Truth-telling and Disclosure In Medicine

Five years ago, a dear friend passed on. I did not even know she was sick. She was only 46 years old and stayed for a month and a half at the intensive care unit because of post-operative complications. She underwent major abdominal surgery after she was diagnosed with a malignant growth in her stomach. The surgery took 11 hours to finish. A few hours post-op, she developed respiratory failure and subsequently, an infection. She was placed on life support and she did improve. Unfortunately, her immune system failed and she developed more infections. The question on many people's mind including mine was, what happened? I asked some surgeon friends what their opinion was and most said that since the cancer seemed localized, meaning there was no spread beyond her stomach and esophagus, a resection was the right thing to do. She was young and a fairly good surgical risk so that there was a good chance for a cure. But she died. And her family, friends and acquaintances do not understand why. Many have started to speculate. Although I have not heard her family say anything derogatory but one friend even dared to say that the doctors "experimented" on her. An unfair statement but understandable under the circumstances because from the conversations during the wake, it appears that the family were at a loss of what transpired during the 11 hours of operation. It is no wonder then that people are making guesses and conclusions about her death.

What Is So Funny About Death?

As health professionals and workers, death and suffering is a natural occurrence that we deal with everyday. So much so that many of us have developed a callous and apathetic attitude towards it, even to the point where we make fun and laugh about it.  Just this morning as I opened my Facebook, the first thing I saw was that of a status post about the "heavens opening" and following that, were tongue in cheek comments about patients who died during the shift.  As I read through it, my immediate reaction was to view these statements coming from health professionals, as inappropriate and insensitive.  But then, as I thought about it, I realized that my opinion was made because I knew these people.  Others who were not familiar with them would not think the same way I did, because without any biases, the remarks were actually innocent enough, like some private joke between people who work together.

When No One Grieves...

In the hospital, we experience death and dying daily but because we are so used to seeing it everyday that it has become "ordinary"...in other words, a part of our daily routine, so that hospital workers are perceived to be callous to pain and suffering.  How often do I get complaints about how our emergency room staff  behaves while the dead patient is still in the ER...like how they could be seen talking and kidding around while finishing up their work.  Is this apathy? I prefer to call it coping.  It's not that we do not feel the pain and suffering...but dealing with it 24/7 can drain a person emotionally and mentally. So the fear is always that if  hospital workers do not learn to distance themselves emotionally from their patients, they will not be able to do their work.  I remember as a young intern I used to cry when I see my charity patients dying. I felt so much anger not because they were dying, but that they were poor and I wished I could do more but did not since I too had limited resources. I would also cry for the elderly because they reminded me of my grandmother and other people's grandmother, who in their old age needed to feel the presence of their families.  But the worst deaths were the ones with no one to grieve for them, yet strangely I don't feel as sad or angry. I often wondered about this and I came to the conclusion that maybe because patients whose families are disinterested with their care, also makes me less interested in them and therefore I don't form any connection to the patient. But yes, I would feel some guilt because I knew deep inside me that I should have cared more. 

Why I Do Not Support the RH Bill

This post first came out in my other blog Politika-et-Kultura on February 23, 2011.  The original RH Bill discussed below had revisions since then, but the current version that was eventually passed as The Responsible Parenthood and Reproductive Health Act of 2012 (informally known as the RH Law) by Congress and the Senate, is for me just as unsatisfactory as the original. I believe it's provisions are unethical and detrimental to all stakeholders involved. The implementation of the RH Law was put on hold by the Supreme Court early last year and will be decided on April, this year. Because of this, I decided to copy it here on my health/ethics blog, with the sole purpose of reminding myself, why I am against the RH Law.

Stop The Debates: Pass The Freakin' RH Bill >:(

The past few days, there has been so much debate on the Philippine Reproductive Health (RH) Bill both in mainstream and social media due to the fact that this week Congress will be voting on it.  For the record, I am an Anti-RH Bill advocate, BUT I realized that the only way to conclude this never ending debate that is not doing this country any good, is to PASS THAT FREAKIN' BILL! 

The Dying Patient

The Daily Telegraph, a UK paper has this health article posted on their website.  The title is Hospitals "letting patients die to save money".  It should not surprise me since euthanasia seems to be a desirable option now-a-days for people in more developed countries who does not want to suffer from a debilitating or terminal illness.  But still, news like this continue to surprise me simply because I believe in the sanctity of life and no one, absolutely no one has a right to take it away. 

The Filipino Patient's Rights

All of us at one time in our lives will experience some sort of illness and become patients. But, does every patient know their rights?  Beginning in 2010 hospitals in the country were required by the Department of Health (DoH) and Philippine Health Insurance Corporation (PHIC) to post these rights prominently around their premises, particularly in the emergency room, clinics and wards.  However, there is no uniform standard on patient rights and each hospital can come out with it's own or adopt the existing standard set by the DoH.

Rational Drug Use

The Philippines, compared to it's neighbor countries has the highest drug prices in Asia next to Japan. Medicines are priced way too high beyond the reach of ordinary Filipinos so much so that many patients die, not because medicines are unavailable but primarily patients cannot afford to buy them.  This high cost is due to an unregulated free-market forces that wreak havoc on the country’s healthcare system.  Indeed, compared to the demand side, the supply side — the pharmaceutical industry — is so dominant that it can dictate whatever price it wants. Corollary to this, patients are often prescribed medically inappropriate, ineffective and economically inefficient drugs. One major challenge of the country's health system is to ensure that all citizens of the country have access to essential, life-saving medicine and rational drug use.

The Health Risks of Oral Contraceptives

I do not know if the non-medical advocates of hormonal contraceptives for birth control have their information wrong or they are just like those health professionals who are succumbing to pressures from health policy makers and government. I say this because it seems to me that there is a continuous refusal to see the facts that indeed there have been many documented adverse reactions resulting from contraceptive use, the latest of which is The Lancet study, that reported that there is a strong link between HIV transmission and the use of hormonal contraceptives, particularly injectable hormones such as Depo-Provera aka "the shot".

Teaching Empathy In Health Care

As a member of the medical profession, it is painful to see a progressive decline in empathy and conscientiousness in recent years among healthcare providers especially among new doctors. Medicine is a service career and what the patients need are compassionate, conscientious and caring doctors who will be role models for all other health care providers. The noble dictum of service above self  seems to have been replaced by the new order of self first before others.  This is the major motivation why I have been teaching Medical Ethics for the last 9 years.

Virtues Of A Healthcare Professional

Virtues are defined as positive traits of character to think and act in ways that are good. It is to do what is morally right. I will not attempt to discuss the concept or philosophy of virtues as a whole, that is not my area of expertise.  But I have been in the health care industry  and teaching profession long enough to know that the character of a person is not given much weight in the evaluation process for entrance to medical or nursing schools, nor is it given much focus in the teaching curriculum.  This lack of emphasis is in my opinion, a big oversight on the part of medical/nursing schools and residency programs.

Damn If You Do, Damn If You Don't!

I have been feeling really down the past few days.

I now know what it feels like to be hated and maligned. In my adult life, in spite of my candid nature, I have tried to make a conscious effort not to offend people...unfortunately, inadvertently in my work and the position I hold I cannot totally avoid it. I am often misunderstood and my good intentions become suspect. I know that what ever I do, I will never be able to please everyone in my life and I will be stepping on some people's toes. It's damn if you do, damn if you don't!  Well, this fact is more true now than at any other point in my life.  In the last four years there are 2 people who have manifested in more ways than one that they hate my guts and would be ecstatically happy if I fall flat on my face. They have tried their utmost to embarrass me and soil my reputation and good name...why? Because they perceived that I have wronged them. I suspect that one very devious person who seems innocent enough but who probably resents me just as much as the other two is conniving with them. There is really nothing much that I can do except be true to the purity of my intentions...I can only pray for a positive outcome for myself. Anyway, I came across this poem while browsing...and boy, did it make me feel good! It was written by Rudyard Kipling and reading it, I felt somewhat relieved. I'm posting it here...maybe someone with a problem or concern will read it...and feel comforted...like me.