2021 Yearender

Finally! A proper yearender post! 😛

Now that things have pretty much normalized for me, with the previous consultant routine slowly getting back on track, this time with a bit of accommodation for further opportunities opened up by my recently-concluded training. 😉

Hmm.. I would say that this year pretty much picked up where the shitstorm that was 2020 left off.. The introduction of vaccines early in the year brought a faint glimmer of hope, as cases were trending down and the vaccine rollout caught steam. This optimism was curtailed shortly thereafter though, as the more contagious (and no less deadly) delta variant finally hit our shores a few months after wreaking havoc in India. I would say that this particular wave finally brought the fight to all fronts here in the Philippines, as the outbreak epicenter shifted to the provinces. Fortunately, we were able to see a bit of change in the trend of admissions.. Vaccinated individuals were apparently less prone to wind up in the hospital and hooked to the ventilator. People who got their jabs still tested positive occasionally, but usually had little to no symptomatology to speak of. That's science at work, and no amount of denial by crazies or the ignorant is going to change those facts.

As the year wore on, the trends showed an ever-decreasing case count as more and more people began to shed their unfounded fears and got themselves protected. People started to go out more, and public areas slowly but surely became congested again, the only difference is that people were wearing masks (thank goodness!).

Enough about Covid for now though.. I admit I was a bit apprehensive about getting back into the game after having been away for so long. Fortunately, he clinics were always so supportive, and old familiar faces started to reappear during consults. In fact, I was extremely touched to learn that an old patient had been waiting patiently for my return and refused to see any other physician, because she said I was the only one she trusted. Fortunately, she followed my last instructions and continued her maintenance therapy religiously, which quite predictably resulted in minimal adverse events in the interim. 😛

I thought that I would have become quite rusty with my pulmo management, but apparently its just like riding a bike, you never forget how to do it once you already tried before. ;)

Let me just say that it really feels so good to be able to conduct face-to-face consultations again. I have become extremely sick and tired of telemedicine consultations as it was the only medium we used during fellowship training. I'm sure patients feel the same way, well, those without heightened anxiety about going out anyway. 😜

Hmm.. it's roughly 10pm, but things have still been relatively quiet outside. Perhaps people in the area have finally wised up and learned that it is not cost-effective to waste your hard-earned pandemic money by burning it all away on celebratory explosives. (Although if the news reports from Bulacan are to be believed, people are still going to be such petulant children who are unable to follow sound advice and still do the stupid things that they do, and lose fingers and limbs in the process. Not really my problem though, as long as they don't cause harm to me or the people I care about)

This past holiday season has been one of the weirdest I have experienced. I don't know if its because 24 and 31 are set during thursdays which threw off my internal calendar, but I seem to have trouble telling the days apart. Unlike previous years when people were more than happy to take time off during these holidays, this year seemed to be more busy, as people were taking advantage of relaxed restrictions to conduct business in an almost-normal setting, something most of us have not been able to do for the past 2 years.. I guess this explains my disorientation, since everyday seemed like a regular workday, only with more people at the malls doing their old-school face-to-face x-mas shopping, something they have not been able to do for ages.

Now we stand on the precipice of starting a new year, with a new, highly contagious variant already within our shores. I can only hope that the reports from Africa are correct, that they have already apparently weathered the storm and cases have already significantly dropped, and that this new variant apparently caused milder illness than previously encountered..

So yeah.. It has been a hodgepodge of a year, with equal measures of hope and anxiety mixed in, causing a roller coaster of emotions for all of us. Still, there was some silver linings that happened, and I am grateful for that.. But there are tragedies as well, especially the severe destruction in the southern part of the country brought about by the typhoon Odette, which caused unimaginable devastation as was seen in clips shot by brave individuals caught in the middle of it all..

Let's all pray for a better tomorrow, and a brighter 2022! Stay safe everyone! Please, keep wearing your masks and keeping your distance by avoiding crowds. Its for everyone's good. If you insist on being bullheaded about it, I  will just pray for your family such that you don't put them at risk with your reckless and inconsiderate behavior, because if anything happens to them, it will most likely be all your fault.

More stories to come, and I hope you will be here along with me for the ride. 😁 Have a Happy New Year!

One month later...

 It is quite late at the time of this writing, so this entry will probably be quite brief. 

After around a month of resuming practice, I have confirmed that I really, really miss doing face-to-face consultations. 😅  I hope that the low Covid numbers hold over the next year, so that it would be so much better for eveyone.

So you wanna be a specialist?

 

 

Original image found here

 

Whether you're a medical student, a recent board passer, or even a veteran GP who is now looking for a change of pace, the prospect of choosing a particular field of specialization to pursue can be quite daunting. There are just so many to choose from, and it weighs heavily on you when you consider that it will define your practice for the rest of your life. Not to mention the hardship and sacrifice you need to endure for a few years as you go through residency training.

I will try to make this as objective as possible, so as not to steer the reader towards any particular area of specialization.

 

Given that this blog can be seen by everyone, let's start of with the basics.

Throughout history, the role of the physician has been continuously evolving. The exponential growth in scientific knowledge has created a need to subdivide the practice of medicine into many different fields, each with its own unique approaches to the identification and treatment of illness. Pretty soon, it became humanly impossible to contain all that accumulated (and still currently growing) fund of knowledge under just one title.

By my own estimate, there are about a dozen "basic" specialties that one can apply for residency (here in the Philippines). Almost all of these specialties allow you to pursue further training in subspecialty fellowships available both here and abroad. Not included are the other special trainings that you can apply for outside of the formal fellowship programs. I shall only touch on the latter briefly, since I am not really familiar with what's available.

Given this intimidating and confusing plethora of choices, its easy to feel very lost and confused. Remember, the most important thing here is that you should be prepared to give yourself wholeheartedly to the specialization that you ultimately choose. It won't be easy by any conceivable measure as you are expected to go through the crucible of residency and emerge as a properly-trained specialist. I shall be discussing residency training in a separate entry, as this one is all about making the choice. In the event that you realize that the specialty is not for you, there is no shame in turning in your resignation. However, it would be much appreciated if you would decide earlier, preferably when the final selection of residents is not yet done, in consideration of the schedule of the remaining residents.

 

I once had a conversation with a relative who happened to be a physician, and he was able to break it down quite elegantly by lumping the choices together into clusters, after which you choose your path from there. After a bit of refinement, here is what I was able to put together:

 

You can lump the different specialties into 5 large groups, based on what you will be expected to deal with:

 

1) Adult

2) Kids

3) Pregnant

4) Cutting

5) Diagnostics

 

I am also adding a 6th Miscellaneous category to accommodate certain specialties that cannot be shoehorned into any of the 5 aforementioned groupings. More on this later.

Lets go over them one by one:

1) Adult - basically refers to Internal Medicine and its vast multitude of subspecialties which are based on the different organ systems.

2) Kids - obviously talking about Pediatrics, as well as its own umbrella of subspecs.

3) Pregnant- the specialty of Obstetrics and Gynecology gets its own category, since the attendance to childbirth is a unique discipline in itself

4) Cutting - refers to all the specialties that involve surgery (excluding OB-Gyn). This would include General Sugery and its various disciplines (Urology, Orthopedics, Thoracic and Cardiovascular, etc), Otorhinolaryngology (ENT-HNS), and Opthalmology.

5) Diagnostics - this would encompass Radiology and Pathology, as well as their respective subspecialties

6) Miscellaneous - Included here are those that do not clearly belong to any one particular category. These are:

- Family Medicine (technically trained to be all-around, if I understand it correctly)

- Nuclear Medicine (the practice of medicine involving the use of radioactive materials defies classification)

- Dermatology (I wanted to put this together with IM, but remembered that they can serve both adult and pedia)

- Anesthesiology (was tempted to lump this together with the cutting specialties since they all share the OR, but thought better of it because they are technically "Internal Medicine in the OR", as what some of our Anesthesia colleagues might say)

The next step would be to choose a particular category, and get things started from there. This advice seems to be catered to those going into IM and Pedia, where they have 3 years to figure stuff out while they choose which subspec they will be going after. Its a bit trickier for the surgeons, as there are certain "straight programs" available where the trainee does not have to undergo the General Surgery residency program before getting started on the subspec.

 There you have it, a simplified overview for choosing a specialty. Hope it helps! 😁 

A new leaf?

 Been a while since i last did a backread of the blog, and I wasn't too fond of what I saw.. I know I had started this blog over a decade ago as a kind of online public journal which has afforded me some catharsis and creative release, but I don't like what it has become in recent days.. All I see are angry rants, COVID news and warnings, and little else other than the occasional entry about specialty training.

I guess its safe to say that I have grown sick of it, and will now try my best to make this space a bit more informative, while retaining the same informal narrative style that I have used from the beginning. Just so we're clear, I have no intention of making this a "fake news" site where I post random scientific musings that can be fodder for the ignorant.

 Oh, and I have decided to clean up the blog again as well, and as such will be removing the random short rants that don't really contribute anything.

Ok, now that I have gotten that out of the way, it's time to jot down stuff that will be more worthwhile, See you at the next entries. 😁

Consummatum Est

 

Image source here

At long last.. I never thought I would actually see this day..

Well, actually this post is roughly more than a week delayed, with the examinations having concluded a while back already. Oh well.. 😅

Once again, I am FREE! 😁 Best of all, mission accomplished! 😎👍 Before anything else though, I would like to thank the Big Guy Upstairs for his unfailing support. None of this would have been possible without Your help. Thank you so much.. 🙏🙏🙏

 As I breathe the much needed sigh of relief, the next question that looms over my head is "What now?". This one is a little tricky, as it will involve both the reorganization and reactivation of previous clinic commitments, as well as an exploration of possible new opportunities that have opened up before me. Things have begun to get interesting, so we shall see what eventually develops.

I miss doing clinics at my usual spaces. I have spoken before of my disdain for telemedicine, so I guess I shall refrain from opening that can of worms for the meantime until I really need to hehe. The art of medical practice was never meant to be conducted behind digital screens. I hope things will really be safe enough when I do begin venturing out into the world regularly, as the last thing I need is to get sick or to bring the virus home to the people I love.

Although the examinations have been hurdled, I find myself in a sort of limbo as the oathtaking to be sworn in as a full-fledged diplomate will be taking place much later during the first quarter of the following year. As such, my practice will be limited until I get myself fully installed in the subspecialty. 😅  All good, I guess. Good things come to those who wait. 😉 Hopefully my practice will eventually return to full swing, and I shall be making more efficient use of my time so that I can finally move on to other, far more greater things in life. 😁 That's the update for this episode. This is actually a creativity primer for another project I have, but that is beyond the scope of this  post to discuss.

Procrastination as a prelude to productivity?

 Yeah, I have something else to do right now.. Typical, huh?

However, I find that doing a bit of creative work like this immediately before doing the more important thing kind of resets my mind for the more arduous task at hand. I have been sitting on this plan to prepare a presentation about my recently concluded paper for a couple of days now, and I just can't seem to get started. It seems that I am having trouble with initiating important tasks, and instead fall into the technology trap of browsing soc-med ad other frequented sites instead. (No, I do not consider Blogger to be a soc-med site. I hardly ever come here except to bridge myself into working shape)

So, now what?

I really didn't have a topic in mind as I began this post, as I find it therapeutic to just sometimes let my stream of consciousness flow.

I now am seriously contemplating the question "What do I get out of blogging in the middle of procrastination?"

Lately I have found myself struggling to find focus. Practicing  a small bit of the mindfulness I mentioned in a previous post, I noticed that when I write creatively, it helps me focus on myself as I type away. I begin to zero in on the keyboard, the letters, the grammar of what I want to say (although not too much, since this is a stream-of-consciousness thing). I was never a touch typist, nor will I ever be because of certain physical limitations, so I tend to look at the keyboard as I type.. Ad now I find looking at the keyboard quite soothing.. It's just me, my thoughts, and this platform on which I will put them up on.

Part of me is tempted to go into another long tirade about the evils of social media and how it affects the modern way we do things, but I don't think that would be appropriate at this time since there are other more pressing matters that demand my attention and effort. I don't have the time or energy for another angry rant. 😅 

Going forward, when everything has been said and done, I have decided to follow a 31-day blogging plan, which I hope would increase my creative output. Hoever, if the topics scheduled may seem too personal, I may just abandon the project altogether. I dunno.. we just have to see what traspires in the coming weeks..

Panic calendar activated!

 Image source here

It it presently a little over two months before I approach another great hurdle, and there's still tons to be done..

Training ended more than a month ago, and I realize that I have been mucking around too much.. 

I will make this brief then. Just a little something to help me get used to typing stuff again and to jumpstart my mind..

--------------------------------

I had this moment of introspection as I was taking a shower a while ago. First, I realized I have not been taking care of myself as well as I should have. A prime example would be putting off bath time just because I wasn't going out. It may not seem like much, but he uncomfortable feeling you get when you haven't cleaned yourself was already weighing on me, and I just didn't realize it yet. I have also been spending way too much time doing a host of mundane things, but these are things that do not add value to myself and instead burns up precious time.. I realize I had been fooling myself that I was accomplishing things, but in reality I was just straying from my goal by procrastinating.

I know that it sounds like such a cliché thing to say nowadays, but I guess I needed to get into a bit of mindfulness to help myself get through whatever this funk is. Looking up the definition, I came across this:

noun

: mindfulness

1. 1.

   the quality or state of being conscious or aware of something.

   "their mindfulness of the wider cinematic tradition"
2. 2.

   a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.

I guess its a way of meditating? Of pausing and looking into yourself to see and acknowledge what you are feeling, in order to be more comfortable with who you are and what you need to do. It may seem like a lot of psychiatric mumbo-jumbo, but it makes perfect sense.

I now realize that I have been procrastinating all this time because I was afraid. Afraid of failing, of doing poorly, of not finishing my goal.. But this begs the question, why aren't you doing it then?

Depression can sometimes strike without warning. One day you may be "feeling" fine, but the next day you find yourself suddenly crippled with apathy and anhedonia. I read a statement yesterday (don't remember source, sorry) that depression may be a symptom of what lies beneath. For me, the underlying problem is the uncertainty about the future. About how things will play out during the boards, and I have to admit that I'm a bit anxious about resuming practice after having been out of the game for so long..

Now that I have identified the problems and issues though, I find myself strangely refreshed and ready to tackle all these things head-on. I'm gonna wrap up this pesky study and finish all of them bothersome requirements so I can really study in peace, and I have no intention of letting my bad Soc Med habits get out of the way. I have done it before, and I sure a heck will be able to do it again.

That's all for this entry. I still have a paper to write, which I predict that I will successful finish by tonight. Let's do this! 💪

Here we go again..

 Sigh..

 Another month, another spike.. The Delta variant is truly here in the country. Numbers seem to be going up all across the Philippines. Hardest hit are the provinces that are experiencing a really bad surge, similar to what we experienced a few months ago here in the metro.

I had no idea how bad it was getting until I came across this image:

Picture came from a post by the Autoindustriya.com FB page

 This was apparently a shot from the exterior of a tertiary hospital in Cebu, where you can see vehicles lined up outside adjacent to oxygen tanks supplying much-needed O2 support for suffering patients within the vehicles. With hospitals filling to capacity, the patients have little choice but to wait it out in their cars until there would hopefully be a vacancy.

It struck me as a particularly shocking scene because I never imagined that it would come to this on our shores. You see images from India where they faced this grim scenario only a few months before that seemed unreal. 

This is similar to the initial outbreak, but the vaccine is the gamechanger here. According to a news report I read earlier, the PGH is nearing capacity for COVID, with a sizeable chunk of patients who were unvaccinated, and only 2.6(?)% were breakthrough infections of fully vaccinated individuals. Even more striking was the fact that the fully vaccinated only had disease of moderate severity, while those unvaccinated were the ones fighting for their lives as severe cases...

Now we face another lockdown in the metro, with the hope of stemming the tide and letting the vaccinations catch up. Keep safe at home folks! Let's all ride out this storm together. 😷

 

 

 

 

Olympic Moment, and a lot of rage (as usual 😅)

 Lemme change things up for a second as I take a break from not doing my case report. 😅

😜😜😜

 Anyone here in the Philippines who is not living under a rock would probably know of the amazing feat that the local weightlifting fairy Hidilyn Diaz was able to accomplish.

Yup, I'd say it's hella difficult to miss posts like these on your feed.

I am no stranger to getting swept up in national pride, and for the first time in so long, I genuinely felt it again. This woman has gone through so much, and trained so hard to get to where she is now, and she really did it for flag and country! Watching her cry at top of the podium while singing the national anthem as Lupang Hinirang played for all the world to hear, gave me goosebumps as I felt an entire plethora of unexpected emotions.. 

I shall never forget this image, and will tell stories of it to my future children.. (Image source here)

The fact that she was praising and thanking God in the middle of it all was so touching and inspiring (Image source here)

To paraphrase and add to what a friend said earlier, she has lifted the country on her shoulders out of the depths of fear and uncertainty, even for a brief moment, to remind us of who we are and what we should stand for. It is just unfortunate that all this happened under the shadow of the pandemic, but that does not diminish her achievement at all. She bested powerhouse China, of all nations, to win the first ever Olympic gold medal for the Philippines.

Looks like Team China wasn't too happy about being beaten at their own game by the country they have been bullying, eh? #SorryNotSorry (Image source here)

I have to admit that I wasn't really an avid fan of Philippine Olympic participation the past years. My earliest memory of interest in the Olympics was when Masueto "Onyok" Velasco Jr. won silver in the 48kg boxing category during the 1996 Atlanta Olympics. Sadly, Onyok terminated his olympic campaign to capitalize on his popularity by acting as a comedian in local sitcoms. The unfortunate story can be read here.

The first Pinoy Olympic hero I was exposed to (Image source here)

Be that as it may, Onyok, like all the other national athletes representing or who have represented the Philippines, also primarily fought for flag and country. Hidilyn's victory made me do some introspection, and has led me to regret supporting another boxer a few years back.

No, I won't be posting a picture of him here, as I do not wish to waste any effort on him, and neither will I mention him by name, because this post is to honor the real sports heroes of the country.

I realized that said boxer was nothing more than just a paid mercenary, fighting not for flag, but for the purse. Filipinos, by nature, gravitated toward him and saw him as a champion of the people. We deluded ourselves that his fights were fights for the country, but that was nowhere near the truth. We threw our support behind him, showered him with praise and adulation. Heck, the army even gave him a substantial honorary command rank in the reserves, all because he was fighting for the millions of pesos that he would pocket after every bout. When he wins, he wins for himself. He brings recognition to the country, sure. Indirectly at best, but bear in mind that it is not an achievement for the nation, and nor should his wins be a source of national pride, kasi pera-pera lang naman yan eh. Our country becomes the "idiot nation" where said mercenary was able to charm the population into voting him into higher public office despite having nary a hint of competency for governance. And no, you can't justify that you will just learn on the fly, kasi hindi ito boxing, gago. The things you do in office will have an impact on populations of people. No wonder developed countries are laughing at us for being a backward banana republic. We put the wrong people in office turn a blind eye to them enriching themselves while the same people moan about how bad things are and how government should do more for them.

On the other hand, you have the true national athletes, languishing in their dilapidated training facilities, with nary a drop of support compared to the one shown to the mercenary. They only get a mere pittance of an allowance, and the government seems to ignore them unless there is a potential photo op to be had. Now I really feel sorry for not supporting Philippine sports in earnest, mainly because I was generally indifferent to sports growing up. Now I know better, and I intend to do better for them.

Another peeve I have for this boxing mercenary is his corruption of sport, although in hindsight, his actions were inevitable and should have been expected. Said mercenary made waves when he was drafted as a playing coach in the highest basketball league of the land. It was in al likelihood a massive publicity stunt by the company behind the said team, but it really pissed me off. You have this guy, a superb athlete in his field (boxing), who just happens to like basketball and plays somewhat well at the barangay level (I dunno, I never cared to see him play), suddenly shoehorned into a roster spot that thousands if not millions of hopeful players have been training their whole lives to earn someday. Initially I was so disgusted by this act, that he bypassed (and in turn, disrespected) the normal grind that any athlete goes through to reach the highest level, and just pissed on it all just because he got fucking popular due to his fights for money. 

I am no athlete, but as an avid basketball fan, I have massive respect for those who train to get to where they are. To have this total amateur take a free ride to the top just like that was just a slap to the face. I though sport was the ultimate equalizer, that money wasn't supposed to matter as long as you had the skills to compete at the highest level (I am aware that getting good training costs money, but that is besides the point I am trying to get across here). Its a bit funny, because the dude came from a humble background, quite similar to other athletes from the provinces who try their luck in Manila by way of college athletic scholarships. Now I realize that I should not have been disgusted, because that is the sort of thing that I should have expected from him from the get-go.

Bottom line is that he should not have deserved my respect and admiration as a supposed national sports icon. If ever, he would just be noticed because he seemed good in winning fights for prize money.

Before I end my piece, I would like to share another thing I saw that got me triggered all over again:

Now this is just pathetic. Coming on the heels of Hidilyn's historic win is another case of Filipinos trying to ride the coattails of someone who does not represent them. No disrespect to the athlete. A win is a win, and this post by no means aims to diminish the achievement. Congratulations all the same. What I'm hitting at is the attribution of the achievement. Wake up guys, the person is still classified as a foreigner who plays for another country, so it's cringeworthy to see putting #Olympinoywalangimposible hashtags underneath this, because she ain't Pinay in the Olympic sense. Kahit pa sabihin niya na Pinay pride siya or whatever, bottomline is ang panalo niya ay hindi para sa atin, kundi para sa Amerika! She does not represent us, and it makes no sense that you are trying to foster a sense of ownership and pride over something that is clearly not ours. That above post should not have been done, or at least could have been handled a bit differently. We go from praising Hidilyn as a true local hero, to lumping her together with all these Fil-Ams and their wins for other countries. We should have more national pride than that. We should not be riding the achievements of people who are not truly "one of us", because they did not really do anything tangible for the country, na nagkataon lang na may lahing Pinoy. Ang pathetic lang kasi.. Nakakahiya na.. Yun lang.

The challenge of productivity amidst bed weather..

Image source here

 I have been here at my desk for the better par of the day, attempting (without any success) to continue the case report that I have (thankfully) started working on yesterday.

But hey, at least I'm not lying on my bed snoozing the hours away. 😅

As the title implies, it's just so hard to motivate oneself under such soporific conditions, which is why I took a dose of caffeine this morning. The net result was that I didn't need to sleep, but I had to pee more often (as expected). 😅

And yet I was still unproductive. 😅😄😄

Which is why I'm blogging this down right now, to acclimatize myself to using the keyboard again as I struggle to complete this requirement before the weekend is over.

The rain has been on and off lately, contributing to a cool, relaxing climate that can easily lull your brain to sleep.. I just hope that the reported flooding around the metro resolves soon.

In the midst of my struggles with procrastination, I chanced upon this interesting TED talk by a brilliant 7-year-old girl who was talking about the impact of parental interactions with children during the critical period from infancy to at least age 5. Her talk (like most TED talks honestly) was short but highly informative. She spoke really well for her age, and was able to get her message across quite clearly. Here is the link below for those who want to watch it:

https://www.ted.com/talks/molly_wright_how_every_child_can_thrive_by_five

Watching that talk reminded me of what I aspire for when I give lectures.. To be able to give a highly informative lecture without boring the audience or causing them to tune out because I made it too long or high-falluting. I understand that aiming for simplicity is not as easy as it sounds when you are talking about academic activities as is typical in the medical field, but what is the point of giving a talk if the people you are lecturing to are unable to take away anything from it? I think a lot of people get too wrapped up in what they want to say, that they tend to forget the people that they wish to convey the information to. Now, this is not a knock against the people who speak at conventions, as I have attended my own fair share of fascinating talks by brilliant speakers. Sadly though, there are those few that fall through the cracks and give a barely understandable talk fettered by too much information. The person is always brilliant to say the least, and is typically a top content expert in the field, so the mastery of the content being conveyed is unquestionable.. 

 However, mastery of content does not necessarily equate to mastery of delivery, and far too often, if you are not in the upper ranks of the academic society, you may only grasp a bare minimum of what the speaker is trying to get across, and I'm not even taking into account those presentations loaded with barely intelligible figures and graphs that may only be decipherable by the presentor.

Please don't get me wrong, I am by no means putting myself above these speakers, because I am quite sure that next to them, I am just a potato. The point I am trying to get across is that the ability to really teach well is a gift, and not everyone has it. Being a remembered as a good teacher, not necessarily in a formal academic setting, is something that I am really aspiring for. There is no greater reward at the end of a lecture, than when you realize that your audience was actually able to pick up a thing or two from what you had shared. 😉

Crab Mentality

 

Image from here

 I was just browsing my old social media posts when I stumbled upon one of my most favorite quotations of all time. It is just a simple comment to an article, but I love it nonetheless. It pretty much hits the nail on the head, so I decided to also repost it here for posterity.

-----------------------------------

 "... Filipinos indeed have this unspoken social protocol of "not allowing others to get ahead". Consider the reverse custom among Filipinos when it comes to celebrating one's birthday. In other countries, your friends throw a party for you (should you be "party worthy" that is), all expenses on them and not on you. They celebrate you being their friend, not as benefactor. In the Philippines, whether to celebrate your birthday or a job promotion, the protocol is "mag-pa-blow-out ka". It's ostensibly done to "share the wealth", but if that were true, then why would people feel resentful if you don't treat "them" during "your" day of celebration? In the process of spending for that blow-out, whatever financial gains you might have had from your job promotion is negated..."

------------------------------------

For those wondering about crab mentality, here is the Wikipedia definition:

"Crab mentality, also known as crab theory, crabs in a bucket (also barrel, basket, or pot) mentality, or the crab-bucket effect, is a way of thinking best described by the phrase "if I can't have it, neither can you". The metaphor is derived from a pattern of behavior noted in crabs when they are trapped in a bucket. While any one crab could easily escape, its efforts will be undermined by others, ensuring the group's collective demise.

The analogy in human behavior is claimed to be that members of a group will attempt to reduce the self-confidence of any member who achieves success beyond the others, out of envy, resentment, spite, conspiracy, or competitive feelings, to halt their progress"

Exit Interview

 

Image source here

I'm roughly a week removed from my official end of training, and I guess it would only be appropriate that I made an entry about it.

I honestly haven't really taken it all in yet, as the previous year was fraught with so many different problems that preoccupied my psyche. It was damn near impossible to do any sort of thoughtful introspection. As a matter of fact, a number of unfinished requirements still bothers me to this day, since I still have a pair of upcoming presentations coming up, not to mention the researches that still need to be passed.. Oh, and let's not forget the logbook and the annual report! 😵

So yeah, there's still tons to do, and I didn't even count the review for the boards! 😱

 Don't get me wrong though. I am really grateful to all my mentors and everyone who has helped along the way for me to be able to gain some semblance of competency in this field. I just hope I don't turn out to be just a big disappointment..

How do I feel?, you might ask.. Well, I guess its pretty obvious that I'm feeling a great relief that the long (extended) year is now finally over, and I will not have to do any more telemedicine consultations for the foreseeable future. Honestly though, I have done enough telemed to last a lifetime. 😅

So yeah, now that I have rested a bit already, I'm now basically working my way through the pile to hopefully get everything done in time to ensure I have enough left for a serious review.

Let's go.

Finishing up

 As time winds down on the few remaining days of my (hopefully last) clinical fellowship, I find myself confronting a lot of different emotions.. Strangely enough, this is a lot different compared to the time that I was counting down the days to the end of my first subspecialty training. Ss I recall, it involved a lot more reminiscing, and I was even doing a daily picture upload to document the approach of my forthcoming exit from the program.

 This time around, the prevailing feeling is one of relief that it is all over. Everyone who has had the experience of training amidst the pandemic has a unique story to tell, the likes of which will have difficulty resonating with others who have not lived through the experience. A lot of adaptations had to be made in order for programs to survive, and ours was no exception. I never thought I would find myself sick and tired of telemedicine consultations, since it has more of that future-tech vibe, but here we are. Zoom fatigue is definitely very real, and hopefully when the time comes for me to resume practice (after the board examinations), people will be brave enough (and completely vaccinated) to engage in face-to-face consultations.

 Talking to a miniature image of a person through a camera, screen, and speakers is way different from the personal engagement and interactions of the classic clinic visit. With the latter, the dialogue is  more nuanced, and the responses more genuine. People have always talked about the dichotomy of medicine being both an art and science. The science is still there, but the art somehow loses its luster when you limit human interactions to remote exchanges conducted through technology, no matted how advanced it is..

Besides my newly-discovered disdain for teleconsultations, this year has been such a roller coaster of emotions that it is near impossible to consider the sum of all these feelings to be a positive one, Sad to say, this may be the first time I graduate from a program feeling like I never want to come back.. 😞

This isn't to say that I won't be helping out the juniors that would come after me though, but that would actually depend on who will be the juniors entering the program. Fortunately, the new faces we were introduced to seem receptive enough, and I would be happy to help them out as they begin their journey. I can't really spoon-feed them everything though, since we had to tough it out ourselves with little by the way of actual endorsements given the situation of the times... But to be honest, it is getting tiresome making excuses for the higher ups..

 I am sure our batch will be compared to those that would follow us, and we would seem like the black sheep who could not do as well as the others, but I hope that we would be remembered as "those guys that kept things going" in spite of everything. It wasn't great or fantastic by any conceivable measure, but at least we survived and put the program in a position to begin thriving again, even though we ourselves will not be there to enjoy the successes that future batches would be able to fully experience...

Let it be known that I am not ungrateful. As a matter of fact, we are extremely thankful to have been in training in spite of everything, and that the bosses went out of their way (for the most part) to ensure that the program would continue through some shape or form. Personally though, it is hard to not feel like a half-baked version of what an actual graduate of the program should be like. However, recent discoveries have led us to conclude that we may not be so different from them after all, but I guess that's a story for another time, if ever.. 😉

I can't wait to put everything behind me, but I also still have so much to do. Today actually marked a big step forward, since I have successfully rested myself the past couple of days, and am fully prepared to face the coming challenge with a renewed vigor and a fresh insight. I had discovered (too little too late) that I was not being myself this past year. I had shifted my way of doing things too much in order to conform to a perceived standard and so that I would not alienate others around me.. But that wasn't me.. Looking back, I realized I had been stifling myself from operating at peak efficiency. The other day, my inner monologue kicked in and I began questioning myself in the car: "What the heck are you doing? This isn't you. What are you so worried about? You got this."

Strange as it may seem, that encounter with my subconscious kind of jolted me awake from my self-imposed hibernation, and right in the nick of time too. I can now approach the coming days with a new kind of resolve because of this healthy change of perspective. I just hope I can sustain this all the way to the submission of requirements and the final examinations.. I'm quite sure I had help from the Big Man Upstairs.. Only He knows me this well, and I'm 100% positive that this is all His doing.. Thank you.. I will do my best. 🙏

On case series and case reports

 Just posting for posterity. Source here.

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"The best case reports describe a unique or nearly unique case, an important variation (outlier case), unexpected outcome or adverse event, or unexpected association between diseases or disorders. Manuscripts are most likely to be accepted if they state why the case is worth reading, describe the case and all relevant data, discuss why the case is unique or unexpected, provide alternative explanations for case features, and offer clinical implications. The best case series include a consecutive well-defined sample of subjects, report interventions with enough detail for reproduction, account for all patients initially assessed and enrolled, and provide adequate follow-up with descriptions of dropouts and losses."