Joey M.D.

One serving of alcohol in the form of red wine is fine, even healthy.  I repeat, in moderation.  According to the Dietary Guidelines for Americans, drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days.

But a lot of people go beyond what is considered moderate drinking. Mindless of the fact that it cause a lot of problems.

There are health problems associated with alcohol.  Chronic diseases such as liver cirrhosis (damage to liver cells); pancreatitis (inflammation of the pancreas); various cancers, including liver, mouth, throat, larynx (the voice box), and esophagus; high blood pressure; and psychological disorders are some of these health problems.  There’s also alcohol intoxication, which means “getting drunk” and results in impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.

Drinking and driving is a no-no.  Statistics on victims of drunk driving should make people more careful, but many still choose to be complacent.

Drinking when pregnant cause problems with the fetal development.

Drinking causes problems in relationships and in social activities.

It’s sad, but most people with an alcohol problem do not even think that they have a problem and that Alcohol Treatment is possible.

For people who know that they have a problem and want to get Alcohol Rehab but are ashamed of their condition, it’s also possible to Private Alcohol Rehab. I’m just not sure if this is already available here in the Philippines, though.

But the first step to rehab is to recognize that you have a problem.  Otherwise, you won’t decide to seek help and you won’t get out of the cycle.

I’ve posted earlier about a doctor’s cell phone, why I give out my number and the guidelines to calling or texting your doctor.  That being said, a doctor does need a reliable cellular phone and a reliable cell phone plan.  That’s because we’re dealing with real emergencies out there and people’s lives are at stake.

It does not have to be the most expensive plan out there.  I don’t use a prepaid cellular phone because I’m afraid I might not always have the time or remember to put in load.  but the plan I’m using is one of the cheapest cell phone plans available.  I make sure it’s from a reliable network (not Sprint since I’m in the Philippines but if I’m in the United States that’s probably what I will be looking up since I’ve heard a lot of good reviews about it) and so far I have no complaints about it.

It’s not really how much you paid for it but it’s important that service is more or less continuous.  That’s so you can be sure that you will be reached when your patient is in the emergency room and the resident needs to inform you about it.

I am so busy lately.  But I’d like to think that that’s good.  I’ve started going to a new clinic which looks very promising.

But I’ve realized that I dress to casually for work.  People want to see a doktora looking a little bit on the glamorous side.  They want an image of a successful woman (or man, for that matter).

Since I’ve given birth though, I haven’t exactly maintained my already-not-too-perfect figure.  But I suppose I do need to buy a few pieces of clothes.  I’m eyeing some summer styles since it’s the most practical style here in the Philippines, us having only 2 seasons.  And maybe get some accessories that would suit those new clothes.  I’m so glad we can actually shop online nowadays, with great sites like shopwiki, as my schedule has been VERY packed lately.

I am also browsing through some men’s clothes since I do believe that my husband also needs to update his wardrobe.  He lost a lot of weight (which is good because he used to be overweight) so some of his clothes hang loosely on him.  He’ll look better with clothes that are better fitting.

The reality for us doctors is that no matter how competent we really are, we do need to project an outward image of professionalism and success.  People do equate success with outward appearance.  So do dress your part.

I’ve given my viewpoints regarding the doctor’s cell phone as a doctor and as a patient.  It’s really the doctor’s prerogative whether or not to give out the cellphone number, but if he/she does, do use the info wisely.

• Please don’t call at unholy hours of the night for non-emergencies. Of course, doctors and patients do have different views on what an emergency is, but getting advise for what’s the best vitamin supplement is definitely NOT an emergency and is best texted during working hours.
• Please don’t expect a doctor to ALWAYS text or call back immediately. He/she might be attending to another patient, or doing surgery.  If you are the patient he/she is attending to at the moment, you really won’t appreciate it if your doctor replies to text messages while he’s supposed to be focusing on you, won’t you?  Or, like any other person, it might be inconvenient to reply immediately — he/she may be driving, or answering the call of nature, or in the shower, or even doing his/her darnedest to soothe his/her crying baby.
• If it really looks like an emergency, bring patient to the emergency room. You may text your doctor to inform him/her that you’re on your way to the ER (or you can just leave the informing to the ER doctors, who will update your doctor with the workups).  Don’t expect the doctor to be able to manage the patient through the phone.  Besides the hospital is better equipped to handle emergencies and there are ER doctors on standby who can see and manage the patient’s case immediately, even before your regular doctor reaches the hospital.
• Don’t assume that the doctor memorized everything there is to know about your case.  Try as we might, we can’t memorize every small detail about our patient’s cases.  If the patient is someone we see a lot of times, we have a pretty good idea but don’t expect us to remember the EXACT details.  If we just saw you once a long time ago, we probably have to look at our charts again.  So, there, it’s still best to go to the clinic.
• Identify yourself. There is a limit to cellphone memory and don’t assume that you are there (you might be, but again you might not).
• Don’t consult on the phone! I know people think this saves time and money, but there is really no substitute for actually seeing the patient.  Verbal descriptions are vague and we still NEED to see the problem to give a good assessment of your case.  The phone is for general advise only, not for the particular individual case.

Here in the Philippines, it is now a trend for doctors to give out their cellphone numbers.  Some patients would feel bad if the doctors don’t give out their cell numbers.  So now, most doctors do.  But please use phone the right way.

To give or not to give a cellular phone number?  That is the question…

I do give my cell phone number to my patients. There are certainly pros and cons to doing so, but for me, the pros outweigh the cons.  But then I’m in a specialty (ophthalmology) that does not have a lot of emergencies.  That’s unlike other specialties who deal with more emergencies.  Here are the pros and cons of giving out a cell phone number to patients.  Of course, this is from a doctor’s point of view.  Don’t worry, I’ll be coming up with another article in another blog, this time from the point of view of a patient or a parent (for pedia patients).

Pros:

• Doctors are perceived to be more concerned and caring when they give patients a way to contact them whenever they want to.
• Patients are assured that the doctor is just a call or a text away.
• Patients can look for still look for their doctor even if he/she changed clinics or clinic hours.
• If the medication prescribed by the doctor happens to be out of stock, the patient can immediately ask the doctor about what other medications can be substituted.
• Patient can set or confirm appointments with the doctor.

Cons:

• Patients can call at all hours…even during the times when we are supposed to be resting or sleeping.
• Patients call for emergencies…but sometimes emergencies need to be addressed not by a phone call or text but with a trip to the ER where the proper physical examination and subsequent management can be done.
• Patient use the text/phone call as a substitute for an actual consultation.  There is no substitute for an actual face to face consult with physical examination.  A text or phone consult is good only for general advise, but of course we know that health conditions are NOT the same for everybody.

So, should doctors give out their cell phone numbers to their patients?  It’s up to you, really.  But in this day and age of easy communication, patients will feel much better if they do have a way to contact you.  My view as a patient here.

My experience with giving out cellular phone numbers is not all bad.  In fact, I do believe that I reap more benefits than troubles.  Most of my patients text only when they want to confirm my schedule (I actually encourage them to do especially if they came all the way from a faraway province).  Some patients call me just after the consultation because the medicines I prescribed just happened to be unavailable at the drug store.  Some patients call when there are floods or storms to reschedule appointments.

Maybe it’s because of my specialty, which is Ophthalmology.  We do not really too many emergencies, so I figured that it would be okay if I give out my number.  And true enough, while I have one or two calls about their conditions and who would be happy enough to see me at the clinic or at the ER, I don’t believe I’ve gotten any call that woke me in the middle of the night for some trivial matter.  I guess the case would be different for doctors in specialties like OB, Pediatrics, or any of the Internal Medicine or Surgery sub-specialties.  I know of some doctors who actually get calls at 3 o’clock in the morning asking for breastfeeding advise.  I mean, come on…that is hardly an emergency!  For really really emergency cases when medical attention is needed ASAP, the emergency room is the place where proper consultation and management should be done.  Not an SMS message or a phone call!

As a patient / mom of patient / daughter of a patient myself, I do appreciate it when a doctor gives me his/her cellular number and as much as possible, I try not to abuse the “privileged” information and just use it when there is really a need to.  Here are the guidelines for “proper” cell phone use.

It’s over 5 years since the tsunami which claimed the lives of my uncle and his two young children.  While they were not able to survive that calamity, it’s admirable how the Thais managed to give maximum help to those who were affected.  One of my cousins, who was found with severe injuries but still alive after the tsunami, spent close to 3 weeks in the intensive care unit.  No expense was spared.  She was given the best antibiotics, was hooked to a respirator during all that time, had chest tubes for her hydropneumothorax and was eventually hooked to a dialysis machine, all in the vain effort of trying to save her life.  My aunt, her mom, wasn’t billed anything at all.

While we mourned and continue to mourn for her eventual passing at the young age of 10, we often thought that if it happened in one of the outlying islands here, her chances of survival would even be slimmer, since we really do not have the resources for this sort of calamity, especially outside the major cities.

Now, with disasters happening all around the world, there is a need for an “instant” hospital which would address the need for emergency medical services in such conditions and with so many people affected.  I came across an article describing so called emergency inflatable hospitals (big tents that could accommodate hospital beds) and I thought that we should have something like that here in the Philippines, so that we can immediately address the need for a wide scale calamity.

Maybe the government can add this to either their Disaster Preparedness Fund (or whatever appropriate division), aside from rubber boats for floods and helicopters for rescue missions.

Source:  http://news.discovery.com/tech/creating-hospitals-from-thin-air.html

It may be at the doctor’s office.  Much as we do not want patients to be inconvenienced by waiting, sometimes there is really no way around it.

In one of our clinics, we have various stuff to try to keep patients and their companions occupied:  we have wi-fi access, newspapers and magazines, a couple of television sets and DVD players and also a small coffee shop.  However, not all clinics have these facilities.

Remember, I was also a patient in a lot of different occasions.  These are what I do to ease the boredom of waiting:

• SET AN APPOINTMENT if possible.  This will considerably cut down on the waiting time.  (vs walk in)
• Bring along a book that I’ve been wanting to read for ages but have never gotten the chance to.
• Look over the text messages I’ve received the day before and reply to those that I haven’t had the chance to.
• Write a couple of passages in the “notes” section of my cellphone.  If I have a lot of ideas, these just might become a basis of a future blog post or even the blog post itself.  Or maybe a future book?  It’s free to dream anyhow
• Chat with my companion.
• Play games on my cellphone.
• People watch

For me, these are general things that we can do while waiting, whether it’s at a doctor’s office, at the airport, at the bank while waiting for your turn (although I guess you can’t do things with your cellphone when you’re in a bank), or wherever you have time on your hands but you cannot just go away.

What would YOU do if you have to wait at a doctor’s office?

(Mylot thread here.  Plurk thread here.)

Tonight, we’ll be going to my grandma’s house for our traditional New Year’s Eve dinner.

I am so glad I am no longer a clerk, an intern or a resident, and that my specialty has very few emergencies, which means that I am neither on duty or on call tonight.

Aside from the fact that I will be missing our annual New Year’s dinner if I’m on duty, I also dread the thought of seeing patients coming to the ER with injuries related to firecrackers.  Unlike ER consults due to real sickness or maybe vehicular or other accidents, firecracker injuries are, for the most part, self inflicted accidents.

But I guess it’s deeply rooted in the Filipino psyche that these extreme noisemakers are a must to welcome in the New Year.

I would be a hypocrite to say that I do not enjoy the occasional show provided by these “lights and sounds” but I’d rather be a spectator rather be the one to light these.  I’d admit that I was more daring when I was younger, but after seeing numerous injuries brought about by these, I started to question that tradition.  Of course, nasa huli ang pagsisisi (regrets always come after the fact) so people won’t really stop with the firecrackers unless they or someone they love loses a limb or an eye.

I’m repeating myself, but I’d rather that people don’t light firecrackers on their own and just simply enjoy the numerous fireworks displays around the city.  But if you really, really must, please protect yourself as much as possible, even to the point of exaggeration.  Wear eye protection (when I was a resident, we had patients whose eyes had to be removed because they got destroyed by firecrackers), use long lighting sticks, run away fast, and don’t use up the remaining powder the next day.

As for me, I’d rather stay indoors with all the windows closed and the aircon running.  There’s a fireworks display later and the window in our room just happens to face that direction.  We’ll just stay up and enjoy the view.

Stay safe, everyone!

Sometimes I feel a little bit frustrated that my medical license is not really borderless.  My prescription would not really be recognized outside my own country.  While I understand this because it’s true that I am only licensed in my own country and not outside its borders, it does create a lot of inconveniences for the patient.

I remember several years back when my mom had an eye irritation while she was abroad.  She called me up long distance to ask about it (since I’m aware of her history and I am an ophthalmologist).  I told her my opinion and told her to get a certain eye medication.  However, that particular eye medication was prescription only and even I did give her a prescription via courier, that still would not be recognized.  She had to see a local ophthalmologist for her problem and to get a prescription so that she can buy from a Canadian Pharmacy.  Since she was just a tourist, she had to pay the doctor’s fees out of her own pocket.

I wonder if there is a way that we could sort of “universalize” our licenses.  Of course, it’s not in the sense that we actually practice in another country even if we don’t take their board exams.  I understand that it would be quite impossible for that and it’s reasonable to request that physicians take the local board exams if he/she wants to practice in a certain country.  What I mean is that our prescription might be recognized by pharmacies around the world.  This is especially helpful for patients who travel and who have regular medications that have to be maintained all the time.  Examples for this would be meds for hypertensive or diabetic patients, or patients with glaucoma — these diseases require constant control.  It would be a great help if their medications could be refilled in another country without having to go through seeing a doctor, especially if it’s just for a refill.

For retail therapy enthusiasts, the Christmas gift giving season is the perfect excuse to go out and indulge your shopping tendencies.

However, shopping may also become quite a bit stressful…and you know that stress is just not healthy at all!  Of course, some people may argue that shopping actually relieves their stress!

Here are a few things I’ve learned through the many years of Christmas shopping to lessen stress.  I don’t always practice them all the time but when I do, my stress level isn’t really too bad at all!

1. Make a Christmas list.  Classify them as family, inaanaks, friends, colleagues etc. and try to prioritize them.
2. Set a budget! Write down how much you are willing to spend for each person.  And do try to stick to the budget!
3. Shop early! If you happen to see the perfect gift for somebody, buy it and save it even if it’s only October.  Then you can put a check mark on that person’s name. :)  Also, malls and the good old Divi tend to be VERY crowded during December, so I generally do not want to go there at around this time.
4. Buy in bulk. If there are several kids on your list of the same gender and age group, chances are they might have the same interests.  You may buy the same gift for them.  You might even get a good deal when you buy from tiangges or Divi!
5. Shop online. You might find things online that would be good for your recipients, without stressing about having to brave the traffic and the crowds at the usual brick-and-mortar stores.  A new resource is http://www.tianggeonthenet.com , it’s new but is aiming to be THE place to find online stores.  Another advantage to online shopping is the ability to compare prices without the salesladies bothering you every so often (a peeve of mine).
6. Don’t bring the kids! So you can concentrate on shopping.  It’s difficult to shop when you have to run after a toddler or feed a baby.  Also, you have to deal with “buy me…” which would seriously alter your budget.
7. Don’t shop hungry. You need the stamina to shop.  So eat first before heading out.  Also, you wouldn’t want to waste time AND money on snacks when you can just
8. Avoid the crowds. I like hitting the tiangges as soon as they open in the morning, when the office crowd is at work.  Of course, that’s because I have some free mornings.  This won’t work if you’re a part of the office crowd, though.
9. Keep crisp bills on hand. And ang paos (Chinese red envelopes) too.  You might just forget an inaanak or a niece and these will certainly come in handy.  Aginaldos from ninongs/ninangs (godparents) are always welcome.
10. Keep “generic gifts” on hand. For those times when some friends drop by your house and you haven’t prepared gifts for them.  Do have some on hand and “color code” the wrappers.  For example, you can have a dark blue wrapper for gifts for men, red wrapper for women, baby blue for boys and pink for girls.  So you can just pull suitable gifts from under the Christmas tree for those unexpected moments.
11. Recycle gifts. I know a lot of people frown upon this, but really, sometimes it’s the practical thing to do.  While a pretty blouse may be in a style you like, your friend might have picked the wrong size.  You can instead give it to your teenage daughter who’s much slimmer than you are.  Or maybe a well-meaning friend may have given you an over toaster, but you just happen to still have 5 more oven toasters that you haven’t even used.  You can perhaps give it to somebody else who may find it more useful.  Here’s an article on my other blog on the art of regifting.

What about you?  What do you do to keep your mandatory Christmas shopping as stress-free as possible?