What do you consider as a good surgeon – a medical intern ask – November 07, 2022

November 07, 2022

Today, when I was assisting a surgical resident in the Philippine General Hospital do a thyroidectomy (part of my surgical education program), a medical intern who was also assisting in the operation, asked me, “sir, what or who do you consider as a good surgeon”?

I tried to recall what I wrote before and answered her. Aside from answering her directly, I promised that I will retrieve my writing before and send it to her.

Here it is – retrieved it – a 2018 writing. I still maintain my answers. However, I will add another quality which I told the intern today. The surgeon must have a patient-centered care management quality. I will provide links to my writings on patient-centered care management. See below.

Qualities of surgeons to look for

Posted on September 2, 2018 by reyojoson

Here are some qualities that I admire in surgeons when they do their operations in the operating room (with the assumption that the outcome is good and there is adequate anesthesia):

  1. Finesse
  2. Speed and without too many unnecessary moves
  3. Decisiveness
  4. Cost-effectiveness

Here are the some qualities that patients usually admire surgeons when the latter do procedures when they are awake (with the assumption that the outcome is good and there is adequate pain control):

  1. Gentleness (magaan ang kamay)
  2. Speed (mabilis)
  3. Decisiveness
  4. Cost-effectiveness




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OLETE stands for Online Learning cum Evaluation Test Exercise.  

Basically, OLETE is an online test and/or exercise that has for its objectives the simultaneous promotion of learning and evaluation of the learners or students. Between the two objectives, promotion of learning is intended to be more important in my design for the OLETE.  The evaluation is intended to be more of a self-evaluation of the student to reinforce his learning.  Although the teacher-facilitator can use the OLETE to evaluate the pretest competency status (as will be reflected in the first attempt) and achievement in the subsequent attempts of the students, it is not the intention in the design of the OLETE to identify which students to flank or which to recognize.  The goal is that all the students get the perfect score at the end of the OLETE which in turn assumes that they all have achieved the learning objectives using the test and/or exercise as the evaluation tool.


Over the years, I have been trying to find an efficient way of education for all staff of a hospital or of a class.  I thought of OLETE in July 2011 and then concretized the concept in July 2012 when I used it in Manila Doctors Hospital when I conducted a seminar on crisis communication management.  In September 2012, I used OLETE for Ciudad Medical Zamboanga, another hospital I was helping.  I used it in the National Training Course for Safe Hospitals in Sri Lanka on September 22 to 24, 2014; in Zuellig Family Foundation’s Maternal Death Control Program in Zamboanga Peninsula in 2015-2016; in Salubris Medical Center in 2016; in Zamboanga City Medical Center Earthquake Business Continuity Program in 2017; in UP College of Public Health and UP College of Medicine; in my Patient Empowerment Program; etc. As of 2022, I still use it.

I will continue to use it using an Internet freeware (I have used QuizStar in 2016 and Google Form – I have confined myself to Google Form).

I personally think the OLETE offers an efficient educational strategy in organizations and hospitals in which one can be confident, if not assured, of learning of all staff with minimal cost and loss of time from services.

Here are the rationales of the OLETE:

  • There is active learning just by answering the questions in the test and/or doing the exercise.
  • There is enhancement or reinforcement of learning by repeating the test and/orexercise until a perfect score is attained.
  • Simultaneously, there is evaluation of baseline knowledge and subsequent ones.
  • All the abovementioned activities are done online for efficiency purpose – quick feedback on the correct answers and quick knowledge of results of the test and/or exercise.

There are several advantages of the OLETE over a traditional paper-and-pen test and /or exercise.

  • Lesser cost – no paper and ink expenses; lesser human resource needed for checking the test and /or exercise.
  • Minimal loss of time from services (of hospital staff who need to man the posts) as they can take the OLETE during off-duty hours.
  • Ensure that all students achieve all the intended learning objectives through a perfect score. In the traditional testing method, the teacher-facilitator usually does not have a good follow-up on the items which were not correctly answered by the students.
  • Can facilitate the re-certification processes (can be used again with some modification if needed as a re-certification test after 2 to 3 years).
  • Ease of documentation and archiving of the test and /or exercise and its results.

For all the reasons that I presented above, I am advocating the use of OLETE as an educational strategy in organizations and hospitals to ensure maximal and efficient learning of all staff in the knowledge domain.  The OLETE is not designed for learning cum evaluation of skill competency. However, it can complement the skill learning and evaluation if formulated in the style of a “table-top exercise.”

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Using Zoom for big gatherings – tips on sound

September 9, 2022

These past 3 nights, I attended novena mass for the dearly departed through Zoom. On the first night, the sound system was bad. I commented and gave advice to the people in charge. I have learned the trick after I attended a zoom necrological services of another dear friend in June 2022. The sound system was also bad.

This is the trick.

Place a gadget (android phone, Ipad, or laptop with zoom) from afar to have a view of the event. Mute this gadget. See 1st picture frame below.

Have another gadget and place it near the speaker or microphone. Unmute the zoom app. This is where the sound with go through. See 2nd picture frame below. The sound should be clearly and loudly heard.

In this particularly event, there is a choir singing during the Mass. If one wants to hear the singing of the choir clearly and loudly, one may place another gadget near the choir. Unmute the zoom app to catch the sound of the singing choir. Just make sure there will be no echo between two unmute zoom apps (one for the singing choir and one for the priest). If there is, one has to mute the app not been used. Example, during the choir singing, unmute the apps near the choir and mute the apps near the priest. When the choir is not singing, mute the apps near it and unmute the apps near the priest.

The sound system improves with this trick.

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MoSCoW Prioritization – ROJoson Notes

MoSCoW Prioritization

How I apply this in my life? At this point in my life (at age 73)?

As a minimalist person, I will consider only MoS – Must Have and Should Have.

  • I must have these and those – the most vital things that I cannot live without.
  • I should have these and those – important but not vital.

MUST HAVES (tentative list – will complete)

  • Intentional Living Plan (up to time of death and life after death)
  • Emergency Preparedness Plans
  • Advance Health Care Directive
  • Contentment Plans after Age 70 or after retirement (I am now 73)
  • Financial resources to spend for the remaining years of my life
  • A house to stay and a home to enjoy for the remaining years of my life
  • A family to love and to be loved

SHOULD HAVES (tentative list – will complete)

  • A computer (laptop) with WIFI
  • A car to bring me around
  • People especially patients and friends to interact

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Some ways of keeping hard copies of medical records by patients

There are so many ways of keeping the hard copies of medical records by patients.

Here are just some samples.

In the end, it is the choice of the patients and/or relatives. What is most important is to keep them and safeguard them.

Some, a few, will make a summary and keep.

As I said, in the end, it is the choice or call of the patients and/or relatives on how they will keep the hard copies of the medical records. What is most important is to keep them and safeguard them.


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Happy to hear this surgeon from Zamboanga City saving a patient from unnecessary breast surgery

August 3, 2022

Saw the following post by Dr. Alex Cerrillo from Zamboanga City.

I responded / commented in his Facebook.

Make my day!

I hope to hear more of this story in the future.

My advocacy – Compassionate Humanitarian Program – saving Filipino patients from unnecessary breast surgery – part of my Patient Empowerment Program also.


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ROJOSON’s Lectures and Teaching Activities – 2022

ROJOSON’s Lectures and Teaching Activities – 2022

ROJOSON’s Lectures –Talks –2022

Target: 12

Actual –

Compared to 39 in 2021 (COVID19 Lockdown)

Compared to 12 in 2020 (COVID19 Lockdown)

ROJOSON’s Lectures –Talks –2022

Target: 12

Actual – 42 as of September 21, 2022   

1January 28, 2022Case Presentation and Discussion and Journal Appraisal UPCM-PGH LU7 (Surg 260) – 6 studentsZoom
2July 20, 2022Case Presentation and Discussion and Journal Appraisal UPCM-PGH LU7 (Surg 260) – 3 studentsZoom
3September 21, 2022Case Presentation and Discussion and Journal Appraisal UPCM-PGH LU7 (Surg 260) – 7 studentsZoom
 UPCPH – MHA MHA Students 
1March 1, 2022Systems-Thinking in Healthcare Facilities UP-CPH MHA HA 202 StudentsUPCPH ZOOM
2March 8, 2022Managing the Department of Surgery UP-CPH MHA HA 202 StudentsUPCPH ZOOM
3March 15, 2022Hospital Quality Accreditations UP-CPH MHA HA 202 StudentsUPCPH ZOOM
 ROJ-PEP TALK Laypeople 
1January 08, 2022THYROID Cancer Development – Fundamentals and Generalities~20Zoom
2January 15, 2022Fundamentals and Generalities in Medical Management of THYROID Cancer –Part 1~20Zoom
3January 22, 2022Fever and Paracetamol: Myths and Tips~25Zoom
4January 29, 2022Fundamentals and Generalities in Medical Management of THYROID Cancer –Part 2~25Zoom
5February 5, 2022Fundamentals and Generalities in Medical Management of GOITER – Part 1~25Zoom
6February 12, 2022Fundamentals and Generalities in Medical Management of GOITER – Part 2~25Zoom
7February 19, 2022Fundamentals and Generalities in Medical Management of GOITER – Part 3~20Zoom
8February 26, 2022GOITER: MYTHS & TIPS~20Zoom
9March 5, 2022Fundamentals and Generalities in Medical Management of SKIN AND SOFT TISSUE TUMORS – Part 1~20Zoom
10March 12, 2022Fundamentals and Generalities in Medical Management of SKIN AND SOFT TISSUE TUMORS – Part 2~20Zoom
11March 19, 2022Abdominal Disorders – An Overview~20Zoom
12March 26, 2022Abdominal Pain – An Overview~20Zoom
13April 02, 2022RLQ Abdominal Pain and Appendicitis~20Zoom
14April 09, 2022Abdominal Mass – An Overview~20Zoom
15April 23, 2022Abdominal Obstruction – An Overview~20Zoom
16April 30, 2022Abdominal Bleeding – an Overview~20Zoom
17May 7, 2022Jaundice – An Overview~20Zoom
18May 14, 2022RUO Abdominal Pain and Gallbladder Disorders~ 17Zoom
19May 21, 2022Pancreatic Disorders~ 17Zoom
20May 28, 2022Hemorrhoids~ 19Zoom
21June 4, 2022Hernias~ 20Zoom
22June 11, 2022Laughter Exercise for Health and Well-being~22Zoom
23June 18, 2022Low-value Medical Care: Unnecessary Prescription of Medications~24Zoom
24June 25, 2022Low-value Medical Care: Unnecessary Diagnostic Tests~20Zoom
25July 02, 2022Low-value Medical Care: Unnecessary Operations / Surgeries~17Zoom
26July 09. 2022Circumcision: Low-value Operation~16Zoom
27July 16, 2022Laboratory Tests – Reading & Interpretation~20Zoom
28July 23, 2022Breast Ultrasound & Mammo – Interpretation~25Zoom
29July 30, 2022Thyroid Ultrasound & Function Tests – Interpretation~20Zoom
30August 6, 2022Medical Records – Keeping~16Zoom
31August 13, 2022Cancer Curability & Survivorship~20Zoom
32August 20, 2022Cancer Incurability and Hospice Care~18Zoom
33August 27, 2022Antibiotics – Use & Misuse~20Zoom
34September 3, 2022Pain Management – Fundamentals and Generalities~20Zoom
35September 10, 2022Urinary Tract Infection – Fundamentals and Generalities in Management~22Zoom
36September 17, 2022Gastroenteritis – Fundamentals and Generalities in Management~23Zoom
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Surrender to the young the technological advances in medicine and surgery

Reflection again – at age 73 and a half – June 24, 2022

Recalling this statement in Desiderata: “Take kindly the counsel of the years, gracefully surrendering the things of youth.”

There are so many technological advances in medicine and surgery that I honestly cannot really cope up with anymore. In the surgical world, there are so many new machines, new equipment, new instruments, and new technical procedures. Again, honestly, I don’t plan anymore to learn how to operate with these new technology.

I will gracefully surrender to the younger surgeons the technological advances in surgery, which is my specialty.

I have resolved to limit myself to and be contented with continuing and refining the principles and processes of contained in my ROJoson Patient Management Processes – offering medical and surgical services including advice that are rational, cost-effective, compassionate and patient-centered that can withstand the test of times despite the technological medical advances.

There are two other quotes which I like to remind myself of in this regard:

“I am in competition with no one. I run my own race. I have no desire to play the game of being better than anyone, in any way, shape, or form. I just aim to improve, to be better than I was before. That’s me and I’m free.”

Don’t switch off and be idle when you retire. You can still do things that are of interest to you, or you can get involved in things that are of value to your community, all at a pace you feel comfortable with.


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A cat eating a kitten? Or is it a rat?

A cat eating a kitten? Or is it a rat?

May 8, 2022, 0745 am, when I was about to do my daily walking exercise, I saw a foot of a black cat in a box of shredded papers which we have provided as one of the resting abode of cats in our garage. There was no attached body.

At that time, I was wondering whose foot was this. I surmised maybe from a black kitten whom I have not seen for almost 2 days.  I was wondering what happened to him or her – run over by a car on the street? I had to look at the street when I walked to get the answer.

I went about my walking exercise for about one hour (more than 3 kms) in the neighborhood streets.  I did not find any scene of a cat being run over.

When I came back home from my walking exercise, when I was about to get equipment to do some gardening, I suddenly saw in another part of the garage a black cat “mutilated” with head practically detached from the trunk; with intestines exposed; with mangled feet; with some the flesh eaten out; etc. The “corpse” looked fresh, most likely “mutilation” occurring only recently (early morning or last night).  A really gruesome picture of a dead cat.  I identified the cat to be the small black kitten that I have not seen for 2 days.

I will not post the gruesome pictures. 

My question: who killed the kitten? Is it another cat (the mother) or is it a big rat?

I searched the Internet.  Yes, sometimes, an adult cat can kill a baby cat for survival.  Yes, too, big rat can kill a baby cat. So which is which in this case? 

I surmised it is the mother cat who mutilated and ate part of the body of the kitten. In the past, I have seen this mother cat brought to the garage a small chicken roaming in the street and ate it.  In other occasion, she ate a dead bird.  This cat is capable of eating other animals.  Why a cat and not a rat? One, a leg of the dead kitten was in another area while the rest of the body in another area.  I have experienced seeing different parts of the mutilated “corpse” scattered in different areas by this mother cat.  Second, the fleshy parts have been eaten and devoured.   Third, the body has been mutilated and mangled.  I don’t think the rat will do all the above.  The biggest rat that I have seen in the neighborhood is only one fourth of the size of kitten that was killed.  The rat might bite and killed the kitten.  It will take some time and effort to mangle the whole body and without being seen by the other cats in the garage (about 3 of them). The extensive devouring of the dead kitten would take some time, probably about 30 minutes.  I don’t think the rat can do this especially in the early morning.  Rats usually work in dark places.  

Why would a mother cat eat her baby kitten?  At first, I cannot believe she can do it.  This mother cat has about 3 pregnancies in our garage.  After delivery, she would take good care of her babies until they are independent already.  She had a track record of providing motherly nursing care.  That’s why I cannot believe it.  After searching the Internet, knowing that she could, I started asking why?  For survival? She wanted more foods to eat? Also in the past week, I noticed the black kitten to be “weak.”  She might have died last night. After dying, the mother devoured her.  This is another possibility.

I don’t know.  I don’t have the exact answer.    

I am doing this narration for my mental exercise – practicing writing a journal and trying to understand mysterious things in this world – to maintain my cognitive ability.

To those who read this, you are welcome to give comments.  Thank you.

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May 1, 2022 – A day to continually uplift the workers and to remember the human and spiritual significance of labor

May 1, 2022 – Labor Day and Feast of St. Joseph the Worker

Today, May 1, 2022, and every May 1 of each year, we celebrate Labor Day as well as the Feast of St. Joseph the Worker.

Today, I meditate on the value of HARD WORK and LABOR as taught by the Bible, St. Joseph and other wise people.

If you are poor, work. If you are burdened with seemingly unfair responsibilities, work. If you are happy, work. Idleness gives room for doubts and fears. If disappointments come, keep right on working. If sorrow overwhelms you and loved ones seem not true, work. If health is threatened, work. When faith falters and reason fails, just work. When dreams are shattered and hope seems dead, work. Work as if your life were in peril. It really is. No matter what ails you, work. Work faithfully-work with faith. Work is the greatest remedy available for both mental and physical afflictions.

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