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St. Luke's Medical Center In Manila, Philippines

One Man's Opinion of St. Lukes Medical Center (Wellness Program), Quezon City

To The Reader: This lengthy article provides a candid, honest assessment of professional services received at St. Lukes Medical Center. Hence, the article has complimentary as well as negative commentary. My purpose is to inform the expatriate community of the Republic of the Philippines from the viewpoint of an educated and experienced gentleman.

My purpose is not to denigrate or make fun of any individual or institution. If I offend anyone, it's not intentional. I apologize, in advance, if anyone takes offense at the enclosed evaluation and commentary.

Introduction: Yesterday, I completed a comprehensive medical examination, also known as an "Executive Health Check-Up," at St. Lukes Medical Center in Quezon City. As a service to this fine forum, and for the archives, I submit the following lengthy report.

Background: St. Lukes is one of the largest and most renowned hospitals in Manila. On the website of the U.S. Embassy, it is listed as one of two recommended hospitals in Manila. St. Lukes provides a variety of medical services, to include some of the most state-of-the-art technical innovations in medical science. St. Lukes claims to be a world-class medical facility.

To be competitive with their main business rival (Makati Medical Center), St. Lukes offers several medical exams. The exams are administered from their Wellness Center (First Floor, next to the Admissions Office and Main Cashier).

The various exams have a broad range of price and complexity. For example, I had Program E, which is a comprehensive medical exam on an outpatient basis. Program E costs P13, 129 (August 2004). There are other exams that are as low as P2, 500. If you have a specific problem (e.g., a heart condition or diabetes), there are specialized Programs available. If you choose, you can be admitted to the hospital, and stay in a private room or suite while being examined. This option raises the price, dramatically. The most expensive option is about P45, 000, which includes a two-night stay at St. Lukes.

My Experience: I arrived for my outpatient physical examination before 7:00 a.m. I was supposed to be triaged by an on-duty doctor prior to beginning the exam, but the doctor was late, so I started the routine exam procedures without seeing a doctor.

My first stop was blood, urine, and stool collection. This experience was fair routine. As most of you know, this is one of the most important aspects of any complete medical exam, but at the same time, one of the most boring and routine jobs for the hospital technicians. Besides having to wait about 20 minutes before having blood extracted from my arm, I have no complaints.

Next stop was a chest x-ray. This was an unpleasant experience. To summarize, the x-ray technician who served me (a young, nice-looking Filipina) was less than competent and impolite. To me, it was obvious she did not enjoy her job, nor did she enjoy working with patients. Worse yet, she made a mistake, and I had to repeat the x-ray. (NOTE: Everyone makes mistakes, and I completely understand and forgive technicians for erring). However, I was unforgiving because the technician made the same error twice, and asked me to repeat the chest x-ray for a third time. I refused. I explained to her I didn't need a third dose of x-rays entering my mature body due to her incompetence and attitude. Also, since I'm a nonsmoker, symptom-free, and I exercise regularly, I was pretty sure my lungs were quite clear and disease-free. The technician was only concerned that the doctor would not be able to read the x-ray due to her mistake. She didn't care, and was completely unconcerned, that she was asking a patient to go through a third regimen of x-rays due to her mistakes.

After the x-ray, I had an ultrasound examination of my abdomen, which imaged the pancreas, gall bladder, kidneys, bladder, liver, and prostate. The technician appeared to be complete and administered the exam with patience and efficiency. At one point in the exam, the technician said "go pay, and come back." I asked her where she wanted me to pay, and how much. Then she said "the CR is to your left." Actually, the technician was asking me to urinate (empty my bladder), but her accent, and use of English slang (i.e., pee), prevented me from initially understanding her request. As a courtesy, I made a recommendation to the technician to use professional, non-slang English while interacting with patients during her hospital duties.

Next, I visited my assigned doctor, a neurologist and general-practice physician. Since I had plenty of time on my hands waiting at each of the previous exams, I took the time to write-out my current symptoms, significant medical history, and current medications. Additionally, I provided a copy of a recent blood test that showed an abnormality in my hemoglobin count. Although I presented the information before the exam with my assigned doctor, he didn't feel it was necessary to read the critical information. When I walked into his office, he said "I haven't read this information; I only want to know what your current complaint is." I was shocked by this attitude, but perhaps this is the norm in RP when you visit a physician (i.e., they are not interested in your medical history and current medications). The rest of the visit went well. He gave me a very quick reflex test, asked me to raise my arms over my head, and tested the range of motion of my head/neck. He prescribed two medications due to a chronic problem with migraine headaches. Additionally, he requested that I get a CT scan of my brain, and an EEG. He asked me to return in two weeks. I didn't want to complicate matters by telling him I would probably not be in Manila in two weeks (NOTE: I believe this doctor thinks I'm a permanent resident of Manila. I am not.)

The next exam was a proctosigmoidoscopy. For those of you that have had this exam, you know it can be quite unpleasant and embarrassing. However, it's an important exam. In this exam, after receiving a Fleet enema, the doctor inserts a long, semi-flexible tube into your rectum to search for abnormalities of the lower colon. Although quite uncomfortable, the doctor was extremely professional, especially in his explanation of the need for the procedure. I can't say enough good things about this doctor. He was a true professional, in every respect. If St. Lukes is looking for a role model for bedside manner and communication with the patient, they only need to look for the gastroenterologist (Dr. Ruiz) who administered this exam.

After a long lunch break, I had a spirometry exam. This is a test to measure the strength of the lungs. The technician was quite nice and professional. Of all the exams, I found this exam to cause more discomfort than any other. Why? You are required, several times, to breathe deeply and expel your breath very forcefully. Later in the evening, I could still feel the strain on my lungs from performing this test.

Next, I had a resting electrocardiogram (EKG or ECG). It was very easy and uneventful. It's an electrical measurement of the heart.

My final test was the Treadmill Stress Test. Using a treadmill, and an elaborate array of sensors attached to your body, your heart, blood pressure, and EKG are monitored as they incrementally increase your heart rate to 85% of its maximum. For me, that value (85%) was predetermined to be 145 beats per minute. As somebody who takes pride in exercising regularly, I knew this would be no problem, since I routinely exercise, for 30 minutes, 3 to 5 times a week, at 135 to 145 beats per minute. At the 5th stage of the test, my heart rate got up to 151 beats per minute, and I felt fine (as expected, since I exercise regularly). Now, what follows is one of my major complaints about St. Lukes and this entire examination process. After getting dressed, the doctor for the treadmill exam entered the room and told me the following: "You have an abnormal test result for Stage 5."Stage 5 is the last stage where my rate got up to 151. I asked, "what type of abnormality”? The doctor said "you had electrical changes at Stage 5."So, as a highly-educated and experienced Electronics Engineer, I immediately asked, "What type of electrical changes, and what does it indicate? “The doctor said "I don't know, we must perform more tests, and you must discuss this issue with your assigned doctor”. Knowing that my assigned doctor is a neurologist, I didn't think he was qualified to tell me what I needed to know about any heart-related “abnormalities”. Needless to say, I was VERY SUSPICIOUS of the treadmill doctor's assessment. With no symptoms, and having done well on the treadmill test, I was extremely skeptical of any doctor telling me I had "abnormalities." Furthermore, when I asked for specifics, the treadmill doctor could not provide additional information. If I was an obese, beer-guzzling, chain-smoking, non-exercising slob, I could understand the assessment. I'm not any of these. I am in good physical condition. My resting heart rate is 55 (indicative of a trained athlete), my blood pressure is 120/70 (excellent for someone my age), and my weight is within an acceptably-healthy range. Now, it's quite possible I have a hidden defect, and it's a time bomb waiting to go off. But, with no history of heart problems in my family (my Father is 74 and still going strong; my Mother is 72 with no heart problems), it's doubtful. I'm far from a perfect physical specimen, but I've taken pretty good care of myself over the years. THE BOTTOM LINE IS THAT THE MANNER IN WHICH I WAS INFORMED OF THIS POTENTIAL "ABNORMALITY," AND THE INABILITY TO PROVIDE SOME TYPE OF IMMEDIATE ANSWERS, ONLY SERVED TO CAUSE ME COMPLETELY UNNECESSARY AND INTENSE ANXIETY AND WORRY. I already have problems with headaches and health problems related to excessive, job-related tension. After returning to my hotel, I was extremely worried, and I didn't know how long I would have to wait to get answers to this apparent abnormality. I SLEPT VERY POORLY LAST NIGHT.

The final step of the comprehensive examination process was learning, at the end of the day, and for the first time, that my blood, urine, and stool exam results would not be available for three days. I WAS NOT informed the results would take this long prior to committing to the comprehensive exam. Also, I was never informed who would do the OVERALL NET ASSESSMENT of my condition (i.e., who would look at ALL the comprehensive exam test results, assess my condition, and provide feedback on the results). I told the Wellness Center staff that I probably would NOT be in Manila in three days, and I asked how the results of all the tests would be provided to me, and who would provide the assessment of my overall medical condition (NOTE: After all, I had just paid P13, 000 for a comprehensive medical exam, and I had a right to know when the results of all the tests would be available, and their meaning). They said it could be sent via e-mail. I then asked, "How can you provide computer-generated blood, urinalysis, and stool results via an unsecured e-mail?” They did not have an answer. They were unprepared to answer such a routine administrative question.

Conclusion: As a recent graduate of a USA Executive Masters of Business Administration (MBA) Program (specializing in International Business); I am appalled and extremely disappointed with the quality of St. Lukes Wellness Program. In my opinion, they have a lot to learn and a long way to go before having a competitive, world-class, Executive-Medical-Exam Program. Many basic business and customer service concepts that are absolutely vital in an international business were violated or completely disregarded.

Am I being overly critical? Am I expecting too much for my P13, 000 ($240 USD)? I will let the reader be the judge. But, I would like to remind the reader that in the RP, P13, 000 is not an insignificant sum of money. Some younger professionals make less than P13, 000 per MONTH. I know several college graduates who would be tickled to have a salary of P13, 000 per month. Accordingly, my initial assessment is that I am not being too demanding for expecting excellent service for P13, 000.

I would also like to point out that there is a tremendous market for this service, including customers from numerous, developed Asian and Western countries. In my professional opinion, this service (Comprehensive Medical Exams for executives, senior employees, and an aging populace) is a potential "gold mine!" However, the customers for this health service are also very knowledgeable and have very high expectations. The clients being served in the Executive health check-up field just happen to be customers that know what needs to be done to properly "serve" the customer, make the customer feel he/she has received value for their money, and, most importantly, these same executives know how to establish/sustain a competitive business advantage in a globalize environment. If you provide such a health service, you had better be prepared to provide nothing but the VERY BEST your institution has to offer. Just as a 5-Star hotel must pay extremely close attention to its clients, so does the medical establishment that provides medical services to executives and discriminating customers. To me, St. Lukes failed to provide their best, and I regret to predict that their Wellness Program is headed for utter and complete failure unless they completely overhaul their business strategy and most of their procedures and processes.

Important: I cannot judge the entire hospital based on this one-day experience. Perhaps they are excellent in other services. I encourage others to contribute to this thread, especially if you have any treatment experience at St. Lukes.

[RRR, 4 August 2004]

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