21 May Is it wrong for doctors to be human?
JUAN SAYS: A blogger in Mexico took a snap shot of a resident (on the cover) sleeping at 3am in a hospital and criticized the resident and said “doctors are obliged to do their work.” We saw this link on facebook (read it here) and many of us couldn’t care less. We think that doctors are just that, people who open our mouths to say aaahhhh and get a hefty sum for well, doing just that. But for most of us, we have doctors to thank for, for attending to our sick parents and for being the instruments of “fixing what is wrong” in our bodies and that of our loved ones. Often times we forget that doctors are human beings too. We asked our associate publisher and resident physician Dr. Angelo de Guzman to take a look at the link and give us his 2 cents worth. He gave more than his 2 cents, he gave us a fortune. Read on and understand.
DR. ANGELO SAYS: Let’s not even venture outside our own backyard the Philippines. I’m a doctor and I speak for a lot of doctors here in the Philippines and since the international community has picked up on this and other doctors defended the Mexican resident, let me tell you first how this works so you have a clear picture of the workload we have and a part of the structure that makes our health system as crappy as it is.
When we get to 4th year medical school here, it is called junior internship. They all say we are at the bottom of the food chain. We do the most ridiculous stuff you can imagine. If the resident or consultant needs gloves even if the hospital has no supply, we produce gloves; when the patient needs syringe and they have no money, we produce the syringe. I’d like to call it slavery. No, sorry, we are magicians. We are expected to come up with supplies out of thin air. If we have a lack of orderly staff, we push wheelchairs, stretchers (skinny beds with wheels where you haul a patient from one area to another), the infamous large tank of oxygen that supports breathing of patients. Yeah I’ve been there, done that and bought all the souvenirs. We rob a nap in between procedures while we escort patients, we do this anywhere, not just chairs and benches, anywhere where our cute little junior intern butt will fit and where our heads can lean on somewhere. Have you been 2nd assist surgeon and scrub nurse at the same time? Retracting an open abdomen open while preparing and handing out instruments and sutures to the surgeon, nice skill right? Have you ever monitored 60 patients in a 50 bed capacity ward? We have. We made sure their blood exams were carried out, and who extracted the blood? We do. No, there are no phlebotomists in our hospital, it’s a public hospital.
Come Senior internship, the load is relatively easier, depends if your junior is a bright upcoming doctor or is as lazy as our local congressmen who only do their job when openly ridiculed. You do the same thing but with the junior intern, less load of course, unless you don’t have a junior, hence you do the same things over again. Neat huh?
Residency? Now this is juicy, there are a lot of types of residents, some mature with age and become wiser and nicer, and some mature like vinegar and become sour by the day (datu puti anyone?). You’d wish the wicked stepmother was your resident doctor because at the very least she lets you eat on time and take a bath. But you cannot blame them for being like this, they started out nice but the toils and pressures of work, day in and day out, help mold their grumpy demeanor. To top it all, consultants sometimes take it out on poor interns by hurling not so nice remarks and insults. Oo may ganun! It is like a military training camp but in a hospital setting. Do as you’re told, follow orders, or else. Excuses are for sissies. Residents would be in the hospital for 48 hours, barely sleeping, just because they needed to finish 13 pending cesarean sections that I admitted. (Sorry Dra. Bagadiong!) We were sleeping on empty shelves already at 2am and I don’t remember how many operations we’ve done. Then there is what you call perpetual duty where, depending on internal arrangement, the doctors will all stay inside the hospital for a week maybe, on call. This is usually done for long holidays like in December. You either get Christmas off or New Year off, take your pick. In certain hospitals being residents are like being Junior Interns again, “order mo, carry out mo”, if you ordered it in the patient’s chart you might as well goddam know how to do it too, because no one is going to do it for you.
I have not personally been in residency, and I don’t have to be, for me to criticize how our learning methods are outdated, justifying this workload to be a sea of learning and that all are opportunities to be better doctors crap? Give me a fucking break. Being the sounding board of irate residents who have had no decent sleep is proof enough and witness of their toils, we work together often and we understand their pain. All this and you think we doctors are rich instantly? Private Hospitals who are also training institutions pay a measly amount of around P13,000 according to a friend per month, and some government hospitals start out with hefty salary of P39,000 grossly, but take home is around P30,000 with some additional benefits and a bonus that is called hazard pay and subsistence pay, as if it’s enough to buy medication when you get pricked by a needle you just stuck into a Hepatitis B positive patient because you’re too sleepy even to remember your name. Oh did I mention the work hours? Usual shifts start at 7am or 8am, duty is 24 hours, and no you can’t sleep or at least don’t tell anyone you are. There is from my experience, duty status that goes from 7am to 5pm the following day, then you go home to sleep, then wake up and go from 7am to 5pm to work at the clinic pre duty status then maybe go on a diminutive social life that you call a date and repeat the cycle the following day for at least 3-4 freaking years or if you choose any surgical course 4-7 years or maybe more.
Oh let’s not even begin discussing the Emergency Room setting action, Grey’s Anatomy (the TV series) doesn’t in any way reflect what we put up in the Philippines and unlike what the TV show portrays, we don’t have a sex life. We miss out on birthdays, anniversaries, vacations, holiday family gatherings, our children’s first steps or first words, we miss out on so many things, our youth, and you say it’s for the money? Those things can’t be bought by money you all know that.
So people give us a break, don’t criticize us for being human and overworked at that. If you can rally on the streets for the beaten down masa, the workers of the burned down slippers factory in Valenzuela, try rallying on the streets for us and our nurses and medical technologists who work long grueling shifts with us, rally for a better health system, rally for more competent people in government. It would be nice to get paid well after all the crap we’ve taken in all those years of learning, but that’s not yet a reality, after the hospital trainings we need to be businessmen and put up clinics, buy hospital rights to admit patients, be able to market ourselves so patients will come to us. Some specialty earn much, but their species are few in numbers because the skill is not easy to acquire and has an expiration. No, even rock star surgeons can’t operate on people up until we’re 90 years old unless we’re really still sharp at that age, or certain specialties who earn because a certain procedure is already for life unless transplant can be done. So you see people, our field is not that simple, we deal with lives and yet you want us operating or managing a patient who is at the brink of death when we have not had a bladder break for 20 hours straight? Who in Heaven’s name works that long consistently? Lawyers? Really? People, next time you go cranky on a doctor who is taking too long and has not examined you, please be patient, there might be someone else they are attending to who is more critical, or they’re resting a bit so they can give you the best service they can. Even in our tired moments, majority we are still thinking of you. We get sick sometimes because we forget to take care of ourselves and our families, just because we need to give more time to our patients who need us. And at the end of our lives if we’re lucky we have few friends and family who remain and understand the times we could not be there for them, we were with you, our patients, making sure your child is safe from further harm, your mother or father is okay during and after operation, or your brother/sister can go home after a few days. You just don’t know how much we gave up to make sure your loved ones are okay. You just don’t.