A Doc's Life is a underground Medical Blog about some poor Singapore doctors. They are sibei sian and very buay song. Best practices not observed!
(Warning: Grammar is non existent in this blog. Those obsessively compulsive about good English please go no further and book an appointment to see your psychiatrist in Singapore.)

Tuesday, September 06, 2005

Ignorance Is Bliss?

A recent post by Blinkymummy sparked an entire debate over whether Hepatitis B is a Sexually Transmitted Disease (STD). Hep B is prevalent in Asian countries like Taiwan and Hongkong where the main mode of transmission is prolly perinataly from mother to child. So to call Hep B a STD in a place where the bulk of carriers never acquired it through sex and where a whole family might be carriers is actually rather distasteful.

But that does not detract us from the fact that it is still a STD. To the medically trained it is as simple as this, Hep B can be a STD not that it is necessarily sexually transmitted. We have no intention to discriminate against anyone with Hep B. The poor doctor who tried to defend this stand got hammered rather mercilessly (read this).

But can we really blame them for their misconception?

Just last Saturday, I was having breakfast with my mother and wife.......

BL: Wah lau, Ma,weather so hot, I want kopi peng, why you get me hot coffee????
Ma: Wah lau, drink kopi peng wait you get tnee jeo (diabetes)
BL: tell you so many times already diabetes is not caused by kopi peng lah! speaking which, are you taking your high blood pressure meds? You know ah, diabetes, obesity and hypertension makes up the metabolic syndrome and is associated with increase in cardiac event........

Wife and mother totally ignoring me, gossiping amongst themselves.

Mother:
Daughter in law ah, you must remember hor, when in confinement, cannot bath har! Otherwise will get hong sip (rheumatism)!
BL interrupts: wah lau, Ma, you know or not one. Rheumatism is due to problems with the body's immune system resulting in the immune system attacking its own body......
Mother: Ah boy! Don't be silly, hong sip is caused by water entering the bones!

Mother and wife laughs at me heartily.

Tell me how I can blame others for not understanding when I cannot convince my own mother kopi peng does not cause diabetes???

Another time, I was trying to convince an ah pek to take his meds.

Ah pek: Limpeh trained in martial arts, body good and strong! Why should I take medcine ar?
BL: Uncle you see ar, this chemical affect this receptor resulting in this effect. So good for your body lah.
Ah pek: Li kong simi? (what talking you?) I just abit heaty mah!
BL: Ok uncle, let me explain to you slowly.

After 1/2 hour,

Ah pek: Lokun, limpeh trained in martial arts, body good and strong, just a bit heaty, why must take this medcine?
BL give up liao: yah yah, uncle this medcine is VERY LIANG (cooling) and VERY GOOD TONIC for old people!
Ah pek: Aiyah say so earlier lah!

45 comments:

  1. Anonymous11:04 PM

    whatever works......

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  2. Anonymous11:09 PM

    You spent 1/2 hour explaining to him pharmacology? Did the patient queue accumulate as you did that? Ai Yoh... Anyway, attempt to educate the uninitiated public is laudable!

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  3. Anonymous11:09 PM

    Hello there!...on my travels i found your blog,not bad at all... If you are interested, go see my Adware Remover related site. nothing fantastic but it's all i got!..lol

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  4. Anonymous11:23 PM

    hahaha...I like your story abt ur Mum n wife. Sometime it's damn difficult to change old mindset. I can really sympathise with u. :-D

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  5. Haha, funny post ;) sometimes talking to my granny also talk until pek chek. Sometimes when my the doc has to do some test on my gran which requires her to fast she'll complain of hunger. So we apply medicated oil (unknowingly to her it's medicated oil) on her stomach and head bluffing her that this releases chemicals to tell your body that your full.
    Sometimes it white lies must be said..

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  6. anyway wat's d diff btwn Hep A n B?
    sry 4 askin so much qn..failed my bio last yr in O-level..hehe

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  7. I enjoyed reading your blog.

    Keep blogging, BL Og!

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  8. Dr quack11:45 PM

    Reminds me of what we learnt in COFM; must understand the patient's background, and then present to him the therapy in a way that he can understand and accept so that he will be compliant to therapy. Heh...

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  9. xiao ming12:40 AM

    NO WONDER QUEE SO LONG LA~!

    30 min explain to old man!

    but good post :D
    keep it up

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  10. stressed12:41 AM

    wah..realised tt the comments for this blog has been increasing..compared to the past entries..haha..muz be all owing to the sunday times' free publicity? =P

    anyway ur blog's always so funny..the way u write it..hehee..keep up the good work!!

    cheers!

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  11. Anonymous10:01 AM

    Singaporean patients are idiots.

    They want doctor to explain but most of them do not have basic intelligience to understand at all, but then will act as though they understand when they don't and go home doing the wrong thing.

    Then there are those who think they know everything and tell the doctor he is wrong when they actually know nothing. It usually ends up a waste of time on the professional's part because they are talking to "Professors" of Medicine.

    There are those who read and know and can have a good healthy open discussion with their doctor.

    Then there is the stupid language barrier. I mean I went out to learn words like Insulin, Triglycerides, etc in Mandarin but most Singaporeans don't have that vocabulary in Mandarin. Speak in English no better. Without much saying I never bothered to learn it in Hokkien. And as usual they talk about Cooling and heaty. Actually after some research I realised that alkaline products with a good K/Na or Ca/P ratio are generally cooling products and vice versa.

    Speaking the TCM language seems to make everything magically right for most Singaporeans even if it is rubbish. Well anything to get the fella out of the consultation room fast!

    NExt!

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  12. Anonymous12:03 PM

    To whoever you are who say singapore patients are stupid. You must be a doctor I guess?!!! And a conventional medical doctor I presume?! I feel so sorry for you after reading your comment. It showed that the medical school has not taught you well. You showed yourself to be narrowed minded. Especially in embarcing other medical system like TCM. If you don't know them, don't start criticising them. Current conventional medicine is not the best either. Be humble hor...

    There are illness that your so called "high and mighty" medical system can't cure either !!!


    Not being able to connect well with patient and convincing them and making them understand is partly your incompetence too, DOC! better brush up on your communication skill. You are dealing with people here!! If your PR skills so bad, cannot convince your patients, cannot build you repport with your patients, then you very clever meh ??!! Don't start critising others just bec they lack medical knowledge. Look at yourself first.

    So what if you have all the medical knowledge in the world. You probably don't have a good heart. You are criticising patients who are paying for your salary!!!!!! Tsk tsk tsk.


    Singapore doctors are so cocky!!

    Are they here to cure patients or make money.

    NExt !!!

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  13. Anonymous12:55 PM

    Haha!

    For your information, yes I am conventional allopathic western medically trained.

    However I am also alternative and complementary medicine trained. Homeopathy, nutritional medicine, pH balance/ying/yang balance, accupressure.

    Dun get me wrong, our conventional health care system is more the "sick" care system. I totally understand the failings of western medicine when it comes to treating certain chronic diseases eg eczema, allergies, connective tissue disorders, diabetes, etc

    I have many patients who I treat using various combinations and complementary philosophies of healing. I have no problems communicating with them.

    But there are people who come in expecting a magic bullet, who refuse to listen, who refuse to accept responsibility for their own health and expect the doctor to do everything for them.

    In Singapore doctors are not paid for their consultation time. Doctors are paid for the drugs/products they sell.

    In other countries, doctors do not sell drugs/products. Patients pay for consultation. In Singapore if you see a doctor and he talks to you for 1 hour with advice etc, how much would you pay? $8?

    Before you go around criticizing doctors as more concerned with making money, do realise what really happens on the ground.

    You idiot!

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  14. Anonymous1:37 PM

    can empathise with you.

    but what i fear from your ah pek is that he'll stop taking his meds when hes no longer "heaty" and will take extra when he is feeling bad again...

    then again, what else can we do? singapore pts are hopeless.

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  15. it is doctor's responsibility to educate pt. we try our best. the next time i see a pt, i will still try to explain as long as he is willing to listen.

    but sometimes, it is extremely difficult to explain an illness if the patient does not have at least some basic scientific knowledge. over simplifying the matter just makes it untrue.

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  16. Anonymous2:07 PM

    Eh bruther!

    How? Did you check up on Australia?

    Patient's there have better IQ level. Much easier to talk to.

    A consult is really a consult, and not an expectation to get some elixir from the doctor.

    Singapore is hopeless lah.

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  17. Anonymous2:17 PM

    Hey, how come someone said that s/pore doc are cocky? I think we are underappreciated. We work from 8am today to even 5pm the next day when we are on call, we do not get to eat all our meals, we do not earn extra by seeing each patient for a longer time, for ordering more test or meds for our patients, yet pple are accusing us of cheating them of their money.

    We are expected to smile to everyone even when u are crying inside, to speak to every relative immediatly upon request (even if u have just spoken to his Bro an hr ago), to do something for anyone immediately, to receive complaints for minor issues, to tolerate rude comments made by patients and their family, to give miracle drugs to cure someone within a day. If we are really that concerned with making money, we would not be doc today. Cos where is the money?

    And where is the appreciation for all that we have done? Is there a doctor's day? hmm.. i wonder why.

    We are but human, who dun have a life like a human. Work 36hrs straight when we are on call, skip meals, work when u are tired and hungry and sleepy and not make mistakes. Pple dun treat us a normal human beings, yet commented that we are lack of human feelings (eg dun cry when ur pt die)...

    so at the end of they day, who are we? or what are we?

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  18. At the end of the day, the patients and their relatives probably have this belief that since they paid for it, they deserve "everything" - meaning the doctors and nurses have to answer to their every whim and fancy.

    Unfortunately, "healthcare" is becoming like any other service industry now. To them, the doctor perhaps is just like a chicken-rice seller. They pay $3 for the rice and expects it to come with everything. Got rice, got achar, got cucumber, got chicken. If too little achar, they complain. If too much cucumber, they complain.

    There are black sheep doctors who are totally money-oriented. There are white sheep patients who are appreciative.

    We are not asking for a lot. Most of us are civil servants. We are paid for by our respective "towkay". We don't need the government to set aside a day for us. We don't need people to take out a full page in the newspaper to express their thanks. We just need a simple thank you. An appreciative smile.

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  19. put it this way, no one took a knife to your throat and force you to be a doctor.

    If you think doctors are being unappreciated, the truth is in ANY professional, unappreciation is common. Thats why it is call a JOB and like all jobs, it comes with its ups and downs.

    I appreciate the rancor that BL og deals with encounters which other people may not have handle in a better and more sensitive way.

    No matter how bad the situation or the patient, its really your attitude that determines whether you make it better or worse for yourself.

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  20. Dr quack3:03 PM

    To the anonymous 2 posts above me:

    I agree with what you've said. Esp the last 2 paragraphs. So many good/kind people I know give so much of themselves to this calling and neglect other aspects of their life and their families.
    Some would say that it's about time management, but honestly to be the perfect/role-model doctor that spends sufficient time with patients, communicating with family, teaching junior staff/med students, CME courses, writing papers, administration, and of course calls...Where is the time for ourselves and family?

    I don't think most of us expect non-medical personnel to begin to understand the complexties of being a doctor, much less expect appreciation from our patients.

    True it was our choice to be in the profession (which isn't like most other "jobs" I promise you), but many of the complaints/issues that patients/families have are usually out of our control (ie: constraints innate in our healthcare system); and so we can feel rather indignant.

    I've given up trying to explain to the people around me. They think that we live in our glided castles, earn a lot for doing very little, and view our calls as an opportunity to earn more money (akin to overtime)...Ultimately people want to think what they think, and it makes them feel like they're superior moral beings; how do we change that?

    My point being that I don't need people to appreciate me at this point; as long as they can think before they shoot off a complaint or whine that doctors have it good, my life will be more bearable.

    Parting note: Medicine/the healthcare industry is NOT a service industry, and we must not let it spiral (further) down the path where the garden is more important than the operating theatres.

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  21. Anonymous3:29 PM

    To the Anonymous Cork who say " Singaporean patients are idiots."
    KAN NI NA BU EH LAU CHEE BY !!!
    listen and listen hard! Nobody is born stupid, its just that they don't know,don't understand or unclear. All u have to do is to have patience n explain.Things you know, don't expect others to know.That simple.
    Do you like people calling u stupid?Or do you like people to call any of your family member stupid too???

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  22. Anonymous3:37 PM

    This goes back to the service industry.

    The worst customers are actually patients.

    And you can understand why when sometimes the customer himself actually dies despite the service his family has to pay for.

    Anyway I learnt that Asians are damn crap people. Anyone who has had experience in doing housecalls for hotels will know the difference between ang moh guests and asians guests (exception of Japanese) when you respond to a housecall in a hotel.

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  23. Anonymous3:53 PM

    To the anonymous foul mouthed idiot with no finesse who cannot resist cursing vulgarity in the face of adversity....

    Well if you are not happy, go write complaint letter lah!!

    BWAHAHAHAA!

    Idiot!

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  24. dear all anons and angry public, before you'll go into an insane rage and start dancing naked on the streets,

    take a step back, breath in. breath out, imagine a happy scene.
    think this thought:

    my dr is the best dr in the world x 10.

    or if you are a dr think:

    my patient is the best patient in the world x 10.

    ok now lets all go eat bun and drink tea!!!

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  25. Lao eh, touched raw nerves siah.

    Actually, it is always the doctor's fault.

    Patient don't understand, means you never explain properly.

    Patient don't work towards getting better, means you never motivate properly.

    What to do? Try harder.

    Dr Og, can link to your site or not? Thanks.

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  26. Thanks, man.

    Buy you kopi-peng and char-siew bao someday.

    (actually I haven't eaten a bao since I became doctor...)

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  27. Anonymous5:26 PM

    hahaha, myths vs truths. how can people easily accept the fact that what they have been believing isn't true. (refers to kopi peng & DM)

    well, layman explanation......

    now that doctors know its tough.

    imgaine the nurses facing the patients day in/out. EEK!

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  28. Anonymous6:04 PM

    actually the kopi peng and DM link can be made.

    In fact a lot of myths do turn out to be truths.

    It's all the in the basic science and nutrition textbooks.

    As doctors we never studied nutrition in med school though :)

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  29. hmmmm, always tot my mother will make a better doctor than me. mebbe there is some truth there as well?

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  30. Anonymous7:25 PM

    For example, post natally, confinement mothers cook oily fish soup for mothers so they will produce good milk for the baby.

    This was what my wife had. At that time I thought it funny and a little unbelievable.

    Prostaglandins Leukot Essent Fatty Acids. 2003 Oct;69(4):237-43

    Obstet Gynecol Surv. 2004 Oct;59(10):722-30; quiz 745-6.

    But take a look at those papers . when you consider the EPA/DHA factor, that babies leech the DHA from the mother's brain during development, it has a link to increasing risk of postnatal depression with successive pregnancies if this is not replaced.

    Also where does the DHA for the baby's brain development come from in breast milk?

    Nutrition.

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  31. good advice thanks!

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  32. Anonymous10:30 PM

    I love your blog. Haha, really connects to what i feel as a doctor. Some patients are frustrating. But I hope we dun lose the touch and continue to see the bright side in medicine.

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  33. Anonymous10:49 PM

    dr bl og
    U r ever so cool n brilliant.. luv it.. to know so many things tat goes on behind that door. Salute to u guys almighty doctors!

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  34. Yup docs in sg are very nice already :)At least they bother to take the effort to explain the patients condition. Sometimes it's really not the docs fault. I must say that Singaporeans are really getting pushy. I myself can testify to that after all those vacations sales job. I feel that docs are here to do their best to cure patients. Not to "service" every whim and fancy of patients. Their job is to save lives not to be in the service line.

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  35. Anonymous11:49 PM

    wow wad a lively discussion.
    think most of the time patients even b4 meetin face 2 face with e doc already pissed off by the waiting time.and then, after waitin, finishes e check with e doc in a fraction of the time

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  36. Dr bl og when u dun go into private practise huh?

    Private practise can earn alot more leh. I think when ppl say Dr do little earn alot is refering to those in private practise loh, although in the end all get sterotyped. (note i dun think private docs do nothing but they sure earn alot!)

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  37. Dr bl og why u dun go into private practise huh?

    sorry typo

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  38. To reply to Mr/Ms/Mrs/Mdm Anonymous who mentioned about waiting time... there are patients with appointment at 3pm but they show up in the clinic at 1pm. When they finally get to see the doctor, they complain that they had to wait for 2 hours... =P

    Some patients have appointment at 2pm, but they show up at 4:30pm and expects to be seen immediately. They will pop their head into the room regardless of whether there're any patients inside or not and demand to be seen. When see, they then complain that why they were not seen straight away since their appointments were earlier. Well... they just don't get it.

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  39. Sorry... it's "...when seen...", not "...when see..."

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  40. Anonymous9:48 AM

    Waiting times in hospital specialist clinics
    [14 Jun 2005, 08:49:40 PM]
    Ever wondered why the waiting times at hospital specialist clinics are so long?

    Well here's the scoop.

    It's a variety of factors actually. Here's what happens when the day starts:

    Doctors start work at 730am where they have a meeting to discuss complicated cases among the senior and junior doctors.

    The doctors then go off to do their hospital morning ward rounds. That means they go see the patients who are admitted to hospital at their beds. Some teams of 4 doctors may have up to 40-50 inpatients to see in these morning rounds.

    The clinic non-doctor staff (nurses and counter staff) open the specialist clinic at 9am. They get the apointment lists ready with the case notes all (hopefully) traced in the shelves on wheels. And then they serve the first few patients who come in.

    Now meanwhile the doctors are franticaly trying to finish seeing their in-patients and get to the clinics ASAP. Sometimes with surgical departments, some doctors may still be in the Operating Theatres operating on the patients that came in the night and hence the other doctors will have to take over their morning duties seeing their in-patients. So more work.

    So let's say it is a good day and the doctor goes into the clinic at 9am sharp.....

    The clinic opens registration at 9am and it takes about 15 minutes for the whole registration/trace your case notes/ doctor call for patient. So really the clinic starts at 915am.

    Now another problem that happens VERY frequently is that people do not come at their appointment times.

    So let's say the first guy who registered at 9am is supposed to have an appointment at 10am. What do they do with him? Well they usually let him be seen first. Now this screws up the whole appointment system. Imagine having 5 patients coming at 9am but their apointments are 10am, 11am, 12pm, 1030am and 12.30pm. Well they get seen first. And then at 9.30am the guy with the 9.30am apopointment registers. Well he has to wait till the first 5 have been seen before it's his turn. So invariably he ends up seeing at 10am. And the problem worsens...

    Now the counter is to tell the people to stick to their appointments. Ie although you came at 9am, but your appointment is 10am so please come back at 10am. The patient will kick a fuss and say how clinic usually wait long long so he comes early, inconvenient to move around, sit and wait for 1 hour too much to tahan etc etc etc. It's a no win situation.

    Of course we always get the patients who come at 12pm for their 10am apointment and expect to be seen first since their appointments were much earlier. But if we let them be seen first, then the people waiting in the waiting area would complain and say they came so much earlier and waited so long and then this person walks in and sees the doctor immediately...

    If we make the latecomers wait till the people before them are seen, then they complain they wait till 1pm when their appointment was at 10am. They will say they came late cos' they know that although the appointment is 10am usually wait 2 hours to see the doctor.....

    Lastly, there are many force in cases from the A&E. That is say the clinic has already fully booked up all the 30 slots in the morning clinic for Doctor A, but A&E has many cases that need to see doctor at an early appointment date, then they will "force book". So in some clinics the list goes to 45 cases. That is over booked by 50%! This makes the problem even worse.

    On the A&E side, if the patient does not get an early date appointment, then they will kick a fuss or demand to be admitted.

    There's no simple solution to all these problems. The first step is for people to know about it first. I never know why they don't just tell people what the problem is.

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  41. Anonymous10:06 AM

    hmm..there's another problem which causes the long waiting time as well..
    from wad i noe..for some hospitals..the appointment time they gave for patients are onli 5 minutes apart..how could one possibly finish the consultation in juz 5 minutes?and also,some patient would tink tt they pay more den $50 to see the doc so of cos the patient would expect to ask the doc more qns and tok some rubbish and that would drag up to 15minutes..thus as the dragging time accumulates for each patient..the waiting time can be up to 2 hrs long..
    so y not they adjust the appointment slots 10minutes apart instead?

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  42. Anonymous10:13 AM

    The appointments do not START off at 5 minutes within each other. The reason why the appointments become like that is because of the problems of demand. Read the above post about the A&E bit.

    If you work at A&E you will know what I mean. There are a lot of "forced in" appointments made from A&E because they are necessary.

    That's why clinics can be 200-300% over booked.

    The problem is very hard to solve even though I totally understand it.

    It really does not help when they want to keep help care costs low and not employ too many specialists.

    Filling clinics with lots of MOs but just 1 consultant each session is also not a good option because as a patient going to a specialist clinic you DO want to see a SPECIALIST right?

    Tough.

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  43. well..i can understand the whole saga thing bout docs etc.. if you do not work in the healthcare industry, i guess you wouldnt know the truth at all. docs do not really earn alot and even if they do,they've lots of work that just doesn't match up with the pay. if u docs c/o bout pt, then what bout us nurses who see them day in and day out?

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  44. Anonymous10:44 AM

    Actually the whole nurses thing is very unfortunate.

    For many years, nurses in Singapore were rather uninvolved in the actual management of patients.

    If you go back 10 years most nurses then did menial work, eg serving food to patients, feeding them, bathing them, changing bedsheets, clearing urine and feces from the bed pans, serving oral medication etc.

    I remember a nurse complaining to me how they had written a letter of appeal to MOH to start a graduate nursing school in NUS. The reply came back that the reason why they did not want a graduate nursing school was that they did not want to pay nurses graduate pay. Keep it at diploma level and keep the wage costs low.

    How unfair is that right? I was very angry when I heard that.

    Then.....

    One day the same nurse complains to me that the hospitals are asking them to give IV medications instead of the HO. And they said they should not be doing that.I suggested to her that she should be more proactive in taking part in the management of patients.

    During my attachment as a medical student in Australia I saw how the nurses actually presented the patient's conditions to the consultants during ward rounds. They managed the IV medication, basic symptomatic treatment, monitoring etc. The HO at the hospital told me the nurses are fantastic.

    Now I am not saying the nurses in Singapore need to go to that extent, but there should be a desire to be more than just a nursing trained personal aide to patients doing menial tasks.

    A few times I get pagedby nurses to see a patient. I ask why? They say "Patient in Bed 10 dun look good." I ask what's the BP and HR? They say "I haven't check."

    I can accept it if the maid of the patient sitting by her bed paged me and said "Doctor, my ma'am dun look good can come see her?"

    But as a nurse I dun think it was too much to ask for to take the vital signs of the patient, get a bit of background information as to the history and current medical problems before paging for the doctor.

    Unfortunately the nurses 10 years ago said they just wanted to be graduates, earn graduate pay and tell everyone they are graduates and earn graduate pay, but day to day continue doing to the simple menial tasks of a domestic maid. I lost some respect for them then.

    I think currently the situation has changed and many young nurses are more eager to be involved. It has to do with many nurses going abroad on their own to do Graduate nursing courses in places liek Australia. Some even have masters.

    Tell me, if they learnt this from Australia, don't tell me the Australia system can be worse than Singapore's!

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