W.W.H.D.

Here’s one they will never ask during the Final M.B.B.S. MCQ paper.


"You are a colorectal surgeon in a restructured hospital.

Two weeks ago an old man was admitted to your team for bowel obstruction.

He was initially seen by his GP, who correctly judged that the case was urgent and the patient had to be seen at the A&E. He referred the patient to a Government Polyclinic, in the mistaken belief that if the patient was referred by a GP he would not be entitled to government subsidy. The patient was seen at the polyclinic and given a referral to the A&E, where the doctor decided to admit the patient.

At the Admission Service, the patient’s family decided to opt for B1 Class for the patient, hoping to let the patient have better service during his stay, not realising that all subsequent follow-up will be at non-subsidised rates.

The patient underwent surgery that same night. The diagnosis was an obstructive cancer. The patient will need follow-up at your clinic (as a paying-class patient) and also expensive chemotherapy. The full cost of his treatment now becomes clear. The family hope that you can help them reduce the medical costs by downgrading them to subsidised-class."

What should you do?

A. Nothing
Continue seeing the patient as a paying-class patient – you're a doctor, not an accountant. Besides, they should have known better when they chose a paying class for the patient.

B. The correct thing
Refer them to the hospital Medical Social Worker for Means Testing since you can't make a decision on the downgrading. The MSW will then assess the family's income and make a recommendation, a process which may take weeks, during which the patient will undergo further investigations and treatment at non-subsidised rates.

C. Exploit the loophole in the system
Discharge the patient from your clinic and ask them to go back to the polyclinic for a referral to the subsidised clinic on the day that you will be there so you can continue to see the patient. There may be some time lag between due to the long waiting list, but at least the family will save some money. Well, a lot of money.

D. Abuse the system
Discharge the patient from your clinic and make the patient to go to the A&E faking severe abdominal pain, so that he will be admitted to the ward (this time as a subsidised patient) where he can have his treatment continued.


What would Hippocrates do? What would you do?