Angry Doctor

Tuesday, February 21, 2006

The Reply

A bit of an anti-climax after the long wait, but here's the reply to the letters we looked at last week:

Team at outpatient clinic led by specialist

WE REFER to the letters 'Are subsidised patients treated by specialists?' by Mr Henry Lim (ST, Feb 11) and 'Doctor-patient link key to good health care' by Dr T. Thirumoorthy (ST, Feb 14).

We assure the writers that our priority is to provide appropriate and quality healthcare for all Singaporeans regardless of financial status. In fact, subsidised patients form the majority of our patients.

When a patient visits the polyclinics, the doctor will decide on the most effective course of treatment. When necessary, the patient will also be referred to a specialist in a hospital or national specialty centre.

Patients who are referred from polyclinics receive treatment at subsidised rates at specialist outpatient clinics regardless of which doctor they see.

Each patient at the specialist clinic comes under the care of a team of doctors led by a specialist. The attending doctor, whether a medical officer, registrar or consultant, would be an integral part of this team.

When a medical officer attends to a case, he does so under the specialist's supervision. As public healthcare institutions, we are a vital training ground for young doctors, who provide care to patients as part of a team of doctors.

Non-subsidised patients see the doctor of their choice and may be attended to in a different area, like the class of wards for inpatients. This arrangement has no bearing on the level of clinical care provided and all patients are assured optimal and appropriate care.

We have spoken to Mr Lim and have clarified that he has been receiving treatment at subsidised rates, regardless of which doctor he sees.

He raised the issue of access to specialists care at hospital specialist clinics for patients with chronic medical conditions. It is more important and effective that such patients get appropriate care in the appropriate setting.

Such patients are best treated and monitored at the primary care setting where possible, as this saves them time and the cost of specialist care that may not be required.

We have implemented various programmes where our specialists work closely with general practitioners and family doctors at polyclinics and in private practice. Together, they manage patients with chronic medical conditions such as asthma, diabetes and high blood pressure.

Some of these programmes are already showing results with patients reporting improvements in their conditions.

We thank both writers for their feedback and the opportunity to clarify these matters.

Dr Fidah Alsagoff
Corporate Development SingHealth

I must say it's a very well-crafter letter. It states the official stand how things are supposed to work (in theory - I leave the conclusion to if that's how it works in practice to each reader's own experience), shows that the original letter-writer was in error (about the fees in this case), refers to 'results' in an unrelated area without quoting figures, and finally thanks both writers for their 'feedback' (thus assuming a moral high ground), and avoids addressing the basic question poased by both writers: does the current arrangement ensure that patients referred to specialist clinics get true specialist care?

This guy is good.



  • Dr Fidah Alsagoff

    He is well trained for the role. "DR Fidah Alsagoff has been directing plays and acting in them for 15 years."

    I seem to see that very often the replies would always move to misdirect the public into thinking about the GPs.

    In reality, the govt and ther hospitals don't really work CLOSELY with GPs at all.

    At the moment we still have to refer our patients to the polyclinic to refer them to the hospitals for subsidized specialist consults. Talk about working closely. Yeah like real.

    By Blogger Dr Oz bloke, At February 21, 2006 5:49 pm  

  • This letter made me see red. I am currently a subsidized patient and I end up seeing a different MO each time.I'll like to see what percentage of subsidised patients actually get to see a specialist...

    I would write a scorching letter to the press only I'm a nobody and going for an op at a government restructured hospital soon.

    How would a complaint letter impact my care I wonder?

    Any advice on how to survive an op at a government hospital?

    By Anonymous Anonymous, At February 21, 2006 8:50 pm  

  • This doctor is really good at wayang. I think we can expect to see him in an election soon all dressed in white...

    By Anonymous Anonymous, At February 21, 2006 9:07 pm  

  • Angry Patient,

    My only advice is that you should speak with the doctor in-charge of you and let him know your concerns.

    You should be able to trust the people operating on you; if you cannot, then think again about going for the operation.

    By Blogger angry doc, At February 21, 2006 9:33 pm  

  • As a subsidised patient, I don't have a doctor-in-charge. I find myself repeating my medical history to a different MO each time.

    In fact, since I have started going for treatment the MOs who have seen me previously have left! This is the kind of treatment subsidized patients get...

    I wonder what kind of private communication Mr Lim received from Singhealth?

    Better to die than to be sick in Singapore!

    Argghhh...should not get so worked up, raise my blood pressure for things I am powerless to change as a destitute nobody...

    By Anonymous Anonymous, At February 21, 2006 9:42 pm  

  • everyone wants to be treated by a specialist, by a senior consultant, by a venerable old professor of medicine/surgery.

    but where did these senior staff come from? hatch from an egg in a nest in the middle of some volcanic crater?

    some cases, some health problems, are very adequately handled by medical officers - and most are competent enough and (should) ahve the common sense to consult their seniors if and when they're out of their depth.

    and at the end of it all, if they think they know what they're doing and you doubt them then (and tough as this may sound), go get a second opinion from a specialist of your choice. it's the best thing for you.

    just be prepared to pay.

    we have to pay for food, for lodging. why does everyone think that healthcare should be free? or cheap?

    would YOU do your job for less, or for nothing?

    of course not.

    By Anonymous Anonymous, At February 21, 2006 10:17 pm  

  • Mediocrity, while I accept that people like myself who are too poor to pay full rates must occasionally act as human guinea pigs,my question is whether the disparity is too great. Also, whether the care provided for subsidised patients is of adequate quality.

    If it is your own mother who is old and sick, would you want her to be in this position? Please bear in mind that not all elderly people have "good sons-in-laws" as advised.

    Most laypersons do not work in jobs where wrong decisions or errors can result in death or permanent disability so the comparison is spurious. Since I am poor, I can live on veggies but can I do surgery on myself with a kitchen knife?! It is your "company" who controls your pay, not consumers.

    Should access to something as essential as adequate healthcare be dictated solely by money? Who will speak for the old, the illiterate and the poor? I suppose they should die quietly and not cause any disturbance.

    I can only hope that you will not be an arrogant, uncaring doctor and do your best for all your patients regardless of your own personal interest or their social positions.

    Merde! I shall not comment anymore on this issue as it is not good for my blood pressure.Au revoir pour toujours to this issue!

    By Anonymous Anonymous, At February 21, 2006 11:49 pm  

  • In Singapore, basic healthcare is affordable.
    The only problem is the definition of basic healthcare.

    Why healthcare should not be free for all can be seen in the attitude of NSF who go for MRI, knee surgery, tonsil removeable like they deserve it.

    MO are well trained and has supervision from his supervisor.

    Solution to this problem

    1. Mean testing to allow only those who deserve subsidy to see specialist in soc

    Problem: political reasons.

    2. Increase no of specialists:

    Problem: low pay for specialists, high medical costs as specialists can indude demand

    3. Have more GPs act as gamekeeper

    Problem: no incentive for gatekeeper.
    Try telling yr customer that they need no medicine or referral.
    U get threats like "What if u miss something? Are u a specialist? Have u rule out the 100 th cause of headache?" "Are u going to take responsibility if something goes wrong?"

    4 Guidelines in management
    Already in place but not for all conditions especially rare ones

    Problem: make doctoring rather like following cookbook recipe.

    By Anonymous Anonymous, At February 22, 2006 12:12 am  

  • Another option....

    Public hospitals to be all of a single same class. That is say B1 across the board.

    Govt provides the SAME service to all patients at all public hospitals. NO such thing and paying class or subsidized class etc.

    If patients want to go private, they go to Mt E, Gleneagles, Camden etc.

    I don't understand why the govt wants to compete with the private sector for private patients. Simply tax the private health sector and use those funds for the public sector.

    That way there will be NO complaints of enequal treatment at the govt hospitals. All patients will be managed by a team of MOs, registrars and consultants, nobody gets to choose which dr they want etc. Equality and fairness, but with no choice at the public level.

    At the moment the poor always say that they are marginalised because we have this CLASS system. Once you do away with segregation at the public hospital level, there will be much less of these accusations.

    As it is I agree that the current team system is adequate (although not perfect). I have worked in the system and 99% of cases are well managed in this system.

    It is the PERCEPTION from the poor that is the problem. They see the nice cushioned sofas at the paying class clinic and they look at the hard plastic seats at the subsidized clinic and their minds start to think.

    They look at the beautifully furbished paying class wards where nurses greet you with a smile and see the stark crowded C class wards where nurses are eternally grumpy and their minds start to think.

    This is the real problem. I say govt please provide a reasonable health care service equal and acceptable for all. Leave the money making to the REAL private sector.

    It makes no sense to build govt hotels that cater to backpackers and royals in the hope of competing with the ShangRi-Las.

    By Blogger Dr Oz bloke, At February 22, 2006 7:48 am  

  • To Angry Patient,

    "Any advice on how to survive an op at a government hospital?

    Just a small tale to tell you what to expect. A friend of mine, a poor nobody like you had to have an endoscopy done at a famous restructured hospital. He was wheeled to a big abatoir like room full of medical students and as he was not under general anaesthesia, he noticed that these students were fooling around and merrymaking. The greenhorn who attended to him with a big hose like contraption tried unsuccessfully to insert it into his mouth and only succeeded on the fifth attempt! As he recounted it, it was the most miserable time of his life. Like me now, he won't want to go to a government hospital for any operation.

    "Merde! I shall not comment anymore on this issue as it is not good for my blood pressure.Au revoir pour toujours to this issue!"

    Please continue to post your comments. Your views are like a breath of fresh air in this foggy blog.

    By Blogger uglybaldie, At February 22, 2006 10:03 am  

  • There is one way to survive an op at a government hospital.

    Find those very nice older GPs who are very good friends with the consultants at the hospitals.

    When you need op. The GP will refer you. At the same time after finding out your appointment, he can call his good friend the consultant and mention your case to him, if you are close the the GP, the GP would request his friend to take good care of you if possible. Sometimes the consultant would take over your case as a matter of goodwill to the GP his good friend.

    So you are well looked after because if not the consultant got to answer to his good friend the GP.

    So the trick is connections. Who knows you is important. Because you never know who they know. The medical community is not very big and every cohort will have their spread of consultants in each field. Those GPs that were generally nice guys and well liked usually have good relationships with the consultants of their cohort.

    By Blogger Dr Oz bloke, At February 22, 2006 11:41 am  

  • Dr. Oz, for patients who are really poor, we don't even have a GP. I have not seen a GP or a dentist for years. Colds are treated with OTC medicine.

    If my financial circumstances should improve, I think I would like to have a good regular GP. I live in Sengkang. Any recommendations?!

    Do I visit every GP in the neighbourhood and check which one I'm most comfortable with? How to find or select one?

    By Anonymous Anonymous, At February 22, 2006 1:51 pm  

  • Wait! I just remembered! Dr. Oz, if I get referred by GP, I would be private patient and pay private patient rates! If I want to be operated on by the consultant recommended, I would have to be a private patient.

    Or how? Ask GP to refer to polyclinic, then refer to government hospital then officially subsidized patient cannot ask for doctor by name. You mean unofficially can still get the consultant with "connections"?

    By Anonymous Anonymous, At February 22, 2006 2:00 pm  

  • Yes unofficially still can be done.

    What we do is we "refer" you with a letter to the Polyclinic doctor to ask him/her to refer you to the specialist. You can choose which hospital you want. So choose the one which your GP knows at least one of its consultants.

    Then when you get the appointment date, tell the GP. The GP then calls his pal in the department there and say so-and-so my patient got tis problem can help look after him? If need surgery can be transferred to his team for the operation and the consultant will take care. If good enough friend and the GP close enough to you can call the consultant to get update everyday for you.

    At the end of the day, it also depends on your relationship with your GP and what kind of person he is lah.

    By Blogger Dr Oz bloke, At February 22, 2006 2:48 pm  

  • "Dr. Oz, for patients who are really poor, we don't even have a GP.
    If my financial circumstances should improve, I think I would like to have a good regular GP. I live in Sengkang. Any recommendations?!"

    There are some free clinics where there are very good, kind hearted GPs working there on regular days. That could be one way.

    There are several organisations who run free clinics. The Catholic churches have some free clinics Woodlands has one from what I know.

    Sai Baba also runs a free clinic. You know opposite the old Tan Tock Seng Hospital?

    By Blogger Dr Oz bloke, At February 22, 2006 2:50 pm  

  • I know of several free clinics but they all offer TCM, not Western medicine.

    By Anonymous Anonymous, At February 22, 2006 3:03 pm  

  • Dear Dr Oz,

    Ya, how does one finds a good GP in their neighbourhood, esp. when one is new in the estate.

    Through trail and error, just like me when i moved to a new estate far away from north to west, left my GP of ten odd years, though he is above average and charges very reasonable. My whole family is under his care, but we never really built the close patient-doctor relationship. Why? basically, he is a man of few words and very serious in look and words.

    When I found him, I was pretty new in the estate, he sets up his clinic much later. So give him a try when I needed a doctor.

    Now, after moving to a new estate, went doctor hunting, near my place,
    till now couldn't find a doctor that I am comfortable with.

    Have tried a new clinic nearby, the doc is very new, from overseas med school. He's ok.

    Later, try another older clinic nearer, but she almost killed my son. Luckily, based on motherly instinct, rush him to A & E. According to the surgeon there, if I am a little late, my son would have died.

    Another old clinic further away, the doc is more interested in making big bucks dealing in slimming and other cosmetics. Had a bad experience with him, had bad side effects after taking antibotics, call him and told him but he believes it is now the case, so trust him, next dose the same thing happen, called to tell him, he dismiss it totally, making me feel like an idiot.

    Not every doc is like you, I am sure you are a good and caring doctor.(where to find you?) So is, not every patient is lucky to find a good doctor.

    I have had my fair share of good and bad doctors, though not as experienced and knowledgable like uglybaldie and of course, not rich too.....

    Have always enjoy reading yr comments and your blog. Keep it up.

    By Anonymous Anonymous, At February 22, 2006 3:36 pm  

  • Dear anon,

    Unfortunately there is no place for good GPs in Singapore.

    If one wants to be a good GP in Singapore, they either choose to struggle paying the rent every month or migrate to other countries to practise.

    As far as choosing a GP in your area, I would suggest you ask around at the market for the low-down on all the GPs in the area. They usually know which clinic is good for what, which is expensive etc.

    By Blogger Dr Oz bloke, At February 22, 2006 3:48 pm  

  • Dear Dr Oz


    Thanks for your advice, will keep in mind.

    Yes, St Anthony's Church in woodlands is operating a free clinic.

    There is one Dr Tan in Redhill area where he waives charges for the old and needy.

    By Anonymous Anonymous, At February 22, 2006 5:04 pm  

  • So why not go to these free clinics for your problems?

    You might just see me at one of them *wink*

    By Blogger Dr Oz bloke, At February 22, 2006 5:08 pm  

  • Dear Dr Oz

    Very sad...... sigh......

    Thanks for your advice, will keep that in mind.

    Yes, St Anthony's Church in woodlands is operating a free clinic.

    There is one Dr Tan in Redhill area where he waives all charges for needy patients. (featured in the newspaper).

    By Anonymous Anonymous, At February 22, 2006 5:12 pm  

  • Dear Dr Oz

    Now, I know where to find you.....

    By Anonymous Anonymous, At February 22, 2006 5:13 pm  

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