Angry Doctor

Tuesday, November 22, 2005

angry doc asks - 2

Tortoise or Hare?

Prompted by what Oz Bloke and uglybaldie posted, I decided to find out something about the patient load in 'the west'.

Here is an interesting article entitled 'Turtles and Rabbits' from the American Family Physician site, and the follow-up article.

Seems like the situation (at least in the US) is not a bed of roses either.

How many minutes do you think your doctor ought to spend with you per visit?

32 Comments:

  • Excellent article you linked there!

    Very very good.

    Anyway I once read a doctor say that there will be patients who want their consults to be quick and there will be doctors who want to see patients fast. There will also be patients who want to spend time with their doctor and there will be doctors who can accomodate them.

    This was true when I saw such different practices in Australia. It is also true from the Article you linked.

    In Singapore? I believe it is also true although the majority are rabbits, most worth mentioning the Polyclinics. Singapore has a rabbit culture anyway in all industries.

    One thing though. Personally I know I can be a rabbit. But I prefer to be a turtle at times. Which means that I can be both. I think most locally trained docs are like me. They can either be rabbits or turtles depending on what they want to be.

    No wonder Singapore docs are so wanted! Isn't it best to be able to both?

    One suggestion I have is to go the old chinese ancient medicine way. Doctors are only paid when the patients get well or are healthy. After all what people really want is results.

    By Anonymous Dr Oz bloke, At November 22, 2005 3:09 pm  

  • as a patient, as long as it takes to find out my problem and hammer out a treatment plan.

    as a Singaporean patient, as long as it takes to write & sign that MC + get that antibiotic for viral flu

    as a doctor anywhere, as long as I get my 8 hours sleep!

    By Blogger andrew, At November 22, 2005 3:11 pm  

  • Andrew wrote "as a doctor anywhere, as long as I get my 8 hours sleep! "

    From that comment one can guess that you work in a system where you are given X number of patients to see a day and it is up to you how long you want to spend seeing them. Or perhaps you are expected to clear any number of patients who turn up at the centre until a certain closing time.

    In such systems, nobody benefits except the practice managers and corporates.

    By Anonymous Dr Oz bloke, At November 22, 2005 3:22 pm  

  • In Oz, there is an increasing time pressure on general practitioners. 15 or 20 mins is probably the average time allocated per patient. In bulkbilling clinics, which are diminishing, probably somewhat more abbreviated than that.

    60 patients in 3 hours is ridiculous! I imagine the likelihood of error as a consequence of such time pressure is rather high, no matter how skilled one is...

    By Anonymous Epicurus, At November 22, 2005 3:41 pm  

  • "Doctors are only paid when the patients get well or are healthy."

    Like that nobody will want to be an oncologist. :)

    Or better still, the Mesopotamian-type law: Building collapses, architect dies. Patient dies, doctor dies.

    By Blogger angry doc, At November 22, 2005 3:51 pm  

  • Well believe it or not that was how chinese sinsehs were paid in the old days.

    By Anonymous Dr Oz bloke, At November 22, 2005 4:13 pm  

  • One thing I noticed in the article though is that at least there is a debate in America among FPs about the amount of time they should spend with patients. And there are groups that will say they are turtles or rabbits.

    In Singapore it's more whether you do aesthetic medicine or not, mesotherapy or not, how much you earn.

    Does SMA do any such studies? Or the COFM? Any statistics on how many patients GPs see a day on average in Singapore?

    By Anonymous Dr Oz bloke, At November 22, 2005 4:40 pm  

  • interesting aRticle.

    having woRked at vaRious clinics, i would say that diffeRent patients have diffeRent demands. some pRefer to spend moRe time with the doctoR, telling theiR long stoRies; some just wanna get their med/MC and go.

    likewise, some doctoRs aRe willing to spend time listening to theiR patients; some just wanna see as many patients as possible as they get bonuses based on the number of patients they see a day. in these cases, aveRage time i've noticed is 3-4minutes for the usual URTI.

    personally as a patient i agRee with andrew. i expect my consultation with the doctoR to be as long as it takes foR him/her to understand my pRoblem and give me suitable tReatment. whetheR short oR long, as long as i'm able to get well eventually that's fine with me.

    By Blogger 幸せな女の子 :), At November 22, 2005 5:11 pm  

  • starzz,

    the problem with that line of thought is that it does not really address the issue you mentioned. For example say a rabbit doctor said he could sort out your problem in 3 minutes when you actually feel it is a more complicated problem and needs 10 minutes. Then how?

    "i expect my consultation with the doctoR to be as long as it takes foR him/her to understand my pRoblem and give me suitable tReatment. whetheR short oR long, as long as i'm able to get well eventually that's fine with me. "

    It's all very subjective what the patient thinks is acceptable for a particular case and what the doctor thinks is acceptable.

    By Anonymous Dr Oz bloke, At November 22, 2005 5:20 pm  

  • I want my doctor to spend as much time as needed with all his patients. That is why I take a book in case I have to wait.

    But I am also prepared with my questions and topics ahead of time so we can be efficient during the visit.

    A good doctor can spend 5 minutes with you and make you feel as though you are the only patient he has.

    By Blogger Kim, At November 22, 2005 7:17 pm  

  • Sorry... Off-topic...
    [[staRz``]]= FAMS ? :Pp

    By Anonymous Anonymous, At November 22, 2005 9:27 pm  

  • dr oz bloke: hmmz. but if the rabbit doctor says he can treat me in 3 minutes and he makes me feel comfortable about it, even if i had thought at first that i needed 10 minutes, those 3 minutes should be able to satisfy me enough, right?

    anon: so smart ah ;)

    By Blogger 幸せな女の子 :), At November 23, 2005 10:26 am  

  • Dear starzz,

    I think that there exists a certain standard of time generally accepted to be sufficient for certain cases.

    What you are alluding to is subjectivity to the extreme. In other words you leave it to the doctor. So if the doctor spends 1 minute but still somehow manages to make you feel satisfied, then it is acceptable?

    What if the doctor spends 30 sec and still manages to make you feel satisfied?

    Is there a limit to how fast one can go? I think there is. There should also be a guide to how long standard consults should be for what kind of cases. Audits on "supersonic hares" should be done to check the authenticity of their consults. You'll be surprised as to how brief some clinical notes are.

    By Anonymous Dr Oz bloke, At November 23, 2005 11:40 am  

  • well, i agree that there should be a certain standard of time that's generally accepted; i guess a certain amount of time is required for the doctor to understand a patient's condition. feel that doctors themselves should be professional enough to give each patient sufficient time and not rush through each case.

    ok i'm not speaking for myself but for some patients i've met. those that come only for the sake of a MC. to them 30secs is acceptable as long as at the end of it they get what they want.

    By Blogger 幸せな女の子 :), At November 23, 2005 12:28 pm  

  • Dear starz,

    "acceptable as long as at the end of it they get what they want"

    Ah here is where it becomes a case of customer satisfaction rather than professionalism.

    To be honest there are many patients who just want an MC. Many of them DON'T want to see the doctor. They just want the MC.

    The issue however complicates when the patient may be suffering from a condition that is more serious than he/she thinks, but at the time they just wanted an MC. If however, the consequences of the slip shod consultand examination caused permanent harm to the patient, then who's at fault? Of course the doctor. But what the patient wanted at that time, may not have been what he/she really wanted on hindsight. They'd probably say, that doctor anyhow see then never pick up my problem properly.

    I'll give a case example. Teenage man complains of abdominal pain. Says he "injured" himself while playing sports. Wants some painkillers and wants to rest, keeps insisting it is not serious. Doctor offers to do an examination. Patient is not keen and says he is in a rush.

    Doctor prescribes the painkillers and gives the MC.

    The patient later has worsening of the "abdominal pain" and presents to the A&E. Turns out he had a testicular torsion. And because he presented late, the testes had already infarcted and could not be saved.

    Is the doctor negligent? Oh yes he is. Did the patient want his testicles to be examined? No he didn't. So what's the verdict? Who is really responsible for the patient's health and illness the moment they step into the consultation room? The doctor or the patient? If it is the doctor, shouldn't the doctor be allowed to do what he needs to? Shouldn't the patient have the attitude that the moment he steps into the doctor's consult room he is agreeing to submit to the doctor's questioning and examination? If it is not the case, then you cannot expect the doctor to be responsible for the damage later suffered.

    By Anonymous Dr Oz bloke, At November 23, 2005 12:47 pm  

  • that's why i say the doctor has to maintain his professionalism.

    well it's a 2 way thing ba. yes a patient who just wants an MC may be satisfied with a 30s consult if they get what they want at the end of it. but the doctor has the responsibility to ensure that the examination is not slipshod.

    as to who is responsible for patient's health, i would say we are each responsible for ourselves. rushing for time is a lousy excuse. how can you enjoy time without good health?

    once in the doctor's room, we should trust the doctor and allow him to do what he needs to do. at the same time the doctor should not betray this trust that the patients have in him and examine the patient as best as he can.

    By Blogger 幸せな女の子 :), At November 23, 2005 12:58 pm  

  • Precisely, and all I'm trying to say is that there exists a certain minimum amount of time that a doctor should be spending with every patient in order to perform his duties professionally.

    One excuse some patients give when a doctor wants to do a test (eg urine to exclude pregnancy or infection) is whether there is an extra charge.

    Of course there is. But the patient is convinced she is not pregnant nor is she having an infection and refuses the test. I must say it makes being a doctor very difficult in such cases.

    By Anonymous Dr Oz bloke, At November 23, 2005 1:03 pm  

  • hmm yar i met such patients before. and patients who say no to a certain xray/blood test when the company HR says they do not cover for that. and i always think to myself: is money more important or your health?

    By Blogger 幸せな女の子 :), At November 23, 2005 1:07 pm  

  • "is money more important or your health? "

    I think in Singapore we all know what the answer is.

    But enough about thinking for the patient or customer. What about us doctors? Should we compromise and practise customer satisfaction and budget conscious oriented medicine? Is that professional? Is it not negligent? Sad to say I know 9 out of 10 doctors compromise.

    What happens if the patient sues? I recall a case in Singapore where a GP wanted to refer a patient to A&E for possible retinal detachment and the patient pleaded with him not to. When she went blind, she sued. The judge told the GP that she cannot believe that the medical profession works in that manner. She said that it is not possible for the doctor to leave the decisions to their patients. If so then her trust in the medical system is totally misplaced. And the GP was successfully sued. Remember this case?

    To this day it haunts me.

    By Anonymous Dr Oz bloke, At November 23, 2005 1:13 pm  

  • so are you the only 1 doctor out of the 10 who do not compromise? :)

    i think doctors should not compromise. and patients must understand that it's the duty of the doctor. well, perhaps we all need some sort of lesson on responsibility for our own health; it's simply wrong to turn the tables on the doctor just like that.

    dr oz bloke u're practising in Singapore now? how was practising in Australia like?

    By Blogger 幸せな女の子 :), At November 23, 2005 1:53 pm  

  • I am hoping I can go to Oz next year.

    Still in Singapore.

    And unfortunately, I do compromise. Otherwise I wouldn't be able to work in Singapore!

    By Anonymous Dr Oz bloke, At November 23, 2005 2:11 pm  

  • lolz. true. i guess that's how Singaporeans are like. i think i've seen quite the worst of them around. -sighs-

    so are u local grad or oz grad?

    By Blogger 幸せな女の子 :), At November 23, 2005 2:17 pm  

  • 100% local grad.

    What about you? Local grad? Practising in SG?

    Any thoughts about going abroad at some stage?

    By Anonymous Dr Oz bloke, At November 23, 2005 2:19 pm  

  • lolz. i'm still v young! what i meant when i said working at various clinics is as a clinic assistant and not a doctor =x

    starting on year1 at oz next year feb. still not decided if i'm staying there or coming back.

    By Blogger 幸せな女の子 :), At November 23, 2005 2:27 pm  

  • If you want my opinion, I'd say stay there for a wide variety of reasons and medical being the least of them!

    By Anonymous Dr Oz bloke, At November 23, 2005 2:29 pm  

  • haha. one of my locum doctors v funny. he said: don't come back...stay there buy a farm and rear cows, sheeps...

    which part of oz u planning to go to?

    By Blogger 幸せな女の子 :), At November 23, 2005 2:32 pm  

  • Melbourne Victoria.

    Hey your locum might be ME!

    Anyway he's right. I did meet a few doctors who owned vineyards and farms. It isn't that expensive really. Just the price of a bungalow in Singapore.

    A 3 bedroom house costs about the price of a 5 room HDB flat in Singapore.

    By Anonymous Dr Oz bloke, At November 23, 2005 2:34 pm  

  • that's where i'm going for my studies! then i shall feedback to you lol.

    hmm ya houses, cars there cheaper than here. my parents doing some calculations and thinking maybe it's more worth it to buy an apartment rather than spending on rent in hall/apartment.

    By Blogger 幸せな女の子 :), At November 23, 2005 2:40 pm  

  • They are probably right!

    After all the money you sink into rental can be used to pay off home loan installments. But watch that interest rate!

    At the moment I think Oz's property market is a bit overheated. I think prices are likely to hold and then possibly drop. There are a lot of sellers. Dunno if there are enough buyers though.

    yeah we can always meet up at angrydoc's place eh? No worries mate.

    By Anonymous Dr Oz bloke, At November 23, 2005 2:46 pm  

  • just experienced sth in relation to this post today.


    patient: number 56 will take how long ah?

    me looking at the 48 showing: erm...

    patient: 10minutes?

    so she expects the doctor to see 8 patients in 10 minutes? i think such situations are common. Singaporeans expect to see rabbit doctors.

    By Blogger 幸せな女の子 :), At November 24, 2005 3:45 pm  

  • Nope, its the 'me first' attitude. They expect doctors to be rabbits when seeing other patients but turtle when its their turn..

    By Anonymous dryvlee, At November 26, 2005 8:31 pm  

  • Liked it
    4 | glance | best glance | 4 | 6 2 | my

    By Anonymous Anonymous, At February 16, 2013 10:10 pm  

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