Davao Blogspace

a href=”http://1.bp.blogspot.com/_3J-pISBmOI8/SRblepFOdyI/AAAAAAAABtM/rKMpKyhdcPg/s1600-h/laptop-stetho70.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}”img alt=”" border=”0″ height=”157″ id=”BLOGGER_PHOTO_ID_5266649128842983202″ src=”http://1.bp.blogspot.com/_3J-pISBmOI8/SRblepFOdyI/AAAAAAAABtM/rKMpKyhdcPg/s200/laptop-stetho70.jpg” style=”float: left; margin: 0pt 0pt 10px 10px;” width=”200″ //aspan style=”font-weight: bold;”E-health 2.0/spanbr /
Since I started a medical blog (span style=”font-weight: bold;”The Orthopedic Logbook/span) , I’ve been very enthusiastic on bringing on span style=”font-weight: bold;”Web 2.0 /spanand health together in marriage, so that the medical blogging community in the Philippines will have a span style=”font-style: italic;”distinct voice undiluted by mainstream media/span. The powers of Web 2.0 has this potential of revolutionizing health care and health care delivery systems in the country. In my upcoming posts, I will be tackling Web 2.0 and how Filipino physicians can take advantage of this promising tool to efficiently and effectively deliver quality health care to our fellowmen.span class=”fullpost”br /
span style=”font-weight: bold;”Amazing Feat/spanbr /
My a href=”http://www.mindanaobloggers.com/”span style=”font-weight: bold;”Mindanao blogging community/span/a experience and how the forerunners of this very vibrant group in the blogosphere made me really gasps at the powers of Web 2.0 and blogging. The recent a href=”http://tacurongmountaineers.blogspot.com/2008/11/talakudong-mountaineer-shouts-mbs2-rock.html”span style=”font-weight: bold;”Mindanao Blogging Summit 2/span/a humbled the reach of a usually constricted mainstream media. With attendance going up to a hundred, imagine how many readers and blog visitors these participants have ora href=”http://www.gensantos.com/2008/11/03/mindanao-bloggers-were-at-the-front-page-of-sunstar-soccsksargen/” how far their reach are/a when they’ll finally “post” their experience. Thus, an attempt at span style=”font-weight: bold;”Blogging the Mindanao Consciousness/span helped correct some of the negative views about Mindanao. Five years ago, you hear nothing but bad news about Mindanao. Try goggling for the word Mindanao and you’ll see what I’m talking about.br /
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Taking cue from the a href=”http://www.gensantos.com/2008/10/27/a-million-thanks-to-you-mindanao-bloggers/”organizers of MBS2/a and how they collaborate to attain goals via the blogosphere, sort of made me ponder. span style=”font-style: italic;”What if we do that for the Philippine health care? /spanFor one, some controversial issues in Philippine medicine caught the “Web 2.0 attention” and somehow changed the Filipinos maturity. The span style=”font-weight: bold;”reproductive health bill/span for example, made rounds in the blogosphere and you hear not just the health bigwigs in the mainstream media. You read common Filipinos enter the limelight and discuss on this issues via blogging! Mind Boggling? Not really. But wait till what web 2.0 can do for health in the Philippines!br /
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span style=”font-weight: bold;”"Collaborative information by the people, for the people” /spanbr /
This is where the power of Web 2.0 lay. And that’s why MBS2 and the Mindanao Blogging community is so successful./spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a href=”http://www.ciccparenting.org/newsimages/istock_000000357240small_child_crying_1.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ height=”200″ src=”http://www.ciccparenting.org/newsimages/istock_000000357240small_child_crying_1.jpg” style=”float: right; margin: 0pt 0pt 10px 10px;” width=”181″ //ab(Disclaimer: All names and characters in this story were deliberately changed to protect the privacy of the patient concerned. If you felt the story was referring to you or someone you know, you are wrong.)/bbr /
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“Hepe, you might want to go the ward now.” The nurse on duty ’s voice on the phone, sound a little bit gloomy. I just came down from assisting a junior for an OR that extended to almost 12 midnight and I barely touched “the bean bag” to rest. My team wasn’t on duty that night.br /
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“Bakit hepe?” (Hepe, is our pet calls for male residents and male nurses in the wards, sort of brotherly respect). “Nag icode/i si bNanay Delia/b..iIkaw yung hinanap nya/i…” For a moment, I don’t know what to think of or how to react to this news. I immediately ran to the wards and joined the code team doing bACLS/b on Nanay Delia.br /
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Just 5 hours ago bNanay Delia/b and I are happily exchanging goodbyes and hugs in what supposedly a very heartwarming patient-doctor relationship punctuated by a successful OR procedure. To thank me, she insisted I’ll take a gift wrapped iPierri Cardin/i hankies and neckties fresh from underneath her pillows. To bNanay Delia/b, I was her savior-son. To me, she was a motherly patient I can never forget. iI am her surgeon/i.br /
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“She what???!!!”br /
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I first met bNanay Delia/b in the outpatient clinic two weeks before this incident. She was this jolly faced 56 years old ilola/i with a very happy disposition and a charming talker. Without make up but only the ever infectious smiles you see in your grandma’s face, her wrinkles in the forehead looked like lines of happiness. Needles to say, resisting her motherly charms is totally futile. Unable to walk because of nagging pain in her right hip, she was totally unfazed by her predicament and was in fact very much hopeful she can walk again.br /
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“Sa tulong at galing nyo doctor!” Nanay Delia was proudly chatting with some patients at the end of the clinic room. She was already infecting the whole OPD team with her crazy punchlines and contagious laughter. We can’t help but be swooned by her charm.br /
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After examining Nanay Delia and her xrays, a decision was made to have her right hip replaced (a procedure known as bTotal Hip Arthroplasty/b) to ease out pain and make her ambulate again. I asked her and her son who was assisting her to come back next week for admission and OR.”Tialaga duktor? Makaka pamalengke pa ulit ako??!/i” Everyone in the clinic saw the face of bNanay Delia/b lit up. She is over flowing with joy giving hugs to all the members of my service. A gesture that touched everyone in my service. Nothing extra ordinary, but a gesture in the right timing and execution, will melt the hearts of stone cold surgeons that we are. “iNany Delia just smooched us all!/i” Said one of my juniors.br /
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Our arthroplasty service see quite a number of outpatients everyday . Believe me, bNanay Delia/b seem to be an epitome of hope among these poverty stricken and ill patients. In this institution, residents spend hours and days haggling for funds and implants among sponsors, philanthropist and politicians(with their CDF),so that these patients can have their OR, free.We were able to get funds for her implants, and since the surgeon, anesthesiologist and procedure itself is free,b Nanay Delia/b will be operated with minimum of expenses.”Hay, salamat talaga duktor!”br /
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bNanay Delia/b passed the cardio-pulmunary clearance and labs easily. The internist classified her “low risk” for this surgery. So the next week, I saw bNanay Delia/b happily sitting in one of our ward beds. A number of bantays and ambulatory patients were already crowding near her bed. I can even here the laughter and giggles these people made because of bNanay Delia/bs funny stories and punchlines. She was the center of attention in our wards because of her friendliness, jolly type personality and talkativeness. She even talk loudly with patients on the other end of the ward, at least 10 meters far from her bed! i”Kung tayo nga na infect ni nanay, mas maganda tong mga patient natin masaya din!/i” I jokingly told my service.br /
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When bNanay Delia /bsaw me and my team coming for the ward rounds, she shouted: “iShhhhhhh! Tahimik na tayo, nandyan na ang mga gwapong doctor natin/i!” She was gesturing her companions to keep quite but I still could here giggles from the other beds. “iNanay, napasaya mo ata ang buong ward ah!!!/i”br /
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I talked with the cardio fellow and seek out another CP clearance, this time asking for repeat ECG and echo cardiogram. This premonition somewhat baffled me also. She was already cleared for OR twice and I was still asking another one. Obviously the fellow hated me for that, but I got what I wanted. bNanay Delia/b was cleared for OR. Nothing in the repeat labs picked up anything suspicious. Getting the final pointers and go signal from my consultants, I scheduled the OR in two days.br /
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Talking to bNanay Delia/b about the procedure, the risks, the benefits and preparations, we were all set for the OR. If there was one happiest person involve in this procedure, she wasb Nanay Delia/b herself. She was so happy and proud that at some point, we heared her overtly exaggerating our scalpel wielding prowess that I can only sigh in disbelief and smile.br /
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It was not my first bTHA/b as a resident and I have planned for this procedure several times In all of my previous surgeries, I have been chided for being too detailed on preparation and precautions to the point of obsession. bNanay Delia/b’s case was no special procedure and she too did not escape my obsession to preparation. Ironically she was a symbol of hope for most of our patients admitted to the wards. Her happy disposition is so infectious that my service actually felt the outcome of her surgery will be the barometer of how good our delivery of service was. “If this procedure will have a glitch, we will be devastated. So lets make this again, our best!” I pleaded my team.br /
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It was an uneventful OR indeed and the most satisfying one, finishing faster than we expected. bNanay Delia /btolerated the OR well and we were so admiring of the outcome of the procedure. The planning paid off and more. Everyone in the OR team had a pat on the back and even bNanay Delia,/b who was mumbling my name under anesthesia.br /
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The next day when I made my rounds, bNanay Delia/b was already sitting at her bed, her eyes glowing in joy. “iDok!, salamat po sa inyo. Maraming salamat talaga!”/i Coupled with a hundred more praises and exaggerations, I can’t help but gave her our “iakbay barkada/i”, a gesture we made to our nicest friends. She was already inviting me to her upcoming birthday and the christening of her grand son, to which I would be a godfather. i /ibr /
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i”Nanay, you still have to start your hip range of motion exercise so that by tom, I can teach you how to walk with quad crutches./i”I deliberately changed our topic of conversation.”iYes doc/i” was her smiling reply. I just shrugged my head. But deep inside, I was extremely please at the sight of one very happy and satisfied patient.br /
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The next rounds she was motioning my team again to her bed. “iKain tau dok!/i” “iMamaya na po Nanay after ma dress natin yang sugat nyo and maturuan namin kayo ng quad crutch ambulation/i.” Teaching bNanay Delia/b ROM exercise was no sweat at all. She was even proudly showing off to us that her hip pain is gone. I was just smiling at her antics. “iHinay-hinay lang nanay!/i” I told her, she will be discharged tomorrow, once I inspected her wound and assessed her fit for home ambulatory rehab program.br /
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bThat discharged never happened./bbr /
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“iAnother epi please!”/i I was shouting while doing chest compression(CC). I am perspiring heavily since nearly doing CC for almost 10 minutes already. I’m still dazed as to what has happened but I’m racking my brains at reviving bNanay Delia/b. “iWhy was I not informed immediately about this?!/i” I was shouting already. “iHepe, ginigising lang si nanay nung bantay nya for meds nung napansin di na pala humihinga. Before natulog yan nakipag kwentuhan pa sa mga katabi at tawa ng tawa/i. She was asking for you and looking for you at may sasabihin daw.”br /
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It was a massive MI according to the IM in the code team. “iHow can that be?”/i I said, bNanay Delia/b was cleared two times before this OR! Even the 2D echo did not pick up anything! It is frustrating to look for impossible answers. The obvious reason was, I, my service became attached so much to bNanay Delia/b. Nobody was expecting this event to happen because everything went well and she was one hundred percent happy just before sleeping. She never woke up to walk again.br /
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When the IM declared bNanay Delia/b dead, I was still shocked and dazed. I was literally angry and frustrated at the same time. “Why did this happen? Was there anything we could have done that might have save her life???” I can see bNanay Delia/b’s smiling face in my mind.br /
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I mustered enough courage to talk to the family gathered around her bed. I offered my best consoling words. I almost cried when each of the family member hugged me. “iShe was asking to see you before she slept, doc. She was very fond of you/i.” I was in the ORbr /
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I excused myself and hurriedly left for the call room. I sat in one corner staring at the blank wall. I am looking at nothing. I still couldn’t believe what has happened. bNanay Delia/b and that this whole procedure meant nothing. I wanted to cry, but I couldn’t. I don’t know where to get my tears..I just sat there and wanted to cry but couldn’t…I was crying dry…br /
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In my most isolated and stoned cold medical life, . I am hardened by pain and several deaths to our patients. I have trained myself to get detached and not be affected by emotions. I was trained to empathize, not sympathize.Yet, every time something like this happened, I felt it is easier to just cry and make ease the burden of guilt. It feels lot lighter and starting again, becomes easier.br /
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bBut tears never came./bbr /
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Perhaps, it was because bNanay Delia/b’s jovial face smiled on us every time. That for a short time, we were able to make another patient happy and satisfied with what we can do with our god given knowledge. That we learned from this mistake and that she gave hope for our other patients. More importantly, Nanay Delia taught us all that happiness is a constant state of mind. And you need no superfluous things or event to enjoy it. No excuse.br /
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I cried dry…/span/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a href=”http://1.bp.blogspot.com/_3J-pISBmOI8/SPg5ubZteII/AAAAAAAABWo/QQHGLi2irB0/s1600-h/fountain.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ id=”BLOGGER_PHOTO_ID_5258016034747414658″ src=”http://1.bp.blogspot.com/_3J-pISBmOI8/SPg5ubZteII/AAAAAAAABWo/QQHGLi2irB0/s200/fountain.jpg” //aDo you have any health concern needing attention? How should one actually go about looking for the “best doctor” if you need medical advice?br /
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Such questions only come up to the minds of most Filipinos during medical emergencies were choices are usually limited. I frequently end up seeing patients who have been through a number of physicians but don’t have any idea about what they just went through or why.Thus, patients and relatives end up in a dissatisfying doctor-patient relationship ornbsp; worst, end up in the arguing courts rather than quality medical service. Not that I am better than the rest, but certainly such predicament put so much pressure on the MD and patients alike that quality service to patients suffer most.br /
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Here’s some tips I can give to patients or parents when they’re looking for a physician (or any specialist, like an orthopedic surgeon) if they need medical attentionbr /
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ollibAsk from a medical practitioner or paramedical personnel you know./b The best opinion usually come from someone you know in the medical field, preferably a physician too./li
libAsk from relatives and friends/b.Past experiences from previous physician-patient interactions give valuable insights to the quality of patient service.br /
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libBrowse the net or search online for MDs in your area/b. In the Philippines such network as a href=”http://doktorko.com/”bDoktorko/b/a have listing and profiles of MDs in the area. Some MDs and specialist maintain a website of their own, publishingnbsp; the area of expertise, credentials, and clinic time of the physician. Most hospitals also list their doctors and alumni on their websites.br /
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libInquire about the physicians credentials and expertise/b regarding the health problem you are about to seek consult. It’s not improper if you ask the physician yourself. br /
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libEvaluate if you can effectively communicate and trust this physician/b He might be the most competent specialist in the field but if you cannot communicate with this doctor, chances are you won’t get the satisfying treatment you want./li
libOpt for a second opinion if you are not satisfied with your physicians interactions/b. It is alright to inquire for second opinion from other MDs in the field so long as you don’t get confused in the process. As a courtesy, always inform the first doctor you consulted.br /
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libStick with the MD whom you can effectively communicate and trust./b The physician’s competency in the field your interested with coupled with good communication and trust, constitute the greatest chance of your problem being addressed satisfyingly.br /
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libAsk for recent, evidence based knowledge regarding your medical problem/b. Check what you researched and read about your medical condition and clarify doubts by asking the physician of choice. /li
liIf you need to be referred to another more specialized level of care,b ask for a formal referral from your previous physician/b./li
libPay your physician’s services/b - even with just a warm ithank you/i and smile. Physicians knew all the sad predicaments we have in this world, and chances are with a warm thank you, most of us will all be a lot inspired in our noble work.br /
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/ol/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a href=”http://www.bryanchristiedesign.com/uploadfiles/279pill_man_lores.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ height=”200″ src=”http://www.bryanchristiedesign.com/uploadfiles/279pill_man_lores.jpg” width=”200″ //aIt’s not only irritating to hear horrendous “cure all” claims of some food supplements manufacturers and advertisers about their “drug” but the lack of advertisement control also nauseates me to no end. The sickening charade of food supplements jumping out of nowhere and claiming to heal all kinds of human afflictions thinkable (just so they can corner the poor man’s pocket) is staggering to say at least. Taking these supplements at advertisement value is already one big step to your sick bed. Deceiving someone with false hopes and killing the patient in the process is another “crime” worthy of span style=”font-style: italic;” harakiri/span.br /
span style=”font-size: 85%;”(Photo taken from Science Blogs.)/spanbr /
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In almost everyday that I listen to the radio, some airtime (at times lasting a full 15 minute!) is spent on miracle cure throttled by exaggerated personal testaments of complete strangers.br /
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What happened to “span style=”font-weight: bold;”PANA/span: Truth in advertising?” or the KBP’s commitment to “Nothing but the truth, so help us GOD?”br /
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Here’s a href=”http://www.bfad.gov.ph/faq.htm”span style=”font-weight: bold;”BFAD guides on how to spot false claims/span/a by these unscrupulous supplement manufacturers.br /
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olliThe product is advertised as a quick and effective cure-all for a wide range of illness./li
liCertain key words like “scientific breakthrough, miracle cure, all natural without side-effects or ancient remedy” are used./li
li The promote claims that medical professionals and scientists have conspired to suppress the product./li
li Adverts contain undocumented, anecdotal cases, but with amazing results. No science involved./li
li These products sell falls hope for extreme physical attractiveness and shortcuts to weight loss. They will never emphasize the value of healthy lifestyles, like avoiding smoking, excess drinking of alcohol, eating appropriately, adequate rest and sleep, and regular exercise./li
li Remember that legitimate health supplement products will never carry claims for quick cures; claims such as cancer prevention, good for arthritis, good for diabetes or good for hypertension, should be high suspect./li
li The product is advertised as available from only one source./li
li There is a money-back guarantee promise./li
/olThe usual excuse laid for such drug supplements goes along the lines of herbal medicine being natural and hence, is the best form treatment. Another sad excuse propagated by these unscrupulous manufacturers and advertisers is the soaring prices of span style=”font-weight: bold;”BFAD/span certified drugs. Both of these excuse “prompts” the ignorant listener to buy the cheaper, food supplements that claims healing every imaginable human disease yet lacking in rigorous scientific testing! It’s like jumping on a plane hoping your jacket will save you (it may even get tangled in the plane’s props) instead of your chutes. Stupidity does have its additive effect remember. It might not only rob you of your hard earned money but it may sometimes kill you or your patient!br /
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To argue that some drugs or supplements need not pass rigid testing to be effective is an outright lie. Often, these arespan style=”font-weight: bold;” Russian Rolette/span type solution to a worsening health economics. Licensing and BFAD approval of any drug aims at at least two basic goals. Rigid and scientific testing makes sure the quality and quantity of any drug is not only safe for human consumption but should also be effective against the illness(es) it claims to combat.br /
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At the very least, any drug must be tested for its safety profile and efficacy. Remove the first and your taking in a poison. Any dubious drug efficacy even in rigorous scientifically studied drugs, is nothing but pure waste of money. Take out both, and you make yourself poor on your way to your deathbed.br /
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One (or two) person’s testimony, no matter how famous that person, is not tantamount to a safe and effective medicine.Some physicians or physician’s name is even attached to these claims. In the current recommended evidence based approach to treatment and procedures, anecdotal testimonies ranks the lowest in the strength of evidence.br /
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Now would you want any food supplement giving you all these complications? Would you even dare to give food supplement to someone you love and risk losing his life base on false claims?br /
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Think again…/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a href=”http://www.greek-gods-and-goddesses.com/images/pandoras-box.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” style=”clear: left; float: left; margin-bottom: 1em; margin-right: 1em;”img alt=”" border=”0″ height=”215″ src=”http://www.greek-gods-and-goddesses.com/images/pandoras-box.jpg” width=”188″ //aAccording to ancient Greek mythology, Pandora opened the “box” (actually a jar which Zeus entrusted but forebode her to open) because of one uncontrollable urge-span style=”font-style: italic;”curiosity/span. The opening of Pandora’s box released all “human evils” kept inside the jar by Zeus, except one human trait.br /
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div style=”text-align: center;”span style=”font-size: 85%;”span style=”font-style: italic;”(Pandora’s Box Painting by JW Waterhouse)/span/span/divbr /
In one striking parallelism, the current brain drain of professionals is rooted in one analogous reason. Better financial and professional opportunities abroad fueled the curiosity of homegrown professionals to go on an exodus and opened the lid of our Pandora’s box.br /
span class=”fullpost”br /
No other profession suffered more scrutinizing eyes than what physicians received in this brain drain phenomenon . Believing that this mandatory return of service will close the exodus of professionals from the country, a congressman filed span style=”font-weight: bold;”HB 4580/span requiring all professionals to a mandatory return of service after training here in the Philippines. Ironically, while the government is drum rolling OFWs as the nation’s new heroes (cultivating the exodus of skilled workers in exchange for dollar remittances) it is quick to criticize physicians who thread the same path of seeking better opportunities abroad. Worse, labeling these physicians as unpatriotic offers the most hideous method of enticing them to come back, and appeal to their nationalistic pride. Why is the government capitalizing on the OFW phenomenon but openly shun doctors planning going out?br /
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Some medical training institutions have tried to close this Pandora’s box with a “lid” of their own. The span style=”font-weight: bold;”UP College of Medicine/span, a government subsidized university, has approved a three year mandatory return of service for its medical graduates. Other government funded medical training institutions have their own return of service program in place as part of a medical training contract for years already. The penultimate questions still remain.br /
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Was it successful in preventing the brain drain of physicians?br /
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Was it able to solve the worsening physician -patient service ratio?br /
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Is this a a wise move to close our Pandora’s box?br /
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span style=”font-weight: bold;”Doc Mel/span ( a href=”http://thephilippinedailyidiot.blogspot.com/”span style=”font-weight: bold;”Philippine Daily Idiot/span/aspan style=”text-decoration: underline;”span style=”font-weight: bold;”) /span/spana href=”http://thephilippinedailyidiot.blogspot.com/2008/08/tbr17-last-week-sobrang-nakakatawa-ang.html”span style=”font-weight: bold;”didn’t think so/span/a. Here’s his egg laying bird nest appraisal of this move:br /
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blockquoteStraight to the point: forcing our dear motherland’s brightest med future (naks, UP med students) after graduation to serve three years in the country smacks of a short-term Band Aid in one thickening subplot of the Philippine Zombie Healthcare System./blockquoteand some more egg laying truth..br /
blockquoteA short-term Band Aid is maybe ok NOT because it is cheap and high-impact. It is ok if only because it is one prong in an all-out multi-pronged approach to a problem. To be charitable about it, give it to the government that it is tinkering with every way possible to do it./blockquoteMost of us in the industry feel this move is a good start, but should be part of wider and broader long term solution to the brain drain and dwindling patient to physician ratio in the health care system.br /
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a href=”http://health.tesstermulo.com/”span style=”font-weight: bold;”Prudence MD/span/a a href=”http://health.tesstermulo.com/?p=477″lauds/a this span style=”font-weight: bold;”UPCM/span move a href=”http://health.tesstermulo.com/?p=477″span style=”font-weight: bold;”(Is Hb4580 the solution to Philippine’s brain drain?)/span/a:br /
blockquoteI find it fair enough that medical students whose education have been subsidized using taxpayer’s money should be required to render a certain amount of time for medical service to the country. Also, I believe this should be applied to graduates of any other courses in all state universities./blockquoteSo doesspan style=”font-weight: bold;” a href=”http://megamomph.wordpress.com/2008/08/26/starting-somewhere/”Pinay Megamom/a/span here (a href=”http://megamomph.wordpress.com/2008/08/26/starting-somewhere/”Starting somewhere/a):br /
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blockquoteI laud UP for making this move. However, its effectiveness to try and address the bigger issues remain to be seen. If other measures are taken to address the other contributing factors to brain-drain (compensation, professional satisfaction, work conditions, etc…), in conjunction with this move, we may actually see some changes for the better. It’s a start./span/blockquotespan id=”fullpost”and span style=”font-weight: bold;”Joey MD/span here (a href=”http://www.joeymd.com/2008/08/26/return-service-mechanism/”span style=”font-weight: bold;”Solution to healthcare?/span/a)br /
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blockquoteI do not think that this will ultimately result in better health care, but it’s a good start. At least, this program will try to ensure that there will be enough MDs, hopefully, to serve the people’s health care needs, assuming that the enrollment in UP Medicine is about the same every year./blockquoteBut weather it will end up in a better health care system on its own, we all sing a united “I doubt it this is a long term solution on its own.”br /
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Several issues and potential caveats where raised by blogger MDs themselves that needs to be addressed if this mandatory return of service will make its impact on our zombie health care industry. Cautioning the government that even HB4580 is not the only solution to this current brain drain, it also has to make appropriations and just compensation for those who choose to work here.br /
ullia href=”http://health.tesstermulo.com/”span style=”font-weight: bold;”Prudence MD/span /acautions that it is unjust to impose this rule on privately trained professionals./li
lispan style=”font-weight: bold;”Mel B/span warned that this band aid approach is a single pronged approached to a otherwise multi pronged problem. And he espoused a “global” caffeine injected solution to a zombie, global capitalist health care system./li
lispan style=”font-weight: bold;”a href=”http://www.joeymd.com/”Joey MD/a /spanechoed the same sentiments of strengthening other aspects of the health care industry (e.g. budget, facilities, health care education)/li
lispan style=”font-weight: bold;”Pinay Megamom/span insists that provisions for adequately compensating those who are forced to work here.br /
/li
/ulUnaddressed, these issues are the same reason why most professionals leave the country. This is what span style=”font-weight: bold;”JA/span (a href=”http://jaaraf.blogspot.com/” style=”font-weight: bold;”Ripples from the river of my though/aspan style=”font-weight: bold;”t/span) put forth in her blog (a href=”http://jaaraf.blogspot.com/2008/08/here-there-or-anywhere.html”span style=”font-weight: bold;”Here, there or Anywhere/span/a)br /
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blockquoteI don’t think that creating laws to keep people from leaving are going to be helpful in the long run though. What is necessary is for young doctors to feel that they are justly compensated during training and actual clinical practice in our country. That way, they will have more reasons to stay than a feeling of obligation to serve the country./blockquoteAnd if we are threading in to the realm of cutting liberties and human rights of physicians in the name of public service, them we might have missed the root cause of this problem. Just like what span style=”font-weight: bold;”Anakat/span ( a href=”http://anakat-thesagacontinues.blogspot.com/” style=”font-weight: bold;”The Saga Continues/a) in “a href=”http://anakat-thesagacontinues.blogspot.com/2008/08/its-never-been-secret-among-my.html”span style=”font-weight: bold;”Exodus part 2/span/a” is saying.br /
blockquoteI am not an expert on human rights or related laws but there has to be a breach of this in the government’s decision to pass this house bill. UP used to be a staunch protector of these rights and freedom. My alma mater has let me down by devising this return service mechanism./blockquoteIn a democratic institution, where does the freedom of a professional ( to choose where to practice) ends and that of public service starts??Or does it end at all? These lines simply put a good thinking salvo on this issue.br /
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In an attempt to close this Pandora box, the various stakeholders tried but failed to understand why the lid was opened in the first place. And while starting a band aid solution to the brain drain problem seem laudable, it has yet to prove its impact on the health care system fraught with vulnerabilities.br /
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Sadly, we fail to discern the reason(s) why our box was opened in the first place. Knowing these reasons and addressing them primarily, maybe we will have a better shot in closing this Pandora’s box. Hope is only what’s left inside this box.br /
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(To the MD bloggers who contributed to this edition of TBR, thank you all! span style=”font-weight: bold;”Prudence MD/span will be hosting TBR 18, for another interestingly relevant topic of our times, ibThe State of Reproductive Health Care in the Philippines/b/i)/span/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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The span style=”font-weight: bold;”World Health Organization/span (WHO) use these a href=”http://www.who.int/whosis/database/core/core_select_process.cfm?country=phlamp;indicators=healthpersonnel#”span style=”font-weight: bold;”core health indicators/span/a to determine the status of health and healthcare delivery systems in a particular country. One of these indicators directly concern me as a Filipino physician. It actually scares me the most.br /
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span style=”font-weight: bold;”Is there a shortage of physicians in the Philippines?/spanbr /
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To answer this question, I tried searching available statistics in the net, evaluated the credibility of these sources and studied the parameters in understanding these statistics. The results surprised me more than being confused some more.br /
span id=”fullpost”br /
Take a look at this graphical presentations and their sources.br /
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div style=”text-align: center;”a href=”http://1.bp.blogspot.com/_3J-pISBmOI8/SKv8qv5BaBI/AAAAAAAABOA/msTi1tuipfM/s1600-h/BMHistoComplexe.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}”img alt=”" border=”0″ id=”BLOGGER_PHOTO_ID_5236556803088672786″ src=”http://1.bp.blogspot.com/_3J-pISBmOI8/SKv8qv5BaBI/AAAAAAAABOA/msTi1tuipfM/s320/BMHistoComplexe.jpg” style=”cursor: pointer; height: 262px; width: 507px;” //a/divdiv style=”text-align: center;”span style=”font-size: 85%;”A graph representing the estimated number of physician(s)per 1,000 Filipinos from 1960 to 2002 (Source the WHO and reproduced a href=”http://worldperspective.usherbrooke.ca/bilan/servlet/BMTendanceStatPays?codeTheme=3amp;codeStat=SH.MED.PHYS.ZSamp;codePays=PHLamp;compareMonde=2amp;definitionMinimum=1amp;codeTheme2=1amp;codeStat2=xamp;langue=en”here/a)/spanbr /
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div style=”text-align: left;”span style=”font-size: 100%;”The same data noted the following trends:/span/div/divblockquotediv style=”text-align: left;”For the whole of the period 1960-2002, an annual mean of 0.4 is recorded for this country. 1997 shows the highest level (1.2),1992 records the lowest (0.1). In this case, the registered change equals 695%. These numbers are based on the results for 14 years of the period 1960-2002. span style=”font-size: 100%;” /span/div/blockquoteTake note, 695% increase, in 42 years. According to this data, there is approximately 1.2 physician per 1,000 Filipinos. Roughly, the same estimates as that of WHO listed a href=”http://www.who.int/whosis/database/core/core_select_process.cfm?country=phlamp;indicators=healthpersonnel#”here/a.br /
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Compare this statistic with that published in a href=”http://www.ehealth.ph/index.php?option=com_weblinksamp;task=viewamp;catid=29amp;id=107″span style=”font-weight: bold;”Philippines Special Report: The Health Care System in the Philippines/span/a December 2001 produced by span style=”font-weight: bold;”MCA Ltd. Virtual-Asia.combr /
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/spanbr /
div style=”text-align: center;”span style=”font-weight: bold;”a href=”http://3.bp.blogspot.com/_3J-pISBmOI8/SKwVHCKEiXI/AAAAAAAABOI/ZT1Na8E9AqU/s1600-h/ADB.jpg” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}”img alt=”" border=”0″ id=”BLOGGER_PHOTO_ID_5236583677307423090″ src=”http://3.bp.blogspot.com/_3J-pISBmOI8/SKwVHCKEiXI/AAAAAAAABOI/ZT1Na8E9AqU/s320/ADB.jpg” style=”cursor: pointer; height: 319px; width: 470px;” //a/span/divspan style=”font-weight: bold;”br /
/spanbr /
blockquoteAccording to bAsian Development Bank/b there is approximately bone doctor per 9,869 /bFilipinos…/blockquoteWhichever statistics you’re believing compare that with the regional and worldwide statistics in this graph.br /
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div style=”text-align: center;”a href=”http://www.who.int/entity/hrh/statistics/spotlight5_chart.gif” onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}”img alt=”" border=”0″ src=”http://www.who.int/entity/hrh/statistics/spotlight5_chart.gif” style=”cursor: pointer; height: 271px; width: 494px;” //a/divbr /
div style=”text-align: center;”span style=”font-size: 85%;”Physician density per 10000 population per region (2008)/span/divspan style=”font-size: 85%;”/spanbr /
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One thing is for sure. bWe lag behind our Asian neighbors and globally!/bbr /
blockquotespan style=”font-weight: bold;”How big is the impact of this indicator in the over all health care delivery system of the country?/span/blockquoteThat I hope I can answer in my future post!/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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Okay, this one really is stretching man’s span style=”font-weight: bold;”EBM-span style=”font-style: italic;”ish/span/span about any form of health care treatment. Trying span style=”font-weight: bold; font-style: italic;”to determine if prayer is a factor for patient’s recovery/span is one very interesting study to make, even on patients undergoing heart surgery! Here’s the abstract of one such study taken from a href=”http://www.ncbi.nlm.nih.gov/pubmed/16569567?ordinalpos=4amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum”span style=”font-weight: bold;”American Heart Journal./span/abr /div style=”text-align: justify;”br /span id=”fullpost”blockquotespan style=”font-weight: bold;”Am Heart J. 2006 Apr;151(4):934-42. Click here to read a href=”http://www.ncbi.nlm.nih.gov/pubmed/16569567?ordinalpos=4amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum”Links/a/spanbr /br /span style=”font-weight: bold;”Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer./spanbr /span style=”font-style: italic;”Benson H, Dusek JA, Sherwood JB, Lam P, Bethea CF, Carpenter W, Levitsky S, Hill PC, Clem DW Jr, Jain MK, Drumel D, Kopecky SL, Mueller PS, Marek D, Rollins S, Hibberd PL./spanbr /br /Mind/Body Medical Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. hbenson@bidmc.harvard.edubr /br /a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://bp1.blogger.com/_3J-pISBmOI8/SI_G_joaVQI/AAAAAAAABLw/2BejAYNwVz4/s1600-h/lady-pray.jpg”img style=”margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 313px; height: 313px;” src=”http://bp1.blogger.com/_3J-pISBmOI8/SI_G_joaVQI/AAAAAAAABLw/2BejAYNwVz4/s400/lady-pray.jpg” alt=”" id=”BLOGGER_PHOTO_ID_5228616487599232258″ border=”0″ //aspan style=”font-weight: bold;”BACKGROUND:/span Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery.br /br /span style=”font-weight: bold;”METHODS:/span Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication within 30 days of CABG. Secondary outcomes were any major event and mortality. RESULTS: In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% (315/604) of patients who received intercessory prayer versus 51% (304/597) of those who did not (relative risk 1.02, 95% CI 0.92-1.15). Complications occurred in 59% (352/601) of patients certain of receiving intercessory prayer compared with the 52% (315/604) of those uncertain of receiving intercessory prayer (relative risk 1.14, 95% CI 1.02-1.28). Major events and 30-day mortality were similar across the 3 groups. span style=”font-weight: bold;”br /br /CONCLUSIONS:/span Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.br //blockquotebr /Take note of their conclusions. In a predominantly catholic country like ours, I think our bishops would not be very happy with this. Unless they come up with another similar randomized multicenter study disproving this same results!br /br /Uh what the!br //div/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://blog.wired.com/gadgets/iphone_1.jpg”img style=”margin: 0pt 10px 10px 0pt; float: right; cursor: pointer; width: 230px; height: 329px;” src=”http://blog.wired.com/gadgets/iphone_1.jpg” alt=”" border=”0″ //aI’m not about as techie doc as anyone here, but for those physicians ogling for the newspan style=”font-weight: bold;” a href=”http://www.yugatech.com/blog/anything-apple/iphone-3g-priced-at-199-worldwide/”3G iPhone/a/span, here’s a href=”http://blog.openmedicine.ca/node/167″span style=”font-weight: bold;”what you can /spanspan style=”font-style: italic; font-weight: bold;”possibly/spanspan style=”font-weight: bold;” do with this gadget/span/a according to span class=”submitted”span style=”font-weight: bold;”Dean Giustini/span, atspan style=”font-weight: bold;” a href=”http://blog.openmedicine.ca/”Open Medicine Blog/a/span/spana onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://blog.wired.com/gadgets/iphone_1.jpg”/ablockquote1. ema href=”http://hlwiki.slais.ubc.ca/index.php?title=Podcasts_and_Videocasts” target=”_blank”Listen to medical podcasts or videocasts/a/em;br /2. emView /empatient charts;br /3. emSearch /ema href=”http://pubmed.gov/”PubMed/a; a href=”http://scholar.google.com/”Google scholar/a; the webbr /4. emPhone /em911 for emergencies; ‘code’ response in hospitals;br /5. emMonitor /empatients; emusing /ema href=”http://www.pockettweets.com/”PocketTweets/a (Twitter for your iPhone) /blockquoteHere’s the big list (a href=”http://www.drpenna.com/2008/06/24/grand-rounds-volume-4-40-at-shrink-rap/”span style=”font-weight: bold;”Grand Rounds Vol 4 number 40/span/a) of what a href=”http://psychiatrist-blog.blogspot.com/2008/07/iphone-3g-activation-blues.html”physicians can do (or not do)/a with span style=”font-weight: bold;”3G iPhonea href=”http://www.drpenna.com/2008/06/24/grand-rounds-volume-4-40-at-shrink-rap/” and medical softwares for it compiled by Dr. Penna/a/span!br /br /All seem to be dependent on the availability of highspeed, reliable, uninterrupted net service and access to an electronic healthcare database in the hospitals. None of these two however is within a mile of my practice.br /br /The recent introduction ofa href=”http://www.apple.com/iphone/” span style=”font-weight: bold;”Apple/span’s newest baby/a to the a href=”http://www.pinoytechblog.com/archives/globe-telecom-confirms-iphone-3g-in-the-philippines”Philippine market (via span style=”font-weight: bold;”Globe Telecom/span), purportedly half the original price/a, made me think my span style=”font-weight: bold;”Nokia 7250 /spanand span style=”font-weight: bold;”Palm Pilot/span is prehistoric. On second thought, Mr. Gunn, a href=”http://blog.openmedicine.ca/node/167″made a comment in this same article/a that struck me more stupid than dumb. Or was I?br /br /Reada href=”http://blog.openmedicine.ca/node/167″ here/a!div class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://bp2.blogger.com/_3J-pISBmOI8/SHs9zZWgZDI/AAAAAAAABKI/p9swcqjBH0Q/s1600-h/ceniffer31_packet_detail_l.gif”img style=”margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;” src=”http://bp2.blogger.com/_3J-pISBmOI8/SHs9zZWgZDI/AAAAAAAABKI/p9swcqjBH0Q/s320/ceniffer31_packet_detail_l.gif” alt=”" id=”BLOGGER_PHOTO_ID_5222836146054128690″ border=”0″ //aa href=”http://www.bookofjoe.com/2008/07/with-email-the.html”Tired of deleting spam on your email’s inbox/a? That’s nothing compared to what happens when confidential information is “fished” out from those email messages sent over the net!br /br /No one is more horrified of this than physicians who use emails to send confidential information across the net. Yes, losing confidential information tru e-mail is as devastating as losing patients. Or worse, losing our careers.br /br /That is what a href=”http://www.openmedicine.ca/article/view/56/144″span style=”font-weight: bold;”Dr. David Kreindler/span/a is trying to avoid when he wrote this article “a href=”http://www.openmedicine.ca/article/view/56/144″span style=”font-weight: bold;”Email security in clinical practice: ensuring patient confidentiality/span/a” published in span style=”font-weight: bold;”a href=”http://www.openmedicine.ca/issue/view/6″Open Medicine Vol 2 No 2 2008/a./spanbr /br /And since it is impossible to strip the email of confidential personal (or patient’s) information (the primary reason your sending that email in the first place) he gave a step by step advice on how to thwart email piracy and help keep email information secure with an encryption software.br /br /Read his article a href=”http://www.openmedicine.ca/article/view/56/144″span style=”font-weight: bold;”here/span/a!br /br /One commenter disagreed though and thoughta href=”http://www.openmedicine.ca/comment/view/56/144/11″span style=”font-weight: bold;” email privacy is overblown/span/a! And he has a point. But I’m not just about to “lay away” my emails out in the open net without some form of security. On the overall, this is just one component of a security policy aimed at reducing confidential information phishing and span style=”font-weight: bold;”making it hard for spammers to get into my inbox!/spanbr /br /(It is just ironic too, that Dr. Kreindler published his email, openly in that article, and with a link too, which is actually a mine for email harvesters!)br /span class=”fullpost”/spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://bp0.blogger.com/_3J-pISBmOI8/SHLnmBCUp1I/AAAAAAAABHc/y1M_V6cJYr0/s1600-h/wrong+site.jpg”img style=”margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 151px; height: 127px;” src=”http://bp0.blogger.com/_3J-pISBmOI8/SHLnmBCUp1I/AAAAAAAABHc/y1M_V6cJYr0/s200/wrong+site.jpg” alt=”" id=”BLOGGER_PHOTO_ID_5220489558375049042″ border=”0″ //aAlthough rare, a href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html”wrong site surgery /ahappens even to the most able and busy OR team such asa href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html” in this hospital/a. Imagine the horror of both the OR team and the patient discovering the closure stitches in the normal side after the procedure. But thats another story.br /br /What I’m a bit surprised is how the hospital administration managed to “rectify” the error and came out with better policies to prevent future incidents like this to happen. Their CEO even a href=”http://runningahospital.blogspot.com/2008/07/message-you-hope-never-to-send.html”blogged about it/a, so the whole community would know about the lapses, the steps taken to correct it, and prevent further “errors” to happen in the same way.br /br /I can help but wonder if most of our health institutions here in our country have the same attitude towards wrong site surgery and medical errors. A a href=”http://www.jointcommission.org/PatientSafety/UniversalProtocol/”universal protocol for wrong site surgery/a has been existing and updated regularly for quite sometime already. The span style=”font-weight: bold;”American Academy of Orthopedic Surgeons (AAOS)/span also had a href=”http://www.aaos.org/about/papers/advistmt/1015.asp”span style=”font-weight: bold;”its recommendations/span/a to reduce surgical sites error in orthopedics. Most of the stories I hear in our country from the gossip tree end up in long, expensive court duels. And even with the pay off, none of the parties learned anything (but money and pride) from the mistakes which should have been preventable in the first place!br /br /Not to be over simplistic about this but parallelisms can be drawn between mistakes like this one and that of mistakes done on people you care of. Admission is a braved act. Facing the consequences is an even braver act. But taking actions to prevent such errors from happening is a mark of a true caring physician. That is how we deal with people we care. To us physicians, that would be our patients.div class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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div style=”text-align: justify;”Quite a number of studies showed that span style=”font-weight: bold;”differences in gender awareness exist in the health care industry/span. However, this is span style=”font-weight: bold;”not limited to professionals on the opposite side/span of the arguing fences,span style=”font-weight: bold;” but also within professionals of the same gender/span. Consider this;br /blockquote”Ms. applicant A, considering this is a very “masculine” dominated training program and specialty, do you have any other training program in mind, that you applied for also and which is more “feminine” that would fit your built?”- Female Interviewer B /blockquoteI don’t know if the interviewer was just “sensitive” enough to “enlighten” the applicant further by giving her options, but its pretty obvious such question is span style=”font-weight: bold;”consequential to the bias created by a less gender sensitive workplace/span.br /br /But what is gender awareness in the first place? Here is one conceptual definition like most.br /blockquoteWhen comparing men and women it is important to clarify the concepts of sex and gender and describe the gender perspective applied. Sex is a biological categorization based on reproductive organs and chromosomes while gender views women and men from a psychosocial and cultural perspective. When studying differences in health, behavior or attitudes it is generally not possible to know what is biological and what is social in origin. A constructivist perspective a name=”IDASYKPM”/a[a href="http://www.biomedcentral.com/1472-6920/3/8#B1"1/a] of gender is then suitable since it underlines that sex and gender, biology and culture are related and inter-reliant. In this perspective gender refers to the constantly ongoing social construction of what is considered “feminine” and “masculine”, based on sociocultural norms and power. Gender is not a fixed or ‘natural’ category, but subject to change and negotiation. We all “do gender” in all kinds of social interactions a name=”IDAKYKPM”/aa name=”IDAXYKPM”/aa name=”IDA0YKPM”/a[a onclick="LoadInParent('#B2'); return false;" href="http://www.biomedcentral.com/1472-6920/3/8#B2"2/a-a href="http://www.biomedcentral.com/1472-6920/3/8#B4"4/a]. span style=”font-style: italic; font-weight: bold;”Risberg et al/span.a href=”http://www.biomedcentral.com/1472-6920/3/8″span style=”font-weight: bold;”Gender awareness among physicians – the effect of specialty and gender. A study of teachers at a Swedish medical school/span/a span style=”font-weight: bold;”BMC Medical Education 2003/span/blockquoteThis same study showed that in popularly male “dominated” specialties like surgery,a href=”http://www.biomedcentral.com/1472-6920/3/8″span style=”font-weight: bold;” gender awareness is notably low/span/a. It is not limited and unique to these specialties however. Similar patterns of an overall lack of gender awareness exist even in “female” dominated specialties and not surprisingly, in our patients’ lounge. The segregation is arbitrary, the debate continuing to no end. But what is glaring is the span style=”font-weight: bold;”consequential biases that results from the on going gender tug of war/span and are whether manifested in the workplace, at home and in our clinics. These consequential biases always implies a dysfunction in the level of gender awareness going far deep amongst ourselves.br /br /That is the bad news.br /br /a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://bp2.blogger.com/_3J-pISBmOI8/SHBkdJVgBjI/AAAAAAAABHU/7JxxaWa1Yts/s1600-h/img07113152810.jpg”img style=”margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 306px; height: 212px;” src=”http://bp2.blogger.com/_3J-pISBmOI8/SHBkdJVgBjI/AAAAAAAABHU/7JxxaWa1Yts/s200/img07113152810.jpg” alt=”" id=”BLOGGER_PHOTO_ID_5219782420007487026″ border=”0″ //aThe good news is- span style=”font-weight: bold;”there is hope for change/span. While the ongoing gender debates may at best be educational to all parties involved, the span style=”font-weight: bold;”call for action needs ideas that work/span. Our society in general, and our profession in particular, should put in place a mechanism to sustain a growing “gender sensitive” policies in the work place. Some training programs I know actually had these policies on paper. But if these mechanisms are just there to attract applicants from the “marginalized gender”, then the span style=”font-style: italic;”stop gap/span mechanism might just be boosting the pervading culture of the “gender insensitives” .br /br /As a physician- educator I believe something can be (or should be) done to correct gender issues. Need a better and a more gender friendly physician workplace? Here are my few advices that goes deeper than the rabbit hole:br //divol style=”text-align: justify;”li span style=”font-weight: bold;”Start young, start at home/span. How young? Nobody knows. But ss soon as the kid discover that phenotypic sex have different biological needs, parents can introduce gender friendly concepts. Remember that most gender biases apparent in the adult life can be traced to the person’s childhood.Most of them proved to be very difficult to change.The formative years has the greatest “stick on” knowledge than any of the stages in a child’s life. It is important that the child understand the difference between sexes and gender and how one is related or how to be “sensitive” about it.br //lilispan style=”font-weight: bold;”Start in school/span. Education perhaps has the single most effective way of combating future threats of gender issues aside from the family.This is more important to a child person who’ s family dysfunctional . This is probably the best area to introduce gender awareness concepts. Sex segregation in this stage is often a result of a misguided awareness by some educators themselves. This is passed on to their students. Parental reinforcement then becomes an essential tool.br //lilispan style=”font-weight: bold;”Quality and productivity driven medical school and specialty programs/span. This is a very controversial issue and often the most debated upon. Thee issue is not about depending one’s gender from another, or gaining points for that matter. Qualifications and productive outputs measures who is best suited for a job description. No giving in or pluses to the gender. If the program do cultivate a culture of “gender insensitive workforce”, it is the taint of the program and not the trainees themselves. If the training gets more sex a than b, the only reason verifiable is because their evaluation and qualification process allows (or disallows) them to and thus cultivate such culture. Change the policies to implement more gender sensitive workplace. No excuses.br //lilispan style=”font-weight: bold;”More role models./span Perhaps one of the more effective “enticing methods” by the few who braved to the opposite sex dominated specialties. Most of the applicants interviewed for a particular gender dominated job alludes there persistence to role models entrenched in the workplace itself. The domino effect of such roles models often determines the number of gender wanting to gain access to that workplace.br //lilispan style=”font-weight: bold;”Educate the patients lounge/span. If you can’t do it for yourself, get someone else more comfortable to do it for you. We get patients we deserve, in one way or another. The quality physicians do not stop at treating their patients only. They educate too. As a physician, we are in a powerful position to create an impact, just like we do when we harbor negative issues on it!br //liliThe last but the most important of course, is to span style=”font-weight: bold;”educate ourselves/span. You can never teach someone else gender awareness without you being “aware” of it in the first place. We all knew what is gender sensitive and what is not. Sometimes we just do what is easy and our patients take cues on our actions. And there’s no denying actions speak louder than words!br //li/oldiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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div style=”text-align: center;”a onblur=”try {parent.deselectBloggerImageGracefully();} catch(e) {}” href=”http://dartmed.dartmouth.edu/winter06/images/disc_gender_01.jpg”img style=”cursor: pointer; width: 354px; height: 239px;” src=”http://dartmed.dartmouth.edu/winter06/images/disc_gender_01.jpg” alt=”" border=”0″ //abr //divbr /Nope, it’s not what you think! But span style=”font-weight: bold;”The Blog Rounds/span span style=”font-style: italic;”Fifteen Edition/span will tackle gender sensitive issues in medicine, on being a physician and on one’s specialty!br /br /Head on to span style=”font-weight: bold;”Manggy/span’s spanblog/spanspan style=”font-weight: bold;”, a href=”http://manggy.blogspot.com/”No Special Effects/a/span, host to this interesting round of blog posts, to get a clear idea of what I’m talking about. His call for articles is already up a href=”http://manggy.blogspot.com/2008/06/blog-rounds-15th-edition-call-for.html”span style=”font-weight: bold;”here/span/a.br /br /span style=”font-style: italic;”For those unaware yet, /spana href=”http://orthologbook.blogspot.com/2008/03/blog-rounds-blogging-our-way-through.html”The span style=”font-weight: bold;”Blog Rounds/span/a is a biweekly compilation of thespan style=”font-weight: bold;” best in Philippine’s medical blogosphere/span, written by a href=”http://orthologbook.blogspot.com/2008/03/tbr-list-of-blogger-contributors.html”physician bloggers (or medically inclined bloggers) /aand hosted on a participating blogger’s weblog. spanArchives and edition/spanspan style=”font-weight: bold;” schedules/span ( plus the host blogger) are listed a href=”http://orthologbook.blogspot.com/2008/03/blog-rounds-archives-and-schedule.html”here/a. The next edition of TBR will be up this span style=”font-weight: bold;”Tuesday, July 8, 2008 7am PST.br /br //spanPhysicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my emailspan style=”font-weight: bold;” kokegulper[at]yahoo[dot]com/span or any of the participating TBR bloggers. Guidelines and updates are a href=”http://orthologbook.blogspot.com/2008/03/blog-rounds-submission-updates-and.html”span style=”font-weight: bold;”posted here/span/a in my website, span style=”font-weight: bold;”a href=”http://orthologbook.blogspot.com/”The Orthopedic Logbook/a./spandiv class=”blogger-post-footer”Bone MD is a board certified orthopedic surgeon and a Fellow of Philippine Orthopedic Association practicing in the hinterlands of Southern Mindanao, Philippines. He took up medicine at the UP College of Medicine and finish his Orthopedic Training at UP-PGH Department of Orthopedics. He is a visiting consultant in the Department of Orthopedics, Davao Medical Center and several other hospitals in South Mindanao area./div
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(This is an old post from my other blog, The Daily Habit, which I thought should be somewhat “related” to the theme of Em Dy’s 14th ed TBR, Paging Doc Hollywood). My well meaning compatriot physicians, please don’t kill me. I’m just reposting a study!)

The much controversial and perpetually challenged hypotheses that male surgeons are better looking and taller than their male physician counterpart has just reached another level. Now, this hypotheses is confirmed and supported by research and published in a very reputable and peer reviewed journal- The British Medical Journal. Here is an excerpt of the whole abstract:

Phenotypic differences between male physicians, surgeons, and film stars: A comparative study

Antoni Trilla, director of preventive medicine and epidemiology unit, Marta Aymerich, consultant, haemopathology unit, Antonio M Lacy, consultant, general and digestive tract surgery unit, Maria J Bertran, specialist, preventive medicine and epidemiology unit

1 Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain

Objectives To test the hypothesis that, on average, male surgeons are taller and better looking than male physicians, and to compare both sets of doctors with film stars who play doctors on screen.

Design Comparative study.

Setting Typical university hospital in Spain, located in Barcelona and not in a sleepy backwater.

Participants Random sample of 12 surgeons and 12 physicians plus 4 external controls (film stars who play doctors), matched by age (50s) and sex (all male).

Interventions An independent committee (all female) evaluated the “good looking score” (range 1-7).

Main outcome measures Height (cm) and points on the good looking score.

Results Surgeons were significantly taller than physicians (mean height 179.4 v 172.6 cm; P=0.01). Controls had significantly higher good looking scores than surgeons (mean score 5.96 v 4.39; difference between means 1.57, 95% confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had significantly higher good looking scores than physicians (4.39 v 3.65; 0.74; 0.25 to 1.23; P=0.010).

Conclusions Male surgeons are taller and better looking than physicians, but film stars who play doctors on screen are better looking than both these groups of doctors. Whether these phenotypic differences are genetic or environmental is unclear.

You can read about the research here.

Not to downgrade our male physicians counterpart, the study also showed film stars acting as doctors look better than both groups. But then again their not doctors anyway.

The research is not the level 1 type of clinical evidence and there are many loopholes you can find. But I never expected such research will actually be undertaken and much less be published in a reputable journal.

Now I can see the wide grin in so many surgeon’s face. Or the film stars.

Filed under: Personal insights into the practice of medicine, The Blog Rounds | Comments Off