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.

Post-digital age syndrome

I thought of blogging about this topic after seeing so many teenage patients the past two weeks.

To have that many teenage patients in my pediatric practice meant that I must be gazillion years old because these kids have practically grown up with me.

The experience I have gained over the years of pediatric practice has been a life changing one. Observing how many of my patients have grown to become teenagers and adults, to parents, has been one helluva roller coaster ride, so to speak.

The youth of today are very much different from our times. I'm quite sure that the more "senior" generation will agree with me that technological advancements has correlated with the current state of today's youth.

I call it the post-digital age syndrome.

Let's face it. Even the more "senior" generation (like me) benefits from the technological advancement and that the digital age has contributed immensely to providing information at our fingertips. No more trips to the library, no more having to wait for days for a response from our clients, no more going to the bank to pay the bills, no more having to make long distance calls that charge an arm and a leg in order to speak to our loved ones, no more having to go through third parties to make reservations, no need for the yellow pages - yup, with the new techie gadgets, you've even got email on the go.

The only difference between the technological advancements is the time frame.

Obviously, the pre-digital age syndrome people had the benefit of searching for information in a more medieval way such as trekking to the library or poring over the voluminous books available to read. The post-digital age people just google it and you can even do advanced or narrowed searches. The latter, however, has the drawback that by making the computer and the world wide web or Mr Google search information for you, the information provided may be one that is lacking or biased (some information may not be published and so you won't see it on the net, such as theses or dissertations of graduate school students, etc.). Many information seen on the internet may not necessarily be complete - such as summaries or abstracts being provided as sneak previews - and because getting the full original versions will require payment, a lot of us end up making conclusions based on these summaries - a case of what you see is what you get! What also is distracting is the fact that anything and everything is published on the internet. Discerning what is factual and true is difficult for those that are not experts in the field of interest. This has its major drawbacks especially in the field of medicine, where patients and parents google symptoms in search for diagnosis, without the benefit of adequate knowledge on how to discern the right information to arrive at the correct diagnosis and eventually how to manage the disease. The piecemeal or "chop-chop" knowledge has contributed to a general sense of misconception, confusion, and panic among patients in the self-search of information for disease states.

Indirectly, the post-digital age has contributed to the obesity I am seeing in the clinics. Kids are growing up with just their fingertips doing the exercise. Some can spend days and days in front of the computer or some gamely gadget (PSP, DS Lite, iPad, Celphone or what have you) or in front of the TV surfing channels. I've noticed families at dinner tables (especially in restaurants) with some of their kids having the headsets of their phones or gadgets hooked to their ears (often times to a deafening volume that I can hear it a mile away even in a mall). No conversation, no discussion, just a deafening silence of words except the chewing of food or the clanking of utensils or the sound effects of the gadgets. Ask them to move their butts and many youngsters complain about wasting time on menial exercise. It's more cool to be on Facebook or be Twitting rather than to be sweating out all that fat from those uncool junk food and supposed healthy iced teas that are nothing but a bunch of flavored teas filled with sugar to the hilt!

While the purchasing power of the peso has supposedly dipped because of inflation, in reality, the household expenditure has increased in the post-digital era because of the added expenses in gadgets and top-ups (loads) for their mobile phones, cable, additional gadgets and games (not including apps and other downloadable items) or even for the poorer members of society - time consumed in the internet cafes. Hard earned money that can go to buying added food (eggs, bread, rice or even chicken) is not enough because the need to apportion at least 10% (some families average 20%) of their monthly wages only to keep up withe the techies.

I am saddened by the fact that the post-digital age syndrome has created a void in many families with gadgets and electronic baby sitters substituting for parenthood. While I agree that "we owe, we owe so off to work we go" has been the prime mover of our economy, I'm sure that everyone will agree with me that the quality time we share with our kids has been relegated to having a gadget or some trek to the mall substitute a day in the park or biking with your kids on Sunday. Sitting down with them for their assignments is relegated to Kumon and sending off the 2 year old to a day care center has become a run-of-the-mill solution to introducing kids to basic education because mom needs to make a career out of her life.

I am not saying that the pre-digital age babies had better lives and are probably happier than the post-digital age ones. I'm putting into perspective the influence that the digital era has imposed on many of our lives. Even the older generation has had changing values and lifestyles because of the rapid technological advancements.

I have nothing against technological advancement. But we need to take into perspective the impact it makes on our lives.

There's a saying that "we cannot have our cake and eat it too". There must be a balancing act in our lives in this post-digital age syndrome that should make relationships, families and friends be one where we end up not being strangers at the end. There needs to be more physical and emotional involvement and investment by each one of us. We cannot make technological advancements dictate the pace and quality of living we have. Otherwise, we end up as slaves to them.

It would be sad that as each of one exits this world, even condolences are sent digitally instead of a simple show of respect with our presence during the wake or burial.

There are many people who have found less meaning to life in the post-digital age than in the pre-digital age. Perhaps the rapid pace of technology has contributed greatly to this meaningless world of existence. Perhaps the post-digital age has made many of us engage in nameless and faceless relationships even with our closest of friends and kins because we've simply not valued spending more quality time with them.

Sadly put, the post-digital age syndrome is a lonely one. It may be a great disappointment in our journey of life if we forget to stop and smell the roses along the way.

Technology and D'Pinoy

Someone once told me that if there is one country that happens to be most advanced at technological advances for gadgets, it is the Philippines. And he added that the Filipinos are tech-savvy. Whatever that meant.

I begged to disagree.

Let me be sarcastic about it. We pretend to be tech savvy. We pretend that we are "knowledgeable" and that the incorrigible Pinoy will always find a way to get hold of the latest gadgets and gizmos in order to show the world that he is at par with the major advances in technology.

The operative word is PRETEND.

Let me cite an example. A few weeks ago, I purchased tickets for the upcoming "David Foster and Friends" show at the Araneta Theater on October 23. Obviously, I wanted to get good seats. I went online for Ticketnet and voila - they inform me that they will email me if there are available seats. Duh? Okay. I remind myself that this is the Republic of the Philippines. The Banana Republic. The country that pretends to be high tech!

I remember that when I got tickets for the Broadway show "Wicked" during my New York vacation, I could select the seats in the theater, buy the tickets online with my credit card, an email is then sent back in less than 2 minutes and I can print out the ticket from my home. This was how I got tickets for the Empire State Building entrance as well. Buy online, pay online and print my ticket from my home.

Anyway, the following day, I receive an email from Ticketnet informing me that they have PRESELECTED SEATS for me and that the seat numbers were __ and __. So much for selecting seats. I guess because this is the Philippines, even seats to the show required some form of graft and corruption on the part of Ticketnet. Why am I not surprised? So off I went to one of the Ticketnet outlets. Where else? Shoemart Department Store. When I got to the counter the girl was accommodating, She told me to please wait awhile. They needed to reboot the computer.

Reboot?!?!!?

Yes.

They close it when it's not in use and no one is buying tickets.

You could actually hear the poor computer with its green monitor (something I had in the early 1980s) whirring to a start. The salesgirl taps the sides of the monitor and the lights brighten up (a little).

She then asks me to what show am I purchasing tickets for?

I give her a printout of the email Ticketnet sent me (which indicated the seat and row).

She looked at it and then typed in my last name. Another first name popped on the screen. Then she started pressing one of the function keys and the first names of each person with my last name crawled slowly on the screen...I was tapping my fingers on the top of the desk. 15 minutes had gone by and she was still scrolling the function key, hoping to see my name pop up. Then she stops and says she cannot find it. Stops her work. Squats on the ground so she can pick up the phone to call Ticketnet. What the hell was the phone doing in the lowest part of the shelf?!?!?!

Another 5 minutes had gone by and she asks for instructions. When it's over she goes back to the screen and types my last name and the FIRST LETTER of my first name and then my name appears. She tells me how much the tickets are. I give her my credit card and she tells me it should be cash.

Cash?!?!?!? Who pays with cash nowadays? I ask her nicely, don't you accept credit cards?

She says they do. But the Ticketnet people put a code that the payment was in cash.

I tell myself, how presumptuous of Ticketnet! They wanted the money at once. (Sigurista!)

I told the girl that I would have to go to the ATM to withdraw. She said she could fix it by calling Ticketnet to change the code. Clap clap clap for the SM girl. Slap slap slap for the people at Ticketnet.

The girl then squats again on the floor and calls Ticketnet to change the code. Another 5 minutes had gone by.

After she talks to the Ticketnet person, she stands up again and then TURNS OFF THE COMPUTER! OMG!

My face was aghast.

She smiled at me and said that she needed to reboot again. That was the instruction from Ticketnet. How can you get angry with her? Tell me.

After another 5 minutes and the same process - slaps the monitor a little, types in my last name then the first letter of my first name, she tells me that it's alright now. I can pay with my credit card.

I give her my credit card and another girl replaces Miss Congeniality. I asked - what happened to the other girl?

Apparently, someone else takes charge of payment. Miss Substitute now squats again on the floor and swipes my card. What the hell was the credit card terminal doing on the floor? My eyes rolled up. I was afraid to ask. Maybe Henry Sy has a fungshei about telephones and terminals being on the floor. I can hear Henry Sy chanting "moolah on the floor make me richer"!

After the swipe and the receipt coming out, it was time to print the tickets. It looked like the little gadget that was spewing my tickets was sputtering the letters slowly and another 5 minutes and I was done.

Note that there was NO QUEUE and NO OTHER CUSTOMER AT THE SERVICES AREA of SM Southmall. I was wondering how long it would take had there been at least 5 customers at 3pm! I was done after 35 minutes.

Two tickets. Thrity five minutes. Jeez....Banana republic....we should hang our head in shame.

We don't even need to go to the extent of purchasing tickets for a concert to see how tech retarded the Filipinos are.

Take the SLEX and NLEX. We are the only country in Asia (and perhaps in the world, considering the places that I've been to), that has both the entrance and exit of the expressways with a barrier that slowly goes up when you go through an E-pass lane. Jiminy Cricket...what the hell is that barrier for? And why do all the cars have to come to an almost complete stop so that the Epass can be read? You should try the Skyway during the rush hours. You have a longer queue on the Epass lane than on the cash lane. What the? Welcome to the Philippines...the land of pretentious techies.

I remain skeptical about the prowess of the technological highway in this country. It is, at the very best, pathetic. I know we try, but trying is not good enough if we cannot deliver premium service for the kind of money we pay for.

This country boasts of the highest number of text users in the world. Every Filipino has at least ONE mobile phone. There is a computer in almost every 10 homes in the urban areas and 1 in every 100 homes in the rural areas (as long as the rural area has electricity). You see the youth hangout in the malls and Starbucks with a frappe in one hand and a netbook or iPAD or web browsing-capable phone on the other hand.

Let me be clear. I have nothing against those into gadgets and using technological advancements. Good for them.

What I cannot understand is how we cannot translate this wizardry into better service for the people of the Philippines. The answer to this, is because those that render service are simply cost cutting and would like to be earning more than what they need to spend for premium service. In short, it is all pretentious.

The death of my MacBookPro

My MacBookPro officially died last night.

In the middle of all the slides for my lectures for the month, I tried desperately to save my files. It was frustrating that I was turning it on and off each time the pixels on the screen would scatter and the cursor would hang. Then the computer would shut down. And I'd have to redo the slides that were half-way saved.

It's been 3 days since the symptoms started. My friend who owns PowerMac told me that it's either the hard drive or the logic board. Most probably the logic board since the power sign kept showing up and the pixels were all scattered already. It would cost me around 30,000p to have the logic board fixed.

All gadgets have a lifespan and my MacBookPro had given me the best 6 years of technological wonder! Since I bought it, it had provided me income through the many slide sets it has produced. It has provided me the window to technological advancement and the highway to much needed information in my work, practice and communication with friends and colleagues.

My partner tells me that material things has no room for sentimental values. While I agreed, something in me disagreed as well. I cannot help but reminisce the times I and my MacBookPro shared the best and worst of times together.

I called the owner of PowerMac to inform her on the urgency of the situation. At 7AM this morning, I woke her to tell ask her to make sure that there was a new unit of the iMac Desktop that I could get at 10AM. I dropped by the store, picked up the new desktop - 3.06GHz Intel Core i3 with 4GB 1333 MHz DDR3 memory, 5.86 GT/s speed on a 21" flat screen with no borders and runs on the fastest Snow Leopard version. Standard optical mouse and optical keypads come with it. The new processor architecture, more powerful graphics, big LED backlit displays, two ways to multi touch is the ultimate all-in-one and is turbocharged.

I got an external hard drive that should allow the transfer of all my files from my MacBookPro. During the last 15 minutes of my old laptop's life - I transferred all the important documents and files to the new sleek hard drive, erased all the contents, wrapped it back in it's original sleeve, and bid goodbye to my friend.

Like all things in life, nothing comes permanent.

It was time to enjoy the company of my new desktop.

iPad, the next generation

OMG!

That's all I could say when I opened my laptop today. My browser actually logs on to Apple's website automatically (as I use Safari) and voila!!! It was a 7 1/2 minute presentation of Apple's launch on it's tablet.



Is it going to change the way we marvel at technology? It's going to be available beginning end of March 2010 for the Wifi, while delivery is in April 2010 for the Wifi + 3G version. It's lowest end in 16 GB is priced at USD$499 for the Wifi ($629 for the 3G), 32GB at $599 ($729 for the 3G) and the 64GB at $699 ($829 for the 3G).

I won't say much about it because once I watched the video, I was in awe! And awe is a description I rarely use. It was definitely jaw dropping, particularly with regards the iBook. Darn, I was drooling...

Now to save enough the next 2 months as I have made my reservations. This definitely will be my new toy!