Member of the Month
Ronald H. Labuguen, MD, FAAFP
Ronald H. Labuguen, MD, FAAFP is a Professor of Family and Community Medicine at the University of California, San Francisco (UCSF). He is the Medical Director of the Adult Urgent Care Center at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), a faculty physician in the Family Health Center at ZSFG and a volunteer faculty preceptor with Mabuhay Health Center, a UCSF student-run free clinic serving mostly Filipino patients living in San Francisco’s South of Market area. A graduate of the University of Virginia School of Medicine, Dr. Labuguen completed his residency at VCU-Hanover Family Practice Residency Program.
Why did you choose family medicine, and what’s your favorite aspect of it?
When I started medical school, I was thinking of becoming a Pediatric Infectious Disease specialist. The summer after my first year of medical school, I took a four-week family medicine elective, which was a new program at my school at the time. Every half-day was a different activity. I loved it, and, by the end, I knew that I wanted to be just like the family physician faculty who taught the elective. I realized that family medicine presented the best combination of my desire to care for patients of all ages and backgrounds, to teach students and residents and possibly to do research.
Were you inspired by anyone to pursue family medicine?
My early life’s inspirations for going into medicine were my mother (an ICU nurse), my aunt (an anesthesiologist and the first physician in our family) and my own pediatrician, a very gentle and caring man who followed my sister and me from birth through adulthood. I remember my last visit with him for my college physical. The faculty and residents in the Department of Family Medicine at my medical school, the University of Virginia, also inspired me, as did my classmates who shared my interest in family medicine. My faculty mentor was Dr. Steven Meixel, a very friendly, down-to-earth, knowledgeable and caring family physician. Another inspiration was Dr. Lewis Barnett, the Chair of Family Medicine at UVA. at that time, who was well respected and well-known in academic family medicine circles. I remember one meeting I had with him at which he pulled out a log of patients he saw in 1970 (the year I was born), as a country doc in Greenwood, South Carolina. He reviewed the first few pages with me. On New Year's Day that year, he cared for about a dozen or so patients, including a mom whose twins he delivered. The next day, he took care of more than 100 patients and talked about how his wife helped him out in the early evening after dinner to finish up the day. It amazed me that a physician could do that.
What is the most interesting/memorable experience you have had when dealing with a patient?
My most memorable patient care experience happened a couple of years ago. I had been following Ms. N, an elderly Filipino patient, with almost end-stage renal disease. She was quite frail and not a candidate for dialysis. Though she had been doing fine, I had spoken with her family about how eventually she would succumb to her disease, but that, in the meantime, we would do what we could to maximize her quality of life. She had been hospitalized about a year before. After discharge, she was placed in home hospice, but the family stopped services soon afterward because they felt the treatments were too aggressive – she had a lot of side effects from them. She survived for almost ten months. Her family took great care of her.
Eventually we arranged for a home health nurse to follow her. The nurse called me one Monday afternoon. It sounded clear that Ms. N was declining. She was capable of being aroused and recognized family, but was no longer eating or talking. I spoke with the family that afternoon, and decided to pay them a visit on my way home from work (the first home visit I’d done in years). The family still was not convinced that hospice would benefit Ms. N, so I wanted to assess her myself and come up with a care plan for her and her family.
Ms. N looked comfortable, lying in bed, not in any pain. Her breathing was somewhat more frequent and shallow, but wasn’t labored. I introduced myself – she opened her eyes to look at me, then closed them again.
All the daughters and one of the sons-in-law were there. A son in the Philippines even Skyped in. I talked with them about what was happening and how I thought things would progress. They still weren’t sold on hospice, so I told them that I thought there was a good chance that they, as family members, could take care of Ms. N’s needs, and went over some simple things that they could do to keep her comfortable.
It turned out that the family still had the medications that had been prescribed by the hospice doctor several months before. Fortunately, none had expired. I went over the two medications, Roxanol and atropine, from which I thought she’d benefit most with one of the daughters (the primary caretaker), , and she seemed comfortable with these instructions.
As is customary for Filipinos, the family asked if I could stay for dinner. I explained apologetically that my family was expecting me at home, and thanked them. It was a really nice visit.
Ms. N passed away peacefully the next morning. I communicated with the home health nurse and the nephrologist who cared for Ms. N with me, thanking them for their help. The family was very appreciative of the care all of us provided.
what one word or phrase characterizes your style of family medicine
"A calling to caring."
what is the best experience you have had during your career as a family physician so far?
That would be the last baby I delivered ten years ago. The family was in the room, including the five-year old sister-to-be. I had followed the mother for her pregnancy, and I did the delivery with one of my faculty colleagues and a resident who also has become a faculty colleague. The mother felt more comfortable out of bed for labor. Her nurse suggested using a birthing chair, and we delivered her baby boy that way. It was a beautiful delivery.
It is important for me to be a member of CAFP and AAFP because:
… the Academy takes care of me as a family physician, helps me keep up through education and professional development and gives me opportunities to get together with other family physicians. The Academy also gives me opportunities to serve our specialty in different ways, especially through advocacy, helping me carry the voice of patients to others who can make a difference in their lives.
what has been your best experience as a CAFP member? Why?
I've had many, ever since I moved to California in 2003. One would be serving as the New Physician Director on the Board between Jack Chou and Jay Lee. That was a unique opportunity to get to know the leaders and staff of the CAFP. Another more recent one was the opportunity to give a talk at this year's Family Medicine Clinical Forum.
The most important resource I find CAFP offers me is:
Education, in a broad sense, through professional development (as a leader and educator) and keeping me abreast of the legislative and social issues that affect my practice of family medicine.
how do you make a difference in family medicine in your community?
In the exam room, it happens one patient at a time, one family at a time. Just really focusing on them, getting to know them and their needs and giving them the best that I can in the limited time we have. With residents and students, it's helping to educate them, doing my best so that they gain an understanding of family medicine; showing them how important it is to know what family physicians do, no matter what specialty they are in or plan to go in to. Through organizations such as CAFP, it’s participating actively and taking advantage of opportunities to share my perspectives and stories. I also precept with medical students at the UCSF student-run Mabuhay Health Center. It's a special and unique way that I've had to give back to a community similar to the one I grew up in, which always supported my development and rooted for me to succeed as a physician.
tell us about a project in which you are involved and why it is important to you:
Zuckerberg San Francisco General Hospital and Trauma Center adopted Lean as a management system about five years ago. I have become one of the hospital’s home-grown certified Lean trainers, and hope to spread understanding of the principles and tools to others at the hospital, especially in the outpatient services. It’s really important for us to take an honest look at how we conduct our business and what effect it has on our patients, and to work knowledgeably, creatively and systematically to continue to improve the way we serve them. I hope to be an integral part of that process at my institution.
What are good qualities a family physician should have?
First is commitment. There are a lot of ups and downs and it’s vital to keep our focus on what's truly important, to make the lives and healthcare experiences of the patients and families we care for better. Also, being active listeners, humble, knowledgeable, open to change, courageous and ready to take the reins of leadership, even when doing the right thing is not doing the popular thing. Perseverance! I think it always helps to have a ready smile.
Do you remember your personal statement for medical school? If so, would you like to share an excerpt?
I do remember that one of the themes of my personal statement was servant leadership. I quoted a Bible verse as an illustration. The context of the verse is important to understand. On the night of the Last Supper, the disciples who had gathered asked one another where the servants were who would wash their feet. This was normally the job of the lowest of servants. To their amazement, Jesus humbled himself and washed their feet, telling them afterwards, “If I, therefore, the master and teacher, have washed your feet, you ought to wash one another’s feet” (John 13:14). Recalling this story, in the Catholic Church, it’s a part of the Mass on Holy Thursday for the priest to wash the feet of twelve people. Pope Francis caused quite a stir a few years ago when he washed the feet of Muslim women during the traditional Holy Thursday ceremony. Since then, he has used this annual ritual to make a statement about what it really means to “wash one another’s feet.” For me, that’s akin to what it means to be a family physician, to practice medicine as a servant leader.
What one sentence of advice would you give to medical students interested in family medicine?
If you want to make a real positive, lasting difference in the lives of patients and families who grow to identify you as one of their own, then family medicine is the specialty for you.
How do you spend your free time?
I love spending time with my family, just hanging out with them. Our boys like to play sports, especially basketball. Usually there's some kind of family event to attend; my wife and I have extended families here in the Bay Area and in southern California. I also love to read, play music (piano, guitar, even singing). I’m a homebody, but I do like to travel occasionally as well.
If you weren’t a doctor what would you be doing with your career?
I'd be a teacher, an engineer, or a scientist, or some combination of all of those. (Well, actually as a family physician, I really am a combination of all of those and more.)
What would your best friend say about you?
He's gentle, smart, loving, playful sometimes, serious other times, family-oriented, funny, caring and generous.
Tell us something fun/unusual about yourself:
I'll give you a choice of three: I once hosted a teen beauty pageant. I once met Muhammad Ali in a Blockbuster Video store. I was on the game show Jeopardy! (I lost to a guy named Brad Rutter – look him up – but I finished second, and my consolation prize was a trip to Club Med. And there’s more to the story – ask me sometime).
Tell us briefly about your family:
My awesome wife, Therese, and I have been married for 12 years. We have two sons who are 11 and eight. Both were homeschooled until this past year. Our older one is a fifth grader in school now, and our younger one is a third grader, still homeschooled. And there’s also our dog, our six-year-old “daughter.”
Each month, CAFP highlights one outstanding California family physician member who lends their voice, time, talent and resources to strengthen the specialty of family medicine and his or her community. The Member of the Month interviews are conducted by CAFP staff. If you choose to share this article, feel free, but give appropriate source and author information. If you would like to share your story or know a family physician colleague who deserves to be recognized for his or her impact or leadership, contact us at (415) 345-8667 or email.