Medicine is practiced differently around the world, and yet some aspects — especially the frustrations — are fairly universal. Where better can you experience the similarities and differences than in the blogging world, where clinicians share stories from their practices and their personal lives? Two physician bloggers, known as “Dr. Dino” and “Dr. Emer,” provide a unique contrast.
When we last caught up with Dr. Dino, he was comparing life as a solo primary care practitioner to that of a dinosaur, slowly watching his species succumb to the hostile environment. He still posts frequent lamentations on the state of American medicine:
Apparently there is more money spent in this country on Viagra, other ED drugs and breast augmentation combined than there is on Alzheimer’s research. I suppose that means eventually everyone will be walking around ready for sex, but won’t remember how to do it. (Or if they do remember how, they won’t have any idea when they last did it.)
A recent post unleashed his fury at a pharmacist who interfered with his patient:
To the friendly, trusted neighborhood pharmacist who told my 74-year-old diabetic patient with coronary artery disease and arthritis to stop his Zocor because maybe that’s what was making his knees and hips hurt:
You … moron! Do you have any idea how hard I worked to get this guy to take this stuff in the first place? Do you know how long it took, how many visits over how many months of teaching, explaining, describing, convincing, persuading, cajoling and begging to get him to agree to even try this medication in the first place? Are you even aware of evidence-based guidelines that recommend statins for patients with diabetes and CAD?
As often happens in the blogging world, that post was mentioned on a pharmacist’s blog, generating significant controversy and discussion, and prompting a follow-up post from Dr. Dino:
I’d just like to point out that obviously many doctors are idiots. Uneducated front office staff calling in prescriptions must be maddening; illegible handwriting, nonexistent dosage forms and ridiculous quantities are certainly infuriating; waiting on hold over and over to clarify these things — while saving the necks of ungrateful patients — surely earns you millions of karma points towards your halo…
It just so happens that there was this one particular patient who really really really needed a cholesterol medicine, and with whom I spent an inordinate amount of time carefully explaining exactly why he really really really needed it. So when this particular patient reported that a pharmacist (actually not one but two) told him he should stop taking it…I did not in fact go ballistic in front of him, but rather spent another extended visit explaining why he didn’t have to take it if he didn’t mind being at increased risk for another heart attack; and succeeded in persuading him to go back onto a different statin, as it happened. Still, there was exasperation, and the blog provided a fun way to let it out.
But for every rant or complaint, he notes the special, intimate nature of this type of practice, as when he made a connection with a middle-aged patient who worked on computers:
“Look,” I began, “If you really don’t want to take another pill, that’s ok. Your cholesterol isn’t that terrible, so I don’t feel that strongly about it either way; but hear me out.
“I’m talking about optimizing your health by fine-tuning all your risk factors, so instead of just being ‘ok’ they’re the best they can be.
“Say I have a computer here, and you notice it could use some updates; maybe some security or other maintenance stuff that — even though it’s working well enough for my needs right now — would fine-tune it, enhance its performance even if I don’t notice anything actually wrong with it; perhaps head off some trouble up the road. I’m sure you see machines like that every day.”
He nodded.
“Now, what if my response to your offer was, ‘No way! Every time someone screws with my computer they mess it up. It’s working fine; just leave it alone!’ I’m sure you meet people like that all the time.”
He looked like a man in a V8 commercial who had just slapped himself upside the head.
Like Dr. Dino, Filipino physician and blogging pioneer Dr. Emer also has a few things to say about the state of healthcare in his country. His blog, Parallel Universes, routinely chronicles perceived inefficiencies and absurdities he witnesses. Faced with a brain drain to the United States and growing economic disparity with neighbors, Dr. Emer is grim about medicine in the Philippines:
In Medicine, we use stages to describe the severity of a medical condition. Stage I is the mild stage while Stage IV or Stage V usually connotes a dire clinical condition. To use the analogy, I’d say Philippine healthcare is hovering somewhere between Stage III and Stage IV.
If I were the attending physician of this ‘patient’ called Philippine healthcare, I think the condition is not that hopeless yet, but as social problems pile one on top of the other, or as surprise epidemics and unexpected calamities occur and join the fray, I am very, very bothered about how my patient [teeters] on the brink of death everytime.
Another source of my extreme bewilderment is WHY the ‘patient’ isn’t being moved to the ICU (intensive care unit) yet?
Why the seemingly cool nonchalance by almost everyone?
Everyone says there is something wrong. Everyone knows there IS something wrong. Everyone agrees something must be done. Yet, nothing we can describe as a “great solution” or a “curative approach” is being implemented as soon as possible.
But like Dr. Dino, Dr. Emer is able to take the good with the bad, as when he reflects on his love of country:
In the US and Europe, if you wanted rice or calamansi or patis or bagoong, you still have to go to an Asian store or Filipino store to get these items. You will always be surprised also how expensive they are there. Here, as long as people know you, they treat you like family. In case you have not noticed it yet, Filipinos are very personal on all matters, because of its family-oriented society. Once someone is a friend, he/she automatically becomes a Tito, Tita, Ate, Kuya, Nanay and Tatay — all terms of endearment addressed to family members. Here, laws are not enforced fully because everyone thinks that since we are one big family, there’s no need to be so serious about enforcing it. Hence, one can always cross the street even if there’s no pedestrian lane, or one can always park anywhere even if there’s a No Parking sign planted nearby.
Reviewed by Dr. Ramaz Mitaishvili
