‘Tao Rin Pala’

Every December, the young doctors of the UP Philippine General Hospital troop to the “Tao Rin Pala” (or TRP), which is an event held by the College of Medicine’s Medical Students Society allowing them to showcase their talents through song, dance and choral music. As the name implies, it’s meant to be a reminder that we are human: more than our work hours or our grades and exams, more than just juniors to our seniors, more than machines taking patients’ vital signs, and more than ATMs shelling out money for patients in need. For years TRP has given doctors the space to stretch themselves in areas that often go unappreciated in the hospital, highlighting hobbies and talents developed prior to medical school and often forgotten.

Reminders of our humanity used to come few and far between. Once we’ve plunged headlong into training we also plunge into the culture, allowing it to shape and change us, so that we do end up expecting ourselves to be machines running on little to no sleep, caring for patient after patient. But recently, social media has taken to reminding us of our humanity—in often the most shameful ways. Doctor-bashing has become an increasingly common part of our news feeds. We have watched colleagues be eaten alive by judgment and cyberbullying. It doesn’t matter that there are posts done in retort, to explain why this or that photo has been taken out of context or misunderstood: The damage has been done; a reputation has been ruined; further mistrust has been introduced into the already fragile physician-patient relationship.

The proposed “Bawal ang masungit” project recently reported by this paper is part of the outcry against these so-called abusive doctors. It gives patients a voice, particularly the most vulnerable, indigent ones, and serves as a reminder to health professionals that private and charity patients ought to be treated with the same kindness and respect. Before we look at nurses and doctors as the villains in this story, however, it might be useful to consider what makes healthcare professionals “masungit” in the first place.

Before we are accused of exaggeration, I ask the reader to consider that doctors in training—most often featured on these social media posts—have the least rights of any licensed professionals. Most programs involve living through the three-day cycle of preduty/duty/postduty; a doctor is awake and on the clock for approximately 42 hours for three days (and more, for more demanding programs)—not counting the hours spent studying, doing paperwork and compiling reports. This makes for poorly compensated 100++ hour workweeks. Nobody talks about the fact that hourly salaries of doctors in training in private hospitals wouldn’t even crack minimum wage, or that nurse wages remain hopelessly inadequate. Residents are also considered lucky if their programs allow for vacation and sick leaves. Full weekends are a foreign idea. Maternity leave is often given begrudgingly and for a limited time.

And it’s not just the work hours. Junior doctors put up with verbal and emotional abuse with no complaint, because a “good” doctor would grin and bear it. Abuse has become such a routine part of our culture that complaints to human resources are not even, as we millennials often say, “a thing.” To put it bluntly, doctors (and nurses, too) endure with swearing, public humiliation and sexual harassment, but nobody ever hears anything about it because we don’t talk about it.

It doesn’t end there. The government might not be able to regulate how doctors behave to each other and how training programs work, but it might consider that part of what makes a doctor’s load so heavy is the inability of the healthcare system to provide the most basic needs of its indigent patients—needs that nurses and doctors often have to supply, or else be unable to get the job done, or be unable to sleep at night due to guilt. As this column has previously mentioned, many junior doctors in public institutions pay for their patients’ expenses, but it’s more than money. Interns produce makeshift splints with cardboard and cut water bottles into half to send arterial blood gas specimens. Nurses improvise a thousand ways to secure intravenous lines and give medications to patients who can’t afford them. The ingenuity comes at the expense of so much exhaustion and the constant feeling of being short of something.

This is not a complaint about the culture of medicine or the healthcare system in the Philippines—two separate, intermingling things that have given rise to so much nurse/doctor exhaustion and patient dissatisfaction that the government now feels the need to intervene, if only superficially. Through the “bawal ang masungit” campaign we can address how doctors and nurses speak to their patients (apparently in the most punitive and judgmental way possible), and this is not a small thing, but we are not addressing anything else.

We are not addressing anything about the system that has given rise to this culture, and we are only adding the further burden of fear of public shame and criminalization to the already extreme load handled by health professionals every day. How strange that, as this paper has reported, the health secretary has spoken about plans to send out ghost clients as part of quality assurance—as though an hour spent in an ER is enough material to judge health professionals by—rather than to probe deeper into what is needed. How strange that instead of wanting to help us out, many should be so determined to catch us out. Maybe they should spend some time in the Pedro Gil area in December; maybe they, too, need reminding that we are only human—or Tao Rin Pala.

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