Angry Doctor

Monday, August 07, 2006

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.



  • interesting to see how sgh will respond...they would need to explain in depth and justify the $78 fee..

    besides, think nhg polyclinic previously charge $1 for medical results, already people complain..

    Out of topic here..but I know this paul chan from a friend friend.. apparently a very helpful guy..

    By Anonymous Anonymous, At August 07, 2006 8:17 pm  

  • kudos to angrydr!

    sighz, a lot of pple seem to not know what exactly they are paying for. who's fault is that? their own ignorance? the gov's spoon-feeding? failure to educate pts abt medical policies?

    i think they're just apathetic n lazy.

    By Anonymous Anonymous, At August 07, 2006 11:19 pm  

  • Nobody wants to pay anything for anything related to health care. That's just the way it is. You can pay for the plasma TV, the Xbox360, but you won't pay for anything health care related.

    Maybe we should gear health care down the consumerism route.

    I've long become disillusioned that there is any point in being a good doctor making an honest living.

    But I cannot bring myself to change and be a hypocrite.

    By Blogger Dr Oz bloke, At August 08, 2006 9:57 am  

  • Mr Halim's Specialist 'friend' probably earns that much when he hits 40, after years of toiling. And even then, I don't think many doctors have it as good as his 'friend' does.

    With 5 years of medical school, number of exam expenses that amount to the hundreds and thousands each time, my husband's ROI has not really paid off.

    In fact, after calculation, he earns less than $35 per hour. Even my friend who teaches kindergarten kids gets more value per hour! He gets home tired, and depending on the posting, has to go back to work on Saturdays and Sundays. On post-call days, his days are absolutely burnt.

    This doesn't even include the studying for the exams. And when, or if my husband even gets to earn as much as that specialist 'friend', I do not know. He may just quit being a doctor before he gets there.

    And yes, churning out a medical report does take effort to write.

    Then again, there's no use 'complaining' here because you guys all go through the same thing. People like Tony Halim and Paul Chan should read your blog.

    By Anonymous Anonymous, At August 08, 2006 10:25 am  

  • Agree with dopey & dr oz. Many people are ignorant of what they are paying for, or don't bother to find out. Add to that their unwillingness to pay, & voila! complaints galore.

    By Blogger aliendoc, At August 08, 2006 2:09 pm  

  • Maybe it is just me....but why do I keep having this bad feeling that I should be ashamed of the money I earn while working as a doctor?

    It's like society feels that I should be working for free.

    It's getting to me. I think I should switch professions. Or earn like $1500 a month while working as a GP.

    Really feeling lousy.

    By Blogger Dr Oz bloke, At August 08, 2006 5:26 pm  

  • Doctor's time is also $.

    If the hospital do not charge the patients for medical report, then everyone demands medical report. Then doctors would end up writing medical reports every day instead of running clinics.

    Patients suffer in the end.

    But out of $78, the poor doctor only gets $25!

    By Blogger Right Hospital, At August 08, 2006 9:19 pm  

  • Hey angry doc,
    i think u made very valid points in yr not post in on the straits times forum to educate the public?

    By Anonymous Anonymous, At August 09, 2006 10:28 am  

  • If you follow the link at the end of the post to the previous post in which I discussed another one of Mr Chan's letter, you will find a similar question to the one you just asked, and my reply. :)

    By Blogger angry doc, At August 09, 2006 12:06 pm  

  • Angry Doc, you are quite right! WHERE TO BEGIN?

    These letters just serve to reinforce my impression that some forum page letter writers are ignorant (intepret as STUPID) but do not seem to realise it. Any intelligent person would get his facts right before writing a letter to be published in a national paper with his full name. Makes me wonder about the IQ of the forum page editor too.

    Based on Tony Halim's figures, his friend would earn >$200k a month. I can only think of fewer than 5 specialists in the private sector who could possibly earn this amount. I doubt they have close friends who are so ignorant, especially one to which they could confide their annual salaries.

    But on the other hand, I am of the opinion that all patients should be given a copy of all investigation results / reports. As a GP, it is extremely difficult to try to guess a patient's diagnosis when they come to their regular, familiar family doctor for reassurances etc. Not that easy to work backwards using their medications, or operation listings.

    I am waiting for SGH's reply. Wonder how much explaining they will bother with. And, how much will it help, anyway. Frankly, the reply should be from MOH, and not SGH alone as these rules are across the board in all non private institutions.

    $75 + GST ( that's how you get $78.75) is a pretty fair charge for a medical report anyway. The number of staff involved to generate a report justifies the cost. It is not just the doctor alone who has to work to do this "favour" for the patient. The Patient Services Officer, MRO staff, the departmental secretary are all involved too.
    - I suppose Mr Halim's doctor friend works alone and does not employ any assistants nor managers in his extremely busy practice!

    By Anonymous Anonymous, At August 10, 2006 7:10 pm  

  • The Forum page has always been my favourite section of the newspaper; I read it before I read the front page, or even the comics - it's usually funnier.

    By Blogger angry doc, At August 10, 2006 8:46 pm  

  • I totally agree!
    One of my Registrars used to tell me when I was a junior MO --> be glad that there are stupid people out there. If everyone were as intelligent as you, you will not be considered intelligent, but just average.

    Remember this. It does wonders to calm you down when you have to repeatedly explain stuff to people who try to appear intelligent but inadvertently appear silly!

    Haven't you guys encountered patients who ask you questions, and after hearing your answer, follow-up with another question. After about 3 questions, you realise that all you need is ONE answer for all his questions. They are basically asking the same thing, but paraphrased in different ways! Makes you wonder if he is actually listening to your answers or he just does not understand them.

    By Anonymous Anonymous, At August 11, 2006 4:42 pm  

  • Actually, I don't really mind 'stupid' patients who take a longer time to understand something. They don't piss me off - the situation (of having to spend time explaning something several times over) does.

    Patients (and people in general, actually) who adopt and persist in immature (or 'non-critical', as a friend perfers) thinking piss me off.

    Ignorant patients do not really piss me off either, unless they start to tell us how to make the world a better place for everyone based on their inadequate or erroneous knowledge.

    By Blogger angry doc, At August 11, 2006 5:49 pm  

  • Singaporeans think that doctors should only earn $5 to write a specialist medical report! Do they know how much lawyers charge for a statutory declaration or just a telephone consultation?

    By Anonymous Anonymous, At August 14, 2006 9:11 pm  

  • I recently had to use the services of 4 specialists and a battery of other diagnostic services. I started out using a public hospital and went back to a private sector specialist to save time. Having spent numerous hours as a user of Singapore's medical services, and using much of that time counting the number of patients coming and going, and calculating the takings per day, assuming a high average of S$100 per patient, I find that doctors in Singapore both in the private and public sector have to work extremely hard to make a decent living. Medical costs in Singapore are too low which results in doctors and other medical staff having to put in logner hours and to see more patients in order to cover the operating costs of their practices and the hospital. While there is a social-economic need to keep medical costs down, this has the effect of less time for research, continuing medical education, a lower likelihood of doctors taking up or learning procedures/methods which are unlikely to be used in Singapore on a mass scale because its too expensive (but which are more sophisticated and have better patient outcomes), the use of cheaper, less effective drugs and overall, less time that doctors can spend with their patients. While the standards of our doctors in Singapore are high, for the practice of medicine to improve and for the medical profession to keep up with advances in medicine, this requires more money and investment. Government subsidies are necessarily limited, and at best ensuring basic medical care. For Singapore to be a world class medical centre, comparable to the US, and for patients to receive a higher standard of medical care attention, we need to recognise that medical costs must necessarily increase. I would advocate that Singapore moves towards the use of commercial medical insurance.

    By Anonymous Anonymous, At August 15, 2006 8:48 am  

  • Actually, they are just confused between investigation results and medical reports. I too would be furious if it cost S$75 to photocopy some lab results.

    As for how to improve the healthcare system... I can't claim to have an answer, but I am always keeping my eyes and ears open to the latest development.

    By Blogger angry doc, At August 15, 2006 5:21 pm  

  • This is all erroneous what you're writing.
    liked it | 2 | 4

    By Anonymous Rolf, At November 07, 2012 11:49 pm  

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