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July 21, 2015

Yes Ma'am, They Are Real!


This morning I got my facebook newsfeed swamped with links to what appears to be a column written by a Ms. Fely Villoria Sicam. The title of her article "Are resident doctors really doctors?" intrigued me so I had to read it for myself, but not before reading some of the comments made already by many who would share the link. Apparently, the article was yet another criticism to a certain sector of fellow health care practitioners. Further reading of the article would reveal that the criticism was directed more to the doctors and nurses working in government hospitals. At first glance I thought it was too stupid an article it has to be ignored. However, I tried to suspend my judgment and gave it another look.



This article appeared to be inspired by a personal experience of an author's friend, narrating how this patient allegedly was not taken good care of while at an Emergency Room of a government-owned hospital. Apparently, the experience was not memorable and the interaction with the nurse and the "resident" doctor was not according to the expectation of the patient seeking care. The article then continued to rant about how doctors and nurses should be more humane in taking care of their patients and any lack of compassion thereof implies lack of authenticity and genuineness and therefore they must be "fake". 

Having re-read the article, my first response was to show empathy for this patient and his folks. Indeed, I am aware personally of how patients, whether rich or poor but more specifically the poor, are not shown enough compassion and consideration whenever they subject themselves for consult in some (again, not all, but in some) government hospitals. How many anecdotes have I heard from different people, from the ordinary to the influential, having bad experiences whenever they go to a public hospital. Some of them, because of this experience, would go to a private hospital with the perception (which is not necessarily true all the time) that private hospitals provide more quality and humane care than government hospitals. So in a sense, the writer, or in this case her friend, is yet another one of those unlucky individuals who happened to visit a health facility with unfortunately "inhumane", "uncompassionate" health care workers. The experience may be worse than how it was described in the article that the writer even had to think, "maybe that resident doctor was no doctor after all".

Unfortunately, ma'am, the resident doctor your friend met is most likely a real professional licensed doctor. And yes ma'am, the lack of courtesy and compassion and even ethics among doctors, nurses, health care workers and other allied health professionals can be as real as it is. 

Don't get me wrong. I am not badmouthing my fellow health care professionals to make me look good. On the contrary, I am perhaps as guilty as that resident doctor in the article when I was still working in the hospital as an intern or while I was a Municipal Health Officer attending to my patients. Looking back, I did not have a clean sheet as well, recalling how in some instances I would show less consideration and compassion to my patients because I allowed stress and fatigue and my own personal hang-ups to get the better of me. And because I came short of showing my compassion and consideration as a doctor in the past, I probably did not listen more, did not spend time more, or even worse. 

And one does not need to be in a public hospital to be devoid of such ethics and values whose standards can be so high simply because of the nature of the work. 

I like to think of this article as a sneak peak on how ordinary patients think of us as health care workers. It may sound stupid (imagine, equating real doctors to being able to speak English!) but I guess patients in general don't know much about us, their doctors. They probably don't know that the "resident doctor"(which should not be confused with doctors taking up residency training) has not yet slept in the last 48 hours because she or he has to supervise the ER, Ward, Delivery Room and OPD all together. In many public hospitals, especially in the rural areas such as district hospitals or municipal hospitals, only one doctor and a few nurses would work around a 24-hour shift. Worse, there are even hospitals with no doctors/specialists. I work for an organization which studies how these gaps in the health care system impact the overall health outcomes of the country. Imagine how many maternal deaths for example could have been avoided and prevented if only there was an Obstetrician working in that far-flung district hospital. Imagine how many deaths could have been prevented if only there was enough competent doctor or nurse to provide first aid treatment at the ER. The question really is, where are the doctors? Where are the nurses? Where are the health care professionals? Why are they too few in the frontlines where much care is needed the most? 

Well ma'am, the reasons cannot be more real as it gets: poor compensation, overworked, lack of resources to practice medicine, too far from home, political dynamics (government hospitals like provincial and district hospitals are managed by the Governor) just to name a few.

Perhaps this is the side of health care that our patients must also see and understand. We must be able to let them empathize with our work, with what we are faced with, because after all, fixing this system would require their participation as well. 

So, after all the negative reaction against this article would subside, we health workers will then realize that articles such as this remind us how high the standards our patients have measured us with and whether it is reasonable or not it is our responsibility to remain consistent with our Hippocratic Oath: "always for the patient...", regardless of whether they are too demanding, ignorant or poor in writing skills. ;-)

Perhaps this also gives us an opportunity to teach our patients,  clarify misconceptions, and show them that an experience with one bad "resident doctor" is not a conclusive experience. I still believe that there are more doctors and nurses and midwives who are really compassionate, caring, altruistic and loving of their patients. They don't get the spotlight more often but they are as real as they can be. 


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