St. Lukes Medical Center, Manila St. Luke's Hospital: "World Class" Institution With First Class Pricing And Third-World Class Doctors, Quezon City, Manila Philippines

IN BRIEF

I took my wife to this "World Class" medical center because she was suffering from seizures and other well-defined symptoms including sweaty palms and soles of the feet, near constant headaches, heart-attack-like symptoms and spots in her vision.  She was admitted for two days, underwent a preliminary EEG, an MRI brain scan (seizure protocol), and a 24-hour video EEG monitoring session.  In all we spent over PHP71,000 at the hospital alone (over US $1,600) and an addional PHP30,000+ in order to travel and visit this venerated institution.

After two days, having reviewed all test results and performed his "diagnosis", our attending physician Dr. Ephraim Maranan informed us of the results: he called me out of the room where my wife could not hear him, and informed me that my wife was "acting" -- "she is faking her symptoms".  In other words, when his initial guess (epilepsy) had been ruled out, he simply gave up.  He ordered no further tests, asked no further questions, did not look into any of her various symptoms, and appeared to have no motivation or diagnostic procedure whatsoever to follow.  He just wanted his P10,000 fee for dropping by a couple of times and then accusing my wife of faking symptoms.

I complained formally to the hospital, and at first it appeared that my complaint was going to be taken seriously by a "Peer Review Committee".  After waiting 4 weeks I received an absurd statement of their findings: 1) that Dr. Maranan had correctly diagnosed "Psychogenic Non Epileptic Seizures" and 2) that Dr. Maranan "should have used tact and compassion".
In other words, Dr. Maranan made a retroactive diagnosis of PNES when confronted by the Review Committee, which they then deemed correct -- and yet, Dr. Maranan had acted without tact or compassion (by claiming that my wife was "acting".)  In other words, she was faking her symptoms but he did make a firm diagnosis based on those faked symptoms!

Google research subsequently led my wife to stop taking the contraceptive pill that she was on: all symptoms have since cleared up.

CONCLUSION

If you want a proper diagnosis in the Philippines, try Google.  It's free and does a better job than doctors who appear to care about little except their fee.  On the other hand, if you have money to burn and don't mind being insulted by doctors who have the title "M.D." after their names but apparently don't have a clue about proper diagnostic procedure, visit St. Luke's.

IN DETAIL

I would first like to say that I am not usually one to complain; I ignore minor issues -- my wife's hospital breakfast, lunch and dinner being served at 9am, 10:30am and 9pm (!) respectively, for example.  It's not a really big deal.

I will also say that St. Luke's infrastructure and general staffing is top-notch; the nurses, technicians, orderlies, rooms, the ambiance, facilities, equipment, organization, and efficiency are excellent -- as one would expect at those prices.

However, a top-notch hospital is not much use if consulting physicians simply give up and dismiss a patient's very real issues by saying they are 'faking' - pretending.  How utterly rude, lazy and unprofessional.

Unfortunately this was the outcome of our two-day stay at St. Luke's Medical Center in Quezon City.

We came to St. Luke's because my wife has been having very worrying symptoms that are beyond what the doctors and facilities in Palawan can deal with (limited specialists, no MRI machine, etc.)  My wife had various neurological symptoms, the most recent and disturbing being seizures.  We came to St. Luke's because of its reputation, recommendations by friends, and its lack of negative reviews.

Our physician, Dr. Ephraim Maranan, apparently believes that we interrupted a comfortable life at our beach house in Palawan for 10 days because my wife was faking her seizures and other symptoms.

For his information, I did not interrupt my busy working schedule without very good reason.  I did not spend PHP35,000 on air tickets and accommodation, thousands more on transport and dining, or PHP71,000 at St. Lukes Hospital for Dr. Maranan to pull me aside and tell me that my wife 'must be faking her symptoms'.

Our initial consultation with Dr. Gatchalian was, despite costing PHP5,000 for 15 minutes, very impressive and well worth it.  Based on his professionalism and his being clearly head and shoulders above any doctor that Palawan has to offer, we had an initial EEG, and went to see the neurologist Dr. Maranan, who recommended admission.

My wife underwent 2 days of tedium, needles, glued-up hair, testing and the inconvenience that hospital life brings.  We accepted the MRI and 24-hour video EEG as being necessary for our expert doctor(s) to reach a diagnosis, despite the fact that the initial 29-minute EEG stated,

"The EEG during wakefulness, drowsiness, and sleep is within normal limits for the patient's age.  No abnormal slowing or any focal epileptiform discharges were seen."

Quite honestly, I saw no point in having the expensive 24-hour video EEG procedure performed, aside from giving the doctor a chance to 'see for himself'.  I had already showed him two of my three high-definition videos of my wife's seizure events, and described them in detail.  But he was the doctor, and this is what we wanted.  We placed our trust in him to do everything he could to discover what is wrong with my wife.

And indeed, he did see for himself: At 2:43pm on the second day of our stay my wife "had an event", captured on video and witnessed by a nurse/technician/Epileptologist.  Dr. Maranan's determination, however, after boasting that he's been in practice for 15 years, was as unbelievable as it was unprofessional: "Your wife is faking her symptoms".

When Dr. Maranan did his rounds on our last morning just before 10am, he called me out of the room to talk privately.  I was concerned, thinking he was going to give me bad news, for example that my wife had a brain tumor.

Instead, I found that I was talking to a doctor who had given up as soon as he saw that there was no simple explanation for the symptoms presented.  A doctor who had no curiosity, no ideas, no apparent diagnostic abilities.  He just labeled my wife as a fake, and that was that.

His only advice: she should see a psychiatrist because it's all in her head.  See a shrink and go home.  But how can one take seriously the opinion of a doctor who appears to be blind to very obvious symptoms, and who appears incapable of performing a proper differential diagnosis?

Did Dr. Maranan research possible causes?  Draw up a list of medical conditions to rule out or confirm?  Did he make a list of symptoms and use these to perform a differential diagnosis?  Ask about which medications she was taking?  No, he did no such thing.

I showed him some of my research connecting hyperhidration, inositol, neurotransmitters, panic disorder and so on.  He agreed this scenario was possible, and when I suggested trying various brain/neurological nutrients, he agreed and wrote a prescription for those.

But I asked myself: why was I making suggestions to a doctor?  Why was I doing the research?  Why am I the one who was coming up with the possibilities?  Who is the doctor in this situation?  Myself, an unqualified person?  Google?  Or the man with "Dr." in front of his name who charges PHP5,000 a visit and apparently doesn't use Google or any proper diagnostic procedure?

We paid our bill and returned to Palawan with no answers other than "she doesn't have a brain tumor".  If "she's faking her symptoms" is a diagnosis that the doctors at St. Luke's are proud to give to their patients, then this is a hospital to avoid.  How utterly, utterly rude and stupid.

Was my wife faking the 3 very obvious seizures that I captured in full HD video and showed to Dr. Maranan?  And the 20 or 30 not captured on video?  Acting?

Was she doing the same faking when she had a seizure while being asked to hyperventilate while connected to wires and being videoed in the specialized EEG laboratory?

What was the *point* of my wasting PHP26,000+ and a very tedious, uncomfortable 24 hours on this video EEG procedure if the requesting doctor was simply going to dismiss anything that didn't go along with his very limited preconceptions as 'fakery'?

Even if my wife was, as Dr. Maranan claimed, 'acting', and deliberately embarrassing herself in public by faking seizures, and wasting her husband's time and money, and willingly being jabbed by the needles that she hates, and undergoing tedious EEG tests that leave her hair full of glue, and being away from her house and daughter, I ask this simple question: Can any human voluntarily turn their eyeballs right up into their eye sockets and flutter their eyelids 10 times per second for a minute?  Up to 5 Times in a row?

Can any human make the palms of their hands and soles of their feet sweat and turn numb and cold at will, often for most of the day?

I am appalled.  Is this really the best that the Philippines has to offer?

St. Luke's seems to be giving its patients the message, "You're better off using Google because our doctors will just give up if there's no obvious answer.  Our doctors can't think outside the box, they have no diagnostic procedures to follow, and they are only interested in straightforward cases.  They will just guess and prescribe drugs before reaching a confirmed diagnosis; they will not consider possibilities such as nutrient deficiencies, adverse drug reactions, toxicity, or hormonal imbalances."

We have spent 10 days of our lives and over P100,000 (US $2,300) to learn that my wife does not have a brain tumor, and does not have epilepsy.  That was wonderful news, but the questions still remained: Why *did* she suffer multiple seizures in a day; why did her hands and feet sweat abundantly and frequently; why did she have regular headaches; why did she often find it hard to breathe; why did she often suffer from numbness and coldness of the extremities; why was she so tired; why were her seizures preceded by her eyeballs pulling upwards by themselves, as well as headache and spots in her vision?

Those are questions that Dr. Maranan could not answer, and made no effort to investigate.  My wife and I do not keep secrets from each other, so I told her the doctor's opinion, namely that she is deliberately faking her symptoms.  She is so upset by his attitude that she never wants to visit St. Luke's again.  As for myself, I do not intend to revisit an expensive "center of excellence" that can easily be out-diagnosed for free at google.com.

OUTCOME

Four weeks after my complaint, we received the following PDF file of a scanned letter:

"Thank you for bringing our attention to your concern in regard the management of [your wife].  We requested the Peer Review Committee of the Institute of Neurosciences to evaluate the management of the case.

These are the findings of the committee:

1)   The diagnosis of Psychogenic Non Epileptic Seizures, based on the diagnostics done according to the standard of care, is correct.

2)   The attending physician's manner of communicating the findings, diagnosis and planned management should have been done with tact and compassion.

We hope we have answered your queries.  We, likewise, apologize for the inconveniences you have experienced but promise to continue striving to deliver the best care for our patients."

(Signed by the Assistant Head of Medical Practice, and the Medical Director)

Unfortunately, this was completely inadequate.  In fact, when I first read it I thought it was a joke.  But then I realized that it is simply St. Luke's way of ignoring problems and trying to get annoying clients out of the door.

The diagnosis by Dr. Maranan was not "Psychogenic Non Epileptic Seizures" at the time of my wife's admission.  Perhaps it was his diagnosis after he reconsidered his position before the Review Committee, but it was not his diagnosis at the time.  Instead, it was simply "Your wife is faking her symptoms."  That was his diagnosis, which he called me out into the hallway to tell me, so that my wife would not hear it.

The response appears to admit that Dr. Maranan did not act with "tact and compassion" when delivering his findings.  In other words, it is agreed that Dr. Maranan was neither as tactful nor compassionate as he might have been.  Now ask yourself which finding is tactless and without compassion:

(1)  "You appear to have Psychogenic Non Epileptic Seizures" (this is what Dr. Maranan claims he told us)

or

(2)  "Your wife is faking her symptoms" (this is what he actually told me)

Clearly the second finding is the tactless one.

In other words, the Review Committee's response contradicted itself.  It was saying:

1)  Dr. Maranan's diagnosis was Psychogenic Non Epileptic Seizures.

2)  Dr. Maranan was tactless and lacking in compassion when he told my wife that she was just faking her symptoms.

How can a patient be diagnosed both with a specific named condition, and at the same time be accused of "faking her symptoms"?  It cannot be both at the same time.  How ridiculous.

Dr. Maranan did not investigate anything aside from his initial guess (Epilepsy).  Then, when it turned out that this guess was incorrect, he gave up and simply accused my wife of faking her symptoms.  He did not investigate even one other possibility.  Not a single one.  He did not ask which drugs she was on (a contraceptive pill only); he did not enumerate her symptoms and draw up a list of possibilities.

In short, Dr. Maranan did absolutely nothing aside from order an expensive MRI and EEG, ignore the results, accuse my wife of faking her symptoms, charge a PHP10,000 fee for that remarkable piece of investigative work, and retroactively claim that he diagnosed "Psychogenic Non Epileptic Seizures".  Which turned out to be wrong anyway.

Existing information on the Internet states that St. Luke's is a "World Class" institution, but our treatment there and the response that we received after waiting for 4 weeks paints a very different picture.  World class equipment, yes, but populated with some "Third World Class" doctors who apparently have no set diagnostic procedures to follow, nor any motivation to properly discharge their responsibilities.  The doctors' fees may be 5-10 times what they are here in Palawan, but the end result is the same: incompetence and even rudeness.

THE CORRECT DIAGNOSIS

By visiting Google, which cost far less than our disappointing visit to St. Luke's, we have now diagnosed the problem ourselves: Side-effects of the contraceptive pill that my wife was taking.  Since my wife stopped taking those pills, all of her symptoms have ceased.  This possibility was not even considered as part of the completely absent diagnostic procedure employed by St. Luke's.