Cast & Curious

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  • Ten daily routines that help me balance my professional and personal lives

    “You don’t find time to do all these stuff outside of your physician’s life. You make time” as the cliche goes.

    Nowadays, I shy away from giving personal advices but instead “listen” until the advise seeker process his or her own personal thoughts and strategy. Knowing how different life circumstances are, my “personal” advices rarely work on everyone else on this planet.

    Yet there is a personal strategy I use everyday (or at least try to) in finding balance to the “tug of war” of my personal and professional life. Nothing in this strategy is original to me. I got most of it from people I look up to or books that I read.  The components of this personal strategy are mostly life tweaks, or hacks, a product of  daily hit and miss experimentations.  So if you are looking for a template to develop your own “personal” strategy, have at look at my daily routines. Pick the ones that would work for you or better yet, tweak to customize your own strategy. Enjoy!

    1. I meditate for 15-20 minutes daily. There’s evidence proving the benefits of mindfulness and meditation. My day would be a bit calmer, tasks and goals clearer and I react less to outside trivial triggers. The goal here is really not to create a state of mind and being but just to be self aware and mindful of everything that comes into mind. Consistency is key for me. The more I do it everyday, the greater is the benefit for me. I use a guided meditation app called Headspace.
    2. I journal everyday. Journalling makes my tasks and goal for the day clearer and simpler. My morning journal also centers on what not to do to weed out unnecessary stuff on my schedule. Journalling triggers a good portion of creative inspiration in me.  At night, journalling gives a sense of fulfillment for completing  small but meaningful tasks . My format is basically a tweaked 5 minute journalling although doodling sometimes eat another good 10 minutes of my time.

      An empty example of my daily journal.
    3. I talk to mentors as often as I could.  I have a set of personal and professional board of advisers I call to for advice. These are people who’s thoughts and advices on subjects add value to my my decision making process. Sometimes, “talking” means reading self help, life hack books to pick out skill sets or strategies and then customise it for my own purposes.
    4. I connect with my advocacies. I knew only a handful of lucky people who’s advocacy exactly coincides with a career that put food on the table. Mine is far from such although I strive daily to align my advocacies and work. An advocacy (like our at #HealthXPh) is self fulfilling while achievement is usually associated with “wins” in our professional lives. Advocacies also steer me directly to an aspirational self “who changes the world” for the better.
    5. I practice my hobby, everyday. Hobbies are not just a distraction but a life essential for me. It is my ultimate source for the creative juice for a life I designed for myself.  I love photography and hiking as well as blogging. So I invest time and money modestly in these to force myself into consistently practicing it. I have to or else my professional life will eat up more time of my daily schedule.
    6. I network with friends outside my professional circle. A nurturing community outside my professional circle is an essential for me. I found out that most of the personal “help” I had in the past was from people outside my professional circle. This network of friends are also a source of life hacks I listen to and emulate.
    7. I read books. Goes without saying that I consider books as mentors too. It is my gateway to new and exciting world beyond what my mind could possibly ponder alone. A good 15-30 minutes or even an hour is spent on reading pages of one or two books, then another 15 minutes for my “marginalia” or very short personal summaries of the pages I read. I also horde books. It’s a screaming bargain!

      Book hoarding for later read.
    8. I aggressively protect my personal and family time. Another very important non negotiable for me. I know this is very hard for most of us in the medical profession but I started out focusing on small day to day opportunities of saying “no” when my personal life requires me to. Key is being consistent on what constitute personal or family time. Sometimes industry will hate me for having such a immovable stance on this, but I felt somehow they’d respect me for doing so.
    9. I consciously build a productivity based and proactive professional practice rather than a reactive one. I can’t work effectively or productively for more than 4 hours each day, except while doing surgeries. I found this primarily beneficial to my patients, who deserved the best and most productive of my time. This translates to less income for me but greater non tangible benefits for my professional and personal life.
    10. I exercise 15 minutes each day. The benefits of regular, consistent exercise is well documented. Doesn’t matter what form of exercise is available to me so long as I move. I sometimes dance when no one else is looking. 🙂

    Well wait you might ask what the heck am I enumerating these for? First,  I specifically mentioned  “processes” or daily routines that help me “win” the balance to a  daily tug of war of personal and professional lives.  These routines help me make better choices or at least avoid the worst ones. Do I have proof that these work? On a personal level, yes or at least I felt it’s working for me. I think finding the balance in our life starts with the small, daily processes and decisions we make. So in this case, to win big, I start with the daily struggle and work from there.

    I hope you will find this useful. Feel free to comment below for your thoughts.

  • Mental Good: How healthcare professionals balance career and personal lives

    “To go beyond is as wrong as to fall short.”- Confucius

    About a month ago a colleague committed suicide just a day after her hospital duty . She was working 72 hours straight without sleep for weeks, but not even her family had an inkling she was about to take her own life.  Two days ago I talked to another friend who is disappointed with his medical career because of the so many challenges he is going through. He is beat up. Today, I talked to another healthcare professional and the same “tone of disillusionment”  is palpable as tears well in the corner of her eyes.

    “This is not what I signed up for medicine”  was the bottom line for this three healthcare professional.

    Disappointment, frustration or simply “burnt out”  is a well known but rarely verbalised, “not so secret” secret among colleagues in the healthcare profession. In fact, it is so common in the medical profession we’ve considered this part of the “normal challenges” of our career path and we expect every physician to survive it. Of course the sad reality is that not everyone survive this challenge.

    Some of them end up dead.

    While the cases of suicide among healthcare professionals maybe small and sporadic (an outlier) what surprises us the most is that nobody seem to have an inkling that physician or healthcare professional A is depressed and suicidal until he or she is actually dead or dying.  Are healthcare professionals good at hiding depression and frustrations or have the general public gotten used to the notion that healers ought to endure superhuman problems and heal themselves?

    The devil is in the small details.

    Most of the telltale signs of depression are what we see as “normal” in the day to day existence of a healthcare professional. Seventy Two hours straight duty? That’s normal. Most even brag about it. Felt bullied by a senior? “Oh thats just normal. That’s needed for you to harden up.” Sometimes, our health system exerts tons of pressure upon a healthcare professional, yet it doesn’t provide an outlet for overcoming stress, deprivation and disillusionment.

    When colleagues on rare occasions do come to me seeking advise on what to do with their career and personal life, I am tempted to answer drawing from my own experience. How do you balance professional and personal life really? I realized though that my experience might be an outlier too and would not be applicable to anyone else even if we thread the same career path.

    So i bring these dilemma for discussion here on our tweet chat.

    T1. As a healthcare professional, how do you balance professional and personal lives? Where do you draw the line of caring for others without harming your personal lives?

    I have seen obviously sick or sleep deprived physicians tending to patients, a dangerous situation for both patient and professional.  Where do you draw the line here?  If you are a patient, what would you suggest to your healthcare professional knowing he is sick or is sleep deprived?

    T2. What counsel would you give to a disillusioned, depressed colleague who seeks your advise,  besides seeking professional help? 

    We always give advise to disillusioned or depressed colleague but we rarely knew or had the chance to follow up if they really did.  What other advise can you give?

    T3. Can you give an example of the “lowest low” in your medical career and how were you able to overcome it?

    Join us this Saturday, May 20, 2017 9:00PM Manila time as we bring balancing life, depression and medical career into the discussions of health in the Philippines!

  • Should Physicians mind their “Webside Manners”?

    Approximately 87% of US adults are online. Of these, a huge 72% seek health information online. Trust for physicians remains high though as 70% of these adults would seek a healthcare professional’s help  for major medical conditions.

    Contrast this trend with how many of physicians are taking advantage of information technology to provide healthcare information online or even clinical care from a distance.  A measly 3% of physicians engages patients online. Even if one in three US physicians use or is planning to use telemedicine, the actual usage of telemedicine by patients is lower though at about 9-15%.

    What these statistics are saying is this: patients are going online for health information but our healthcare system is slow to adapt. The advantages of Telehealth and telemedicine especially for the archipelagic Philippines is pretty obvious but so are the staggering challenges.

    How about Social Media?

    Telemedicine is broadly defined as providing clinical care from a distance, using telecommunication and information technologies. Strictly speaking, social media isn’t part of telemedicine yet. Dr. Joseph Kim pointed out though that there’s a small (albeit increasing) percentage of doctors who use social media to provide health information and professional networking.

    Extending Bedside Manners

    The traditional physician-patient interaction in the clinical setting is governed by a set of attributes, behaviour or communication skills called “bedside manners”. Studies have shown that bedside manners ultimately affect delivery of care. The entry of information technology into actual patient-physician interaction clearly changes too the clinical setting. Perhaps this is an opportune moment for examining how effective a physician’s manners are in the light of information technology or maybe, we need to expand our concept of manners.

    Webside Manners

    The concept of webside manners came with the advent of telemedicine. While “bedside manners” pertains to how a healthcare professional interacts and communicates with a patient in a face to face encounter, webside manners probably refers to how the healthcare professional interacts or communicates with a patient over a medium (of information technology) to provide clinical care.

    So lets talk about “webside manners” this Saturday November 26, 2016 at 9PM Manila time and determine whether it should be (or it should be not) part of our bedside manners:

    • T1. Does Telemedicine have a role in clinical care? How about Social Media?Why or why not?
    • T2. Should our bedside manners need extending, to include webside manners with the advent of information technologies like telemedicine or social media?
    • T3. What webside manners do you think are most needed?

     

    Don’t forget to include hashtag #healthxph when joining the chat on Saturday at 9PM Manila time. See you!

    Image: https://commons.wikimedia.org/wiki/File:Telemedicine_Consult.jpg

    Resources:

    http://www.pewinternet.org/data-trend/internet-use/latest-stats/
    http://www.pewinternet.org/2013/01/15/health-online-2013/

    https://en.wikipedia.org/wiki/Telemedicine
    https://www.accessrx.com/blog/current-health-news/how-many-family-doctors-are-using-telemedicine/
    http://www.mobihealthnews.com/45682/survey-9-percent-of-consumers-have-used-a-telehealth-service

  • Patient centric healthcare technology, anyone?

    Carlos is not my patient. Well not yet and probably never will be. Here’s why.

    Carlos is a 35/M who complained of knee pain after playing badminton one weekend. He sought consult from their company physician who requested x-rays of his knee and was referred to an orthopedist for evaluation. Carlo is single, lives alone in his house and works as an information technologist in one company . He took a week off work because he could hardly walk and his knee in pain. He scheduled that appointment with orthopedist, hired a pedicab to fetch him in his house, bring him to the diagnostic center to have his xray taken then ferry him back to his house. He has to wait for 3 days to get the results of his xrays, then hire that pedicab again to ferry him  to and back from the diagnostic center just to get the results. Never mind the long queue for just getting the plates.

    On the appointment day he hired a pedicab again to fetch him in his house, bring him to the orthopedist clinic and back. He have to queue in line, get his priority number, sit and wait for his time to be called and examined by the orthopedists. Never mind if the call is an hour late, for some unknown reasons.  After being seen and examined, he showed his xray and lab results to the orthopedist,  “Not enough for a diagnosis” was his physicians words. So the orthopedist ordered another diagnostic, an MRI, prescribed him some pain meds and was advised follow up with MRI results.

    His knee pain unbearable, Carlos asked pedicab driver to bring him to the nearest pharmacy to buy his pain meds. He soon found out it is not available there, so he went on looking for it in other pharmacies. Only then he can get home and rest his knee.

    The whole rigodon took Carlos the whole day, while bearing the pain on his knee. Thinking about an MRI made Carlos sigh in frustration. Not only that the MRI cost so much but the idea of repeating the whole rigodon doing this diagnostic and bringing it to the orthopedists just so his knees wouldn’t be painful anymore, is just too painful than his “painful” knee. Why is it that with all this healthcare technology- EMRs, Digitalized lab results, imaging,  eased the work of  healthcare providers but not of the patients?

    Of course Carlos is a fictional character. But what he went through is a chimera of the “regular” charades most patients go through when they seek physician consult. Technology is supposedly going to ease these for him, but It hadn’t trickled down to patients yet. While most healthcare providers (institutions, physicians) benefited  from the use of technology in healthcare, many patients like Carlos do not share this sentiment.

    Join us this Saturday June 4, 2016 9:00 PM Manila time to crowdsource  a patient centric approach in easing patient burden in health processes

    Many healthcare technology innovations and movers want to solve this problem-easing out the patients burden for health processes, by efficientisizing technology on the provider side. Which in some systems worked out, eventually. I’m not a health information tech guy but like Carlos, I’m very much interested in easing out this health processes burden for patients.

    • T1. Are there any health technology innovation models that will actually lessen the “patient burden” in the healthcare processes?

    As we all know, the shift to patient centric model of healthcare system, from a provider centric system isn’t exactly a fantastic honeymoon between providers and patients. Health is definitely not easy on change. Most of us knew that patient driven health is the future of medicine and we aren’t ready to accept it yet.  Thats why there’s quite a few who are developing technologies that eases out the patient’s burden.

    • T2. What are the opportunities and challenges in a patient centric/ driven healthcare technologies?

    While Carlos story is well know to healthcare professionals (and will cringe at the thought) not a few will dismiss this as “part” of being a patient. The irony of it all that sometimes, the pain we’re giving patients going through this health process is even worse that what he or she already have from his/her medical condition. “I’m sharing this doctor because you know what’s best for me” resonates both the frustration and godly adulation patients have for their physicians.

    • T3. As a patient or patient advocate any patient centric health technology  you think (or experienced) that have eased out the patient’s burden? How?

    Carlos’ story is a story told so many times. As a physician I have my armamentarium of healthcare tech to help ease out the burden of practice, but have none to unburden my patient’s charade. This often bear much on my decision to order (or not) a diagnostic procedure, a referral, a prescription or even follow up. Patient’s rarely comply because, as a matter fact it takes more than just the patient to go though this burden. Not even us physicians. We can cry foul, or technology sucks.  But patients, they rarely have..

    So patient centric healthcare technology anyone?

    Join us this Saturday June 4, 2016 9:00 PM Manila time to crowdsource  a patient centric approach in easing patient burden in health processes!

  • Disruptions in Health: Healthcare information technology in a limited resource community

    How could information technology improve healthcare in a limited resource community? 

    This is one of the questions asked in one of the health information technology appreciation talk I gave recently.

    When care is complex, expensive, and inconvenient, many afflictions simply go untreated.

    Health information technology is a broad concept that encompasses an array of technologies to store, share, and analyze health information.  In primary care, examples of health IT include the following:

    • Clinical decision support.
    • Computerized disease registries. (e.g. Trauma registries)
    • Computerized provider order entry.(CPOE)
    • Consumer health IT applications. (e.g. wearables)
    • Electronic medical record systems (EMRs, EHRs, and PHRs).
    • Electronic prescribing.
    • Telehealth

    HIT ultimately aims to help healthcare providers provide excellent care to their patient.  HIT does this by improving point of care areas along the patient – provider flow, from the time patient goes in the hospital to the time he/she went out and up to their home. (see figure below)

    cds flow
    Conventional flow of patient /point of care in a hospital setting

    Some of these HITs (EMR, CPOE)  have been shown to reduce medical errors by up to 80%, prescription errors by up to 55%. While HIT has the potential to reduce utilization of healthcare, investing in HIT is not cheap so far. The main challenges are investing cost and resources.

    The real hope is in disruptive innovations in health that uses these information technologies to bring down healthcare cost but improve quality of care.

    Disruptive innovation, a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors. – See more at: http://www.claytonchristensen.com/key-concepts/#sthash.iNDhe9BG.dpuf

    Areas like telemedicine and consumer health products are just beginning to pick up trend. But cost and quality of care metrics has yet to be validated to yield a significant disruption.

    Information technology that has potential in improving quality of care
    Information technology that has potential in improving quality of care

    So going back to the question earlier, I’m a believer that somehow a disruptive innovation would breakthrough with these sets of HIT and  improve delivery of healthcare in low resource communities.

    I’m inviting all health stakeholders- MDs, Nurses, allied med professions, policy makers, health institutions, research groups, pharma and medical devices to a tweetchat this Saturday May 14, 2016 9PM Manila time.

    Lets crowdsource ideas from HIT thought leaders and healthcare community what would these potential disruptions and innovations that will impact low resource communities.

    • T1. What health information technology you use now to provide quality care and why?
    • T2. What specific disruptive information technology do you think would improve delivery of care at a lower cost  in limited resource community (like PH)? How?
    • T3. What is the main challenge to this disruptive technology? Research? Policy?Education?

    Don’t forget to use #HealthXPh. Se you all!

    Readings:

    https://www.healthit.gov/patients-families/basics-health-it

    https://hbr.org/2000/09/will-disruptive-innovations-cure-health-care

    Disruptive Innovations That Will Change Your Life in Health Care

    http://www.forbes.com/sites/ashoka/2013/04/23/disruptive-innovation-a-prescription-for-better-health-care/#f7dfd447c442

    http://mobihealthnews.com/31470/revisiting-how-christensens-disruption-innovation-in-healthcare-means-decentralization