The Case For Asking

 

If we are shopping for a new phone, we ask first, "Magkano po ito?" If we are hiring someone to build our dream house, we ask, "Magkano kaya ang aabutin nito?" If we ask a lawyer to represent us in court, we ask, "Magkano ang PF mo, Attorney?" Even when we buy mangoes at the palengke, we ask the price before we negotiate.

So why is it so uncommon, almost taboo for patients to ask doctors, “Doc, how much do you usually charge for your services?”

Doctors don’t have standard rates across the board. Our fees are shaped by a mix of factors: complexity of the case, urgency and risks, type of institution, location of practice, years of expertise, scope of services, and even personal values and principles. And ahh yes, included in that list is the difficulty and attitude of the patient and the family members (I'm smiling, but not joking).

Some of us deliberately charge below the norm because we believe that healthcare should be accessible. Others match industry standards to ensure long-term sustainability: for themselves, their staff, and their families. And yes, some charge higher, and may have very good reasons for doing so. These could include the rarity of their specialization, the intensity of their training, or simply the number of hours they spend at work and in continued learning.

Over the years, various medical societies have attempted to standardize professional fees, releasing guidelines and tariff schedules to help physicians navigate the complex landscape of pricing. But our profession is unlike others, it is both a science and an art, a business and a calling. The truth is, in these offical society statements, the disclaimers are often longer than the prescribed rates. “Depends on the case,” “Depends on the hospital,” “Depends on the procedure”, "Case-to-case basic", "Upon the discretion of the physician". We’ve all said those lines before. Because pricing in medicine is never one-size-fits-all.

Every doctor is different, and so is every patient. Which is why transparency is key. And the best way to begin is to simply ask.

So my proposal to this perennial professional fee issue is simple: wouldn’t it be better if we normalized the question, “Doc, may I ask how much your PF is for this kind of case?”

It is not offensive; it is practical. It empowers the patient. It opens the door to a respectful conversation where the doctor can explain the range, the rationale, and any possible caveats, such as added procedures, complications, or extended care. It also avoids later awkwardness, or worse, assumptions of greed.

Surgeons and anesthesiologists can do this. Why can't internists?

Patients deserve transparency. But transparency is a two-way street. If a patient is expected to trust a doctor with their body, health, and sometimes even their life, then trust must also extend to finances. And when that happens, when patients ask before doctors render their services, and when doctors answer with honesty and fairness, we meet each other with dignity. There’s no guilt. No awkwardness. No insult. Just mutual respect.

It is true that the physician-patient relationship is a fiduciary one. It is built on trust, shaped by the ethical imperative that doctors always act in the best interest of the patient. And whether we like it or not, this relationship is inherently unequal. The physician holds the medical knowledge, the tools for diagnosis and healing, and often, the authority within the room. The patient, by contrast, is vulnerable: physically, emotionally, and sometimes financially.

This is precisely why transparency matters.

Even with this asymmetry, or in my opinion, perhaps because of it, we must strive to bridge the gap in all the ways we can. And one of the most accessible and respectful ways to do that is to talk about money: clearly, kindly, and early.

To empower patients is not to deny that the relationship is unequal; it is to acknowledge it, and then to offer clarity as a form of care. When patients feel informed about their treatment and about the costs involved, they feel safer, respected, and more in control. And when physicians are asked respectfully, not second-guessed or assumed to be greedy, we are reminded that trust can be mutual.

And once the patient and the family are informed, they can now be empowered to negotiate. To me, and I am not speaking for the entire profession, it is never wrong to ask if something can be made more affordable. But context matters. Timing matters. Tone matters. And assumptions, especially the ones made without knowledge, can bruise even the most compassionate hearts.

So if you’re a patient, ask first. I hope that while you trust us with your health and with your lives, you also trust that we are not doing what we do to enrich ourselves. 

As for me, I can promise that when you ask, I will answer clearly and with care. And I will listen to your negotiation with compassion and justice.