Thursday, August 23, 2007

To say I had a bad week would be a gross understatement.

Within that short period of time, I witnessed a wide spectrum of disappointing displays of self-righteous arrogance, by both patients and fellow medical colleagues ( not within my department, thankfully ).

Worse still, one lied shamelessly to save his/her own skin, another denigrated my MO's good character, while the last tried to wrestle an MC using fear tactics.

The outcome?

The first, it turns out, has already been exposed thanks to prior statements given to other interviewers, and was severely reprimanded.

The second was proven wrong, thanks to the wonders of hospital computer software, which allows me to track every investigation done, including the ward's discharge summary.

The third didn't succeed in his/her quest for medical leave, even though I was yelled at in public, and hurled a loud threat to "write to the Forum Page".

One of the above events depressed me so terribly because I drew parallels between this incident and another which befell me 7 years ago.

Perhaps due in part to this emotional trauma, a second cycle of inner turmoil surfaced, resulting in my decision to relinquish a rather high-profile position in a bid to save my health and sanity.

Fortunately, everything is almost completely resolved. And despite persuasion to rejoin the group, I maintain that I made the right choice, as evidenced by a liberating sensation of a heavy burden being lifted off my constricted chest.

Now if only I can get myself removed from the mailing list. Stop wreaking havoc with my mailbox, argh!

The bottomline: I'm getting insomnia thinking about the state of the local medical profession.

You can draw your own conclusions.

The Return

...of Grey's Anatomy, woohoo!

I've grown very fond of this show, which I admit started off with a nauseating overdose of melodrama, but gained a huge fanbase for its smart scripts which, though implausible ( bomb disasters, Florence Nightingale scenarios, all that sex pre-, during and post-call ), grabbed our eyeballs and refused to let go.

I managed to latch on to a few favourites -- the recurring theme of betrayal in its many varied forms; George O'Malley, whose unrequited love, kindness and sincerity tore me to pieces; Isabel Stevens, the perfect blonde beauty whose doomed romance with end-stage cardiac failure patient Denny was the pinnacle of television emoting ( I cry every time I watch that heartrending scene where she begs him to stay alive for her *sniff* ).

Last night's premiere of Season 3 was slightly disappointing, mostly because of the unnecessary bawling scene involving Miranda ( aka The Nazi ) and a patient who lost his wife ( the guy being Eugene from The Practice ). Good thing I recorded it, 'cos I pressed the fast-forward button really hard during this segment.

In any case, I've already read the episode guide online, so I know what transpires -- at least in the finale.

But I'm still gonna jump on the rollercoaster ride. I'm nothing if not loyal. :)

Finished, At Last!

Harry Potter & The Deathly Hallows, that is.

Took me almost a month -- as a friend put it, yes I'm "pathetic". :)

But that's what happens when you do all your reading at bed-time. The sad part is, I used it as a sedative. And a very effective one at that!

I'm sorry, man. JK Rowling's writing skills have deteriorated awfully. The plot meanders too often for comfort ( I absolutely detest all those lengthy bits where Harry and his pals Disapparate from one hiding spot to another, where they scrounge for food and plan their next move for weeks and weeks on end. ).

Call me dense, but I failed to make a connection between all that mumbo-jumbo about the Deathly Hallows and the Horcruxes. The finale was limp, the epilogue cheesy.

I love the concept of Harry Potter, and consider the first 3 books among the best I've read.

But I'm saddened by the franchise's undignified closure. Surely Harry deserved much better.

There is, however, one good and memorable line on page 575:

"...perhaps those who are best suited to power are those who have never sought it. Those who, like you, have leadership thrust upon them, and take up the mantle because they must, and find to their own surprise that they wear it well."

Let's see how Rowling fares with her Scottish crime thriller.

I still recommend John Berendt to anyone who'll listen. :)

I also recommend Numb3rs ( link available on the right ), which is getting super cheem these days. Listening to the dialogue is a major intellectual workout, requiring some degree of additional processing before I fully comprehend what the heck they just said.

Ahh, but how I love the vocabulary acrobatics! All those algorithms and mathematical theorems! Particle kinetics, waveform analyses, hypotheses, etc!

They make it look so easy, with cool examples drawn from everyday life, applied to a math genius' interpretation.

Truly one of the smartest TV series around. I'm a geek through and through. :)

And speaking of geeks...

On The Lot - The Finale

Sadly, this reality show failed to live up to many expectations.

It had a promising start, but lost steam somewhere in the middle, and fizzled at the end.

The last 3 episodes were dull, to say the least. At a crucial point where the top directors are fighting for a dream job, the producers elected to HAVE REPEAT SCREENINGS OF THE CONTESTANTS' PREVIOUS WORK?!?

Anyway, was hoping Zach Lipovsky would win the title, but Will Bigham got it. I personally thought Adam Stein was the strongest contender post-Zach, but hey, as long as Jason didn't emerge the victor, I'm happy.

Going to play some Internet games now. Need to relax.

Saturday, August 11, 2007


Yes, it's been another one of those weeks.

Oh wait, make it three.

Incapacitating exhaustion. GERD flares. The occasional anxiety about an incident which I'm forbidden to discuss in a public forum. But most of all...

An Issue Of Trust

A recent email to fellow medical colleagues posing a clinical question unexpectedly turned into a massive effort to discredit the histories provided by 2 patients I saw in the ER.

And I suddenly realized how the sacred doctor-patient relationship has eroded beyond repair.

As Dr. Gregory House would gleefully proclaim: ALL PATIENTS LIE.

The outcry was severe. My willingness to believe my patients' stories was beaten to a bloody pulp. I was accused of maligning our hardworking and often misunderstood general practitioners. It got pretty ugly.

The original query is probably now buried deep beneath other grouses, but the lack of trust within the medical profession isn't something we should ignore either, so let's discuss it further.

5 Questions for Singaporean Doctors
( if you're not from Singapore, please indicate this if you choose to answer )

1. Do you agree that the doctor-patient relationship has deteriorated?

2. Do you think you can trust your patients:
a) >90% of the time
b) 75-90% of the time
c) 50-75% of the time
d) 25-50% of the time, or
e) <25%>

3. Have you ever been the victim of baseless accusations from a patient and/or patient's relatives?
Please supply a few details ( be sure to omit patient and clinic / hospital names ).

4. Why do you think this is happening?

5. What can local medical professional bodies do to rectify the problem?

I obviously don't have statistics on this issue. But drawing from my 8 years in the busy government sector:

1. Yes, definitely.

2. c

3. Too many for comfort.
Fortunately, however, I had the benefit of reliable witnesses, good documentation, irrefutable time stamps ( thanks to computerized ER case records which log everything from time of consultation to investigation / treatment orders and dispositions ).

One memorable case had an elderly lady's son lodging a nasty complaint against me regarding an incident which occurred during the first day of the MOPEX changeover a few years ago ( during which we saw 400 patients within a 24-hour period ). The patient was stable but already placed in the priority queue and I completed the consultation within a very short period, before asking a nurse to transfer her to the observation ward to await a ward allocation.

Her son later arrived at the obs ward and was upset that I didn't speak to him personally, then repeatedly harrassed the nurses to call me over, despite my having my hands full in resus and critical care.

Finally, I spoke to him over the phone as I frantically typed notes in yet another patient's case record, apologizing ( yes, APOLOGIZING ) for my absence and attempting to explain the ER situation, but he would have none of it. He wouldn't stop screaming at me and accused me of administering an antibiotic which caused his mother to have chest pain and breathlessness. I informed him that she mentioned nothing of the sort, and that her recent discharge summary never indicated any adverse reactions to any of the powerful antibiotics given to her ( the one I injected was milder by comparison ).

Undeterred, he continued to berate me, until I gave up and said, "If you won't believe anything I say, then I'm afraid I can't do anything more to change your mind."

A few days later, the complaint arrived.

Aside from calling me "rude" and "unfit to be a doctor", he alleged that his mother waited "more than 1 hour" to see the doctor, and waited "more than 30 minutes" for an x-ray. But thanks to computerization, it was clearly shown that I saw her within 9 minutes after triage, ordered the x-ray 15 minutes later, and sent her to the admissions task list 10 minutes after that. ( I still have the complaint and case records to this very day -- that's how POed I am ).

He also claimed his mother told him I'm "unattentive and uncompassionate". If only I had video footage of myself holding the vomit bag for her as she coughed and retched into it, and of my ongoing narrative as I explained everything I was doing for her. She even nodded her head and asked questions, for pete's sake!

In short, the computer saved my ass.

4. Many reasons:

Increasing affluence and educational qualifications perhaps, which translate into some form of superiority complex that makes people feel they're entitled to whatever they ask for ( or more often, DEMAND IN LOUD, ATTENTION-SEEKING VOICES ).

The media, which encourages public complaints, however inaccurate they may be. ( Best example: the woman who launched a massive Forum Page tirade against the SNEC, only to retract it later and have the Straits Times relay on her behalf that she actually went to a private eye surgeon instead. NO APOLOGY ISSUED. )

Sadly, there's the possibility that mistrust of doctors stems from bad experiences with our medical colleagues. I see enough patients who refuse to return to their original hospitals because they hate the staff there. One fellow with a heart attack even told me he didn't consent to an angiogram because "I just didn't trust the cardiologist".

5. I posed this problem to one such body in my email, but as I said, it got shredded and the central issue was completely side-tracked. Hence, I have no answer to this question.

On A Happier Note

Only 6 more weeks before I go on MAJOR LONG LEAVE, YES!

I've been dreaming of this destination all my life, and have an excellent itinerary lined up, in addition to a detour to the world's greatest emergency medicine conference.

More details after I return. :D

Cool Dudes

Two in particular.

One's fictional, from the TV series The Closer.

There's this FBI agent, Fritz Howard, played by Jon Tenney ( click his name on this page ). He's smart, successful and strong-willed, yet fully able to appreciate the idiosyncracies and equally strong mind of his girlfriend, a ballsy LAPD Deputy Chief, no less.

Initially a small part, Howard receives an increasing amount of screentime as Season 1 progresses, and earned my first big-smiled "Awww" during an episode where he not only demonstrated some masculine take-charge attitude, but also displayed beautiful chivalry and patience which illustrated his comfortable sense of self-confidence and security.

I know a few men like that - they're the best! If only I had the time to hang out with them more often. :)

If you have a chance to rent the DVD, please do.
Season 2 should be arriving soon.

Oh yeah, the second dude. :)

Met him yesterday during a stint at the Istana.

Naval officer, maybe in his early 40s. Good-looking chap, tall, slim, and one heck of an entertainer.

We were treated to a tour of the estate, to help "orientate us in case we're called to attend to someone".

He proved to be a most helpful guide, and I was adequately impressed by what I saw ( though nothing quite compares to the grand opulence of the Vatican ).

The cheeky teasing was a nice touch. I didn't realize our military personnel were so charming, heh heh!

The Saga Continues

Am two-thirds of the way through Harry Potter & The Deathly Hallows.

I don't really like it, but unfortunately, I want to finish the book because - well - I have to. Sorry, I can't stop myself.

The plot meanders, the conversations are repetitive, and what's with the Deathstick concoction? Is that an act of desperation on JK Rowling's part? Why not just leave it at The Elder Wand / The Wand of Destiny? Yeesh...

Farewell, Bar None

Don't think I'll feel up to attending the party on August 31st.

But I have the best memories of this wonderful little place, which I've visited often with various friends, for various reasons.

You've had a good run, guys. I'll miss you.

More next time. Wishing you a good week ahead. :)