conversations on rough terrain

Buti nga ngayon libre ang ospital, nung araw wala,” says our patient [1]. It was a run-of-the-mill patient encounter. After doing my share of inspection, palpation, percussion, auscultation and special tests, I had left the room.

Several minutes later, my remaining classmates exited as well, asking around for a BP cuff. Then, an ECG machine. The patient, whom I had just been joking around and interacting with, was experiencing chest pain, difficulty breathing, and light-headedness. It was hypertensive urgency.

It’s the fear of any first or second-year medical student, who knows more than the average person but less than any clinician. Thankfully, there were many qualified doctors ready to respond [2].

When all was said and done, and our patient was once again laughing, we began to talk. As she rested, I learned three things:

  1. She suffers from a chronic disease, but she doesn’t take her medicine due to the expense
  2. She didn’t know her maintenance medication is covered for free by the Barangay Health Center
  3. Despite her fears, she’d rather let the disease take its natural course than spend effort on its management

Intellectually, she knows health care is a must. Emotional insight is another matter.

If I were to write this same post ten years from now, I am sure I will add many similar encounters a hundred times over. Rinse, repeat. These happen all the time, with or without me blogging about them.

If our patient didn’t volunteer for an encounter, would she have gotten adequate treatment? If we weren’t there to talk to her, would she still eventually commit to a check-up? If a tree falls in a forest with no one to hear it, will the tree plant itself? –wait.

It’s maddening.

There are financial constraints, and there are cultural restraints. I know a lot of old people who define dignity of aging as the refusal of medication. They’d prefer the slow deterioration of quality of life, instead of suffering the care and effort of their younger loved ones.

There are gaps in health communication. Some don’t know what PhilHealth is. Others don’t take advantage of the programs barangay health offices offer. Many are now distrustful of evidence-based medicine in general.

Thinking on it, the problem gets more complex. It’s part education, labor, transportation; part culture, community and communication. Our patient doesn’t want to inconvenience her working family just to accompany her to check-ups; going out means paying for commute; acknowledging sickness means being weak. Where do we begin?

Idealism: if everyone works with the same vision in mind –like a world where our old and vulnerable need not compromise– then there’s a better hope of getting where we need to go. All hands on deck.

Even more idealism: in our daily conversations as students, family members, and professionals. Whether you’re a medical student or not– if you know someone who’s clearly sick, advice them to rest, or otherwise seek a check-up. Tell them not to trust websites that diagnose them with cancer. Wash your hands. Don’t spit on the ground [3]. When you have the time, search the current policies on PhilHealth and public health programs. When people ask, you know the answer.

Another thing life teaches. Little misconceptions can define our choices.

What if my silence today costs a person their best future? [4]

Log: 15/Mar/2018
conversations on rough terrain
Posted originally at

[1] “Good thing hospital care is now free“, compared to the days when she was young. It’s almost universally free for senior citizens in Makati City.
[2] I have this recurring daydream of being the only medical professional-adjacent onsite during an emergency requiring CPCR and BLS, and the only thing I could do is say “Hey, hey, are you okay?”.
[3] Spit your phlegm on the ground and we are not friends. I’ll still try to educate you to keep your infection to yourself, but I’ll be out of there before you can blink.
[4] Opportunity costs.

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