Angry Doctor

Wednesday, November 23, 2005

angry doc asks – 3

How do you pick your doctor?

The thing about being a doctor is, short of you having a condition that requires the attention of a specialist, you don’t really have to pick a personal doctor.

Or rather, you never had to pick blindly. You know which colleague to go to if you needed an MC or some drugs, and you also knew which of your colleagues you wouldn’t trust.

So when a reader asked me how to be sure the doctor she was seeing would not be a quack, I didn’t have an answer.

Help me out here: how do you pick your doctor? What makes you stick with him or her?



  • Short of my family and friends, there are three persons who are very important to me. They are: My doctor, My lawyer and My stockbroker. In that order.

    My family has been with our present doctor for the past fifteen years. Over this period, we have built up a bonding of sorts. He knows all of my family's medical history and that is a family spanning four generations! He doesn't come cheap but neither is he a rip off man. Although he only has a basic MBBS, his diagnostic skills are very much above average. He makes the choice for us when we require specialists' attention. And he will also not hesitate to recommend someone in a public hospital if he feels that someone is capable of handling the problem. He is not adversed to putting grandma's leg on his lap to make a thorough clinical examination. How many young punks out there would do the same thing nowadays? Most importantly, he explains every medical situation with you in a clear concise manner so you know what is expected of you to get well soon. He doesn't think that everyone who has not been to medical school is a duffer. The respect is mutual.

    I am sorry the above narrates what makes us stick with him for so long. We picked him by chance and it was a lucky break for both of us.

    By Blogger uglybaldie, At November 23, 2005 9:40 am  

  • "putting grandma's leg on his lap to make a thorough clinical examination"

    Gee...don't all doctors do that? I mean it's either the couch (but difficult in not mobile elderly) or rest the lower leg on my thigh while I examine the knee for effusion.

    I never knew some doctors don't do that. Then how do they check for effusion in a flexed knee?

    By Anonymous Anonymous, At November 23, 2005 9:49 am  

  • Hi OZ doc,

    You'll be surprised that not many new docs are like you or my doc. It may be required in a med school environment to tell your prof that you are doing the right thing. But in the real world, you can, if you choose to, not do it by the book.

    I remembered my driving instructor telling me this:

    Look here, when I am teaching you, you damn well follow all my instructions if you want to pass the test. When you get your licence, just drive as it pleases you ok?

    By Blogger uglybaldie, At November 23, 2005 10:04 am  

  • Dear uglybaldie,

    well I'd say you are right. But you see in my opinion, doing a thorough examination shows the patient that you are interested, caring,dedicated, and professional. While you may have to rush through the steps depending on the work conditions, at least you bother to touch them.

    I would say there is one area that I find a bit strange in Singapore and I'm hoping you could tell me what it's like in Oz.

    When women present with obstetric or urological complaints eg groin itch, pain, lower abdominal pain, vaginal discharge, it is expected of the doctor to do a full pelvic examination. (In the exams you of course fail if you don't and in a court of law you will be termed negligent)

    However when explained to the female patient that she should have an examination, they usually either give you funny looks, with expressions of avulsion and disappointment or simply refuse to. The comment is usually that "most" doctors don't need to do it so why should I need to. And they usually just want that medicine the doctor gave previously.

    I hardly see these patients again.

    I'm just thinking, is it really the norm in SG that male doctors don't do pelvic examinations routinely? In this case, doing the right thing seems to harm business.

    By Anonymous Anonymous, At November 23, 2005 11:30 am  

  • Hi OZ Doc,

    In Singapore, this is my take as a layman. Unless you are a certified gynaecologist or an obstetrician, very few female would want a physical examination below the waist and above the knee. This silly trait is very pronounced if you are a male doctor even though there is a chaperon around. I suppose it may again have something to do with culture. Local girls, despite their outward show of bravdo is still very much conservative at heart. The Aussies as you know are different. They are brought up in a very different culture and trust their doctors to a larger extent. Locally, I suppose, cases of molestation by medical people reported in the papers further exacerbate the situation.

    If I were a doctor in Singapore, I would assume that any female under the age of 45 would NOT want a pelvic examination and if they have a problem "somewhere there", I would recommend that they see a gynaecologist.

    By Blogger uglybaldie, At November 23, 2005 12:40 pm  

  • Haha. Reminds me of this exchange during an O&G posting...

    Reg: When was the last time you examined a vagina?

    MO: You mean professionally?

    By Blogger angry doc, At November 23, 2005 12:45 pm  

  • Interesting comments.

    I wonder though whether I could say that in a court trying me for negligence.

    For example I'm sure conditions like vaginitis can and should be treated by Family Physicians. But do the FPs examine the perineum? If not then is that acceptable? Or perhaps all such patients go to Gynaecologists? Man Singaporeans must be damn rich.

    By Anonymous Anonymous, At November 23, 2005 12:52 pm  

  • Hey doc, How often do you get a problem "somewhere there"? If I were a female singaporean, this is what I'll do. Look up the symptoms on the net. Go see a female doc. Anyone will do. Get medication. If not ok, see a gyny.Less than 150 bucks including medication. Hell, I am already spending more than that for a facial at the spa. LOL.

    Pardon me, I am in a hilarious mood today man. The market recovered slightly from yesterday.......

    By Blogger uglybaldie, At November 23, 2005 1:16 pm  

  • Well to be frank, I dun get the problem presenting to me commonly. Most patients probably do as you described.

    But when they do present....I always have this problem.

    I wonder if writing in the case notes "patient declined pelvic examination" is acceptable to the courts.

    By Anonymous Anonymous, At November 23, 2005 1:29 pm  

  • Yes, it is. If they do not want it, you can't force it. If you force it, it's prima facie evidence that you had a motive that is other than professional in insisting on a pelvic examination even in the presence of a chaperon.

    By Blogger uglybaldie, At November 23, 2005 1:38 pm  

  • the unequivocal refusal for a pelvic examination should also preferably be witnessed by your clinic assistant.

    By Blogger uglybaldie, At November 23, 2005 1:41 pm  

  • Ah, the good old witness.

    To make it even mroe binding we should have the patient sign a form stating that she unequivocally refuses to have the examination against the doctor's advice. Wouldn't that make it stronger?

    Well I would say it all builds to a very unpleasant consultation if you know what I mean. And this happens quite a bit at A&Es.

    Most patients would say "why should I sign this!" And then it all just degenerates from there.

    Since when did medicine become this non-medically complicated?

    By Anonymous Anonymous, At November 23, 2005 1:52 pm  

  • When God in his infinite wisdom or folly, created Man and Woman.

    Ha Ha Ha.......................

    By Blogger uglybaldie, At November 23, 2005 1:56 pm  

  • Jokes aside, I think the form is superfluous. It just make the encounter more unpleasant than it really is.

    By Blogger uglybaldie, At November 23, 2005 1:58 pm  

  • Haha. Wait till you get the reverse:

    "Doctor, can you please sign here to state that you refuse to treat me?"

    By Blogger angry doc, At November 23, 2005 2:09 pm  

  • It's a breakdown of Parson's law isn't it? :)

    By Anonymous Anonymous, At November 23, 2005 2:13 pm  

  • Any patient who asks a doc to sign a form as suggested by you walked into the wrong clinic. He should be redirected to the Institute of Mental Health!

    LOL. Wah Lau, this discussion is racking me with laughter. Downer is just wondering what the hell is going on.

    By Blogger uglybaldie, At November 23, 2005 2:19 pm  

  • Parson described a sociological model, not a law, unfortunately... :)

    But yes, when the forms come out, the patient-doctor relationship break down.

    I can't imagine either side willing to buckle and sign the form. It's legal suicide, more so for the doctor than the patient.

    In fact, a patient can't be sued for being a 'bad patient'...

    By Blogger angry doc, At November 23, 2005 2:26 pm  

  • I remember asking that question. ;P

    For me, how I choose my family physician is really by chance and like what you mentioned before, it’s a bit of luck.

    Also, if a person work for a decent company, chances are he/she will be covered for medical and the company usually have dedicated panel of doctors. People usually go to those panel doctors bec the medical consultation will be free. I do that too. I usually go to my company’s panel of doctor ( ie, near my office ) if I just have some small ailments like flu or headaches.

    But if I have serious medical problems, I usually go back to my family doctor.

    And seriously, the factors that one will consider in choosing a doctor will probably be based on the following ( not in order of importance ) :

    1)Credential ( ie. Referral from friends, doctors is quite important )
    2)Cost ( even if a doctor is very good but if he charges exorbitantly, chances are I won’t go to him )
    3)Convenience ( ie. Location of his clinic )
    4)Comfort ( ie. Whether you are comfortable with that doctor )
    5)Medical Condition - depending on what kind of medical problems you have. ( ie as mentioned in other post, if it’s a obstetric or urological problems, patients may prefer to see a female GP and not go to her normal male family doc ) .

    By Anonymous Anonymous, At November 23, 2005 2:42 pm  

  • you last comment reminded me of something that happened to me some time back.

    In a certain segment of our society, the patients are very reluctant to see the doctor but are forced to. I used to work in such a system.

    I received a lot of abuse from the patients. Most did not respect me. Some even cursed me with vulgarities. And yet I was told that as a doctor I had to be professional and should not retaliate in any way.

    However when I did report these incidents, the upper management couldn't care less. They always gave the excuse that these patients were sick and thus not in full control of their emotions and asked for my understanding. In truth I suspect they just did not want to have more work that's all.

    It left me to conjure the image of myself the doctor as a small chihuahua tied to a tree beign beaten with sticks by all these vicious boys and all I could do was let out soft yelps and barks. I could not bite back.

    By Anonymous Anonymous, At November 23, 2005 2:43 pm  

  • Wah PTSD.

    But let's be honest: we tied ourselves around the trees to begin with. At least now you are moving to another tree...

    By Blogger angry doc, At November 23, 2005 3:08 pm  

  • Let me say which kind of family doctors i will not go to, based on experience. When you're running a flu and you go into the consultation room, doctors asks you about your condition and after sometimes strays into another topic such as "how did you get your tan?" and then proceeds to say that the choice of sport you do is not v good because nobody watches it(at that time rugby both touch & contact). And i shd instead change to street soccer or volleyball so that more boys will look at me. Yay thank you v much doctor, you've also become a love doctor? And he spends almost 10-15minutes on this conversation, while i am sniffling and miserable, and just anxious to take my medicine and sleep. No thanks i'd rather travel further to see another doctor.

    By Blogger Unknown, At November 23, 2005 3:18 pm  

  • Yes, you can or could if your management cherished its human resources a little more. A little more...............

    A notice in one of our restructured hospitals says that, in essence, they value their staff and if there were any abuse, the police would be called in.

    Being in your own practice, you may have escaped the abuses but you are presented with perhaps constant worries about patient load, paying the rental, utilities and competition with clinics mushrooming all over the place.

    I know a fare number of doctors in Singapore who wondered whether they took up the right profession or not. In my view, in the Singapore context, it is not such a good idea to be just a family physician. If you wish to go into medicine, you have to be a specialist carving out for yourself the distinction of being an authority in your chosen field. That way, there is a sense of accomplishment and the everyday grind is no longer a ticket to a meal or survival.

    By Blogger uglybaldie, At November 23, 2005 3:19 pm  

  • I'm hoping the new tree I have has bigger fiercer dogs tied to it. Eg Alsatians or Dobermans. So less boys will dare come near.

    But I heard at that tree, the boys don't come with sticks. They sneak up at night and slit your throat!

    By Anonymous Anonymous, At November 23, 2005 3:19 pm  

  • Hey blindcat you saw a lovesick medico. He is the one in need of a consultation not you.....

    By Blogger uglybaldie, At November 23, 2005 3:23 pm  

  • uglybaldie,

    what you mentioned about pursuing specialties is precisely what is happening. It is the trend. Few doctors want to take up Family Medicine.

    As such there are various reports of shortages of GP/FPs both in Singapore as well as Australia. In Singapore the shortage is in the polyclinics which is why we see so many foreign doctors working there now.

    With so many specialists, health care cost also goes up. Surely it costs more to see a urologist for a urinary tract infection that a GP.

    I believe there is still a place for good family physicians. It is a matter of having patients give the doctor a chance to get to know them and earn their trust and for the doctor to do his best to earn his patient's trust.

    By Anonymous Anonymous, At November 23, 2005 3:30 pm  

  • Apparently he's also the one that got sued in recent times for harassing some female patient. But the case was settled later. He frames it up in his clinic, alongside his english telephone booths, postbox & street signs.

    By Blogger Unknown, At November 24, 2005 7:12 pm  

  • Was the clinic the one involved in some en bloc sale? :)

    By Blogger angry doc, At November 24, 2005 7:22 pm  

  • I choose the doctor that

    i) Gives me the type of medications I request for!

    ii) But who is also competent!

    By Anonymous Anonymous, At November 24, 2005 8:49 pm  

  • Dear Anon,

    as long as you are competent enough to know the right medicine to request for, then your doctor should be competent no?

    If your doctor says you should not get the medicine you ask for because he is trying to be competent, then it would violate your rule number 1 anyway.

    You don't need a doctor anymore. You just need to become a pharmacist.

    By Anonymous Anonymous, At November 24, 2005 11:33 pm  

  • doubt so though. some spectacle wearing doctor who practices in the west side of singapore

    By Blogger Unknown, At November 25, 2005 1:02 am  

  • "some spectacle wearing doctor who practices in the west side of singapore"

    That probably describes 25% of all doctors in Singapore!

    By Blogger angry doc, At November 25, 2005 8:19 am  

  • Dr Oz Bloke,

    The highly sought after document ie mc is only available from the doctor

    By Anonymous Anonymous, At November 25, 2005 11:02 pm  

  • Hmm MC?

    Well I must say if I were the boss of a company, I'd tell my workers forget about the MC.

    You've got a certain number of days you can call in sick, you don't need to show me an MC. But beyond those number of days, it's going to be cut from your salary.

    As doctors I'll tell you there is no hard and fast rule whether to give MC or not. Who best knows if you can or cannot work? The doctor or the patient?

    Any compassionate doctor would give 1 days MC rest to a patient who requests it. If he does not , he is called an incompassionate doctor. And which doctor wants to be called that?

    As for companies, that's where the problem comes about. Are companies compassionate to their workers? Not in Singapore as far as I know.

    By Anonymous Anonymous, At November 26, 2005 9:56 am  

  • The problem with socialists, Oz Bloke, is that they have an idealised view of 'the worker'.

    How many workers will not claim their 'full entitlement' of 14 days sick leave? As it is there are patients who come to see you at the end of the year just to consume the balance before the year runs out.

    By Blogger angry doc, At November 26, 2005 10:15 am  

  • Precisely.

    Hence it is no longer a medical problem, but a social problem.

    As a doctor my goal was to comfort, relieve suffering and always be compassionate.

    In the customers eyes, they want satisfaction.

    Hence I see no reason why doctors need to be the "gatekeepers" of medical outpatient leave. This is an extremely outdated practice.

    For those doctors who feel that abolishin this rule would lead to a loss of income, I wonder if somewhere along the line we have forgotten what medicine is about.

    By Anonymous Anonymous, At November 26, 2005 10:23 am  

  • That is very true. When I was working in a polyclinic years ago, I used to get many patients from the surrounding factory. Many came just for the MC because if they don't make use of the full 14-day allowance, they feel they 'lugi'.

    I called up the factories and advised them to give an annual bonus equivalent to 14 days' pay if the worker does not take any MC and cut it down accordingly based on the number of days they were absent. The patient load from those factories that took my advice dropped considerably.

    By Anonymous Anonymous, At November 27, 2005 5:09 pm  

  • pathdoc, you made a difference!


    By Blogger angry doc, At November 27, 2005 5:34 pm  

  • Haha

    I asked the SAF to form a sick fund incentive of $50 a month which the soldiers could keep if they did not spend it.

    Each consult would cost $10 which meant average of 10 report sick sessions a month! If the soldier saw the MO in excess of 10 a month, there would be no excess charge above the $50 but he would be monitored closely to see what was wrong.

    Good incentive for soldiers to keep healthy and not see the doctor and also allow the SAF to keep track of the true "regular" report sick people at a administrative HQ non-biased level.

    SAF's response. We don't have th budget. Yeah right and they go buying all these Apache helicopters....

    By Anonymous Anonymous, At November 28, 2005 9:07 am  

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