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‘Kawawang doktor’

How do you differentiate the value of dealing with an easy or a difficult case even if it takes you the same 10 to 15 minutes to do so.

Brian Michael Icasas Cabral

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I still remember not too long ago when traffic wasn’t so bad, when going to the Philippine Heart Center took an hour from Parañaque, and when being a doctor meant not only being a valuable member of society, but a profession where one could expect to make a decent living.

Professional fees at that time were about P300 to P700 a consult. To get on the South Luzon Expressway you only spent P2.50G. Gas was about P7/liter and a decent haircut could be had at P50 to P100. These are my memories of some 30 years ago.

Currently, the medical community is abuzz due to a recent announcement requiring physicians to display “rates” for services rendered in their clinics. I can tell you right now that most physicians probably don’t appreciate having to do this very much. Not only because of what we feel it represents, which, in my opinion, is a cheapening and declining view of society with healthcare providers, but more because this is just one in a long list of pot-shots doctors have had to endure in recent years.

Let me enlighten you further. Seen as the lowest hanging fruit, and as a notoriously placid group, doctors are easy targets for policy changes favoring other members of society.

Thirty years ago, there was no senior citizen discount; no VAT and tax agency officers weren’t sitting outside your office pretending to be patients; PhilHealth was at least still able to pay on time; there wasn’t as much paperwork; “ambulance chasers” weren’t as common; HMOs paid about P250 to P300 per consult; there was no color-coding scheme for cars; no one was thinking of giving doctors the death penalty or life imprisonment for making a mistake; you didn’t have to pay annual dues for two or more professional societies to maintain accreditation as a physician; and you only had to pay about P30,000 to start your practice at a decent hospital.

Fast forward to today and you’ll see that a lot has changed, and some of the things that we wish changed actually stayed the same.

Some physicians will still charge P700 (I’m sure there are others who charge less) for a private patient consult and HMOs still pay P250 to P300 per consult, while taxes have gone up, toll fees have increased 60 times from back then, traffic is worse than ever and even if doctors are supposedly exempted, should you get caught by a no-apprehension camera, you still need to go to a government office to sort that out. In addition, now you usually need to pony up more than P3 million just to start a practice in a decent hospital.

Doctors are now on the radar of government agencies not only to enforce what they are mandated to do, but also perhaps because doctors are the easiest to identify in reaching their apprehension quotas. PhilHealth’s mandatory contributions have increased, granted this is for everyone, but it’s a little ironic that the doctor who takes care of you also pays the most for PhilHealth benefits and accreditation.

But before I lose track, let me go back to what prompted me to write this column today: the requiring of physicians to post rates for services rendered. Granted I understand other industries do the same. My barbershop has prices for haircuts, shampoo, a shave and so on. When you go to a fast food restaurant you can see the prices of their burgers, fries, desserts and what have you.

Unfortunately, it’s just not that simple when you’re a doctor. How do you differentiate the value of dealing with an easy or a difficult case even if it takes you the same 10 to 15 minutes to do so? How much should you charge for a phone call consult? Or even a text consult? These are, after all, things that doctors still do, things done for patient convenience as well as their safety, but not considered in current billing practices of physicians.

Just since I began writing this column, I’ve gotten at least 10 text messages and two phone calls from patients… I’d never considered billing a patient for phone calls or text messages but this new requirement is making me reconsider, as I’m sure other physicians are as well.

We would do well to remember that doctors are inherently kind people. Some would call us naïve — I prefer to look at us as altruistic. We just want to help, we want to cure, we enjoy making patient’s lives better and we enjoy helping others. That’s why most of us don’t mind the phone calls, most of us don’t mind the text messages. For us, it’s just us being us — caring, concerned and empathetic. It becomes difficult for us to monetize the value of the service we provide because it’s really not that simple.

All this reminds me of a quote I read somewhere on social media that said: “Your $50 is not for the 15 minutes I spent with you, but for the 15 years it took for me to become the physician you wanted to see.” Think about it… Just how much is your health, or even your life worth to you? After all, that’s really what doctors take care of during that outpatient consult.

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