Change of Plan-ner

I used a Belle De Jour planner for 2011, a gift from my youngest sister last Christmas. In contrast to my previous planners (Starbucks), I used all pages from January to December. Aside from reminding myself of important activities like birthdays, anniversaries, I was able to keep track of must-do's, errands to follow, and other important details. The weekly design was very useful because I was able to write down thoughts, reflections on anything and everything that happened on one day. The downside was the discount coupons which I occasionally used. I confess I'm not very "kikay" and it will just encourage me to spend more rather than save. Also, it's bulky since it's hard-bound. So far, it's the only planner I was able to successfully use.

But for 2012, I wanted to look for other planners. Perhaps there's another planner that's useful as BDJ but less kikay. 

Last month, I bought a Paolo Coelho Daily Moments 2012 planner at Powerbooks in Greenbelt 4. It's supposed to be for my youngest sister as her christmas wish list. But she changed her mind. Instead, I gave it as my exchange gift during our department christmas party. I didn't like the design - it has no monthly calendar, has a few lines to jot down important events, thoughts during the week. 

I went back to Powerbooks to search for my next planner. I saw Navi. It was done by the same people behind BDJ but less kikay, lesser coupons, cheaper. Without hesitation, I bought it. Navi is short for navigator and as the name implies, it is a travel journal. Very, very appropriate for me - I like to travel & I want to travel. I also adore the uniqueness of the design - the right page of each book is blank. I have the freedom to write down anything & everything under the sun, I can paste pictures, and even draw. 

I can't wait to start writing down on it. :) 

Offer - Rejected!

While at work this afternoon, I made up my mind regarding the offer of employment at Tan Tock Seng Hospital in Singapore as one of their medical officers. With the help of a forums site, I learned a lot about the job description of medical officers (or clinical associates), and their condition/s outside of the hospital. Plus, the contract said I was going to work under the Department of Geriatric Medicine. I know for a fact that they have an aging population, and it was mentioned to me during the interview. I remember I told my interviewer that I just had 1 month rotation at Geriatric Medicine during my last year in senior residency but it was less intensive - mostly giving prescriptions to the patients left & right so that they can buy their medications at the pharmacy. Little did I know that it was going to be offered to me seriously.

It wasn't an easy decision but deep down, I felt that that job is not for me. On the other hand, it can be a good stepping stone for possible employment at New Zealand, Australia, or other Commonwealth country. I asked myself several questions -- what are my intentions there, knowing that I have less chances of being recognised a family physician there since I didn't earn my medical degree there. Am I after the practice itself? Am I going to receive potential recognition from the Singapore Medical Council in the future as a family physician? Or am I just there for the money? When my contract ends, what then? Is the monthly pay justifiable or sufficient enough to shoulder all of my expenses? Most importantly, am I going to be happy there? Well of course, we'll never know until it happens.

I know other physicians will gladly grab the opportunity if they were in my shoes. Sa kanila na lang. But for me, thanks but no thanks.

Prayer Answered

I just received the best christmas gift ever... Never mind that it arrived early.

I passed the Diplomate Exams! Woot!

My batchmate and I were going nuts since yesterday about the results. I was hesitant in calling the PAFP office to learn the result. I was so scared, anxious. While I was having my usual clinic hours in the morning at a big industry, little did I know that there was a text message going around about the results of the exams. My batchmate called me over my mobile phone, she was frantic and I could barely understand what she was telling me. I was also distracted because I had a patient/employee in front of me at the same time. Keeping my professionalism, I told her I'm quite busy and I hanged up. After 30 minutes, another female colleague (junior co-resident) called me & greeted me "Congratulations!" Coincidentally at that moment, I didn't had a patient so I talked with her for a while. She told me about the text message. I was puzzled because I haven't received any other text message that morning. She said that according to the text, my batchmate and I passed! I swear I wanted to shout for joy right then and there. But I still had doubts, maybe it was a hoax. After our conversation, my inbox was flooded with messages saying "Congrats!" It was around 10am that I received a forwarded text message stating that we indeed passed the exams. The original message was sent by 1 of the national directors of the Academy and a former specialty board member. My doubts were cast aside and I felt relieved. I told the good news to my family and my boyfriend. Everyone's happy for me.

Aside from my batchmate, I also greeted 1 of my co-workers (had residency at Veterans Memorial Medical Center) for passing the exams. I'm extremely happy to share the same joy with them, relief that we won't go through the same hardships all over again.

Can't wait to wear those togas during the Annual Convention next year. And I'm psyched to add 5 initials to my name - DPAFP.

I just wish my professional fee also goes up. Haha! :p

The Damage Has Been Done

Projection Exams
December 2, 2011
1600H
UST Faculty of Medicine & Surgery Medical Informatics Lab (Formerly known as LRU)

The first part of our 2-day Oral Diplomate Exams. The exam consisted of pictures (skin rashes, microscopic anatomy, ECG, x-rays, etc.) in timed powerpoint slides. In less than 2 hours, we were done. But before I could say "Thank goodness", we still had two more tests that involved purely Family Medicine physician's skills. After 30 minutes, I could finally give a sigh of relief - well, for that day. The projection exams were satisfactory.

On a side note, I was impressed with the new facilities of LRU. Flat, bigger screens, updated operating system, keyboards and mouse. So that's where part of the tuition fee is going.


OSCE
December 3, 2011
0800H
UST Faculty of Medicine & Surgery

"This is it!"

7 stations (5 manned, 2 unmanned), nerves, butterflies-in-my-stomach feeling, members of the Specialty Board going around, colleagues reading/holding books while you're not holding any. While you're in the holding area, you hear the bell countless times. And then, you hear your colleagues review many things like leopold's maneuvers, classification of body mass index, etc. Oh boy! I hated the agony of waiting.

When it was my turn, holy cow! My nerves got the best of me. I did very, very poorly. When I was finished, I cried my heart out. I wanted to think positive, be optimistic but in the back of my mind, I was already anticipating that I'm going through this again next year. I tried to smile but deep inside I was sad. I thought "Let it be done, according to Your will."

Results are going to be released 1 week after. I'm going to pray my hardest.

Preparing for the Oral Diplomate Exams

2 days to go before our Oral Diplomate Exams.

In contrast to preparing for the written exams, I'm at a loss on how to review for our Orals. Perhaps browsing through our Proceedings could be valuable but what will I read next? Bates? De Gowin? Dra. Maglonzo's book? Heck, I really don't know.

I feel like going to a war, unarmed.

So help me God.

Hello SG?

2 days after that interview for a hospital in Singapore, I opened my e-mail and received an unexpected reply. I was successful at the interviews, the official letter of offer will be available within two weeks. Alright then.

But I didn't tell this good news to my parents. Only to my other younger sister and my boyfriend. At the back of my mind, something might flop along the way. I decided to tell them if the letter of offer actually arrived at my doorstep & if I really want to be a medical officer in Singapore. That will mean being away from my family, boyfriend for quite some time. For how long am I going to be away? I have no idea at this time. Everything's stated in the letter of offer. If it comes or not, well at least I tried.

Application for TTSH, Singapore

During the looong holiday break last week, I got an e-mail from a former co-resident/colleague regarding a job opening in a hospital in Singapore as a medical officer. Without doing any research on what a medical officer does in Singapore, I gave my resume to the HR head of the hospital by e-mail and kept my fingers crossed.

After 2 days, I received a reply from the HR head inviting me for an interview in a 5-star hotel in Metro Manila on a sunday afternoon. Coincidentally, it was the same day as the fun run my sister & I will be joining. The email also mentioned the requirements that I should bring during the interview. The requirements were a challenge for me - since Singapore follows the British system, I hardly understood the papers/documents they would be looking into. I asked a colleague who's working in another hospital in Singapore, but she also has no idea about the requirements. I thought "Bahala na."

We met at the lobby of the hotel, proceeded into a cafe and were given sheets of paper. It was a written exam! It composed of less than 10 cases and asked regarding diagnoses, management, etc. We were informed that failure to pass the written exam means oral interview will not be conducted. I had to dig deep into my brain & remember everything that I've encountered/read/seen/observed during residency. I'm not an internist but while answering, I acted that I was.

Thankfully, I passed the written exam. I was accompanied into another room, met a top official of the hospital (who is also a physician). After less than 5 minutes of "tell me about yourself", I was shown ECG tracings & x-ray films from his laptop. WTF? I swear I was blabbing crazily. I felt like I was going through the Oral Exams already.

Finally, he asked me if I had enough experience/exposure with Geriatric Medicine. I told him that I don't have enough exposure since we only have 1 month rotation in Geriatric, and most patients I dealt with consulted for refill of their maintenance medications. Yet, I'm always willing to learn.

As usual, his parting words were "Thank you for your time. We will inform you via e-mail regarding the interview." The sentences entered my left ear, and left my right ear.

SGV Fun Run

My youngest sister invited me to join a fun run organised by her employer, SGV. For this year, this is the 2nd "fun run" we joined together. The run happened in the grounds of SM MOA but it was a rainy start. I thought the run was going to be suspended but the organisers decided to push through. Thankfully, the rains stopped before the race started.

The roads were damp, the air was cold, and it was cloudy. Thank goodness, or else I'd be looking hard for a sunscreen. With new, comfy running shoes (ahem!), it was a good day for running. Not to mention, it was a long weekend. So I didn't mind the muscle sores that will happen after.

My sister ran ahead of me, but I didn't care. I alternated my jogging with walking and occasional brisk walking. Nevertheless, I crossed the finish line and she was waiting for me. I asked her if our gap was long. She said it was less than 5 minutes. After a few drinks, we headed back to our car and went home.

I'm not a fitness buff but I'm glad to run again. I just wish I had the luxury of time to run more often.

Preparing for the Written Diplomate Exams

For the past several months, one of my batchmates and I have frequently discussed if we're going to take the Diplomate exams of the Philippine Academy of Family Physicians this year, or postpone it for next year. We've debated countless times the pros and cons of taking it this year. We usually end our discussions uncertain, anxious, no definite answer.

Last month, I received a letter from the Academy telling me that I am eligible to take the examinations. I was torn - take it this year or next year. I know my preparation is not going to be enough, and I will be relying on my stocked knowledge (if there was, or was it "stucked"). A deadline was set and my batchmate seemed eager to do it. I had no choice, I went with the flow. I was like a robot when I went to the office of the academy somewhere near Buendia, Makati City, to pay for the fees (written & oral). I told myself "Bahala na si Lord if I'm making the right decision."

Before I knew it, it was the end of September and I haven't opened any single reference book in Family Medicine. I didn't know where to start! I had two weeks to study/review but I was not determined, had no drive. My almost-daily trips to Starbucks Coffee to review (similar to what I did when I reviewed for the local licensure exams) became my sort-of security blanket. Most of the times I was drained. I watched movies, window shopped, strolled around the malls, even got my hair rebonded, and slept more hours than my usual. 

Then the dreaded day came - the day of our written exams. I surrendered everything to the Lord. With the few stuff I reviewed, I hoped & prayed that I could remember them all.  

RIP, Grandma Regina P. Lopez

July 27, 2011
Around 1pm

While having lunch with my youngest sister somewhere in Pasig, I got a call from my younger sister informing me of an unusual situation back at home. She was called firsthand via mobile phone by our helpers that our grandmother was found unresponsive in her bed. I told her to bring her to the nearest hospital immediately and we will follow them. At that time, my parents were also somewhere else but they were also informed about the situation. 1 hour later, I arrived at the hospital. Our grandma was being attended to by the emergency physicians on-duty. Being a physician myself, I told them about her past medical history - diabetic for more than 15 years, controlled, not on any insulin therapy nor oral hypoglycemic agents, had stroke around 2003 with left-sided residual weakness, had upper gastro-intestinal bleeding due to aspirin intake, transfused with 2 (I think) bags of packed red blood cells, admitted at another private hospital last year due to complicated urinary tract infection. The ER physician also told me his working impressions - another episode of stroke, possibility of heart attack (NSTEMI/non-ST Elevation Myocardial Infarction), Pneumonia in the elderly. I saw my grandma intubated, but with stable vital signs, yet still unresponsive and a high capillary blood glucose level. I was also told that she must be admitted at the intensive care unit/ICU but I didn't give my consent. Instead, I told them I had to wait for my mom & will ask her. I doubt she'll agree with it. Moments later, my parents arrived and they went to the Admitting section to get a room. Not surprised, my mom didn't consent for my grandma to stay at the ICU. She opted to hire a private bedside nurse instead. 3 hours later after arriving, we finally settled in 1 of the private rooms in the hospital. And we hoped, prayed for her recovery.


July 28, 2011 to August 3, 2011

I always visited her at the hospital on my way home from work. There were moments that she was "going down" and I had a feeling that we will not be able to bring her back home alive. My mom decided to bring her home to her original home town, even if it meant travelling by ambulance for many hours. My mom's relatives arranged for my grandma's transportation and transfer of hospital. On her last night at the hospital in Manila, I realised that probably it was the last time I'll see her alive. She was transferred after midnight. She was accompanied by my parents and another relative on the maternal side.


August 4, 2011
AM

When I woke up for work, my dad left me messages on my mobile phone, giving me updates about their travel and grandma's condition. It seemed that she was "stable" during the entire travel. They finally arrived at another hospital by 9am. They were attended to, immediately brought inside a room. I thought everything was going to be okay.

12noon

I got a text message again from dad. The content was what I dreaded for - grandma joined our Creator. I was stunned, distracted from work. I informed our friends, other relatives about it. Details regarding the wake and interment followed suit.

She was 86 years old.


I went home (with my youngest sister) to Ilocos night before her interment. When we arrived early morning, everyone was in frenzy and we were extremely busy. No time to catch up for some sleep. Mass was at 8am, followed by the procession to the cemetery, the burial rites, and finally lunch at her place. We headed to the beach for awhile at high noon for a ceremonial "cleansing" and letting go. Of course, we had to put lots of sunscreens on ourselves. Then back again at the house for bathing.

(My younger sister stayed behind in Manila because she was reviewing for the Physicians' Licensure Examinations. Thankfully, the results turned out to be great.)

The activities didn't stop there. Since we had guests from Manila, we toured them in Vigan, ate empanadas, bought lots of souvenirs. By night, I was so tired. Since I was also headed back home, I decided to sleep in the bus. I was in Ilocos for less than 24hours.

Tomorrow is her supposed to be 87th birthday. We will still celebrate it, like she's still alive.

We will celebrate her "40 days death anniversary" on 13 September 2011. I'm not sure if I was going to Ilocos because of work. But I'll try to file for a 2-day leave.

Jitters

For the past few months, I've constantly re-vamped my work - I've been going on/off in different clinics, various schedules almost everyone is confused regarding my work schedule. They've always asked me "My bago ka na namang clinic?" I know they're confused. Me too.

Like before, I'm going through another series of changes starting next week. Today (as of this writing) is my last day here at Tokyo Healthlink in Makati. After less than 4 months of being their part-time Family Physician (from a reliever promoted to a regular physician just in the middle of June), I resigned one week ago due to personal, professional, and financial reasons.

My mother company, Health Delivery Systems Inc. recently has tied up with Philippine Long Distance Telephone Co. (PLDT) to be the third party outsource to man their different clinics in select branches. HDSI has recruited lots of specialist physicians, nurses to be assigned in different branches. I was offered this job & accepted the offer. In exchange, I had to leave Tokyo Healthlink.

Yesterday, we had our orientation regarding their electronic record system. Their system is very different, more complex in comparison to what we have in Health First. During the entire orientation, one thing was in my mind "Nosebleed ito!". There were more tabs to click, but with few available characters, more complicated steps. I got more & more confused because they have a system uniquely their own. Immediately I became worried, nervous about my performance on the first few weeks. Adapting to their system will take some time (but not too long, hopefully). Being the first doctor to "start the ball rolling" every tuesdays, punctuality is the top priority. I have to brace myself for a more toxic workload than in Health First.

After the orientation, I had many reasons to go back to HDSI Office. I signed my contract with PLDT, tried which size of long coat fits me for use at PLDT and anywhere else that is a client of HDSI (like in my case, at DMPI and Health First clinic itself), posed for a 1x1 picture & specimen signatures for our IDs at PLDT, filled an application form for an HDSI privilege card. I thought "Finally! They're starting to treat me like one of them" since I'm starting to get privileges.

However, this journey was not smooth-sailing. I went into argument with one of their HR personnel several times before; I almost thought of refusing this job completely. Since this is the beginning, taking an absence, looking for relievers is not being considered for now. I made some sacrifices, I postponed some personal matters. It was hard for me to accept at first & after crying through it, I thought that this job is the priority & it will be for my best.

But really, as early as now, I'm having jitters when I think of tuesday next week. Waah! Goodluck to me (& to all of us as well).

Advanced Cardiac Life Support (ACLS) Training

After successfully passing the BLS training, I can now proceed with the Advanced Cardiac Life Support (ACLS) training. During those 1 1/2 days, we were handled by 3 different ER physicians, and 1 anesthesiologist. Comparing to BLS, this is more difficult, more nerve-wracking, more stressful - more different algorithms to learn, more ECG tracings to identify, more drugs to give.

Prior to class, we were instructed to visit the website of AHA to read their supplementary discussions regarding ECG interpretation and pharmacology. They will not be discussed in class. Furthermore, we were also instructed to answer a pre-course evaluation, print the results, and submit it to class.

The class was already divided into two groups, alphabetically.

Day 1, July 7, 2011

2 to5:30 pm 

More videos were shown and we still had practice sessions regarding Rescue Breathing, BLS Surveys. No surprise, there were practical exams regarding them, but they were all a "piece of cake" (since we just had our BLS hours ago). Unfortunately since we started late, we also finished later than planned. Plus, we weren't able to discuss Acute Coronary Syndromes (ACS) as scheduled because we ran out of time. Prior to dismissal, we were all instructed to read our books, study the checklists (found at the appendix section) in preparation for the Megacode the following day.

I did try to read but I was distracted by something else, and it's not related to ACLS.

Day 2, July 8, 2011

8am to 7pm

I arrived at the place 30 minutes earlier. Everyone was talking about the Megacode, saying that they're unprepared because they just slept the entire night, they can't wait for the day to finish, blah blah blah. When we entered our classroom at quarter to 8, we saw that the mannequins, cardiac monitor, other equipment were ready. Gulp! It was going to be a loooonnggg day.

We met 2 different physicians - another ER physician and an anesthesiologist. One of them began to worry about our schedule since we failed to discuss ACS the previous day. Like a domino effect, the succeeding topics were adjusted as well. All of us bore the consequences - the discussions regarding the algorithms were fast, next thing we knew we were being tested individually as team leaders (but it wasn't graded). We were being criticised, corrected, reminded constantly.

My preparation for the course paid off - since most of our decisions, orders are based on correct ECG interpretations, I was able to go through the practice session well (when I was the team leader twice - cardiac arrest algorithm & arrhythmia algorithm). My groupmates had a hard time reading the ECG tracings that they kept on looking at me for answers or clues on what the tracing is. Ironically, some of them were physicians.

Thankfully, we had time "to put it all together" as a review before we went into the dreaded Megacode. We were given time for CR break, last few minutes to read our manuals. Then, it started.

My case was ok, but I had some flaws - my case was again Stable Tachycardia. I should've been lucky to get the same case twice but I screwed up. My instinct told me to do vagal maneuvers [when the QRS complex of the tracing went from regular-wide (I already gave adenosine 6mg) to regular-narrow] but I listened to my groupmate's whisper, telling me to give adenosine 12mg & I ended up doing that. Wrong! One cardinal rule - always follow your instinct. The other one was a SVT that was pulseless. I told the facilitator it was Pulseless VT and following the algorithm, I ordered for a shock. I was wrong again! It was PEA. I learned about my mistakes afterwards. I was able to see my paper and the remarks were high. Well, not bad but I'm not happy either because I felt I had an easier case, compared to the others. I had no excuse for messing up.

After the megacode, we weren't done yet. We still had the written exam to take. The rule was to obtain a score of at least 42 (or 84%) out of 50. Otherwise, you'll have to undergo remediation with 1 of the facilitators. I was the first to finish and I got exactly 42. Whew! It was more difficult than the BLS exam, because it asked questions all the way from the previous day's topics & it involved cases. Among 12, only 3 students (myself included) didn't had to go through remediation. We graduated from the course ahead of the others, claimed our IDs and certificates, and left the place; while the others have to wait more, go through remediation before they can get their IDs and certificates (if the facilitator is satisfied). I observed that if most of my classmates were prepared for this, we would've gone home earlier.

Once again, we were told to answer a course evaluation for the ACLS. Just like yesterday, I gave the course high remarks.

With regards to the current AHA guidelines, they are more simpler, easier to understand. There are major, major changes and it will take awhile for those changes to sink in & be actually applied. I just hope that everyone, physicians and non-physicians alike, will be able to apply it & be able to save lives.      

Basic Life Support (BLS) training

I underwent a basic life support (BLS) training last thursday at Global CE of America in Sta. Ana, Manila. This is my 3rd BLS training course, but my 1st training that is AHA (American Heart Association)-accredited. It's more expensive than my previous trainings but it's worth every penny.

Actually, I enrolled into 2 courses - BLS, and Advanced Cardiac Life Support (ACLS). Of course, you need to pass the BLS before progressing to the ACLS. During my enrollment, I paid half of the course fees and received the books for advanced reading. I started to prepare a week earlier, and read the BLS manual in just 1 day. Preparing for the ACLS was longer because I also had to review certain ECG tracings and pharmacologic drugs. We were instructed to arrive at class on-time since there are so many topics to discuss in such a limited time. Still, some students arrived late. Oh well... Old habits die hard.


Day 1, July 7, 2011
8am to 1pm


Our BLS instructor, a dermatologist by profession, started on time. After a brief "getting to know you" & laying down of the house rules, we proceeded to watching the videos followed by practice sessions with the mannequins. No lectures were done. The videos simply reiterated what was written on our textbooks, and it also serves as a review. Since AHA regards as all as professionals, they treat us as adult learners. No spoon-feeding. Personally, it's better that way because you're after the skill, the correct manner of doing it. Each part of the BLS algorithm was discussed & shown clearly - starting from 1-rescuer, we started with chest compressions then mouth-to-mask breathing, then 2-rescuer now with the incorporation of an automated external defibrillator (AED) & the correct way of switching roles. It was followed by the child BLS (which was faster) and finally the infant BLS. Like in the adult BLS, the steps are almost the same except for the manner of doing chest compressions, and the ratio of compression-ventilation when there are 2 rescuers. The video also showed how to relieve patients from choking - both in the adult and infant.

Of course, we are evaluated by 2 ways - a practical exam and a written exam. If you've read the book & watched the videos closely, the written exam will just be a "piece of cake". The practical exam is easy too. If you watched the videos closely and took the practice sessions seriously, then it will not be a big problem. You can be criticised by your instructors but they will be just few or minor pointers for further improvement.

In return, we also evaluated the course, the instructors, the place. I had no complains and I gave them high remarks in all aspects. I didn't put on any comments, and I couldn't think of other suggestions for improvement. I was completely satisfied & happy for what I came for.

In the end, I got my ID and certificate. Their valid for 2 years.

I was asked by the Operations Manager if I want to be a BLS instructor with them. I said sure (since being a BLS instructor is a "plus" factor not only for my resume but for practice as well. Oh yeah, source of additional income. Haha!). This seems promising for me. :)  

Busted Tail Lights

My green Honda car (1997 model) has gone through many repairs and replacements in the past years. Just like people who age, gradually its parts have succumbed to wear and tear. Well, I don't know which is more cost-efficient - summing up the expenses of the repairs or buying a new car instead. Hey, where's the promise of giving me a new car when I pass my medical boards?

I've recently noticed that the tail lights were still left open after I've turned off the engine. It's noticeable during the night, but not in the day. Before leaving the car, I've always checked if the tail lights are still open. I don't want the battery to be drained empty. Besides, it was just replaced 1 month ago.

My fear came true when around lunch time, after my clinic work in Pasig, the engine didn't fire. Every time I turn on the ignition, all I heard was "click!". Thankfully, I was parked in a secure place thus I felt confident leaving the car, to look for a mechanic and/or nearest motor shop. I was directed by a tricycle driver to a motorshop along Pioneer St. The mechanic went to my car, brought a spare battery, and some cables to do a "series". We got to the parking lot thru his motorcycle (yeah, I rode at the back of his motorcycle - my first time). The mechanic connected my battery with another one, and after one click, the engine roared to life. Then, I drove the car back to the shop and have it checked. Turns out the battery current is still adequate (not emptied as I initially thought). I mentioned to him regarding the tail lights and he hypothesized that the electricity could be grounded. No other repair was done. On my way to my other clinic in Paranaque & when I went home, I didn't encounter any problems.

I already told this to my dad. He'll have it fixed next week.

I thought "Bumili na kasi ng bago. Palitan na iyan".

Blame It On Miscommunication

String of bad lucks happened to me recently. One thing lead to another. In the end, I had no work today. Blame it all on miscommunication.

Yesterday, 20 June, monday was a public holiday. On a regular day, I was supposed to be at Del Monte Philippines Inc. as their company physician (by third-party outsourcing). But last monday, June 13, the HR manager and I have agreed that I will hold my clinic with them on a wednesday. It's like having a make-up duty. I informed my company (Health Delivery Systems Inc. or HDSI for short) immediately of my plans. The response of HR to me was "Ok po." I thought everything was settled. I wasn't aware that the HR manager from both companies discussed amongst themselves to hold a clinic on a tuesday and will look for my "reliever" instead. I felt that they "by-passed" me.

At home, our two helpers resigned. With my grandmother handicapped and a parish fiesta looming, everyone was uber busy. Last thursday, my parents talked to me about filing for an "undertime" at work today supposedly. There are many parish fiesta activities that they had to go to, no one will look after our grandma from 6pm onwards. I said I'll try.

Last saturday afternoon, I asked permission from the clinic manager of Tokyo HealthLink Makati (where I work T-Th, 8am to 8pm) if I could go on "undertime" just for today. She said it was against company rules to go home earlier, since we're being paid on an hourly basis. Instead, they'll find a reliever for me. Since family comes first for me, I decided not to hold clinic, have another colleague take my place instead.

Afterwards, my mom called to tell me that there's no need anymore for me to go on undertime at work today. They've asked one of our relatives to go to Manila and look after grandma & be one of our helpers temporarily while looking for replacements.

Since I was available, I called up the HR manager of HDSI to tell her that I'll have my clinic 1 day earlier than planned. Then, she dropped the bomb on me. I was surprised! I became mad because they've made their decision without informing me, or consulting me first since I'm the company doctor; and if I haven't called her, I would've also gone to DMPI as I've planned, thus making it two doctors visiting the company in one week alone. The reliever has already committed to it, and there's nothing I can do about it.

I went back to Tokyo Health Link. Unfortunately, they've already called up a colleague and she has already agreed in relieving my post today.  

I tried to look for other work as reliever. Too bad, there was none.

Ako ang nawalan.

Net Book Or Smart Phone?

Just a few weeks ago, I've posted something about my laptop being fixed and how I almost bought a new laptop. Even if it's fixed now, my perennial problem is still there - it takes approximately 30 minutes to start up the system, and running some programs take time. Like for example when I open Adobe Lightroom, other programs hang, it will take 10 minutes before the window of Adobe Lightroom pops up and I can resume my activities. It's "turtle-like" actions has been my complain for several years, and people have been telling me to buy a new one. It crashed for three times already and I'm getting dissatisfied more and more. I thought maybe because of the operating system (Windows Vista Home). But if I'm going to buy another license to change into Windows 7, heck! I'll just buy a new one instead. Perhaps a net book.

On the other hand, I just got a new mobile phone unit (white Nokia X3-02 Touch & Type) at the start of the year because of plan rebate and upgrade of postpaid plan. For basic necessities like SMS, calls, FM/AM radio and camera functions, it's ok. The downside is when you surf the internet. The screen is very small and I'm confused with its buttons/controls even if I've read the user manual many times. The OS of the phone is Symbian, not Android. Probably perhaps it's not quiped for frequent 'net users like me. For months, I've been studying/looking into Android phones. Not primarily because it's the trend but the necessity of installing applications into mobile phones for quick reference, specifically medical ones. I have an iTouch but having too much gadgets is confusing & heavy on my pockets. I barely use it nowadays, strange as it may sound. 

Both gadgets (the model units I'm targetting at least) are priced almost Php25K. I want 'em both but I have to choose only one and prioritise which I need more - the new netbook or an Android phone? I'm starting to weigh the pros and cons of each one.

Beauty Blog 1: Daily Facial Routine

During residency, I cared less about my looks. Because of pressure, workload, doing basic tasks like washing your face, toothbrushing and even taking a bath were a luxury instead of necessity. Especially if you're a first year resident, in which you're always "first on call". As one of my colleagues said before "Sayang ang damit."

By graduation, I've begun to be more conscious of myself. Actually, I should thank my sisters and my boyfriend for this motivation. Aside from the daily facial wash, I gradually added stuff to my daily facial routine - first was a toner then I bought night cream, eye cream, a serum & the latest addition is a day cream. Yeah I used to place a moisturizer before but I was not religiously using it. But due to the growing number, my dilemma was rising. Back when things were simpler/fewer, it was cleanser-toner-moisturizer. Period! With the creams and serum at hand, now where do they come in? Is the arrangement of my application right? Is there something redundant?

My regimen became this: cleanser-toner-moisturizer-serum-eye cream-day/night cream. In denial that I was unsure of what I was doing, I did that for 2 months (I think). It was only last night I got the courage to ask a friend if what I have been doing was right. Well, almost. And my instincts were right - some areas in my regimen were redundant. Call it overkill. Haha!

In summary, here's her advice. As a bonus, she also gave me tips for the morning regimen.
AM: facial cleanser-toner-eye cream-moisturizer-sunblock
PM: facial cleanser-toner-serum-eye cream-night cream (no need for the moisturizer)

In order to make the most of what I have (para hindi sayang), I can alternate the moisturizers and the day/night creams. For example, day/night creams today, no moisturizer. Then tomorrow, moisturizer in the morning and evening, omit the day/night creams. And so on. At least, I still get to use all of them.

------------------------------------
Here are the brands I patronize:
Celeteque Facial Wash
Celeteque Oil-Control Toner
Pure Beauty Eye Cream (once consumed, I will be shifting to Pond's Age Miracle Dual Eye Therapy)
Celeteque Moisturizer
Cetaphil UVA/UVB Sunblock
Pond's Age Miracle Concentrated Resurfacing Serum
Pond's Age Miracle Day Cream
Pond's Age Miracle Overnight Repair Cream

Clinic Blog 1: GERD

Almost 2 years ago, we organized a post-graduate course about Respiratory Diseases. It was well attended, and a successful one following its predecessor course which was an utmost or near failure. The last topic of the said conference was about Chronic Cough. What set it apart from the other topics that day was that it was the only interactive session and we asked help from UMED. The take home message was simply for cases of chronic cough, think of three differentials - pulmonary (PTB), allergy, or gastrointestinal (GERD). Thankfully, everyone enjoyed the fruitful and productive discussions.

Yesterday, I was able to apply what I've learned from that session. I had a female patient, with 3 months history of dry cough. She already took different classes of cough medications (mucolytics, cough suppressants, etc.) in the past, but nothing seemed to work. She also underwent chest x-ray with normal result, and sputum AFB for 3 days which all yielded negative results. Last week, she sought consult and was also prescribed with a broad-spectrum antibiotic (claimed to be compliant) because of upper respiratory tract infection. There was slight relief of symptoms but the cough was still there.

I extracted that when she was still working with her previous employer, she had several episodes of skipping meals and/or not eating on-time; she drinks coffee (1 cup a day), softdrinks, and loves spicy foods. She also experiences burning abdominal pain at the epigastric area radiating to substernal chest, bloatedness, and early satiety. She doesn't smoke, doesn't drink alcohol, and doesn't take any NSAIDs. There were no BM changes, dysuria, nausea/vomiting, weight changes. I was zero-ing on GERD. My physical examination further proved my point - (+) epigastric tenderness, tympanitic abdomen.  I explained my clinical impression to the patient (& her companion). I prescribed her medications now targetting against the acid reflux which could be the source of her cough & explained my management approach (lifestyle, eating habits, etc.).

All now I could do is hope and pray for her.

Almost

Yesterday afternoon, my laptop's networking feature was corrupted - internet access was impossible, the bluetooth cannot be detected. It was like my laptop became useless. I became distracted because I needed the internet badly (nowadays, who doesn't?).

I had no choice but to go to a service center and have my laptop fixed. At the back of my mind, I anticipated that it may have to be reformatted. The last time I reformatted my laptop was way back October 2009 when the fan broke down. I brought it at Sony Service Center near my previous training hospital. I didn't pay anything because it was still covered by its 1 year warranty. Thank goodness for my already stored file at the Seagate external drive, creating back-up files were very short. I admit I never copied some files (i.e. Adobe Lightroom, new mp3 files) thus I have to painstakingly download them again. My anti-virus program (Kaspersky 2011) will also be erased. I still have the cd but I don't know if I can still install it (since it can only be installed in 1 computer). Sayang.. Hay..

The technician told me he'll try to solve the problem by reformatting the entire system, the problem could be the software. Otherwise, the problem lies with the hardware and changing the hardware is expensive. I had to wait patiently for 3 hours while it is being fixed (hopefully). I started to windowshop for a new laptop since I thought the possibility of buying a new one is inevitable (ouch!). I had a target - Toshiba Notebook NB--- worth almost Php25K. I was keeping my fingers crossed that the problem is just with the software. Sana.. Sana..

When I got back at the center, I was happy to learn that it was just a software problem. He was also generous to (secretly) install a new anti-virus for my laptop. To test if the network connection is restored, he installed Yahoo Messenger and Google chrome. The system runs faster compared than before. My laptop seems very new. At least, I only paid for the service fee, a smaller amount compared to a new notebook. It was a close call in spending something that I don't need at this time. Almost..

Travel Blog 2: Pagsanjan falls, Laguna

Last week when I fetched my sister from her last hospital duty as an intern, her first words to me were "Ate, labas tayo!" I thought it was a simple gimmick or malling, but she meant it as an "out of town" trip somewhere we'd never been to before. And she wanted it within that week or the following week. I immediately thought that the timing of the trip could be a hindrance because it was short notice and plane tickets could be expensive then.

2 days after, a trip was set for Puerto Princesa, Palawan. Yehey! Underground river here I come. But it was also cancelled because my sister chose to prioritise her clearance from the hospital where she had her internship. I had mixed reactions about it. Instead, my parents planned to go to Pagsanjan Falls & Kamay ni Hesus as Mother's Day celebration. Never mind it was also the fight of Manny Pacquiao but it was the opportunity and the only time we could all go out.

It was cloudy when we left home at past 6am. While cruising along South Luzon Expressway, that was when it started to rain. We first arrived at Kamay Ni Hesus at Lucban, Quezon at past 9am. It was raining and windy. The uphill garden was closed to the public because the steps were so slippery. I just took shots of the statues from our spot below outside of the church. Parts of the Garden of Eden were open but it was small compared to what could be seen in the garden. We also didn't get to see the interior of Noah's Ark because a retreat was being conducted. Because of the unfriendly weather, we all decided to skip and re-schedule the Pagsanjan Falls trip at a later date. In exchange, we all craved for a hot delicious bulalo as lunch. By 11:30, we were on the road back north and listened to a live broadcast of the Pacquiao-Mosley bout.

Pagsanjan Falls

We had lunch at Pagsanjan, Laguna by past 12. Surprisingly, it stopped raining, the sky became clear and the sun seemed to shine. The river became busy with swarms of korean tourists riding small boats heading upstream towards the falls. Since we were already there, we decided to go for it. After inquiring around, we settled to get two boats (max of 3 persons per boat + 2 boatmen each) to take us to the falls. The trip upstream was longer because we were riding against the current and the boatmen had to literally push the boat against the rocks. We passed by 3 smaller falls before we saw the main attraction. We left all of our things (bags, watches, glasses, cameras & even my slippers) at the rocks with 1 of the boatmen as the "watcher" before we rode a bamboo raft & went underneath the falls. The bamboo raft was strongly & tightly secured to big ropes & was navigated by a very muscled native. I had the coldest, hardest, & most unique shower of my life & definitely got drenched from head to toe! After 5 minutes, we were heading back to the rocks. It was so "bitin". I really wished to go back for round two. Haha! Unfortunately, the muscled man said one round lang. Awww.. After staying at the rocks for another 5 minutes, we decided to go back. It was faster going downstream, less effort for our boatmen because we were going with the flow. It also poured hard on our way back. I was careful with my DSLR because I don't want it to get wet. We got back at the river banks past 4 pm and hurriedly changed out of our wet clothes. We were all happy and we enjoyed the trip. It was worth it!        

E-Records

Yesterday, I had the privilege to be a reliever in Health First Clinic in Shaw Blvd, Pasig for the first time. Just like in any typical clinic, there were consultations and pre-employment medical examinations to be conducted. I was surprised to learn that they strictly use electronic medical records (or E-Records for short) from queueing of patients to charting/documentation to laboratory/ancillary procedure requests to dispensing medications and billing of consultation charges. Thank goodness, I don't have to call out the patient's name because all I had to do was call the operator and page for the patient. Since the clinic has its own pharmacy, I had to enter electronically the medicines I will prescribe then the pharmacists will hand it to the patient. Unless the medication is not available, that's when I do it manually and the old-fashioned way. The same goes for laboratory requests - just type it in the computer, instruct the patient to go to the laboratory. Of course, laboratory results can be viewed in their intranet as well. Not surprising, the x-ray plates can also be visualised in the computer without going out of the room. Previous consultations are also stored in the database as well. Convenient isn't it?

How I wish all clinics have this kind of system in order to avoid clutter, piles of papers/charts in one side of the room, occupying a big space. Imagine the trouble of pulling out 1 chart when you have so many stacked up, piled up.

On the downside, hopefully they have a generator if in case there's power failure. And a back-up system if the system hangs or the computer has been infiltrated by a virus. For our mentors who are not used to paper-less system, this could pose as a challenge for them.

Scorchingly Hot!

I am not the only one complaining about the recent extreme humidity in the metropolis. I thirst every now and then, the highest thermostat of my aircon is not enough, and I add ice in my bath water (because even the water is humid), I'm always craving for ice cream &/or Razon's Halo Halo. (Well, I'm not complaining about that. Haha!) And when I have to go out, applying sun block has become a necessity, leaving the house without an umbrella, a pair of shades and a fan is a big "no no". If given the choice, I wouldn't dare go outside especially between 9am to 3pm, when the humidity is at the extreme (but what the heck! Even at 6am, it's so scorching hot!).

Isn't it PAG-ASA mentioned weeks ago that summer will be brief, and it's going to be a rainy summer because of the La Nina phenomenon? Well, we're eagerly waiting for that rainfall that they've predicted. I pray that it will arrive sooner.    

8 Days.. Going Strong..

So far, my own version of Project 365 is going strong. For the past 8 days, I've posted different pictures of bits and pieces of my daily adventures, life experiences. There were days I was really tempted to post not just 1 picture but I sticked to the rule of the Project. Admittedly, there were days that I ran out of ideas, subjects to shoot. Yet I still found subjects even in the comfort of my own room. I know I may be having shots of my previous subjects. I'm after the skill of practicing my skill in photography, my love of the hobby.

348 more shots to go. :)

My Project 365 - Transfer of Site

For those who are interested to look at my pictures (kung mayroon man.. Hahaha!), I've continued my Project 365 in another blogsite. The link is located at the right side of my blog called My Project 365. Since it's hard to keep track of daily photos, I've decided to make another one just dedicated to my photos. Hopefully, I can put up with my site/s. 

Photo 3: (Medical) Books

Being a medical student years ago, buying books became a necessity for me and secondarily, a security blanket for me. Since we underwent a non-traditional, innovative curriculum, books became our best friends in a span of three years. Never mind that I only opened those books very seldom, these things helped me to be who I am today. It's sad that these books will never be put to use anymore. Since Medicine is a very dynamic profession, so do these books. Latest editions are being published I can barely keep up what's new.

Photo 2: Grass

Just a few hours ago, me and my family went to a purchased lot somewhere in Tagaytay. Since it's not yet very developed, most of our surroundings were grasses, grasses and more grasses. I know some may see these as "nuisance" but I still want to see pieces of Mother Nature, even if they don't last very long.

This was taken with my Canon 1000D camera, and 50mm lens.

Next Assignment: Project 365 - A Photo A Day & Photo 1

This time, I'm gonna deviate from my usual posts regarding my work (& my habitual monthly change in employment). Recently, I noticed I hardly touch my Canon 1000D DSLR camera. Even on important occasions like my youngest sister's recent graduation from UP Diliman, I left my camera at home because I was so lazy to bring it and I just relied on other people's camera. Then when we were at the place, I got envious. Iyan kasi! Also, my boyfriend has noticed that I've not been posting my (latest) shots recently over the internet whether it's in Facebook or Twitter. Basically, there's nothing new to post. But because of recent events, I've decided to do it again - even if I had to review the basics all over again. That's what I get for not practicing one of my favorite hobbies. I promised myself I should take at least 1 shot daily. Keeping my fingers crossed, hopefully I'll be able to accomplish this task.

Photo 1: The Bouquet of Flowers

Since I've mentioned my youngest sister's graduation last sunday from the state university with her Masterals Degree, we gave her flowers as her gift. As of now, some of the flowers have wilted and some have still kept their natural colors. Since I love flowers because of their simplicity and uniqueness, I decided to make it my first photo.    

You're Hired!

As planned and as promised, I went to the interview this morning with the CEO of the 2nd company I applied to within this month. I arrived at the office 10 minutes ahead of schedule. I wasn't called in first for the interview. I thought that probably there are other interviews aside from what's happening. Then, it was my turn. I faced the CEO confidently but I wasn't pinning my hopes on getting the job. I was there half-hearted. When my interview ended, he called the HR Manager inside the room and told me the news - I was hired! My term with them was only for 6 months (not 2 months as mentioned to me 2 days earlier), contractual. I met the outgoing house physician for proper endorsement and oriented me to the stuff he usually do as house physician. He showed me the weekly census he's doing (which made me dizzy & confused afterwards).

In the afternoon, I formally signed the contract with them. I told myself that even if I was half-hearted with this, I will give this a try. 6 months is just a short time, then I will let fate decide where I should be. At least, I have a stable job. It will also be good on my resume. So help me God!

That Kind of Job Description

I haven't stopped searching.. Perhaps I never will until I see that workplace where I know I will be comfortable, and where I feel that my practice will eventually peak.

My latest search was so far successful. Yesterday, I was called in for interview, not once but twice. Unfortunately, this job is "up for grabs" because there were 4 applicants screened (myself included) but only 1 will be hired. There will be a third (& final) interview with the president. Then, the management will decide who to hire. I was also informed that the job will be 2 months contractual, renewable afterwards based on performace. The job title is "In House Physician". The job description is more into Industrial Medicine - annual and pre-employment physical examinations, executive check-ups (ECU). I'm no stranger to those things because that's what I partly do at another clinic in Makati, and my exposure during residency training with ECUs. But honestly speaking, I'm kinda sad when I heard the job description. My reaction was "Ha? Ganyan na naman?" But of course, I didn't show my reactions to the HR Manager. I was expecting more beyond that. Being in that place, I was eager for more clinical practice, other than just doing PE day in, day out. As of now, I don't care if I don't get hired.

Big Choice To Make

(This is a follow-up post to my still ongoing dilemma regarding my status as Medical Officer 1 in a nearby hospital.)

By golly! It's already April and I still don't have a word regarding my contract with the public hospital where I currently work in. I have nothing against my colleagues there, the other paramedical personnel and even the security who always greet us cheerily day in, day out. But I wonder if this is really meant for me. I swear there were mornings when I'm so lazy to go work, I feel like I'm being forced to do it as security blanket or just to keep myself busy (but actually not enjoying it).

Again and again, I continuously search for job opportunities over the internet. Thankfully, I found one yesterday. I submitted my resume by email and prayed that the employers will call me. My prayers were answered - I was invited for interview. During the interview, I realised that it was the job opportunity I was praying for a long time - in an out-patient setting, I am a Family Physician and an Occupational Physician as well. The site of the clinic is along a national road, surrounded by different companies and also various subdivisions. The rate is 60-40 professional fee (PF) rate. Fair enough, right? I also have weekends off. The clinic manager already gave me my clinic schedules. Now, my problem is how to tell this to my parents, since they think that working in a hospital is the best job for me and for me to gain experience as well. I'm going to break some people's hearts again.

I don't know what I've gotten myself into.

I've observed that I change jobs every month and this is going to be the 3rd month of doing it. Hopefully, this will be the job that will make me stay for good. Hmm.. I think I've said that before. 

Ranking as Medical Officer.. Does It Matter?

I graduated from a residency training where we didn't use the terms "medical officers" nor "medical specialist". They were only used in public hospitals.

I looked for job opportunities left & right, was not accepted, and only found/learned the hard way that being a resident-on-duty (ROD) all over again is the only option left. I swore to myself that after residency, I won't be agreeing to any 24hour duties again but it seemed that I had to break my own promise. In a way, it can be of very good use to me since I'm planning to take the diplomate exams of PAFP at the end of the year (as they say, experience is the best teacher). Though it may sound that I'm "moonlighting", I had no other choice. I applied for work at a nearby public hospital and was eagerly accepted. But the item being offered to me is just "Medical Officer 1". At first, I just agreed without knowing what that truly means. Then last week, a colleague told me that that rank is INappropriately low for me. According to her, her rank in a public hospital (where she is currently a resident) is "medical officer 3", and kapag diplomate status na, the rank goes up to "medical officer 4" (or some would say that it's already "medical specialist 1"). I thought twice.

I know I am after the training/experience but I have mixed feelings regarding the item/rank being given to me (as MO 1). I feel like I stooped down to GP level when in fact I'm already trained & a consultant/specialist in every way. Siyempre, CFP (Certified Family Physician) na ako. As of now, I haven't signed the contract yet (a blessing in disguise na rin siguro). Probably it's a sign that I should still look for something else &/or a better opportunity will come in my way. I'm afraid that if ever my consultants, co-residents hear about this, they might say bad things like I'm just bringing utmost injustice to my previous training.

Right now, I'm torn - should I stay for experience? Or should I leave? 

Does the rank/item as medical officer matter, in terms of my professional career, financial gains? Will it look good in my resume when I apply for future work?

What Can I Do?

For the past three years, I only knew a little about the real health economic status of my country. Most of the patients I have encountered "can afford" basic laboratories, common medications. I was fortunate that the hospital where I went at have complete (well, almost complete) facilities. They follow-up at your out-patient clinic (as instructed), and everything goes well. In the ER where most patients are HMO holders or employees of affiliate companies, requesting for laboratories and/or ordering for medications was simple - just write it on the chart, nurses either encode the lab/get the medicine from the pharmacy, and patiently wait for the outcome. Sana ganun sa lahat, pero hindi.

This month, I started to work as a medical officer in a public hospital (primary-type, based on hospital bed capacity). Since most of my duty schedule was concentrated in the emergency room, I am always faced with the concern that the relative and/or patient has little to no money. I usually encounter a dilemma on how to come up with even just an initial clinical working impression (among my differential diagnosEs) when my patient cannot afford to pay for a simple laboratory examination. I cannot treat a patient who comes at the ER because he doesn't have the means to pay for a medication. Worse, the hospital has incomplete facilities - the laboratory can only process urinalysis, fecalysis, capillary blood sugar requests; the rest have to be sent or done outside. Likewise, the pharmacy has incomplete stock of medications. As faced with this scenario, paano naman kapag emergent na or urgent yung case? I pity the patient.

Just like in 1 of my previous duties - I saw an unstable patient. We sounded the "code blue" but we were really slow and delayed with our approach because of incomplete stock of medications. The relative was out & late in buying the needed medications. We can only use whatever is available. Eventually, the patient expired. I can only shake my head in disbelief & dismay. I believe we could have saved him. If only... I wonder if the management is really concerned about their patients. Of course, probably not. Imagine if there was a customer satisfaction survey conducted, the hospital could have failed in all aspects, big time.

I know that this is not unusual. For colleagues who have trained in public hospitals, this is very common & this always happen. Kawawa naman si Juan dela Cruz kapag nagkakasakit siya. He ends up six feet under.

Occupational Medicine

The workplace is not always a safe place to work in. Just like at home, there are always structures, elements that in 1 way or another may become a hazard and may cause injury or disease to an employee - whether regular or just contractual and even to the employer. The impact will be decrease in production and/or bad image for the company. 

For example, that Eton Construction Incident which happened last January in Makati City. 10 employees dead, 1 gravely injured. They were just going to have their lunch. Unfortunately, they rode a gondola which can only carry 2-3 people. Their weight was more than what the gondola could bear. The result - fatality. Is it a case of ignorance from the management, an unsafe behavior by the employees, or both?

Occupational Medicine is a gradually booming specialty, as recognized by the Philippine Medical Association. Its specialists are likewise recognized by the PhilHealth. Some companies are gradually recognizing (& hiring) physicians which have taken the basic course (either in Occupational Medicine given by the Philippine College of Occupational Medicine, or Occupational Safety & Health by the UP College of Public Health). The training courses are all recognized and accredited by the Department of Labor and Employment Bureau of Working Conditions (DOLE-BWC). Many specialists are also gaining interest in this specialty - thus, this is not limited to general practitioners, or family physicians only.

The basic course is an 8-day course, running from thursdays to sundays for 2 consecutive weeks, starting from 8am to 5pm. You receive a handbook, and served free meals (2 snacks, 1 lunch). The venues are either in Greenhills, San Juan, or in North Avenue, QC. Attendance is very strict (checked twice a day), absences are prohibited, tardiness is a no-no. Otherwise, you get a sanction. As the course director has mentioned several times, the most important days are the first two days, and the last two days. A plant visit is conducted on the second to the last day, followed by workshops and the graduation. Examinations are conducted before and at the end of the workshop to evaluate our knowledge.

It was like going back to medical school - instead of classmates coming from different pre-med degrees and schools, I met colleagues from different specialties (general practitioners, dentists, pediatricians, internists, etc.), different locations (mostly from NCR, some came from provinces as far as Batac, Ilocos Norte, Cagayan de Oro, Cebu), different fields of work (cement factories, call centers, private clinics, etc. and yes, even those unemployed like me). If you're lucky, you get to see your batchmates (from highschool, or pre-med, or medical school) who have also enrolled in the course at the same time with you. With time, we got to know each other, be more comfortable and be friends. There was no sense of competition, prejudice.

I was included in the first batch of the workshop for the year 2011. I was part of 54 participants. As the course director said, it was the largest group. Not to forget, there were 18 applicants who were placed on the "waiting list" & was unable to join. Our resource speakers were not bored with us, said that our group was very participative in the discussions. We were able to finish the workshop panels on time, and 1 of us got the highest score in the post-workshop exam for the past 2 years.

The discussions were extensive - ranging from medical topics like Occupational Cancers and Skin Diseases, Musculoskeletal disorders just to name a few, some engineering topics like Plant Sanitation, and administrative issues like Physician as an Executive, Employees Compensation Commission (ECC), policy making, etc. On the bad side, I've observed that the discussions were congested to just 1-2 hours. Because of interests, experiences of my colleagues, some of the open forums were cut or limited. Second, the fact of taking-in too much knowledge in so little time is too much to bear. 

The basic course is just an overview of what's instore for the Advanced Course before taking the Diplomate/Specialty examinations. Sounds exciting & promising, isn't it?

Hopefully, this will be accepted and recognized not only by physicians, companies but also by the government.

All 54 participants of the first class of Basic Course in Occupational Medicine for the year 2011

Photography Review: Still Life and Landscape

Next week, I'll be at Cebu for the annual convention of the Philippine Academy of Family Physicians and WONCA regional conference.. Since it's gonna be my first trip there, I have to take a lot of shots of the city, the people, the famous places. One important thing that I'm gonna surely bring is my DSLR camera. However, I've been on "hiatus" for quite a while on my once-favorite hobby.

Reviewing what I learned when I enrolled for a weekly photography class in Quezon City, here are the notes I've scribbled down during that session. I've also included some of the pictures I've taken prior to the lesson and after it. (Most can be found in my flickr account.)

Still Life Photography
- Object photography, meaningfully or artistically
- Kinds: Indoor - most common
             Floral - this is my most common subject
             Sculptural
             Food - most difficult
             Impressionistic
             Imitation - from existing art work
- Characteristics: Clear subject
                           Simple
                           Good use of colors and contrast
                           Good light
                           Unique perspective
                           Has a "personality"
- Techniques: In "M" or "Av" mode -- sorry, I'm using Canon. I don't know its equivalent to Nikon. 
                     Large aperture (F5 or larger)
                     Single drive
                     AWB, cloudy can be used for wooden subjects
                     Use telephoto lens - 50-100m
                     Zoom in
                     Single AF area mode
                     Center weighted metering

** Tips in taking pictures of flowers and plants --> I barely remember this part. Haha!
- Look for a sense of order or layers or patterns
- Understandable shapes
- Remove distractions or other elements


Landscape photography
- Pictures of an outdoor location
- Emphasizes local colors, culture of the place
- Unique man-made, or natural structures
- Subject is the back-ground
- Types: Natural
             Urban/Cityscape
             Road
             Skyscape
             Seascape
             Night
- Techniques on how to take it: 3 layers - foreground, midground, background --> 1/3 bottom, 2/3 sky --> if you want to emphasize the sky. But according to the great Mr. Scott Kelby, you can deviate from this rule. 

Bangui Windmills

                                                "M" or "Tv" priority
                                                Small aperture (F8, F9...)
                                                Dynamic shutter speed
                                                Single drive
                                                Auto white balance (AWB)
                                                Wide-angle lens (18mm, 17mm, 10mm)
                                                Dynamic AF area mode
                                                Evaluative or matrix metering mode



I am also reading photography books by Scott Kelby and watching lessons on the YouTube. I haven't joined any photowalk yet but given the opportunity, I'll gladly join one. Most importantly, I gotta have lots of practice and patience.


                                 

S2 Application & Yellow Prescription Pads

During our oath-taking last September 7, 2007, I remember what the Chair of the Medical Examiners said after we swore the Hippocratic Oath - "you can now prescribe". Well, we can but not all of 'em. There are some medications, drugs that are restricted. In order to prescribe those restricted drugs, we need to have an S2 license. It can be applied at the Philippine Drug Enforcement Agency (PDEA) office in Quezon City. The cost is Php1,500. It is valid in the same duration as the PRC license, renewable after 3 years. So if you plan to apply for one but your PRC license expires also on that same year, it's better to renew your PRC license first.

The requirements are the following:
1. PRC ID card or duly certified true copy
2. Official receipt of professional tax receipt (PTR); or latest certificate of employment for government physicians or duly certified true copy
3. Tax identification number (TIN) card or latest income tax return (ITR) or duly certified true copy
4. Drug test result (DOH-DDB IDTOMIS-generated report)
5. Two pieces of 1x1 id picture if applying for a S2 paper ID card. If you want to get the PVC ID card, submit two pieces of 2x2 id picture instead.
6. For those who will be renewing, previous S2 ID issued. For lost ID, submit proof of publication of loss
* Duly certified true copies can just be simple but clear photocopies. Bring your original documents for verification.
* Personal appearance is required to facilitate entry & capture of current photo & information into the automated system. Once entered, need not apply in person on succeeding period.
* Government physicians are exempted from payment of license fee. However must submit original duly-notarized affidavit that the S2 license shall be used exclusively in government practice only.


Drug test result - just like when applying/renewing your driving license, urine will be collected to check for presence of methamphethamines. Picture & legal signature will be taken when doing this test. Depends on the laboratory you go to, release of results maybe 1 week after. Forgot the price of this test. I personally went to Hi-Precision Diagnostic Lab. 

I filed for an income tax return the same year I applied for an S2 license, so that's what I used. I didn't had a TIN card.

Application for the S2 license was very fast since a few number of physicians were applying. Aside from me, there was also a veterinarian and another physician in queue. I applied for the PVC ID card. If I applied for the paper ID, I was scared that I might mistake it as a trash & throw it away. The card was released after 1 month from my application. But I was given a temporary ID in the meantime. When I claimed my ID, I was informed I can buy yellow prescription pads but that had to wait for half a year. Instead, I used typical prescription pads from my former institution since I was still a resident. Btw, bring another valid ID because you'll leave one at the entrance. And wear closed shoes when going there.


When I finished residency, I've decided to buy yellow prescription pads for my future practice. I inquired at two institutions - Philippine Children Medical Center and East Avenue Medical Center. After phone queries, PCMC has no available stocks of the yellow Rx pad; EAMC has. It was worth Php300 each pad, and I can buy maximum of 3 pads as first-time buyer. So I went there but I bought 2 pads instead. The pads were thick and I thought it would take awhile before I use 'em all. Up until now, I haven't used any piece coming from my yellow Rx pad.  

I have my own PRC license number, yearly PTR number, and now my own S2 license. I gotta be more careful. They're all under my name.

http://pdeapress.org/phase/ONLINE_S2_APPLICATION_PROCEDURES.htm

Deja Vu

I'm in this very familiar situation wherein I'm standing in the crossroads again. A little trip down memory lane: after I passed the PT boards way back 2001, I was a bum for 4 months because I was confused whether to apply for licensure in the US or stay here. I decided to stay & I became a PT volunteer for 5 months in 1 of my previous rotations during internship, then I went into medical school. Fast-forward to 2007 after I passed the medical boards, I was again confused & undecided whether to take local residency or USMLE. My mom insisted that I take residency locally. Ok fine! It wasn't easy as it seemed. Turned out that the first specialty training I applied for is not for me. After just 1 day of pre-residency, I decided to quit. Sadly, my parents hit the roof when I told them the bad news. I told them I wanted to go into Family Medicine and they were not initially happy with it (but eventually they had no choice but to accept it).     

And then now.. I've successfully finished my residency training. Finally, I'm out of the hospital, no more duties. I was so excited, psyched to get out again, be on my own, set my "own" rules. I've pondered on implementing what I've wanted to do before - take examinations for other countries (i.e. Australia, USA) to "seek for greener pasteurs". However the thought of asking my parents for financial support for these exams was very embarrassing for me. For the past 3 years, I seldom ask money from them; every penny I spent came from my meager salary as a resident. Instead, I wanted to have a job - as a physician, of course. Not just to earn but to use what I've learned & gained. The examinations have to be "deferred", again.

I've tried to search for jobs over the internet, asked around from colleagues for possible connections. Some have called me back for interview but no reply from them afterwards, but most did not respond. I have also taken into consideration what colleagues say as the "hospitals/institutions to avoid" before applying, because of many reasons (i.e. majority said because of low pay, unfriendly staff, etc.) In the back of my mind, I know I may not have some of their requirements at this time, like if I have attended any module in Occupational Health and/or Occupational Medicine, but I'll get into it. I am being called/informed every once in a while to hold clinic somewhere as a reliever but it's not permanent and not regular. There were mornings I asked myself "What am I going to do today?" 

My current work doesn't make me happy, fulfilled. I just think of it as something that keeps me pre-occupied in the meantime while waiting and looking for a better opportunity, and hoping to land one. I've thought of applying for jobs that a moonlighter does, but it's my pride (as a junior consultant but short of a diplomate status) that's stopping me from doing that. We never know. I maybe wrong since I haven't tried that actually.

I am not alone, I know. It's really difficult to start his/her own practice, let alone have a private clinic. But somewhere, I have to start and from there let's see what happens. If ever I land a job, I hope that it will be for the long run.

My Unhappy Work

(Again, a re-post from my Multiply account)

Last month, I looked through the google website for job searches as physician. I stumbled upon an advertisement which said "Post-FM Female Residency for hire in a private clinic in Makati blah blah blah..." It also mentioned the contact number and schedule of the clinic hours. I wrote the details down in my old Starbucks Planner. That was not the only post I jotted down. And then I forgot all about it. 

Last week (because of my desperation for job searching), I remembered about the job entries I wrote down. I prayed that the job is still open. After several inquiries by text, my prayer has been answered. High pay, good clinic location. Looks promising. Or so I thought..

When I was called in for interview last weekend, I was surprised to find several patients waiting in queue. While waiting at the holding area, most of the patients said the word "Canada". I thought if this is a clinic that screens immigrant applicants for Canada? When I was called in for interview, my thoughts were echoed out by the owner. No actual out-patient consultations; I will just be doing physican examination to applicants (for Canadian, or New Zealand visas) plus arrange/sort-out paperworks, or encode data in a computer. I got quite disappointed & I had second thoughts. For someone who graduated from an accredited residency training, I wanted to leave right then and there. I thought that the job description is fit for a GP or a moonlighter. Sadly, the owner introduced me to her staff right away after our interview. She kept on saying to them that I'll be starting on monday. I wanted to stop her from saying that. Instead, I just smiled at her. In the back of my mind, why was she looking for a graduate of a residency training kung iyan lang ang ipapagawa niya? At bakit ko naman yun kinagat? The pay is nice (clue: more than Php20K per month) but everything I've learned during residency will just be wasted & I might regret this later since I plan to take the diplomate exams at the end of the year.

Yesterday, I reported to work for the first time. I met another physician who have been working there for more than 1 year na. She introduced me again to the other clinic staff, gave me a thorough orientation of the clinic & learned some rules, including the fact that we don't start screening applicants until the owner arrives. I was also surprised when I saw the mountains of papers piled in different areas of the clinic. So is that what I'm going to sort? Am I going to encode? When we started seeing applicants, I was observant on how the other physician briefly examines an applicant. When I had the initiative to examine an applicant on my own, the owner scolded me. Probably, she doesn't trust my PE findings for now since I'm just a "newbie". I assumed she's defensive about everything that's put into writing in the documents because her name is at stake. But I'm so dismayed & defeated. For the past two days, all I've ever done was take the anthropometric measurements, visual acuity of the applicants. I suddenly remembered 1 of my rotations during residency, but this was worse. I always tag along (like a dog) with the other examining physician.

My searching doesn't stop here. I'm determined to find & pray for a better work, something that will help me professionally. Financial gain will always follow suit.

My Professional Journey Called Residency Training

(Again, this is a re-post from my Multiply account.)

After 3 years of residency training, thank God it's over. I'm glad my efforts have been recognized. I'm happy that my co-residents have appreciated my work as their colleague and as a leader. I'm grateful for the support my family, friends, and consultants over the years - through good and bad times.

During the first year, I was the "alipin", the "utusan". I was always on the move, the burden of heavy work was always on my shoulders. I was not surprised because all 1st year residents go through this. Heck, I was even lucky to have "weekends & holidays off" compared to others. On the other hand, I was not privileged to file for a vacation leave. When December 2008 came, I was relieved for many reasons - I was promoted to second year and our senior co-residents were graduating. Honestly, I didn't establish good rapport with them. But I didn't care and I didn't feel like it was my loss. I prayed that sana nga, makaalis na siya ng Pilipinas. I'm hopeful that the next leader will be very unlike her predecessor. Well, I was wrong.

I experienced the most "downs" in my residency during second year. It was very chaotic, confusing not only for me but for the department as well. New rules were made just for the benefit of some poeple while those in the lower years suffered, decisions were made without asking what other consultants and residents thought about it, actions that were uncalled for. A rift was created - consultants vs consultants, and residents vs residents. We all knew who sided with whom. It got to the extent that it became personal - our previously graded evaluations were re-evaluated and we all obtained lower (more often, failing) marks. Some of us thought of quitting. However, we reflected that nothing good will come from it, it will make matters worse and we just fought our points-of-view in vain. Withstanding whatever was thrown to us, we stood our ground. The issues died down eventually. On the good side, I was able to have my vacation leave. In terms of training, I felt that I've rotated in only two departments - Family Medicine and Emergency Room Medicine. I rotated at the ER for 3 months and at FM/Floors for 4 months. As early as my second year, I've already consumed all of the assigned number of months rotation (7 months for the entire training) at the Floors. I thought that that was also an act of revenge against me. I wondered how was I going to file for a vacation leave during my third year (as a department rule, we can only go on "vacation leave" as FM/Floors rotators or Community/OPD rotators). It was also during this year that I filed for my sick leave - because I was striken with the novel H1N1 virus. I was the ER rotator then. Because of countless I performed swabs on my patients, hayun! Nahawa na rin ako. I was isolated for 10 days.  

My third and final year opened my eyes on the administrative side of our department & became less on the clinical side. The paperworks, meetings, workshops. They were nerve-wracking! One of our consultants gave praises to us - she said we can be event organizers after seeing that our post-graduate course was very organised and a huge success. Yehey! Many big & important stuffs were on my shoulders while I was a chief resident - the PAFP re-accreditation, Accreditation Canada Int'l (ACI) accreditation, our post-graduate course, the dreaded research presentation, and our christmas party. Everyone was cooperative and we all had teamwork. In this final year, I had the privilege to have outside monthly rotations at UP-PGH for Psychiatry & Behavioral Medicine, Wellness, Supportive, Palliative & Hospice Care (SPHC) Medicine, and a once-a-week rotation at the Geria Clinic of General IM OPD. For some strange reason, I enjoyed my rotations there and the atmosphere of being surrounded by more doctors. Never mind that some of its facilities suck but the bulk of learning was all there.   

I was sad to depart from the department. Until now, I'm still having separation anxiety. Now, the challenge that the department throws at me is what to do with everything that I've learned and how I will put it into good use, before I earn that diplomate degree. Then I can come back to them as a consultant, a good product of their training, and be an example to those who are undergoing and will undergo residency.