Have been catching up with the latest issue of the SMA News, and the article, "SARS at TTSH" was compelling reading. Written by our esteemed Prof. Chee Yam Cheng, it gives a detailed account of the epidemic at SARS central during the peak period of March this year, with some valuable insights into the personal experiences of healthcare workers based there. It reminded me again how remarkably brave our fellow colleagues are. It certainly was a test of the human spirit which they passed with flying colours.

However, the glow of our heroics is fading along with everybody's short memory, and an article in yesterday's Life! section illustrated this very clearly. The reporter started off by being charitable, of course, saying how she has the greatest admiration for those at the frontlines of the SARS war and so forth, then delivering the punchline -- how she's personally had bad experiences with some doctors, and how medical professionals shouldn't be put on a pedestal when they're fully capable of making mistakes like all other normal humans.

I don't know where she gets these ideas, but from my experience, patients are far from being dazzled to the point of letting their physicians get away with anything. Sure, we get more respect, and a number have expressed their appreciation, which was very gratifying. However, there hasn't been a major shift in our patients' behaviour -- they still complain when waiting times are longer than expected, they get annoyed if you don't explain things to them in greater detail, and yes, they get very upset if something goes wrong, even if it's a small matter.

If a patient were in this reporter's position -- the doctor who attended to her didn't double-check her name and thus assumed she had cancer in the wrong breast -- I predict that there would've been a complaint lodged. But that also depends on the kind of person the patient is. The sensitive ones will call up patient services. The easygoing ones will just let it pass, or even laugh it off. After all, in the reporter's own words, it was an honest mistake -- everyone wore masks, names were muffled, and she herself admitted to answering when the wrong name was called.

She also relates how she had an unpleasant experience with a surgeon in the US, and how, after consulting her "oncologist friend", she sought a second opinion and landed up in the 4th best cancer centre in America for final treatment. My question is, if you've got an oncologist friend, why didn't you speak to her prior to getting your own doctor? My non-medical friends and relatives ask me for advice regularly, from treatment for simple conditions to referrals for major surgery. Oh, maybe she didn't want to bother this friend of hers about something as serious as breast cancer. Okay then.

And her call for patients to be more pro-active in their own healthcare? I've been asking for this since I started housemanship! The amount of interest Singaporeans show in the management of their medical and surgical conditions is abysmal. Ask them what meds they're on, and you'll get a look of utter confusion. Ask them what heart condition they have, and they'll say, "Errr, weak heart lah." To be fair, a number of these patients may not have had very communicative doctors taking care of them. But judging from the departments I've had the pleasure of working in these past 4 years, most if not all my peers and seniors often painstakingly explain things every chance they get. One cardiologist even draws out the coronary tree in order to illustrate which vessels are blocked and which need angioplasty, while one surgeon sketched out the entire biliary system to show a patient's relatives which parts were cancerous and how the surgery would address them.

If a patient asks for an explanation, he / she will get one. However, patients should also understand the limitations of certain situations, especially busy outpatient and polyclinics, or overflowing wards filled with critically ill cases that absorb most of the team doctors' attention and energy. Some relatives also have a bad habit of turning up separately and asking for repeated updates from already harrassed house and medical officers, sometimes after office hours. Anyone who's done night calls in medicine and surgery will tell you that they're absolute hell. Having to throw everything down to flip through case-notes belonging to a patient whom you've never seen before, and then give a general explanation of the management plan without fully knowing the actual thought process of the doctors-in-charge, can be very stressful. Some complaints have arisen from such misunderstandings, where family members mistake a doctor's non-commital answer to "not knowing what's going on".

I mentioned this article to fellow SMA News editorial board and Singapore Medical Council members, one of whom correctly wrote that the title of the piece should have been "Choose the right doctor", rather than the less complimentary "Re-examine your doctor". I agree that trusting your doctor is important, which is why patients must be pro-active in gathering knowledge about their own illnesses, instead of sitting around waiting to be spoon-fed, then later realizing they had other treatment options and whining about it. My own mother has been consulting the same private eye surgeon for 20 years, but when her vision deteriorated so severely, and the surgeon told her it was merely a cataract which wasn't ripe enough to be removed, I advised her to get a second opinion. After the 2nd diagnosis, I got a 3rd opinion, and she eventually ended up at the Singapore National Eye Centre, where she was later operated on by one of its most senior consultants, who did an amazing job. I had the benefit of having an experienced ophthalmologist friend's advice ( he was the one who recommended the SNEC ), but those without medical connections can also do their part, like many of the patients in haematology and oncology, whose resourcefulness and almost encyclopaedic knowledge regarding their complicated diseases earned my unwavering respect.

Even the Life! reporter admitted to being struck mute when she consulted the first surgeon, allowing herself to be scheduled for an operation before the oncologist stopped her. Someone once described her as "very vocal", and friends of mine who encountered her at TTSH a few years ago used stronger terms. Why did she go to the clinic unprepared? Why didn't she ask questions and demand reasons?

In light of the more prevalent issue of patient apathy rather than medical incompetence, I propose the article be retitled "Re-examine yourself".