Time to Dance with Reality

First of all, I would like to thank the Lord, St. Cupertino, St. Ignatius of Loyola, St. Clare of Assisi and Our Lady of Manaoag for guiding me as I prepared and successfully passed the medical board examination. Two weeks ago, I was so happy upon knowing that I have passed the board exams. Tears of happiness flowed from my eyes endlessly. I went to all the celebration events that were happening. After the Blue Toast, the reality strikes in just like lightning.

Everyone is going crazy about all the deadlines! With everyone going into residency, I got a taste of the pressure as well. Last week, I know I am not ready to go into residency just yet. Knowing what I have been through Medicine, and how it burned me out mentally, emotionally and spiritually, it is best that I would not go into the same battle again unarmed. Before I get into the same fiasco, I want to be recharged and excited to be finally achieving my dreams. Yes, there will be disappointments and questions of "Why am I not going into residency?" I firmly believe that 3 months may be enough for me to rest but it is not enough for me to consider all of my options. I doubted myself many times as I was studying for 5 years. I even thought of quitting med school during my 2nd year of training. But I said, just swallow it and finish it! Then again, I had the same doubt and frustration in Clerkship. But all went well during my Internship (thanks to my group too).

For residency, my top 3 choices are: (1) Pediatrics, (2) ENT-HNS and (3) Radiology.

Pediatrics: I love working with children. It has been a part of me since college. No other explanation needed.

ENT-HNS: I really enjoyed my rotations and loved it academically. What's stopping me is the surgical part. I cannot stand assisting in their very long ORs and tedious procedures, where the structures they would want to avoid are the structures that I cannot see!

Radiology: Considering that I enjoy anatomy, this is the closest that I can get (since I don't like Surgery). It is a stress-free specialization where there are no emergencies and I get to sit down and relax.

Being settled with foregoing residency for the meantime, the question is, "What should I do?" There were a number of options that were presented before me.

1. Take the USMLE Steps 1 and 2 CK/CS
2. Take a year off and teach
3. Pursue a non-clinical career
a. Health leadership training
b. Public health
c. Masters in Psychology

FIRST OPTION: USMLE

Since before, I was planning to do my training in the US for reasons I shall enumerate below:
1. Better training (highly recommended by doctors I've talked to)
2. US citizenship
3. Widening my horizon and going beyond borders (as Fr. Bu encouraged me to do so)
4. The promise of coming back and offering something better and different to the Philippines
5. Pre-requisite for my fellowship of choice

However, the cons of this choice are the following:
1. Different patients (foreign) compared to my final plan of practicing in the Philippines
2. Beyond my "comfort zone" (people, language)
3. Expensive (but my parents are willing to support me financially)
4. Delay in finishing my residency
5. No certainty of being matched right away to my choice of residency

This is a risky choice that I am considering. The uncertainty of this option makes me doubt myself on a regular basis if I am making the right decision. Deep down I know this is the best opportunity that I can get a hold of. Upon encountering this dilemma, people who are willing to help suddenly became available. I am glad that I have let myself dive into this dilemma since it has forced me to look for ways on knowing more about this choice that I am making. I got to talk with a consultant who also took the same path and is now practicing in Singapore.

However, the worry of not being able to adjust and being far from comfort are the ones holding me back (now that I've thought of it). I know it is no joke to study there, in an unknown land where I've only been to once in my life. English will be my primary language (I can but I express myself better in Filipino). Re-reading my previous blog entries, I found a common theme on how frustrated I am with the medical training I have been receiving: (1) unhealthy competitive culture, (2) inability to provide the best healthcare, and (3) irrelevant hierarchy. These points were enough reasons for me to choose which institutions I would choose to train here in the Philippines.

This frustration may be a craving of something more, of how healthcare should be. Studying in another country with good reputation on medical training may be an answer to this call for change. In knowing how things can be, hopefully, I can bring it back here and apply it. Rarely do people training abroad come back to the Philippines since they have a good life already there. That I cannot live with.

SECOND OPTION: TEACHING

I have come to realize my love for teaching during my year in med school. In every patient encounter, I enjoy explaining to them in layman's terms the physiology and pathology behind their diseases. It challenges me to translate everything that I know into simpler terms. After each encounter, they would thank me for taking time to explain things to them since no other doctor does allocate time for it.

When it comes to students, my love for formation and inspiring them to be a better version of themselves can be the caffeine that keeps me awake as I create activities or plans. I would read books, spend time learning and talk to more professionals so as to create the proper tools for these goals. I love the feeling of being able to share a part of me even in the simplest ways.

THIRD OPTION: NON-CLINICAL

This last option I have not really thought about it since it is my fall back. I have attended a Public Health Career talk last week headed by Dr. Jaime Galveztan's team. After the talk, I noticed that I did not have the same spark as the speakers or my close friend, Ginger did. I cannot connect to whatever they are saying. I applaud their efforts but I would say this is not the path for me. I cannot imagine myself living in distant communities and doing house-to-house visits. However, I can imagine myself creating systems for it and training people. Currently, I cannot see any opportunity for me here in terms of health leadership training among doctors. Most of the programs here are public health-directed (meaning targeted at the grass roots). The problem with public health is people have the passion but they don't have the tools of letting the community realize that they need to change their health behavior or beliefs. In becoming proactive about health will only the health system improve. If you see patients who ask questions on topics they have researched about, it would push the doctor to learn more and pursue further training. This will provide opportunities for advancement in the health sector. (I think too big, that's one of my illnesses.)

I have never found a decent answer to my question: "How can you encourage doctors, who are tired from studying, doing duties and taking care of patients, to do more in inspiring their other colleagues and other health professionals to go beyond their roles and do what it best for their patients?" That is what leadership is all about. Without you doing much, great things are happening. That's how we can move mountains. Concepts in business leadership is good and has been used in many professions. However, these principles came from structured environments where the goal is the be a great company which can be equated to income, employee performance and the like. Unlike in health, we deal with life. Now, how can you quantify such an abstract concept. Does it only matter if the patient lives or dies? Does his quality of life after discharge matter? How can you go beyond your specific roles as physicians in the clinics or hospitals?

There are programs offered mostly in United Kingdom on Healthcare Leadership but all require their students to be key players in the field of medicine. So this has to be parked until I reach that position in my life.

When all else fails, my love for Psychology will still be there. I can take a Masteral Degree in Psychology (which was my other option if I did not pursue Medicine). With this option, I would be training in the US for this.

WHAT IS MY CHOSEN PATH?

Currently, I am choosing to take the USMLE.

I wanted to be a Pediatrician but I also love Healthcare Leadership. It is just a question which goes first. Hence, Healthcare Leadership requires experience, I need to become a notable doctor or hospital employee for me to be considered. Knowing there are are only less than 30 Pedia Hema-Oncos in the Philippines, training here for fellowship is good but if opportunities of training abroad would be better given their advances in research and technology. Most of the protocols used are based in the studies done abroad. Hopefully, after being exposed, I can create my own cancer research facility where we can create protocols fit for Filipino children. With my training in Kythe, I would like to add this to the service it shall be providing to its future patients. It is great to dream but to make it a reality is the painful part.

My goal is to become a part of the hospital administration and be able to qualify for that Healthcare Leadership training.

I pray to God that he will always be with me in every step of the way. I know he would not give me challenges that I cannot handle. He gives me these opportunities since he believes I will grow and be a better person after.