Today we visited a public academic tertiary hospital, Philippine General Hospital. We start in the outpatient setting, passing dozens of people waiting for the different specialties: pediatrics, orthopedics, dermatology; all in their own separate waiting areas. There are few large air conditioning units, but it doesn’t even feel like they are on. People come from all over the country to get healthcare here, as this is the top public hospital in the Philippines. Being an island nation, transportation is a big barrier for many and it takes a huge effort to show up in Manila. Boat ferries are usually the cheapest way to get to the main island of Luzon, and then cars, jeepneys and other modes of transportation take you to Manila. Dr. Lopao tells us how people come early in the morning, like 4 or 5 am, to start lining up to be seen. They are hoping to get a same day, if they can’t then they have to try again tomorrow. Even if they do have a pre scheduled doctor’s appointment, they still have to start waiting hours before to be seen. We find out that the rules have changed and that they now fit in all walk in patients that show up before 11 am.
We see the family medicine outpatient clinic. There people are in a room with a bunch of cubicals. This is where the magic happens. There are two residents in each section seeing their own patients. Like the other outpatient clinics here, residents, not attendings, are the health care providers of the people. They are interviewed in the cubical and then led to a separate space set aside for physical examinations. I get observe a patient-doctor interaction. Everyone is so grateful for their healthcare here. Filipino patients are also respect their doctors more than patients in the U.S. They trust their physician is making a decision that is their best interest. They don’t google diagnose or web MD here. Doctors also learn to use more clinical diagnosis here. Patients have limited funds so lab tests and imaging is only ordered if truly needed. Healthcare is so much cheaper here in the Philippines based on those facts alone.
One of my favorite aspects of how this hospital thinks about healthcare is their outpatient counseling. Here they have more time to talk to patients and help them with weight loss, depression and other health issues. I wish we had time to that in the U.S., we could really help people a lot more if we took the time.
We move to the hospital side of Philippine General, starting in the emergency room. Dozens of metal stretchers fill one large room. There are not any mattresses or curtains to separate patients, only the basics; IV poles if needed and a few heart monitors. The room is hot, not only because there is no air conditioning, there are a large number of non-patients as well. These are the companion (a family member or friend), and every patient needs one. They are the ones who directly provide healthcare to their family member. They help retrieve things the patient might need and help provide health care to their family member in the hospital.
When patients are admitted to the hospital, they are brought to a bed in a large room with other patients. I now understand where the term wards come from. I was not able to take pictures but this image from google is pretty much what I saw.
There is also a private sector on the same campus. We open the door to go into this emergency room bay, immediately hit by the cool air. It’s the only place I could actually feel the air conditioning in the hospital. There are curtains to separate patients and mattresses. It doesn’t look that different from a hospital in the U.S. We also walk to see the private outpatient setting. There are food vendors inside and an elevator. The building is air conditioned and there are A LOT less patients, like 4-5 baysIt looks like home in the U.S. It is easy to see why people who have the funds access the private system, in spite of no difference in outcomes and out of pocket costs. Everyone is just more comfortable.
We have a discussion afterwards about what we have seen. I’m not exactly surprised, but it will be interesting to contrast it with the private hospital tomorrow….
Here are some cool pics from the medical school…..