Nolim’t-Jay T. Raquel

December 16, 2002



            I started my surgery my surgery residency training since January of 1997 and had been in the program for 6 years


Objectives of the paper

1.      To reflect onhowmuch I have imbibedthe basic framework and core values expected of me as part of my learning objective in the training program

2.      To formulate strategies for continuos improvement on the basic frameworks and core values after graduation




Basic frameworks:


Patient management process

            During my first three years in training I was using the traditional way of obtaining complete history and physical examination but could not discern how to process these voluminous data to arrive at a diagnosis. With this patient management process I found out that there is a systematic way of using these data to formulate the most probable primary and secondary diagnoses. It is from these diagnoses in which treatment options are formulated. Choosing the best treatment option will be based on the benefit-cost-risk-availability parameters. It is this same process that I can give the best advise to my patients thereby making them understand what is happening and is being done to them. It is my best tool to avoid complaints and medical malpractice suites.

            There are still lots to learn so I can improve. I need to learn more about the benefits, risks and cost of every treatment or diagnostic options and these requires constant search from literatures because the best option at present may just be a better option tomorrow.


Operation surgery process

            Success of the operation lies first on preoperative preparation. I was taught of the importance of determining co-morbid problems, prepare things/materials to be needed, and doing selective laboratory work up. It is also important not to forget securing informed consent and to provide patient with psychosocial support.

            The operation should be well planned. Setting the objectives and knowing how to accomplish them by using the benefit-risk-cost-availability parameters to every maneuver/step during of the operation also have a great impact on the result of the opeartion.

            This process will still be very useful after my graduation. If ever given the chance to be connected to an institution with residency training I will propagate this process.


Problem-based and self directed learning process

            My idea before about learning the diagnosis and treatment is by looking into available literatures about the topic regarding the disease and read everything about it. I ended up confused and still feels that the information was not sufficient. Setting the objective on what is needed to be learned and search for its answer makes learning easier and more fulfilling.

            Two patients with same diagnosis may not need same management. Patients with choledocholithiasis receive different form of management depending on their co-morbid factors, capability of the patient for financial support and availability of the treatment in the locality. That is why learning the disease and its management should be patterned on the specific patient.

            After my graduation, the management I had learned which I think is the best for the patient may not be the best later depending on the individual characteristic of my patient and the availability of diagnostic tests and form of treatment.


Physician Teacher process

            I felt not qualified to become a teacher – educator but I realized that to be surgeon I could not escape the responsibility to educate my patients, their relatives, medical students and junior colleagues. Our residency training provided us venues to cultivate this aspect through daily rounds, conferences, during the operations and even in the follow-up of patients in the OPD. Upon graduation I need to pursue being a surgeon-educator so I can help in promoting the patient management process and the use of selective laboratory work-up just to mention some of the things I have learned that needs to be promoted.


Physician Researcher Process

            One of the most difficult aspects in the medical field is the research because of difficulty to do statistical analysis. I thought I had to be a statistician first before I could do these. I just tried finishing research papers as requires by the hospital for promotion to higher year. With of our chairman who set the goal of publishing good research papers even outside our institution and his help in improving our research studies we were able to experience joining in research contests even winning prizes.

            Research is a vital part of surgery. Through research that management of patients are improved. There are lots of studies that can be undertaken even for the common diseases like appendicitis and hernia. After graduation there is a pressing need to continue research for patients’ welfare.


Physician Manager Process

            Our training provided us venue to cultivate our administrative capabilities. Being the surgeon in a particular case especially in difficult situations already developed my administrative ability because as the captain of the ship I was already given the opportunity to decide on what is best for my patient. In my senior years I was given enough time to become chief resident providing me chance to tackle administrative problems and acting as liaison officer between our department and the hospital. It taught me accepting my limitations and to know when to refer to others for help especially to higher authorities and how to delegate important works to others with the result of achieving best solutions.


Community Surgical Health Process

            In line with the vision of Healthy Urban Poor and Health for All Filipinos, we took part in the fulfillment of this vision because we too believe the community health is an asset and would bring productivity to the community. We identified diseases that affect much of our community population and tried to find ways to solve these issues through our operasyon pinoy which provided fast, cheap if not free, and effective treatment not only once a year but everyday in a year.

            I feel adequate to take lead in addressing community surgical health management if ever I will be assigned to a certain locality. Informing the public of free medicines is an essential way of enticing patient to come out for treatment so I would try means to seek donors for such materials.


Core Values


Respect for human lives

            During presentation of cases whether on conferences, referral to consultants or bedside rounds, I was used to begin introducing my patients with this statement- “This is a case of a _ year old. This attitude was changed since Dr. Joson introduced the management process. Since then I started my statement as “This is Mr. Juan dela Cruz, my patient.” With this I found and felt the essence of a patient-doctor relationship. I have learned to treat them not just as a case or a problem but as a real living patient. I have learned to treat them the way I should treat my closest relative.

            Respect for human lives also means knowing when to and when not to offer treatment especially to cancer patients. Though they have terminal illness they still have their right for a good quality of their remaining lives and this should be respected.

            I am very proud and grateful with this value and I will propagate it by teaching others as I leave this institution.


Honesty and sincerity

The ability to do grave dishonesty comes from the ability to do slightest dishonesty. I was involved in the so-called intellectual dishonesty which I thought it was not at all a dishonesty but I realized that it can destroy my good values as a surgeon if not been corrected.

I also learned the importance of being honest to my patients. They have the right to know about their disease and what is being done to them.

Sincerity can be shown if I believe in the things that I do to my patients.


Ethics and integrity

Respect to my colleagues is an important value. If ever my colleague will refer his patient to me I will explain my plan of treatment to him and to the patient but not to the extent of taking the patient as my private patient.

Scheduling of patients for operation will be based objectively and not because they are pay patients that they will be prioritized over charity patients.

Being a surgeon my responsibility to offer healing will be my primary intention and financial reward will just be secondary.



            I have learned to be punctual. Every time the scheduled cutting time of the operation is 7 AM, I had to make sure that the patient should have been wheeled in the OR at 6:30 or earlier. I also have learned to respect my colleagues (which includes the clerks and the interns and the doctors in other hospitals who referred the patient) not to make bad remarks about them when I am with the patient. These bad remarks create distrust from these patients to my colleagues.

            My stay in our department also taught me how to develop a good working relationship with the anesthesiologist and nurses. They are part of the team and should be respected.


Continuous improvement to achieve quality and excellence

            The quality analysis of morbidity and mortality is a way to have a better quality of service and excellence in the management of patients. It is a self-assessment of where I failed and where I can improve. This is not only applicable during my training but even into my private practice. I should have the continuous desire for improvement and excellence.


Team Work

            As a junior resident I have learned to follow and perform the duties assigned to me by my seniors. As a senior resident later I have learned to assign duties to my juniors that I think they can do and yet taking the responsibility whatever the result of their performance of their duties. I have learned to function not just as an individual but to give my part to the team to achieve a common goal.

            Teamwork does not only exist within our department but also with the other department during referrals for co-management. This was done through direct communication and made myself approachable thereby removing barriers for fast and effective results.


Social consciousness

            The issues on circumcision and swallowing of santol seed made me aware of my responsibility to society of giving beneficial information even to the point of breaking their tradition, beliefs and habits. I have learned the necessity of getting out from the comfort of the conference room and operating room to be able to inform the public regarding important issues through lectures and interviews through television and radio. As a result the public did not only become aware about these issues but also have let them aware that the institution/department is active and existent.




            I chose Ospital ng Maynila Department of Surgery where to acquire my training because it offered only four years. I was sad when I have learned that the training was suspended and it would take us about six years. I thought six years was a very long span of time but reflecting on what happened during these years seemed like I had only spent 6 short months. This was because I enjoyed my stay in this department and in the hospital as a whole. Training was made easy since I was not counting my stay here per day. I thought that I have to come regularly because I felt I was a part of this institution. I felt I was a part of a family with a responsibility to perform aside from my training. I had all these feelings because the institution had let me feel such. I would like to thank then the people who had shared their time and without them I would not be a graduate of this prestigious institution.


            First I would like to thank all the nurses for their support. Because of them I have learned to be more mature in my decisions especially which patient should be prioritized for operation. They were so willing to bend from the OR policies just to be able to accept my requests.


            To my co-residents thank you for the camaraderie. I have learned a lot from you guys. I hope you also have learned even a bit from me. You made my life here so easy and yet so fruitful.


            To all the consultants thank you for accepting my referrals especially during late at night. Thank you for the knowledge you have imparted more so for showing me what a surgeon really is.


            To Dr. Joson- Sir, thank you very much for. You made my training so structured. With that I have learned and understood what a surgeon must have. The patient management process that you have taught was to me the cornerstone that I was able to acquire the basic frameworks and core values a surgeon should have. You made me a well rounded surgeon. Thank you for helping me in the research area – my waterloo. I still could not believe that I was able to present a study outside the hospital - PCS at that!


            To my dear patients – the very reason of my existence in this hospital, who put their trust to me as their surgeon thank you very much.