Angry Doctor

Friday, July 03, 2009

Arrogance of ignorance

Once in a while angry doc comes across a blog post or comment that makes him get personal - a post on Emerald Hills today managed to do that to him. angry doc reproduces his comment on that post below:

Your post contains many unfounded accusations directed at health professionals, policy makers, and some segments of the population, and ignores some of the facts we already know about the virus.

I think the latest direction from MOH is in fact a reasonable one based on what we know about the virus so far.

The DORSCON system was designed with a deadlier virus in mind. Current evidence is that the virus we are dealing with is not as deadly as previously thought, so it is reasonable to modify it than to stick to what is ‘on paper’. This shows that the policy makers are monitoring the situation and adapting, rather than blinding adhering to protocols.

Given that patients can be asymptomatic and still be infectious, I fail to see how raising the alert level will help contain the spread.

Given that the disease is mild in the majority of the cases, and that Tamiflu can have adverse effects, it makes sense to reserve its use in patients in whom the benefits will outweigh the risk. Doctors are trained to identify patients who are at higher risks – just because you are ignorant doesn’t mean that health professionals are too.

Also, the fact that the disease is mild in the majority of the cases means that an accurate diagnosis is not helpful in the treatment of the patient most of the time – a patient with H1N1 but is not severly ill will not require Tamiflu or supportive treatment, while a patient who is ill will require supportive treatment regardless of whether it is from H1N1 or seasonal flu.

You display the arrogance of ignorance with your post, thinking that your knowledge of the virus and medical science allows you to criticise the efforts of our policy and healthcare workers, when in fact you have merely displayed your ignorance on the subject, and have not come up with any solution (except to raise the alert level, although you have not explained how that will help make things better).

As a healthcare worker in the frontline fighting against the virus, I am offended by your insult to the competence and professionalism of my colleagues and myself. You are like a panicked airplane passenger who demands to have a say in how the plane is piloted when it hits a turbulence, thinking that you have the training and experience to tell the pilot how to do his job, when he is vastly more qualified than you are, and fully aware of the responsibilities he bears, because if the plane goes down, he goes down too.

Added Jul 04 2009: See this post on the Singapore MD site and decide for yourselves if doctors "make conclusions and decisions blindly, without the necessary facts to back them up".


  • Hmm... I don't see your comment there now. Did they delete it?

    By Blogger The Key Question, At July 05, 2009 12:43 am  

  • It's still awaiting moderation.

    By Blogger angry doc, At July 05, 2009 3:16 am  

  • Hi angrydoc,

    I was at ground zero during SARS (I was admitted for suspected SARS and my colleagues died from the virus) as well as involved in the current H1N1 efforts.

    Looking at the reports from all over the world as well as the experience locally, we can see that our current plans to control any disease outbreak has failed. This is not just for Singapore but everywhere in the world.

    Fundamentally, our approach is wrong. And all the data will back up my statement.

    If we really wanted to prevent the spread of a disease globally, we should enforce a 30 day lock down on all travel in and out of each country/state.

    The key to prevention of a disease that spreads from human to human is to minimize contact between humans period.

    The real reason why we don't do anything close to this is because of economic concerns. In other words.....MONEY.

    And frankly, in the scheme of things you can see why money is the MOST important thing to consider for leaders who have to make decisions.

    Singapore seemed to be doing well in the fight against the H1N1 until we had the June Holiday season and people started returning from their trips. It is debatable whether this merely increased the pool of patients that were tested for H1N1 and thus led to the rise in our statistics or whether there were really more cases imported.

    But the official reason why we would not enforce a travel ban was for economic reasons.

    Every country said the same thing.

    During SARS, the disease was controlled and died out because people stayed at home. Hospitals were empty. Clinics were empty. Shopping centres were deserted. There were almost no visitor arrivals to Singapore. In other words minimal human to human interaction as far as possible. People were scared because the virus had a high kill rate.

    I hate to say this but the only way H1N1 can be stopped is if it starts killing more people and causes panic.

    Panicked people fearful of death from a virus that they can catch from anyone would naturally stay at home as much as possible. And that is how you stop the virus from spreading. Not taking body temperatures 3 times a day, contact tracing etc while people continue to pack cinema halls, discos, meeting rooms etc.

    Only when faced with the prospect of death does money seem less important.

    At the moment H1N1 has a low death rate. So expect the disease to continue to spread.

    As doctors we can't do anything that will make a real impact.

    In conclusion my view is that a lot of the measures are political. WHO is doing all this to show they are doing something. Our government is doing the same.

    No one wants to be seen as doing nothing now because when things turn ugly, then they will all be blamed. But the only people who can make a REAL difference is not WHO, MOH, doctors, and nurses......but WE the people.

    I don't wish for the virus to become deadly, but if it does, then truly it will once again be survival of the fittest.

    By Anonymous drozbloke, At July 05, 2009 7:06 am  

  • TCM practitioner?

    By Anonymous Edgar, At July 05, 2009 9:48 am  

  • Public health measures are always about money, Oz Bloke, but decisions on cost-benefits must be based on hard evidence - that's the point.

    And everything is political, because politics is about everything.

    This virus is not SARS and behaves differently. From we know about the virus, the current measures are appropriate. If the virus mutates into a deadlier strain, you and I both know that there are people watching the situation and devising strategies and policies to deal with it.

    Emerald Hills' call for more 'drastic' measures based on ignorance and rhetoric causes unnecessary fear and confusion, and erode people's confidence in the healthcare system. It should not be unchallenged.

    By Blogger angry doc, At July 05, 2009 10:08 am  

  • Ed,

    Maybe Emerald Hills is Oz Bloke. :)

    By Blogger angry doc, At July 05, 2009 10:17 am  

  • Hi angrydoc,

    I'm not emerald hills lah. Why you call it that anyway? I don't read that much blogs these days.:lol:

    I think what I was trying to say is that, all the measures we have will never be preventive. They will be reactive.

    But the thing with reactive measures is that they tend to be just adjuncts to what the people are already naturally going to do.

    I don't think it is practical economically to have more drastic measures for H1N1 than what we have now based on the current facts about the disease. It is a very mild disease just like seasonal flu. In fact I think we are over reacting in what we are doing. A part of me says, it might be better to catch the mild form of the disease earlier as you might end up with immunity against the more serious form if it mutates. Of course that is not a guarantee and who knows when the virus would mutate and you are "lucky" first one to catch the mutated more deadly form?

    You see we are doctors. And we get patients who expect us to "guarantee" their safety, ensure their survival that sort of thing. And I can understand that concern and expectation.

    But if you really want me to cover all bases, then you have to pay the economic cost. Which people do NOT want to pay. That is the cost of prevention.

    So how? Unless I know what will happen in the future at exactly what time, the only way I can have a really safe plan of action is to cover all bases. And that will cost a lot.

    Hence I don't bother anymore. All these are just things we do for various reasons.

    The measures usually seem illogical on hindsight most of the time.

    But people have to be fair to doctors as well. Look at the bankers and finance people. Subprime crisis? Why didn't the big guys see it coming earlier and prevented it? Mind you these fellas earn a way LOT MORE money than we do as doctors.

    So be fair lah. :)

    By Anonymous dr ozbloke, At July 05, 2009 4:59 pm  

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