Angry Doctor

Thursday, January 22, 2009

The heart has its own reasons...

No, this is not another post about true love, but a follow-up to a question posed by angry doc's teacher in the previous post:

What do you think about the changes in SCDF policy in today's ST re: pts with Acute myocardial infarcts?

angry doc did not read the story mentioned, but an article in Today today gives the background to the issue:

"Dr Lee Wei Ling, the director of the National Neuroscience Institute, wrote in a Sunday Times column that the two hospitals did not have the resources after office hours to handle heart attack patients."

"In her article, Dr Lee wrote that she had engaged ambulances under the Singapore Civil Defence Force, NHC and NUH, and got them all to agree to bypass the two hospitals if they pick up acute heart attack patients."

So is it a good policy to send all patients with acute heart attacks to NHC or NUH?

Management of acute heart attacks is not angry doc's area of specialty, but in general where both options are available, primary anigoplasty ("angioplasty operations... as a first course of treatment if needed") is superior to thrombolysis ("just medication to break up or dissolve blood clots").

In the event that primary angioplasty is not available at the nearest hospital and the nearest centre that does provide the service is several hours away, thrombolysis may be a valid option (feel free to correct angry doc if you know he is wrong); but is it a valid option in the local context?

angry doc does not have the answer, but it is not important, because Prof Lee's article (reproduced on this page) wasn't really on the availability of cardiac specialists in certain hospitals after office hours, but her belief that:

If there is something wrong that we know of, I believe we should try to set it right whether or not it is our business to do so. Not to do so implies we condone the wrong and hence we would be guilty of committing the wrong too.

So even though Prof Lee's recommendation for all patients with acute heart attacks to be brought to NHC or NUH may have been rendered moot by changes which have taken place, angry doc cannot fault her reason for speaking out.

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  • Hi angry doc,

    I'd like to make a small observation together with an anecdote of my own.

    Recently a medical student wrote to the papers regarding HAART in Singapore and MOH's '3rd world mentality' pertaining to subsidy. The Dean's Office of YLLSOM gave a talk to the class on decorum, on how such opinions should first be brought up within the medical fraternity, rather than on a public platform. The Minister, Mr Balaji, then met up with the class again regarding this matter.

    I am just wondering if anybody is going to meet up with Prof Lee regarding decorum too.

    Or is there a need to?

    By Anonymous Anonymous, At January 23, 2009 9:43 pm  

  • I would like to answer your question, but I'm afraid I'll have to discuss this with members of the medical fraternity first...

    (Let me sleep on this, and maybe I'll write a post about it later.)

    By Blogger angry doc, At January 23, 2009 10:16 pm  

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