Practice Blue Print

Blue Print

My dad was in the construction business for the longest time.  One of his project is helping start up families  build their first home. I would hear him advice them on how to plan for their dream home.


It may not happen now”,  he would say, “but as you build this house, lay the foundation for the dream house”.


You can start with a single storey, but  plan and design  for a multiple storey.  You can build in stages. When money comes, add on and make it a project.


Starting  a practice is very much like building a dream house.


 A  blue print  helps create the life you want  one step at  a time.  Just like in a house, a blue print  helps connect the different “rooms” in our life .


It  also helps us recognize opportunities that fit into the dream  when they come.


A friend  wanted to have clinic only  in the mornings.  She would like her afternoons free to do other things.  But the schedule she likes is taken.  She approached a  friend who is currently occupying the clinic slot she likes and told her  that in case her friend gives up the slot, she would gladly take it.  She did!


When I was planning, I defined what I wanted by imagining how things will be. I wanted time for my family. I would like to be able to bring and fetch my son in school.  I wanted to finish with patients early. I would prefer less calls at night. I wanted most of my patients to be first born. I want patients who do not hop from one doctor to another. I want a relationship with my patients and their families. I should be able to get home to tutor my son.


Because I imagined how things will be, I scheduled my clinic hours around my son’s school hours. I decided to practice in a hospital where there are residents. I tied up with a friend who teaches Lamaze to first time parents teaching basic baby care before they give birth.


Picture your dream practice. Build on it.

How Much PF is Right?

professional fees

Harry Beckwith  in his book  Selling the Invisible  tells about  a carpenter who was called in for a house call.  The house owner could not figure  out where the creaking sound on his floor was coming from. The carpenter walked around the room . Then he started to hammer at a certain area.

Suddenly the creaking noise was gone! So how much do I owe you for this? the house  owner asked.


What? Such price for just hammering my floor! That’s outrageous!  The  carpenter calmly responded,

I am not charging you for hammering the floor. I am charging you for knowing where to hammer.


The issue of charging  patients for our services is a very difficult  and delicate matter to discuss.

Most often because there are really no written guidelines.

Another reason is the numerous factors to consider in setting it.

So how much is just right?


 Dr. Guia Tan,  a consultant in our hospital gave us a very insightful way of  approaching  this delicate issue of professional fees. Here are some excerpts from her talk  .

First the facts.

Most of  us  are on a fee for service structure (we are paid for every service we render or patient we see).

We earn a living through the fees we receive.

We have an obligation to ourselves and those who depend on us.


 But we also  have an obligation  to society.

We have an obligation to preserve the standing of the profession but we are expected to regulate ourselves.

This issue about fees requires  perspective, sometimes differing perspectives.

For some patients, high fees  may mean that they are  esteemed and are actually proud to be paying much.

Others do not mind the fees at all as long as they feel it is worth it.

It is also important to consider who actually “provide”  the resources. For the uninsured, others may provide the resources. Or the state takes care of it.

Decision on how much to charge is also a matter of asking ourselves who will be affected by such decision and what its effect will be.


One final food for thought is the test of publicity:

Can you disclose your fees without qualms?

Walk in My Shoes

Walk In My Shoes

“Parang nasasakal”. Chest heaviness. Cold and clammy. Shortness of breath. This is a patient’s narrative of a very scary experience.

And that patient was ME.

I was on my way home when I suddenly felt bad. Am I having a heart attack?  Oh no, too young  to exit!   I was contemplating whether I should bring myself to the emergency room.

The patient in me was in a denial stage saying, “I could be okay in a while.” The doctor in me was already making a diagnosis. “ If this is a heart attack, I only have a few minutes. Going back to the hospital from the house could mean its too late.

And so I decided to bring myself in. Lying down on a stretcher, I was given oxygen by cannula. I kept on sitting up because I was very anxious. Will I end up in ICU? More than that, will I make it through? I see the people around me, their faces familiar but it does not relax me a bit. ECG was done. Blood was extracted for cardiac enzymes.

I was wheeled to the cardiovascular lab on a wheel chair for 2D echo. This was my scariest experience ever.

Hey this time, I was on the other side of the bed rail!

It’s a  very strange feeling to be the one lying on the bed instead of the one lording over it.  It was humbling to be wheeled around the same hallways I walked on everyday. My first time to ride a wheel chair too!  It was terrifying to wait what my attending doctors would tell me about my tests.

After this experience, I have greater respect for the patients who is in every inch vulnerable, scared and probably feeling helpless lying on the stretcher.

 I have better appreciation of the patients who chose to put their vulnerability  on our hands.

 I had greater understanding of what they truly needed from me as their doctor…because I have walked in their shoes.

Any “walk” you wish to share?

Walk in your patient’s shoes. Your understanding will never be the same.

PS.  The diagnosis was GERD.  I was having coffee more than I should. Blame it on the  coffee recipe tasting  I was doing for a project.

Do You Know vs. Do You Care?


When I was an intern, I would hear elderly patients tell Dr. RA “gagaling nako, nakita ko na  doctor ko.”

He is a brilliant doctor.

Going on rounds with him, I realized why his patients would make such a comment. His warmth towards them, attention to what they were saying, reassuring their anxiety, and ensuring even the tiniest detail about their entire stay are the things that endears patients to him.

During residency training,  parents would make similar comments to some consultants. Patient feedback in the hospital would  be, almost always  about whether their doctor cared enough.

I  believe  that when patients come and see us, expertise is a given fact.

Pediatricians know children. Cardiologists know the heart. Orthopedic surgeons know the bones.

What they are figuring out  during the first encounter is whether we care enough.

Do we care enough to see them on time? Do we care enough to pick up  what they are truly feeling? Do we care enough to know  their circumstances? Do we care enough to verify their understanding? Do we care enough to offer  our time  beyond the clinic visits?


Can you please share  how  else we can show our patients we care enough? Please write in the comments below.



Patients come and stay because we cared enough. 




image by photostock/

The Best Investment Today

Best Investment

I am no finance expert but  one  investment I made  that resulted to unimaginable  returns is when I decided to learn from other disciplines other than medicine.

Our years in medical school has given us the opportunity to learn about the human body, its uniqueness and ways to keep it healthy.  But this body belongs to a person who appreciates the arts, who has mouths to feed, likes to be appreciated and who belongs to a bigger world. There is so much to learn out there.

After residency, I took a business course, seminars on communication, marketing, writing, internet marketing, coaching, cooking  etc.

Over the years, I have met teachers, internet marketers, IT experts, politicians, nuns, hoteliers, fitness instructors, digital artists etc. They are all interesting.  I have greater appreciation of what I do and the world I am in because I have come to know and understand theirs.

Read on personal  finance. Try photography or painting. Learn how to teach or make powerful presentations. Dabble on entrepreneurship.  Learn from internet marketers. Study something that excites and interests you. Talk to different people. Ask them about their world.

Do you have other  classes you want to take? Write them in the comments below. I might take them  too!

Invest on yourself.  Its worth every cent.

Where To From Here?

Road Ahead

Finally, I will have the luxury of sleep and long, relaxing showers!  This was my first happy thought after finishing residency.  A few more days into  it, things began to sink in.

So,  “where to from here”?


During training, it was  hard to think about  how things will be post –residency or fellowship. There are   calls to answer, patients to see ,  books to read  and cases to present.


I was in my last few days into finishing when a generous consultant gave a few tips on how  to get started. I was so grateful  and felt lucky that I have something to start with.  I told her, “it’s a good thing I am learning this now.” She told me  “you should have thought about all these on  day 1 of your training!”


Well, if the best time was years back, the next best time is now.


When the jolt of  being  “jobless” finally came, many questions started to crowd my now fully rested but almost dormant brain. I thought it was the end of the line. Okay, time to find a place, set up clinic, put up a signage and wait for patients to come.


But, if I were to be part of the hospital, shouldn’t I consider another two to three years of study?  Our department was growing and they needed a lot of subspecialists. We were prompted to go for further training. Should I take this option?


At the same time I was thinking, I have a son to raise. Maybe I should start to practice now.


I did applied for subspecialty but was lucky to snap out of it right in the middle of my interview. See my story.


When I finally decided to start, there were more questions. Where do I practice? What is the best time to hold clinic? How much do I need? As a I get one question answered, another one pops up. 


Wait! It can’t be this way. I seem to be doing a lot of things and yet I felt uncertain. Rather busy but uneasy about how things are going. I felt like I was just grabbing whatever comes my way.


I sat and got a piece of paper. I divided the paper into two: One column says LIKE, the other column says I DON’T LIKE. I started to scribble…I like to do other things other than seeing patients….I don’t like to hold clinic all day…I like  to have ME time…I like to work around my son’s schedule…I don’t like …etc. What seems like cobwebs hanging over my head started to clear up.


I realized that if I were to be happy doing this for the rest of my life, I have to really think about it.  And so I set out to plan.


“If you don’t have a plan for yourself, you’ll be part of someone else’s.” ß Didn’t want this to happen!


Set up your practice for success.  Take time to plan.

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