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.