Abusive

Over the weekend, some of my colleagues and I were in discussion over text consultations by patients to their doctors and the ethical dimensions surrounding text consultations.

With over 93 million active mobile phones AND 130 billion text messages being exchanged each day in the Philippines (yes, ONE HUNDRED THIRTY BILLION) you can undoubtedly state that text messaging has been widely used, and may I say, disproportionately abused by the Filipino patient.

Text messages fly back and forth between the patient who 99.9% of the time triggers the initiation of text messages, and the physician.

During the discussion, we asked how many of us gave out their cellphone numbers to their patients. Three out of five had their mobile numbers on their calling cards, prescription pads and 100% available to their patients. I give my mobile number to about 30% of my pool of patients. Only one of us REFUSED to give her mobile number to any of her patients.

Some of us buy a second phone (which I think is impractical) or even go to the extent of having a dual SIM phone so that one can be a private number while the other number is an office phone number on the same cellphone. Whatever it is, the bottom line is that once you give out your mobile number - your privacy has been invaded.

Many (if not most of us) do not give pre-arranged instructions which should be something like:

1. They're not allowed to call! I am not your text mate, I don't plan to be and I don't like it when people who are NOT in my contact list call me IF and WHEN they want. I do not save the numbers of my patients in my contact list. And I cannot stand the temerity of some patients who ask me to SAVE their numbers! Duh!!! Most of all, I may not be in town and if I am out of the country, I end up paying for the roaming charges because someone just wanted to find out what they can give their son because he apparently has fever of 37.8C!
RULE NO. 1: TEXT BEFORE YOU CALL. It's only but fair and etiquette dictates it, to see if the other party can pick up your call.

2. They should include their names or identify themselves when they send text messages (because I don't save your names). You should also not expect an answer in the next 5 minutes or when you want a reply. (I may be at meetings or in a plane somewhere or in a movie house [YES we have a life outside of the clinic my dear patients], or doing something in private [ahem, I hope you people get what we mean] or seeing other patients or driving.) In short, we are NOT at your beck and call.
RULE NO. 2: IDENTIFY YOURSELF. Don't waste my money having to text back - "who is this please?" or have to guess "this is the mother of Joaquin..." Joaquin who?!?!! It's not like your son is the only one that has the name Joaquin in the Philippines. You can ask the National Bureau of Investigation and you will get gazillion hits with that name alone!

3. They should be more specific with the concerns that they text us with (if the patient has fever - describe the pattern of the fever and not just text "may lagnat si Junior, what to do?". The reason for this is because we spend replying back to them as well (usually I don't reply back if they don't observe the rules I inform them when I give out my mobile number from the get-go). But because the text message service is probably UNLI, these patients think that it's alright for them to waste other peoples time by engaging in texting back and forth. Of course, if they pay more for the text message, I guess this should put them in the proper perspective of having to think what to text before they send a text message.
RULE NO. 3: Complete the description of the concern. Please avoid having to make me guess what the hell the concern is about by just texting me that there's fever or there's tummy ache or other one liners. Try to be as comprehensive as possible. Be considerate with other people's time.

4. In case of emergencies, DO NOT CALL ME! I am not an emergency room. Just bring the patient to the ER. Period. The ER will call me.
RULE NO. 4: I am not an emergency room.

5. No MMS messaging please! There are those that actually send pictures of a lesion on the skin of their child and expect me to make a diagnosis and a prescription!!!
RULE NO. 5: First of all, I do not prescribe through text. It is unethical to do text consultations and against the LAW to prescribe prescription drugs by text messaging. Besides, sending a picture of patients is like pathetically altogether wrong. You don't see the whole picture and cannot make a clear diagnosis without a good history and thorough physical examination.

6. I can't stand it when patients text me in the middle of my clinic asking if "they can call me" because their kids are sick. They know my clinic hours. They know my schedule. They can call the clinic. But NO!!!! They don't want to do that!!! They don't want to call the clinic because the secretaries are busy assisting me and other patients. They don't want to queue. You can even see how inconsiderate the others are because they will call the clinic, ask the secretary they want to talk to me because his kid got bitten by a mosquito a few seconds ago and they're afraid of dengue!?!?!!?! I want to slap someone today. But puhleezzzz, gimme a break! My secretaries are trained to tell patients that "I am seeing a patient currently and that we will get back to them after office hours".
RULE NO. 6: There is a secretary in the office. Do not text me if you want to find out if we have clinic or not. Text the office or call the clinic.

While these are but a few among my many concerns, these are basic rules that I make patients follow if they want my number. It is ironic that many of them seem to have early onset Alzheimer and forget that these rules.

So there's got to be a way where physicians and patients know that there is and there needs to be a yardstick distance between them. After all, the relationship between doctors and patients is strictly a professional one. We are not removing the human factor of having to relate with patients - showing empathy, explaining the burden of the disease, explaining in layman's terms the treatment options, and most of all staying within the ethical boundaries in the practice of health care.

Somewhere along the way, technology has provided a vast avenue of easier communication between people anytime, anywhere. And like anything that's highly accessible, comes abuse. Without anyone or any other way to regulate this abusive practice, it's bound to get virally blown out of proportion. While text messaging has its positive attributes, it should be relegated to before and after service only. Before service which means that patients inquire only for consultation hours and minor concerns on whether the doctor is around, and after service means that the patients may have concerns on medications or instructions after the consultation or discharge and text messaging is only for clarification purposes.

There is a need to get the whole equation back to professionalism, ethical relationship, and most of all the etiquette of mobile phone usage has got to be taught to the general public ONCE AND FOR ALL.

Wee Nam Kee and the Spa - Fed and Pampered...

To say that it was a stressful week for me was an understated description on the week that was!

The Pediatric Infectious Diseases Society of the Philippines Convention held at the Crowne Plaza last February 15 was a huge success. After two lectures and one Breakfast symposium, my week wasn't over. There was the lecture for the residents at Cardinal Santos on Thursday and then rushed to One Esplanade to give my final talk for the week at the Convention of the Philippine Academy for Family Physicians.

I think my partner pitied my so hectic schedule that he decided on treating me to dinner and pampering at the Spa.

First off was dinner at the newly opened Wee Nam Kee at the Alabang Town Center.

Wee Nam Kee is a Singaporean restaurant that serves their famous Hainanese Chicken Rice. I've tried the Wee Nam Kee in Singapore and the natural reaction when it opened in Manila was - at last!!

The interior design of Wee Nam Kee at the ATC mall was sparse and similar to the Singaporean restaurant was designed in enough simplicity and yet an inviting ambience. The tables are really small, so even if you're two, sharing a table for your dinner, make sure you don't order too much as there wouldn't be enough space to put the orders! The queue to the restaurant is relatively long. Obviously, looking at the prices of the food on the menu, you'd probably say that it's relatively cheap for family dining...

Until you see the portions of the order.

We had its famous Hainanese Chicken (which chicken rice and chicken soup). I told my partner not to order the personal size as it is really a small serving (unless the "small lady" in the Senate probe was going to eat that plate). If you are two people sharing, make sure you get the half chicken order (and while it says that it's good for 3-4, believe me - it's really good for two. Again, unless you're part of the construction worker team building the other stalls around the mall who have one bucket of rice with two slices of chicken, then that small order would probably fly.)

To get a taste of both ways of cooking the Hainanese Chicken - order it as roasted or plain white chicken.

Don't forget to mix the sauces - garlic, soya and hot sauce - together to make the flavors stand out.

On my insistence, we ordered the Cereal Prawn (only because I tasted this already in Singapore). Unlike the Singapore version where the Cereal was mixed with Floss, this came out really wanting in taste for the Prawns. (They indicated in the menu that one order would have 4 prawns, but I counted only 3.) There was too much "cereal" covering the whole prawn serving that I thought they did that to cover up what was lacking.

Total bill: P1058.40 ($25)
Recommendation: The hainanese chicken is one of the best but the servings are really small. Get the bigger servings. So that you really feast on a great Singaporean dish - order two sizes up!!! It will be worth the upgrade. Their orders are in reality, single servings. Next time you order, think Singaporean price so that you'd get your moneys worth.
Would I go back? Why not! The food is contemporary and good.

After the dinner we headed off to the Spa to get a relaxing massage. Obviously, this wasn't a first choice. We actually prefer the Mandarin Spa (either at the Casa Vicente of the ATC or Bellevue), but both spas were full (there must have been a lot of stressed people that week). So we settled for the Spa.

While the Spa may have great amenities and a nicer ambience (including jacuzzi, showers, steam room, private lockers and well appointed rooms), at the end of the day - it's the massage that counted! We got the 90 minutes complete rub down and it was pure bliss.

Never mind the mega bucks. And don't forget to get a private room (it will spare you with the noise of the hands slapping against so much flab and fat and the snoring of the other customers.)

As the advertisement would say, everything else there's Mastercard...pampered, relaxed and destressed - priceless!

Total bill: P3300 ($80)
Recommendation: A bit on the steep side but that's because you're paying for both the ambience and the wet floor (jacuzzi, shower, steam). But if you're not really going to use the wet area and want a better rub down, the Mandarin Spa is still the best massage in terms of value for money!
Would I go back? I've been back and forth here - but only when the Mandarin Spa is fully occupied.

It was a great way to cap a stressful week. Being fed and pampered...now I know what a pig feels like before being slaughtered!

Xoi - A taste of Vietnam

I've been to Vietnam several times to give lectures. Saigon (Ho Chi Minh) in particular.

Aside from the gazillion motorcycles in the country, the once war torn country has amazingly recovered from the devastation of the Vietnam War. Today it is an industrial hub and the economic growth in this country has amazingly surpassed many neighboring Asian countries, including the Philippines.

Besides the modernity amidst the backdrop of once old Saigon, the shopping in Vietnam is one of the best in the Asian region. And then of course, there's the food that you shouldn't miss.

When Xoi (Vietnamese Kitchen) opened at the Alabang Town Center, I wanted to see how authentically Vietnamese the food would be. Of course, there's already Pho Hoa. But the latter has not lived up to the expectation I had of a Vietnamese cuisine - lacking in flavors and originality.

Located right beside PF Chang at the ATC Mall, Xoi's interior is simple and the servers are dressed in well, trying hard Vietnamese outfits. Our server Mai was very helpful and while she may have lacked the Vietnamese look, she compensated with her Filipino hospitality what the place was highly lacking in ambience. The kitchen was open to the dining area and it's interiors looked like it was on a really tight budget - minimal in decor and had a crowded and noisy feel.

Now off to the food.

For appetizers, we had the Fresh Spring Rolls

whose peanut sauce had a dash of Tabasco, which made the flavors of the rolls really stand out well.

The main course consisted of Five Spice Chicken in Herbs

Fried rice with Chinese Sausage

And the piece de resistance of their original Garlic Fried Crabs (with the shell all removed) and a side dish of pasta in parmesan cheese (that came free with the Crabs. Incidentally, you'd get one really large pitcher of Lemon Iced Tea for ordering the Crabs).

The chicken was nicely cooked and had a sweet and salty taste to it. The sauce that accompanied the chicken was nothing spectacular and reminded me of the dipping sauce of Inasal. The rice was a small serving and truly lacking in other ingredients of a Fried Rice meal. It had very sparse amount of chinese sausage and that was about it. It was a bit soggy but tasty. The crowning glory of the meal, however, was the crab! This crab was divinely cooked and meaty and you could taste the freshness of the crab as it was sweet amidst the garlic that peppered it. If you're someone who doesn't like getting his hands tainted with having to peel off the crab shell, this is something you'll appreciate as it comes as a "Naked Crab" - where they peel off the shell completely and serve it all crab meat!

After the main course, we asked if there was a dessert menu. Unfortunately, Mai informed us that they weren't serving dessert as yet.

Total Bill: P2100 ($48)
Recommendation: I would recommend this to friends who would want to try a taste of Vietnamese dish. However, it's not really a far cry from Pho Hoa aside from some of the more authentic seafood that Xoi offered. I wanted to try to mussels in garlic white wine sauce but unfortunately, it must have been a popular choice because they ran out of mussels by the time we had dinner. Incidentally, make sure you have enough cash because the crabs (we had the medium size good for 2 people) are quite expensive - it was 60% of the total bill and they charge an extra P100 ($2.50) for removing the shell for you! Nevertheless, it was worth the bucks!
Would I go back? Definitely. I'd like to try out the other food on the menu. They're really not that pricey but the servings aren't that large either.

The prelude

It's been a few weeks since I've been doing a bit of pencil pushing and sitting down with all concerned parties regarding a project that would entail the use of digital technology in improving the delivery of health care services between the patient, the pharmaceutical industry, the healthcare business, and the health care providers. Because all these segments are linearly related and cross paths at different angles, it makes sense in providing a business solution at addressing the gaps encountered in the efficient delivery of better, optimum and quality health service and information to all the parties at stake. After all, the healthcare industry, while complex in nature, is the most vital of all services we all seek. There is a price we need to pay for staying healthy, and a greater price we pay for being sick.

For one, it is time that we professionalize the process and services of patients whom we provide health service to on a pay-for-fee basis. We can improve the relationship between the health care provider and the patient by making patients more accessible to doctors to address their needs - from having to queue at the clinic, to responding to requests for information even when we are out of the office. I am sure my friends will agree with me that most of us are selective to whom we give out our mobile numbers to. While we are justified at keeping our private lives less accessible to patients, the latter may have serious concerns that will require our attention after they have consulted us in our clinics. Unfortunately, if there is no regulation at the text messages sent to the doctor, this problem escalates to being simply ABUSED ending in a scenario where patients text messages anywhere from inquiring if you're still in your clinic to asking for a diagnosis or a prescription based on an MMS photo sent as a diagnostic challenge to the physician.

On the other hand, as physicians, we need to provide patients with efficiency in the delivery of our services to them as well. When we say our clinic begins at 9AM, we must at most times, start on time. Unfortunately, many of us would make patients queue till forever because we don't want to wait for them or we would prefer that they're all there already when we start our clinics - which is unfair for the patient who also has other things to attend to or whose time is equally important to them as it is to us.

The age of digital technology has changed the landscape of creating a more productive relationship between patients, the pharmaceutical industry, the healthcare industry and the healthcare provider.

From Apps designed to providing electronic medical records to designing programs where patients can access their health records and linking to pharmacies where they can easily pick up their prescriptions paperless, to having their labs available real time - there are countless ways at improving the interlocking grid of the healthcare industry.

Two decades ago, Pocketbell or the paging system became the defining line as a business solution to providing more efficient service through prompt communication to all. In less than a decade, the advent of mobile phones replaced the paging system. Today, digital technology has literally changed the way we live - from eating to breathing, from fine dining to shopping, from selling to promoting - we have become entrenched in the power of the internet. It has served as the portal for many successes and solutions to improving every imaginable service.

No one can stop an idea whose time has come.

At the end of the day, by putting order in this chaotic complex healthcare system, it becomes the avenue for efficiency so that we can all lead more productive, healthier lives.

Virtually at our finger tips - we can make the healthcare industry work to the advantage of all stakeholders.

My Virtual Health Care Solutions...it's about time.