Sunday, December 20, 2009

Singapore Healthcare- A Personal Perspective

Hi Friends,

I know our healthcare system is not perfect.

And our doctors are definitely not “angels”.

But there are still Singapore doctors out there who are ethical and abide by the spirit of the Hippocratic Oath (even in the private sector) that I feel a defence of our system is warranted here.

Is our healthcare more expensive than our neighbours’ ? Are there times when we wished that the results from surgery or treatment were better? Are there black sheep in our system who are “outliers” as far as indications for treatment or treatment fees are concerned? The answers are of course “Yes”!

But would I still recommend my loved ones to be treated here in Singapore? Of course (except for the most trivial conditions).

In all hospitals (public and private), volunteer doctors and other personnel sit in committees to look into how healthcare can be better delivered to our patients.In my hospital, Gleneagles Hospital, amongst other things, committees ensure that there is Quality assurance; that all deaths are independently reviewed and surgical specimens from patients confirm that operations were really needed etc.

When near-misses or actual mishaps happen, we help the hospital to diligently look for the root causes and design correct processes to plug gaps in the system. We are often pleasantly surprised to know that in many near-misses, these mistakes are identified further down the line by another vigilant colleague who actually helped to avert potential disasters.

An “honour” system where healthcare workers including nurses and doctors, voluntarily submit “Hospital Occurrence Reports” (HOR) whenever such incidences occur. These range from serious ones such as prescribing patients with drugs that they are known to be allergic to, to trivial incidences such as patients having broken skin when plasters are removed.

In fact, reporting near misses is not unique to the healthcare industry. The aviation industry also reports near misses and the familiar safety rule of turning off electronic devices that can interfere with navigation equipment, is a result of this.

However, when staff (including doctors) are recalcitrant and disregard established safety norms, they are investigated and disciplinary actions are taken when appropriate. Some doctors have had their working privileges suspended or get reported for further action by the Singapore Medical Council and the Ministry of Health.


Cheers

Dr Huang Shoou Chyuan


The unabridged letter (20.12.09) ( I will append Salma Khalik's letter the moment I find a digital copy) Click here for the "edited" published letter.

Dear Editor,

I refer to Salma Khalik’s article “Make hospitals and docs more accountable”.

Khalik refers to the unfortunate case where the tissue biopsy diagnosis from a “quick analysis” frozen section (FS) (usually obtained within minutes while the patient is already in the operating theatre) differed from the final permanent section (usually reported at least one day later). It is internationally accepted practice for a surgeon to rely on FS for guidance as to whether a major operation should proceed.

In this case, the final permanent section showed “no cancer” – by which time major surgery had already been done as the FS reported a diagnosis of “cancer”.

FS is an invaluable tool used by surgeons. However, as with any diagnostic tool, there are limitations that allow errors to occur, including the initial selection of tissue by the surgeon, the tissue sampling by the pathologist, the technical expertise required to prepare the slides, errors in interpretation, and delivery of the result back to the surgeon.

Some diseases are so complex that even the most renowned pathologist would make errors in the FS or even in the permanent section!

To complicate the issue, a converse situation could also happen. The FS could report “benign” and surgery aborted, only to be proven wrong much later- by which time cancer might be too advanced for curative treatment.

Let me cite an actual example. My patient had thyroid surgery in another country. FS was not done and only partial resection was done. On re-evaluation of the tissue slides by our pathologist, “cancer”was confirmed and a second operation was needed for total resection of the cancer-bearing organ. If initial surgery was planned with FS, he would only have needed one operation.

Despite what Khalik has written in recent times, I sincerely feel that Singapore’s healthcare in both public and private hospitals has proven, time and again, to meet the needs of Singapore’s residents. The “complaints” published in the media pale in comparison to compliments we hear about our system from our patients and families.

Doctors, especially in the public hospitals, frequently miss meals as the 5-10 minutes slots allotted for outpatients are not sufficient for complex cases and those needing procedures.

Yes, mishaps do regrettably happen and on a daily basis too, but these are mainly minor with no “adverse outcomes”. This is unsurprising as Alexander Pope had said that “To err is human”.

Time does not permit me to elucidate measures taken by hospitals to minimize mishaps.

I am particularly heartened to learn that despite suffering from the KKH chemotherapy mix-up, the patients were willing to forgive. They remind me that Pope’s quotation ended with ..” to forgive is divine”.

Dr Huang Shoou Chyuan

36 comments:

Anonymous said...

Dear doctor do you think that no matter in what cases we should avoid any surgery procedures and try other means to cure a problem first? we should always leave surgery to the last option if possible.

few years ago my grandmother in her early 70s passed away after she went for operation for the cervical to prevent cancer to form. after operation she looked fine but she die from internal bleeding about 1 week after the operation if i am not wrong.

i am sad for my grandfather who is now single. i am sad myself as well. few days before her operation she seem to be worried and think of not having the operation. but i told her healthcare in singapore is very advance should not be worry. maybe my grandfather is also very sad as he also ask her to go for operation. if she did not go for the operation maybe she is still here today.

i wish i am a doctor myself so that i will know if she really need the operation or she die not because of the doctor fault as i am not so sure of the death report as well.

hope no matter where she is now, she is fine and happy. hope my grandfather will be happy and live to a ripe old age.

hope most doctors in singapore are good doctors if not all.

nofearSingapore said...

Hi anonymous 7.52,

I am sorry about your grandmother.

As a general rule, if something can be cured without surgery, of course it should be attempted first. However, for known conditions such as “cancer”, it is often that surgery and sometimes other treatment after that eg chemotherapy or radiotherapy, cannot be avoided. It is also true that for many cancers, the first surgery could also be the best chance for cure. If the first surgery was incomplete , when the next time surgery is done, the operation site could be “contaminated” by cancer cells and cure may now not be possible.

My own grandma had the same cervix cancer and by the time we found out, it had spread. Surgery was not possible by then and radiotherapy only helped a bit.

I wish for a day when cancer and other diseases can be cured. Until then, we should live a healthy life and avoid known vices eg smoking and help doctors try to cure our loved ones who are sick.

Dr Huang

Anonymous said...

Dear Doctor,

I have just stumbled upon your remarkable blog, read a number of the entries, which reveal a true passion for your work, and a deep understanding of the ethical duties that comes with such a profession.

I wish there were more like you in Singapore.

I am from France, where the standard of healthcare is quite high. Sure, the system is not perfect (it often gets abused), but you do get treated properly and can, in general, rely on the advice and competence of doctors. They overwhelmingly put the patient ahead of economic considerations.

Not let me tell you about our latest experience in Singapore, in Gleneagles, the very hospital where you practice.

Two months ago my wife bought a test and found out she was pregnant. Having had a very bad experience with her former gynecologist at the Camden Medical Center, a greedy lady who was charging ridiculous amounts for the simplest exams, she proceeded to find one at Gleneagles.

To cut a long story short, the baby turned out to not be viable, but it took 3 preliminary scans before the intervention, 1 other consultation to make sure, the intervention itself, and another scan post surgery to get the issue resolved. And the doctor is now insisting on another scan a month from now "just to be sure"

I've just done my insurance reclaim today, and we have so far disbursed $4,700. I have to point out that none of the appointments have lasted more than 20mn. We are lucky to have a good personal insurance, so should not end up out of pocket, at least not too much. But we are SHOCKED at the way doctors operate in the private sector here. There doesn't seem to be any restrain and the main motto seems to be "quick buck". You are not considered as a patient (that would entail ethics), not even a customer (that would entail quality of service), you are basically an ATM.

I guess we saw the reality hit us the evening when we left Gleneagles after the surgery. It was at the time when doctors were leaving the hospital, and it felt like being in the middle of a Porsche showroom. Unbelievable.

I find it incredible that there is no guidelines as to what doctors should / can charge, even in the private sector and that such crass behaviors are tolerated (remember, it is the 2nd gynecologist out of 2 who rips us off). I know that, in Singapore, businesses / corporations' interests are systematically prioritized ahead of consumers' right, but one would have hoped this would not apply to health.

One will say:"if you're not happy with that doctor or Gleneagles, you're free to go to another hospital, even a public one". Well, that's exactly what we intend to do next time around. Firstly because, even if we get 100% refund by the insurance policy, we cannot tolerate to be ripped off in this fashion. Secondly, because we find Gleneagles seriously run-down. Small town public hospitals in France are better kept / renovated than this. The gynecologist's practice itself was absolutely filthy. A public hospital can’t be worse. Seriously.

Sorry for the rant, and I know all doctors are probably not behaving like this in Singapore. But while we are still happy to live here, this episode has made a dent in our opinion about this country, where making a buck seems to trump any other consideration.

Cheers

nofearSingapore said...

Dear anonymous 7.51,
It would not be professional nor fair for me to make comments about your wife’s 2 gynaecologists other than to say that doing many scans before an invasive treatment could also be interpreted as being cautious. If a doctor tells a patient that she needs “intervention” after only one scan- he/she might also be construed as being “knife-happy” or greedy to make money at the expense of the patient’s well-being. But I am not a gynae- so I am no expert.

On “guideline for fees” – I am just as disturbed by you and I have also had letters published in the newspapers’ forum pages on this. Read my blog on this issue at http://nofearsingapore.blogspot.com/2009/02/medical-guideline-on-fees-should-be.html

On lifestyle choices of doctors eg Porsche cars etc- Just as I would not want others to decide for me what sort of car to drive nor where to spend my holidays, I am indifferent to these choices. The types of cars has nothing to do with whether a doctor is good/ethical etc. Just in case you think I am a tad defensive here- my car is old and not a Porsche and I have never been on a ski slope , but I do golf- badly. I know of some very ethical doctors who charge very reasonable fees who drive something much sleeker than the Porsche. I also know some who drive humble cars whom I would not send my enemies to.

From your sweeping statements about private sector doctors- my only conclusion is that you have been unlucky and have not had the opportunity to meet my friends.

The public hospital doctors are all good- but do expect that waiting times etc will be longer.

Best wishes

Dr Huang

nofearSingapore said...

Hi
anonymous 7.51,

Typo in second para:
On “guideline for fees” – I am just as disturbed as you and I have also had letters published in the newspapers’ forum pages on this. Read my blog on this issue at http://nofearsingapore.blogspot.com/2009/02/medical-guideline-on-fees-should-be.html

Anonymous said...

Dear Dr Huang, thank you for sharing. Indeed, there are black sheep in our medical system, just as there are similar fiends in the legal and finance sectors. It appears that the subject of the tissue biopsy diagnosis from a “quick analysis” frozen section is the same mentioned in Dr Lee Wei Lin's article in the Straits Times. This must be a hot topic in your medical circles. Given the current medical understanding that the final permanent section examination will provide a more accurate diagnosis, couldn't the doctors have waited for one more day before operating? Surely surgery for cancer tumors is not time critical like defusing a IED in Iraq, there is sufficient time for a second opinion. Chemotherapy also takes weeks, if not months, of a long drawn process. Why then are there “knife-happy” professionals, to borrow your expression? In my personal experience with a brother lost to colon cancer, the first doctor in attendance recommended surgery. But then a senior registrar came into the loop, and he proposed chemo instead to shrink the tumor. Latter didn't work, and he had the tumor cut out a couple of months later. We never knew which doctor made the correct decision, but he died as a result of infection from the operation, not from the cancer. The frustrating part was that during the convalescence stage after the operation (he was so strong he didn't even have to be in ICU after the op, he was wheeled straight back into the ward), as long as his temperature was even one degree above normal, he was not allowed to continue the chemo treatment. To this day I still fail to understand the doctors' logic that the fever could be more deadly than the metastasizing cancer. The other frustration was the doctors' reticence to discuss their observations, despite my pesistent efforts to be at my brother 's bedside during their daily rounds. The palliative care doctors were more open, but then it was too late.i

nofearSingapore said...

1.Frozen section obtained in OR- sometimes the surgical approach into the organ (eg brain/lung) is tedious and getting there can take hours. A specimen is obtained and sent to pathologist who is already waiting in a side room for this specimen. The surgeon and anesthetist then sits there and wait for the pathologist’s FS report ( minutes). All this time patient is under general anesthesia with all its risks.

If FS reported as cancer or whatever- op go on as planned. If no cancer- op aborted and patient’s operative site is stitched up.

2. Permanent ( also called Paraffin ) section- this is the final specimen which is taken out after the FS was reported as “cancer” and the op proceeded with. If FS is negative- no permanent section.

I hope you understand why FS is so invaluable. Would you like surgeon to spend time to do first operation to remove a part of "tumour"and close up. Wait for pathology report (at least 1-2 days). Then re-operate ASAP if reported as "cancer". A second operation within days is full of danger and for cancer- risk of cancer spread from first operation is great. Sorry but issue is complicated and not as clear cut as what you think. We surgeons do everything to avoid cutting- we do scans/ minimal biopsy eg fine-needle biopsy etc and only after need is clear do we operate.

3. Chemotherapy- kills cancer cells as well as normal immune cells. During some period during chemo, the patient is literally defenceless and a simple cold can kill him ( not exaggerating).

4. Doctors’ rounds- we must respect professionals when they do their work. When techinicians come around to repair my air-con/ piano/computer- I don’t hang around and hover over them watching them diagnose the problem. I trust them – if not why do I call them? When doctors treat my loved ones- I leave the room and trust they know what they are doing. They know I am senior doctor but they know I trust them and do not second guess them. The worst relatives that we doctors hate are those who second guess us and think they know everything by just surfing the net or speaking to their friends ( not talking about you). Medical school= 5 years. Specialist training = 5 years. Sub-specialist training = at least 2-3 years. We do all that not just to drive Porsches but to do our jobs well as professionals.

Dr Huang

aliendoc said...

Nice letter, Dr Huang.

A slight digression, if I may: many complaints voiced against doctors arise from lack of/poor communication between the healthcare professionals & the patients/patients' families, resulting in the mis-perception that the physician was negligent or wrong in his management of the patient. I hope that the "Communication" aspect of medical care will be improved upon. It was not something that was emphasized upon when I/we were in medical school...!

nofearSingapore said...

Hi aliendoc,
I totally agree with you about our doctors' poor communication skills.I don't blame public hospitals' docs cos they only have 5 min to explain clinical findings/CT Scan findings/differential diagnosis/modes of treatments and risks/ prognosis etc. I take 20-30 min for each patient ( or more).
But there is hardly any excuse for private specialists who do not take time and trouble to communicate. The days when patients think we are "gods" and believe everything we say unquestioningly are over. This is the 21st century and patients want respect and we should treat them with respect and dignity.
I always tell my patients- it is your RIGHT to get a second opinion. DEMAND that your doc release all your scans ( with reports) and get your tissue slides ( or specimen blocks) and seek opinion in another clinic/hospital/country if you do not have complete trust in your doc. I also never push or rush a patient into surgery or doing any test unless he/she is convinced about its need.
Do unto others ...

Anonymous said...

Dear doctor,

I somehow agree with "The palliative care doctors were more open" as mentioned by Anonymous 10.04

Is there any particular reason for this or this is not really true?

But as you have also mentioned communication is also very important and the rights of patient to seek 2nd opinion and to keep a record of all findings. I think very true.

But Singapore is changing. Last time, an ex-MP Dr Tan from West Coast write in newspaper about some GPs are more interested in money making cosemetic procedures then helping people with chronic diseases like diabetic.

Therefore I feel the government of Singapore should surely play their part, and should be a major role, to ensure most doctors are of good heart, to ensure most doctors are concern about patient and interest in medicine and not money or cars or the title of DR.

Do you think our government has done really a lot?

I think they can do much more.

What do you think doctor?

Thank you.

Anonymous said...

THE chief executive of a $1 billion property firm died last week, following cosmetic treatment at an Orchard Road clinic.

On Dec 30, 44-year-old Franklin Heng was ferried by ambulance from the clinic to Tan Tock Seng Hospital, where he was pronounced dead.

TTSH chief executive Lim Suet Wun said the case has been referred to the coroner.

'The patient came from a GP clinic and had had liposuction done earlier that afternoon,' he told The Straits Times.

Although Mr Heng showed no signs of life when he arrived at the hospital just after 5pm, doctors spent almost an hour attempting to resuscitate him, said Dr Lim.

A spokesman for the Health Ministry also said it was investigating the matter.

http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_474477.html

Why GP do cosmetic surgery?

Is it because of money, money and more money?

All doctors should be helping people and have a kind heart.

nofearSingapore said...

Hi anonymous 2.42
1. Whether doctors should be cosmetic surgery/procedure is controversial. Some doctors feel that since “lack of beauty” is not a sickness- doctors should be spending time treating the sick and not the “ugly”. Others however feel that doctors who do cosmetic surgery are meeting the needs of some patients.
2. Min of Health had apparently studied the issue intensively and had decided that GP’s can do some “simpler” cosmetic surgery. Now from this case, we know that simple surgery is not so simple after all and have led to death (tragically in this case). So the GP’s (even in this case) are not doing anything illegal ( if they had followed MOH’s guidelines for mini-liposuction in their clinics). We do not know what will happen next but we just have to wait for the results of investigations.
3. Many of my doctor friends feel that by allowing GP’s to do procedures such as mini-liposuctions in their clinics, we were just waiting for such tragedies to happen.i. Surgeons take at least 5 years to train- how much training have GP’s?ii. If complications happen in hospitals, at least there will be expertise available at hand which might help to lessen damage or even save lives.
4. MOH will have to take a serious look at the whole matter before more tragedies occur.

Anonymous said...

I feel that MOH should be blame for this type of things to happen since they allow GP to do cosmetic things.

I hope the GP’s (in this case) are not doing anything illegal (and they had followed MOH’s guidelines for mini-liposuction in their clinics).

Let's see what health minister have to say this time round.

And some more this time round a rich guy has died.

A poor guy like me may have just die that's it.

簡單 said...

Man proposes, God disposes...................................................

Anonymous said...

A lot of doctors' top priority is money. Self-regulation is no use in such a culture. People who believe otherwise are just naive.

Anonymous said...

if overheads like rental are so so high, if doctors are not concern about money how to survive.

but how come rental are so high?

this is all the government fault.

government should control rental from getting higher and higher.

if rental for all businesses, no matter it is GP, dentist, the recent open private hawker centre in sengkang, tuition centres, bookshops, optical shop, resturant......all can sell cheaper and can be much more
humane, then it will surely benefit all singaporean.

please government, please control the rental 1 beg you.

it is the root of all problems.

Anonymous said...

government let private operators bid for hawker centres before leasing out to stall holders. government should just rent direct to singaporean like old hawker centres. rental will be much cheaper.

hdb shops have to go through open bidding. sometimes the bid is extremely high as a result. hdb should practice like last time. secret bidding. rental will be much more average.

Anonymous said...

its all about money money and more money they just want more and more money.

government and hdb is not like a private company eg capitaland.

some more capitaland link to Temasek and Temasek link back to?? everyone knows.

government should help all singaporeans.

please help all singaporeans.

Anonymous said...

In my view and experience as a patient, I would endorse the SGH as the best tertiary medical institution in Singapore and the region.

The medical expertise, facilities and nursing staff they are all there -first rate.

In contrast, the vast majority of private hospital are set up to scalp the medical tourist, the loaded Indonesians and other wealthy foreigners who don't have comparable expertise and facilities back home.

Perhaps the ONLY complain about SGH is that there are more and more foreigners going there for treatment which means less beds (including A class) for locals. Like so many other govt facilities in Singapore, the infrastructure and staff were NEVER intended to take care of the very heavy extra load added on by foreigners.

nofearSingapore said...

Dear anon 12.30:
I am glad that you are happy with SGH’s service.
However I feel that your comments about private hospitals are sweeping and uncalled for. We have many honest and ethical doctors in the private hospital system and you are just tarring all of them unfairly with a very broad brush-stroke.

There is no doubt that hospitalization in the private hospitals can be much higher esply when compared with subsidized cases in the public hospitals. The private hospital do cater to rich Indonesians (FYI there are poor Indonesians too!) and foreigners, but it also caters to Singaporeans of all economic classes who for whatever reason prefer treatment there eg preference to specific doc who is in private system only; shorter waiting time; perceived better service etc.

Both private and public systems play a role. Can you imagine Singapore without a private hospital system? You think the public system will be able to cope then?

mousey said...

Dear Dr Huang

Yes, both private and public systems complement each other in providing healthcare to the population.

From personal experience, the cost of seeking medical help from doctors at pte hospitals are not necessarily always higher than those of govt hospitals (assuming no subsidy given). We, the patients need to put in effort to check around.

I can't imagine Singapore without a private hospital system! The efficiency and availability is something I have learnt to treasure, having stayed overseas. I rely on it as I'm happy to have found very good docs in this system (whose charges are very reasonable) long before having to go overseas. They continue to provide continuity of medical care even when I have to be away for more years to come.
Cheers!

Anonymous said...

i heard a lot of people mentioned cgh not as good.

but my grandmother passed away in sgh after operation.

someone even advise me not to go nuh as next to it is med sch.

i think maybe life is all fated.

when the time is up no matter you are tom, dick or harry.

no matter you are lee or whoever.

no matter you are pap, sdp, wp, rp, pp.

nobody and no party can escape.

live or die. win or lose.

one day surely things will change.

Anonymous said...

recently i read in straits times forum that a woman mentioned her dad visit cgh and was inserted a urine tube instead of a food tube.

cgh reply that it is ok to replace food tube with urine tube when they is no food tube.

DO NOT KNOW WHO IS RIGHT OR WRONG.

nofearSingapore said...

Hi anon 3.54:
A PEG (Percutaneous Endoscopic Gastrotomy) tube is a tube used to channel liquid diet directly into the stomach through a percutaneous gastrotomy which is a direct opening in the abdomen into the stomach. This is used in patients who have serious conditions where they cannot swallow ( I don't know the circumstances of this present case).

When a PEG tube slips out accidentally (like this case), another tube must be inserted into the hole as soon as possible. If not, the hole will close up within one or two days and the patient will need another operation just to create another hole (opening).

CGH A&E dept doctor did what most doctors would do by inserting a tube into the opening as a temporary measure. This tube could be a PEG tube ( which is not easily available in the A&E) or a Foley’s catheter which although usually used for the urinary system can be used for many other systems. In Ear Nose Throat specialty ( which is my field), I have used a Foley’s catheter in the nose to stop bleeding etc. This Foley’s catheter is sterile ( ie no germs) and is safe. Liquid diet can be poured through the tube.

CGH did the right thing. The Straits Times forum page should have printed both questions and answers on the same page. Why make readers and public anxious unnecessarily?

Anonymous said...

I see.

reading your reply make me feel more clear of the truth.

maybe the doctors at cgh did not explain clearly to the lady?

or the lady might not understand clearly?

and straits times should publish the 2 article together as not to confuse me.

and if i read only the first article only, i will think "ai yah its cgh again their service not good one not uncommon"

but i happen to read the 2nd article which is reply by cgh. actually i still feel "cgh might still be wrong"

but now you mentioned all these again and confirm the truth i feel much better.

sorry to wrong cgh in my mind.

but maybe cgh should explain again to the lady.

or maybe if you explain to the lady might be even better as well.

as you are independent third party and your answer is much more clearer and easy to understand

Anonymous said...

oh i suddenly remember the lady say the urine tube too small and food cannot be feed to his dad.

and the appointment to insert back the food tube like too far away.

so his dad has to bear with the hunger.

hiya quite complicated case.

not easy for the doctor and not easy for the patient also.

tough case.

Anonymous said...

Dear Doctor,

Recently in newspaper there is a brain doctor who do treatment i think which is not approved but have research proof, on patient and get punished.

Then another doctor send sample of patient to non-approved overseas lab to test also might get punish.

Then a lady doctor charge extremely high fees for a patient also might get punished.

Actually i have not sure about medical things. i just think, not sure if true or not

1)for the first 2 male doctors maybe they are doing things and thinking out of the box. as govt always encourged people to do so.

but maybe medical things cannot.

2)then for the lady doctor i thought singapore is a free market. means pricing is up to seller and buyer. if i want to sell chicken rice at $100 so be it as long as i can sell.

but maybe medical things cannot use on free market?

but how come government can just say they want to charge $100 for casino entrance fee then charge. which i think it is an idea that is out of the box and a idea that is also too extremely expensive.

to see a medical specialist for just consultation is less than $100only.

doctor what is your view?

thank you.

nofearSingapore said...

Hi anonymous 2.16:

Let me just mention some simple principles which I think is sound and fair to doctors and patients.

Whatever a doctor does-not only should it not harm the patient; it should also be based on well-documented research ( and not just on some personal opinion). If not- how can we doctors consider ourselves scientific and modern. We will be no different from the "medicine man" which I used to see in the 60's and 70's in my kampong.

If a treatment is not proven, then we should not use it. Unless it is a life-saving measure and other methods are not available- then the patient should be told that this is purely experimental and perhaps the patient should be provided this treatment for free (or just pay a very low fee for this.) This is to prevent doctors charging high fees for unproven treatment.

Tissues from patients which have been removed should be sent to recognized labs only. If I send a sample to lab of unknown standard and it reports that I have X disease and that this requires Y treatment ( which is expensive), how do we prevent the patient from being defrauded ? ( I am not saying there is any fraud in the present case). If this unknown standard lab says you have cancer- how are we sure that you really have cancer and that the expensive chemotherapy and radiotherapy is really needed. The treatment itself can cause side-effects and even death. So forcing doctors to send tissue samples to recognized labs is to protect patients.

Since the Competition Corporation of S’pore ( or whatever the name is), took away the fee guidelines, does it mean I can charge $1 million for an operation when 99.9% of doctors in the world charge less than $5k ( for example)? In my humble opinion, a free market is only really free when there is free competition and free information flow. If all doctors are forced to show their fees in a centralized computer system , then patients can go to see the doctor with their eyes opened. Then if doctor Z charges $1 million when you can see with your own eyes that all others charge $5 k or less, then I have nothing to say. It’s your money!

Anonymous said...

thank you Dr for the explaination.

i think the newspaper should explain to us why some of these doctors are caught.

if not i might think it is unfair to them.

Anonymous said...

A doctor has been fined S$5,000 and censured for failing to exercise due care in prescribing drugs to his patients.

Dr Mah Mun Mo, Malcolm, who was a general practitioner at Pacific Mah Medical located at Blk 452 Ang Mo Kio Ave 10 pleaded guilty to nine charges.

The Singapore Medical Council (SMC) said eight of the charges related to the dispensation of Subutex, which is used to wean drug users off their heroin addiction. It was banned as an over-the-counter drug in 2006 following rampant abuse.

The other charge was over prescription of Benzodiazepines, a hypnotic medication used to treat patients with insomnia- and anxiety-related problems.

The SMC said Dr Mah had voluntarily ceased medical practice since August 2007 and has not been practising as a medical practitioner ever since.

Dr Mah had to give a written undertaking to the SMC that he would not engage in similar conduct, and was ordered to pay the costs and expenses of the disciplinary proceedings.

I read the above from channel news asia.

first i must mentioned, anyhow give drugs surely must get punished.

the other thing i wish to point out is you see nowadays to be a doctor also not easy. not to say other industry.

you can see deep inside singapore actually has a lot of problems need to be solve.

maybe on surface singapore look fine.

hope the government can really find good ways to solve problems and not do things like increase gst to 10% and also hope govt can take a lower pay.

hard live for citizen.

Anonymous said...

SingHealth's Group chief operating officer, Dr Wong Yue Sie has died after developing a massive stroke. He was 49.

SingHealth says that despite emergency surgery after his stroke last Friday, Dr Wong succumbed to the severity of the condition yesterday, without regaining consciousness.

He is survived by his wife, Mdm Choy Sok Cheng, 47, and two teenage daughters.

In a statement, SingHealth's Group CEO Professor Tan Ser Kiat said that they have ve lost a gifted clinician leader and a selfless individual who made time for anyone who needed him.

He adds Dr Wong has left a lasting legacy for his family, colleagues and staff.

Among other things, Dr Wong had been the Chief of the SAF Medical Corps.

In 2008, he was seconded to Ren Ci Hospital as its chief executive officer upon the request of the Ministry of Health.

One critical task he faced was the completion and opening of the Ren Ci Community Hospital.

From channel news asia.

Dr Wong was the Chief of the SAF Medical Corps when I was a medic during my NS.

I do not know him or have chat with him personally before. I only heard one of my NS friend (a dental officer assistant) said he was a orthopedic surgeon because he said before enlistment for NS he was examined by Dr Wong. And Dr Wong wrote a letter with regards to his condition to SAF MO. After he was enlisted then he found out actually Dr Wong was not only his doctor and was also Chief of the SAF Medical Corps. Then I said that Dr Wong letter to SAF MO should be the most "powerful" letter. And he said yeah since Dr Wong is the biggest doctor in SAF during that time. So if there is any condition he saw there will be no doubt and any up or downgrade of pres will be 100% sure since other SAF MO most likely will not have any doubt as well.

I found out from your facebook (if i am not wrong) you are Dr Wong are friends. Any interesting things to share about Dr Wong?

I feel it is very sad Dr Wong died so young. I personally do not know how a person he is, But I just feel he was a Dr, a BG, a senior management in Singhealth yet very pity he died so young. Like Singapore wasted another talent.

And there is 1 more thing I am concern. Developing a massive stroke is it can happen to anyone suddenly? and is this condition very common or very rare in Singpaore like what are the chances? Any prevention? Dr Wong to me looks to be in very good health.

Maybe everything in life are fated. Maybe Dr Wong daughters may follow his footsteps in the future to be doctors and finished whatever he has not completed.

Anonymous said...

Hi,

I read from Monday Straits Times Obituary that you and Dr Wong Yue Sie were MBSS classmates.

In life there are so many unexpected things.

Anonymous said...

The Ministry of Trade and Industry (MTI) has declined a request by the Singapore Medical Association, SMA, to exclude its Guideline on Fees (GOF) from the Competition Act.

SMA removed its Guideline voluntarily in April 2007 after being advised by its lawyers that it could contravene the Competition Act.

It then requested the Minister for Trade and Industry to exclude it from the Competition Act on grounds of public policy.

In SMA's opinion, the guideline on fees increases the information available to patients on the prices of medical services, thus preventing overcharging and keeping health-care costs down.

However, MTI, in consultation with the Health Ministry, has assessed that MOH's current and continuing measures to improve information transparency better serves this purpose.

MOH's measures include publishing actual medical fees on its website, requiring hospitals to provide financial counselling to patients and requiring medical bills to be itemised.

MTI said these measures provide more information as they are based on actual prices.

On the other hand, the guideline on fees is a system of recommended fees set by a group of doctors, which creates risk of anti-competitive behaviour.

It's also unlikely to play a significant role in keeping health-care costs down.

It also applies only to the private sector.

Currently, the public sector through the restructured hospitals and government-owned specialty centres provides 80 per cent of hospital services.

These public healthcare fees are independent of the guidelines.

MTI noted that MOH's assessment that the primary care segment which is provided largely by general practitioners in private clinics is already competitive.

MOH has also increased price transparency in this segment by requiring clinics to display their common charges.

MTI said the removal of the fees guideline is thus unlikely to have any effects on the prices of primary care services.

In addition, the SMC is empowered under the Medical Registration Act to act upon complaints received against medical practitioners, which may also include complaints on over-charging that brings disrepute to the profession.

MTI said the government has put in place various measures that are more effective and direct than the GOF in addressing the key problem of information asymmetry in the health-care market, without the potential risk of anti-competitive behaviour.

I read from CNA.

Dear Doctor,

I could not really understand the above article totally. Can you help to explain in even more layman terms and explain as your capacity as a doctor.

Thank you.

nofearSingapore said...

Hi anon 4.10pm:

I attach my post on the above topic.
http://nofearsingapore.blogspot.com/2009/02/medical-guideline-on-fees-should-be.html

I wrote to the forum page on this topic.

Our healhcare costs is going out of control and I feel a guideline that is easily accessible by the public will do prevent doctors from charging exorbitant fees. The MTI does not agree.

We are killing the Golden Goose. So be it.

Dr Huang

James Franklin said...

Cheers for the info. It was a good read.
It’s hard to find knowledgeable people on this topic, but you sound like you know what you’re talking about! Thanks

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