White Coat

Dr. Raffy Castillo assists Dr. Bibly Macaya with his new white coat at the AMCM’s 1st Physician’s Recognition and White Coat Ceremonies

FEATURE STORY

The iconic white gown doctors wear while making rounds or seeing patients in their clinics is highly symbolic of the high standards that the doctors must always measure up to. The following are excerpts of the keynote address of H&L editor, Dr. Raffy Castillo, during the 1st Physicians’ recognition Night and White Coat Ceremonies of the Adventist Medical Center Manila on March 22, 2018


I’m sure everyone here realizes, our white coat is not only meant to be a fashion regalia for doctors to make us look good when we make rounds or see patients. Neither is it just a shield so the bugs in the hospital don’t stick to our clothes when we go home.

It is symbolic of our passion and zeal for our chosen profession, yes our professionalism and professional excellence which we must always uphold. It’s also a symbol of authority, reflecting our expertise in our chosen field, and the need to maintain that expertise by continuing education and learning.

And it’s white so we can be constantly reminded that it can be easily soiled or stained if we don’t take good care of it. I’m sure we don’t want to wear soiled and stained white coats. So figuratively, to preserve the whiteness of our coats, we should make every effort to maintain the highest standards of integrity, character, service, competence and professional excellence. These are the high standards which our white coat constantly reminds us to measure up to.

We’re truly blessed that we’re in a profession where we can practically have the best of both worlds. We can fulfill our passion for rendering meaningful service to those who need our service, and at the same time, we can earn well to afford us the comforts in life.

Sometimes we get additional perks, like being recognized as in tonight’s occasion, or even being considered as heroes for having saved people’s lives. But I’m sure, for many of us, all the financial incentives and other perks can’t compare to the joy and gratification of simply seeing our patients healthy and enjoying life to the fullest, especially seeing our elderly patients enjoy a good quality of life during the sunset years of their lives.

Casting a giant shadow

Occasionally, I’m invited to give keynote messages during graduations; and I always exhort our young colleagues to aim high and try to cast as big a shadow as they can with their works, hopefully a global shadow.

The other day, Becky texted our daughters Shelly and Abbie by Viber about tonight’s occasion and that I was keynoting it. Shelly gently reminded me that all doctors like her and her sister Abbie are actually casting their shadow, in their own little corner, in a meaningful way. I told her that’s great. The simple secret of being an accomplished physician is to love what we do everyday, with every patient that we see. And for every patient that we help get well, we’ll make a world of difference in the life of that patient and his or her family. Count that so many times every day, and just imagine the world of difference we’re making in so many lives over time. That’s more than tantamount to casting a global shadow.

And we don’t have to be brilliant, with superior or near genius IQs, to achieve this. If we’re really passionate about our profession, hard work automatically follows, and hard work and solid character—not only a pleasant but superficial personality—can always trump brilliance or intelligence any time.

Lessons to remember and pitfalls to avoid

Let me just share with you a few simple insights on how we can cast a long shadow in our own little corner, aside from the ones we already know. We can learn four basic lessons from water—humility, harmony, open-mindedness, and stewardship; and we must try to avoid three pitfalls which continually confront us in any stage of our career— these are professional inertia, arrogance or pride and loss of direction.

Water is symbolic of so many things. Many of you are more knowledgeable than I am on this, but I believe that in the Bible—among other things—it can be symbolic of our faith as typified when Peter started to sink in the Sea of Galilee when his attention was diverted from focusing on Jesus to the buffeting winds and waves around him.

As we get busy with clinical practice and our other undertakings, we sometimes get distracted by the myriad of day-to-day challenges we encounter, and we may tend to be distracted by them and loose our focus on our faith.

Because water can assume so many shape, depending what its container is, it also symbolizes the channels God uses to address man’s needs. And I believe God was also referring to us as His “springs of water” in this verse from Isaiah 49:10—”They will not hunger or thirst, Nor will the scorching heat or sun strike them down; For He who has compassion on them will lead them and will guide them to springs of water.”

“Sometimes, unwittingly, our success and prominence in clinical practice may get to our heads; and we may be acting like we’re God’s precious gift to Medicine and our patients”

Even Chinese philosophers recognize water as a philosophical tool or medium, and one ancient Chinese philosopher, Tao Te Ching, wrote a small book or booklet, less than a hundred pages thick, on the philosophy of water. Each page of his book has a short poem followed by some of his insights. Let me read to you one of his short poems…

The Philosophy of Water
By Tao Te Ching

The supreme goodness is like water;
It benefits all things without contention.
In dwelling, it stays grounded;
In being, it flows to depths.
In expression, it is honest;
In confrontation, it stays gentle.
In governance, it does not control;
In action, it aligns to timing.
It is content with its nature,
And therefore cannot be faulted.

It’s a short but very meaningful poem . It tells us of the very things we mentioned to keep our white coat, symbolizing our profession, as really clean and unsoiled. Water teaches us humility (“In dwelling, it stays grounded; It is content with its nature”), harmony (“In confrontation, it stays gentle”) , openness or open-mindedness (“In governance, it does not control; In action, it aligns to timing”), and stewardship (“It benefits all things without contention”).

Humility

Water teaches us to be humble. From the smallest body of water, like mountain springs, it flows to the streams, to the brooks, rivulets, rivers and then the open sea. As we note, so the water can flow freely, the bigger bodies of water have to be at a lower level as the smaller bodies of water. If you’re a river, you must be lower than the brooks and streams so their water could flow to you; and the sea or ocean, being the biggest is at the lowest level, so it can be the receiving end of all the water coming from the smaller tributaries.

As Spiderman said, “With power and privilege comes responsibility.” We as doctors are given the privilege to occupy a respectable position in society because we pledged to serve the sick and the weak, regardless of their status, beliefs, financial capabilities or other factors.

We’re counseled in Romans 15:1 “We who are strong have an obligation to bear with the failings of the weak, and not to please ourselves.”

Every time I have a patient who’s ‘makulit’, who complains a lot— and when I feel like telling him or her—“Go find another doctor”—I just take a few deep breaths and tell myself, God sent this patient to me for healing and not to be driven away.

It’s a paradox of sorts. We’re strong, and yet, we become weak because of our temperament, our other weaknesses; so we have to remind ourselves, too, that we’re not perfect, probably not as strong as we think we are. But whatever weaknesses we have, if we lift them up to the Lord, we realize we’re revitalized and strengthened by the Ultimate Source of all energy and strength. But first, we have to be humble enough to admit that we have these weaknesses.

The practice of Medicine can put us in all sorts of dilemma—like we’re walking on a tightrope. It’s that confused, discomforting feeling like when managing problematic cases—patients with advanced malignancies and a lot of comorbidities, patients with refractory heart failure, toxic-looking patients with an infection, and you can’t even identify where the focus of infection is.

When confronted with such a situation, I just remember these words from Psalm 46:10 “Be still and know that I am God.” I’m not strong or good enough to handle some problematic situations, but our God is. And He’s always in control, only if we allow Him to take control. Some of you might have noticed the beads I’m wearing. Definitely, they’re not for fashion. They’re supposed to be therapeutic beads, but I can’t really say I’m convinced about their efficacy. I wear it more as a reminder to be humble, so I call them my humility beads. They were given to me by one of my patients who had severe arthritis of the knee joints. I have referred her to several specialists—the rheumatologist, rehab therapist, acupuncturist—but without significant relief of her joint pains.

Then about a year later, she came back to the clinic, no longer on a wheelchair, but walking by herself. She told me that she had discontinued all the medicines we prescribed her for her arthritis because they were causing her stomach upset. Someone told her about these beads, and decided to try them. After only a few weeks, she felt much better and she continued to improve further over time.

I was speechless; it was a humbling moment. But we medical specialists have to be humbled from time to time to make us realize there are still a lot in the profession of healing people that we don’t know yet.

Harmony

Water teaches us Harmony. It’s fascinating how water normally does not force itself on any resistance it encounters. It just flows ever so gently and goes around anything blocking its way. But did you notice that over time, even rocks could be gently eroded, or should we say, molded by the water constantly hitting its surface. So for me, there are two lessons on harmony we can draw from water here.

First, it teaches us to respect other people who may not have the same beliefs and practices as we have. That includes prescribing practices.

It also teaches us to remain harmonious when arguing with other people. As the saying goes, you can disagree, but disagree in an agreeable manner.

For us, doctors, I think the second lesson on harmony water teaches us is that—whatever treatment we give our patient should be in harmony with Nature, which God has richly provided, so it could be our ally in healing patients. But sometimes, our prescriptions may not be in consonance with Nature’s healings, like when we immediately prescribe antibiotics even for self-limiting viral infections; or when we neglect to counsel our patients on lifestyle changes when the medical problem they have is clearly due to unhealthy lifestyle practices.

There’s a lot of truth in what Voltaire advised us—“The art of Medicine consists of amusing the patient while nature cures the disease.”

Openness

Water teaches us to practice openness or open-mindedness if you will. Open-mindedness means being flexible, adaptable, unbiased, unprejudiced, and tolerant. I believe as mentors to our interns and residents, we should practice open-mindedness, too, realizing that these young doctors we mentor have different talents, passions, strengths and weaknesses. Stereotyping them so that they should all conform to a particular stereotype we have in mind is not really conducive to good training. Allowing them to flourish where their particular passion is—be it in clinical medicine, research, corporate medicine or whatever—allows them to fully develop and harness their talents so they could be the best that they could ever be.

As Albert Einstein said—“Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.”

Dr. Bibly Macaya, president of the Adventist Medical Center Manila (AMCM), poses with his new white coat given during the 1st AMCM gowning ceremony

We must not also set milestones in their careers with corresponding timelines. We always tend to impose on them our own timelines based on our own expectations. Each one has his or her own fated timeline. We should be fully supportive of our students and other young colleagues we mentor and be instrumental in molding them to be the best they could ever be, but be open-minded enough to let them develop at their own reasonable pace.

We make them aware of their unique talents and strengths, but we should also allow them to express and harness their talents and the skills they have learned during training in a manner they deem best. Our role as mentors is just to guide them, but not to impose ourselves on them.

Stewardship

The fourth lesson water teaches us is Stewardship. Like we said, we can serve as springs of water which can never run dry as God has promised. Everyone can drink from it without limit. The water flows to the streams where the water just keeps on flowing. Water in the stream is also so clean, one can drink directly from it.

Compare it with the stinking water accumulated in a dam, where the water is murky, and no fish can thrive in it.

It’s also like the Dead Sea, which has no outlet, so it accumulates all its rich minerals, making its water so dense for any living sea creature to survive.

We may fall into a similar trap if we don’t practice good stewardship. We may be so rich in material treasures, and be too engrossed in them that we’re no longer playing the role God wanted us to play—to be a blessing to others just as we are richly blessed.

Let’s remind ourselves that we’re blessed by God so we could be “living springs of water,” from which everyone, who is thirsty, could drink and be refreshed.

So water teaches us lessons on Humility, Harmony, Openness and Stewardship. And if we practice these lessons, chances are, we could avoid the pitfalls that we may encounter in our career, and these are Professional inertia, Arrogance and Loss of direction.

Physical inertia

For our senior colleagues, and that includes me, this can be quite a challenge. The piles of unread journals in my library is testament to this.

I also catch myself begging off when requested to be more actively involved in training. I frequently give the excuse that I’m busy; and besides, I’ve done that role before, so the younger consultants should take over. I have to remind myself from time to time that we have an even bigger responsibility to share whatever clinical wisdom we have accumulated over the years or decades of clinical practice. Senior physicians may no longer be the best source of late-breaking clinical trials and researches, but they will always be a wellspring of good clinical judgment and wisdom.

We’re blessed we’re in a profession where there’s no fixed retirement age. In the corporate world, it’s 60. In the judiciary, it’s 70. But in Medicine, there’s no retirement age.

The medical profession is like biking. You keep going for so long as you keep on pedaling. The moment you stop to pedal, and remain still, you loose your balance, and you fall down. Just like our medical practice. We may cut down on our practice and just see a few patients daily and enjoy also other facets in life. That’s okay because that keeps us still going as physicians. But when we completely stop seeing patients when we’re still strong and able, then we may be shortchanging our profession.

A perfect example of this is Dr. Ramon Abarquez, Jr. He passed away around three months ago. He’s been in and out of The Medical City for seven months; but up until the day he was confined, he was attending conferences at the UP-PGH and he would always be the first consultant to arrive early in the morning on his wheelchair. He was still reading from page to page various medical journals. That I know because of the monthly commentaries he submitted for his column in H&L magazine; and he was citing at least 40 references per commentary. I wish all of us would have the same zeal and passion for our profession as Dr. Abarquez had.

Arrogance or pride

Some degree of pride is a healthy measure of self-confidence or self-esteem. But when it becomes excessive, it becomes arrogance. And as they say, arrogance is even worse than ignorance.

Sometimes, unwittingly, our success and prominence in clinical practice may get to our heads; and we may be acting like we’re God’s precious gift to Medicine and our patients. As such, we develop this peculiar ‘sense of entitlement’ on how we should be treated. We get angry when patients directly contact us, especially on weekends when they have emergencies.

“Matthew 5:16 clearly tells us what our main purpose in this life should be—‘You are the salt of the earth; let your light so shine before men, that they may see your good works, and glorify your Father Who is in heaven’

Of course we can’t be faulted if we consider weekends and holidays as sacred and no one should bother us, but we’re in the medical profession wherein in most fields, occasional emergencies happen. If our patient calls us every weekend even for non-emergencies, then we have the right to get mad. But if it’s only when there’s a real emergency, then we should accommodate our patients and instruct them what to do, instead of reprimanding them.

The ‘sense of entitlement’ can also rear its ugly head when we’re invited by pharmaceutical companies to lecture for them, or even just to attend a symposium or scientific activity. We must constantly remind ourselves to maintain our professionalism at all times.

Loss of direction

It may not be so much a problem in this institution where everyone is always reminded of our life purpose and spiritual direction. Nonetheless, as we become busier in our career, it is a pitfall we must be constantly aware of.

A story is told of Albert Einstein who boarded a train on the way to a destination. When the inspector came to inspect tickets, Prof. Einstein looked everywhere and could not find his. The inspector said, “It’s ok, Sir. We all know who you are, and we know you bought your ticket.” He moved on and he was about to go to the next coach, when he saw Prof. Einstein behind still looking for his ticket. He went back and assured the famous professor, “It’s okay, Sir. Everyone knows who you are, and we know you bought your ticket.”

Prof. Einstein looked at him and replied, “Yes, young man. I also know who I am, but I don’t know where I’m going, and at which station I should get off.”

In a way, many successful professionals including doctors are like Prof. Einstein in this story. So many things preoccupy our minds; and so many distractions divert our focus. We may forget what our main purpose in life is, and which direction we should go.

As a student, and later on as a young physician, I found myself always feeling lost, although it was quite clear what I wanted to achieve in my career as a doctor. And despite the small feats I accomplished along the way, there was that hollowness in them, which I could not explain. God sent me Becky, who later became my wife, to herd me back to the right direction. Through her, I was introduced to God’s words in the Bible, which bears all the instructions to make sure one is always headed North where God wants him or her to go.

“You, Lord, are my lamp; the Lord turns my darkness into light.” (2 Samuel 22:29)

Matthew 5:16 also clearly tells us what our main purpose in this life should be—“You are the salt of the earth; let your light so shine before men, that they may see your good works, and glorify your Father Who is in heaven.”

Praise God indeed for the wonderful blessing to be His physicians here on earth. To be God’s instrument in healing people is a great privilege for each one of us. May we always glorify Him, and not ourselves, in our amazing and awesome life journey as physicians.

May 2018 Health and Lifestyle

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