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December 2, 2011

The Facebook Note From A Complaining Doctor

A few days ago, I was able to read a posted note from fellow doctors on Facebook. The shout out reads, "“If you ask yourself why doctors charge so much for consults, it's because we don't get paid vacations, we don't get paid sick days, we don't get bonuses for outstanding performances nor for Christmas. We don't have insurance plans nor do we qualify for unemployment. We sacrifice our family on special days so that we can bring treatment to others. Illness or personal affairs are not excuses for a misdiagnosis or mismanagement. Next time you ask, remember that doctors are doctors because of the love of life, but that love doesn't pay the bills." Re-post if you're in the medical field" I felt my skin crawling actually when I read this note. I wanted to write a comment but another doctor friend of mine, perhaps unable to withstand the creepy feeling this note brought to some doctors and ordinary people, was able to beat me up to it. I am reposting what he wrote regarding this Facebook note.

"This has been posted and re-posted in Facebook by several friends and colleagues. I do not quite agree with this statement and while it may appear to be logical at first glance, I believe it is wrong on several aspects.

First, we signed up for this kind of life when we decided to become doctors. If we wanted a more laid-back lifestyle or a regular job with its attendant leaves and bonuses, we should be in government, maybe as an accountant or a technocrat.

Our life in med school provided us with ample amounts of experience to prepare us for this life and nowhere did I ever hear in med school that life will be much easier on us once we become doctors. So the fact that we lead difficult lives punctuated my innumerable or even unspeakable sacrifices should be no reason for us to “charge so much for consults”. This is insulting to the integrity of the profession.

Second, there are doctors who DO behave badly, not just in terms of hypertension-inducing “professional fees” but also in terms of poor bedside manners and even unethical practices. Those who have been in government training hospitals have seen these types, whose “love of life” is highly suspect because it ranks a poor second to “love of self”. Unfortunately, these are the pricks that give the profession a bad name and are the ones that people remember.

Sadly, some of us may know who these people are but may have chosen to just ignore them simply because we wanted to maintain a certain “peace”. Perhaps it is high time that we do something about them, maybe in a manner of self-regulation.

Third, adequate remuneration is a legitimate concern for many doctors, especially the young ones or those who are in the public sector. However, it may be a bit hard to commiserate when the doctor complaining about “love doesn’t pay the bills” is a regular patron of the Cultural Center of the Philippines and drives around in a brand-new Monterosport SUV, aside from his Honda CRV.

Personally, I believe that whether we are paid in chickens or in six-figure cheques, doctors are never paid too little or too much because there is no measure, no monetary equivalent to what we do. How we care for life, how we manage our patients, cannot be simply put in terms of pesos and centavos. The “payment” that we receive at the end of our care is a mere acknowledgment of our importance in their lives, perhaps more of a token of goodwill than an actual payment. After all, the relationship we have with our patients is based primarily on trust.

Therefore, the premise that doctors “charge so much” is flawed, which brings me to my last point.

The FB statement above seems to be directed at our patients, if not the general public, who are assumed to be ignorant of the state of lives of doctors. As such, it is misguided.

Are they the ones who complain that doctors “charge so much”? I do not think so. Even the poorest of our patients will so readily part with what little belongings or money they have (if they have any), if only to hand us something by way of “thank you”. The scrooges who scrimp on spending on their own health may complain, but will simply not come back and move on to another doctor.

In fact, on issues affecting doctors, our patients usually stand by our side. They are the first ones to take the cudgels for our cause and in many instances, offer their services, as though still trying to repay us.

If this FB statement stems from the Aquino government’s renewed efforts to tax physicians, then we should reserve our venom for this government and its bureaucrats, who are turning taxation into the next pandemic.

In a press conference a couple of months ago, the Bureau of Internal Revenue stated that their computations showed that doctors in the country were paying only an average of P 5,000 per year in taxes. Adding twisted logic to their bizarre math, they concluded that doctors were charging so much but not paying enough taxes and should therefore be subjected to unrelenting taxation, with a dash of intimidation.

But in a study by Ibon Databank a few years ago, taxation is more efficient on those who earn less. Simply put, daily wage earners or ordinary employees pay more tax in relation to their income than the billionaires who bilk the national resources. It is because these billionaires either pay their way off in paying the right taxes, or employ people who help them avoid paying the right taxes.

Thus, the Aquino government is just acting like a big bully. Since government has neither the tenacity nor the desire to tax big corporations that have a slew of lawyers, it just flexes its muscle on those who are “powerless” to fight – the people who actually work for their money, including doctors.

This is disgusting. This is also a poor way of treating doctors who actual stayed here to practice and serve. Verily, something is wrong when the government does not care for those who actually care for the lives of Filipinos.

Something must be done. There is no dearth of doctors in government, from the Department of Health to Congress, and all of them should be able to articulate the problems faced by their colleagues. Government should at least talk to us, and talk to us as productive members of society, not as enemies of the state. After all, “taxation without representation is tyranny.”

And if government refuses? Then the dictum becomes, “When injustice becomes law, rebellion becomes duty.”"

(written by Doc Gene Nisperos. Picture is taken from

Going back therefore to the original post, it is not a reason, as mentioned by Doc Gene, that for those reasons mentioned any doctor can charge patients with very high costs. It is also not true that doctors don't get paid vacations. Junkets sponsored by the pharmaceutical companies that they patronize are quite common. It is not also true that doctors don't get paid on sick days or receive bonuses. Doctors working for the government receive such benefits. Those who are private practitioners need not get those benefits considering that they usually charge their patients 200 or 300 pesos more than the General Practitioner. Doctors too have the option to get insurance (e.g. SSS) but it is all a matter of choice. Doctors don't need so much health insurance anyway. Other than Philhealth (to which they can become individually paying members), there is an unspoken oath among doctors not to charge fellow doctors for their services, including their immediate families. While it may be true that some doctors would sacrifice time with their families whenever they would respond to certain emergencies, most doctors have the luxury of time to the point that they can even decide to open their clinics as late as 11a.m. or 2 p.m. Of course illness and personal affairs should never be an excuse for a misdiagnosis, that is why if you are sick, you have to excuse yourself from work. This is not only an exclusive advice to doctors but to all professionals (whether you are an engineer or architect, banker or lawyer). While the doctor is expected to receive his due pay, being a doctor alone is not reason enough to charge your patients exorbitantly without consideration of his or her predicament.

Lesson learned: let's be more thoughtful of what we post and repost on facebook next time.

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