I spent my 58th
birthday (3/28) at the cardio-vascular unit (intensive care medical management)
at a hospital in southern Metro Manila, where I live. I stayed there for 4
nights. My last hospitalization was in
2008 for exactly the same illness: ventricular tachycardia (fast heartbeats),
disrhythmia/arrhythmia (irregular heartbeats), and pneumonia (which aggravated
my chronic obstructive pulmonary disease [COPD]). .
My cardiologist ordered that I
undergo a “perfusion thallium scan” (a specie of “nuclear medicine”) of my
heart muscles and heart veins to see if there were blockades. I dutifully underwent
the said test. The results showed that my heart veins and the blood flow in my heart
muscles were normal. It was a great
relief to know that I need not undergo in the near future a “coronary
angiogram” or an “angioplasty” procedure or, worse, a double/triple “open-heart
by-pass operation”.
My health insurer refused to
shoulder the cost thereof, which was less than 2o,000 Pesos. Worse, it did not
cover the period of my hospitalization and medical costs counted from the date when
I underwent the said test (3/29/12) until the date of my discharge from the hospital
(3/30/12). The health insurer argued that the said test was “the same as coronary
angiogram”. (Coronary angiogram is an “exclusion” in my health insurance
policy).But the perfusion thallium scan was not a “coronary angiogram” in
definition, nature, and method. In fact, my cardiologist told me twice the said
test was and should be covered by my policy and that it was not a “coronary
angiogram”. She was an accredited doctor
of my health insurer.
I was forced to pay for the cost
of the said test and the hospitalization/medical expenses from the date I
underwent the said test (3/29/12) until my discharge (3/30/12). The total was more
than 40,000 Pesos. The health insurer paid more than 60,000 Pesos to the
hospital (hospitalization/medical expenses for 3/26/12 to 3/28/12). In other
words, it cost my health insurer and me more than 25,000 Pesos per night in
intensive care hospitalization/medical expenses. That is the current rate for
intensive care unit confinement in Metro Manila nowadays. In 2008, my previous
confinement, the rate was only 15,000 Pesos per night.
Having been diagnosed for hypertension since
1997, for arrhythmia since 2000, and for chronic pulmonary disease since 2005, I
have learned a few things as a patient:
1. Despite
the stress during my confinement caused by the aforementioned disagreement with
my health insurer on the full payment of my hospitalization/medical expenses,
my confinement was an unexpected opportunity (i.e., a blessing in disguise) for
complete bed rest and plenty of sleep, which were badly needed by my over-fatigued
and aging body and my tense and tired mind. Being alone, resting alone, and
praying and meditating alone are liberating and enlightening, as The Buddha has
taught. Truly, “solitude” is not necessarily equal to “solitary loneliness and hopelessness”.
2. My
tachycardia was caused by “electrolytes imbalance” (low sodium, potassium, and
magnesium). This was always the case
every time I was confined in the past. (Yes, electrolytes imbalance can kill
you). My cure was always the same: an anti-tachycardia drug called “Cordarone”
(generic name: “Amiodarone”). I told the medical team attending to me about
such fact and they indeed administered the said drug to me during my
confinement. In less than one night, my heart was stable, but I had to be
confined for three more nights for “more tests and observation”.
3. The
global trend among doctors seems to be
“defensive medicine”, i.e., the imposition of many costly (also unnecessary and
duplicating) medical tests on the personal pocketbook and on the coffers of the
health insurer for the legal purpose of building up the doctors’ documentary evidence
of “competence and due diligence” as a defense against future “malpractice
suits”. “Defensive medicine” harms the unquestioning patient (and his health
insurer) because it is expensive, tedious, dilatory, stressful, and oftentimes
unnecessary.
4. You
must be very familiar with your health condition, the scientific nature and
medical history of your specific diseases, and the medical management of your
diseases to assist your attending doctors (and their expensive retinues of
medical residents and fellows) in their individual and collective diagnosis and
prognosis. Doctors do not explain in detail the prescriptions that they issue
to their patients, as a general rule, except for the dedicated and friendly
ones who stick to their “code of ethics” and thus respect the right of the
patient to “informed consent”.
5. In
Metro Manila, a visit to the doctor lasts for only ten to fifteen minutes, at
the most. However, the patient spends one to two hours for a roundtrip drive to
his doctor’s clinic and back to his home plus additional thirty minutes to one
hour of idly and tensely sitting at the clinic bench sheepishly waiting for
your name to be called by the clinic secretary. That very short visit can cost
you 600 to 800 Pesos by way of consultation fee, depending on the alleged [i.e.,
self-advertised] experience and prominence of your doctor. That amounts to
3,200 Pesos per hour.
6. Since
you cannot rely on your doctors to give you “detailed lectures” (or, at
least, “general orientation lectures”)
on your specific diseases and the specific drugs that they prescribe because,
it seems, they are too busy for such task, you must take the initiative and, in
fact, the responsibility to personally research
on your specific diseases and specific drugs in the Internet to better know
their nature, causes, treatment, alternative medicine, as well as drug side
effects, indications and contra-indications, efficacy, price competition, scientific
commentaries and peer reviews, pending class suits against the pharmaceutical
companies, malpractice suits against the doctors prescribing the drugs or
managing the treatment, and other relevant medical, non-medical, political,
economic and legal information that should interest you as the “consumer” of
the medical service of the doctors and as the trusting consumer of the drugs that
they have prescribed.
7. Google,
indeed, has equalized and democratized knowledge on medical management and has
fortified the patient’s right to “informed consent” and his right of “access to
medical information” about his own health condition and drug management. There
are many reputable and trustworthy medical websites (public and private
sectors), mostly USA-based, that give free medical information as a pro bono
service to their site visitors and the global public. Mankind should thank God and
Nature for Google and social websites like Facebook, Twitter and the like because
they have revolutionized the ordinary people’s “access to medical information”
and they have radically helped promote the right of patients to “informed
consent”. In fine, they have served as global facilitators for the satisfaction
of the need of the global consumers/patients for accurate medical information
and for data on alternative treatment/medicine. It is a sad statement to say
that patients have been wittingly or unwittingly neglected, if not abandoned,
by their busy fee-oriented doctors in terms of “practical medical education”
and “basic human courtesy” to “customers”. (“Patients” are “customers” and
“consumers”, in law and in fact, regardless of whether their status in the
records of the doctors are “paying” or “non-paying”). This is more acute in Asian countries like the
Philippines, where poverty, disease and ignorance -- aggravated by corruption,
bad governance, lack of transparency and accountability, political dynasties, patronage,
warlordism, economic oligarchy, and feudalism -- are endemic.
8. You
cannot depend on Philhealth alone to answer for your hospitalization and
medical expenses when you are confined or your healthcare needs, in general. You
must secure reliable private health insurance coverage to support your measly
Philhealth coverage. The problem is that health insurance coverage is very costly
and beyond the reach of many Filipinos, except those who are lucky enough to
work abroad or whom big private companies, particularly multinational firms,
employ. Philhealth shoulders only 15 to 20 percent of your total healthcare
bills, if I am not mistaken. Therefore, we have to make radical and surgical decisions
to “overhaul and universalize” our health insurance coverage for the sake of
middle- and low-income Filipinos. Otherwise, what kind of national growth and
progress can you expect from a struggling and inequitable country that is
composed of ill, sickly, weak, hungry, undernourished, ignorant, and unproductive
people? Can you expect such a country to successfully compete in the global
market where open, free and cross-border competition, access, and free trade
are the paramount guidelines for contemporary global survival?
9. The
national government, through the Securities and Exchange Commission (SEC), the
Insurance Commission (IC), and the Bangko Sentral ng Pilipinas (BSP) should
work as a team, under the able leadership of the Chief Executive, in strictly
monitoring, supervising, regulating and disciplining pre-need companies and
health insurance companies that somehow have a direct or indirect effect not
only on the healthcare needs of the people but also on the general financial
and economic operation of the Philippines as a nation in order to protect the
rights and interests of the investing public and their beneficiaries. This past
decade we have seen very big and prominent pre-need firms and health insurance
companies, whose executives were paid by the millions, which filed judicial
“corporate rehabilitation petitions” to save their necks, while many others
simply died a natural (and shameful) death as juridical entities due to
recklessness, mismanagement, corruption, and corporate greed.
10. Do
not depend on your doctors to insure your good health. Better yet, do not
depend on others for your good health and quality of life. You alone and nobody
else can and must have the primary (if not sole) duty and responsibility to
insure your good mental and physical health and happy “quality of life” as a
person.
First, STOP SMOKING. Do you
know that I smoked one to two packs of Marlboro for 30 years before I decided
to stop in 2005 when I vomited blood and was hospitalized for one week? That
was the year I was diagnosed for chronic obstructive pulmonary disease. Smoking
kills. Period.
Second, STOP ALL INTOXICANTS
that cause heedlessness, disorderliness, confusion, arrogance, and
irresponsibility of the mind, e.g. alcohol, stimulants disguised as “energy
drinks” whose main driving element is caffeine, regulated/prohibited drugs, and
the like.
Third, although this is not
mandatory but simply preferred, BE A VEGETARIAN. If this is not possible, at
least, reduce by half your consumption of meat products. Eat a lot of fruits.
Drink a lot of water.
Fourth, adopt a HEALTHY
LIFESTYLE. Exercise (which I vow to commence after my present regime of drugs).
I have just bought a mountain bike for the purpose. I plan to bike to work from
my house and back (10 kilometers roundtrip) when I have no court hearings or
formal legal meetings. However, I still have to clear this regimen with my
cardiologist and pulmonologist to insure the normalcy of my heart.
Fifth, MANAGE YOUR STRESS. Get
enough rest, sleep and recreation. Meditate. Pray. Control your temper. Be
contented. Detach. Attachment is the road to perdition. Accept reality as it
is. Give time for silence, stillness, quiet, and solitude.
Sixth, DO NOT LET YOUR CAREER
ABUSE YOU. This is self-explanatory. Do not bring home your unfinished work.
You and your loving family alone should be the sole focus of your time and
actions at home (which is a king’s palace, no matter how humble your status in
life may be). There should be a clear boundary between workplace and home. That
boundary is your gate at home. At the end of your trek in this short lifetime,
you will be judged by how much love and affection you have given to your family,
not by the paper credentials you have received as a worker or the amount of money
in your bank account or the self-promoting prominence your PR consultant has
fabricated and slanted in the mass media about your sweet public image. They
mean nothing at all. Why? Because they do not last forever. Love and compassion
alone do.
In closing, there is so much to
write about HAPPINESS. Philosophers and spiritual leaders have spent hundreds of
recorded years, defining, classifying, and divining happiness as a “concept of
liberation from our endless cycle of human suffering”. I define it as “enlightenment
that results in seeing reality as it is”. It is the true kind of wisdom and
discovery that leads to full liberation. This is what The Buddha has taught us.
How to achieve it? That calls for another (kilometric) write-up. Meanwhile,
visit www.dhamma.org and attend the free
10-day Vipassana meditation course for beginners in Dasmarinas, Cavite.
Atty. Manuel J. Laserna Jr.
Las Pinas City
Postscript:
1.
I thank my children Machelle Laserna-Adricula,
Mabelle Laserna-Nuyles, Manuel A. Laserna III, Paulita J. Laserna (my mother
living in LA, CA, USA), Dr. Florante Jonsay (special client), Atty. Myrna
Mercader (law partner since 1989), Primo Cueva staff since 1989), and my heart
and lungs doctors for their kind support during my recent confinement. I thank
the Universal Wisdom Foundation (New Manila, QC) and the Philippine Vipassana
Meditation Society (PVMS) for my Dhamma education since 2005 and for my
Vipassana meditation exposure since 2006.
2.
I shall sue my health insurer soon for breach of
contract and damages as well as to secure a judicial declaration that “coronary
angiogram” (an exclusion in my policy) is not the same as “perfusion thallium
scan” of the heart. It would be a “test case” that we hope would benefit
thousands of policyholders of the said health insurance company. The suit
starts with a final demand letter, which my law office will prepare and deliver
this week. Fighting a big health insurance company can last up to 13 years from
the RTC to the Supreme Court. It does not matter. Let the “test case” test (a) not
only the health insurance contract but also (b) the state of the justice system
of the Philippines.
