To The Trainees..

I had a chat sometime ago with a promising junior who was struggling with the rigors of residency training. As I was drawing from my own previous experiences in figuring out what I had to say, it dawned on me that it would be of much better use to a greater number of people if I were able to condense that into a universally relevant message.. 

With that being said, this post is dedicated to all the residents- and fellows-in-training, no matter what your specialty or subspec may be... (although I guess it would be more relevant to the junior residents, since the fellows already know what they are getting into, having finished their own residency programs earlier. hehe)

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To all those struggling in their training, I say to you, don't give up!

There will SURELY come a time (or multiple times even) in your training where you would contemplate just giving up, abandoning everything, and just going home.. It's not exclusive to being a junior, because I have felt that compulsion too as a fellow-in-training..

The reasons are varied: they would often be those things that are beyond your control like hostile seniors or a hospital/department system that doesn't work well for you, toxic patients (or relatives of said patients), a heavy patient load, rigid academic standards, difficult batchmates, the list just goes on and on...

Having said all this, there is one thing you have to understand.. These things that you are experiencing, they will not go on forever.. The bad seniors will eventually graduate, the toxic patient will eventually get discharged, the patient and academic loads will stop once you graduate, and your won't necessarily have to deal with your batchmates again after you finish training.

So, to leave just because of these things would be a major folly.. Yes, sure, leaving the program might result in an end to whatever hardship you are presently going through, but you will deprive yourself of the proper training as a specialist, which would have led to proper certification and a fruitful practice for the rest of your life..

Another discouraging feeling I recall which could drive a person to quit would be the feeling of inadequacy.. A conscientious trainee would feel that he or she is not good enough to train when he/she would commit a lot of errors and understandably be repeatedly chastised by seniors or consultants. These feelings of shame and guilt would build up inside you and make you question why the hell you started training in the first place..

Having been on both sides of the coin first as a hapless junior on the verge of quitting and then as a senior trainee evaluating prospective juniors, I just have to say this: The training committee of your respective departments generally accept trainees because they see the potential in you, otherwise you would not be accepted outright. The personal challenge for you is to grow into that potential and be what they see you can eventually become. This would entail a lot of personal growth, not just academically, but emotionally (and even spiritually as well) if you are to survive to the end of your training.

Going back to the basics, being told that you made a mistake really sucks. Different people have their own ways of processing this. Some would get angry and lash outward, especially those who are so full of themselves and think that they are so much better than they really are. Others would get depressed and punish themselves internally, since they would see themselves as failures and this just validates their own insecurities about their abilities. Both of these methods are not only throughly useless, but are very destructive as well.. If left unchecked, continuing on with any of these would result to either an expulsion from the program or the trainee dropping out due to the pressure.

Being wrong hurts, I get that. The mindset is very important here though.. Undergoing training would expose you to the uncomfortable truth that you are still inadequate. It would render visible to all the deficiencies and gaps in your clinical knowledge. How you would respond to that would be entirely up to you.. You could just throw your hands in the air, say "I give up" and just leave, or you could take note of these deficiencies and use this as an opportunity to grow by filling in the identified gaps through study and research (if the need arises).Getting better in training is not an option, it is the only way to go. This growth would entail some degree of sacrifice. It is a well known cliche that nothing easy is ever worth it, and medical training is no exception. The hardships you encounter here will mould you into a better and wiser version of yourself, as long as you let it. You may not be comfortable leaving some facets of your past behind, like being comfortable with mediocrity or procrastinating 'til the last minute, but if you have the will to improve and be a better version of yourself, these "sacrifices" would eventually matter little to you since the better version of you no longer has need for them.

An image about training I thought of recently was that of a plant in a garden.. Imagine an untamed bush (which would represent the new trainee). This bush would have grown wildly since the prospective trainee had just probably finished medical school and have so many different bits of acquired knowledge but with little wisdom when it comes to application. When the trainee anters the program, he/she enters the custody of a gardener (which would represent the training program, seniors, consultants) which would trim the plant as it grows, removing unecessary branches and allowing other parts to grow.

Training does that to you. It removes any preconcieved erroneous/flawed.incomplete notions about disease entities including the diagnostic and therapeutic approaches which may have been misunderstood in medical school. It allows other necessary parts to grow by letting the trainess fill the gaps in his or her knowledge. New branches would also grow, which would repepresent new skills that would have otherwise not been learned under the wing of a program (advanced medical and surgical procedures for example). It would also create a change in the way you perceive the world, and the way you work and deal with people. All of these are part of your growth, so you don't have to fight it. More often than not, these adaptaions would result in changing you for the better. Eventually, the plant in the garden would grow to be a beautiful well-manicured tree which would bear much fruit for years to come, and thus be of benefit to a great number of people.

So when you are thinking of quitting, take time to step back and take a look at the bigger picture. This brief moment in your life is insignificant compared to the beautiful and complicated tapestry that lies far ahead and stretches as far as the eye can see, and all that is needed of you is to stay on this path.. Get better and grow if you need to. Acknowledge your deficiencies and work to fill in the gaps. Growth is never instantaneous and would sometimes require a great deal of effort. Keep your eye on the prize and never lose sight of what you want to become. Eventually though, you would be able to look back after everything has been said and done and tell yourself "Damn, I went through all that??". ;)

Good luck guys! I will be praying for you! :)

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!