The author of this article: Zhouyou
February 16th at 23:00 in Manila, Philippines, I was going to sleep.
Suddenly, the two-year-old baby who was sleeping beside him woke up with poor breathing, crying, difficulty breathing, larynx, abdominal pain, and bulging abdomen, which lasted for about 15 minutes.
As an ophthalmologist, what a shame I didn’t see what was wrong! While packing up to go to the hospital, I WeChat contacted my college roommate and pediatrician. But because it was too late, there was no contact.
Hospital emergency
The hospital was close to home, and 10 minutes later, we were in The Medical City, the top 10 private hospital in the Philippines with a separate pediatric emergency department.
After arriving at the pediatric emergency department, the baby’s breathing has improved significantly, and the belly is no longer bulging and soft. The receiving doctor asked if we had a fixed pediatrician in the hospital.
In the Philippines, the average family tends to have a regular doctor. So the child is sick, and the usual process is for the attending doctor to call the private pediatrician, and then refer directly to the doctor.
But I consider that the doctor’s specialty is neonatology, which is not appropriate; the child’s condition is more urgent, I am afraid that the Filipinos are not in a hurry, and I will call back and forth, and the doctor will come back again. May be wasted time.
So, I said I forgot the pediatrician’s name (Filipino names are so long, I really forgot).
The hospital assigned us a pediatrician on duty, a young, mild-mannered female doctor who appeared to be in her twenties.
After seeing the child, I asked about the medical history for a while, and my husband said anxiously, “Are you going to check it first?”
She took the baby’s temperature, ear temperature: 38.7.
This is weird, I don’t feel hot when I touch my head and body?
During our doubts, another pediatrician who looked very young came over and continued to ask about the medical history, and also watched a few videos of symptoms when the baby had an attack, and did a retest. :
Body temperature: The temperature is normal after repeated measurement;
Blood Oxygen: Normal, Heart Rate: 140;
The stethoscope listened to the lungs and said nothing, and the abdominal examination said nothing.
The doctor didn’t seem to know what the disease was, and he went to write the medical records after the examination. After a few minutes, he came and said, “You can observe.”
Because when the baby was sick, I felt her belly bulging, so I asked the doctor to do an abdominal examination.
The doctor said, “Then do an anal exam and take a stool to see if there is anything unusual.”
I refused because my baby had normal bowel movements during the day, and the bowel movements were normal twice, and there was no vomiting or abdominal pain. Now the baby’s belly is soft and there is no Not to mention stomach pain.
I usually play finger-pointing games with my baby on the ears, nose, stomach, etc., so the baby can basically identify and point out the pain.
The doctor said, “Then get a plain abdominal radiograph.”
Photo courtesy of the author
Then a special person will push the baby in a wheelchair to take the baby for examination. After the results of the plain film, the doctor’s final diagnosis is: constipation.
Photo courtesy of the author
Really just constipation…?
Although I can’t confirm it, due to the sensitivity of the doctor, I always feel that the baby’s throat sounds abnormal when the baby is sick, so I put the pediatric resident doctor in the hospital again. The newly recorded video, and then confirm the condition and diagnosis.
But she still found no abnormality, and finally gave lactulose and antipyretics for half a month, and let us go home.
Final payment, I was shocked when I saw the bill.
Going to the emergency department did two things in total: the doctor asked for the medical history, a simple physical examination, and an abdominal plain film. It cost almost 800 yuan.
Photo courtesy of the author
Diagnosed
When I got home, I didn’t sleep because I was worried my baby would get sick again. Just in case, I stayed up until after 7:00 in the morning, and I sent messages to my fellow doctors, the pediatrician at my hospital, and the doctor in the department I thought was related to the baby’s disease to help diagnose.
My college roommate diagnosed her with acute laryngitis through a video I sent her and a description of the baby’s symptoms 9 hours before the baby’s onset.
At the same time, our hospital’s chief pediatrician also gave a consistent response via video.
Photo courtesy of the author: Chat records of domestic pediatricians
I heard that it was acute laryngitis, and I immediately broke into a cold sweat. The onset of this disease is fast, the disease is serious, and there is no delay. Thanks to the baby’s own strength, it has survived.
Children’s acute laryngitis is a common acute respiratory tract infection, with the highest incidence in children aged 6 months to 3 years old, and the onset time is concentrated from October to March of the following year period.
When acute laryngitis occurs in children, local edema of the larynx will lead to narrowing of the airway. If not treated in time, it will lead to difficulty in breathing or even suffocation.
According to my roommate’s guidance, nebulized budesonide suspension + oral prednisone tablets. The baby got better after taking it, and now he is alive and kicking again.
Forgive
The two pediatric residents in the emergency department of the Philippine hospital did not diagnose the baby’s illness, however, I choose to forgive.
Misdiagnosis is a fact, but fortunately it didn’t cause a catastrophe.
After all, I also came here from a hospital novice. I don’t think any doctor would dare to say: Every patient I met in my medical career can do 100% Diagnosed.
What’s more, as a senior doctor in charge of me, I am not very good at learning, so how can I blame others?
My baby told me that it hurts two days before the onset of the disease, which may be a precursor to acute laryngitis. I didn’t care, I ignored it.
In this case, aside from the mother’s guilt for not being able to detect the child’s illness in time, as an ophthalmologist, my doctor’s qualification certificate actually includes the scope of ENT practice, but I didn’t see it either.
I have also worked as an intern in a Philippine hospital, and I also understand that their medical system is very different from that in China. The doctor training mechanism and doctor promotion are basically similar to the United States.
Usually night shifts are trainee, trainee, or junior resident physicians. Senior doctors will visit patients at designated points. If there are junior doctors who can’t handle it Patients, or patients in need of surgery, they take over directly. However, the first diagnosis is generally handled independently by the former.
The two emergency physicians I met were probably junior doctors with little clinical experience.
I think the lack of diagnostic experience, the shortage of medical staff under the influence of the epidemic, and the mistakes made by doctors in their busy schedules and chaos are also excusable.
Growing through trial and error
This experience, in addition to being alert, also sighed at the difference between the Philippines and the domestic medical environment.
On the one hand, I deeply feel that the domestic patients’ access to medical resources and the government’s support for hospitals are far superior to those in the Philippines, and the quality and price are affordable.
Private hospitals in the Philippines have a good environment and advanced machinery and equipment, but the doctor’s consultation fee is also very expensive.
Baby this time, the doctor’s examination fee is more expensive than the examination fee. If you are hospitalized, the doctor’s bill and the hospitalization expenses are separated when you are discharged. Assuming that the total hospitalization cost is 100,000 yuan, the doctor’s diagnosis and treatment costs may occupy 10,000 to 20,000 yuan.
Photo courtesy of the author: St. Luke’s Hospital
Top private hospital in the Philippines
In China, if you meet an experienced pediatrician or an otolaryngologist, for acute laryngitis, you only need to spend a registration fee and a drug fee. Usually, the first consultation is three Got it for fifty bucks. Even if an X-ray is taken, it will cost dozens of dollars to check in China, but it will cost thousands in the Philippines.
Domestic like urgentIn the department of diagnosis, especially pediatrics, which is extremely understaffed, it is possible that vice-high and high-ranking officers have to work night shifts.
Although the Philippines has compulsory social insurance for employees, according to statistics from relevant Philippine departments, only over 30 million of the 100 million people in Manila can enjoy health care services, and most of them are unemployed. or unemployed persons without access to any health care services.
On this basis, many people can only go to public hospitals to see a doctor. The free public hospitals in the Philippines have far less medical equipment and environment than private ones. Among the top ten hospitals in the Philippines, only one is a public hospital.
Source: Visual China
Although the equipment and sanitation of national and public hospitals are not satisfactory, doctors’ diagnosis and examination are free, at least for those in need Basic medical insurance.
And the overall level of public hospitals is not as good as private hospitals. Free medical care, coupled with the implementation of the medical separation system, the hospital has no revenue.
The Philippine government has an annual budget of 9.7 billion pesos (approximately US$176 million) for 72 state-level public hospitals, but since most of the funds are used for daily expenses, many public hospitals cannot make ends meet, resulting in Many equipment are outdated and outdated after overdue service, and the environment of some hospitals is comparable to that of field hospitals.
Source: Visual China
On the other hand, although the overall medical level of the public hospitals in the Philippines is not very good, I am quite envious of the doctor training system in the Philippines.
Because doctors in the Philippines have more valuable trial and error opportunities that domestic doctors lack from the stage of traineeship and internship. Their training mechanism may be cruel to patients, but it is very beneficial to the growth of doctors’ business.
Self-growth will be faster during the training, especially in surgery. After the training, the basic common operations can usually be passed.
I have rotated in a Philippine public hospital before, because my language is not fluent and the efficiency is not too high, but I have never received any complaints from a single patient. Even in the emergency department, unless a patient of that particular emergency arrives, there’s a long queue of people quietly waiting to be called.
In private hospitals, the health insurance system also assigns patients to trainees and residents. Patients can pay less for medical treatment under the premise of informed and consent.
From the education in the school, to the hospital’s philosophy of emphasizing practice, including the tolerance and recognition of patients, I can feel the patience of this country for the cultivation of doctors. The hospitals in the Philippines are undoubtedly good cradles for cultivating residents.
The profession of a doctor is a hands-on job. For surgery, first aid, or technical departments that require hands-on skills, only by continuously accumulating the amount of surgery can you slowly change from quantitative to qualitative.
Finally, a special thanks to my dorm roommates in 4317: Pediatrics, Gastroenterology, Cardiology, Emergency, Ultrasound, and Neurologist, anytime, anywhere, day or night , as long as I need it will always appear the first time. (Planner: Beatrice, Producer: gyouza)
Acknowledgments: This article has been professionally reviewed by Feng Ye, Deputy Chief Physician of Pediatrics, Acheng District People’s Hospital, Harbin.
Image source: Visual China