We all have friends. And we abuse them. Say it. “That’s what friends are for.”

In the medical profession, we practice a courtesy of “not charging” a professional fee to our colleagues. I have no idea how that started, but it’s in the Philippine Medical Association’s Code of Ethics. (Maybe someone can let me know it’s history.)

The medical profession (like many professions) is not standardised when it comes to charging professional fees. The latter would depend on how critically ill the patient is, any special procedures needed, the complexity of the illness and so on and so forth.

This pet peeve story is not about professional fees (although I know that it is for some). It’s about the ones we charge to experience. The NCs – relatives, friends, colleagues and those minions who ask for a discount just because…

1. Returning the favor

It is an unsaid rule that as a “courtesy”, we don’t charge our colleagues or their immediate relatives. That’s because it is an honor that a colleague has picked you to be their doctor. When your colleagues are willing to put into your hands their health and lives, then you must be a good doctor! A respected one at that! And that’s how you can tell that the doctor you’re seeing is the best – your colleagues defer to your judgment call.

And you deserve a pat in the back.

I prefer to settle the professional fee. But it’s not going to happen. So I will now have to find a suitable “gift” as a token of appreciation.

RULE IS – IF you’re going to give someone you owe your life and health to as a token of appreciation, kindly put some thought into the gift.

It’s rude to give something that looks like it’s been recycled gazillion times. Those who have less in life and whom we waive professional fees out of the kindness of our hearts, have simple but well thought of gifts. I know that it’s the thought that counts but giving a “token” that had expired in 2016 with stale moss growing inside the box is taking the “thought” a bit too lame.

2. Extended families

I am amused at how some people introduce themselves by name dropping other doctors names. Like I’m the niece of the mother-in-law of Dr. So-on-and-so-forth. Or, you know my cousin, Dr. X? Uhmmmm yeah. Who is he/she?

Name dropping is a common Filipino trait. I’ve not seen it in other Asian countries except among Chinese. Yes! Your read it right. The Chinese have mastered the art of name dropping and its rubbed on like glue to the Filipinos.

RULE IS – NCs are up to the immediate dependent relative only. Anyone away from that (second, third, fourth, nth degree) and their neighbors or barangays should be charged the full fee.

I don’t understand why we need to give discounts to their “relatives” just because of affiliation and relation with a doctor. And that holds true with employees of hospitals where you work. The employees are gainfully employed. We do not run a charitable institution. We pay our taxes, rent and dues. There are incidentals like secretaries wages, electricity, water, security, office equipment, calling card, supplies, prescription pads, to name a few, that need to get paid. And it is not fair that other people who have less in life are shouldering the NCs of those who have more. That’s Economics 101. You need to have a rule for whom we don’t charge. Otherwise your clinic would be running a medical mission everyday. But think about it. Even medical missions will need resources!

Be grateful if your doctor extends you more than his/her professional courtesy. Don’t forget to say thank you, because that’s really what we all want to hear. (A well thought of gift is appreciated. And yes, it’s the thought that counts.)

3. The godparent discount

And it’s okay to say NO. There are patients who I don’t even know from Adam or Eve. I’m appalled by the fact that they come up to you and matter of factly ask – can you be the godparent of our son/daughter? Uhmmm….who are you people?

Filipinos always say that it’s bad to turn down an invitation to be a godparent. Well I tell my friends, to hell with that! When you don’t really know the people who ask you to be the godparent of their child, it is polite to turn it down. After all, you really don’t know them!

RULE IS – You’re not obligated to waive the professional fees of your godchildren. You can give them a discount (a huge one if you wish) but the services rendered shouldn’t be charity. Especially if they make you their godparent so that they don’t need to pay for the healthcare of their kids!

4. Star struck

Yes the stars have doctors too. But like all stars (and high ranking government officials), they want to be treated special. The star struck phenomenon is a stark reality. Many of them (especially the two bit ones or the co-starring) are such a pain. They want to get seen ahead or they have a preferred time or excuse me, do you do home service?

I pay to watch your entertainment and pathetic commercials. You earn much more than I do. I mean, have you seen their houses in the magazines?!? My house would look like their garage or storage bin in their homes!

Or personalities flaunting how much taxes she has paid in the last year?!? Or how many commercials they’ve made?!? We get the message! Money isn’t a problem. You want privacy and you can pay for home services.

RULE IS – if you need to make house calls (and I wouldn’t mind doing that at all), make sure you charge an arm and a leg. They can well afford to have you close down your clinic for the day, they can very well pay your professional fee for that block of hours you spent on the road and away from your clinic.

But there are those who are suckers for stars. I have had several personalities or “important people” who I’ve seen once or twice. And they don’t return. Why? Because I don’t acquiesce to the request that they be seen ahead of everyone else. And yes, I charge them. Just like all my other patients. After all, he/she who has more in life, needs to share the largesse.

Nothing in life is free. Gratitude to services rendered is highly appreciated. And true gratitude is all we ever desire.

Which goes to the last point. The bureau of internal revenue (BIR) will never credit back the freebies you give. How will they charge 5 kg of fresh shrimp that is paid, for services rendered? When patients cannot pay, and we simply brush off the professional fee, does that get deducted from the “losses” for the year? The last time I know is that financial liabilities should be considered when computing for annual taxes! These little intangible yet practical economic considerations should be factors when running a professional clinic so that we can charge patients fairly and equally.

Services rendered. Services paid for.