Doctor & Patient Talking
18 September 2023
Drs Enrique and Brenda Reyes:
Dr Enrique Reyes, a urologist, and his wife Brenda, an anaesthesiologist, have both been practising in Manila for some 20 years. After graduating from medical school, Enrique took his speciality training in Australia, whilst Brenda took hers in Singapore.
For doctors like the Reyeses, life in Manila is busy, busy, busy. Dr Brenda reminds the interviewer, “There is only one doctor per 1,500 people in the National Capital Region, including Metro Manila".
To cope with their number of patients, husband and wife wake up early in the morning, navigate their way through traffic to reach the major hospital where they hold clinic. They don’t get back home until well after nightfall when they then have supper. “It’s not only the number of patients we see, but also the horrendous traffic situation in Metro Manila”, says Dr Enrique.
“It used to be worse”, he continues, “There was a time when doctors would hold regular clinic hours in two or even more hospitals on a given day. But the commuting time was unpredictable, so patients would sometimes have to wait for a long time as doctors were often late, and then because of time pressure, they could spend only 15 minutes or less per patient.
“Lately, though, as we might have long-standing patients in different clinics, we have grown more realistic and have concentrated our practice in one or at most two hospitals—dividing our clinic hours by the days of the week. Thus, Mondays, Wednesdays, and Fridays, we might go to Hospital X, and Tuesdays, Thursdays, and Saturdays to Hospital Y.
“Another way to cope with the situation is to dispense with appointments altogether and treat patients on a first-come-first-served basis. The downside of this is that patients, especially those coming from the nearby provinces, might have to wake up very early in the morning and get to the clinic before local residents start to arrive—this is if they wish to ensure that they get back home the same day. Waiting time could be very unpredictable. I have seen patients wait in a doctor’s clinic for more than four or five hours. That’s the reason we both don’t hold clinic this way”.
Despite their own long hours, husband and wife say in unison that coming back after their training abroad was an easy decision to make. “Medical doctors here are highly valued. We live on better paychecks relative to most other professionals in the country, and simply from the multitude of patients we treat, our clinical experiences are great learning opportunities. Besides, both Brenda and I are nationalistic.
“Our patients are indeed very grateful for what we do, and you know how expressive Filipinos can get. This is especially the case for our free patients at the Philippine General Hospital, a public hospital where we also practise. For these patients, we might even have to shell out our own money for supplies and medicines, but we don’t mind.
“We are likewise very pleased that, lately, the government seems to have awakened to the health needs of the country. The salaries of doctors, nurses, and other health practitioners in public hospitals are now often much higher than those in private hospitals, so much so that more nurses who can’t get into the former leave the country rather than be employed by the latter.
“This is not to say that all big problems have been addressed. There's still a lot of labour migration, and another problem we have is the lack of systems. The provision of medical services is often slow—we need to ensure safety and efficiency by streamlining processes for, say, admission and discharge. Diagnoses are sometimes confusing because of a lack of necessary details, or worse, they are contradictory. Still, things are looking up. I hear that the Department of Health (DOH) is currently appointing professional managers to more senior positions instead of yet more medical doctors. Moreover, a new initiative, the Universal Health Care, requires the provision of more family medicine doctors for every Filipino family. To date, there are relatively few family doctors".
The Reyeses have seen practices abroad that they wish were adopted in the Philippines. For example, akin to family doctors are general practitioners (GPs). Patients here often go directly to specialists for specific ailments. This precludes a more holistic approach to health care that a GP could provide. “In my own practice”, says Dr Enrique, “Patients would sometimes tell me they take some medication prescribed by, say, their gastroenterologist, but the gastro wouldn’t know that I am likewise treating that patient for his kidney problems, and that a particular medication could be too strong for them, so we two doctors are working at cross-purposes. Also, specialists undergo further training and so would often be more expensive than a GP.
“On the other hand, GPs can treat minor ailments, or in more serious cases, can refer a patient to a specialist whilst retaining their health care history for referencing. In the UK, for example, specialists often require a referral from the GP, then after seeing the referenced patient, the specialist would have to write a note to the GP outlining what they did for that patient. The patient is copied on this, thereby becoming better informed. In short, the GP’s clinic acts as a clearing house for the patient’s health history.
In lieu of the system of GPs as practised in countries like the UK, Dr Brenda has seen in Singapore how every patient is tagged with a unique barcode which contains all their medical records. Each doctor the patient would thereafter visit would have access to this barcode, thus ensuring efficiency in medical services and avoiding malpractice suits.
On balance, husband and wife have observed that many Filipinos would still rather get their medical treatments here than abroad, even for those who can afford to go overseas, primarily due to our malasakit (compassion) culture. As a culture, we have better EQ (Emotional Quotient) than many medical practitioners in foreign countries. We are more caring, and our families are here to give us support at a time when we might need them most.
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Mrs Alice Sanchez:
Alice is a school teacher. She hates hospitals, and says, “Can you blame me, after the experience I had giving birth a couple of years ago? But I guess hospitals are a necessary evil. My husband Bert and I don’t believe in hilots (therapeutic massage from an unlicensed “midwife”) and albularyos (medicine men who treat illnesses with herbs and other alternatives, including faith healing).
Additionally, because public hospitals are reputed to have low-quality health care and long queues for the most basic of services, Alice and Bert opted to deliver their first baby in a private hospital in Manila. “This is the most important event of our lives”, adds Bert, “We don’t want to skimp and take any risks. Besides, we found out that a normal delivery package in a private hospital would cost about Php75,000, excluding doctors’ fees. Our obstetrician told us she would charge Php30,000 and the anaesthesiologist Php20,000. With our joint salaries, plus PhilHealth medical insurance and a health card (HMO) from Alice’s company, we decided we could afford these expenses".
Alice did deliver normally soon after they arrived at the Manila hospital. But the baby boy refused to be fed. He was diagnosed with an infection and would have to be treated with antibiotics. A paediatrician was called and the baby was promptly transferred to the NICU (Neonatal Intensive Care Unit), where he would have to stay for seven days.
“This was when our troubles started”, continued Alice. “We only saw the paediatrician twice during that week, each time for a couple of minutes, and only because we kept asking to be informed when she visited the NICU. I was already discharged by then, but we decided to stay in a hostel nearby to be close to our son.
“If the baby indeed needed to be monitored during the seven days, we asked if he could be transferred to a regular room and we could stay with him. The NICU was extremely expensive and we weren’t sure if it was all that necessary since our son was responding to the antibiotics and was now feeding well. But the Doctora was firm. “If you’re thinking of the money to pay for all of this . . . I have to tell you, gano’n talaga. Wala tayong magagawa. (That’s the way it is. We can’t do anything). We had further questions but apparently, our couple of minutes were up. She told us to ask the resident doctors whatever else we wanted to know as they were taking care of everything.
“We found this totally heartless, but didn’t have any choice except to accept things. I remember telling myself, bahala na, we'll think of the money later. As it turned out, our bill came to Php250,000. The paediatrician charged us Php44,000. Philhealth covered Php14,000 and my company, unfortunately, didn’t cover most of the expenses related to birthing, but paid for some miscellaneous expenses amounting to Php3,000.
“Our out-of-pocket was thus almost two-and-a-half times more than what we had projected. But we were extremely touched when my fellow teachers passed the hat around, and we collected another Php10,000.
“I have heard of worse cases, of how other people would have to sell assets in order to pay for the hospitalisation of a gravely ill family member—maybe the car, or even the house, just to have a new lease on life.
“I am sorry to have to say this. I am sure there are many doctors who take their vocation seriously and honestly wish to serve, but there are also a lot who are mukhang pera (greedy). They will fit in as many paying patients as possible even if they can no longer properly care for them, ask patients to come back even if there is no need, or order unnecessary procedures just to be able to charge more money. Of course, these are only my own observations”.