Angry Doctor

Tuesday, December 13, 2005

Now repeat after me...

... there's no such thing as a free lunch.


Surprise request makes senior citizens' blood boil
FREE checkup, but there's a BLOOD 'FEE'?
By Maureen Koh
December 13, 2005


THEY had fasted for 10 hours - no food, only water - to prepare for a health-screening the following morning.

Three of them, all aged above 55, woke up as early as 7.30am to make their way from their Bedok homes to the community club at Joo Chiat where the screening would start at 9am.

All for what the publicity banners had promised: Free health-screening.

It was to be a public service to senior citizens above 55 years old.

But to their surprise, they claimed they soon learnt that this 'free' service came with a condition:
Some elderly participants said they were told they had to sign a consent form to agree to take part in a study.

For this, they each had to give 20ml of their blood, of which 5ml would be for the health-screening and 10ml to be used for research purposes.

The remaining 5ml would be stored up to five years for future related studies.

'TURNED AWAY'

It might not have been much, but it was enough to turn some people away.

One of them was Madam J Wan, 63.

The housewife, a diabetic and former stroke patient, said in English: 'I explained that even I had difficulty drawing blood for my own home-tests, and that I was not prepared to donate my blood.'

She claimed she was then told by one of the nurses who had attended to her: No signature on the approval form, no free health-screening.

Said Madam Wan: 'How can they say this? In the first place, it was not stated anywhere (on the banner) nor was it properly told to us that there were conditions attached.'

The Department of Psychological Medicine of the National University of Singapore, which is conducting the research, however, said it was a miscommunication.

But another participant, who wanted to be known only as Mr Tang, 59, agreed with Madam Wan.

NOT CLEAR

He said in Mandarin: 'I think they should make it very clear. I mean, it is quite ridiculous to expect us to fast, make our way there and then be turned away because we do not agree to them taking 'extra' blood.'

Those who refused were allegedly given back their identity cards and told that they could go home.

Mr Tang signed the form. He said: 'What do you expect me to do? Go home? I don't have a job, so if I can save some money, why not?

'People will probably call us 'cheapskates', but when you are poor, every cent saved means something.

Anyway, you can see it this way - I did not get it for free. I paid for it with my blood,' he said.

For cleaner Leong A J, 65, it was more a matter of principle.

She said in Mandarin: 'To me, they are not different from sales people who claim they are giving away free things, then later tell you that you have to spend a certain sum of money first.'

The episode did not end there for her.

According to her, someone called her later in the day and wanted to find out why she had not agreed and if she minded going back again.

Said an annoyed Madam Leong: 'After I had wasted four hours of my time, I still had to put up with this.

'It was not even because they just wanted feedback - but they were more concerned that they had lost a potential 'donor'!'

Mrs Lim, 64, a nanny, also claimed she received such a call.

Some of the elderly citizens also alleged that none of the personnel there could tell them what the research was for.

Delivery man Ishak, 58, said in a mix of Malay and English: 'I asked the woman what's the name of the research, and she was unable to answer. She just muttered, 'Some research, lah.'

'That is really so strange. How do you expect us to trust them if the answers were not forthcoming?' he said.

Madam Wan said that the way she was 'dismissed' was a case of adding insult to injury.

She alleged: 'One of the women who returned my identity card commented, 'Anyway, you are not from Joo Chiat!' '

HUMILIATION

According to the Patient Information Sheet and Informed Consent Form that the participants received, residents living in all areas covered by the South East Community Development Council (which comprises Geylang Eunos, Aljunied, MacPherson, Bedok and Marine Parade) are eligible.

Madam Wan said: 'We may have gone for something free, but that does not mean that we should be treated this way.'

Madam Winnie Foo, 56, a school administrative assistant, said the publicity materials should have clearly stated the conditions.

She said: 'When they do that, we can make our own decisions.

'To the healthy, an extra 5ml of blood may mean nothing, but some elderly folk may have reservations.

'I guess, as the saying goes: There's no free lunch.'

Misunderstanding, says don

IT was impossible to list all the details of the free health-screening on banners displayed in the neighbourhood.

So said Associate Professor Ng Tze Pin, director of the Gerontology Research Programme, from the Department of Psychological Medicine at NUS.

'There was no way anyone can put all that information on the banners,' he told The New Paper.

'It was just a case of miscommunication.'

The health-screening was part of the Singapore Longitudinal Aging Study, a medical research aimed at increasing the understanding of ageing and health among elderly Singaporeans.

POPULAR

Prof Ng confirmed that 20ml of blood was to be taken from all participants, of which 15ml would be used initially for the health-screening and the study.

Another 5ml would be kept for future related research.

But Prof Ng insisted that it was not his team's intention to turn away people even if they declined to donate blood.

He said: 'These allegations are not true.

'Our programme is very popular with many people and we have many subjects who sign up.

'Of course, there are those who would refuse and they cite health reasons like they are anaemic, have low blood pressure or that they may feel faint.

'We will still accept them.

'There may be unique cases where the subjects decide against participating altogether.'

Figures given to The New Paper showed that since the programme started in September 2003, there have been 2,728 participants.

Of these, 17 were enrolled into the programme even though they declined to donate their blood.

TROUBLESOME

At the Joo Chiat Community Club, where the team has been operating since 19 Sep this year, 585 participants have signed up for the study.

Prof Ng stressed that staff members have been reminded to explain the details fully.

'They have been told to handle the subjects carefully and patiently.

'We always tell our staff that these are old people.

'They are not educated and can be troublesome, which is expected because of their age.'

However, he added: 'While we do our best to explain the details, can they understand them fully?

'Even if you tried to do so, can you guarantee that they can understand you? We can only do our best.'


Well, not enough information for me to tell who's wrong or right, but certainly proves once again that there is no such thing as a free lunch... or 'free' health screening.

Labels:

35 Comments:

  • One thing this shows is that Singaporeans have very little knowledge about blood or in particular how much blood they have and how much 20mls is in relation to what they have.

    I have encountered this many times when taking blood samples.

    Singaporeans are always so stingy with their blood and will complain and complain about how much blood I am taking and how they will die etc. When you try to explain to them they won't believe you and then they will ask "wah my blood so dark colour means no good is it?" Another nonsensical question and misconception.

    Sigh. Educated Singaporeans are hard to come by.

    Little wonder why most of our blood donors are forced NSF and NSmen!

    By Anonymous Dr Oz bloke, At December 13, 2005 1:56 pm  

  • Lay people like us don't get to see blood smaple every hour, mah... So, of course very curious about the color of own blood under different lighting... sometimes look Dark Red like concentrated red wine, sometimes look like got tinge of purple color ???

    Those senior citizens sometimes can be v intimidating when they not happy... especially those chinese speaking ones... Damn Fierce.

    By Anonymous Anonymous, At December 13, 2005 2:20 pm  

  • I do hope there will be a follow-up on this issue, because as it stands the reporter has done a very good job of making Prog Ng look bad.

    If you look at the last section, it is almost tantamount to an admission that the department was aware that it was collecting blood samples for study with the knowledge that the consent given may not be 'informed consent'.

    By Blogger angry doc, At December 13, 2005 2:47 pm  

  • In my opinion, this incident does not favour the image of the medical profession anymore than a shifty second hand car dealer selling me a dud.

    Shame on beguiling defenceless and ignorant senior citizens.

    I don't even need a doctor to order a blood test. I just walk into one of those analytical labs all over the island, get a blood test and analyse the results with the help of Dr. Google.

    By Blogger uglybaldie, At December 13, 2005 3:53 pm  

  • Uglybaldie, welcome back!

    Well put it this way. At least this time they bothered to tell the people that they were going to use some of the blood for a study.

    They could easily have said 20ml is what you need to do the tests and probably have gotten away with it. Or maybe not? I guess some people must have complained why must take so much blood?

    Yes it is true that you can do your own blood test at the lab and then get the results and consult dr google. That's fair. If Dr Google and you make a mistake, it's fair game.

    If you need treatment, heck consult Dr Google and buy the treatment over the internet. If you need surgery, consult Dr Google and get your son to do the operation!

    By Blogger Dr Oz bloke, At December 13, 2005 4:21 pm  

  • "defenceless and ignorant senior citizens"

    Haha. uglybaldie you make them sound like unwilling victims rather than people who want something for nothing.

    Sure, they too can walk into a private lab and spill 20mls of blood, but then they didn't.

    By Blogger angry doc, At December 13, 2005 4:44 pm  

  • Uglybaldie wrote :"In my opinion, this incident does not favour the image of the medical profession anymore than a shifty second hand car dealer selling me a dud."

    The only difference is that you would have been going to the second hand car dealer hoping to get a car for FREE!

    I guess you get what you pay for isn't it?

    Agree with angry doc's comments.

    By Blogger Dr Oz bloke, At December 13, 2005 4:50 pm  

  • hiya Dr. OZ,

    My favourite doc, down to earth and as always friendly but sensitively arguementative.

    Thought I'll kill time with some hogwash to this esteemed blog whilst waiting for my trade to be executed.

    You know, most times, the blood test results come back negative and within range so no need to do anything except maybe take some broad spectrum antibiotics and paracetamol. Any unusual results of course got to go and consult the medical man who incidentally nowadays scratches his head very often and say, "We really don't understand and know why........"

    As for the surgery part, rest assured that if I really do need the services of such butchers, it will be the grade of assoc. professor and above. Because only these buggers can afford to pay the hefty damages over and above what the MPA is willing to settle for.

    By Blogger uglybaldie, At December 13, 2005 4:51 pm  

  • Uglybaldie wrote :" You know, most times, the blood test results come back negative and within range so no need to do anything except maybe take some broad spectrum antibiotics and paracetamol."

    What kind of blood tests are you doing? And for what kind of condition? Man, if it can be settled with just antibiotics and paracetamol why need to do blood tests!

    If you were my doctor I would have no qualms about declaring you trying to earn money from me by doing unnecessary tests!

    You're wasting your money lah. Oh but I forgot, you patronize private hospitals and to afford it just "simply" outperform the STI.

    Ole!

    By Blogger Dr Oz bloke, At December 13, 2005 4:56 pm  

  • Yeah man, that's my talent.

    In fact, my wife's latest Louis Vuitton bag was paid for by some newbie who followed the herd and got burnt.

    And doc, your reasoning power is slipping away. I said if the test for certain maladies are negative then most likely to be the flu with secondary infection and not something insidious.

    By Blogger uglybaldie, At December 13, 2005 5:05 pm  

  • Doc Angry,

    You cannot blame the senior citizens because our good government organises, through the aegis of various bodies frequent health screening exercises that are free and with no strings attached. So how can they be blamed for being asked suddenly to give away most of their blood. You must also understand their pysche. Most think that since they are old and feeble, they need all of their blood otherwise if they become anaemic, who is going to take care of them? Yeah sounds funny to you fellows but hear this from one of them.

    As for just walking in, your typical grandpa and grandma doen't even where these labs are located let alone having the wherewithal in terms of knowledge and expense to get themselves tested.

    By Blogger uglybaldie, At December 13, 2005 5:30 pm  

  • I don't 'blame' them, but I think it helps to give them a reality check.

    I think you under-estimate the knowledge and resources of these senior citizens...

    "The housewife, a diabetic and former stroke patient, said in English: 'I explained that even I had difficulty drawing blood for my own home-tests, and that I was not prepared to donate my blood.'"

    She is a known diabetic, has a home test kit, and as a former stroke patient would probably have had her cholesterol checked too. Yet she still chose to go for a 'free' screening test.

    Does she need to be screened for diabetes? She already knows she is diabetic! So why did she go?

    It is as well this wasn't really a charitable event, since if she did go for one organised by a charitable organisation, she would in effect WASTE money donated for charity.


    "I don't have a job, so if I can save some money, why not?"

    He obviously knows he can get tested by paying (be it a lab or a GP), but decided to take the 'free' test instead.


    It's hard to find fault with what the 'victims' have said on face value, but I suspect less reasonable words which were uttered were not quoted.

    By contrast Prof Ng's statements seem to be tailored for a public relations suicide.

    Like I said I would be very interested to see how this plays out.

    By Blogger angry doc, At December 13, 2005 5:54 pm  

  • Uglybaldie wrote : "I said if the test for certain maladies are negative then most likely to be the flu with secondary infection and not something insidious. "

    Well then you are a terribly lousy doctor. Why do you need tests to come to that diagnosis?

    You fail lah!

    By Blogger Dr Oz bloke, At December 13, 2005 6:22 pm  

  • Uglybaldie wrote : "In fact, my wife's latest Louis Vuitton bag was paid for by some newbie who followed the herd and got burnt."

    Amazing isn't it? Here people are arguing about justice when paying a few dollars for a blood test or giving a few mls of blood.

    And there everyday, stockbrokers like you rob people of their money enough to buy Louis Vuitton bags.

    Absolutely criminal!

    By Blogger Dr Oz bloke, At December 13, 2005 6:26 pm  

  • Well, doc, that's the way the world works.

    I didn't design the world system. I just ride along intelligently.

    Like you said, you should have learnt to dissect financial statements instead of insects, frogs and the like.

    But then, no use talking "with the benefit of hindsight" In fact, you won't make a good money man or for that matter a stockbroker because you are very risk aversed. No pain no gain. The government is very concerned about singapore citizens going into the casinos coming up. That's why there is a levy on citizen patrons. Hell, you wouldn't go in even with Lucifer masquerading as an angel holding your hand.

    We are actually "debating" on the principle of the whole thing not the few dollars and cents that grandpop and grandmom has to dig into their pockerts to pay for the tests. In actuality we are "debating" on the ethical obligation to tell these old folks what they need to do to get the free health screens. And not indulge in skulduggery to "entice" them into giving what they have qualms, justified or not, to give. Don't forget these are old and weak senior citizens whose pennies saved may be the difference between a good meal and a pack of maggie mee.

    LMAO

    By Blogger uglybaldie, At December 13, 2005 6:47 pm  

  • Personally, why doesn't the government give these tests free to the public anyway?

    I mean we pay taxes don't we?

    Maybe Singapore's system is just that it is like that; the rich and powerful prey and feed off the poor and weak.

    Survival of the fittest. Nothing to do with risk.

    By Anonymous Dr Oz bloke, At December 13, 2005 6:52 pm  

  • "We are actually "debating" on the principle of the whole thing not the few dollars and cents that grandpop and grandmom has to dig into their pockerts to pay for the tests."

    I don't think we have even agreeed on what we are debating on. :)

    "Don't forget these are old and weak senior citizens whose pennies saved may be the difference between a good meal and a pack of maggie mee."

    You exaggerate. Almost all those quoted work, are aged below 66, and at least one owned a home test kit. They are not frail old people living on the poverty line. If you look at the slant the reporter was writing from, do you think she would not have picked older, poorer people to quote if she was able to?

    Regardless of their age and financial status, however, you point stands. Had this been a study on healthy, young, rich adults, the underlying issue does not change. But then again, you were the one making an issue out of the 'ignorant', 'defenceless' victims.

    'Professionally' the question is about full disclosure and informed consent. The 'human interest' just confuses the issue.

    By Blogger angry doc, At December 13, 2005 7:23 pm  

  • "Personally, why doesn't the government give these tests free to the public anyway?"

    Frankly, Oz Bloke, I did not expect that to come from you. You are not being ironic again, are you? :)

    "I mean we pay taxes don't we?"

    Depends on whom you mean by 'we'. 60% of Singaporeans do not pay Income Tax.

    "Maybe Singapore's system is just that it is like that; the rich and powerful prey and feed off the poor and weak."

    The truly rich and powerful prey and feed off the slightly less rich and less powerful. :)

    By Blogger angry doc, At December 13, 2005 7:29 pm  

  • At the end of the day, I think Prof Ng had good intentions.

    I mean it was meant to be a win-win situation. The department does screening tests for people and funds it with the research grants, while the participants give a sample of their blood for the study.

    I am pretty sure that if they had explained clearly on their banners and flyers, things would have not taken such a turn. For example they could have emphasized that they were doing a study and were calling for participants to give 15mls of blood. The participants would then be given a free screening test for their help. This would have eliminated any controversy. AND I bet they would still have many people coming to give that 15mls and take the free screening test.

    I recall you writing an entry about free screening tests from NKF etc and that there was always some reason why they gave "free" tests. This is a good example.

    Like I said, I think Prof Ng had good intentions. I really doubt he was out to hoodwink people.

    By Blogger Dr Oz bloke, At December 13, 2005 7:35 pm  

  • Dear angrydoc,

    Well I guess I was just trying to make a point. If anything is "free" it should be from the govt.

    I mean in this current period of time even the charities are having a tough time "convincing" people of their altruistic intentions.

    There are a lot of "poor" people as well who want free stuff.

    In the end someone has to pay for the tests right?

    Hmmm maybe we should ask them to come to my clinic. We give a lot of free consults, medicines and tests to many patients actually. And really no strings attached!

    By Blogger Dr Oz bloke, At December 13, 2005 7:39 pm  

  • I think I was actually taught by Prof Ng before... but in any case, I will not speculate on his intentions. Afterall, the 'good' in 'good intentions' is subjective too...

    Agree with you though that a 'Enrol in Scientific Study and get a Free Health Screening' approach would have been better than the 'Free Health Screening*' (* - small print) one.

    In fact, more people might have taken up the offer then since they would appear to be 'contributing to medical science' rather than 'cheapskate'. :)

    By Blogger angry doc, At December 13, 2005 7:45 pm  

  • "Well I guess I was just trying to make a point. If anything is "free" it should be from the govt."

    My question (or rather doubt) was: do you believe that universal screening of asymptomatic individuals is a cost-effective way to reduce healthcare burden in Singapore?

    By Blogger angry doc, At December 13, 2005 7:48 pm  

  • "My question (or rather doubt) was: do you believe that universal screening of asymptomatic individuals is a cost-effective way to reduce healthcare burden in Singapore?"

    Ah! Good question.

    If you ask me, I think more should be spent on educating the public on healthy lifestyles, diets and activites. That should be far more cost effective than screening. I personally think that the tests that conventional centres screen for are quite pointless. (We have discussed this before remember?)

    But at the moment it appears that in Singapore the general opinion of the man on the street is that screening DOES help them. I suppose the HPB might have created that situation by what they have done and what they have NOT done.

    By Blogger Dr Oz bloke, At December 13, 2005 8:06 pm  

  • The reporter probabaly successfully gave the nuh psychomed dpt a bad name... and i think now there's also going to be a barrage of comments about informed consent... But then, the prof himself is evidently not the best spokesperson for the department. haiz... Oh dear, he's done it again...

    And these few sentences he's said:
    'They are not educated and can be troublesome, which is expected because of their age.'
    --> this almost sounds like going against what the gov has been trying to promote - the elderly as a treasure at home... and when one says something like this to the nurses/volunteers at the health screening, do you expect them to treat the elderly with proper respect? and take the time to explain to them what the research is all about?

    However, he added: 'While we do our best to explain the details, can they understand them fully?

    'Even if you tried to do so, can you guarantee that they can understand you? We can only do our best.'
    --> Even if the patient/elderly were not able to understand you, it does not exempt you from getting informed consent.

    I'd rather he'd just stuck to his story of a miscommunication and sincerely apologised for any misunderstandings, AND emphasise that any refusal to take part in the study does not mean that the elderly cannot get their tests done. (if this were indeed true of course...)

    By Anonymous dopey, At December 13, 2005 9:00 pm  

  • Yes. If you omit the last section ('TROUBLESOME') the article becomes almost balanced! :)

    Seriously! Read it once again without and last section and see the difference for yourself.

    By Blogger angry doc, At December 13, 2005 9:27 pm  

  • I totally agree that the TROUBLESOME section with Prof Ng's politically incorrect comments really screwed things up for him.

    But that's journalism in Singapore.

    You see in Singapore if you read the local news, you will find that the only scandals or slams that the papers can do are towards doctors or government approved scapegoats eg TT Durai, NKF.

    The point is that the only professional that the journalists do not need any approval to slam are doctors. All else you need some for of approval and to be careful.

    Doctors will never bite back. They can only bark softly.

    By Anonymous Dr Oz bloke, At December 13, 2005 9:32 pm  

  • yah... very unfortunate...

    would sound better w/o 'troublesome'

    note to self: when doing such studies in the future, always plan what you're going to say to the media first.

    By Anonymous dopey, At December 14, 2005 1:23 pm  

  • I also feel that there was probably some miscommunication. The organisers would probably have sought their IRB's approval etc...especially after that UK's guy scandel...

    By Anonymous Anonymous, At December 14, 2005 8:24 pm  

  • This reporter is good.

    If you read the article again you will find that she does not directly allege any wrong-doing on the part of NUS.

    Everything is 'claimed', 'allegedly', or 'according to'.

    If all the allegations turn out to be unfounded, TNP can easily absolve itself?

    And I am guessing Prof Ng told the reporter much more than what he was quoted in the article.

    By Blogger angry doc, At December 14, 2005 8:38 pm  

  • It is unethical to conduct research by offering undue influence such as rewards or remuneration. People must be given free screening regardless of their consent to participate in the study.

    This is totally unethical and I do not know how this can get through the ethics committee...

    By Anonymous Anonymous, At December 15, 2005 1:42 am  

  • Maybe it was meant to be free screening and then voluntary opt in for the study, hence the ethics committee approved it?

    But then on the ground, the staff were instructed to "encourage" the participants to take part in the study as well and this made people unhappy.

    Perhaps nobody really officially said that if you dun take part in the study you won't get screening? Maybe it was a slip of the tongue by some staff members and then the debacle started?

    Anyway like I said, wacking doctors is the safest lah. NO doctor has ever sued anybody as far as I can remember.

    By Blogger Dr Oz bloke, At December 15, 2005 10:26 am  

  • Oh well, Prof Ng's currently my tutor now and he's a nice chap. But I think doctors should avoid talking to the press unless they have a speech VERY carefully planned out.
    The article makes him sound like a young turk when he probably already/almost fits the age range for the health screening.

    By Anonymous Anonymous, At December 24, 2005 3:39 pm  

  • Anon, do remember this lesson when you start practising.

    To my mind, the media just wants a story, regardless of what consequence that might have on you after it is published, and they never have the same agenda as you.

    By Blogger angry doc, At December 24, 2005 4:50 pm  

  • No wonder Prof's been kind of grumpy recently.

    Actually, I thought the IRB would have required them to submit the recruitment posters, forms etc.

    By Anonymous Anonymous, At December 25, 2005 1:40 pm  

  • Should have referred TNP to prof Kua, then maybe they dare not slam.

    By Anonymous Anonymous, At December 26, 2005 3:54 pm  

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