Pain and Suffering builds RESILIENCE among Healthcare Professionals

In our hospital, there is a problem of the decreasing number of applicants for residency training, particularly in pediatrics.  I've heard it said before that the new generation of doctors (those who were trained virtually during the COVID-19 pandemic) lack grit and resilience.  They stay away from discomfort and inconvenience and from traumas and rigors of residency training. So they are looking for alternative careers that are available to them.

This is why I would like to talk about RESILIENCE and how we develop resilience among the younger generation.

T1.  How do healthcare workers exhibit resilience?

What is resilience?

The US Department of State defines RESILIENCE as the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity.  It's the ability to "bounce back" from difficult experiences.  

Ian Robertson questions whether in today's culture we are reinforcing a "mental illness" mindset rather than fostering resilience and building "mental wellness".  Pain is your friend, so embrace pain for resilience.  "Resistance + pain = degree of human suffering" is the pain paradox.  Resisting or avoiding pain leads to more suffering.

To develop resilience, we must learn to lean into pain rather than avoid it. Embrace pain as if it were a trusted companion. By fostering a new relationship with pain, it begins to shift and become more manageable. 

This chat topic was inspired by a reel I came across on facebook of the NVIDIA CEO saying "I wish upon you ample doses of pain and suffering..."

https://x.com/joshuapliu/status/1769439388155482606

I understood then that the lack of resilience among the younger generation of healthcare professionals is because our parents shielded us from trauma, pain and suffering.  However, overcoming pain and suffering is how we develop resilience, and resilience is critical to success!  Therefore, in order to develop resilience, we need to overcome pain and suffering.  

The thought struck me again when I heard my mother listening to promotions about oud oil production from agarwood.

The speaker was saying that agarwood is a simple tree, and hardly valuable.  It is when agarwood is injured and inoculated with a fungal pathogen that it creates a resinous wood chips where oud oil comes from, which is valuable for fragrance, more expensive than gold.  It is the pain and suffering of the agarwood that makes one more valuable.

It makes sense because an oyster needs the irritation of a stone to produce a pearl.  Carbon undergoes intense pressure in order to become a diamond.

Residency training is tough because one day the discipline that we learn from training will spell the difference between the life and death of our patient.

T2. How do we develop resilience among our healthcare professionals?

Natalie Franke shares five simple steps to build resilience:

1. Nurture a positive view of yourself
2. Move toward your goals
3. Take decisive actions
4. Accept that change is a part of living and be willing to innovate
5. Make connections

The challenge stil boils down to BALANCE - with all the talk and importance of work-life balance and being mindful of mental health, how do we make sure we are providing amples doses of pain and suffering for our healthcare worker trainees to develop not only resilience but also GRIT?

T3. How do we balance developing resilience through pain and suffering while uplifting mental wellness?

References:

1. US Department of State Diplomacy in Action at https://2009-2017.state.gov/m/med/dsmp/c44950.htm#:~:text=Resilience%20refers%20to%20the%20ability,have%20or%20don%27t%20have

2.  Ian Robertson, October 24, 2025.  The Benefits of Pain and Suffering: The Key to Developing Resilience at https://ianrobertsontherapycounselling.com/our-blog/benefits-of-pain-and-suffering-developing-resilience/

3.  Natalie Franke, November 11, 2019.  Five simple steps to build resilience at https://nataliefranke.com/2019/11/5-simple-steps-to-build-resilience/

Sleep Hygiene

I have difficulty sleeping.

I've always been a night owl most of my professional life.  I am most productive from 6pm to 10pm.  Somehow, when menopause hit, I had difficulty sleeping before 12 midnight.  Some nights I watch the clock chime 5am to meet the sunrise.

I looked up Sleep Hygiene for tips on how to get better sleep.  One tip stuck to me, is the last line that you don't use your bed for anything but sleep and sex.

Body Odor Stinks

It feels depressing when your own team talks about you behind your back, when they only see your bad side and feel that you are just there to make work and life complicated for them.  It becomes difficult when your team is not rowing in the same direction.  Worse is when this is all an open secret, and everybody knows all this except you.

It's like body odor.

Everybody can smell it and they just laugh at you without you getting in on the joke.  People make all sorts of memes and jokes and have fun at your expense, because nobody cared enough to take you aside and tell you what the problem was.  Other people don't know how to tell you so you wouldn't get offended.  Other people don't know how to tell you so you don't get hurt.  

The truth hurts.  You're not perfect.  When you have a blank white page, the one that draws your attention is that tiny black dot - the imperfection.

All my life I had difficulty fitting in because I always felt like an ugly duckling.  In high school I had to endure bullying and rumors about me because I was  different and I came from another school.  I know how it feels to be vulnerable, knowing that others had the power to hurt you.  I know how it feels to be rejected, when you're always the last to be picked when joining teams. 

The coping mechanism is to develop a hard shell to protect you from ever being hurt again.  Or you can continue to risk yourself to vulnerability in the hopes of opening up to being accepted for your own true weird self.

Career Choices: what influenced you?

I would like to share some of my thoughts with regards to the questions for tonight's #HealthXPH tweetchat on career choices:

T1. What specialty/field are you in, and what is the most interesting thing about this field for you?

Doctor for all seasons.  I am an obstetrician-gynecologist.  We take care of women.  This is like taking care of the whole family since the woman is the pillar and the light of the home.  

Mobilizer.  The training in OBGYN requires you to coordinate and work in multi-disciplinary teams because we need to make sure our patient gets what she needs:

During childbirth, we need the nurse or midwife and the pediatrician.

In gynecologic surgery, we need the anesthesiologist, the surgeon, the internists, the OR nurses and even the orderlies.

In women protection, we need to coordinate with social workers, police and community advocates.

Clinician.  OBGYNs hold clinics for women from womb to tomb, providing outpatient care and performing office procedures.  The OBGYN is involved with diagnosis and management of reproductive health diseases. 

Surgeon.  An OBGYN is a surgeon with surgical procedures involving the female reproductive tract, with cesarean section as the most common major surgical procedure.  As the saying goes, a good surgeon should have an eagle's eye, a lady's hands and a lion's heart.

Public Health Advocate.  As empowered women empowering women, OBGYNs promote health and wellness, screening and early diagnosis for early prevention.  Maternal health is always a priority in healthcare because of its impact in public health.

Researcher.  As women's health is considered a public health issue, maternal health and reproductive health is always included in research priorities.  Being an OBGYN allows me to participate in research activities.

T2. What inspired you to go into this field? What fueled your enthusiasm?

Aura.  I was rotating in Fabella hospital as a clerk when I first assisted a normal vaginal delivery.  The parturient was having twins.  Despite not really knowing what to do, I was calm and patient, which the patient appreciated amidst the pains of labor.  The assisting midwife told me that I had the "aura" of an OBGYN...  At that time, I had my eyes on a surgical residency, but the observation stayed with me until the day I had to finally decide on my residency application.

Flexibility.  Ultimately, I envisioned that I would like to have my own clinic, make an impact on community health and be able to perform surgery.  I realized that obstetrics and gynecology ticked off all the items on my checklist, and comparing how prim and proper "amazon" OBGYNs presented themselves during conferences compared to the rugged surgeons, I chose to pursue my residency in obstetrics and gynecology, and later on a fellowship in infectious diseases (but that's another story altogether).

Empowerment.  Today, I am fortunate to be able to do what I love to do.  When I finished fellowship training and transferred to Cebu, my grandmother ordered me to rest and not work for a few months.  Then I got bored.  I asked permission from Dr Helen Amorin to volunteer to go on duty at the labor room doing labor watch.  It was something that felt natural to me, to simply be present and lend support to women amidst the pain of labor, coaching them that difficult roads lead to beautiful destinations.  There is light at the end of the tunnel and that after experiencing horrific pain is the joy of holding one's baby.  We are blessed to participate in the miracle of birth, taking care of women from womb to tomb.

Stigma Reduction.  Imagine delivering also women living with HIV.  In addition to the challenges of pregnancy itself, they need to deal with stigma and discrimination.  As empowered women, we empower these women to claim their own rights and to ensure that they get the treatment, care, and support they need for themselves and for their children.

Administration.  Amidst the hustle and bustle of the COVID19 pandemic, I was somehow dragged into hospital administration unintentionally.  The skills of coordination and facilitation and organization that we need in obstetrics and gynecology is also useful in managing institutions and health facilities in general.  Although this was unplanned and God seemingly led me into this, I am glad that I am able to make a contribution towards strengthening health systems.

T3. What advice can you give to someone who is still starting a career in your field?

Know your WHYs and choose something that you love doing so that there will be joy in your work.  If not, then find out what is NEEDED in your area so that you can strategically contribute to nation building and improving healthcare service delivery, because the country needs quality healthcare.  The Filipinos deserve quality healthcare service delivery.

In the end, we should remember that being a doctor is more than a job, it is a vocation.  Medicine is more than a career, it is a love for humanity.  The relationship with patients is based on trust.  We studied as best we could in med school because we knew that one day what we learned could spell the difference between life and death, and that the patient's life would be in our hands.  Choose your career based on what you do best, based on what is needed the most and based on what your heart desires.

Employee Empowerment

 

Employee empowerment is getting employees to do what needs to be done rather than just waiting and doing what they are told.  Empowerment is an act of building, developing and increasing other people's power through cooperation, sharing and working together to develop their COMPETENCY (knowledge, skills and attitudes).

It takes a level 5 leader to authentically empower their team to surpass you to reach their full potential.  It takes self-awareness, self-effacing and humility to genuinely empower one's employees.

Zig Ziglar Theory identified a list of seven steps associated with goal setting, identification, benefits, obstacles, skills, people, plan and timelines.

A stretch assignment is a project or task that challenges an employee to go beyond their current skills set and experience fostering growth and development by pushing them outside their comfort zone.

Situational Leadership

Situational Leadership is an approach where the leader matches and adapts behavior with the needs, commitment, capability and maturity level of his individual employee or team.

Leadership POWER

I was tasked to attend the Civil Service Commission Supervisory Development Course Track 2 and I share the nuggets of wisdom and learnings.

POWER is the prime mover of people and events, the ability to make things happen the way you want to.  The essence of power is influence over the behavior of others.

POWER is the ability to lead and inspire based on TRUST, respect and wholehearted commitment freely given and earned.

Impending Sense of Gloom

 

"There are days when your life clouds over and the world gets so dark, that all at once you can't tell night from day..."  this song from Miss Saigon seems to echo in my ears.

There are days when I do feel thankful for waking up to another day filled with hope and renewed opportunities but somehow I have difficulty finding the motivation to get up and do anything.  What's the use of giving it your best if tomorrow you will probably die anyway?

This is the problem with transitions - some transitions may be painful, because change is not easy.  Whether it's the transition from a child to an adolescent, from an adolescent to adulthood, from singlehood to married life, from nulligravid to primipara, from menstruating to menopause.  All through the life cycle there are changes which are affected by biological, emotional, psychological, social and mental factors.

I've been struggling with the effects of menopause like insomnia, musculoskeletal pains, vasomotor symptoms like hot flushes, headaches and even depression.   I am not one to take medications, as much as I can avoid it... So I take things one day at a time, accepting these transitional changes as part of life. 

While others talk about quiet quitting and giving only the minimum compliance to keep from getting fired, I have always used work as a clutch.  Work has become a coping mechanism for me to keep me pre-occupied and distracted from the silence that somehow has become so frightening that I am at risk of being enveloped in the darkness and swallowed whole by an overwhelming sense of gloom.  Are these thoughts suicidal ideations?  I cannot be sure.  I keep thinking and praying for death... "for in that sleep of death what dreams may come, when we have shuffled off this mortal coil, must give us pause..."

In that terrible silence, I hear the small voice that whispers to Lola Sising that I just want to be a good girl.... but all the wounds and scars from battles both mental, psychological and social, add to that overwhelming oppression of need and longing and rejection. 

Quiet Quitting in Healthcare

Minimum compliance is not enough when you aim to provide quality healthcare because health is wealth and lives of patients are at stake.  So what happens when the healthcare professionals and managers face the phenomenon of "quiet quitting"?

Pyramid of Quiet Quitting

When an employee suddenly leaves our work chat groups for no reason, I asked if she was ok and she simply said "I'm ok, but there are just too many chat groups." then she laid low on work activities, not exerting much effort or engaging co-workers in improving the system.  

When I searched Google Generative AI about this, I discovered a new term called quiet quitting.

QUIET QUITTING refers to employees disengaging from their work by doing the bare minimum to maintain their jobs, without explicitly resigning, and often as a sign of dissatisfaction or burnout.  This can lead to decreased productivity, reduced innovation, and a decline in employee morale.  Signs of quiet quitting include not volunteering for extra projects or leadership roles, limited participation in meetings or team discussions, refusing to take on tasks outside of the job description, arriving late or leaving early, focusing on the minimum required to keep the job.  Quiet quitting can be addressed by improving employee engagement and morale, providing opportunities for growth and development, encouraging open communication and feedback, addressing burnout and stress.

Heather Whitney  writes in her blog Quiet Quitting: Meaning, Signs, and How to Prevent it that in a survey they conducted, the majority of quiet quitters said their manager affects their work ethic (57%), as does their mental health (55%) and compensation (51%). 

Gray Towers says that quiet quitting offers both opportunities and threats for talent acquisition teams.  "their loss is our gain" if quiet quitters are enticed to apply in your company.  However, if the reasons for quiet quitting still pervades in the work place, these quiet quitters can be the reason to need recruiting in the first place.  Bottom line is that employers should have a good employee engagement program.

T1.  How do you understand the concept of "quiet quitting" in healthcare workforce?

T2.  How do you think the concept of quiet quitting affects work-life balance and healthcare service delivery?

T3.  What factors do you think impact work ethics of healthcare professionals?

Transitions

I was searching Google about "transition clinics" considering that we have an adolescent health clinic that helps patients transition to the adult clinics...

Patients attending antenatal clinics are preparing for the transition from being single and available to experiencing motherhood.

I wish there were perimenopausal clinics as well to prepare women to transition to menopause, because now I am experiencing a lot of symptoms like aches and pains and difficulty sleeping.

According to Google AI, transition clinics provide specialized care and support to patients as they move from one stage of treatment of care to another such as from pediatric to adult care or from hospital to home, focusing on medical, practical and emotional needs.

T1.  What transitions in health have you experienced, and how has it affected your life so far?

T2. Do you think these health transitions are severe enough to warrant transition clinics?  Why or why not?

T3.  What practical health tips can you offer for patients undergoing health transitions?

 

Journaling

I started my "Dear Diary" habits way back in grade school when I did not have the courage to verbally express my feelings then.  I needed an outlet to vent out my thoughts, feelings and emotions without affecting anyone else.  The problem was that when my mother read my diary, she found out all my secrets and I had felt betrayed.

So now I would like to think that I've grown smarter, with the sage advice of Yoda "guard your thoughts lest they become words.  Guard your words lest they become action.

"Fear is the path to the dark side.  Fear leads to anger; anger leads to hate; hate leads to suffering.  I sense much fear in you."

Take Care of Your Heart

How can we make our heart see God and neighbor more clearly?

Healthcare Conversations with Lola

 

In Filipino, Lola means grandmother.

I was remembering how my lola Sising and my lola Flora were both working girls helping to make both ends meet to provide for their families.  Although they were not medical doctors or homebodies, they knew how to take care of their children when they get sick.

Tonight let us remember the things we learned from our grandmothers and their approach to healthcare, tonight at 9PM MLA time on #HealthXPH.  See you on Bluesky!

T1.  What alternative medical treatments did your lola expose you to when you were growing up?

T2.  What have you learned from your exposure to your lola's approach to health and wellness?

T3.  What health advice did you receive from your lola that you could also pass on to future generations?

LET THEM Theory

The LET THEM THEORY helps you save energy and get more work done.

Four big ways that you've turned other people into a problem:

1.  You let people stress you out.

2.  You consider what other people think about you.

3.  You allow emotional immaturity in other people and in yourself to dominate your actions and how you move through your day.

4.  You constantly compare yourself with others and this makes you feel that life is unfair, and that other people are against you or competing with you.

All four of these obstacles are simply not true, so let them!

When you no longer allow people to stress you out, you have more energy.

When you allow other people to have negative thoughts about you because whatever negative they think about you is beyond your control anyway, let them.  Focus instead on the things that are within your control.

When you operate in a way that makes you proud of who you are, you authentically don't care about other people's negative opinions.

Be better than you were yesterday, no matter what others are achieving you are competing only with yourself.

We meet ourselves

I realize that no matter my approach to people, no matter if I put on a brave or friendly face, if peope don't like you they will snub you and overlook you or completely ignore you.  It doesn't matter how much effort you put into meeting them halfway.  If they are not willing, then it simply is not worth it.

On the other hand, there will be people who watch out for you and care enough to correct your mistakes and teach you how to move forward.  These are the people who matter.  Be motivated to work and improve yourself so that you can be like them.  

 

Survive

 

Learn something new everyday!

I decided to try learning how to use the Canva app on my phone.  I heard that students nowadays hardly use Powerpoint anymore because Canva is allegedly easier to use with lots of templates and designs... so i decided to try it out.  

After all, the best characteristic for learning is the willingness to try something new.

It started out with me making inspirational posters for my brother as part of my gentle reminders for him to take his maintenance meds... one poster per day from pictures grabbed from facebook and sayings/messages from my newsfeed.  Better you know it, I had created 10 designs!  I've started to get used to Canva.

As they say, practice makes perfect.  If you want to learn a new skill, you if you just want to maximize the use of an expensive cellphone so that you don't regret your purchase...

T1.  What new skill did you learn recently?

I remember when I was 17 years old, I was soooo excited to get my learner's driving permit so that I could learn to drive my car... I think my father almost had a heart attack when I was starting to speed up and didn't break abruptly when he said to stop.  He then delegated the rest of my driving lessons to my uncle Tony.  Today I enjoy driving because of the freedom it affords me.

T2.  Is this new skill a milestone?  How does this new skill impact your life?  Why?

The first time is always memorable.  

I remember singing the psalms in church the first time.  I was given a tape to listen to then the next day I sang in church.  No biggie.  I kept singing the psalms on Sundays until I had to leave for college.  This taught me how to be confident in my God-given talents.

I remember the first time I rode on a bus by myself to UP Los Banos and to rent a room and live away from home.  This was a new phase in my life when I had to learn how to budget and how to motivate myself to wake up on my own in the mornings, how to fend for myself and decide whether to walk or to ride the jeep... This was a lesson on independence and self-reliance.

I remember the first time I performed cesarean section as the primary surgeon during residency training.  My eyes were as sharp as an eagle's.  My hand was as steady as a sewer.  My heart was as brave as a lion's.  I had to keep in mind that surgical mistakes can spell the difference between life and death.  This taught me humility in service, accountability and stewardship.

T3.  What skill do you hope to learn someday?

My mother is a great homemaker.  She goes to market and makes sure she gets her money's worth.  She cooks and bakes.  She sews me dresses and bed covers and curtains and blankets.  She gardens.  She cleans the house.  She even does her own carpentry and paint jobs.

If I can only learn one of these homemaking skills, I would be more like my mother.

BRANDING

 

Last January 13, 2025 I was officially relieved of being the division chief of the Professional Allied Health Services (Health Information Management and Medical Social Services).  I gave my endorsements and I left all the group chats.  So now I can focus on leading the VSMMC Research Institute - to genuinely provide an enabling environment for research, as well as the KAAMBAG Clinic HIV/AIDS Core Team - to target enhanced awareness and control of HIV/AIDS in Cebu.

THIS WILL BE OUR BRANDING:  the way we make others feel will be our trademark.

Our strategy is to find ways to streamline our process flows so that nobody is indispensable.  All the staff are empowered to take on office functions in the absence of the other co-workers.

We spend hours on meetings, discussing our strategies and identifying our priorities to avoid getting overwhelmed.  After all, the journey of a thousand miles begin with a single step.  Ever forward we go, not allowing our fears to paralyze us, trying to do things differently each time until we find the best solution.

Go ahead and write.

I read Ronnie Baticulon's post and was genuinely happy for him.  His first book is still selling well in physical bookstores.  To all medical students out there, I highly recommend you get your copy of this memoir of a neurosurgeon, and the very real challenges of being a doctor in the Philippines.

Even our staff Alden Arsenal was bold enough to self-publish his book "Walay Bayot sa Langit" in Bisaya.  This gives me courage to pursue a collaborative effort to come up with the KAAMBAG Coffee Table book and start producing booklets in installments as both a way to raise funds for our programs and to reduce stigma and discrimination against PLHIVs because they are humans too, who need love, care and respect.