(no subject)
Tess' take on why doctors should leave the country
Not so few medical schools and hospital training programs have closed because of the dramatic decrease in applicants. Only those medical schools, usually the long-established and big ones, can attain its yearly quota of enrollees. This is an indicator that a battle for survival has begun. As often the case, the strongest and the best adapted will survive. In smaller hospitals, junior consultants and “moonlighting” general practitioners go on 24-hour duties because of lack of residents-in-training. And in bigger hospitals, residents’ training year would begin with complete set of residents, only to depleted by midyear. One by one, they were dropping out of the training program in favor of a better job offer in private clinics, locally or abroad, or even job offers not in the medical field, such as call centers. Others would rather pursue a master’s degree in a different field; others study nursing, after which they leave the country.
So, why not dwell in a career that took almost half a lifetime to build? Why rather be anything but a doctor nowadays?
Work Not Satisfactorily Compensated
First of all, people have this erroneous notion of doctors being overwhelmingly wealthy. Driving around with luxury cars, wearing designer clothes, or globetrotting. This may be true for a handful but, what most people fail (and refuse) to know is that this image of the wealthy medical doctors should be treated obsolete. Most of the few remaining doctors who may be considered rich are those who have either come from wealthy families or have acquired their wealth through long, long years of stable medical practice or through businesses.
So, what about the other doctors? Doctors that have to compete for patients with several thousand others in the cities?
To setup a practice isn’t so easy, as one would think. No doctor could just admit his patients in any hospital. He has to pay for clinic space where he wants to practice and this could amount to anywhere from P300,000-P1,000,000 (in really “high-class” hospitals). Then he has to buy medical equipment necessary for his clinic, which could be from P15,000-P100,000.
So, how can a doctor, with all these expenses, gain back his investments with only a handful of patients per day?
Most people can’t simply imagine how a doctor, with long line of patients waiting outside his clinic, be anything but out of money. What people don’t know is that most of these patients consulted either for free, because being referred by a relative or friend, or with a discount on the professional fee (most of the patients, by the way, do ask for discounts in the professional fees). What is even more troubling is that, because people think doctors are rich, they continually beg for discounts on just about everything, thinking it wouldn’t really hurt the doctor. But the cumulative effect is that it does hurt, especially when everybody else will refuse to pay the amount that is rightfully due for his services rendered. People just fail to consider that the service they’ve been given took several years of study in the hell of medical school and hospital clerkship and internship and specialty training, not to mention the several hundred thousand bucks spent by hardworking parents.
It is sometimes so disappointing and disenchanting to hear some patients haggling doctor’s fees, as if they are in the market buying vegetables and meat, that it almost leaves a bitter taste in the mouth afterwards.
Patients’ Growing Mistrust of Doctors
I’d say this is a direct consequence of ordinary people being bombarded everyday with television and printed news of “bad” doctors and “bad” hospitals, not realizing that most of these stories are either incomplete or biased (after all, journalists aren’t forced to present both sides of the issues).
Several questions run in the minds of patients whenever they consult doctors. Is he competent enough? Can he diagnose my problem? Is he going to overcharge me?
And when the doctor begins probing their schedule of medications, habits, and diet, patients suddenly turn defensive: Is he trying to pin the blame on me? Is he telling me I’m not compliant with my medications? Is he telling me I’m not eating properly? Is he telling me my vices led me to my illness? No, no, no!
And thus, the denial of one’s responsibility for one’s actions ever increases.
As the TV character, Dr. House, succinctly puts it, patients lie. And they lie to cover up details of themselves deemed too intimate or too incriminating. The doctors’ job becomes all the more difficult with this lack of cooperation, stemming from mistrust. It’s like trying to feed a stubborn, obnoxious toddler with his healthy dose of leafy greens for the day: the more you insist, the more they resist. Waiting for the patient to willingly divulge that information (or try beating around the bush for eons) or consent to a diagnostic procedure is just like waiting for the stubborn child to finally open his mouth to take in that spoonful of food. One can understand such behavior in a child, but not in the adult patient.
Another disturbing observation is that patients have developed the attitude that doctors should always be there for them, as needed and as wanted. Patients come to the emergency room to be treated as an emergency case, even if their problem isn’t an emergency at all, and then get mad if left suddenly unattended because a real emergency case arrived and needed the attention of all the doctors and E.R. staff. Patients come at the outpatient clinic during lunchbreak, demanding to be seen immediately. And if asked if they could wait for a while longer because everybody is on a lunch break, they’ll give outbursts that they couldn’t because they don’t have the “time” to wait. And then, they’ll fling obscenities at doctors in the E.R. because they think they aren’t attended to completely enough. When they find out that they’re making a fuss about nothing at all, they would defend their bad behavior by saying they got emotional, angry, and panicky, and they have the right to because they are “patients”. For them, they need not to be civil with doctors because doctors aren’t human beings, with no right to hurt feelings or suffering undue psychological and physical stress. And to top it all off, adding more insult to injury, doctors working for 24-hours (the kind of doctors who most often encounter these ungrateful patients and who suffer most from the above-mentioned assaults) get paid P100 or less per hour.
After all those years of hardwork in medical school, the hundreds and thousands of pesos spent by parents, wishful for the day when they’d be called lucky fathers and mothers of doctors, the two-year long hell of being clerks (glorified term for the lowest form of animal in the hospital) and then interns (glorified term for the second to the lowest form of animal in the hospital) and the months of grueling study for the medical board exam, of which result will dictate the life or death of a budding career, we get paid a measly fee? And then, patients, when feeling slighted,come up threatening to take away our licenses as if they own it?
The doctor-patient relationship’s foundation, like any other professional relationships, is trust. Patients should trust that doctors will, firstly, do no harm (this is what we have sworn when we swore the Hippocratic oath) and will do his best for their greatest benefit. Doctors should be able to trust patients giving them correct information that would be a big factor in the treatment of their disease. But if patients have no trust in their doctors, then what’s the point of the whole doctor-patient relationship?
Why Should Doctors Leave
A recent eyeopener was an article I read in the Philippine Daily Inquirer last January 13. It was written by a young medical doctor who is part of DOH Doctor to the Barrios program and works in underserved areas of the country. She described the fulfillment she gets, being able to help people receive the medical attention that they need. She said that people around her have thought her crazy for not wanting to work abroad. A simple life is all she wants, it seems.
Maybe the life she has is enough for her. For now. But how about later if she decides to raise a family? Would she settle for raising her kids in the province where the nearest hospital could be miles away? Would she settle down in one area or go from barrio to barrio, her family tagging along with her?
There is no doubt that her deed is a noble act and that she renders the country great service. However, nobility do not require selflessness all the time. Noble is he who performs his work well for the sake of working and seeks his rightful fulfillment, be it monetary, in career, family, or spiritual.
But what if he cannot find fulfillment in work here? Where will he go? Obviously, the person in search for fulfillment will go somewhere where his efforts are appreciated and given worth.
The problem is, however, people here in this country expected all doctors to be sacrificial lambs to the great deity called “Patriotism”. But isn’t that behind this “deity” hides the self-righteous people who perpetually ask others to make sacrifices for them? Aren’t these the kind of people who perpetuate a justice based on mendicancy?
As a doctor, I continually ask myself the question: am I receiving my worth? For the duration of my practice, I’ve let myself work and be underpaid for it and still it’s okay. After all, it is “service”. But for how long can I stay this way? How about my parents whom I have to support? How can I support them if other people will expect me not to receive my worth for their sake? So that I could heal them and guide them to living healthy lives and then threaten to take away my right to practice if, in as much I try to defend myself from those who abuse me?
So many are clamoring for patients’ rights, claiming that doctors are out to victimize patients. But have you ever heard of anyone defending the doctors from patients who not only abuse their service, but take away their right to be humans? None. Because not everyone believes that doctors are human beings, too, and they work for survival, just like everybody else.
To my fellow doctors, my message is: Let us leave this place, if we can and while we still can. Let us not let ourselves believe that we shouldn’t receive any less than what we have earnestly worked for. Let us not let them tell us how and why to practice. Let us live for ourselves. By knowing our real worth can we all be of true service to our country. In time, when people have learned that one man do not live for the sake of another man, we could come back. Let us live by this mantra, taken from Ayn Rand’s novel, Atlas Shrugged:
“I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine.”
To the people, do not expect us doctors to bleed dry for unthankful, unappreciative fools who think we owe our lives and our licenses to them. Do not expect us to live when you are trying to kill us. Give us the worth of our work and we will live, not for you, but because it is our right as we worked hard for it. When you have learned, we will, no doubt, come back.
But for now, M.D.’s are leaving. We are on strike.
Not so few medical schools and hospital training programs have closed because of the dramatic decrease in applicants. Only those medical schools, usually the long-established and big ones, can attain its yearly quota of enrollees. This is an indicator that a battle for survival has begun. As often the case, the strongest and the best adapted will survive. In smaller hospitals, junior consultants and “moonlighting” general practitioners go on 24-hour duties because of lack of residents-in-training. And in bigger hospitals, residents’ training year would begin with complete set of residents, only to depleted by midyear. One by one, they were dropping out of the training program in favor of a better job offer in private clinics, locally or abroad, or even job offers not in the medical field, such as call centers. Others would rather pursue a master’s degree in a different field; others study nursing, after which they leave the country.
So, why not dwell in a career that took almost half a lifetime to build? Why rather be anything but a doctor nowadays?
Work Not Satisfactorily Compensated
First of all, people have this erroneous notion of doctors being overwhelmingly wealthy. Driving around with luxury cars, wearing designer clothes, or globetrotting. This may be true for a handful but, what most people fail (and refuse) to know is that this image of the wealthy medical doctors should be treated obsolete. Most of the few remaining doctors who may be considered rich are those who have either come from wealthy families or have acquired their wealth through long, long years of stable medical practice or through businesses.
So, what about the other doctors? Doctors that have to compete for patients with several thousand others in the cities?
To setup a practice isn’t so easy, as one would think. No doctor could just admit his patients in any hospital. He has to pay for clinic space where he wants to practice and this could amount to anywhere from P300,000-P1,000,000 (in really “high-class” hospitals). Then he has to buy medical equipment necessary for his clinic, which could be from P15,000-P100,000.
So, how can a doctor, with all these expenses, gain back his investments with only a handful of patients per day?
Most people can’t simply imagine how a doctor, with long line of patients waiting outside his clinic, be anything but out of money. What people don’t know is that most of these patients consulted either for free, because being referred by a relative or friend, or with a discount on the professional fee (most of the patients, by the way, do ask for discounts in the professional fees). What is even more troubling is that, because people think doctors are rich, they continually beg for discounts on just about everything, thinking it wouldn’t really hurt the doctor. But the cumulative effect is that it does hurt, especially when everybody else will refuse to pay the amount that is rightfully due for his services rendered. People just fail to consider that the service they’ve been given took several years of study in the hell of medical school and hospital clerkship and internship and specialty training, not to mention the several hundred thousand bucks spent by hardworking parents.
It is sometimes so disappointing and disenchanting to hear some patients haggling doctor’s fees, as if they are in the market buying vegetables and meat, that it almost leaves a bitter taste in the mouth afterwards.
Patients’ Growing Mistrust of Doctors
I’d say this is a direct consequence of ordinary people being bombarded everyday with television and printed news of “bad” doctors and “bad” hospitals, not realizing that most of these stories are either incomplete or biased (after all, journalists aren’t forced to present both sides of the issues).
Several questions run in the minds of patients whenever they consult doctors. Is he competent enough? Can he diagnose my problem? Is he going to overcharge me?
And when the doctor begins probing their schedule of medications, habits, and diet, patients suddenly turn defensive: Is he trying to pin the blame on me? Is he telling me I’m not compliant with my medications? Is he telling me I’m not eating properly? Is he telling me my vices led me to my illness? No, no, no!
And thus, the denial of one’s responsibility for one’s actions ever increases.
As the TV character, Dr. House, succinctly puts it, patients lie. And they lie to cover up details of themselves deemed too intimate or too incriminating. The doctors’ job becomes all the more difficult with this lack of cooperation, stemming from mistrust. It’s like trying to feed a stubborn, obnoxious toddler with his healthy dose of leafy greens for the day: the more you insist, the more they resist. Waiting for the patient to willingly divulge that information (or try beating around the bush for eons) or consent to a diagnostic procedure is just like waiting for the stubborn child to finally open his mouth to take in that spoonful of food. One can understand such behavior in a child, but not in the adult patient.
Another disturbing observation is that patients have developed the attitude that doctors should always be there for them, as needed and as wanted. Patients come to the emergency room to be treated as an emergency case, even if their problem isn’t an emergency at all, and then get mad if left suddenly unattended because a real emergency case arrived and needed the attention of all the doctors and E.R. staff. Patients come at the outpatient clinic during lunchbreak, demanding to be seen immediately. And if asked if they could wait for a while longer because everybody is on a lunch break, they’ll give outbursts that they couldn’t because they don’t have the “time” to wait. And then, they’ll fling obscenities at doctors in the E.R. because they think they aren’t attended to completely enough. When they find out that they’re making a fuss about nothing at all, they would defend their bad behavior by saying they got emotional, angry, and panicky, and they have the right to because they are “patients”. For them, they need not to be civil with doctors because doctors aren’t human beings, with no right to hurt feelings or suffering undue psychological and physical stress. And to top it all off, adding more insult to injury, doctors working for 24-hours (the kind of doctors who most often encounter these ungrateful patients and who suffer most from the above-mentioned assaults) get paid P100 or less per hour.
After all those years of hardwork in medical school, the hundreds and thousands of pesos spent by parents, wishful for the day when they’d be called lucky fathers and mothers of doctors, the two-year long hell of being clerks (glorified term for the lowest form of animal in the hospital) and then interns (glorified term for the second to the lowest form of animal in the hospital) and the months of grueling study for the medical board exam, of which result will dictate the life or death of a budding career, we get paid a measly fee? And then, patients, when feeling slighted,come up threatening to take away our licenses as if they own it?
The doctor-patient relationship’s foundation, like any other professional relationships, is trust. Patients should trust that doctors will, firstly, do no harm (this is what we have sworn when we swore the Hippocratic oath) and will do his best for their greatest benefit. Doctors should be able to trust patients giving them correct information that would be a big factor in the treatment of their disease. But if patients have no trust in their doctors, then what’s the point of the whole doctor-patient relationship?
Why Should Doctors Leave
A recent eyeopener was an article I read in the Philippine Daily Inquirer last January 13. It was written by a young medical doctor who is part of DOH Doctor to the Barrios program and works in underserved areas of the country. She described the fulfillment she gets, being able to help people receive the medical attention that they need. She said that people around her have thought her crazy for not wanting to work abroad. A simple life is all she wants, it seems.
Maybe the life she has is enough for her. For now. But how about later if she decides to raise a family? Would she settle for raising her kids in the province where the nearest hospital could be miles away? Would she settle down in one area or go from barrio to barrio, her family tagging along with her?
There is no doubt that her deed is a noble act and that she renders the country great service. However, nobility do not require selflessness all the time. Noble is he who performs his work well for the sake of working and seeks his rightful fulfillment, be it monetary, in career, family, or spiritual.
But what if he cannot find fulfillment in work here? Where will he go? Obviously, the person in search for fulfillment will go somewhere where his efforts are appreciated and given worth.
The problem is, however, people here in this country expected all doctors to be sacrificial lambs to the great deity called “Patriotism”. But isn’t that behind this “deity” hides the self-righteous people who perpetually ask others to make sacrifices for them? Aren’t these the kind of people who perpetuate a justice based on mendicancy?
As a doctor, I continually ask myself the question: am I receiving my worth? For the duration of my practice, I’ve let myself work and be underpaid for it and still it’s okay. After all, it is “service”. But for how long can I stay this way? How about my parents whom I have to support? How can I support them if other people will expect me not to receive my worth for their sake? So that I could heal them and guide them to living healthy lives and then threaten to take away my right to practice if, in as much I try to defend myself from those who abuse me?
So many are clamoring for patients’ rights, claiming that doctors are out to victimize patients. But have you ever heard of anyone defending the doctors from patients who not only abuse their service, but take away their right to be humans? None. Because not everyone believes that doctors are human beings, too, and they work for survival, just like everybody else.
To my fellow doctors, my message is: Let us leave this place, if we can and while we still can. Let us not let ourselves believe that we shouldn’t receive any less than what we have earnestly worked for. Let us not let them tell us how and why to practice. Let us live for ourselves. By knowing our real worth can we all be of true service to our country. In time, when people have learned that one man do not live for the sake of another man, we could come back. Let us live by this mantra, taken from Ayn Rand’s novel, Atlas Shrugged:
“I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine.”
To the people, do not expect us doctors to bleed dry for unthankful, unappreciative fools who think we owe our lives and our licenses to them. Do not expect us to live when you are trying to kill us. Give us the worth of our work and we will live, not for you, but because it is our right as we worked hard for it. When you have learned, we will, no doubt, come back.
But for now, M.D.’s are leaving. We are on strike.