Dr. James Javier - On Line

14/01/2026

Authority Bias vs Humility Intelligence

Authority can make decisions faster, but it doesn’t automatically make them right.

Authority bias happens when we stop thinking just because someone has a title. Humility intelligence, on the other hand, is knowing that no matter your position, you can still be wrong—and being open to that.

The best leaders aren’t the loudest or the most senior. They’re the ones confident enough to listen, question themselves, and let evidence speak louder than rank.

In medicine and in life, authority should guide decisions—but humility keeps us from making dangerous ones.

31/08/2025

🌿 “Standing Too Close to the Elephant” – A Hospital Perspective

In healthcare, perspective matters. When we stand too close to the elephant, we only see what is right in front of us — our own discomfort, stress, or workload — and we lose sight of the bigger picture.

- For patients, it may be the frustration of waiting, without realizing that triage ensures life-threatening cases are prioritized.

- For physicians, it may be the stress of overwhelming patient numbers, where firmness can unintentionally cross into rudeness.

- For healthcare workers, it may be the burden of tasks and pressure that makes teamwork and compassion harder to see.

By stepping back, we can see the whole elephant and the larger purpose of why we are here. To work together, care with empathy, and ensure every patient receives the right attention at the right time.

29/08/2025

KIDNEY CHECK: DETECT & PROTECT

The MICRAL test is an essential tool in the early detection of kidney-related issues, specifically microalbuminuria, a condition marked by the presence of small amounts of albumin (a protein) in the urine. It serves as a quick and easy-to-use dipstick test that is highly beneficial for people at risk of kidney problems, particularly individuals with diabetes or high blood pressure. Early detection through such screenings can help prevent the progression of kidney disease, which is why the MICRALR test is so important for those in vulnerable health groups.

MICRAL TEST

The MICRAL test is designed to detect small amounts of albumin in the urine, signaling microalbuminuria. This condition is often an early warning sign of kidney disease, especially in high-risk populations like those with diabetes or hypertension. The test is primarily used for screening, identifying individuals who may need further diagnostic evaluation.

The test has a high degree of accuracy:

• 83.2% sensitivity: It effectively detects most people with microalbuminuria.

• 92.3% specificity: It efficiently rules out people without the condition.

However, the test's reliability depends on the prevalence of microalbuminuria within the tested group. If microalbuminuria is common in the population, the test is highly accurate. But if it's rare, a positive result may require further confirmatory tests, such as a urine albumin-to-creatinine ratio (UACR).

In summary, the MICRAL test is a valuable first step in detecting kidney issues, particularly in high-risk individuals, but additional tests are often needed to confirm the results.

16/08/2025

🩺 The Peter Principle in Hospitals: Are We Promoting the Right People?

In management theory, Dr. Laurence J. Peter (1969) described the Peter Principle: “In a hierarchy, every employee tends to rise to their level of incompetence.”

This means people are often promoted because they excel in their current role, not necessarily because they have the skills for the next one. Eventually, they may land in a position where they struggle.

👉 In hospitals, this is very common:

1. A top-performing nurse is promoted to head nurse but struggles with staff scheduling and conflict management.

2. A brilliant physician becomes a department head but finds budgeting and admin tasks overwhelming.

3. A skilled technologist becomes a section chief but lacks leadership training.

This doesn’t mean they are bad employees — it means their promotion did not match their skill set.

💡 To avoid this, hospitals can:

1. Provide leadership & management training before promotions.

2. Create alternative career paths so clinicians can advance without being forced into admin roles.

3. Use trial leadership roles (like Officer-in-Charge or committee head) before permanent promotion.

4. Reward excellence with recognition or bonuses, not just promotions.

👉 Question for discussion:
Have you seen the Peter Principle at work in your hospital or workplace? How should healthcare institutions balance clinical skill and leadership ability when promoting employees?

📖 References:

Peter, L. J., & Hull, R. (1969). The Peter Principle: Why Things Always Go Wrong. William Morrow & Company.

Benson, A., Li, D., & Shue, K. (2019). Promotions and the Peter Principle. Quarterly Journal of Economics, 134(4), 2085–2134.

14/08/2025

Teaching Kids to Handle Failure

In life, we often hear that success is important, but what we don’t emphasize enough is the importance of how we handle failure. Teaching kids to view failure not as something to fear, but as a learning opportunity, is just as crucial as teaching them how to achieve greatness.

Failure doesn’t mean the end—it means growth. When we help children understand that failing is part of the journey, we equip them with the resilience to bounce back stronger. It's not about always getting things right, but about being able to stand up, learn from mistakes, and keep moving forward.

By teaching kids to embrace failure in a healthy way, we prepare them for a future where setbacks don't define them, but fuel their motivation to achieve greatness. 💪✨

Let's teach our kids that true success lies in perseverance, growth, and the courage to try again.

14/08/2025

A Profession That Was Once Understood

Being a doctor is one of the most complex and noble professions. Yet, in today's age of social media, we often find ourselves subject to misconceptions and harsh judgments. Many times, especially when one belongs to a community where poverty shapes their mindset, hardship is seen as something intentional—an act of the ruling class. This perspective can lead to misunderstandings, especially about how doctors communicate.

Being stern or direct in giving medical advice is not being "masungit" or "pinapagalitan", nor is it about treating patients poorly. It is about being firm in ensuring the best possible care and making sure patients understand the gravity of their health situation.

Pinapangaralan is not the same as pinapagalitan. A doctor’s role is to educate, to guide, and to make decisions that are in the best interest of the patient's health. Sometimes, the truth is hard to hear, but it is always given with the intent of healing, not hurting.

Additionally, the payment required for consultations is a necessary part of sustaining the healthcare system. It allows us to continue providing high-quality medical care, maintain the facilities, and ensure that healthcare professionals are fairly compensated for their expertise. While we understand that not everyone can afford the full cost, offering discounted rates or providing financial assistance is an act of compassion. It’s a way of balancing our commitment to helping patients while keeping the integrity of the profession intact.

Let’s remember that behind every white coat is a human being dedicated to improving lives, not adding to hardship. We are here to help, not to harm.

22/07/2025

🌧️ Karaniwang Sakit sa Panahon ng Tag-Ulan

1. Leptospirosis
Sanhi: Ihi ng daga na humalo sa baha

Pag-iwas: Iwasang lumusong sa baha, magsuot ng bota, panatilihing malinis ang paligid

2. Dengue Fever
Sanhi: Kagat ng Aedes aegypti na lamok

Sintomas: Mataas na lagnat, sakit ng ulo, pananakit ng kasu-kasuan, pantal

Pag-iwas: Linisin ang paligid, tanggalin ang mga nakaimbak na tubig, gumamit ng kulambo o insect repellent

3. Typhoid Fever
Sanhi: Bakterya mula sa maruming pagkain o inumin

Sintomas: Lagnat, pananakit ng tiyan, diarrhea o constipation

Pag-iwas: Kumain ng lutong pagkain, uminom ng malinis at pinakuluang tubig

4. Cholera
Sanhi: Bakterya mula sa kontaminadong tubig

Sintomas: Matinding pagtatae, dehydration

Pag-iwas: Panatilihing malinis ang inumin at pagkain, proper handwashing

5. Influenza (Trangkaso)
Sanhi: Influenza virus

Sintomas: Lagnat, ubo, sipon, sakit ng katawan

Pag-iwas: Iwasang mabasa sa ulan, palakasin ang resistensya, proper hygiene

6. Acute Gastroenteritis (Pagsusuka at Pagtatae)
Sanhi: Bacteria o virus mula sa maruming pagkain o tubig

Pag-iwas: Malinis na paghahanda ng pagkain, wastong paghuhugas ng kamay

7. Pneumonia
Sanhi: Bacteria o virus, lalo na kung naulanan at nabasa

Sintomas: Ubo, lagnat, hirap sa paghinga

Pag-iwas: Iwasan ang biglaang lamig/ulan, palakasin ang immune system

22/07/2025

⚠️ BABALA: LEPTOSPIROSIS
Isang seryosong sakit na maaaring makuha sa tubig-baha na kontaminado ng ihi ng daga.

🦠 PAANO NAKAKUHA NG LEPTOSPIROSIS?
Paglalakad sa baha na may sugat sa paa o balat

- Paglangoy o pagbabad sa kontaminadong tubig

- Pag-inom ng tubig na galing sa baha o hindi malinis

❗ MGA SINTOMAS (2–14 araw matapos malantad):

- Mataas na lagnat

- Pananakit ng katawan (lalo na sa binti at likod)

- Pananakit ng ulo

- Paninilaw ng balat o mata

- Pagsusuka at pagtatae

- Pulang ihi o ihi na kakaunti

- Pagsakit ng tiyan

Kung mapabayaan, maaaring magdulot ng kidney failure, meningitis, at kamatayan.

🛡️ PAG-IWAS SA LEPTOSPIROSIS

- Iwasan ang paglusong sa baha, lalo na kung may sugat

- Magsuot ng bota o proteksyon sa paa kung hindi maiiwasan

- Panatilihing malinis ang kapaligiran, lalo na ang mga lugar na pinamumugaran ng daga

- Itapon nang maayos ang basura

- Uminom ng malinis at pinakuluang tubig

Kumonsulta agad sa doktor kung may sintomas

🚨 PAALALA:

Kung nakalubog ka sa baha at may sintomas, huwag mag-atubiling magpatingin agad sa pinakamalapit na health center o ospital.

21/07/2025

Paki-heart naman. Thanks.

"Drag and Drop Off"
by JAVIER, Jesusa N.

Unlike with technology, you can’t just “drag and drop” straight into any bin when it comes to physical electronic waste—but as depicted, you can drop it off in an e-waste bin! This way, you can make sure that the steps in proper e-waste management are observed, and your old electronics get the second life they deserve. But mere bins can't reimagine our waste on their own. This is why I've included people, because we've got to work together to take back what we've lost to landfills, and to make space for more opportunities and futures to flourish!

20/07/2025

Lung Cancer Doesn't Wait

They were just coughing.

Then came the weight loss.

A little fatigue.

Maybe it was just stress.

Until one day, it wasn't.

Lung cancer is one of the deadliest cancers- not just because it's aggressive, but because it hides. By the time symptoms show, it's often too late. You don't get a warning. You get a countdown.

I lost someone I love. One day we were still making plans. The next, we were saying goodbye.

Cherish your time. Know the signs. And if you or someone you love is at risk-smoker or not -get checked.

Because lung cancer doesn't ask if you're ready.

It just takes.

Cancer Awareness TooSoon Together

20/07/2025

Mga Posibleng Dahilan Kung Bakit Nahihirapang Matulog ang Naka-Dialysis:

1. Restless Legs Syndrome (RLS)
- Pakiramdam ng pamimitig, pamumulikat, o parang gumagapang sa binti kapag nagpapahinga.

- Dahil ito sa kakulangan sa iron o imbalance sa electrolytes.

- Mas lumalala tuwing gabi, kaya hirap makatulog.

2. Sleep Apnea
- Pagsikip o pagbara sa daanan ng hangin habang natutulog → pigil o putol-putol na paghinga.

- Mas karaniwan sa dialysis patients dahil sa fluid overload at pamamaga sa leeg o lalamunan.

3. Uremia (Maruming Dugo)
- Kapag hindi sapat ang dialysis, naiipon ang mga lason sa katawan → hindi komportable ang pakiramdam, puwedeng may pangangati, pagod, o pagkabahala → hirap makatulog.

4. Pangangati ng Balat
- Uremic pruritus (pangangati dahil sa CKD) ay madalas lumalala sa gabi, dahilan ng pagkagising o pagkawala ng antok.

5. Depresyon o Anxiety
- Maraming pasyente ang nakararanas ng stress, lungkot, o takot sa kanilang kondisyon, na maaaring makaapekto sa tulog.

6. Hindi Regular ang Oras ng Dialysis
- Ang dialysis schedule (lalo na kung gabi o maagang-maaga) ay nakakaapekto sa body clock o natural na cycle ng katawan para matulog.

7. Pagod o Sobrang Antok sa Araw (Daytime Fatigue)
- Dahil sa pagod mula sa dialysis, puwedeng nakakatulog sa araw → hirap makatulog sa gabi.

8. Imbalance sa Hormones
- Ang may ESRD ay may abnormalidad sa hormones tulad ng melatonin (sleep hormone), kaya hindi madaling antukin.

🧠 Paalala:
Kung palaging nahihirapang matulog, mahalagang sabihin ito sa doktor o nephrologist. May mga paraan para maibsan ang sintomas—tulad ng pag-adjust ng gamot, pag-manage ng pangangati o stress, o pag-evaluate para sa sleep apnea.

20/07/2025

Bakit Mahirap Kontrolin ang Presyon ng Dugo ng Mga Pasiyenteng Naka-Dialysis
Ang pagkontrol sa blood pressure ay isang malaking hamon para sa mga taong naka-hemodialysis. Narito ang mga posibleng dahilan:

1. Sobrang o Kulang sa Tubig sa Katawan

a. Sobrang tubig sa pagitan ng dialysis → mataas na BP (hypertension)

b. Masyadong maraming tubig ang natatanggal sa dialysis → mababang BP (hypotension)

c. Maaaring lumalampas sa limitasyon ng iniinom na tubig o maalat na pagkain ang pasyente.

2. Hindi Na Tama ang Gana ng Bato

a. Hindi na kayang i-regulate ng bato ang tubig, asin, at hormones sa katawan.

b. Ang mga sistema ng katawan na nagkokontrol ng BP tulad ng RAAS at sympathetic system ay maaaring sobrang aktibo → tuloy-tuloy na mataas na BP.

3. Matigas na Ugat

a. Dahil sa matagal na sakit sa bato, ang mga ugat ay nagiging matigas at barado → mas mahirap i-kontrol ang BP.

4. Gamot at Dialysis Timing

a. May mga gamot sa BP na nawawala sa katawan habang dinadialysis, kaya hindi na epektibo pagkatapos ng session.

b. Hindi laging tama ang oras ng pag-inom ng gamot kaugnay sa dialysis.

5. Problema sa Automatic Adjustment ng Katawan

a. Ang katawan ng may ESRD ay hindi na nakakapag-adjust ng BP ng maayos, lalo na habang nasa dialysis → pwedeng tumaas o bumaba bigla ang BP.

6. Kakulangan sa Dugo (Anemia)

a. Kapag mababa ang hemoglobin, nagkakaroon ng kompensasyon ang katawan tulad ng pagbilis ng tibok ng puso → pwedeng magpataas ng BP.

7. Komposisyon ng Dialysate

a. Kung masyadong mataas ang sodium o calcium sa dialysate → naapektuhan ang BP.

b. Kung masyadong mainit ang dialysate, puwedeng magdulot ng pagluwag ng ugat (vasodilation) at pagbagal ng BP.

8. Problema sa Hormones ng Buto

a. Ang mataas na parathyroid hormone (PTH) at imbalanseng calcium/phosphate ay puwedeng makaapekto sa ugat at BP.

9. Hindi Pagsunod sa Gamot o Diyeta
Pasyente ay maaaring:

a. Hindi umiinom ng gamot sa BP nang tama

b. Hindi sumusunod sa diet (maalat, maraming tubig)

c. Umiinom ng herbal o over-the-counter na gamot na maaaring makaapekto sa presyon.

🧠 Paalala:
Ang kontrol sa presyon ay bahagi ng pang-araw-araw na pag-aalaga sa sarili ng dialysis patient. Kailangan ng tulong ng doktor, tamang gamot, pagkain, at disiplina para mapanatili ito sa normal