Angry Doctor

Wednesday, October 12, 2005

Angry Professor – Part 2

As expected Prof Lee’s letter generated a few replies on the ST Forum yesterday and today.

I counted five letters, all criticising her point of view, some denying that Singaporeans who donated to the patients’ families were gullible, and all citing that heart and hope were more important that science in these cases.

They all seem to have missed Prof Lee’s points.

The truth of the matter is, from the onset Singaporeans were duped into donating money without being given all the facts.

Ask yourselves: how did they find out about the cases?

Answer: The press.

How much did they know about the clinical facts behind the cases?

Answer: As much as the press told them.

Would they have continued to donate so generously if they had known that these "were cases who would not benefit from surgery"?

I think many still would, but I also believe almost all of them donated out of the hope and belief that the poor children will benefit from the operations, and that many now ask themselves why the low chances of a good outcome were not explained to them by the press.

At the end of the day, the press had what they wanted - sensational stories, heart-warming tales of generosity, tales of the miracle of modern medicine, and a sense of the journalist’s duty well-done.

But that there were no miraculous recoveries that lasted. And worse still, there might not have been any miraculous recovery to hope for to begin with.

So yes, I agree that they were gullible, even if it was due to the goodness of their hearts.

The second, less explicit point that Prof Lee wanted to make, I believe, was the point about full disclosure, which was countered by the issue of ‘hope’.

As doctors, we often have to inform patients and their families about their diagnoses and the treatment options available to them. Most of the time it’s pretty straightforward, but in cases of cancer or neurosurgery, things can get more complicated.

It’s hard for patients and their families to accept that sometimes, no matter what we do, the outcome will not be what they hope for: a full and complete recovery.

Sometimes the treatment prolong life a bit more, but leave the patient in an uncommunicative state.

We understand how difficult it can be for the patient’s family to cope with having a relative in a vegetative state long-term. OK, we don’t fully understand, but we can see their pain.

One patient’s mother told my senior in neurosurgery, after seeing her son a vegetable for weeks, that he “tried too hard”.

But we had offered the operation to evacuate the blood clot from his head and explained the risks and likely poor outcome even if he lived, and she had given her consent for it. Now she thinks we “tried too hard”.

Offers of hope must be tempered with a healthy dose of reality. Sometimes all the heart and hope in the world is not going to produce a good clinical outcome.

Sure, at the end of the day it’s still your money and yours to throw away as you see fit. But try to have a better understanding of the medical facts in question before you decide, and if you choose not to, at least have the courage to admit that you were duped when you are.

Afterall, nobody seemed to be embarrassed by the fact that they felt duped by NKF.



  • The issues of "informed consent" & "full disclosure" are undoubtedly important & been discussed ad nauseum by many in the medical circles. However, in real life, intangibles like emotions, family relationships all come into play, making the doctors' job even tougher while trying to explain complicated medical procedures, risk statistics, possible complications to already stressed-out family members & patients. Add to that the fact that oftentimes, doctors harrassed for time just are not able to cover everything in their explanations - & it doesn't help matters if junior doctors are the ones to obtain consent in many situations. How to correct the situation? Well, I believe that proper documentation of ALL discussions is sooo important including signed acknowledgement of such discussions by all parties involved(of course, the doctors would have to make sure that the appropriate & complete information is given). I know, very leh-cheh, but what to do?

    As for the media - what they want is to sell papers; & the best way to do that is by publishing sensational stories, even if it means leaving out important nitty gritty details...

    By Blogger aliendoc, At October 12, 2005 10:04 am  

  • Doc,
    This looks like a good topic for my dissertation...

    Appreciate if you would share your views on what medical professionals are allowed to (or should) do vis-a-vis the press, and separately, to ensure that members of the public are not misguided. Coz to address any situation, the onus cannot rest on one party alone.

    By Blogger ckyh, At October 12, 2005 1:05 pm  

  • Er... a blogger's personal views are probably not the best thing to put in your dissertation.

    What an individual doctor may communicate to the media is spelled out in the SMC Ethical Code (you can find it on google).

    What a doctor as an employee may communicate is probably spelled out in his contract. You might want to write to the two healthcare clusters and some of the larger private medical groups to find out what kind of 'gag order' they have.

    The press I believe have their own rules on what they can or cannot publish.

    The relationship between the press and healthcare providers in Singapore is indeed an interesting topic to look into. I hope you do study it and come up with a paper that you can share with us.

    By Blogger angry doc, At October 12, 2005 2:09 pm  

  • Heheh, no lah, I didn't mean that I wanna insert bloggers' views in my dissertation... that's not scientific.

    Am still thinking about feasible topics to do, so if you know of any media-related topic that might interest the healthcare industry, lemme know pls... heehee...

    By Blogger ckyh, At October 12, 2005 11:16 pm  

  • I think the medical circle and the media have an ambivalent relationship.

    We need to media to spread some messages, but at the same time we are afraid they may sensationalise any medical mishap. We are well-aware that the press do not have the same agenda as we do.

    Because we need them more than they need us, this is an unequal relationship.

    Maybe that's one angle to look at the issue.

    By Blogger angry doc, At October 13, 2005 8:24 am  

  • does'nt help that certain members of the press have bones to pick...

    By Anonymous Anonymous, At October 14, 2005 12:58 am  

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