My Medical Practice

I started doing Physical Examination to pre-employment applicants. That's the usual thing that happens to new graduates. It's the thing that we do very religiously (kahit anong liit ng findings, kahit insignificant, nakasulat yun!), sometimes unnecessarily. That's what we mastered during 3rd year, when we had interaction with patients in the form of history taking and PE. As a new graduate, I was quite apprehensive about management, especially prescribing, which was understandable. But doing pre-emp and annual PE somehow erased fears of confronting paying patients, and after getting used to it, fears about discussion of pathologies are also erased. Gradually, I got used to my new title without feeling guilty that (I feel) I did not know that much. Pag nakausap mo na ang ordinaryong tao, magugulat ka rin pala na marami ka nang alam.. I was still underboard when I first took that job, part-time. Then when the board results came out, I started doing the real thing, of course after about 2 days of observation at my uncle's clinic.

My uncle's clinic has been in business for 20+ years now. It started just as a 24-hr clinic, then later opened branches that catered to diagnostics and pre-employment. The small clinic has an average of about 50 patients when I was still working there (there was a tremendous increase in the number of clients from the first year I worked there). The many patients exposed me to a lot of common and rare illnesses. But because I was a general practitioner, I referred many cases that needed special assessment, and oftentimes would not have follow-up of it (my schedule might have differed from the consultant's).

Probably because my uncle was a surgeon, I was inclined to also take that path. But if I would be in such a practice, the sexist Filipinos would not trust the hands of a female surgeon. Even in medical practice, there is stereotyping. Mas bagay kung OB-Gyn, but the reverse is not so true (male OB-Gyn are well-accepted). And because I hated morbidity, I did not consider IM. While it was a very challenging specialty in that a lot of analytical thinking is required, it can be so frustrating in that the management depends a lot on the patient's financial capability and compliance (my father, who has been hypertensive for years now has not stopped drinking and smoking, and it's not for lack of advise from me or other members of the family. Matigas lang talaga ang ulo). I took pre-residency training in Fabella, despite my uncle's persuasion that I apply at private and public hospitals near his clinic, with the ulterior motive of coaxing the patients to turn to his clinic instead. I spent one month there, but despite my good credentials and performance, politics set me on the wrong footing. I had no connections at the DOH (and Fabella is one DOH tertiary hospital). Mabuti pa ang bobo (batchmate ko yun na walang alam), kuha agad. Nawalan na ako ng gana. One very good friend of my uncle, an anesthesiologist, and his wife, an OB-Gyn at Medical Center Manila, offered to help me get into their OB-Gyn residency training as soon as I decided to go for it, but I declined the offer. The problem of being too busy to attend to my parental duties still posed a problem, plus the lure of getting into a nursing career instead was there already, not to mention that residency training in private hospitals meant low salary.

Soon the Maritime Industry dictated that clinics doing pre-employment med exam be ISO certified. My uncle and his wife were half-heartedly attending seminars about it but did not do anything. They thought it was just one of those seminars you attend to earn certificates and credits. Eh mahirap pala yun! They had to prepare documents that tell their practice and they had to implement several elements of the Quality Management System. The moment he asked me to attend on his behalf, he realized, by my explanation, that it was something that ought not to be shrugged off. It needed action, starting with documentation. That was where I had to stop temporarily my practice as a physician, and was forced to do this daunting task. I had to attend several Quality Management seminars and come up with measures to start implementing the elements. I had ato constantly correspond with a British consultant to put into practice what we had written, and I had to convince my uncle that we needed further training for some personnel, including me, so we could come up with documents to prove our credibility (duh!). It was another artificial job, if you ask my opinion.

However mind-reeling that experience was, I learned a lot about government bureaucracy and some matters that the DOH wanted to be left alone (like I once asked a lecturer about a certain organization that caters to the OFWs bound to the middle east. Ibang usapan yun, she said. Letters I received from a certain organization was soliciting support (financial and otherwise) against the monopoly of a few clinics over such a big market, and the government's tolerance of the practice, implying that the DOH also had income from it. Hah! Ayoko ng ganito! Hindi na ako doktor! Nakakabaliw! I asked my uncle to return to being a physician at the clinic, working during night shifts, because I was slowly forgetting how to manage even the simple hypertension! I still continued with the ISO thing, only until I had the clinic certified. After that, I festinately trained another personnel to take over my role.

I still preferred being a general practitioner. I enjoyed dealing with the patients, especially the masa (majority of our patients then), experiencing bliss at their sincere gratitude at my kind approach in treating them, and being honest about my limitations. I was quite patient, probably because I came from a poor family, but nevertheless, the rich patients get the same treatment as long as they did not project an air of owning me (just because they paid for the services, which actually went to the clinic, and I earned only a small percentage of the total income, being an employee there). There were times I would not ask from indigent patients, and asked the nurse to keep it off the record, or if they had already logged the patient, to tell my uncle, if questioned, that it was my decision. (tapang eh! palibhasa malaki na ang ulo ko dahil marami na akong nagawa para sa kanya sa kakarampot na sweldo...) One patient (who could not sleep because of anxiety and went to the clinic at an unholy hour, to which I listened for about 1 hour 30 minutes about her grievances, only to extract a PF of P150. We had no night differential for such night-morning calls) asked me to take Psychology for residency (hehehe! Ano, bale? Lahat ata ng residente ko nun sa Mental, puro me tililing na sa ulo. Nakakahawa no! Another patient (a diabetic one to whom I lectured about the essentials of nutrition) asked that I be an internist. Ngiti lang sinagot ko. Nakakataba rin ng puso.

Another strategy that my uncle approached in the medical business is offering retainership contracts with such companies as Dusit Hotel (so I got a chance to experience how it was to be a company physician, without being directly hired), Sharp Appliances, etc., all through the marketing efforts of one indispensible manager in one clinic branch.

Of course there were medical missions, some enjoyable, some not. As I have pointed out before, some medical missions that I joined were a political projects. Some are good-intentioned ones. I did not care if there were amenities to enjoy after the med mission (like good food in a resort, swimming or videoke party), but that was a definite plus, especially that we seldom get paid (eh med mission nga eh, bat kami papabayad? Pero alalahanin, project ng mga pulitiko. Pagka ganon, baka gusto nilang bayaran ang oras namin. Kakainis kung hindi ka naman makahirit dahil padala ka lang ng uncle mong umiiwas sa ganong trabaho. Kunswelo na lang yung pagkain at kung anupang pampasarap no!). It was okay to attend med missions, but my conflict then arose from the fact that: (1) med missions take time off from paid work, and (2) med missions take time and energy off that could have been for my kids and family. Hindi maintindihan ng uncle ko yun nun, until maibulalas ko sa manager ng Taft branch nila, who was also the one responsible in the growth of his medical business.

One form of revenge for us doctors vs. this plight of being almost penniless is being wooed by medical representatives. Well, some who are very sincere in their reaching out to you to help them in their job win our prescription despite their long or permanent absence. But a lot are very insincere, and only noticed us young (frontline) doctors once they realized that we spent more time in the clinic in a day, seeing all kinds of patients, than the consultants, and if ignored, we tend to boycott their product (we call on other general practitioners, sometimes we even ask the consultant to admonish the med rep for neglecting us). Through med reps, we poor doctors got a chance to have a taste of Italian, American, Chinese, Japanese, Thai, etc.cuisine and even free seminars in out-of-town locations like Cebu without spending a cent! (My uncle was always sponsored for trips to US! That's how a big market his clinic was when it came to drug sales. Which is why many med reps were also keen on making partners with us young doctors. Often we would get invited to scientific meetings where everyone else belonged to the geriatric population. Kami lang ang cute).

When I moved to Bulacan, to be finally with my kids, I tried to set up my own clinic. It was not that easy with the limited resources that I had. I finally had to swallow my pride and get back to my uncle. I also applied at the hospital nearest my house to have one duty day per week, so that when any of my family member would get sick, it would have easy access to healthcare without me having to shell out cash right away.

These are photos in that hospital (Gardenville Hospital in Sta. Maria).

The building was big, but we were lucky to have 5 patients in a day. Many residents would not last practicing there because their brains got stale. To me, it was a break from the long trip to and from Makati the rest of the week and the hectic work there, plus I could bring my kids to the hospital and play or study with them without worrying that they might disturb my work. That's also where I spent the last month of my stay in the Philippines.