Rational Rationing?

The reply to Mr Chi's letter is published today.


Patient gets priority when the case is urgent

I REFER to Mr James Chi's letter 'Switch to 'private patient' gets quick test' (ST, Oct 26).

We have contacted Mr Chi to thank him for his feedback. I understand his concern and assure him and your readers that the National University Hospital is committed to providing appropriate medical care and services to all our patients regardless of their payment status.

Patients who are assessed to need urgent medical treatment will always be given priority and no patient will be denied care and treatment due to their inability to pay.

Mr Chi was referred from the polyclinic on Oct 12 with a general referral (i.e. non-urgent and with no specialist named). He was given the earliest available consultation appointment on Oct 31. Although all appointment slots were filled, an exception was made to accede to Mr Chi's request for an earlier appointment when our staff sensed his anxiety.

He was seen on Oct 16 at our colorectal clinic and assessed by the team specialist. His condition was assessed as non-critical and there was no indication for an urgent or early colonoscopy. Thus the earliest available appointment for the colonoscopy in mid-November was suggested.

Referrals from the polyclinics to our specialist clinics are managed by a team of doctors instead of named specialists. Patients enjoy a good level of care which is heavily subsidised by the Government.

Thus the demand is high and waiting time for appointments or procedures is usually longer.

On the other hand, patients who choose to be under the care of a specific specialist are charged at higher rates. Depending on the individual specialist's schedule and the demand for his service, there may be more flexibility and shorter waiting time for appointments and procedures.

As Mr Chi expressed his preference for an earlier colonoscopy appointment, he was given the option to have the procedure performed by the specialist on a non-subsidised basis. In Mr Chi's case, the specialist was prepared to perform the procedure before he left for an overseas conference the following day.

For continuity of care under the same specialist, a non-subsidised patient retains his payment status when he returns for subsequent consultations. However, patients in genuine financial difficulties have various avenues for assistance, including downgrading of payment status if they qualify.

I apologise that these points were not adequately explained to Mr Chi by our staff. We have reviewed his feedback and will improve the counselling process at our specialist clinics.

Following the colonoscopy, a consultation with the specialist was necessary for the doctor to review Mr Chi's condition, explain the colonoscopy findings and answer any queries.

We would like to assist Mr Chi if he has any other concerns. He can contact Ms Deborah Ee, Senior Manager, Quality Improvement Unit, on 6772-2296.

Chua Song Khim
Chief Executive Officer
National University Hospital


It seems now there are three ways to determine priority in receiving medical care: according to the severity of illness, the patient's paying status, and the patient's anxiety level.

I don't suppose anyone has problem with the idea that the sickest patient gets seen first.

Some of us may be uncomfortable with the idea that paying more gets you priority.

How many of us feel that a patient's anxiety level should be a factor when it comes to priority?

Given two patients with the same condition assessed to be non-urgent, should the one who expresses more anxiety get priority?

Given five patients, all of whom have the same condition assessed to be non-urgent, should the one who expresses the least or no anxiety be put at the back of the queue?

Should the squeakiest wheel get the oil first?

A patient's perception of his medical condition is not always commensurate with its actual severity; that's why triage is a medical-personnel-directed process, not a patient-directed one.

Or maybe 'anxiety' is a new parameter in the latest triage protocols, and angry doc needs to go on a course to learn how to 'sense' anxiety?