Sunday, February 22, 2009

HOW TO ...use a P.O. card :-)

I just spent a very instructive afternoon at Metro - Ayala. To the as yet uninitiated on the workings of a P.O. card, here's what I learned:

1. First of all, I did not learn what the acronym "P.O." stands for. For once in my life, Wikipedia failed me. The nearest it could come up with was "purchase order" but when I read the actual article on purchase orders, it didn't sound anything like a P.O. card.

2. A P.O. card is not a card. It's a piece of paper that looks a bit like a water or electricity bill. You know, with a row of holes on both ends. If you've never had to deal with either bills or P.O. cards in your life, you're lucky. (Or you're still largely dependent on your parents, which I also am.)

3. What a P.O. card is, is, like, the poor man's credit card. (No offense to the P.O. card users out there. Hey, as of this afternoon, I'm one of you!) The card-that-is-not-a-card is worth a certain amount. You buy the card, you buy stuff using the card, and you pay [cash] at a later date.

4. HOW TO BUY A CARD: I got mine from Opaw, who got it from his sister, who is a registered Guarantor at Metro - Ayala. (I don't actually know that they have to register, but she has a Guarantor's ID number, so it's a good guess, if I may say so myself.)

If you don't know a Guarantor, I recommend just hanging around the store's P.O. Card Verification and Payments area. There's bound to be a Guarantor there somewhere.

Anyway, I got a card worth P500, and I paid P25 for the card itself. The actual P500 I have to pay in four installments spaced 15 days apart. (Aren't you just learning a lot? Hehe. Because I am.)

5. FILL THE CARD UP. Write your name, address, whatever information they require. This is the easiest part.

6. Next, GET THE CARD VERIFIED. Ask the guard or the salespeople where this is done. In Metro - Ayala, you do this at the 4th floor (the one where there are kitchen stuff and fabric and electronics). Bring a valid ID. (As the people in front of me at the queue learned to their dismay, no, a cedula will not do.) The lady behind the counter scans the card, tears half off, and gives you back the other half.

7. SHOP. Almost as easy as filling up the card, except that you have to use up the entire value of the card on the same day. And they won't give you change. You can spend it on separate purchases, though; after one transaction, the cash register prints the card's balance at the back. Oh, and the whole process is called "franking."

(Learning...)

At Metro - Ayala, surcharges are applied if you use the P.O. card on groceries or at the pharmacy. And if the item you buy is on sale, there's a surcharge of 5%.
(So, if an item originally costs P100, and it goes on sale at 5% off, and you buy it with a P.O. card...
Relax, you still get a balance of 25 cents off. That's still something, compared to...well, compared to nothing.)

8. PAY UP. Of course.

The inevitable verdict: Cash is better. Unless you don't have it.

HOW TO ...join Doctors To The Barrios

My old friend, new doctor Pura Rodriguez, is joining Doctors to the Barrios this year!

Okay, so that really isn't surprising, if you know Pura, and you know where she attended university, and you know who her father is. But what talking to her made me remember is that there really isn't that much information on the web on how exactly to join the DTTB. People have mentioned searching the Pinoy MD archives and the DOH website, but I've tried both, and I didn't really find anything helpful. Good thing I got to know Doc Che -- proudly Filipina and DTTB alumna, now on her first year of Family Medicine residency -- who gave me the info I needed.

To everyone else with the desire to serve the underserved, here's what to do:

1. Write a letter of intent, addressed to:

Dr. Kenneth G. Ronquillo
Director IV
Health Human Resource Development Bureau
Building 12-A, Department of Health
Sta. Cruz, Manila

2. Also submit a copy of your:
transcript of records
diploma
PRC license
PRC certificate
NBI clearance

3. If you can, head to the 2nd floor of the DOH office mentioned above and look for Sir Jon or Sir Gil.

(ALL THE INFORMATION ABOVE COURTESY OF MERRYCHERRY, MD)

Tuesday, February 17, 2009

as a bee

Yes I am.

Busy.

Been working 12-hour days lately.

And I am not on training.

Wasn't it just a few days ago that I complained about having nothing to do even when I'm online?

Should've kept my big mouth shut, shouldn't I?
PICTURES FROM HERE, HERE AND HERE.

Thursday, February 12, 2009

my vote's for norman gentle!

And the welder! And the guy who works at an oil rig!

If it wasn't for American Idol, I would have never heard the song I Hope You Dance by Lee Ann Womack. I love its lyrics, and I just want to share it with all of you.

I hope you never lose your sense of wonder
You get your fill to eat but always keep that hunger
May you never take one single breath for granted
God forbid love ever leave you empty handed

I hope you still feel small when you stand beside the ocean
Whenever one door closes I hope one more opens
Promise me that you'll give faith a fighting chance
And when you get the choice to sit it out or dance

I hope you dance... I hope you dance.

I hope you never fear those mountains in the distance
Never settle for the path of least resistance
Livin' might mean takin' chances but they're worth takin'
Lovin' might be a mistake but it's worth makin'

Don't let some hell bent heart leave you bitter
When you come close to sellin' out reconsider
Give the heavens above more than just a passing glance
And when you get the choice to sit it out or dance

I hope you dance... I hope you dance.


*
(By the way, if it isn't obvious yet, I'm busy.)

Sunday, February 8, 2009

bravo for bill gates

"Microsoft founder turned disease-battling philanthropist Bill Gates loosed mosquitoes at an elite Technology, Entertainment, Design (TED) Conference to make a point about the deadly sting of malaria.

"'Malaria is spread by mosquitoes,' Gates said while opening a jar onstage at a gathering known to attract technology kings, politicians, and Hollywood stars.

"'I brought some. Here I'll let them roam around. There is no reason only poor people should be infected.'"

READ THE FULL STORY HERE.

Wouldn't it be great to care, and to be rich enough to actually do something about it?

Thursday, February 5, 2009

ho hum

Back when I didn't have internet at home or at work, I would make a list of things to do during the infrequent occasions that I am online. Download this. Google that. Upload this and that. Stuff.

Now it's like, "Oh, no, nobody's written a new blog post in the last 30 minutes. What do I do now?" And then, "Oh, well, I might as well make one up myself."


I've even updated my Friendster account (uploaded a couple of photos), set up a Facebook account (I now have a total of one friend), and customized my Multiply.

"But don't you have work work?"

Um. Yeah. There are times that it's really busy, and there are times that it's not. Today was Not.

"And don't you have anything else to do at home?"

Oh, sure. I arrive home just in time to bid my father good-bye as he goes off to work. I watch American Idol when it's on. I have dinner with my mother and we talk and laugh. And then I talk to my dogs and adopted cat, as well as my lolo's dog and sometimes even the neighbors' dogs (because, let's face it, nobody else will talk to them if I don't).

And then it occurs to me, "Maybe somebody's written a new blog by now!"

(BUT the blog that I am supposed to write -- something about love, for the TBR that Em Dy is hosting -- I haven't written yet because I'm just a little jaded about that stuff right now.)

I really should get a life.

But first I need to finish customizing my Multiply.
PHOTO BY CHRISTIEM

standards standards

Some women take feminism to an extreme.

(Or feminism itself has become extreme? I'm not sure, not having dabbled in it.)

I've heard of some girls who take offense when a guy opens a door for her. I think it's crazy. I think opening doors for people is just good manners, being nice, doing as you would be done by. I certainly wouldn't mind opening a door for a guy, and I would think nothing of it, and I would think the guy crazy -- not to mention downright ungrateful -- if he makes something else out of it.

I wholeheartedly agree that males and females are created equal. I think, though, that it's being simplistic to translate this as that males and females can do all things equally well at all times. The best way to illustrate how I think about the whole issue is this: 100 = 100, right? But the 100 on the left side of the equation may have been arrived at by adding 2 and 25 and 73, while the one on the right side may have been the sum of 5 and 62 and 33. (This pause is me making sure I've got my addition right. Hehe!) The difference in composition doesn't make one 100 and the other 100 any less equal.

This applies not just to men and women but to people in general. We've all got different strengths and weaknesses, and that's what makes us valuable. To paraphrase a popular saying, if two people are completely alike, one of them is unnecessary.

*
I am ruminating on this topic because, having said all that, I think Beyonce's If I Were A Boy is relevant and is a pretty accurate description of some guys. (SOME! Dili pod dagway tanan. And naa pod dagway mga girls na dapat ma-igo. Anyways, I think the fact that it has spawned a "response" means it struck a few sensitive chords.)

"If I Were A Boy"
If I were a boy
Even just for a day
I’d roll outta bed in the morning
And throw on what I wanted then go
Drink beer with the guys
And chase after girls
I’d kick it with who I wanted
And I’d never get confronted for it.
Cause they’d stick up for me.
-Chorus-
If I were a boy
I think I could understand
How it feels to love a girl I swear I’d be a better man.
I’d listen to her
Cause I know how it hurts
When you lose the one you wanted
Cause he’s taken you for granted
And everything you had got destroyed
If I were a boy
I would turn off my phone
Tell everyone it’s broken
So they’d think that I was sleepin’ alone
I’d put myself first
And make the rules as I go
Cause I know that she’d be faithful
Waitin’ for me to come home (to come home) [Chorus]
It’s a little too late for you to come back
Say its just a mistake
Think I’d forgive you like that
If you thought I would wait for you
You thought wrong
But you’re just a boy
You don’t understand
Yeah you don’t understand
How it feels to love a girl someday
You wish you were a better man
You don’t listen to her
You don’t care how it hurts
Until you lose the one you wanted
Cause you’ve taken her for granted
And everything you have got destroyed
But you’re just a boy

*
To be fair, I think double standards do still exist, even in a world of political correctness.

(Politically correct... Hmmm... For me, what's really important is that we mean well and do as our conscience tells us to do. And I do think that's how we shall eventually be judged -- by our actions in the light of our intentions. I'd be happier if all this striving for political correctness results in politicians doing the correct thing at all times.)

(Anyway.)

For example, when wives don't have enough time for their families, they're failures. But when husbands don't have enough time for their families, the reason "para ato ra bitaw ni" is more easily accepted. Then again, there is more pressure on the guys to be the ones who feed their families and all that -- another double standard. Factor into that the question of what is "enough" time.

Yupak! :-)

Monday, February 2, 2009

the manifesto

I published a rough draft of this "manifesto" a few days ago but decided to remove it, resolving to finish it first before I lay it down again before the feet of the world. I've realized it's unsettlingly personal, but, well, there may be people who want to understand.

Heading for Bunker Hill

While watching Good Will Hunting (again) a few days ago, I realized that, while I might wish I had Matt Damon's character's gifts, it is actually Sean Maguire (played by Robin Williams) to whom I can relate, more so today than when I first watched the movie. Sean teaches at Bunker Hill Community College and agrees to counsel Will Hunting when other high-priced shrinks had surrendered. In the movie, he has a shouting match with his former classmate, MIT professor and Fields Medal winner Gerald Lambeau.

Gerald tells him, "Don't infect him (Will) with the idea that it's okay to quit. That it's okay to be a failure, because it's not okay!" He points out that Sean is "smarter than us then and you're smarter than us now" and accuses Sean of being "angry at me for being successful, for being what you could have been.... You resent me. And I'm not going to apologize for any success that I've had.... Ask yourself if you want Will to feel that way for the rest of his life, to feel like a failure."

And Sean explodes, "That's it. That's why I don't come to the goddamn reunions! Becaue I can't stand the look in your eye when you see me! You think I'm a failure! I know who I am. I'm proud of who I am. And all of you, you think I'm some kind of pity case!"

For some reason, their exchange reminded me of the first few months following the August board. At first it was the norm to vacillate, to be doing nothing substantial, to have no idea where one was headed. But as days turned into weeks that turned into months, I learned to hate bumping into anyone from the medical world. I would inevitably be asked, "Asa na man ka ron?" and, when I answered, I would as inevitably be asked why I hadn't gone into training yet. There was no acceptable answer of acceptable length -- the short answer was unsatisfactory; the long version would be too good to waste on mere acquaintances whose genuine interest, beyond mere curiosity, was doubtful. At least that's what I thought.

At this point, very early in our careers, no one has yet called me a failure. But I think I can definitely foresee a time when some people will think that of me. I'm not sure I will particularly care, but I would definitely be tempted to think that those people just don't understand. And I might be further tempted to think that it might be because they are not capable of understanding, which assessment of their capabilities would be unfair if I had not, in the first place, given them a chance to understand by explaining myself. I usually dislike having to explain myself, since I tend to feel that only those who truly know me would be able to understand. But in this case, I think, an exception will have to be made.

The GP According To Juan

Just recently, I had dinner with some med school friends. One of them, who is currently studying for the USMLE, asked the rest of us what our plans were. Before we could reply, he added, "Basta ayaw lang gyud mo pag-GP. Don't deteriorate!"

The tendency to view General Practitioners, and even Family Medicine specialists, as inferior is not uncommon. It is reinforced by the practice of many GPs/FMs to admit patients under their own services (that is, the GP/FM is the patient's main doctor) while leaving actual management of the patient's problems to other specialists with whom the patient is co-managed. This awful practice makes people think of GPs as inutile, and FMs as only a bit better.

But I don't believe that is necessarily the case.

Broadly speaking, a general practitioner can still be excellent in his practice of medicine. True, there are a lot of cases beyond his capabilities. Initial management of a stroke, for example, would require referral to a neurologist. A myocardial infarction would necessitate a cardiologist. But the same would be just as true if one was, say, a pulmonologist. Specialists still refer patients to each other. One cannot know everything. What is important is for a doctor to know what he can and cannot do, to be aware of his limits, to be prudent in decision-making, to act for the patient's good at all times, and to be fair -- to refrain from demanding professional fees when he hasn't done anything significant.

The Case for "Underachievement"

Mostly, when I mention the possibility of general practice, people say it's "sayang," when I have the potential of being a good specialist. Crazy, but only a few people ever stop to think that I might actually have the potential of being a good generalist. (So thanks, Tonette, for saying my patients would be lucky. Hehe! But I still have much to learn.)

I can't say I blame them. Society has been conditioned to think that specialists are better than generalists, and subspecialists better than specialists, in the same way that neurosurgeons are regarded with more awe than are general surgeons, and those who have trained in America are more capable than those who have trained locally, or, heck, in the same way that doctors are held in higher esteem than janitors, and being a president is better than being a mayor. When God knows we need them all! For myself, I would rather be Tommy Osmena or Sonny Belmonte than Gloria Arroyo, I would think more of a kind janitor than a doctor with bati'g batasan, and I would rather be Dr. Arco than...well, let's not go there.

There is always a pressure to achieve more, to be more. However high up you've gone, there will always be something higher that you can aspire to, if heights are your cup of tea. For me, though, what's more important is to be good at whatever you are doing. Mediocrity, rather than underachievement, is for me the worse enemy, and excellence, rather than achievement, the worthier goal.

Bigger and brighter does not necessarily mean better. The Sun is no Betelguese but it's all we have and, for the solar system's everyday purposes, it's enough.

Purposes

Having thus set aside as invalid the notion that I have to be a specialist if I am to be anything worth a damn, I then proceeded to ask myself if I want to be one. And the answer to that was: I didn't particularly mind, either way.

(Which wasn't very helpful.)

So I tried another question: what did I want my daily schedule to be like ten years from now?

This is what I came up with: Wake up. Fix breakfast for the family. Have breakfast with the family. Go to the clinic. Maybe have lunch with my parents. Spend a couple of hours doing things for myself, like reading a book, or having coffee with friends, or shopping, or writing (ideally, a column for a local paper, but a blog will do). Back to the clinic. Fix dinner. Spend quality time with my family. Sleep (and not have to wake up because of a patient). Do fun things on weekends. Travel. Sit on the porch and contentedly watch the world go by.

(I will not be a hypocrite and add stuff like "cleaning the house." I am awful at cleaning. Luckily, allergic rhinitis gives me a perfectly valid excuse. Haha!)

Rounds? Updates from residents? No, thanks. I'd rather spend all that time with my family. I joke about wanting to be a part-time doctor and part-time housewife, but, well, jokes are said to be half-meant. If my kids or husband ever feel that I don't have enough time for them, then I would feel like a failure.

Choices

Well, then, I've ruled out inpatient work. By choice, not circumstance.

The thing is, most residency training programs I know -- for IM and FaMed, having ruled out OB and Pedia a long time ago, and Surgery having pretty much ruled me out, hehe, but, well, not that I was actually interested; anyway, most programs I know -- focus on inpatient work. Which, considering the "blood, sweat and tears" that a resident puts in (just read Brian), seems pretty pointless if I'm not actually gonna be using what I learn [the hard way]. I mean, I'm not gonna be computing anion gaps in my little clinic, am I?

The way I see it, the only reason for my going into residency right now -- with the residency options available -- is because of the preconceived notion that that's what doctors do after passing the board. If I had found a training program in Cebu that focused solely on outpatient diagnosis and management, I would have jumped right in. But there is none that I know of.

(I recently asked Dr. Berdin, one of my teachers at CIM who is also a practicing FM, about the "alternative pathway" for Family Medicine, and, as far as I understood what he said, he described it as a doctor with a "community-based" practice undergoing a sort of preceptorship. It sounds cool -- I get to build my own practice, but at the same time I get guidance from a mentor with more experience. However, Dr. Berdin says it isn't being done in Cebu. Yet.)

The Game Plan

So. I haven't really closed my doors to going into a residency training program, but, as of now, there just aren't any interesting prospects out there. And just as I don't mind specializing in something, I certainly wouldn't mind staying a GP either. I figure, all I want to do anyway is to have my own little clinic in Talamban, and most of my prospective patients probably couldn't afford a specialist's fees.

This, then, is my game plan.

I'm going to set up my own clinic -- the Solera Primary Care Clinic. (I even have a name for it! Haha! What I'm trying to say is, I've got a plan, guys. And it's a concrete plan, not castles in clouds. Don't worry about me so much.)

(Potential slogans:
(1) Quality health care for all.
(2) I did not become a doctor for those who can afford specialists. Go away.
(3) If you don't trust me, don't bother me.)

(I'm kidding!)

BUT I won't be a chipipay sort of doctor. I'll give my patients FAQ handouts on whatever sakit they have. I'll have a waiting area with reading materials. (It's a coin toss on the TV.) I'll even put up a coffee shop next door. (Hehe! Maybe.) My records will be computerized. And I'll spend time with my patients. I'll explain their illnesses to them. I'll be nice. :-)

However, since I can't set up a clinic until next year at the earliest (it's a long story), I'm working full time at an HMO, to build capital and pay my bills and stay solvent. In reverse order.

And I'm trying to learn as much as I can (and as far as my attention span allows).

This I guarantee: if I stay a GP, I'm gonna be the best @#$%^&* GP I know.

I'm gonna be a good doctor, and a good wife, and a good mother, and a good daughter, and a good sister, and If I do all that, I will never feel like a failure.

And if people still can't understand, they have no more excuses.

something to kick away the monday blues

I hope Doc Ness won't mind me re-posting this. It's been 47 years since I first saw these precious images in her blog, but they crack me up every time I see them. Monday schmonday... Life is good!