A penny for your thoughts?

I wasn't planning to discuss this topic which came up in the ST Forum a few weeks ago, and as a result I did not archive the original letter and the reply from the hospital. I can't claim to be accurate in my retelling of the accounts given by each side, but briefly, a patient wrote to the ST Forum complaining of being charged more than $70 for copies of her investigation results. The hospital replied that the $70-plus price-tag sounded more like the fee for a specialist medical report ($78.75 to be exact) and not for copies of investigation results; in any case, there was no record of a request by that patient for a medical report.

Curious. Was the patient mistaken, or did someone illegally bill her for some photocopies which should not have cost that much? There wasn't any point in speculating, and I thought that was the end of the story.

Then two letters on the topic are published in the ST Forum today.

The first one asks:


How does SGH arrive at $78.75 for a copy of specialist medical report?

I refer to the letter "$78 fee applies only to special medical report" (ST, July 28).

It would be of great interest to major stakeholders of SGH, we patients, to know how the rate of $78.75 is derived.

It was mentioned that this fee is for time the specialist spends to retrieve the record. I believe that with the advancement of IT in SGH, the specialist is most likely able to retrieve the record from the computer with a few clicks of the mouse.

That would probably take at most five minutes. At the rate of $78.75 per five minutes, it seems to me that this fee is derived from the average earnings of a specialist.

At $78.75 per five minutes, it translates to $945 per hour and $7,560 per day (assuming an eight-hour working day). This is very close to the rate of my specialist doctor friend's average daily earnings.

If indeed the fee is based on the specialist's average earnings, the question would be whether it is justified to do so? I feel a nominal fee of $5 would suffice for five minutes of simple work.

Tony Halim


And the second one states:


Charging extra for medical report unfair

I REFER to the letter, '$78 fee applies only to special medical report' (ST. July 28), by Mr Wong Loong Kin, chief financial officer of Singapore General Hospital. I find the statement that charging for test results and medical reports is a standard practice in restructured hospitals puzzling.

It seems to mean patients are not entitled to know their own medical condition - for better or worse - and do not need a copy of medical test results to keep or for a second opinion.

The patient pays for the whole package, including interpreting and generating the medical report. Charging extra or not giving him the report seems to run contrary to medical practice regarding the patient's right to know his own health.

I did an MRI 64 slice scan on my by-passed heart in Mount Elizabeth Hospital recently. I was given a copy of the complete report plus a CD. When I wanted to understand more about the report and CD, I was a given a full explanation while viewing the CD at no cost.

Why should it require a specialist to extract relevant information from medical records for the report when a printout or photocopy will do? At the end of the day, the patient is privy to his own full medical condition.

With the implementation of e-filing of all medical data, I hope hospitals will make it a practice to furnish a copy of patients' medical reports for the benefit of both parties.

Paul Chan Poh Hoi


Good grief. Where to begin?

Well, let's start with definitions first. There are actually a few different things we are looking at here. They are:

1. Medical Records, which refer to the notes kept by the doctor for each consultation, documenting the patient's symptoms, signs, his opinion, and his treatment.

They are the 'intellectual property' of the doctor making the notes, and do not belong to the patient.

The Medical records are not usually released, except by a court order.

2. Investigation Reports, which refer usually to the laboratory or radiology results. In the case of the former it is usually just a list of values with no opinion, and in the latter a description of the findings, followed by the opinion of the radiologist reading the X-rays. (I know, gross simplification, but we're after a general idea here.)

The Investigation Reports (or rather copies of the reports) are often released, usually with a small charge.

Personally, I don't see why the cost for producing a copy should not be built into the cost of the investigation, and a copy be given to the patient by default though.

3. Medical Report, which refers to an account, written by a doctor after reviewing the Medical Records and any Investigation Report, detailing (depending on what exactly is required from the party asking for the report) the history of the patient's illness, his diagnosis, progress, past, present and future treatment, and sometimes an opinion on how the patient's condition is likely to progress.

It is not routinely done for every patient after every consultation, but usually for specific purposes such as insurance claims and legal proceedings.

A Medical Report is not merely a sum of the Medical Records and the Investigations Reports. I am loath to use the term, but the doctor 'value-adds' to the raw information that is the Medical Records and Investigation Reports. It definitely takes more than 5 minute and a few click of the computer for the doctor to retrieve and gather the necessary data, process it in his head, and to present all that information in a coherent account, which may have to be read and understood by a non-medically-trained person.

In fact, even after providing the report, a doctor may be called upon to clarify any queries raised by the receiving party, and sometimes to resubmit a report if amendments or clarifications are required, with no extra fee.

I'm not sure if $78 is too high a fee to charge for all that work, but I do feel $5 is too little.

How much, I wonder, does Mr Halim's specialist-doctor friend think he should be paid for a specialist medical report?

How much do you think the doctor's time and effort are worth?

As for Mr Chan's letter? Well, it seems he has confused Medical Records with Medical Reports. I do wish he would look up the facts before suggesting improvements to our healthcare system in the future.