Medical Honorifics

I guess it's just common sense that a physician would be addressed by the general public with "Doc" or "Doctor" attached as a prefix to his or her name, in the same way that lawyers are called "Attorney" or priests are called "Father".

In medical school, especially during 4th year or the so-called Clerkship/Junior Intern year, one becomes a part of the hospital hierarchy and thus everyone senior to you is addressed accordingly.. or so I thought..

When I was in my clerkship year, "Doctor" was the norm, and everyone was fine with that, since it made perfect sense. However, during my Legal Medicine rotation where I found myself at Camp Crame, we encountered a senior intern from a different medical school for the first time. What struck me the most was that in their institution, senior doctors were addresssed as "Sir" or "Ma'am" instead of the conventional "Doc/Doctor". The rationale he gave was that the use of Sir/Ma'am was the highest honor you could give someone, plus I guess it came in pretty handy when addressing someone you weren't sure was a doctor or not.

"Ok", I thought "that seems reasonable." but something in me argued that "You can call anyone Sir or Ma'am, but you can't just call anyone Doctor". In hindsight, this seemed like a pretty arrogant thing to say, and to be perfectly honest, I am quite ashamed of having thought that way before.. :/

As I went further along the path of rising through the ranks, I encountered more people from different schools, and I discovered that there was such a heterogeneity of how trainees use the honorifics. Eventually I found myself using "Sir" and Ma'am" more often, as it seemed more comfortable and less awkward to say. Hmm, I guess you can also add the fact that I had unpleasant experiences as a junior in my alma mater which made me averse to any similarities to the way the hierarchy was run over there. :P

As I previously stated, everyone else calls you doctor anyway, so why do you have to require your juniors to say the same? It seems kinda redundant (and a little too pretentious if you ask me) to call each other "Doctor" all the time. I now wholeheartedly agree with the concept that "Sir/Ma'am" conveys a whole lot more respect when said by a junior to a senior, as it sets clear bounbdaries between the two of you. "Doctor" is more ambiguous can be used when talking to peers from other departments who you aren't close to, or even used sarcastically by consultants talking down to juniors. (In retrospect "Sir/Ma'am" can also work for the former. Hehe)

Sorry if this seemed long-winded and confusing.. The basic point I wish to get across is that the use of "Sir/Ma'am" as an honorific title when junior doctors speak to their seniors seems much better than addressing your bosses as "Doc" or Doctor". And yes, It really does come in handy when respectfully addressing someone whose medical status is unknown. Manners maketh man I guess. :P

Getting Started

After everything has been said and done, here we are at last...

I'm approximately two and a half months removed from the passing of the diplomate examinations and the start of my new life as a Pulmonary consultant.. Man, starting a practice is not as easy as it seemed.. Wait, let me rephrase that.. Starting a practice is HARD! :/

Despite now seemingly having all the time in the world to do my own thing at my own pace, things have gone by pretty quickly just the same.. Hospital and clinic applications, government registrations, training certifications.. the list just went on and on.. Looking on the bright side, at least I gave my life excitement and variety. :P

Now that I have finished all the startup stuff and have somewhat settled into a regular routine, I'm presently assessing gaps that I need to fill. These concerns could be academic, emotional, or spiritual.. I'm still feeling stuff out, and I'd be lying if I said I wasn't scared by all the uncertainty. This is a whole new ballgame for me, since I have been in school or training for almost the entirety of my adult life thus far.. The vastness of the possibilities terrifies me.. It's always a tossup between staying the comfortable and safe course, versus the unknown with possibility of high payouts..

I'm also concerned about how my decisions now could set the precedent of how things would turn out for the rest of my life.. I guess it boils down to my not wanting to have regrets in the future over wasted opportunities that didn't quite seem all that viable at the time, but actually would seem like a really good idea in hindsight..

Hmm, I guess it would all boil down to how you want to live your life and how you want to be known/remembered for..

Yeah, life is pretty scary business, but we all eventually have to face it.. and I would like to face it on my own terms.. ;)

A wide-open space..

True Freedom.

For the first time in my life, I can claim this with absolute certainty.. at least for a little while :P

It finally happened.. I am now officially done with training and its' associated culminating examinations.. All that remains is the oath-taking, but that is of little consequence in this context..

No longer do I find myself in pursuit of a particular schedule to adhere to a rigidly-defined set of goals as prescribed by a rigorous curriculum.

Yes, schedules and tasks are here to stay, but the academic burden has now been lifted from my shoulders.. Only to be replaced by the more awesome responsibility of life as a private physician.. There are no more safety nets, no more easy fallbacks.. Every move must now be more calculated than ever, as a wrong move could send all your hard work spiraling down the drain..

Scary? Yes, but exhilarating all the same. I am now bracing for a very different kind of lifestyle from what I had grown accustomed to in the past years.. Finally gone are the endless duty nights, the relentless need to study for yet another exam irregardless of your state of mind, the ceaseless errands.. But yeah, I will be missing mostly the kind of fatigue that is unique to residency and fellowship training..

Life will still be tough, I will still get tired, and sleepless nights will still be spent, but it is comforting to know that all these hardships will now be done mostly on my terms and not in partial fulfillment as a requirement for something and such..

I was never too much of an academic. I had a slightly different way of processing information, and thus classical techniques of learning and review didn't work well for me. I needed to understand concepts and construct them in my own words, otherwise all my efforts at memorization would come for naught. The caveat of this was that I tended to simplify things to the point that even though the knowledge would be usable, I would purposely omit long-winding (what i deemed) unnecessary details so as to make the information so much easier to digest and process. As a result, my exam grades were never really all that hot. :P 

This was often a cause for concern whenever I took examinations, since I tended to finish early. Just to be clear, this was not due to any sort of brilliance or intelligence on my part. It was actually more of my dislike of retaining the information longer than I had to. I wanted to finish as soon as possible so that I could finally release my mind from all those bits of knowledge I was fighting to retain for examination purposes. Granted, I never really got high marks, and even failed quite a bit, but at least my brain got some catharsis :P. Fortunately, some things do eventually get ingrained into my system with repetition, which is why I think having my residency at a public hospital worked so much better for me as compared to my experiences at private institutions. This is not a knock to the private hospital people. Its just that the program you have may not work for some people, and conversely, other residents are not suited to be in public institutions.

Hmm.. going a little off topic already there.. Hehe.

I'm presently in the middle of completing my requirements and sending my applications out to potential places of work. I never knew being this free could also be this much stressful. :/ Now I finally have my entire future to think about, and I can now think of my goals more concretely than before, since I have finished what there was to finish.. It kinda makes all the sacrifices seem a bit worthwhile.. ;)

Simply grateful..

I'd like to start off this blogging season with a shoutout to the people that matter..

- Firstly, I would like to thank the Lord (for the umpteenth time) as he is always there for me and comes through whenever I need him.. Thank you so much, as nothing would have been possible without you..

- My family, the most wonderfully dysfunctional support system a person can ever have.. :P Thank you for putting up with me and all my crazy idiosyncrasies..

- My Other Half, who was there every step of the way, cheering me on and encouraging me to get stuff done until I finally made it.. Thank you for keeping me together and inspiring me to push through 'til the very end. :)

- My BNO boys, thanks a lot for putting up with my crazy schedules and tailoring some outings just so that I could tag along. ;) 

- My mentors. It was such a great honor to have trained under such great minds and educators! Thank you so much for lending us your time, patience, and experience that allowed us to grow into the specialists we are today. I hope we will be able to make you proud someday..

- My batchmates. Here's to the most dysfunctional bunch of doctors that I have ever met! :P Despite all our un-cohesiveness and many, many interpersonal issues, we still managed to pull of the rare hat-trick of the entire batch passing research on time, taking the boards, and scoring the 100% pass rate! Congrats to us, and thank you as well.. Fellowship wouldn't have been what it was kung wala kayo.. (although it could have been better.. much, much better.. :P)

- My pulmo juniors. You saw a lot of me this past year, mostly being a nuisance at the OPD or just hanging out at the callroom. :P Thank you for being my sounding board of sorts when I was already freaking about as the date drew nearer.. and thank you for the graduation gifts! They are very much appreciated!!

- My co-fellows from the other departments. Alas, here we part ways.. Thanks for being there to answer our referrals (for the most part :P). I'll never forget you guys!

- The hospital support staff. Thank you for being a part of our journey, as we couldn't have done it without you as well! 

- Lastly, to all the patients that I handled, both living and deceased.. Thank you for teaching me to be a better person and physician...

 - To everyone else that I may have missed but has touched my life in one way or another to eventually help me get to this point.. Thank you so much! :)

2017 Retrospective (AKA 2018 "Yearstarter")

I had originally planned to write this entry in the waning moments of 2017, but I guess fate had other plans.. It seems like Im really doing annual retrospectives from this point on.

This has been a very unique year, to say the least. It is typical to find tremendous upheaval contained within the context of 365 days, but this marked a transition of sorts into a new era.. (for me anyway :P) 

Foremost among the  aforementioned changes is the acquisition of the family vehicle, and with it, the ability to safely go to previously inaccessible destinations on our own, what with a handful of trips outside the metro as we began to satisfy our long-standing wanderlust. :) I think the vehicle goes beyond just the thrill of ownership. It also brought along a host of new experiences which only served to enrich our pool of experience even further. Every aspect, from purchase to maintenance are now ingrained in our minds, making sure we won't struggle or panic through the process the next time around..

This year also marked the long-awaited end of my formal training as a specialist.. it was bittersweet in a way, since I had been looking forward to the end for as far as I can remember. The end was thankfully not anticlimactic as I haddread. Instead, it was kind of like going away peacefully, without much fuss or fanfare, just the way I like it.. :) I wasn't gone long anyway, since I spent the better part of my first two months post-fellowship stuck at the hospital in a bid to complete my research project and secure my final clearance from the alma mater. 

I guess I did have a bit of separation anxiety, since I found myself back there a lot more than I would have liked (since I did turn down the offer to extend another year if deemed worthy). I guess it's just my nature to never be truly gone from places I had once considered home..

Speaking of second homes, this year also granted me an opportunity to give something back to the Old Hospital as I was invited to give a short career talk regarding Internal Medicine to the outgoing PGIs..Preparing that presentation was definitely a lot more different..Having been trained properly in presentations by virtue of the workload during fellowship, speaking before a crowd was not a concern. This left me more time and effort to spend on preparing something that would get my message across to those impressionable minds and hopefully turn them into potential recruits. The actual turnout was quite disappointing though, with only a small handful of QC babies applying for pre-residency this past year..

This year also brought great blessings to my Other Half, who not only passed her examinations, but was also accepted into training in one fell sweep! :)

This has also been a year of good times with good friends, of outstanding movies and memorable bonding moments, of adventures with family and quiet times with loved ones...

Granted, this is also a year where I seemed to see the world unraveling before our eyes due to events and decisions both locally and abroad, but I on't dwell on that..

Here's to a bright new tomorrow! 

Welcome 2018! Be kind to us, please? :P

A post that is long overdue

In fact, this is more than a week late to be exact, but here goes..

CONGRATULATIONS to the passers of the September 2017 Physician Licensure Examinations!!! :)

You can see the results here at the PRC Website, or here at PRCBoard.com just in case the first link doesn't work anymore. :)

Welcome to the wild and crazy world of Philippine Medicine! :P See you guys around!

It all boils down to greed

I noticed that the tone of this blog has lately veered from the personal to the realm of current pressing issues. This entry will be no different. There is just so much going on in the world now that bothers me, and even though it is not my objective to polarize people by way of my opinions or be a social media influencer (whatever the hell that means), I feel this need to put my thoughts down as it has proven very cathartic for me to do so. 

In short, I'm doing this not for your amusement or attention, but for myself and myself alone.

Among the great many issues floating around today, few have been as enduringly infamous as the so-called war on drugs here in the Philippines. It's actually a good idea if you think about it. The president of a nation declaring an all-out war on one of the most virulent ills of society, promising to use any means necessary to pull it off. Although I do not personally approve of the mounting death toll, I won't exactly call out against it either. Let me explain..

Drugs are a menace to society, period. Drug make people do a lot of crazy things, including heinous crimes like rape and murder. Personalities are destroyed due to addiction, and you are left with a hollow shell that would do absolutely anything and everything to get another fix. This is why you get reports of people killing their parents/grandparents because of the latter's refusal to provide money for drugs. Drug addicts are a scary lot. You have no idea what they are thinking. Previously personable individuals are converted into these monsters who would do violent stuff on a whim, or may easily be set off at the slightest provocation. They could do dangerous things on a simple "trip", causing much harm to themselves and others. I mean, I wouldn't really give a rat's ass if a crazed drug addict commits suicide, but when that act involves an innocent drug-free bystander getting hurt or killed, that's one of the most senseless ways to die in my opinion and thus should be prevented at all costs. The addict is usually beyond redemption, while the innocent bystander could very much be a productive member of society.

Addicts in their drug-fueled states could have no inhibitions or remorse whatsoever, and are thus an ever-present danger to those around them. Then when they wake up from their drug fix behind bars, they act all surprised and horrified at stabbing a baby or decapitating their ailing grandmother. The list of atrocities just goes on and on, and thus I agree that it most definitely is a war.

These substances in question, especially the synthetic ones, serve no true useful purpose to society. They are just created by unscrupulous individuals for the sole purpose of generating a quick buck without any regard for basic human decency of human life in general. I agree that all of this would be able to stop when the drugs are cut off at the source, otherwise the cycle would just continue.

The junkie would continue to commit crime in order to get his fix (think of those who rob peope in broad daylight then stab them as well), which in turn would support the supposed "livelihood" of the pusher/dealer (who turned to peddling drugs in the first place  because it was such an easier way to make money than to get an honest job with an unfortunately smaller paycheck). The money trail would then be traced back to the big shots who get all the dough from the manufacturing of said substances, and as always, they also prefer this mode of "livelihood" because it is an easier way to make lotsa money.

So I guess it all stems from the greed of those individuals at the top of the illegal drugs food chain. They are unwilling to let their empires go because it makes damn too much money which would support theit overly lavish lifestyles since they aren't accustomed to simple living. it's just greed, pure and simple.

Imagine a perfect scenario where all the illegal drug manufacturers (along with all their stockpiles) suddenly just turn clean, (or are carted off to hell where they belong, I dont really care). The supplies would dry up. Sure, some addicts who are far gone might not survive the subsequent withdrawal, but the rest of the population would hopefully pick up new decent lives and work together for the development of all. Remember that the drug problem permeates all levels of society, so in addition to the masses becoming more compliant (since drugs are no longer an issue), the people higher up would hopefully take up cleaner pursuits and actually serve the public for once now that they're no longer preoccupied with keeping their trail clean or doing shady dealings with the underworld.. 

There would be other great effects when humanity as a whole would decide to just drop greed and be more focused on helping everyone else. It's too much of a utopian vision, I know, since these syndicates are too far gone along their path of evil acts that it does not bother them anymore. Heck, I don't think it even bothered them in the first place anyway.. And that makes me sad.. I find it impossible to imagine anyone cooking up this plan to sell poison to people on such a massive scale with all the associated societal ills it would bring. People are capable of effecting massive change and doing great things in the world. The seemingly far-off dreams of a human race maximizing a sustainable environment and exploring what lies beyond the planet is supressed by humanity's inability to just chill out for a moment and see that being collectively selfish ins not good for anyone.

The trend in society today is to place a more intense focus on the individual. Now before I say anything else, I would like to state for a fact that I do not like the idea of communism. Its another extreme that would inevitably destroy people's lives and only works if people are not people.. :P

Everything today seems to be centered on making the individual happy, like feeding our individual egos through seeking hollow approval via  social media likes, or promoting this culture of ultra sensitivity or ultra-tolerance. I hate a bigot as much as the next guy, but it is also foul when someone goes the other extreme endlessly pushes this selfish agenda just because of a presumed notion of self-importance and entitlement. 

People sometimes laugh at nuggets of wisdom passed along by our elders, but I guess the saying "Too much of anything is no longer good" applies universally given the very basic nature of people. Taking something to the extreme on one end of a spectrum or another is never a good idea and just promotes hatred, friction, and intolerance.

I'm sorry to have been posting such negative stuff lately, but there is just so much I need to get off my chest..