It’s Just a Matter of Perspective.

Very recently, a doctor named Josebelo Chong who is now based in the United States made a blog entry in response to my previous post. It is an interesting read from the perspective of another Post-Graduate Intern who had a different experience when he had his internship in UP-PGH way back in 2002.

To those constantly texting, emailing, and sending me messages on Facebook, here is my response:

 

Screen Shot 2014-04-29 at 1.20.05 PM

 

 

Also, a close friend and blockmate Dr. Kay Rivera made this amazing entry entitled UP Medicine: the (un)easy life -a good read about UPCM and UP-PGH internship from the perspective of a UP Grad!

 

At the end of the day, how we experience life is just a matter of perspective. May we always choose to see the goodness in everything that comes along our way.

 

God bless! 🙂

 

 

10 Reasons Why Medical Graduates Should Aim To Do Internship at the University of the Philippines – Philippine General Hospital (UP-PGH).

Photo by Dr. Mario Bes (DFCM Chief Resident)

Photo by Dr. Mario Besa (UP-PGH DFCM Chief Resident)

 

Ever since the first week of my post-graduate internship at the UP-PGH, I have had a number of friends from the UP College of Medicine (UPCM) who were constantly asking these questions:

Of all hospitals in the country, why PGH?

Hey Fred, how are you? No regrets yet?

Yet even before internship started, I already had these answers in mind:

I have always wanted to train in UP-PGH because I would want to see as much patients and as much variety of clinical presentations of disease entities as I can. What better venue of achieving this goal than in UP-PGH? As they always say, “Kung hindi na kaya ng lahat, ipapadala din yan sa PGH.” (If other doctors / hospitals can’t handle it anymore, they will eventually send the patient to PGH).

Being accepted in UP-PGH, I have never been happier and fulfilled as a medical doctor. Regrets? How can I regret something I have always wanted?

 

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Now that graduation from internship is just a few days away, I think I can say with evidence and confidence that PGH is “the place to be” for fresh medical graduates looking for a hospital to have their internship. Here are the top 10 reasons why:

 

1. You will train with, and be guided by the best of the best. We can’t deny the fact that the University of the Philippines is a place where most, if not all, of the brightest people in the country get accepted and enroll. So yes, if you do your internship here, you will be amazed how sophisticatedly intelligent they are –but DO NOT BE INTIMIDATED. They are generally nice people, and they will be your co-interns –which means, you’re just on the same level ground, no one is superior to the other. And we should always remember that becoming a good doctor is not just about intelligence, but is more of diligence –something all of us, whether you’re from UPCM or not, have equal chances of doing.

Just like you, your residents have been thoroughly screened before being accepted, and are stellar in their own way. So expect to be guided and taught really well. The intern – resident relationship in UP-PGH doesn’t have that kind of hierarchy like in most other hospitals where an intern can only speak to a first year resident, a first year resident to a second year and so on. In PGH, even medical students ask questions to consultants during conferences! And take note, the consultants in UP-PGH aren’t just any consultant, but they’re mostly the people behind Clinical Practice Guidelines being promoted by the different medical specialty and subspecialty societies used by all doctors in the country!

 

With Dr. Elizabeth Jacinto, Trophoblastic Disease Specialist and Author of POGS guidelines for Gestational Trophoblastic Diseases

[OB-GYNE Tropho Rounds] With Dr. Elizabeth Jacinto, Trophoblastic Disease Specialist and Author of POGS Guidelines for Gestational Trophoblastic Diseases

[PEDIA SGD] Discussing TB Meningitis with Dr. Ma. Liza Antoinette M. Gonzales, Author of Philippine CPG for Treatment of TB Meningitis Treat

[PEDIA SGD] Discussing TB Meningitis with Dr. Ma. Liza Antoinette M. Gonzales, Author of Philippine CPG for Treatment of TB Meningitis

On Duty with Board Topnotcher Residents

[IM] On Duty with Stellar and Board Topnotcher Residents (Dr. Faltado, Dr. Gauiran, and Dr. Samala)

2. SERVICE and LEARNING has, is, and will always be emphasized. UP-PGH is a government hospital under the management (and budget) of the University of the Philippines – Manila. If you are a person hungry for patients, this is the place for you. There is an overabundance of patients, and it can sometimes be tiring. BUT, just imagine the lessons each and every patient can teach you. For instance, if you see at least 10 different new patients everyday, and learn from each patient 5 new things, then that means you learn 50 new concepts every day!

You might think that you won’t find time to study due to the patient load, but I will argue with you with this thought: Finding time to study is a matter of choice. It’s like eating –if you choose not to eat, then you will end up hungry. If you prioritize food, then you will not starve. If it sometimes gets too tiring to hit the books after duty, worry not my friend –the DAILY endorsement rounds with residents and consultants in UP-PGH will teach you very important clinical pearls and must-knows as a clinician.

 

[SURG] Usual day at the ER

[DEM] Usual day at the ER

[PEDIA - NICU] Daily Teaching Rounds

[PEDIA – NICU] Daily Teaching Rounds

3. You will have boundless opportunities to help people. Majority of the patients in UP-PGH are underprivileged in a lot of aspects –not only are they financially-limited, but most of them were not able to finish basic education. Some people may think that these are limiting factors to our work as medical practitioners since patients won’t be able to do expensive diagnostic exams, and most of them do not even have any idea what their disease is all about. I challenge you to change your mindset and think about it this manner: you will be forced to use your clinical decision making skills in managing patients in the least expensive means using cost-efficient and cost-effective ways –simply put, you will master (and yes I say MASTER) the science and art of history taking and physical examination. In the current trend of medical practice where doctors are so quick to order diagnostic “baseline” tests, in PGH, you will be trained to only do the ESSENTIAL laboratory exams. As Dr. Bryan Lim (UP-PGH IM Resident) said, “It is through your patients’ lack of resources that you will be trained how to be resourceful.”

With regards to your patients’ lack of education, imagine the opportunities for you to teach them about health. You will be amazed that people from all walks of life have different health beliefs and misconceptions. UP-PGH’s Department of Family and Community Medicine will instill in us that we always respect the beliefs, but through patient education and counseling, we will always have the chance to correct the misconstructions. You might think that this is something petty, but believe me, what we teach our patients go a long way in their lives and in the lives of their families.

 

[PEDIA] Ward 11 Team

[PEDIA] Ward 11 Team – Tired but Happy and Fulfilled

4. Your good deeds will be highly appreciated. People in UP-PGH are generally good-natured. You will be surprised how residents and patients alike would commend you for a job well done. Correct me if I’m wrong, but as far as I know it is only in UP-PGH that residents write notes of appreciation to clerks and interns on the patients’ chart as part of their entry!

 

[PEDIA - NUERO] A text message from the mother of one of my patients in the wards. After being in the hospital for nearly a month, they finally got discharged!

[PEDIA – NUERO] A text message from the mother of one of my patients in the wards. After being in the hospital for nearly a month, they finally got discharged!

[IM] This left me speechless. =)

[IM] This left me speechless. =)

5. You get the chance to ACTIVELY manage patients as if it were your own. In UP-PGH, interns (and clerks) are always told that they are in the hospital not just to carry out orders, but as part of the health care team –this means that you can always “suggest” your plan of management for your patient. If the resident agrees to your suggestion, then he/she will note on the chart that your orders be carried out.

 

[PEDIA] Little things that make my day. =)

[PEDIA] Little things that make my day. =)

6. You will be able create wonderful friendships with people from all over the country. UP-PGH is a place where doctors from all parts of the country come and train. If you are friendly enough to bond with them, when you guys graduate and practice in your own provinces you will have friends from different parts of the country that can make your networking strong and can help you establish your linkages whether it’s for work or leisure.

 

[IM] NICU Rounds

[IM] NICU Rounds with Stellar Clerkies and Dr. Magallanes!

7. UP-PGH isn’t all about work. You will have SUFFICIENT TIME to study and even go on long distance trips every once in awhile. Work in UP-PGH is generally tiring (especially on your Big-4 rotations, special mention to IM and Pedia wards) but ALWAYS fulfilling. And hey, in between these big rotations are the benign ones where you will have the chance to have free weekends! This is possible because first, the interns are the ones making the schedule. And second, it doesn’t really matter “who” is on duty, but more importantly, the job at hand “gets done.” So talk among yourselves, cover each other up, and everyone is happy with their weekends off.

 

[Block W] Party party!

[Block W] Party party!

[Jonas' Block] Chillin at the beach like a gangsta.

[Jonas’ Block] Chillin at the beach like a gangsta.

We do sleepovers...

We do sleepovers…

 

[BLOCK W] And, we do road trips as well. <3

[BLOCK W] And, we do road trips as well. ❤

8. The hospital environment will keep you grounded not only as a doctor, but as a person. Interns in most hospitals in the country are being call “Doc” –a word that somehow makes us feel being placed on a pedestal and a bit superior from others. In UP-PGH, people will call you “Sir” or “Maam.” Do not be offended. It is not there to put you down or to disrespect you because this is how we also address our residents and consultants. I think the concept behind this is to inculcate in our minds as early as clerkship and even as you become a consultant, that as a medical doctor, we may be the leader in our patients’ management, but we are also PART of the team, just like the nurses, the nursing attendants, the midwives, the manongs, the residents, the interns, and the clerks, and that each one of us, regardless of position, have an EQUAL responsibility to provide the highest possible quality of care to our patients.

 

[OB] Post-Conference Bonding with Residents, Fellows, and Consultants

[OB] Post-Conference Bonding with Residents, Fellows, and Consultants

9. The system will make you realize that a lot of work still needs to be done in our country. UP-PGH will open your eyes to both the good and the bad in the healthcare of our country. It may make you frustrated when, as a triage intern, you’d have to turf (verb: meaning “to send away” or “to force someone to leave somewhere”) patients who came all the way from Ilocos to the PGH ER for cough and your assessment is Community Acquired Pneumonia – Low Risk. You would think “How in the world is it even possible for a person with simple cough to travel for 12-14 hours just to be seen by a doctor?”

There will be days when you’d receive patients with Uncomplicated UTI at the OPD and it will make you wonder how the health system of this country really works. And how a patient with a disease that can be managed by a rural health unit end up at the OPD of a tertiary hospital. Yes, indeed, you will realize that a lot of work still needs to done in this country. And you would only know its gravity and urgency, if you’ve experience its severity.

 

Interns and Residents at the PDAF Rally

Interns, Residents, and Consultants at the PDAF Rally

 

10. PGH will not just hone your skills and intelligence, but more importantly, it will help you build your character. On top of the usual daily rounds and conferences, below is a list of the nitty-gritty things that interns generally do at UP-PGH:

  • At the start of every rotation, all patients of a department you are currently rotating in will be divided among interns (and clerks if they’re around) –eg. 80 patients in IM, 10 interns = 8 patients per intern.
  • You will be called “SICs” or Student-In-Charge of those patients.
  • Everyday when you report to work, you do rounds and make SIC notes on each of your patients IDEALLY BEFORE your residents do their RIC notes. If your resident agrees with your chart entry, he/she may countersign your entry (and for many, this is a defining moment of an SIC). If your RIC makes his/her own notes, its either your RIC is just super diligent, or he/she does not agree with your entry. Try to read between the lines.
  • SICs carry out all the orders for each patient –this starts with making laboratory requests and making sure they are paid by your patients; facilitating CT scan, ultrasound, and xrays. If they can’t pay, you make sure they are referred to Medical Social Services (MSS). By “making sure” it means that they know WHEN and WHERE to go. Interns are also responsible for extracting blood samples from their patients, and see to it that all specimens are sent immediately to the lab. Yes, you will master the art of doing ABGs, even to newborns.
  • SICs do the necessary referrals –which includes two referral slips, and one abstract. Some departments have specific forms –good luck if you’re tasked to do an Infectious Disease referral!
  • Interns (together with clerks) do the Q15min, Q30min, Q1H, Q2H, and strict Q4H monitoring of patients in all departments, including special posts like the Cancer Institute and the Recovery Room. When I say monitor, I mean taking their BP, CR, RR, Temp, SaO2, and Neuro VS for neuro patients.

 

[IDS Referral] Make sure it is filled up completely. Otherwise, it will be rejected! Good luck.

[IDS Referral] Make sure it is filled up completely. Otherwise, it will be rejected! Good luck.

In other hospitals, interns don’t really do the routine vital signs taking of patients, referrals aren’t that hard to do, and medtechs do all the blood extractions from patients.

So what does an intern get from doing all these? And why am I still urging you to enter UP-PGH? Let me remind you that you are doing INTERNSHIP, and not “observer-ship.”

You may feel discouraged to enter UP-PGH because of the bulk of work an intern does within its walls, but hey, isn’t this why we wanted to become doctors in the first place? So that we can help the needy and the least fortunate?

 

[SURG] A reminder at the OPD.

[SURG] A reminder at the OPD.

Here, we do not stand and watch, but we actively participate. We do not blindly take the vitals of our patients, but we talk to them, we become friends with them, and in the process we become their allies in health. We do not simply extract specimens for the sake of extraction, but we learn the art of comforting them and a feeling of genuine concern that heightens rapport is established.

In UP-PGH, acquiring skills and theoretical intelligence is already a given, but I think what’s more valuable is the opportunity for you to build your character –a character not only of honor and excellence, but also of humility and discipline.

If there’s one thing I’ve learned in my one year of internship here at UP-PGH, it is the fact that in life we will always have a choice, and we can always choose to place ourselves in situations that bring the best out of us, or we can choose mediocrity and forgo the chance of maximizing our potentials.

The choice is yours. And whatever you choose, I pray that you find true happiness.

 

With my block -the best block ever.

With my block -the best block ever.

 

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Intern Fred Ting, signing out. =)

Intern Fred Ting, signing out. =)

Intern Fred Ting, together with all the other post-graduate interns and UPCM Batch Labing Apat Walang Katapat signing out in 7 days. Highly appreciate our clerks, residents, fellows, and consultants!

 

#100%fortheboards #100%UPCM #100%UP-PGHinterns

Ang pagbobomba.

Ako’y dumating sa ER kaninang umaga

At sa isang sulok may batang kawawa.

Ang kanyang ina ay nangangamba

At unti-unting nawawalan ng pag-asa.

 

“Ate kamusta po kayo?”

“Okay lang.” sagot niya kahit papano.

Pagkatapos ng rounds, “Sir, pa-bag naman.” sabi ng residente,

At ako naman ay wala nang nasabi.

 

Naku patay tayo!

Ang dami namang trabaho ang mababacklog ko.

Sapagkat ang oras ko ay magagamit sa pagbobomba,

At ang procs at monitoring ko ay mapapabayaan nang sobra.

 

Pero noong kinuha ko ang bomba sa kamay ng kanyang ina,

Siya ay tuwang tuwa at siya ay nakapagpahinga.

“Salamat Dok.” ang unang buka ng kanyang bibig

At sa akin siya ay nakatitig.

 

“Walang anuman.” lang ang aking nasabi,

At siya ay umupo sa aking tabi.

Sa aming pag-uusap, aking natuklasan na siya ay single mother.

Dito na ako sobrang na-bother.

 

Hindi niya na daw alam kung ano pa ang gagawin,

At sobrang pagod niya na at hindi pa nakakain.

“Sige kami na muna dito, pahinga kana.”

Pero ayaw niya na ang kanyang anak ay walang kasama.

 

Grabe talaga ang pagmamahal ng ina,

Damang dama ko sa aking nakita.

Dahil dito aking na-alala,

Ang rason kung bakit ako naging doktor sa simula.

 

Andito tayo dahil gusto nating tumulong sa mga may sakit at nangangailangan,

Kahit sa mga maliliit lang na paraan.

Ugaliin sanan nating mahalin ang ating obra

Kahit ito ay ang napakasimpleng pagbobomba.

 

Ang bomba.

Ang bomba.