Relative Joy

[PARENTAL GUIDANCE IS RECOMMENDED.  THE LANGUAGE USED MAY BE INAPPROPRIATE FOR CHILDREN]

It’s never appropriate to give away your personal mobile number to patients. Unless the number you give is an office phone, or you have a personal secretary whom patients can get in touch with, then yes, it’s never appropriate to give away your personal phone numbers.

Patients will ALWAYS want to know how to get in touch with the doctor. I get that. Many, usually ask for your mobile number – just in case – they need to get in touch with you when they or their kids get sick.

Ever since I started my practice, asking for my personal number has been my number one pet peeve. “No you may not have it. On my card is the number of my clinic where you can contact me during office hours.”

During the earlier days when the pager was still in vogue, I didn’t mind that my pager number was emblazoned on my calling card. After all, it was one anonymous number and the patient had to get through another anonymous person who would filter the information that would be sent to me. It’s like having a private secretary that you needed to go through before I got the “emergency” message. My pager would vibrate. The message would appear. And I could call from my landline or phone (there were no Smartphones then), wherever I was. Or I would just save it for later if it wasn’t urgent.

But technology would change the landscape of clinical practice. Gone were the days when you were the CEO of your own private practice. Smartphones and tablets changed the way you dealt with patients. There are medical professionals who have “professionalised” their medical services providing online “consultations and opinions”.  Some take it a level higher by being able to “Viber” or  FaceTime with patients as well! And here’s where it gets really tricky and icky.

I have no quarrel with technology. Just where and how it’s used.

1. Personal space and professionalism is important

Doctors have a personal life. When the patient has an emergency, I am not 911. Take them to the nearest hospital. They should know what to do there. For the younger ones who’re trying to give away their personal numbers so that they can create a following (or a patient base) – DON’T! You’re making yourself open to liabilities and law suits by acquiescing to the patients desires. Keep a professional distance.  If they can pay to go to the hairdresser and queue to watch a movie, I think they can pay for a professional medical/surgical consultation. NEVER EVER GIVE A DIAGNOSIS TO A PATIENT YOU HAVE NOT PHYSICALLY EXAMINED OR SEEN.

I will tackle a general pet peeve on mobile phone use etiquette another day. Remember, you don’t have a right to call anytime you like. Because there is a text messaging service, kindly text first if the party you are calling can take your call. If they don’t reply in the next 5-10 minutes, it means they’re busy. Don’t call just because they don’t respond. If it needs attention, resend the message after 5-10 minutes. We may be seeing other patients or watching a movie or having fun with our family or cooking dinner or sleeping. We have a life, too.

The rule of thumb is – if it’s urgent or an emergency, take the patient to the hospital.

2. The email has landed… together with shit

So the Smartphones have made it “business is open” 24/7 for everyone.  It’s like a “pager” all over your precious space.  It’s all over my business card anyway, so I allowed it to be part of how to “contact” me.  And with “data” being cheaper than SMS services, it was fine, until the day I received a lot of shit in my email. I meant, literally, SHIT.  Pictures of their baby’s SHIT! SHIT! SHIT! and more SHIT!

Some moms thought that sending me those gross looking shit enveloped by a diaper would make me clinch the diagnosis.  It’s like an online revalida! I had questions to ask – did he have a fever, were there precipitating situations that made your boy poop green turd, is there any form of pain, are there rashes, what was his last meal? Of course, I wanted to ask if there was a stethoscope lying around in the house and could she listen to his tummy and tell me if the boy had hyperactive or normoactive or hypoactive bowel sounds.  Feel his tummy and tell me, is the liver big, can you feel the spleen, is there a mass, is there direct or indirect tenderness? Oh by chance do you guys have an ultrasound machine lying around in your house as well? Coz if you do, can you get to do an abdominal ultrasound while you’re at it?

The email just threw my whole textbook of physical examination and history taking out the window! All because the mother was worried about the turd!

The rule of thumb is – if it’s urgent or an emergency, take the patient to the hospital.

The second rule of thumb is – for God’s sake, take him to the nearest doctor in your area. I won’t mind!

You don’t have to flash all that turd or take naked pictures of the body and send it by email for me to give you a “provisionary” diagnosis. And hopefully get a prescription.  Some of these people will even exchange emails with you when you tell them that they need to bring the child to the clinic.  The favourite excuse? CODING!!!!!

I’m like, come on, if you feel that the kid is really sick and you need to go to see a doctor, I don’t think the traffic officer will try to stop you.  If he does – SHOW HIM THE F*CKING TURD YOU SENT ME BY EMAIL AND THROW IT IN HIS FACE!

3. Time is precious

A few years after I started my practice, I tried implementing a “by appointment” system.  That meant that patients who wanted to be seen without having to wait could do so by setting up an appointment (instead of the first come, first serve basis).   That’s because patients were complaining that the queue was too long. There was no cut-off.  They had other appointments to go to. And so on and so forth.

Did it work? NO!

Sadly, I think I was either ahead of my time or that this kind of system is unfit for Filipino patients.  Why did I say it did not work? It’s like this – they liked to make appointments, BUT 99% DID NOT BOTHER TO CALL IF THEY WANTED TO CANCEL!!! It’s soooo Filipino.  It’s like sending out an invite with the letters RSVP in bold.  You think they’d even bother calling to say they’re not coming? NO!!

The rule of thumb is – make sure that you respect each other’s time (both doctors and patients). 

I hate it as well that when a colleague says that his clinic hours are 10AM-12NN, he arrives tadaahhhh – 1PM!  We need to be conscious of other people’s time. Professionalism dictates that we observe the time of our patients as well.  After all, they have a life as well.  We all need to be somewhere, somehow, doing something that is important to us. If you’re running late, let the secretary know so that the secretary can inform the patients the time of your arrival. Let’s all respect each other’s time and space.

Of course, that means there’s the patient who’s also running late. Very very late. So when I say that clinic hours are 10am-12nn, it means that the last patient must come before 12nn because I need to leave at 12nn. But no!! Some of them pile up at 12nn so that they think they’re the last patient and won’t have to queue. (A separate blog on queuing is on the menu.) And the patients get irritated that they’re not the last to be seen. Five of them arrive at exactly 12nn. And there are still 2 more on the way. Each hoping to be the “last” patient for the morning. And that my friends is why the doctor is late for his next clinic at 2pm at another hospital.

4. Dear Google 

The internet has made everyone a keyboard warrior.  We’re only a few taps away from asking what the diagnosis of Burkitt’s Lymphoma or Kawasaki Disease is.  Press search and your friendly reference Google will help you find 1,000,000 hits in less than 1 second.  What do you do with all these references? Without appropriate training on how to critically appraise the published literature, the typical patient will scan through the easiest to understand (read – written in layman’s terms) or get discombobulated with the complex terms.  The next day, they’re at your clinic, all anxious and worried that their lives or of their children are about to end. On one hand is a whole envelope of print outs from what was downloaded last night! And they have a million questions…

They are, after all, within their right to ask.  That’s why there is a consultation.  How you face Google as their defence attorney is another matter altogether.

The rule of thumb is – Google is not a doctor.  Wikipedia is not a good reference material (READ: ATTENTION MEDICAL STUDENTS).

Which goes to the point of keeping up with the changing paradigms in the practice of your specialty or subspecialty. It’s called CONTINUING MEDICAL EDUCATION. Medicine is not an exact science.  There are hits and misses.  Mostly hits.  But we need to make sure that we are updated in our practice.  Because the patient sure is! And it would be shameful that when you’re caught with your pants down where the patient knows more than you, they’re probably not going to go back to you or recommend you.  It would be doubly shameful that you try to get around the fact that you didn’t know the reply to the great question your patient posted, by LYING through your teeth.

Remember, we’re all entitled to second, third, and even more opinions of our clinical condition.

The second rule of thumb is – Brush up on your practice. Take your Continuing Medical Education seriously.  Patients deserve nothing less when it comes to treating them.

Technology may assist us at organizing our office files and databases and create better efficiency in the hospitals and clinics. It is NEVER, however, the best way to assess the health of your patient. And not seeing the patient and fully examining, yet providing a prescription treatment through text messages or emails that later results in an adverse reaction is a recipe for disaster and a law suit.

State-of-the-art gadgets, equipments and medical devices are useless if what is between those ears are empty.

A gentle reminder. If your doctor gives you his/her personal mobile number – don’t abuse it. It doesn’t mean you’re besties already and that you need to send a text even at an ungodly hour or when he/she is out of the country (yes – we pay the roaming charges not you), if and when you need to. Proper decorum dictates that you treat each other in a professional manner or find someone who’s willing to live up with your expectations.

Being considerate is highly appreciated.

p.s. Don’t use the messenger on FB or other social media apps to get in touch with your doctor. It’s rude.