Oh promise me…

This post is not about a love story or relationship. It’s not about happily ever afters.

It’s about promissory notes.

The kind that patients make if they can’t pay your professional fees.

It’s the one thing that has no financial value. Seriously, if I recorded all the promissory notes of patients who were unable to settle their professional fees with me in the last 30 years of practice, I’d probably have retired 10 years ago with a farm on my backyard or the sea as my view from my balcony.

I owe, I owe so off to work I go.

The medical profession is one of the kindest (if not most amnesic) professionals in the planet. And I say that with conviction. It’s rare you’ll get a doctor who won’t give you a discount, waive a professional fee to the needy, or even perform “miracles” for free. It’s just in our system to “let it go” and let God do the rest. Gratefulness after all is such a joy.

To a certain extent.

Let’s face it.  Doctors have bills to pay.  Need a roof over their head.  Families to raise.  A life to live.

The medical profession is significantly skewed when it comes to reimbursement. (And I’m not talking about those that charge an arm and a leg. I’m just talking about the average Dr. Juan.) Here’s where I put the disclaimer. While we’re a noble profession whose mission is to save lives, heal the sick, provide health care for those that need – we are not a purely charitable institution. That’s why I admire the doctors who dedicate themselves to the Barrios that they work for. Risking life and limb. Sacrificing family and friends. Working in the most dire of circumstances to care, heal and cure. If this selfless journey isn’t enough, I don’t even know what kindness is in this world anymore.

The majority of us do pro bono in our own little ways. There’s the medical missions to far flung areas or depressed communities. (By the way, medical missions for campaign soirees during elections DON’T COUNT.) Seeing the sick people in your community (Yes. When they know you’re a doctor, some of them knock on your doors in the most unholy hours to seek consult OR cry for help because of a legitimate emergency.) Attending to medical concerns while in flight or on the road.  You name it, we’ve done it. And we don’t charge a single centavo to these.  We do it because it is our calling.  And out of human kindness.

When the patients are seen in either out-patient or in-patient, professional fees are in order. There are times when you’re requested to see patients with scarce resources.  Many of us don’t deny the privilege of being able to do good by lending our expertise and touching the lives of the least and the last. I have yet to see a physician who has not waived his professional fees for patients who had to make ends meet.

Unlike other professions, the job doesn’t get done if you don’t settle the staggered dues in the promissory note. For example, you can’t have your house finished if you haven’t given due date payments to your contractor/architect. If you don’t meet the payments, you’ll never get your house done. It’s a common denominator for professional services – services rendered, services paid for. The form of payment (staggered vs. one at completion of all services) will differ.

Those affiliated with HMOs don’t have less burden in collecting promissory payments. After all, the HMOs will reimburse their fees after the patient is discharged, albeit, months later and for a pittance. Nevertheless, as the Chinese would say, “pakyawan naman“. That’s of course until the patient’s hospital limit has been breached. And the patients are on their own – for both the hospital bill and the professional fees.

In the Philippines, majority of out-patient and in-patient health care remain out of the pocket. Fees would range depending on the specialty or subspecialty of medicine seen. The generalist and family physician is usually the primary physician in the rural areas. In the urban communities, patients have preferences for specialists. Hospitals are run like businesses. And with reason. After all, in order for the healthcare industry to survive, continue to employ allied health care professionals and improve on its services, it needs to be run wisely (at times insensitively) with a clear business sense. Bleeding hearts and charity cases are pointed in the direction of government hospitals. The burden of care is after all, the government’s concern. (Unfortunately, that’s the reality of our healthcare system.)

Hospitals are also unsympathetic when it comes to professional fees of doctors. Sometimes (oftentimes?), when the final bill of the patient is released (particularly for patients that needed intensive care your resources will definitely be usurped within a week or two). Many (if not all of the hospital finance departments) will ask the patient or their family to settle the hospital bill, then settle the professional fees with the doctor’s separately (or ask the doctor for a larger discount on the bill). Promissory notes are then flung left and right.  The hospitals will always require a guarantee and can send a legal team to demand payment later on.  The doctor is left to collect on his own.  More often than not, it’s left as a promise. End of story.

I write this not because I’m encouraging every physician to squeeze every little centavo out of our patients who are at the end of their resources to pay the professional fees. The profession should bat for government remedies in the form where unsettled professional fees can be claimed as part of losses in income for the year when we pay our taxes.  After all, like any legitimate business, unpaid promissory notes are tantamount to unpaid debts and should be dealt with fairly when declaring our income tax returns.  It’s the least the government can do to assist the profession in declaring tax returns properly. In the same vein that the patient is required to fill up a form that the professional fee was waived (and have it notarised), those that are unable to settle professional fees should be made to fill out a form and have it notarised and that it can be used to adjust our annual tax returns.

We can’t just have every foregone promissory note settled as two words “God Bless“. And while I’m flattered with the thousands of blessings profusely pronounced, we accept cash in installment or postdated checks as well.

For those that are the end of wits end on how to settle those promissory notes, we’ll take God’s blessing anytime.


2 thoughts on “Oh promise me…

  1. Ethel November 28, 2018 / 4:38 pm

    So true…great blog again…. . most don’t realise that this profession is 24/7 no time limit. And charging of PF does not include the total minutes spent on the case (like lawyers), phone calls, sleeplessness night, time spent repeatedly taking to every family members who want to talk to the doctor.

    Tax deduction for promissory notes will be so helpful when close to 50% of your earnings already go to tax.


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