"Doc, magkano po ba yun operasyon? Ang mahal naman po! Pwede po ba discount? Baka pwede pa po bawasan? Pwede po ba kalahati muna? Doc, mag-iwan na lang muna ako promisory note.”
Filipinos are so fond of asking for discounts. In Divisoria, you’ll often hear bargaining for items…
Buyer: Magkano yun blouse?
Seller: 200 pesos. Tapat na.
Buyer: Bawasan mo naman, 120 na lang.
Seller: Di kaya sa puhunan. Lugi. Hanggang 170 lang.
Buyer: Bawasan mo pa konti. 140 na lang.
Seller: Hay naku, sige 150 na lang, Ilan ba kukunin mo?
Buyer: Ok 150! Paki balot yan isa.
In the medical field, you’ll also hear patients asking for “tawad” from doctor’s professional fees. I read an article a few years back written by an anesthesiologist. She and her partner surgeon did an operation on a patient for about 6 hours. It was a life-saving operation the patient couldn’t have lived without. When the patient was about to go home and was billed Php 60,000 PACKAGE price for the surgeon, anesthesiologist, cardiologist and endocrinologist, the patient said, “ang mahal naman doc. Baka pwede 30 thou na lang?” The surgeon, being a dutiful and charitable physician, said ok and agreed to the amount. However, the patient only paid half, 15 thousand, in cash, and the remaining 15 thousand as promisory note.
Why is it when doctors charge big, it is always taken against them? Do you know the cost of being a doctor nowadays? A medical student (i mean their parents) would have to shell out 160-180 thousand pesos PER YEAR for tuition fees alone. Medical books would set you back around 20-30 thousand PER YEAR. If the medical student would live in an apartment or dorm, that’s another 10 thousand per month. Before a medical student would have finished the 4 years in med school, he would’ve spent almost a whopping 1 million pesos. And at this point, the med grad isn’t even licensed yet.
So after 4 years of pre-med, and 4 years of med school, the new med grad has to under go 1 year of post-grad internship in a hospital WITHOUT ANY COMPENSATION. This is a requirement before the med grad can take the medical board exams given by the PRC. After internship, board exams follow, and if passed, one is considered a fully fledged GENERAL PRACTITIONER. If he wants to specialize, say, internal medicine, that’ll take another 3 years of training, then the “specialty” board exams. Then subspecialize into cardiology, that’s another 3 years of training, and another “sub-specialty” board exams. That’s a good 15 years (and 3 major board exams) from college to finally being a cardiologist. Then, now, he gets paid 20-50 pesos for every ECG tracing he reads.
So when a doctor charges a patient, say, 50 thousand pesos, for a life-saving medical intervention, it really isn’t “expensive.” But filipinos will always ask for “discounts,” not because they can’t afford, but it’s just filipino nature. So it will really drive the doctor crazy if the patient asks for 50% discount but the doctor sees the patient and his wife and children all with cellphones all worth more than 15 thousand. And this, the doctor charges for a LIFE SAVING PROCEDURE.
Why is it when a mid-ranged actor or model, doing just a 1-hour photoshoot, charges 100 thousand, it’s acceptable. But when a team of doctors operate on a patient for 6 hours and charges 60 thousand PACKAGE, it’s considered “inhumane” to put a hefty price on medical services. Do you know for every patient a doctor charges, the doctor also sees a patient he doesn’t charge? There may be more patients a doctor won’t charge in his/her entire career.
But as doctors, we do understand our patients plight. And we do give “discounts” and even free medical services. And as a christian i know God has blessed us a special position to help. But i posted this just to show that there is much more than just money a doctor gives when he gives a discount or totally free services. He gives a part of himself. So is it ok to bargain for your health? Yes, to a certain extent. Huwag lang sobrang “barat.” Or your doctors might end up looking like this…
Medical Mission Time! 
The Guardian Angels of America Foundation --- the name speaks for itself. Our country is very lucky to have people like Ms. Loi and Mr. Bing who, in spite of not being physically present here all the time, are still with us in spirit. In spite of every bad thing that we see, read or hear in the news about our country today, this.... this is something worth our attention. Each one of us stood and said something... "thank you for the opportunity of allowing us to become better doctors".... "she's my officemate and eversince I knew she's into humanitarian projects".... "being a doctor is about treating a person, physically mentally and emotionally... and GAAF is a catalyst to that".... each one had their own story to share. Then, they started handing out certificates of appreciation to all the volunteers and organizers. The program ended with a group picture, honestly, it felt like we were about to take our family photo. We dont know each other personally, their stature, their background, but through the med mission and GAAF, we were like ...family. 
It was a very busy Saturday (December 12, 2009) for the Guardian Angels of America Foundation. We all started early. I went to the Mabuhay Manor at around 9:30 in the morning with Dr. Philip Cruz who was kind enough to give me a ride to Ms. Herrera's place. When we arrived, Ms. Herrera was already preparing the boxes full of toys and clothes for both the Inquirer Read-Along Event and the Medical Mission in the afternoon. The Baranggay Chairman, Hon. Michael Del Rosario (Dr. Cruz's Cousin), the Medical Mission's beneficiary and his kid were also there. I also met Mr. Bing Dela Vega, founder of the PeDRO (Philippine Emergency Disaster Relief Organization) who, like the GAAF, is also based in the United States. After loading 3 boxes full of toys in Mr. Dela Vega's van, we went to the Inquirer Office in Makati to join their Read-Along event.
Another thing that Dr. Philip Cruz mentioned during the Appreciation Dinner last night at the Mabuhay Manor (again, I will post an entry later about this) during our discussion with PeDRO's Founder Mr. Dela Vega and his nephew is that his drive to pursuing medicine is "Making a Difference.... Leaving a Legacy". 
Then... to my suprise, my ultimate suprise... God has blessed me the privilege of meeting the person I have been reading about. Dr. Fe Del Mundo, now 98... on her bed, frail but still feisty. Honestly, I went teary eyed in awe.. the woman who has changed the face of not only Philippine Medicine, but of the entire Medical Institution is here in the same room with me. Our group handed her a blue stuffed bear and we could see her nonverbal cues of appreciation. As we were getting our photos done, she suddenly spoke: "Balik kayo sa pasko bibigyan ko kayo"... then we all laughed. At her age and stature, she still has her humor, who during her twilight years, have endured some of the greatest trials in life, and still be able to put other people especially children, her priority.
The Guardian Angels of America Foundation (founded by Ms. Loi Herrera) held it's annual Toy Drive last December 10 and 11 which gave out thousands of toys to our sick and poor little brothers and sisters. Some of whom, never had a toy in their entire lives. I learned about this foundation through Dr. Philip Cruz, a fellow Pinoy.MD and MIND member (he is actually one of the founders of these orgs). He posted the itinerary for the 2 day-Toy Drive. I immediately said yes, with a very selfish reason: I was after the free toys. 
I was still holding the Mickey Mouse, tighly if I may add, when I came across Little Becky (not her real name) who is suffering from Acute Myeloid Leukemia and her mother, they were staring at the prized toy I was holding. Suddenly, there was this lightning that struck me, of sorts, and voices telling me, "The Toy is For Her". I didnt hesitate, I went straight to Little Becky and gave her the Mickey Mouse. Even with a flu mask on, I heard her "maaaraaamiingg salaaamaaat pooo" and squinting eyes as if she was smiling. Her mother also greeted me a joyous Christmas, I smiled and replied, and went on my way to follow the rest of the group who are about to leave the hospital. Suddenly, Little Becky's mother went running towards me and said "kuya ano po pangalan niyo?". "Macky po" ---- then the mother said with a smile on her face "Macky ang ipapangalan ng anak ko sa laruan niya". Then I realized, Christmas isn't about me getting free stuff... it's about them, about children and making other people happy.
So ganito na nga --- nung matapos ang usapan, binaba ang telepono at nagsuot kagad ako ng jeans.. kinuha ang susi ng kotse at umalis kagad papunta sa bahay nila sa paranaque.. teka wag kalimutan ang nurses kit na naglalaman ng steth, bp app, cotton balls, alcohol, at iba pang essentials.. as usual nagpakabibo na naman ako at feeling ko e ambulansya ako.. pagdating ko dun.. syempre.. hindi ko nakalimutan ang ADPIE ng nursing... inassess ko ang kalagayan ng lola ko.. andaming nursing diagnosis.. planned my actions and implemented them... (charing!!)---- pero isa sa mga ginawa ko eh ang pag inject ng 1g Streptomycin IM as per doctors order.. imbis na ilabas ang lola ko (usually kasi dinadala siya sa ospital malapit sa kanila para dun) pero dahil nanghihina siya at parang ayaw gumalaw --- dun nalang mismo maginiksyon.. at ako ang maglalagay (tutal RN naman ako~~ at aware ang mga attending ni lola tungkol dito... pinayagan ako na maglagay)
ang order eh 1g streptomycin in 1.5ml sterile water deep IM... so prinepare ko na yun (following strict aseptic techniques syempre... lagot ako kay Ma'am Subido pag nalaman niyang hinde) --- grabe ang hirap tunawin... siguro mag 4 na minutong pagshake and roll onto palms ang ginawa.. tinulungan narin ako ni tita mag prepare ng mga gagamitin... so eto na... assume comfortable position.. warn about possible discomfort.. alcoholize injection area... inject... aspirate -- no blood... proceed.. withdraw needle and place pressure over site with cotton ball... then assess for reactions..
pero di lahat eh may Goldilocks mamon este, smile.. meron ding pagkakataon na.. napalapit ka sa pasyente, inalagaan mo ng ilang araw... (3 days duty per week kami... 8hours per duty) pagbalik mo sa susunod na duty.. mababalitaan mo... "si miss minchin (di tunay na pangalan)... wala na siya" ... syempre nasaktan ako na para bang nawalan din ng kamag anak.. (yan ang pangit sa tinatawag na transference.. in this case countertransference) ... pero ganun ang buhay.. ulit.. si "Patch" Adams, sabi "you treat a disease, you win or lose; you treat a person, you win no matter what the outcome is" ... 
