"Blow Out"

An interesting story that perhaps all doctors in Singapore could do well to follow.


No specialist would see injured child in hospital

ON OCT 18, my five-year-old daughter fell at home and hurt her eye. I brought her to Mount Alvernia Hospital. She was seen promptly by the doctor and the x-rays showed a fracture. The doctor wanted a specialist's opinion.

As my daughter is insured under my husband's company medical insurance with Aviva, the specialist had to come from the panel of doctors appointed by Aviva. There were six ophthalmologists on the list. The hospital called all of them but none could come to treat my daughter.

The doctors were uncontactable with no phone number or answering service, and those who were contacted said they had other appointments. One or two of them declined to treat my daughter. Another doctor said no because he did not treat patients at Mount Alvernia Hospital. The hospital then called its own specialists. They were not on Aviva's panel and this had ramifications on the claim process. But because we had waited a long time, I agreed to it.

But Mount Alvernia's doctor was on leave and his colleague declined because he said he did not treat pediatric eye cases.

Finally, in frustration I took my daughter to KK Women's and Children's Hospital where she was treated.

My questions are:

Can doctors choose their patients? How ethical or professional is this? Clearly, if a doctor is called after office hours to attend to a case, this is likely to be an emergency. Yet none of the six or seven doctors contacted would go to the hospital.

Why should people pay to be insured under a medical insurance scheme which does not guarantee prompt treatment by its panel of doctors?

How are doctors selected to be on the panel for insurance companies? Do they screen the doctors before appointing them? Surely a condition of such appointment must be their willingness to treat patients at any hospital.

Mount Alvernia Hospital must also look at its specialists. If a patient cannot get treatment in a private hospital, why would they go there?

But I want to commend Mount Alvernia Hospital for its excellent, caring and sympathetic nurses at the A&E department. They tried their best and made many phone calls to get help. While the nurses provided good service, the specialists fell far short. For Singapore to be the region's medical hub, the doctors have to do much better than this. I hope Aviva, Mount Alvernia Hospital, the Health Ministry or the Singapore Medical Association can comment on this.

Patricia Chong-Koh Hee Ching (Mrs)


Now angry doc has no idea how to manage (what sounds like) an orbital fracture in a five-year old child (yes, there is no 'orbit bone', so technically no such thing as an 'orbital fracture'...), but he imagines it might be akin to putting a miniature Humpty Dumpty back together again. Not that all fractures of the walls of the orbit need to be treated surgically, or that it would automatically be a life- or vision-threatening condition though.

The Singapore Medical Council Ethical Guidelines states that a doctor 'shall be prepared to treat patients in an emergency or humanitarian basis unless circumstances prevent him from doing so'. I guess the key here is whether a child who was already in a hospital, had been assessed by the emergency department doctor, and is awaiting a second opinion or definitive treatment constitutes an emergency situation.

Certainly the doctors must have had their reasons for not wanting to take on the case, and we shall probably learn of them when a reply is posted.

angry doc just finds it ironic that despite insurance coverage and a 'private' paying status, no specialist could be found to take the patient's case and she had to seek treatment at a 'public' (restructured) hospital.

Perhaps 'market forces' isn't as powerful as we thought it is?