FOR THE GRADUATES: Go and make us proud. Dr. Miriam Roxas Timonera

(Dr. Miriam Roxas Timonera delivered this speech before the graduating students of Medicine of the Mindanao State University College of Medicine in Iligan City last Sunday, March 27)
ILIGAN CITY (MindaNews/29 March) — Vice-Chancellor for Academic Affairs Dr. Zenaida Ababa, Officer-in-charge Dr. Cristina Achacoso, former Dean Dr. Emma Macaraya, former Dean Dr. Ombra Tamano, faculty members, graduating students, dear parents, relatives and friends, good morning!
Thank you for inviting me to speak to you this morning. I asked two of the graduating students what they were interested to learn from me and one gave a general topic, the other a specific one and these are: “What is the secret of success” and the other is “how do we choose a career or specialty”.

Okey. So, we will do this little exercise. Now close your eyes. Close your eyes and try to visualize yourself at the peak of your success. Try to make this image as clear as you can. What are you wearing? What are the things around you which are symbols of your success? Do you seem them clearly?

Buti pa kayo. Ako kasi di ko ginawa yan. (You can open your eyes now.)

Di ko ginawa yan kasi wala talaga sa listahan ko ang “what I want to be when I grow up,” yang “I want to be successful.”

But just now, there is something I do so want to be successful in. I do so want to impress upon you, graduating students, to henceforth strive for “honor and excellence”.

Several months back, somebody emailed me the link to a youtube posting of Solita Monsod’s last lecture wherein she discussed “honor and excellence” and castigated the graduates of the UP College of Medicine. You can look this up for yourself but here is my version.

Two quotes:

1. “The most tragic thing in the world is a man of genius who is not a man of honor”
– George Bernard Shaw

Concrete example: Think of our national leaders who came from the best schools and appeared to have brilliant minds but ended up stuffing their pockets instead of giving back to the people.
They could sell all their brand new cars and all their beautiful mansions and still they would not be able to buy back their good name.

2. “He has honor if he holds himself to an ideal of conduct though it is inconvenient,
unprofitable, or dangerous to do so.” – Walter Lippmann

I am very fortunate to have encountered through the course of my education, teachers and mentors who have served as my role models because they have chosen to maintain their idealism and keep to a lifestyle that will allow them to do this.

When I was a first year premed student, I had a professor in Zoology who came to class in faded T-shirt and gabardine pants. He was rumored to be an ex-political detainee at the age of 21 and to be one of the owners of a big chocolate factory. But he chose to be in the academe instead of going abroad or maybe managing their family business. He was one of the best professors in his field and inspired in us his students a great awe for the wonders of the world of invertebrate zoology. When I had my kids of my own and brought them to the beach, I would tell them stories about the star fish and the sea urchins and the sea cucumbers and my kids’ eyes would light up and grow bigger. And I would think about this professor.

When I was in med school, I had a professor in Pharmacology who commuted from UP Diliman in Quezon City to UP College of Medicine in Manila on a bicycle. When we asked him why he didn’t have a car, he said that he could not afford this with his salary. He spent his free time meeting with us students and other hospital workers to discuss the National Drug Policy Program and Rational Drug Use, measures which would make medicine more accessible to the marginalized Filipinos. While his colleagues were doing sidelines with drug companies and earning quite a pretty penny, he was doing extra “teaching work” pro bono, done for the public good without compensation.

After med school, I and a group of classmates formed the Community Medicine Development Foundation. I spent the next three years doing medical missions and training health workers in Lanao del Norte and Lanao del Sur. This is a payback, a down payment to the Filipino people who paid for my education through their taxes. It was also a fulfillment of my mother’s prayers. When I was preparing for my board exams, my mother approached me and said “Miriam, you’re gonna pass the board exams; because I prayed to God that if He will make you a doctor, you’re gonna serve the poor.”

After working in the community, I had my training in Internal Medicine and Cardiology, and worked with a professor who taught us to always always always put the patients’ interest above our own. He discussed to us such concepts as conflict of interest or why doctors should not own diagnostic machines and pharmacies which could turn the practice of medicine into a business; and ethical relationships covering doctor-doctor, doctor-patient and doctor-pharma or how drug company-sponsored junket trips and fellowship nights make medicine more expensive for our patients and compromise our decision making in choosing what is best for our patients.

Because I have known these people, it has become easier for me to choose a simple lifestyle so I could afford to practice medicine as a profession and as a vocation.

So YOU, when you leave this training institution and go out into the big big world out there or decide to pursue further training, be on the lookout for people who have lived their lives with honor, get close to them enough to make them your text mates, not just friends in Facebook, text mate, and keep in touch with them. They will not only be your role models and mentors, they will also be your lifelines when you find yourself in situations which could make you compromise your ideals.

And what is the reward for sticking to your ideals?

Well, I could afford to drive around in my own car – a secondhand, very stylish black Nissan March with some paint peeling off.

And while I take care of my patients, my patients care for me.

I get the freshest tiger prawns and king crabs from a patient who is a market vendor. This is what she would bring to my clinic after several free consultations and hospital admissions.

Recently, I was on my way to Dr. Uy ICU and found myself driving the wrong way in a one-way street. Alas, at the intersection was a traffic policeman, shaking his head and walking towards me. Then suddenly, from a jeepney which was passing by, a man stuck his head out and shouted. “That is Dr. Timonera! She has an emergency!” So I pulled out my stethoscope, showed it to the policeman and said sorry, and the policeman let me go.

But the one I like best is this line from an old Muslim patient in his 70s. He would come to my clinic with his wife and wait for their turn until 11pm or even 12MN. They would then have to travel an hour and a half back to their place in Marawi. One time, as they were leaving my clinic, he turned around and told me: “Doctora, I am always praying that you will convert to Islam because you are so good to us, I want to see you in heaven.”

I really love my patients….

Okey. Now we go to EXCELLENCE.

Have you heard of the quip “Half of everything you learned in school is wrong: the problem is you don’t know which half”?

Case in point: Beta-blockers for heart failure. When I was in med school, heart failure was a contraindication to the use of beta-blockers. Now, beta-blockers is class I recommendation for the treatment of heart failure based on grade A level of evidence.

And here’s another quip: “Just when I knew all of life’s answers, they changed all the questions!”

Imagine this scenario:

You are a first year resident and your consultant asks you if you think that a funny channel inhibitor could be substituted for a beta-blocker for your patient with chronic stable angina. You go to your textbooks and there is hardly any mention of a funny channel inhibitor. Have you heard of funny channel blockers? That’s no joke. There is such an entity.

What’s the next step? Where do you go for this information? The internet? Ok. So how do you do an internet search for medical information? How do you choose from hundreds or thousands of published articles? How do you appraise the validity of the results? How do you weigh the benefit versus risk of one intervention over another? And finally, how do you decide whether to use or not to use this intervention for the patient in front of you?

To be able to maintain competence in the practice of medicine, a physician should always update himself. To be able to EXCEL in the practice of medicine, a doctor should have a mastery of the knowledge and skills on how to acquire, appraise and apply research evidence to guide his health care decisions. We have just defined “Evidence-Based Medicine.” “EBM is a systematic approach to the acquisition, appraisal, and application of research evidence to guide health care decisions.”

Believe me when I tell you, if there is one kung fu that you will need to master to be able to survive in the competition of ideas in the field of medicine, it is Evidence-Based Medicine.

Now let me go back to the two questions from the graduating students.

“What is the secret of success?”

It is HONOR and EXCELLENCE.

Find a role-model and mentor who will help you in the HONOR department and master the kung fu of EBM to keep you ahead in the EXCELLENCE department.

“How to choose a career or specialty”

No matter what career or specialty you choose, you will always be one of the best if you have HONOR and EXCELLENCE.

Now go and make us proud.

(Dr. Miriam Roxas-Timonera, a graduate of the University of the Philippines College of Medicine, is an internist-cardiologist practicing in Iligan City. Before undergoing her residency and fellowship training, she volunteered as a community doctor, serving rural communities in Cebu and Bohol, then in the two Lanao provinces for three years)

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