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
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.