Sunday, February 19, 2006


Life's just a continuous line of hurdles. Another one down, 10 million more to go.

March is going to be hell.

To everyone who's emailed but received no reply as yet, I humbly beg for your forgiveness. Seems you all asked a few common questions, so:

1. I will be tied up indefinitely. No chance of a dinner, drinks or toilet break.

2. I can't find the time to watch Brokeback Mountain, but thanks for the invite.

3. I'd love to hear more about the Mayo Clinic. Next coherent email, I promise.

4. Great job on the latest SEMS newsletter.

In Other News

Decided to put the US trip on hold. Need a proper holiday break. And soon. Thus, a switch to tour Switzerland, Bavaria and Austria this July. Looking forward to Mozart's 250th anniversary celebrations. :)

Another ST headline worth laughing over: the day the feature titled "Bed shortage problem solved" came out, one A&E closed and informed us there were FORTY patients waiting for beds, so we couldn't transfer their old cases back ( ie. ambulances diverted so these landed on our doorstep ). A certain super-bug which made the news early 2005 has also recently hit another hospital ( not that the ST has even mentioned it, hmm ), which makes for some pretty interesting scenarios.

So please, don't believe everything you read, ok?

Reasons ERs Always Lose Money

1. MOs LOVE to order blood tests.

I wasn't in a good mood yesterday. When an MO came up to ask me about an abnormal blood result, I learnt that the test was done "because the patient is old". Presented with a complaint of knee pain, later diagnosed as osteoarthritis, so the bloods were clearly not warranted. The MO in question is a very nice chap, but after 3 months in our department, I had to tell him off.

Same goes for x-rays. Senior ER physicians review all abnormal radiological reports, so I've come across quite a few doozies -- patients ( especially those involved in road traffic accidents ) who get zapped from head to toe for the slightest pain, EVEN if there're no deformity, EVEN if there's full range of motion, sometimes EVEN when there's no definite trauma. The x-rays cost $300, the patient gets discharged, and pays a measly $80 for the whole consult. So the radiology department earns big bucks, the A&E foots the bill and gets interrogated on why it exceeded the department budget, while the MOs get away scot-free.

2. Patients LOVE to get poked and irradiated.

Earlier this week, I saw a fellow with a well-known history of atypical chest pain. Followed up at the National Heart Centre because he has hypertension and regular complaints of chest discomfort, but stress testing always came up negative, and the cardiologist didn't think an angiogram was indicated.

So he comes in yet again for "tightness in my chest". Completely atypical variety, ECG pristine, but I decide to put him on our chest pain protocol for good measure. Since he's been in and out of our ER many times, I only take Trop T levels and forgo the usual FBC, renal panel, CXR set.

"Aren't you going to x-ray me?" he asks, sounding a bit miffed.

"Err, no. I don't think you need one," I reply.

"What?! But I ALWAYS get a chest x-ray each time I come here!"

"I know. But the x-rays were ALL reported as NORMAL."

"So you're really NOT going to x-ray me?" ( starting to sound fed up )

"That's right."

"Well, I WANT an x-ray."

"Well, I'M the doctor, and I'M not going to order one, because you DON'T NEED IT."

We stare at each other. He is NOT pleased.


The thing I've noticed about Singaporeans is how they expect a definitive diagnosis during the very first consult with a doctor. If you explain that you're not sure and need to investigate further, they then assume that any blood test or x-ray or scan will miraculously yield the answer they've been searching for. If you tell them the results are normal and refer them to a specialist clinic, they start to freak out. "Huh? You mean you don't know what's going on? I thought the blood test / x-ray / scan will reveal everything!"

On a few occasions, I decided to ask where they got such an idea from. The answer: their polyclinic or family doctors.

I'm not pointing fingers here. These are truths based on actual interviews.

"My GP / OPS doctor told me the hospital can do a lot of blood tests to find out what I have."

"My GP / OPS doctor said I can come here for a FULL-BODY CHECKUP. TODAY."

"My GP / OPS doctor assures me I can have an OGD / colonoscopy / MRI - heck even brain surgery - TODAY."

It's bad enough we have to entertain loads of frivolous referrals to the ER on a daily basis ( e.g. a patient with Bell's palsy sent to us for "??Bell's palsy", a potassium level of 5.1 with normal creatinine and a history of ACE-inhibitor ingestion, a haemoglobin level of 13, "floaters x 10 years", "itchy throat", "itchy ears", etc ). It's worse when we have to bring these patients back down to earth and explain that our specialist clinics' appointment slots are filled to the brim and no, they can't be seen by a specialist that very day because what they have isn't urgent.

Sometimes, when I get realled ticked off by a particular referrer's stupidity, I just tell the patient point-blank that the referring doctor shouldn't have sent him/her to the ER because there wasn't any need to. And I don't bother to defend the physician when the patient becomes furious. I cover up mistakes most of the time, but if the referral clogs up our queue and demonstrates a clear lack of understanding of basic management, I think it's only fair that the responsible party is highlighted.

Anyway, I'm getting really tired and want to take a walk in the nearby park, so I'm gonna stop here. No idea when my next entry will be so drop by the other links to get your usual dose of angst, haha. :)

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