‘Wala ka kasing puso’ – The challenge for new doctors

I’d like to start with a story

A few months ago at the Pedia outpatient department I was interviewing a patient when a younger colleague approached me. He and his classmate had been interviewing a father and son when suddenly the father became agitated and demanded to speak with a resident. As the resident had not arrived yet I decided to speak with the patient’s father.

I approached him, introduced myself as an intern and I took a quick look at his 7 year-old son. He was sitting slumped on the chair coughing and febrile but stable.

“I’m sorry sir, pero mamaya pa konti dadating ang mga residente ngayon, may conference lang po kasi sila sandali”

To which he answered with:

“Wala pang residente dito? Hindi ba pinagprapractisan niyo lang kami?”

I explained that as PGH was a teaching hospital it was usual for patients to be interviewed by students first, but that all patients would eventually be seen by a resident. Until then they would unfortunately have to wait. I suggested that he take some paracetamol for the fever while they waited and my younger colleague actually offered to go and buy the medicine for the child, but the father was still unhappy and unsatisfied with all our efforts.

“Ang tagal na naming naghihintay. May anak ka ba? Kung may anak ka siguro maiintindihan mo ako.” He then muttered something I will never forget.

“Wala ka kasing puso.”

By this time the residents had arrived and the patient and his father were moved to the other room. I never saw them again but that statement stuck with me. Not because it was particularly mean, but because deep down it made me wonder whether what he said was true.

I am lucky that my misunderstanding with a patient ended there.

The popularity of social media has deeply affected the dynamics between patients and doctors. It seems like every other week there is a new story of a doctor making its way around social media. Posted by the disgruntled loved ones of patients along with an angry commentary about how the doctor had been inefficient, uncaring, rude or all of the above. The comments that follow are often cruel and personal. Reading these stories, it is difficult to say whether the doctor committed any wrongdoing or whether this was all the result of a bad misunderstanding. But the nature of the social media is that once it’s out there, it’s out there. The doctor involved has very little opportunity to defend his actions or explain his side.

In a few short weeks we will all take the boards and become licensed doctors. And each of us runs the risk of having one bad day or misunderstanding that will confront us in the public sphere.

How should we as young doctors react when confronted with this? Should we shy away from social media in general? And what about how we interact with patients? Are we to now give in to every request from a patient over what we believe is sound medical advice because of the fear that they may become angry with us?

These are difficult questions to answer. While this development is as daunting, there is a silver lining. As much as it is a warning to us all, it is also a challenge to all of us young doctors here today.  

The first is a challenge to show more compassion and the second is to address the root cause of the dissatisfaction of our patients.

I’m sure many of us have become close to a patient or two during our stay here in the hospital. I know I have. I spent part of my internship year rotating in the pediatric cancer ward, and it was there that I met Mark. I was there when Mark was diagnosed with Acute Myelogenous Leukemia. I recall that I was responsible for a lot of the discomfort he felt during his visit. I was the one who would wake him up several times a night to take his vital signs and there was hardly a day when we didn’t extract blood from him. It was there that I also met his family and became close with his mother, Elsa. We talked a lot when I was on duty and she shared with me her worries about how life would change for her 6 year-old son. They eventually were discharged, I left pediatrics and I did not hear from them again.

A few weeks ago when I began to write this speech I received a text from Mark’s mother saying he had passed away. This was also around the time I began to panic about how little time was left before the boards. She had just texted to thank me for taking care of her son and talking to her those nights I was on duty. I had almost forgotten about this, but it struck me that it meant so much to her. In the end we could not save her son, but she was not angry or bitter with us. Instead she was grateful for everything her health team had done for her.

I know this is not something we can replicate with every patient. First of all, not all patients can be admitted for as long as Mark was, not all relatives are as open and friendly as Ma’am Elsa. There are some nights we barely have time to sit down, much less talk to our patients or their relatives. But we should try and make that connection with our patients, even if just for a little. Ask them what they do for a living, or ask them where they’re from. Or you could even share something about yourself. Then the 56 year-old male with chest pain becomes Mang Benny who worked as a taxi driver for 22 years and lives 10 minutes from where you grew up. Similarly, you are no longer a nameless, faceless intern. You’re Intern Hannah who has a lot of patients to attend to in the ER but you’re doing your best to take care of them.   

It is a challenge for us to communicate better, to open up to patients, and to let them see us as people as much as they see us as doctors. My father used to tell me “I’d rather have a doctor who knows what he’s doing over one who only knows how to hold your hand.” But why can’t you be both? Magaling na, magalang pa.

The second challenge is much harder because it forces us to confront the factors that actually cause most of the frustration in the first place. We, as interns at PGH feel its problems and the problems of the health care system more acutely than anyone, except maybe the patients. And their frustration about our health system, whether its that the ambulance took two hours to get to the nearest ER only to be turned away for the lack of functioning CT scans and OR rooms, manifests itself when they arrive at another emergency room and the doctor that receives them greets them with “bakit ngayon lang po kayo dumating?”

Our health care system is still far from ideal, and now that we are entering the workforce we can now play a larger role in helping improve healthcare for the 102.7 million Filipinos who not only helped fund our education, but also entrusted their lives to us.

And can we do it?

This year alone we have gone through many difficulties as a class. The academic shift was a necessary change but it left us at times manning one ward or several wards on our own. Our classmates who are part of the MD-PhD program at one point were unsure if they would be able to take the boards with us and sadly won’t even be graduating with us today. But this still didn’t discourage us from coming in everyday to take care of our patients. That didn’t stop the interns who came to duty sick because they felt they had a responsibility to be there. If you go through PGH, you are used to things being tough, and you learn to be tougher. That’s why I know we can overcome whatever is thrown our way.

Today is a day to look back and celebrate the journey we have all made together. We have many people to thank.

First and foremost our loved ones, this day is as much for them as it is for us.

Our parents who worked hard to make sure had uniforms, books, and who basically put us through medical school only to now disregard our medical advice.

Next are our teachers and mentors, all of whom took the time out of their busy schedules to impart everything they know so that we have the knowledge it takes to be capable doctors. And all without expecting anything in return. That is truly honor and excellence.

While we have many people to thank, noticeably missing here today are the people who have ultimately made us doctors, the thousands of patients at PGH. We have all touched their lives and in return they have taught us why we are doctors.

To end, I’d like to share a quote by Dr. William Osler,

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

Thank you.

Hannah Lim Co, M.D. (UP College of Medicine 2016) is one of the Ten Most Outstanding Interns of the Philippine General Hospital for 2016. She graduated Magna cum laude, BS Biology from the University of the Philippines, Diliman.