Angry Doctor

Wednesday, August 02, 2006

W.W.H.D. 2

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


"You are an orthopaedic surgeon in a restructured hospital.

A young man is scheduled for bone-grafting for non-union of a scaphoid fracture. He asks you for a memo to his company stating that he was referred to your clinic from the polyclinic.

You check his notes. He had in fact presented to the Emergency Department for chronic pain in his wrist a few months after his initial injury, and had been referred to your clinic from there.

You ask him about this discrepancy in his history and he explains that as per his company policy, the company would only pay for his surgery if he was referred to a specialist through a polyclinic, but not the Emergency Department."

What should you do?

A. Be honest
Tell him you cannot provide such a memo.

B. Use a little imagination
Write a memo stating that even though he was not referred to your clinic from the polyclinic, had he gone to a polyclinic, he would have been referred to your clinic.

C. Use a little creativity
Advise him to visit a polyclinic to obtain a referral to your clinic, then provide a memo stating that he had been referred to your clinic from the polyclinic, but leave out the relevant dates in your memo.

D. Lie a little
Write a memo stating that the patient's condition was so urgent that he needed to be seen at the Emergency Department and could not have waited to be seen at a polyclinic.

E. Lie a lot
Write a memo stating that the patient had been referred to your clinic from the polyclinic.


Will your answer differ if his injury was sustained during work? Will your answer differ if his injury was not work-related?

What if he tells you neither option B nor D will carry any weight with his company?

What would Hippocrates do? What would you do?

11 Comments:

  • wa..i also got that kind of problem sia..no polyclinic referral=no subsidy..

    By Anonymous Anonymous, At August 02, 2006 6:08 pm  

  • Which is why I think MOH should consider having a system where fixed subsidies are available if one goes to the private sector or without going to the Polyclinic for referral too.

    As it is, we doctors are put in a bad situation. If we help the patient, we are liars. If we don't help them, then we are money grabbing bastards?

    By Blogger Dr Oz bloke, At August 02, 2006 10:19 pm  

  • Probably A....

    By Anonymous Anonymous, At August 02, 2006 11:00 pm  

  • C. Since it is a non-urgent case, anyway; I wouldn't play around with the dates; I don't think that would be right.

    No difference to me whether it was work related or not...would handle it the same way.

    By Blogger aliendoc, At August 02, 2006 11:27 pm  

  • Actually I would write a combination of B and D and try to appeal to the compassionate side of the company.

    But I would let the patient know that by doing that, his company could exercise the right not to pay for his treatment.

    And if he is not willing to take the risk, then we will do C and I'll "act blur" or "conveniently forgot" sort of thing.

    A is probably correct but shows no effort to help the patient and patients feel that doctors should be helpful and caring etc etc.

    E is good for the patient, but goes against the public/company view that doctors are honest upright etc etc etc.

    By Blogger Dr Oz bloke, At August 03, 2006 11:34 am  

  • Some of the previous comments have missed the point ! It's a wonder you passed the MBBS. He is NOT asking for subsidy. He ALREADY HAS subsidy, having been referred from the A&E.
    Honesty is the best way to go, ie opion A. But we have to change the image that surgeons don't care for patients, other than solving their surgical problems. He might really need the extra financial help.
    He obviously does not need urgent surgery. I would ask him to go get a referral from the Polyclinic and go through the whole process again. Re-consult and then list for surgery. I could be nice and choose option C, but he would not learn not to visit the A&E for chronic problems in future - he is an abuser of the A&E department, and there are too many of these types running around.
    Hey, Angry Doc --> if his injury were work related, we would not be having this discusson. His company's insurers would have to pay for his treatment irregardless of the source of his referral. In fact, he would be entitled to a B1 bed for his surgery.
    Hippocrates never had to deal with the type of patients we see today.

    By Anonymous Anonymous, At August 03, 2006 3:46 pm  

  • Bollocks. The answer is very simple. A.
    If the patient knows that the company doesn't subsidise them if they come via the EMD then he jolly well runs through the polyclinic.
    If you start providing B-E as your answers, you'll find that you'll have a never ending problem.
    Its not that I as the doctor am uncaring. Its just that by abetting with the patient to "cheat" the company, it reinforces to the patient that he can get away with this (in future) by bypassing the polyclinic. This is utterly unfair to the A&E. The system is there for a reason, each individual doctor may have his own opinion about it, but everyone should toe the line. If not, why bother having a system?

    By Anonymous Kraxpot, At August 03, 2006 4:28 pm  

  • Yes, the patient is already under subsidy, but is not under Workmen's Compensation.

    (Even for those under Workmen's Compensation, some companies have the rather cruel policy of requiring their workers to go through the polyclinic in order to go to the A&E, and a worker with an open wound or a closed fracture can sometimes wait half a day to get definitive treatment.)

    I raised this scenario to highlight the fact that oftentimes doctors are asked to intervene in policy matters that really have very little to do with medicine, and not so much with A&E-abuse; but as usual readers in the trade can always see the multiple themes in a post. :)

    Workers-patients who feel unfairly treated seem to see asking for help from doctors as something easier than seeking recourse from the Ministry of Manpower.

    Well, on to the next part of the question then...

    By Blogger angry doc, At August 03, 2006 5:15 pm  

  • We cannot lie or we will get in trouble ourselves. Tell him to go and get a referral from the polyclinic. The only memo you can write is to state the facts: that he came through the Emergency Department.

    By Anonymous Anonymous, At August 03, 2006 9:10 pm  

  • To me, C is the only option.

    Sorry to say, we have to jaga our backside. If you choose D, and E, you would end up in trouble. The patients instead of being grateful, would tell his other workers about this great surgeon who lies for him. The next thing you know, that story goes to the employer, employer writes to the hospital, hospital check his casenotes and you are screwed, big time. SMC might even suspend your license.

    Then, instead of trying to help this one patient, you end up not being able to help all your other patients once you are suspended.

    By Blogger Right Hospital, At August 08, 2006 9:26 pm  

  • Thanks for this article, very effective information.
    check | ... | 2 3 | -> | 1 look | 1

    By Anonymous Anonymous, At February 16, 2013 10:27 pm  

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