable business model. That social media is hog washed in false information and dubious health messages is also not true. There’s no dearth of superior quality health information online according to Keselman (2019). Despite the presence of superior quality and credible online health information, some health campaigns failed to mobilize a hyperconnected populace. Why did it fail? Was it the messaging? Platform? Theme?

    T2. What are the reasons behind the failure of some health social media campaigns to mobilize the crowd and effect change?

    In their book New Power: How Power Works in Our Hyperconnected World- and How to Make It Work for You, Heimans and Timms (2018) placed leadership archetypes into a spectrum, a quadrant on how leadership structures (termed old/new power) use old/new power values to effect change.

    Leadership Archetypes in a quadrant with examples of leaders/organizations who best exemplifies each quadrant. Image from HBR article here https://hbr.org/2014/12/understanding-new-power

    Arguably, the top down, cascading model of social media campaigns don’t work effectively in digital social media environment.

    Old versus new power values. Image from HBR article here https://hbr.org/2014/12/understanding-new-power

    The “I’m the expert just follow what I say” seem to be a less appealing to social media crowd than that of the “bottoms up, grassroots or collaborative approach. The new leadership model committed to empowering the crowd with new power values are the most successful ones. Values like collaboration, radical transparency, maker mentality and overall general participation characterise this new power value. Social media smacks right into the heart of these new power values. Leaders who are adept at these new power values empower and mobilize the crowd .

    T3. What best strategy can you advise health leaders in using social media to mobilize and effect change in healthcare?

    Thankfully, many organisations (old and new power structures alike) are restructuring, recalibrating their health campaigns to align with the intricacies of new power tools, like social media. That is something we can learn from this deluge of disease outbreaks and health misinformation. This is the topic of this #HealthXPh chat come February 9, 2019 9PM Manila time as we build consensus of how to’s in implementing health social media campaigns that empowers and mobilizes the crowd.

    Join #healthXPh chat with these guide questions in mind:

    • T1. What old media health campaign strategies work in social media?
    • T2. Why did some social media campaigns failed to mobilize the crowd and effect change in healthcare?
    • T3. What best social media strategy will you advise health leaders in mobilising and effecting changes in healthcare?

    References:

    • Keselman A, Arnott Smith C, Murcko AC, Kaufman DR (2019) Evaluating the Quality of Health Information in a Changing Digital Ecosystem J Med Internet Res 2019;21(2):e11129 URL: https://www.jmir.org/2019/2/e11129
    • Sak,G; Diviani, N; Allam, A; Schulz, P: (2016) Comparing the Quality of Pro- and Anti-vaccination Online InformationA Content Analysis of Vaccination-Related Webpages BMC Public Health. 2016;16(38) 
    • Heimans, J; Timms, H. (2014) “Understanding “New Power””. Harvard Business Review. December 2014.
    • Heimans, J; Timms, H. (2018) New Power: How Power Works in Our Hyperconnected World- and How to Make It Work for You. New York, Penguin Random House LLC

  • How should healthcare professionals respond to a medically related social media posting?

    If you were the medical professionals in these two examples, how would you respond to social media postings related to your actions?

    • Case # 1: A medical intern was captured on a cellphone video, was ate bedside of a patient, holding a phone on his left hand and a paper ( a referral letter? ) on the other hand. This video was posted on Facebook with a caption (in Filipino language) “Are all doctors like this?…My patient is near death and he still does this?”
    • Case # 2: A physician regularly conducting medical missions in one hinterland wrote several letters to local government authorities regarding the unusual prevalence of Hepatitis B in one tribe of local indigenous people. He asked for help to the same authorities for years. He related help never came from the government sector. As a last resort, he posted his difficulties on Facebook.  This Facebook postings did receive a ton of encouragement and support. What’s more scathing though is the few “negative comments”. The physician is clearly devastated.

    What’s common in these two examples?

    Trial by publicity spinoff

    First, the healthcare professional’s medical actions went public via a social media site. Second, while both healthcare professionals received encouragements and support, the negative comments hurt more in both cases.

    Negative publicity

    “Negative publicity” is one reason why healthcare professionals shy away from social media. Negative publicity take toll on personal and professional life. The reality is someone- somewhere and somehow, will post something about our medical actions online. It’s simply a question of “when”.

    Key components of a social media response

    A previous tweetchat about protecting online reputation summarises two key components of a social media response- a prompt but well thought out reply. A prompt, well thought out social media response could only come from a personal or institutional social network strategy.

    Social Media Response Strategy

    The recent spate of healthcare related negative comments online urges us to examine deeper these response strategies.  Vanderbuilt University Medical Center developed a Social Network Response Guide for healthcare professionals on how to respond to social media postings related to their profession. You can find that algorithm here.

    Dr. Iris Isip Tan adapted  this Social Network Response Guide for UPCM/ PGH in developing their own social media policy.

    vanderbuilt
    Vanderbuilt University Medical Center Social Network Response Guide as quoted and modified by Dr. Iris Isip-Tan for use of UPCM-PGH in developing their own social media policy ( Photo courtesy of Dr. Iris Isip- Tan)

    The end goal of this guide is for the healthcare professional to have a calibrated response using the strategy of transparency, timelines for thinking and responding, a more personal tone and credible sources.  How we implement this algorithm to our own specific case is one of the main goals of this tweetchat.

    Join us this Saturday July 9, 2016 9 PM Manila time as we discuss how should healthcare professionals respond to social media posting related to the profession
    Our aim for this upcoming chat is to provide template guides for healthcare professionals in responding to social media postings related to our profession.

    • T1: How should healthcare professionals respond if the social media post about him or her is “positive”
      T2: How should healthcare professionals respond if the social media post about him or her is “negative”
      T3: How should healthcare professionals act if you are not directly related to the social media post or posting is not within your area of expertise.

    Join the discussion via twitter, using the #HealthXPh in all your tweets, answering the above topic questions, from 9-10PM Manila time July 9, 2016.

  • Part I: An Introduction into Aligning Social Media Strategy to your Advocacy Goals

    Social Media Strategy and Healthcare

    There’s no denying social media is here, now. Our society live and breathe social media. In fact, many experts believe social media is the “game changer” in many sectors of our society now and in the foreseeable future. #HealthXPh believe social media is a tool to positively change or improve healthcare in the Philippines.

    Ethical Issues

    Put simply, the use of social media by healthcare professionals is  strictly governed by the same professional code of conduct practiced offline. At #HealthXPh, we believe that our online self is a reflection of our offline self. Thus, #HealthXPh crowdsourced a Healthcare Professional Social Media Manifesto to guide health practitioners on the ethical use of social media. This manifesto should not discourage health professionals from using social media. In fact, health professionals now have a guide walking the path of a tricky social media.  There are numerous examples on the ethical use of social media to improve healthcare. #HealthXPh believe social media democratizes access to healthcare. It provides a venue for healthcare stakeholders to speak and be heard on matters pertaining to health. No other forms of media had this added value of “engagement” between the different stakeholders of health.

    Healthcare Social Media and its “Return on Investment” (ROI)

    One of the more pervasive perception about social media healthcare is that it is just a “waste of time”. Social media is a waste of time if you are using it just to kill time. Our value proposition  for healthcare social media at #HealthXPh is different, positive and complimentary to existing developmental strategies for health. Social media provides an alternative, fast, cheaper, broader reach platform for discussing healthcare issues. Social media demands transparency and accountability to all those who use it. Our long term goal is to democratize discussion in health, by giving the different stakeholders a platform for discussion and effect change by crowdsourcing ideas.  Positive engagement is our key and that is what we set out to ultimately measure our ROI in healthcare social media.

    Lack of ROI for healthcare professionals engaged in social media is the very reason why some called it a “waste of time”. The inability to measure social media’s ROI for health is the culprit. That’s what the goal of my topic today here, in the Second Philippine Healthcare Social Media Summit- Advocacy Track.

    Return on investment (ROI) is a business phrase that describe the benefit to an investor resulting from an investment of some resource (Wikipedia). Allow me to draw the same parallelism in healthcare social media. To clarify, the investment and benefit maybe anything of value to the investor and may not be always monetary. At #HealthXPh, we defined our ROI as the positive engagement we obtained from convening social media healthcare professionals.  This is still a short term goal and is continually evolving until we find our metrics for our ultimate goal- improve healthcare in the Philippines.

    ROI as we defined it, declutters the social media noise and allows us to focus on our social media advocacy goals. #HealthXPh as an advocacy aligned our social media strategy to our advocacy goals. Hence, a method of measuring our social media “success” or ROI, is a measure too of our advocacy’s success. Demonstrating social media success by measuring ROI fine tunes our efforts and streamline logistics to advance our advocacy goals. In other advocacies or companies, demonstrating success by measuring ROI is a way to encourage or gain support from advocacy leaders or executives.  It is thus imperative we measure ROI in social media healthcare. It is not the lack of ROI but the lack of defining our social media ROI for our advocacies. This is the ultimate goal of my talk today.

    To share to you what I’ve learned about Aligning Social Media Strategy to Your Advocacy Goals and developing metrics to measure your healthcare social media’s success!

    So are we ready to dive into social media strategy for healthcare advocacy?

    (This post is part of series on “Aligning Social Media Strategy to your Advocacy Goals“, a presentation by the author Dr. Remo-tito Aguilar, on the Advocacy Track of the Second #HealthXPh Philippine Healthcare Social Media Summit held last April 21, 2016 at the PICC, Manila.)