Georgina C. Pastorfide, MD, FPDS

The PDS’s membership has grown through the years since its inception in 1952. Its organizational structure and functions have been well-defined by our immediate past president Dr. Arnelfa C. Paliza in the administrative manual. The challenge that currently faces our Society is how we can form a truly dynamic organization that can impact the lives of Filipino people meaningfully– in other words, a Society that can make a difference!

The theme “PDS FOR ALL” implies a sense of oneness or “unity and cooperation” among its members. Indeed, we can become a dominant and influential society to be reckoned with if we set aside the bickering, pride and internal competition which only promote divisiveness and discontentment within the society. On the other hand, if we make an effort to harmoniously work together, unselfishly share knowledge among members and become committed to achieving common goals that benefit everyone, then PDS will be a strong, dynamic, and unified force that can make a DIFFERENCE in so many ways.

During our two-year term, the PDS Board will promote “unity and cooperation” within the society through sponsoring the following projects, namely, research workshops, multicenter studies and personality growth and development workshops.

The Good Clinical Practice (GCP) workshop held last April 1-3 and April 15-17 brought together all first and second year residents and some consultants from the ten training institutions. (At the time, the St. Luke’s Medical Center was not yet formally certified by the Accreditation Committee as one of the PDS training institutions.) Because of the positive feedback from the GCP workshop, there is now a clamor by the attendees for a protocol-making workshop which may be implemented sometime in August of this year upon the approval of the PDS Board. The research workshop not only fostered “unity and cooperation” among the residents and consultants from the various institutions but also provided a more thorough knowledge and enthusiasm for research-making.

Last April 14, 2009, the PDS Board approved the purchasing of Patch Test kits for the eleven training institutions. This approval was based on the fact that not all PDS training institutions will order patch test kits since they are expensive and they are often not able to get their return of investment. To resolve this problem, the PDS Board will generously provide all the institutions with Patch Test kits based on the following reasons: first, patch testing is an integral part in the dermatologic training of residents; second, with the patch test kits on hand; PDS training institutions will be better equipped in providing quality dermatologic care to all their patients for free; and third, as an off-shoot of the availability of patch test kits to all institutions, a multicenter study supervised by Dr. Clarissa Cellona is achievable – with the goal of possibly producing a PDS allergen series. This study, exemplifying “unity and cooperation” among our institutions, may be presented in the forthcoming 2011 World Congress in Korea or 2012 Regional Congress of Dermatology (RCD) hosted by the Philippines.
Likewise, the research committee chaired by Dr. Teresa Belmonte intends to undertake systematic reviews on herbal studies done at the PDS training institutions. Again, this multicenter study will not only foster “unity and cooperation” among the eleven training institutions but it will also produce a worthwhile study from the Philippines if presented in the upcoming 2011 World Congress or 2012 RCD.

The membership committee chaired by Dr. Angela Lavadia will continue enhancing the personality growth and development of all PDS members through a one-day motivational workshop sponsored by Schering Plough Philippines. Last April 14, 2009, the residents and consultants from Makati Medical Center dermatology department underwent the workshop with the general concensus that it was useful, practical and an opportunity for bonding among residents and consultants. It is hoped that through this workshop, “unity and cooperation” will be enkindled among our members, thus producing better PDS dermatologists.

The PDS Board will continue to cultivate “unity and cooperation” among its members because it is not only our current theme, but also one of the key factors to becoming a highly-recognized society. Let us all work together and share our talents, knowledge and expertise with one another. The success and accomplishment of the PDS as an organization is also the success and accomplishment of PDS members contributing in their respective capacities. Let us all do our part in making the goals and objectives of our Society a reality. With the achievements gained by our Society both locally and globally, we can confidently say with resounding affirmation: “I am proud to be a PDS dermatologist.

Atty. Elizabeth Amelia V. Tianco, MD, FPDS

Q:
In daily practice, we see a lot of patients coming in for cosmetic procedures. These cases are usually litigation-prone. How do we minimize the risks for such actions?

A:
More often than not, we as dermatologists may be the subject of litigation due to medical negligence. The best way for us to minimize the risk of litigation is to practice according to the standards of our specialty. If we do this, we have more than half the battle won.

In the event of litigation, the patient complainant has the burden of proving 4D’s: our duty to the patient (which must be within the standards of care of our specialty), dereliction of our duty, damage (physical damage or money loss) and proximate causation (that cause which, in the natural sequence of events, without any other intervening factor, would have caused the damage and without which the damage would not have occurred). To explain proximate causation, let us say that the dermatologist did not have the patient put on protective eye goggles during a laser treatment on the face, and the dermatologist inadvertently directed the laser light into the patient’s eye, causing blindness. The failure to have the patient put on the goggles is the cause of the injury and without which the blindness would not have occurred, for otherwise the light would have been deflected by the goggles. However, this is because there was no efficient intervening cause. What if, even before starting the laser treatment, there was a massive earthquake which caused debris to fall in the patient’s eye, causing the blindness? In this case, the dermatologist can argue that he or she had not yet completed the preparations for the procedure, including having the patient put on the protective wear. It will be difficult to say that the failure to put on the protective goggles was the proximate cause of blindness since there was an efficient intervening cause, that is, the earthquake.

The way to prove the 4 D’s is for the patient to bring in an expert witness, who will be a dermatologist with the knowledge and skill pertaining to the treatment or procedure done. If it involved a laser ablation procedure, then the expert witness should be one who has done such, and not just one who has read about it in the textbooks. Of course, no expert testimony is needed if the injury or damage sustained is such that it leaves no doubt as to the negligence of the dermatologist (resipsa loquitur, “the thing speaks for itself,” such as when the patient became blind during the laser procedure due to not having been made to use protective eyewear, and nothing else intervened that could have caused the blindness).

Don’t feel offended if a colleague testifies against you. It is the duty of all doctors to weed out the incompetent from their ranks. Besides, you can always vindicate yourself by having an expert witness who can testify that you practiced within the standards of care of our specialty.

We should have good rapport with our patient and show our sincere concern. If our patient thinks that we are just after the financial reward from doing a procedure, it will be easier for him or her to bring a case against us should something go awry.

We should neither be haughty nor arrogant. We should not taunt the angry patient with “E, di maghabla ka.” Such haughtiness will almost surely result in the patient bringing us to court, if only to teach us a lesson.

We should get a written informed and enlightened consent for the procedure to be done, and we should be the one to personally explain to the patient the benefits of any treatment or procedure, the risks, complications, side-effects, alternative treatments or procedures, and the results of no treatment. We wouldn’t want the patient to claim later that he or she did not consent to a procedure, especially when it is one for cosmetic reasons.

We should not take on more than we can comfortably take. If we accept too many procedures in one day, we may be too tired and our level of care may go down. Schedule on another day when we are more relaxed and have had a good rest.

When we don’t know how to do a certain procedure, we should refer the patient to a colleague who has the experience. We should get the patient’s permission but if we are refused and the patient insists that we do that procedure for which we have not adequately trained, we should not agree but rather decline to continue as the patient’s physician.

We should not take our patient for granted. Even the most amiable patient can be dissatisfied enough to file a civil case for damages, a criminal case for reckless imprudence leading to say, physical injuries, or an administrative case with the Professional Regulation Commission for the suspension or revocation of our medical license.

I like to reiterate over and over, take care to follow the Golden Rule: “Do unto others what you would want them to do unto you.” Let us put ourselves in the shoes of our patients. If we, as patients, wouldn’t want something done to us by our doctors, then we – as doctors – should not do it to our patients.

Joseph D. Ortiz, MD

Professor, Marianing, Dr. Ortiz, Tatang: this is what colleagues abroad. Local contemporaries, preceptess, students and residents called Dr. Mariano R. Ortiz, Jr.

Dr. Ortiz finished his medical degree at the University of Santo Tomas Faculty of Medicine and Surgery Class 1953. He then took up internship and residency training in Internal Medicine at North General Hospital (now called Jose R. Reyes Memorial Medical Center).

It was his sixth month as a Cardiac Fellow when he got hooked to the field of Dermatology. He had a case of Vasculitis referred to the service of Dermatology. There were no residents at that time so the patient was seen by the late Dr. Socorro Simuangco. After making her rounds, Dr. Simuangco was impressed with Dr. Ortiz that she offered a residency position in Dermatology and invited him to visit her at her Taft Avenue Clinic after a week for his decision. A week later, still undecided, Dr. Ortiz went to Dr Simuanco’s clinic and upon seeing the multitude of patients he agreed. During his residency training, Dr. Ortiz would see patients alongside Dr. Simuangco and occasionally her private patients when she was away giving lectures or attending conferences abroad.

During his senior year, Dr. Ortiz was chosen for a grant – the Colombo Plan – and together with Drs. Pablo Campos and Milagros Lopez, became the first Filipino dermatologists to set foot in the prestigious St. John’s Institute for Diseases of the Skin, London, United Kingdom. It was there where he met some luminaries in Dermatology which included Drs. Rook and Fitzpatrick.

When Dr. Ortiz got married, he then asked permission from Dr. Simuangco if he could set up his own practice at Avenida Rizal, far from hers to eliminate competition. Dr. Simuangco gladly gave her blessin after eight years of service.

During his stint at North General Hospital and UST, he also had the privilege of imparting his expertise to young and aspiring dermatologists that included Drs. Lina D. Torralba, Filomena L. Montinola, Ma. Luisa Venida, Gertrude Chan, Marita LimKe, Carmencita Salud, Jesusa Barcelona-Tan, Monina Macam, Arnelfa Paliza, Daisy K. Ismael, to name a few.

His interest in Acne and Psoriasis led him to be close acquaintances with international stalwarts in these fields: Drs. Alan Shalita, James Leyden, William Cunliffe, John Voorhoes, Prof. Griffiths and Robin Marks.

Dr. Ortiz also had the opportunity to serve the Philippine Dermatological Society and the former Philippine Aesthetic Medicine as Vice President, Secretary, Treasurer, Board of Directors, Board Examiner and Council of Elders for both societies.

He also had the honor of establishing Sections of Dermatology at St. Luke’s Medical Center and Cardinal Santos Memorial Medical Center, henceforth becoming the first Chief Section of Dermatology in both institutions.

Most of you probably remember him for his silly jokes and innuendos as well as his “words of wisdom” and “pearls” during conferences, scientific meetings and round table discussions here and abroad.

I will remember Dr. Ortiz not only as an excellent dermatologist dedicated to his career but more as a loving husband to my mother, as a great father to me, my sisters, brothers-in-law and doting grandfather to my children and nephews.

One night after last year’s PDS Annual Convention, while having dinner, I told him: “Did you know Pa, there are now 700-800 PDS members?” He replied: “Eh di mabuti, ikaw at si Ditas bata pa kayo marami pa kayong magagawa para umunlad lalo ang PDS, tulungan ninyo ang PDS, mahalin ninyo ang PDS, dahil ang laki ng pinaghirapan ko para sa PDS… minahal ko ang PDS, pag wala na ako kayo na ang magpalago nyan.”

I guess this message to me by my father offers a challenge not only to me but to all of us PDS members – to make the PDS soar higher, and to be dedicated and excellent dermatologist, just like Dr. Mariano R. Ortiz, Jr.

Ivan A. Singzon, MD, DPDS

I remember it was just a little over the year ago when my friends invited me to yPDS event at Discovery Suites. I was a little hesitant to attend because I thought the format would be like a round table discussion or a straight-out lecture from a dermatology consultant. I also guessed that there would not be that many people in attendance since it would be held on a week night. With these things in mind, I decided to stay home and study for my upcoming board exam. In the following days, I received phone calls from friends telling me that I missed a fun and well-attended event. They were raving at how great a speaker Mr. Francis Kong was and that the event was very stimulating and well-organized. Regretting not going, I asked my friends when and where the next event would be. When I learned that it was to be held in Fiamma, I was pleasantly surprised; it was hard to believe that a PDS activity would be held at an informal venue, a popular hangout bar. Even if I had my orals for the board exam scheduled three days later, I promised myself that I would not miss another yPDS event. The event was truly worth my while. The topics – image enhancements and wine testing – were very fresh and informative. There was crowd participation so there was not a dull moment. The food was plentiful and delicious, complementing the different kinds of wine offered. Unfortunately, I did not have any wine because my consultants did not allow me to drink, knowing I had to study in the following days. However, I did win a complete set of peel products from our gracious sponsor in a raffle which made my evening more memorable.

The third yPDS event was just as successful as the previous one. Held at CAV, it featured Mr. Anthony Pangilinan as guest speaker, who gave a very energetic and fresh talk about work-life-balance, which I found very applicable to my daily life. He entertained and captured the crowd with his witty humor. The food was sumptuous, the unique selection of hors d’oeuvres titillating to the palate, and I got the chance to drink a glass or two of the fine wine they served. It was a sight to see the PDS president, officers, and board members gathering together in a bar, drinking wine. They were mingling with us young dermatologists like we were all one big barkada. We were made more comfortable with their presence in a non-intimidating environment. Towards the end of the evening, they invited everybody for a group picture to be taken with them.

The final event of the year was held at Palacio de Maynila, a few days before the PDS convention, with Mr. Francis Kong and Mr Chinkee Tan enlightening the audience personal and private practice finance, as well as how to stretch one’s income. These were relevant topics, considering the global recession, hard economic times and the increasing price of gasoline. I have not forgotten the pearls of wisdom they shared that evening. I hope they will be invited to speak again in future yPDS events so they can impart their knowledge to new members or those who were not able to attend the past events.

Reflecting on the events of yPDS, I feel that the organizers put much thought and effort into putting it all together. I would like to congratulate them for a job well done. The events gave me the opportunity to socialize with my friends from other institutions, who I rarely get to see. I was also able to make new friends and meet more senior colleagues in the yPDS. I was very impressed by the support of Dr. Arnelfa Paliza and Dr. Francisco Rivera, and of the officers and board of directors from the PDS. The dedication and enthusiasm of each member of the core group is also noteworthy. With their leadership, I know the yPDS will continue to grow and be a venue to help young dermatologists in their clinical practice and to lead us in becoming active members of PDS. Keep up the good work. To all the young dermatologists and future members, I encourage you to attend the social events and join the yPDS yahoo groups. You will be welcomed with open arms and experience the camaraderie among the yPDS members. I look forward to more yPDS events in the future.

See you all there!