Samuel D. Ang is a top general surgeon and surgical oncologist in the Philippines. What is amazing in observing his practice is not the overflow of patients in the waiting room, but the diversity of patients, representing various sections of the Philippine economic pyramid.
Sunfu: Thank you for allowing us to have you as our first medical doctor to appear in our blog. Dr. Ang how long have you been practicing medicine?
Dr. Ang: I have been practicing for 30 years already.
Sunfu: What surprises you still about medicine?
Dr. Ang: The truth is I am surprised by how insignificant we are as doctors to saving a life. Sometimes you have done your best, you think you have been instrumental in curing a patient, and then you find out, you did not cure the patient after all. The older I get, the more I feel there is a greater Being, and I am humbled by this experience.
Sunfu: Are you saying your profession has made you more religious?
Dr. Ang: Yes, definitely. I can give you an example: I have two 90-year-old patients right now. The surgical operation I had with them is actually very simple. But I know for 90-year-old bodies, with all the technology and advances in science, so many things can go wrong. As a doctor, I am not so egotistical as when I was young when I thought the doctor could do this without anything going wrong. At the same time, I am also not so hard on myself when something does go wrong. Before, if something goes wrong, I blame myself. Now, I just do my best, but God takes care of the rest. When people congratulate me that I am so good for supposedly curing a patient, it doesn’t affect me. I know where I stand in the scheme of things. I am just an instrument.
Sunfu: What is the state of the Philippine health care capability in terms of cancer? People want to go to the United States, saying the protocols there will be different, in fact superior.
Dr. Ang: I think Filipino patients who go to the US have a shift in perspective when they go to the US. In the US, there is a more impersonal care, and the patient usually is not able to negotiate with the doctor. So in a sense, the expectation is also heightened because some believe the quality of care will be better. I happen to disagree. Of course the amounts of money spent when in the US are staggering, so there is also a tendency to want to justify, or to rationalize, the expense.
Sunfu: But wouldn’t they have better machines?
Dr. Ang: Yes, no question about it. If you are talking about radiologic oncology, yes. But if you are talking about chemo therapy or surgery, I don’t think there is a difference. They have the money to invest on very expensive machines because their patients can pay for them. We hardly have any users among our patients for these very high-end machines because Filipinos cannot afford them. Yet for those who can afford, many go to the United States directly, so hospitals here do not want to invest in them. We are talking about, in US dollar terms, a difference of going through machine diagnosis and paying $40,0000 versus going for the same machine diagnosis here and paying only $2,000. The insurance takes care of it there in the United States. The US hospitals have the money to invest in the latest and most expensive machines. In molecular pathology, we are definitely behind. A genetic test will cost around $5000 US dollars. How many people can afford that here? Not many. There is also an advantage, maybe, of going to places like Harvard, where they are doing clinical trials on the latest drugs.
For the usual cancer, the more common cancer, I have no doubt our quality of care is equal the US and Europe.
Sunfu: What are your criteria for you to call someone a good doctor?
Dr. Ang: First, compassion is the most important for me. The desire to learn new things is also important, because if you stand still, you are already behind, especially in oncology. The progress is simply too fast. Pacifico Yap is a great doctor who I admire because he is already in his eighties in age, yet he is still studying and trying to learn.
What I don’t like is doctors who complain because, for example, a phone call from a patient is a nuisance for them. For me if you don’t have that compassion, if you don’t enjoy seeing patients, you should not have gone into medicine in the first place. A great majority of people go into medicine because they want to serve and they have good hearts, so it is rare to find a doctor who doesn’t like seeing patients.
Medicine is a vocation. If you don’t enjoy it, get out.
Sunfu: How about doctor-teachers, who have been important to you?
Dr. Ang: Dr. Abes, Cresensio Abes is a great surgeon. I admire him. Dr. Augusto Sarmiento I admire for his very sharp mind. Dr. Ernesto Domingo was never my teacher, but I have great admiration for him. Of course in the category of friends, Dr. Patricia Tan and Dr. Fernando Chua, they are friends but I also admire them. Dr. Conrado Cajucom, among the young guys, I admire. I admire all these young bright minds, these high IQ people. Maybe because I consider myself a regular guy who has to work doubly hard, when I meet bright people like my classmate Dr. Richard Yap, I admire them.
Sunfu: What excites you about your field today?
Dr. Ang: Oncology? A lot. I think Atul Gawande is correct: the surgeon as God, as superstar, as hero, that time is over. Teamwork excites me. Team work is the best. You cannot carry the burden of the world. When I was a student, the surgeon is the only guy who mattered in the surgery room. From the macro part, radiation oncology, the surgeons, to the micro part, the development of the patient, they all excite me. In the early days, the concentration was simply the disease, but now it is more than that. This is the reason why alternative medicine became too popular, and Steve Jobs is a good example, a bright guy who thought fruits and vegetables and lifestyle changes would cure him of cancer. Before we just took out the tumor and passed the patient to chemo, and if the patient was not killed by chemo, he went to radiology that would have burned him. Many doctors then were not compassionate, but were too disease centered, and their actions pushed the popularity of alternative medicine to the detriment of the patient.
Sunfu: You have four kids and all of them are now doctors. What do you tell them?
Dr. Ang: I tell them they do not have to be very bright, but as doctors, they have to have the heart, the heart to help people. Money is not the priority if you are a doctor. Or else, you will just be frustrated.
Sunfu: Where did you get this sense of compassion?
Dr. Ang: I guess my mother. I come from a poor family, a very poor family, but money was never a subject of discussion. We had a small sari-sari store in Davao City, and our relatives from the outskirts of Davao, we open our doors to them and we always had guests, and we cook for them and we welcome them. My mother was very hard working, and my parents were willing to always share what they had. I guess I got it from that upbringing, from that very open environment.
Sunfu: I know you are a big reader of books. Please give us a few names of authors you would like to share to our readers.
Dr. Ang: Atul Gawande’s Checklist Manifesto and his book Complications. Siddhartha Mukherjee’s Emperor of Maladies is a beautiful book, a book on the history of cancer. Eugene O’Kelly’s Chasing Daylight: How My Forthcoming Death Transformed My Life. This is a book about a former KPMG CEO who was about to die. Fiction I really liked Jhumpa Lahiri’s Namesake.