Angry Doctor

Friday, July 10, 2009

don't need doctors anymore

Concerned patient commented in an earlier post:


I find that doctors do too many tests these days. Can't they just be sure about something without having to do tests? It costs $8+ to consult a doctor at the polyclinic but $10+ for a test. Is the test worth more than the doctor? From where the money goes it seems to be the case.

maybe we don't need doctors anymore.

There are actually a few interesting observations to be made here.

First of all, it tells us that when a service is priced too lowly, it is also valued lowly; something that perhaps the Ministry of Health would do well to consider.

The question of whether doctors do too many tests is also an interesting one. To be more specific, we need to ask: are doctors ordering than they need to be sure of what?

To be sure that they can make the diagnosis?

Or to be sure that they will be able to cover themselves in a court of law?

The reality on the ground is probably a mix of both. To conduct an accurate study of the situation one would theoretically need every case to be audited by one or more doctors - clearly an unrealistic proposition.

But what angry doc is really interested in discussing is the idea conveyed in the last sentence: that tests render doctors obsolete.

Once again, we witness the arrogance of ignorance.

Tests do have their place in the management of patients. They allow doctors access to facts they wouldn't otherwise be able to have using only their senses, and help them come to the diagnosis. But too often patients think that there is a test for every symptom or set of symptoms that would effectively diagnose a condition, and that the process of diagnosis involves simply ordering every test from a 'menu', and the results will give us the diagnosis, which then allows us to institute the treatment. Wrong.

There are literally hundreds of tests you can order from a standard laboratory and imaging ordering form - the doctor's job is to decide which few out of these to order based on the patient's presentation and therefore possible and likely diagnoses. Granted there are 'panels' and 'batteries' of tests which are often 'packaged' together for operational ease, but angry doc bets most doctors would rather do away with these and to tick more boxes on the form than to have to deal with all the incidental mildly-elevated AST that crops up far too often; what tests a doctor orders is sometimes as important as what tests he does not order - we want 'actionable intelligence', not 'noise'.

Similarly, a doctor will be ordering tests to get the positive results he expects, as well as the negative results he expects, because ruling out a diagnosis (or several diagnoses) is also an important part of arriving at a diagnosis.

Once all that thinking had been done and the results are available, the doctor still has to interpret the results and see how they apply to the patient. This involves an understanding of the false positive and false negative rates, as well as pre-test probabilities, all of which will tell us if a positive test really means our patient really has a disease, or if a negative test really means he really does not, and which is very clearly illustrated in this wikipedia entry.

Will they come up with a computer programme someday that can elicit a history and perform the required physical examination to arrive at a list of differential diagnoses, and which can determine which tests to order to eliminate and ultimately confirm diagnoses from that list, and subsequently come up with the recommended management?

Probably.

But they haven't. And until then angry doc thinks he deserves more than $8+ to do all that thinking. Don't you?

To end, angry doc would like to share a video with his readers, not because it has anything to do with what we are discussing here, but because he thinks this song doesn't played as often as it should. Have a good weekend.


Labels:

43 Comments:

  • When I sprained my ankle and it swelled up I decided to go for an X-ray at the polyclinic. I was hobbling and unable to stand properly on my own. The doctor looked at my ankle and he could not decide whether I had a fracture or not when I asked him and he said he needed to do an X-ray to confirm his diagnosis. According to him if there is pain on pressing the ankle, a lot of swelling and cannot put weight on my ankle when standing it is likely to be a fracture but he cannot be sure. So he wanted the X-ray. Actually I also wanted the X-ray. But I was wondering whether there was a need to see the doctor in the first place? Why not just let me do the X-ray and forgo the consult charge?

    Turns out I did not have a fracture. I asked the doctor whether there have been cases where he thought the patient did not have a fracture and the X-ray turned out that it was a fracture and he said yes.

    What's the point in having the doctor like that?

    If I have an injury and I think I might have a fracture why not just let me have the X-ray. If I have a fracture then I'll see the doctor.

    By Anonymous Concerned patient, At July 10, 2009 11:17 pm  

  • You are right, CP. Your one encounter justifies not having doctors anymore. Patients should just order their own tests and see a doctor only if the test is positive for the disease they think they have.

    Except there won't be doctors for them to see anymore.

    By Blogger angry doc, At July 11, 2009 8:29 am  

  • is it possible for a doctor to CONFIRM whether one has or does not have a fracture without an X-ray? Similarly is it possible for a doctor to CONFIRM whether someone having chest pain is having a heart attack or not?

    Some doctors have told me that in this day and age where patients are very demanding and tolerate zero error it is better to do everything possible for the patient rather than to try to save the patient test that are not needed.His point was that reducing costs and waste was a role doctors performed for society. But doctors take the risks of being "negligent" if they failed to do a certain test trying to save costs. And when that happens they take the consequences on their own. Hence it was not worth fighting a war for someone else where they had everything to gain but nothing lose. Whereas the doctor has everything to lose but nothing to gain.I sort of emphatize with the doctor.

    By Anonymous Anonymous, At July 11, 2009 8:42 am  

  • Even if there was one test to confirm if there is a fracture, even if there is one test to confirm if there is a heart attack, it still doesn't justify this 'self-service' approach to tests because patients do not see a doctor for a fracture or a heart attack - they see a doctor for a pain or chest pain. If the test the patient thinks he ought to have to confirm his diagnosis is negative, what happens then? He is still left with a pain and none the wiser. Perhaps that is the result of the skewed pricing policy -patients place more value on the test than the consult because of the cost, and lose sight of the actual worth of each.

    By Blogger angry doc, At July 11, 2009 8:51 am  

  • But then why is it the price of consultation is so low compared to the tests?

    How come you doctors don't make any noise about that? When I see my neighbourhood GP the consultation charge is $5 but the medicines can come up to $45!Sometimes I just ask the doctor to give me an MC and I would rather self medicate. $5 only. But the doctor is unhappy and says I need to take some medicines. I stamp down my foot and insist I don't need the medicines.

    It is not my fault as a patient that the consultation charge is $5. I am jsut thankful there are doctors silly enough to think that we patients are stupid enough to get conned. Sorry it won't happen to me.

    By Anonymous CP, At July 11, 2009 9:09 am  

  • I'm not saying it's your fault that the consultation is priced lower than the test, CP, just that the conclusion that you draw from it - that doctors are redundant to the process - is wrong.

    You base your arguments on two rather simple encounters you have had, conveniently ignoring the fact that there are a host of more complicated cases other than yours.

    Thank you once again for displaying a fine example of arrogance of ignorance.

    By Blogger angry doc, At July 11, 2009 9:54 am  

  • To CP:

    I don't understand why you think that if consultation fees are cheap, then we don't need doctors any more.

    I think your reasoning can be illustrated this way -

    "Can't they just be sure about something without having to do tests? It costs $8+ to consult a doctor at the polyclinic but $10+ for a test. Is the test worth more than the doctor? From where the money goes it seems to be the case.

    maybe we don't need doctors anymore."

    When I was in primary school, my school fees was $3.50.

    But all my textbooks and workbooks cost much more than that, certainly more than $10+ in total.

    Are textbooks worth more than teachers?

    Maybe we also don't need teachers anymore, right?

    "According to him if there is pain on pressing the ankle, a lot of swelling and cannot put weight on my ankle when standing it is likely to be a fracture but he cannot be sure. So he wanted the X-ray. Actually I also wanted the X-ray. But I was wondering whether there was a need to see the doctor in the first place? Why not just let me do the X-ray and forgo the consult charge?"

    According to my teacher, clouds are formed when water vapour condenses at high altitudes. But it already says that in my textbook! Why not just read the textbook myself? Why do we have to pay teachers?

    "How come you doctors don't make any noise about that? When I see my neighbourhood GP the consultation charge is $5 but the medicines can come up to $45!Sometimes I just ask the doctor to give me an MC and I would rather self medicate. $5 only. But the doctor is unhappy and says I need to take some medicines. I stamp down my foot and insist I don't need the medicines."

    Perhaps I should have just asked my teacher to give me a PSLE cert and I would rather self educate!

    Jokes I aside, I really don't understand your reasoning. I must admit that this is the first time I have heard of such a view.

    People who complain that tests are too expensive or medicines are too expensive(or textbooks) are too expensive normally blame the people who produce those things, such as the testing labs, drug companies(or publishers).

    Your reasoning is that a profession that performs a lowly-priced service should not even exist. I project that you must have an even less favourable view of unpaid volunteers.

    "It is not my fault as a patient that the consultation charge is $5. I am jsut thankful there are doctors silly enough to think that we patients are stupid enough to get conned. Sorry it won't happen to me."

    You say that it's not your fault that the consultation fees are cheap.

    But how did you then arrive at the conclusion that there are doctors who think that patients are "stupid enough to get conned"?

    Medicine is expensive - but you don't blame the drug companies, instead you accuse doctors of "conning" you because their consultation fee is cheap?

    Something doesn't make sense here.

    By Blogger Lim Leng Hiong, At July 11, 2009 10:49 am  

  • I think you are trying not to see what is already there. Doctors undercutting each other on consultation fees. Giving in to demanding patients. It is so easy to intimidate doctors. Just threaten to complain against them to SMC they will all cower in fear.

    It is sad actually.

    By Anonymous Anonymous, At July 11, 2009 12:22 pm  

  • I've discussed the issue of doctors undercutting each other previously while looking at the withdrawal of the guideline of fees from the SMA, anon; we are looking at two different issues here now: the effect of pricing on how we value different components of our healthcare system, and whether tests render doctors obsolete.

    By Blogger angry doc, At July 11, 2009 2:24 pm  

  • Interesting discussion.

    Is it fair to say that in "some" situations it might make more sense for someone to have an X-ray before seeing his doctor?

    Some A&E departments put a senior doctor at the triage who will order the relevant tests before they see the doctor.

    There are also times when the ideas,concerns and expectations of a patient revolve mostly around a particular test that they wanted to have. Some patients might have visited the clinic merely to get a particular test.

    I feel it is too extreme to say that tests render doctors obsolete. But I can understand why patients might feel that it is not much use seeing a doctor when he cannot make a definitive certifiable diagnosis without a test.

    But tests are merely part of the equation. You need someone to interpret them. The reason why concerned patient felt that all he needed was an x-ray is because at the polyclinics, every x-ray done comes with a report by a radiologist (who is a doctor). So even if CP went to the polyclinic and did not see the GP there and jsut had an x-ray with a report, effectively a doctor was still involved ; the radiologist.

    So doctors are not rendered obsolete by tests.

    If CP feels otherwise, next time ask for a test eg a blood test or X-ray film (no report) and ask him to interpret the results himself/herself

    By Anonymous dr ozbloke, At July 11, 2009 2:33 pm  

  • "Wantatestitis" is not a disease, Oz Bloke. :)

    "Some A&E departments put a senior doctor at the triage who will order the relevant tests before they see the doctor."

    Still a doctor involved, and a senior one at that. A very good concept, although I wonder what that does to teaching (and learning) - how does he communicate his thought processes to the junior doctors down the stream?

    Oh, and in some departments, nurses order the tests (and treatment sometimes) according to protocols before the patient is seen by a doctor.

    I believe medicine can be 'protocolised' and one day performed adequately by computers, but that day is not here yet.

    I did read somewhere that chickenpox is one of those diagnoses that laymen can confidently make though. Not that that requires a test...

    By Blogger angry doc, At July 11, 2009 2:54 pm  

  • Simple. Just charge more for consults and any and all forms of advice. These days, dentists charge for Oral Hygiene Instructions aka how to brush/floss/use special brushes which is separate from the standard long and short consults. You could always also itemize the x-ray into the film itself and the report, allocating a fee to each.

    By Anonymous Ed, At July 11, 2009 3:38 pm  

  • Speaking from an ER physician's perspective, I find some of the comments interesting, since my experience in the ER ( though skewed ) is that patients don't care about paying $80-$100, as long as SOMETHING is done - e.g. blood test, ECG, xray, scan etc.

    ( I'm of course excluding those who were referred by another doctor from the polyclinic / GP sector. But still... )

    Defensive medicine is becoming more prevalent these days. Seems to be passed down from the wards, where 10 "routine" blood tests are done the minute you're admitted, no matter what you present with ( even for simple food poisoning ).

    Sometimes it seems as if the A&E is the last frontier where doing limited investigations is concerned. We get scolded by patients quite regularly when we tell them no, we CAN'T do an MRI in the ER.

    By Anonymous spacefan, At July 12, 2009 10:48 pm  

  • drs never win.

    if they charge the consult they feel they should charge (i.e. high(how much is high anyway?)), then they will receive complains that they are overcharging.

    if they charge ridiculously low consult, then pple will think no need drs.

    really sad.

    btw, u still need dr for ur mc. lol.

    By Anonymous lys, At July 12, 2009 11:48 pm  

  • Yes, yes; but does no one else think the song is cool?

    By Blogger angry doc, At July 13, 2009 9:18 am  

  • The idea of a computer program replacing a doctor is intriguing since there are a finite number of known ailments.

    The tricky part is to distinguish diseases with similar symptoms.

    The guy shouldn't complain about $10 tests.

    Tests are really expensive in the US. I went to the ER recently and landed with a US$4000 bill just for test.

    The doctor could find nothing wrong and it just turned out to be a very upset tummy(actually colon infection) and nothing serious.

    The nurse on the phone wanted to even call an ambulance but I chose to walk as the ambulance would be US$1500.

    That was just for the use of the ER and the blood/urine test. I am still waiting for the doctor's own bill.

    Lucky, I have insurance so only pay US$500 after the deductible.

    By Blogger skeptic, At July 13, 2009 3:09 pm  

  • Is it true that consultation charge at Polyclinic is $8? That's more expensive than what my pte GP charges! Where's the govt subsidy?

    Sometimes my pte GP spends about 30+min with me patiently answering my many questions. I'm amazed he still charges $5 for that 30min.

    I know lawyers would never have that. It's a consultation fee for a professional's advice!

    Having said that, when we get advice from financial advisors, we don't pay them any fee, they only earn when we buy some financial product from them.

    Perhaps GPs are also moving in that direction and make profits from the tests and drugs they give to patients?

    By Anonymous Anonymous, At July 13, 2009 9:22 pm  

  • "Sometimes it seems as if the A&E is the last frontier where doing limited investigations is concerned. We get scolded by patients quite regularly when we tell them no, we CAN'T do an MRI in the ER."

    Are doctors paid bonuses depending on how much they have saved the government money in unneeded tests?

    I heard of a someone who had a relative who had gone to the ER with head injuries and the ER doc said a CT scan was not needed. He insisted that the relative have a CT scan. The ER doc then agreed to admit the relative so that she could have a CT scan.

    But the relative turned bad in the ward and they tried to arrange for an emergency CT scan but she died in the scan room.

    Can doctors really tell with certainty who needs and who does not need a CT scan?

    Why take the risk of being sued? Are there perks for trying to save the government money? Otherwise I can't think of why doctors would be crazy enough to risk their reputations like this!

    By Anonymous space monkey, At July 13, 2009 9:49 pm  

  • Is it more fun to tell you the answers, or ask you questions to make you come up with the answers yourselves?

    "Sometimes my pte GP spends about 30+min with me patiently answering my many questions. I'm amazed he still charges $5 for that 30min."

    If your GP makes $5 in 30 mins or $10 an hour, how much do you think he makes a month?

    If the polyclinic charges $8 per patient, how much does each doctor gross a month? How much is each doctor paid a month? How much profit is made per patient, after deducting utilities, cleaning bills, expendables, wear-and-tear of non-expendable equipment, etc.? Is there any profit? That will answer your question: Where's the govt subsidy?

    Try not to see all the world's problems from the perspective of your personal experience, anon.

    By Blogger angry doc, At July 13, 2009 11:17 pm  

  • "Are there perks for trying to save the government money? Otherwise I can't think of why doctors would be crazy enough to risk their reputations like this!"

    If that is the only motivation you can think of to not do a CT scan for every patient who thinks he needs one, then I feel sorry for you, space monkey. I hope you are not a doctor.

    By Blogger angry doc, At July 13, 2009 11:23 pm  

  • "The idea of a computer program replacing a doctor is intriguing since there are a finite number of known ailments.

    The tricky part is to distinguish diseases with similar symptoms."

    I personally don't see how a human doctor will necessarily be better at distinguishing two diseases with similar symptoms than a computer programme which is fed the same information.

    If anything, doctors tend to base their diagnosis on past experiences and jump to conclusions when seeing something which looks familiar. Most of the time this will probably be sufficient, but occasionally this bias may result in a wrong diagnosis.

    A computer programme will not - and in fact cannot - jump to a conclusion. It doesn't have to - it can go through all the required decision points faster than a human can, and still come up with a diagnosis in the same time it takes for a human to jump to a conclusion. It will not get tired, it will not get sloppy, it will not gamble.

    By Blogger angry doc, At July 13, 2009 11:38 pm  

  • "A computer programme will not - and in fact cannot - jump to a conclusion. It doesn't have to - it can go through all the required decision points faster than a human can, and still come up with a diagnosis in the same time it takes for a human to jump to a conclusion. It will not get tired, it will not get sloppy, it will not gamble."

    Actually this would probably lead to more tests being ordered for "completeness" sake to be less "sloppy"

    By Anonymous Anonymous, At July 14, 2009 11:16 am  

  • No, the computer will order only the required tests as indicated by the programme, no more, no less.

    By Blogger angry doc, At July 14, 2009 11:43 am  

  • angry doc said "Is it more fun to tell you the answers, or ask you questions to make you come up with the answers yourselves?"

    After angry doc has had his fun, I wish he would give us a straight reply on the following issues raised:-

    a) GPs charge less than polyclinic doctors for consultations.

    b) Reason for A&E doctor to NOT order CT scan for head injury.

    This will provide more incentive for a laymen to continue visiting this site for useful information, not just for fun.

    By Anonymous Faircomment, At July 14, 2009 4:08 pm  

  • But it also depends who the person who wrote the program is.

    If you go by the USA medical protocols.....

    So in the event there is a malpractice suit who gets the brunt? The software company?

    By Anonymous Anonymous, At July 14, 2009 4:09 pm  

  • I would like to think that my readers (doctors and laymen alike) come here for fun and appreciate the thought processes that go on here rather than for straight answers, Faircomment.

    Can we really conclude that polyclinics are not subsidised based on the case of the GP who charges $5 for a 30min consult?

    Can something the scale of a polyclinic operate solely on the gross of $10 per doctor per hour and still make a profit, or will it make a loss?

    I think it's more important that my readers play with the numbers in their heads and come up with their own answers, than to accept whatever answer I may give.

    As for the allegation that doctors are not ordering test solely because of the 'bonus' or 'perks', I think it's more a reflection on the character of the person making it than a genuine question. If you are prepared to think that all doctors are motivated only by the same sentiments that you are, then you are unlikely to accept any explanation I may give.

    By Blogger angry doc, At July 14, 2009 5:41 pm  

  • "So in the event there is a malpractice suit who gets the brunt? The software company?"

    A very relevant question.

    I would imagine that the company or organisation producing the protocol will be liable for adverse outcomes which result from the correct application of the protocol, while the software company may be liable for outcomes which occur as a result of the wrong application of the protocol due to a glitch or a bug.

    Your question does highlight the role of the doctor as a *person* to be held responsible though.

    By Blogger angry doc, At July 14, 2009 5:45 pm  

  • Somehow I feel that after a patient sees a doctor, it is unacceptable for anything bad to happen to the patient especially if he was sent home.

    I've seen parents who bring their children to see me complaining of chest pain when they run and are concerned about sudden cardiac death. There's really no way to make sure they won't get SCD is there?

    So the safest thing I can do for everyone concerned is to certify them unfit to run.

    I wonder what happens when NSFs present with the same concerns?

    By Anonymous Young MO, At July 14, 2009 9:11 pm  

  • Read some comparison of doctors with bankers. Seeing a doctor is like seeing a banker who tells you that you can invest your money with him and he will keep it safe for you as long as he can but that you will definitely lose all of it eventually. The strange thing is that people still believe in the doctor being able to keep the money safe for him forever. If only people could realise the truth.

    By Anonymous SFI, At July 15, 2009 10:49 am  

  • That's a meaningless comparison, SFI.

    Seeing a doctor is like seeing a doctor.

    Everybody dies. The difference is in how long you live and how healthy you are until that day, and doctors can make a difference.

    By Blogger angry doc, At July 15, 2009 11:22 am  

  • To SFI:

    "Read some comparison of doctors with bankers. Seeing a doctor is like seeing a banker who tells you that you can invest your money with him and he will keep it safe for you as long as he can but that you will definitely lose all of it eventually. The strange thing is that people still believe in the doctor being able to keep the money safe for him forever. If only people could realise the truth."

    I don't know much about bankers or the "truth" but I do believe that forever is a fairly long time.

    Even one quadrillion years (15 zeros), which is 73,000 times longer than the age of our Universe is only an infinitestimal fraction of forever.

    So far I haven't met anyone who can help me keep anything forever for nine dollars.

    Do let me know if you find anyone who claims that.

    By Blogger Lim Leng Hiong, At July 15, 2009 12:12 pm  

  • I get very irritate when I see a doctor who don't want to do test that I want at the A&E. I understand if the test is danger to me but it is just a sample of blood. Why the doctor cannot just do the test for me? Often the doctor say don't need or that it waste money. But I am the customer, I go to the doctor is to get the test in the first place. Go there then don't do then is waste my money. Doctor save money for who like that? Wait anything happen to me cos never do the test how?

    By Anonymous Anonymous, At July 15, 2009 2:16 pm  

  • Anon,

    I'm going to assume you are asking genuinely and that yours is not a parody-comment; frankly, sometimes it's difficult to tell between stupidity and sarcasm.

    The reason why you feel frustrated is because you misunderstand the nature of a consultation.

    When you see a doctor at the A&E, you are not a customer but a patient.

    The doctor is not a waiter - he is not there to take your order and get you what you want, but to assess you and recommend what he thinks you need.

    'Waste' here does not refer to just money, but to waste of time and resources which can be put to better use.

    And there are risks in doing a blood test, both to the patient and the person taking the blood, as well as anyone who handles the blood subsequently. And then there is the problem of false positives, which I wrote about in the main post.

    If you think you are qualified to decide what tests you need, to interprete the results, and to implement the proper treatment based on them, then you can go to a private lab and ask for the tests yourself; you won't have to wait at the A&E and other less-qualified patients can get to see the doctor sooner.

    By Blogger angry doc, At July 15, 2009 2:54 pm  

  • doc,I don't undertstand your logic. If I go to private GP clinic they usually say no problem if I want to do any test. They might say no need, but if I say I want then then just give. But go to public one then cannot. To me this is trying to save money on the doctor part. I think sometimes want to save too much then can be dangerous for patient.

    By Anonymous Anonymous, At July 15, 2009 3:03 pm  

  • So who do you think is right: the GP, or the A&E doctor?

    If you think the A&E doctor is wrong, then why do you go to the A&E?

    By Blogger angry doc, At July 15, 2009 3:05 pm  

  • Pte must pay mah. A&E is free for me. Nowadays I go to Polyclinic. Easier to get what I want. I got friends who also go to Polyclinic as it is cheaper. If the doctor not helpful just threaten to complain he sure scared one.

    By Anonymous Anonymous, At July 15, 2009 3:23 pm  

  • "Pte must pay mah. A&E is free for me. Nowadays I go to Polyclinic. Easier to get what I want. I got friends who also go to Polyclinic as it is cheaper. If the doctor not helpful just threaten to complain he sure scared one."

    Nowadays with this kind of patients, it is getting much harder to practice medicine. This kind of mentality is really childish, to say the least.

    By Anonymous vince, At July 15, 2009 10:32 pm  

  • These days it is easy to make complaints. Avenues of feedback are easily accessible. One might say it is encouraged. Anyone who has worked in the service industries will know how the system works. Customer complains about ground level staff service to upper management. Upper management asks ground service for information and explanations. Upper management goes to unhappy customer and apologizes ON BEHALF of the ground level staff and attempts to mitigate with whatever possible means.Ground level staff is often left cold without an answer to what the upper management said or did for the customer. Ground level staff always feel like they were always wrong as a result. And having many complaints = bad work performance.

    By working in this system, everyone realizes that everyone else in other organizations use the same system. So if you are on the receiving end of this, why not be on the other end giving it out as well for your own benefit? After all this is the accepted system we all use and want in our organizations.

    It is a lot easier to give customers what they want. But as a doctor there are things that can be unethical, dangerous, illegal which patients cannot understand. Health care organizations are run with the same systems that other service organizations use. And the upper management people are majority non-medically trained as well. In the end you have so many normal non medical service trained people telling medically trained people what to do. So medically trained might be better off conforming to regular standards.

    By Anonymous Anonymous, At July 16, 2009 8:39 am  

  • Well, we get the patients we deserve, and soon they will get the healthcare system that they deserve. I can't reveal more, but (I hate this expression) mark my words changes are being planned in response to this trend.

    By Blogger angry doc, At July 16, 2009 9:06 am  

  • mark my words is a bit like make no mistake. Who are the people planning these plans? Upper management? Why would they want to make changes that give more power and authority to the ground level staff (ie medical staff) and less for themselves? Doesn't make any sense. The only way for that to happen is for the medical staff to have dissent and revolt or refuse to co-operate. We all know doctors and nurses are not like that. They are selfless and accomodating, subservient to their patients (and in turn anyone else).

    Wishful thinking angrydoc!

    By Anonymous Management, At July 16, 2009 9:33 am  

  • No, Management, I am not saying that 'they' are giving "more power and authority to the ground level staff", but that 'they' are taking 'choice' out of the equation for both the doctors and the patients.

    It's not something I would 'wish' for, and I can only hope that the changes will at least lead to better health outcomes.

    By Blogger angry doc, At July 16, 2009 9:47 am  

  • As long as there are patient satisfaction surveys and customer service feedback, we cannot ignore what patients want. The challenge is in how to manage the costs and still have good service. Works in both public and private sectors. I feel sorry for doctors sometimes because they bear the brunt of the anger when it comes to these "cost control" measures that we management people come up with. We don't meet angry patients directly and have to put up with them. The doctors and nurses do. I leave you with a question; who is the one calling the shots?

    By Anonymous Anonymous, At July 16, 2009 10:46 am  

  • we want 'actionable intelligence', not 'noise'.

    Angry Doc justify his own act real well, though. I vote him in the 'noise' box. Because he did not provide any positive alternative after his long speech here. LOL.

    My recommendation to all of you young doctors / senior registrars who are genuinely interested in the welfare of our patients, is get this copy ,(it is 175 pages long)YOUR BODY NEVER LIES (The Complete Book Of Oriental Diagnosis ) by Michio Kushi. A very simple and accurate guide to the gentle art of using touch, sight, and pressure to detect common health disorders.Actionable intelligence need more than action.

    By Blogger Its ME, At July 25, 2009 11:38 am  

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