Saturday, October 11, 2008

Catching My Breath the tail end of a tiring night shift.

It wasn't bad in the textbook sense, but the patients trickled in continuously, and the nursing changes piled up until by 3am, there was a mountain of folders stacked on the counter, waiting to be sorted out.

This wasn't helped by the usual flood of drunks, and a stream of "chest pain" complaints, assaults, and of course, NS boys.

I chanced upon this article in the latest issue of the SMA News, written by a friend who currently sits on my institution's medical board. He mentions a Straits Times piece which dwells on the same topic, but I missed it as I was overseas at the time. Would appreciate a link, or an emailed soft copy.

My two cents? The problem is a lot more complex than most people imagine. Raising the consultation fee is no deterrent, as evidenced by the many "bad debtors" we see flagged in our computer systems. Some of these patients come almost daily, but never pay their bills. This constitutes what hospitals describe as "write-offs", because you know you'll never get the money no matter what tactics you employ.

Coming up with a "sliding scale", with higher fees for certain hours compared to others? Makes sense, but doesn't seem fair. After all, there are those who come at odd hours because they had to finish a shift or had other important business to attend to first. Some choose to tolerate their symptoms, only to have them magnified in the wee hours when they realize they can't sleep because of the pain, or become anxious and decide they'd better get themselves checked out once and for all.
Many visit the A&E after midnight for gastrointestinal symptoms, no doubt related to suppers / pub crawls and other nocturnal activities. With our central location and easy access, it's only natural that they'd flock to our ER.

It's hard to penalize such cases based on attendance time alone. In fact, it's impossible to do it to anyone. All they have to say is "Well, I didn't know I wasn't that sick and could've seen a GP / waited till the next morning. I'm not a doctor what." How do you answer a question like that?

As for the NS boys, one can never be sure what's brewing beneath the surface these days, with our seemingly healthy young men dropping like flies for unknown reasons. It's genetic, I tell you. Perhaps some autosomal dominant gene on the Y chromosome that doesn't manifest till adulthood. The genius who discovers that should win the Nobel prize.

Patient education? Good luck. As locals become more well-educated, they choose to use their knowledge for worthy pursuits, such as (1) demanding to be seen stat because how can you call yourself an emergency department if I have to wait 30 minutes dammit, (2) telling you they want blood tests, xrays and scans, just because they know they're available at the ER, never mind whether they're indicated or not, and (3) lodging complaints.

How about channeling your energy and so-called intelligence into learning more about your own medical conditions, instead of telling me you have "a heart problem" each time you come to the hospital? Stop telling me "everything's on your computer, right?" when our technicians decide to shut everything down during one of their upgrading exercises. And by the way, we can't trace any cardiology records if your last appointment was more than 3 years ago.

I'm just appalled by the fact that these well-educated adults often have no idea what medications they're on, expecting us to retrieve their prescriptions from the system. Those who are managed by private doctors almost never bring their meds to the hospital, necessitating a phone call to the physician-in-charge, or at worst, compelling a relative / friend to trudge home and bring the meds to us.

I mean, I consider Singaporeans to be pretty smart, but their lack of interest in something as important as their health is just deplorable. Compare them to the Westerners who occasionally pass through -- they're able to recite complex medical terms and rattle off medication lists without blinking an eye. Either that, or they come carrying relevant medical records from their home countries, which make our lives so much easier.

Locals, on the other hand, treat their ward discharge summaries like toilet paper.

For now, the best solution is to boost manpower in the ER -- nurses, doctors, healthcare assistants, security guards. We're overworked, constantly at risk of making mistakes, and frequently harrassed by angry patients and relatives. Stop spending money printing posters and doing up corridor walls and put those funds where they'll do some real good.

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