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  • The (high) cost of hospitalization in the Philippines

    I’m not talking about top quality health care that is available to those who can afford. I’m not even compounding the issue with other factors such as health insurance system and access to medical care. Not even the extensive use of public health facilities by the poorest 30% of the Filipino population.

    I’m talking about this patient’s words

    Doc, di nalang ako magpapaadmit sa ospital kahit kelangan. Di ko po kaya ang gastusin” (Doc, I don’t want to be admitted in the hospital  even if its needed. I can’t afford the expense)-Indang

    Her words not only rang the current “cost” of being a “poor” sick here in the Philippines but of frustration and disgust for having been a victim of a doubly whammy – that of being a poor and getting sick here in the Philippines.

    The findings of a study to assess the three year implementation of Health Sector Reform Agenda
    narrates a littany of negative factors that promotes this double whammy among the poorest of this country. One i could highlight is this:

    The average hospital bill is three times the average monthly income. Costs are so prohibitive so that a 10 percent increase in the price of private hospital services will reduce utilization by as much as 30 percent.

    Not only sounded true but also alarming. Compared to the Mayo Clinic which is among the highest-quality, lowest-cost health-care systems in America, ours pales on its reach and delivery. Philippine General hospital tries to deliver such high quality low cost health care system also but even such healthcare system hurdles not a few logistics problems.

    Here’s one good thing the guys at Mayo clinic are doing:

    …Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,”

    I’d like to think this should be another thrust among health care reforms (among a plethora of other issues) be implemented. Maybe we should look at our health cost utilization and unnecessary diagnostic costs. Put patient first and then work on to minimize health financial expenses. Maybe its not who pays or how are we paid as physicians and how we can maximize health expenses. Lowering cost of expense is second only to quality life of patients.

    What do you think?
    (Photo taken from the Daily Herald, here)

  • How much weight should kids carry on their backpacks?

    I overheard this conversation over one radio/tv show that made me gulp in disbelief. Probably pressured by parent’s questions regarding how much weight should kids carry on their bags going to school, the lady anchor asked one orthopedic surgeon from a known celebrity hospital in Manila. Frankly, I found the good surgeon’s answer a bit complicated and technical.

    The simple answer should have been within 10-15% of the kids body weight, assuming that kid use a backpack to carry his/her school stuff. Beyond this carrying weight “cap” the kid will probably experience back strains and muscle strains NOT a slipped disc or arthritis as the anchors are trying to insinuate. Of course if you let this kids carry tables or chairs regularly, then probably!

    In choosing backpacks for your school kids take note of that weight limit and the following important pointers:

    1. Find a “lightweight” pack, usually made of water repellent (not necessarily waterproof) material but not leather. Leather weighs heavier.
    2. Get a double strapped well padded pack. Find  a pack with a well padded back. This will ease back pressure a bit.
    3. It’s preferable to have multi-compartment packs as they promote organization. But make sure the heavier objects are placed nearer the kids back so they won’t stoop back often and get back strains.
    4. Waist belts keep the pack from “jiggling” on their back, preventing weight shifting that hurts their back.
    5. Don’t get bags that are too large (meaning the bag “material” is bigger than the kids back) nor buy packs higher than his neck. With large bags, comes the tendency of kids to just load everything in there.
    6. Lastly, dont buy packs with too much plastic and paints on the outside. Some of them easily peel off and contain lead materials.

    Why do I know this stuff? Well I’m an orthopedic surgeon and a frequent mountaineer/backpacker too. We use this “guides” to pick our bags and gears. This will at least prevent back sprains and strains from carrying to heavy stuff.

    For more ideas on buying and choosing your packs wisely, visit this site (www.kidshealth.org). They’ve got more tips for kids’ backpacks.

  • I hate guns.They kill my courage!

    “Patay na si Mingoy.Nabaril sya sa uma” (Mingoy is dead. He was shot while he was in the farm)- text message on Joy’s phone.

    This SMS shocked me and Joy. It took us a while to regain our composure. Returning back from a hearty lunch with my cousins earlier we immediately talked about what to do next. Joy called nanay on the phone and told them not to go to the farm anymore as the “assailants” may still be lurking there. We then proceeded to the hospital where the body was brought in. We were all too late. Mingoy is dead.

    Mingoy is dead on arrival when he was brought into the hospital. His body is in the morgue when we arrived there. Talking to the first few people who saw and brought him to the hospital and to the investigating officers on the scene, it seems like he died from an “accidental shot” to the side of the abdomen. No one actually saw what or how the incident happened.Mingoy was gasping for breath and wasn’t able talk before he died. Nanay is in disbelief when he heared this story.She knew Mingoy didn’t have any firearm. But when Mingoy’s friends and some neighbors told the investigators Mingoy  was hinting/showing a “paltik” days before this unfortunate incident, Nanay calmed a little

    According to the investigators’ findings, Mingoy was watching a noontime tv show while (semi supine semi sitted) on a wooden long chair. TVis still on when the police arrived there and his shirt hanging on the chair rest.. Mingoy tucked his “paltik” gun (inside an an unsecured gun holster) tucked inside his shorts. The gun supposedly slipped through this holster when he lay supine, landed on the cement floor gun butt first and then self fired itself. The paltik has no safety lock, has a long hammer pin that almost kiss the bulletshell’s bottom and is loaded with a 20 guage shell. It often fires when loaded even on slight nudging.The slug hit him on the side of his abdomen, probably because he leaned over to the side to pick his gun. There was no exit point and probably he died from an “internal hemorrhage”.

    We were all in disbelief. I was totally aghast at the accident. How could such unfortunate incident happen when just about two days ago, Mingoy was jokingly asking for my professional service in case he falls into an accident!

    Of course there was also these fear of a possible “hit” by persons he had previous grudge with. Nobody remembers Mingoy has had previous fights or arguments with any other person. Besides, the bullet entry point and trajectory plus the evidences (gun, prints, house access, etc) all points to an accidental firing scenario. I asked for an autopsy just to allay our “hit” fears.This will also at least clear up the doubts on Mingoys cause of death.

    But one loose end still remains. The paltik. Nobody knew where it came from. Her in our place, the dead won’t talk.

    That’s why I hate guns. They do nothing but kill…

    (Post note: Mingoy is a distant relative of Joy and their de facto farm care taker. He has been with the family since he was a teenager. He is single and was a very cordial and sharp guy)

  • The Blog Rounds one year and counting

    Yes folks! We’re not infants anymore! Despite numerous delays and whatnot, The Blog Rounds‘ still here blogging and we are still blog hopping.

    True to our real busy lives in the clinics, I forgot to commemorate its first year on the net. But that’s not the same as, err we are dead. Are we??

    No we’re not. I’m not. And for as long as I have an internet connection TBR will continue to do its rounds in the blogosphere.

    Thus, I’m jump starting the ‘commemoration” with what else?, commemorative edition round up of course! Details of this edition will be posted soon, so medical bloggers and TBR contributors, prepare your articles!

    So who wants to host this edition???

    Any suggestions on what to do with TBR’s first year anniversary??? leave your comments or suggestions here!

  • What we do for living is "Heal"

    I found this amazing animation about what orthopods do when patients sustain multiple fractures. Aptly titled “heal” and produced by genius animators of Ghost Productions, this high definition video was presented during one American Academy of Orthopedic Association (AAOS) convention and it awed a lot of viewers.

    And even you tube visitors were equally amazed at the production. So go see for yourself!

    One short note though, we do all of these with patient anesthetized! Helps allay the gory innuendos some may think about this orthopedic procedures!