Recruit Tan's appointment was at 9am, he decided to arrive early just to make sure he got seen on time. The clinic started registration at 8:50am and there was already a lot of aunties and uncles forcing their way into the front of the queue. When he finally recieved his queue number, it was "Room 10, 1030".
"What! Isn't the appointment at 9???" But he thought to himself maybe the number was not reflective of the appointment time. He knew he was wrong when the first number that flashed on the board was "0900". Still he kept quiet.
It was 10:40am on Recruit Tan's casio watch and he was not called in yet. The anticipation was killing him as he fidgetted in his seat. "What the hell, tell me to come at 9 am then until now still not seen!" The number flashed again "1025". "Ok, Ok next me liao!" But when "1025" came out, the number flashed "1040". Now Recruit Tan really became very kan cheong!
"Maybe they forgot me?" "Maybe I wasn't properly registered?" "Maybe they made a mistake??"
He went up to the counter to ask, was given a cold hard stare that said "Can't you see we are already very busy!" and asked to wait some more.
The numbers jumped up and down a few more times before Recruit Tan was seen at 11:30am. The doctor simply took a look at his Xray, gave him three months excuse running and told him to go get his painkillers from the pharmacy. He came out of the consultation room at 11:33am.
All the Hokkien expletives Recruit Tan ever learnt (from his father) was going through his head as he walked to the pharmacy. "Why the Hell they make me come so early and wait almost 3 hours!" Now he got no time to go see girlfriend. Hell, he didn't even have time to eat lunch as his CSM only gave him the morning off. He approached the pharmacist with his prescription and was told,
"Please take a queue number and wait for your number to be called."
------------------------------------------
If you haven't guess by now, I was the chow recruit Tan (name changed to protect MY identity). I had also experienced first hand the long and often ridiculous wait be it at GP, polyclinic or specialist clinics. As with the comments contributed in earlier posts, the factors leading to long waiting time can be attributed to 3 main areas: patients, doctors and admin.
Patients
1. If you come too early, you just wait longer.
Singaporeans are just kiasu. Everything also must be faster than other people. So if they have appointment at 10am, they will come at 9am hopping to be seen earlier. When they realise that they still have to wait, they will give excuses like they have to rush to work or have to fetch children from school in a hope to cut queue. But when everyone has the same excuse, who should we help???
2. Come late cannot wait, don't come don't say
Many patients come late since they have to wait anyway. When they do arrive, they want to be seen before those who come on time since their appointment time is already over. This simply jams up the queue and everyone ends up waiting longer. Worse still, those who default, do not cancel their appointments to free up the slots.
3. The Clinic Disruptor
These are people who have endless requests and goes in and out of the consultation room disregarding the fact that other patients exist. After they have been given their prescription, they leave the room only to come back for a memo and then comes back in again to ask for 2 more days MC. These people not only interrupt the consultation process but also compromise other patient's privacy with their behaviour. And YES! Head popping is also very irritating and disrupting!
Doctors
1. Bao Sua Bao Hai (Cover Moutain Cover Sea)
There is simply too little doctors to go around sometimes. The doctor gotta go for ward rounds in the morning and rush to clinics by 9am. If the round is long with too many patients, it can drag up to 12noon even. So the doctor goes to the morning clinics late, end the morning clinics late and starts the afternoon clinics late. Halfway, he may also have to attend to emergencies in the wards that HOs are unable to handle.
2. Just Late
Of course there are also doctors who goes to clinic late for no excusable reason.
3. Over Specialisation
The doctor in room 1 only sees leg problem, the doctor in room 2 only sees hand problem, the doctor in room 3 only sees finger problem. You see the problem? Suppose we have 10 patients and they can be distributed evenly over the 3 doctors, waiting time will be shorter than if all the patients have leg problems and can only specifically see room 1 while room 2 and 3 shake (their own) leg.
Admin
The REAL problem
Patients are not to be blamed. Most (like Recruit Tan) wait quietly for the doctors. We must really really thank them for their patience!
Doctors are not to be blamed. We don't like to chiong until like tat can? We also want to eat lunch in peace and not with palpitations, end the clinic early and go home early.
So where is the real problem?
The people who plan and run the clinics are not those who practice clinically there. They look only at statistics. Since on average, 30% of patients do not turn up for appointments, we can overbook the clinic by 30%. Yipee, problems all solved. But that is on average! If one day suay suay all turn up??? Then the clinics is running at 130% load. Who suffers?
Do they factor in pee breaks for doctors? Do they factor in patients who have impairment taking more time to come in and out of the room?
Yes, we can see patients in that 5 minute (or less) time frame. Only because we have no choice. Only because we are made to do so!
right. blame it on admin folks agn. sighs. we can never do right! docs are such difficult creatures to work with. u do realise we are at the beck and call of the higher-ups..
ReplyDeleteEh bruther!
ReplyDeleteThe funny thing is you go private sector also the same. See patients in 5 minutes. Why? Cos all contract. More patients seen per hour = more money made per hour after all each contract patients makes you $2 only!
The problem is not really just admin! It is the culture!
Singaporeans dun value consultation. They value the actual treatment. Eg medicine, injection, cast, operation, physiotherpay.
That's why can have patient tell you "I never eat anything for 3 months." (in hokkien) You ask "why? Is it becuase no appetite? got pain in abdomen?..." And the fella shouts at you "@#!$ you doctor you should tell me! Why you ask me?"
So little wonder why most Singaporean patients would never pay for a consult which does not include a big bag of medicine or an injection. They will only for the treatment. They do not understand the value and process of the consultation and diagnosis.
How?
Go Australia lah bruther!
poor admin folks.
ReplyDeleteWe totally understand. It is the higher ups. And then the higher ups will say it is the ungracious people.
You never watch National Day Rally meh?
In the end no hope lah. Cos there is no cycle. Everything go to the top and get stuck there. The dirt all stuck there, the people down below want to clean also cannot clean. Then the up there will say not their fault so dirty, all our fault.
And what the up there do? All just talk big.
I will give every MO/HO/Registrar out there a good tip. Very often patients will request things out of your control. Eg waive bill, why the couch leather cannot be changed to new one, why the air con so cold etc.
What you can do is to tell the patient "Ok sir I will help you. I will help you write a memo to support your request and you can take it to the customer service counter and tell them yoru request with my supporting MO"
My memo will read
To person in charge
MR TAN AH KOW
S0100210F
The above mentioned has requested that his clinic bill be waived due to his excessive long wait to see the doctor.
He also requests that the old PVC coverings for our examination couches be replaced with new leather ones.
Kindly assist him accordingly
Thank you
XXXX
ALL the patients walk out very happy. And I have never had any admin person call me up to explain why I wrote the memo. But I don't know what happened in the end.
But seriously such "damage control/customer relations" work is not the doctor's. It is the admin's/customer relations officers job. But where are they in the clinic? We never see them around.
So just pass the work to the correct people, look like you are listening to the complainant ,support him/her to the best of your ability and get on with the real work we are supposed to do.
dear admin people, if you feel that my post is unfair, pls do leave your opinions and views. perharps as a doctor and patient i am unable to see things from an admin point of view.
ReplyDeletewe can all ventilate, kpkb, then go back to our usual miserable ways! YIPEE!
Can whoever is the anonymous person stop critising singaporean or singaporean patients??!!
ReplyDeleteIF you are a Singaporean and you think Singaporean are crap, then go migrate lor. And if you have already done so, then good for you. Don't ever come back here.
If you are not a Singaporean, then what makes your nationality so great to be able to keep making general statements like that??
For your information, I went to see a doctor in Singapore and I DID get charge for CONSULTATION!! It was broken down clearly in my bill. My bill came up to S$477. Consultation is $120, Lab test is $120, and the rest are medicine.
So stop making statements that "SINGAPOREAN" don't understand the value of consultation and process!! It is untrue.
I gladly pay my doctor for the whole consultation and medication. And didn't complain a bit.
I think one thing doctors fail to recognise is that :
IF you are good,and you can cure patients of their medical problems, no matter how much you charge, patients will still pay!!
But if they perceived that you are not worth the money and your attitude and service is crap, and you keep giving patients the kind of attitude that:
"you are doctor, you know best, patients stupid, don't know anything"
Of course people " buay song" to pay you lah!!!
This is simple logic, you also don't know?!!
For your information, my doctor took time to explain my condition to me, ( and for your info, there are a load of patients waiting outside and that time was almost 9plus at night already !) ...He even apologise saying that it was a busy night for his clinic , wrote down some pointers for me to go back and do some research on my conditions and ask me to go back to see him again. I see him for almost one hour for the whole procedure.. but I gladly pay the hefty sum of medical fee.
Hmm....
ReplyDeleteThat sounds very much like my clinic.
For all you know I may be your doctor :)
Of course there are various kinds of people and you know who you are.
But as a whole, I still find that the large majority are not like the good people like you.
si lang doctor
ReplyDeletegot time to blog in 8.30 am no time to see patient!
i complaint u ah!
:P
basket, I change the timing so that the post will come out on top lah! si lang anon :)
ReplyDeleteand the problem of shortage of doctors amazingly disappear when foreigners, who are willing to pay a premium, seek treatment?
ReplyDeletethere is a dept somewhere in some hosptial that caters specially to foreigners, the dept has dedicated drs but most of its referral is made to our local specialist, trust me, they also have to wait.
ReplyDeleteIn fact they pay so much more for dunno what that i also feel like we are ripping them off.
I'll like to believe that the "premium" they pay goes back to our subsidized patients but that one you gotta aask the admin people.
In other country, even if you want to see GP, have to make appointment.
ReplyDeleteOne country will audit their doctors. GPs only allowed to have 6000 consults per year. If there is more, they will question why and GP has to justify.
This ensures amount of time spent per patient and quality of care.
In med school we are taught to take proper history. How long does that take? Then you go to the Polyclinics or GP clinics and how long is the consult? No need to be a genius to know the history taking is non existent.
I know of a few OPS registrars who have quit and gone to Australia to work.
They were sickened when they had to hand hold the foreign talent doctors on simple things like hypertension management in the polyclinics. Worse was to come when after 1 year of service in the OPS, the foreign doctors were given FULL medical registration in Singapore without having to sit for any exams. They were free to go and open their own clinics. Just one year!
It cheapens our medical licences. When you talk to these guys in Australia now, they tell you that work is much more rewarding and less stressful.
it's not that doctors do not want to turn up on time in clinics. we need to do ward rounds followed by clinics. sometimes, we get paged to come into clinic earlier because patients want to be seen earlier although the appointment given is not.we are stucked in ward rounds, seeing loads of patients.when we are busy in clinics, we get called by the staff nurses regarding work in the wards. we need more manpower!
ReplyDeleteActually we all know one way how this problem CAN be solved or at least alleviated....
ReplyDeleteGet those senior consultants to do some REAL WORK!
See patients in the subsidized clinic everyday. Help do changes in the ward etc.
Many times where are all the consultants?
Hey then i must really thank National Skin Centre (NSC).
ReplyDeleteI used to go there frequently to treat a large ugly scar on my knee due to an army motorbike accident.
(nitrogen to 'freeze the scar' to make it softer and then inject some medicine into it)
and they have an excellent system. Firstly, patients have to buy a $10 voucher booking fee that is refundable. It is non-refundable only for no-show. (i think if u change ur appointment more than 2 days in advance, they still honour the booking voucher)
so this discourage no-shows.
2ndly, they have an SMS system to remind patient of their appointments 1 day beforehand.
3rdly, when they give u a time and u arrive on time, u actually get to see the doctor on the allocated time!!!
DAMN SOLID. :)
Hmm sounds good.
ReplyDeleteWell I guess it's the old money trick.
People don't turn up unless there is money to be gained or in this case returned.
What a great society.
Wahh.. Arguments breaking out in comments?
ReplyDeleteThank goodness I'm not smart enough to make it to the med school. But I think my doctors are rather nice. They always apologize to me for making me wait for too long.
And who says we don't appreciate the consultation? I go for checkups to get a clean bill of health. And NOT to get the medication.
To anonymous who charge for consultation...
ReplyDeleteYou don't sound like my doctor leh ...
Why he don't sound like your doctor? Cos he charge for consultation?
ReplyDeleteSo your doctor don't charge?
Actually how much do GP charge for consultation these days?
Anyone?
When my clinic assistant tells me that some patient insists on being seen because she "waited very long and is a very busy person", I always think to myself that she should ask ALL the patients before her whether she can jump queue, if they have no objections, then I don't have any either. Isn't that fair?
ReplyDeletedr quack, I think you are my soulmate, man.
ReplyDeleteLast time I in orthopaedics, they never overbook our list... they just list 5 full lists for 3 MOs to see!
Actually the MO seeing patients in specialist clinics is not right isn't it?
ReplyDeleteI remember as a first year MO in Ortho seeing referrals from my seniors in Army and GPs!
Now as a GP I shudder to think who I am referring to if I send patients to SOC in govt hospitals!
yah how come my dad was seen by registrar but he only noticed that the doc had mbbs when referred by poly to the ortho dept of XX hospital.
ReplyDeleteIn fact there were 2 others doctors of the same type in the other consultation rooms and my dad could see they kept consulting each other on the cases they see..Where's the image of competency and professionlism?
Hmm actually this person just exposed an often kept secret in the govt hospitals.
ReplyDeleteA lot of patients are seen by new and trainee doctors more often than specialists.
When I was younger I always thought doctors who work in the hospitals must be very good otherwise they would not be there. I mean the hospital is like the place to go if the clinic cannot help you right? So the doctors there should be more senior and better?
WRONG! The hospital is mostly run by young fresh out of university medical graduates.
Most likely your dad was seen by some Medical officer doing his rotation posting in his training.
Strange thing is that you still pay the amount that you would pay had you seen a real consultant.
Wah kena cheat one! Can sue hospital or not ha? All patients out there, better be more alert and make sure put in forum page that we all kena conned!
ReplyDeleteYou won't win one.
ReplyDeleteMOH and the hospitals will just say that as teaching hospitals they have a large number of junior doctors undergoing specialty training.
Rest assured that the doctors are carefully monitored and supervised blah blah blah. Besides it is true that this is how doctors learn mah.
You dun even want to know what happens in the operating theatres where you think the surgeon operating on you is a fully qualified one!
What you expect?
Dr Og, the Australians want us!
ReplyDeletehttp://www.medicaust.com.au/
See August issue of SMA News for ad.
P.S. - Hobbit not funny this issue one.
The fact that MOs man speciality clinics are hardly a secret and in fact a major cause of complaints. The policy is such that if you pay private rate, you CAN specify the doctor you want to see by name and of course everyone will choose a consultant. But a subsidized case will be allocated a doctor depending on factors like severity of illness. Usually each department has its own safe guard. For example, a new case will first be seen by a MO who will report immediately to the consultant. If the case is simple, the MO will follow up, otherwise the consultant takes over.
ReplyDeleteThis system has been in place ever since there was a hospital. In fact as our society becomes more sophisticated, the duty of junior doctors have been decreasing by the day. In Malaysia, HOs perform caesarian sections. Locally, only a MO trainee after many supervised operations can perform such an operation.
yo angry (don't mind me calling you tat), haven't read the SMA journal. you really thinking of australia?
ReplyDeleteYou see the problem is that to us doctors, this is hardly a secret. And in many ways we find it acceptable.
ReplyDeleteBut the large majority of people in this country do not know this fact. And when they find out they usually think we are trying to hide this from them and they also do not approve of it.
The problem is two fold. We don't publicize it (interpreted as we are hiding something shameful from them). And the public do not approve of such a practise.
Hey angry doc,
ReplyDeleteYes Australia wants us!
You applied already?
I might meet you there! :)
Og, can call me angry lah.
ReplyDeleteI actually have no plans yet. Maybe nuah a bit here first and see how.
A lot of things which we find acceptable are unacceptable to laymen. But got to be realistic lah.
I used to do table 5B ops solo as a baby MO some more...
This comment has been removed by a blog administrator.
ReplyDeletedear dr angry and anonymous,
ReplyDeletedont leave spore leh!
think of how the patients will suffer.
more local drs leave>> patients seen by more foreign 'talent' docs who either accent so cheem til ah pek/ah ma dun understd or can barely articulate themselves in english, much less counting on em to understd singlish.hokkien, malay,mandarin etc.
patients(esp elderly0 tio suay
and more local drs leave>> less local drs in hosp>> remaining local drs bcc(bin chao chao) cuz no time to pee, eat, drink. patients tio suay again.
yah, i agree that the admin sh not schedule too pack a appt list everyday. from patients' view, who dare to see dr who haven slept,eaten,drunk,pee for dunno how long?wrong diagnoses how?
from a med student view, drs are human too!! they nd to drink, eat, pee to maintain health.MOM got regulate this or not?
rest is also impt to a dr's cognitive abilibty lo, if drs not so patient packed, cognitive skills=better patient care.
Heh heh, Angry doc: when I read your blog I constantly think "yes!" in my head too; you are my soulmate I think =). And perhaps we have worked in the same Ortho dept that has more lists than MO's; or do most departments do that too?
ReplyDeleteAnd to those who gripe about MO's running specialty clinics, if you think the system should allow only reg's and consultants to see outpatients (subsidised and private), the alternative is a much longer lapse til your appointment date and a longer waiting time on the day itself.
If there are any constructive ideas on how to improve the system, I'm sure the MOH would love to hear about it.
To anon 2 posts above:
ReplyDeleteWe fall under MOH, not MOM. And no there're no clauses in our contract that states there should be protected pee time of 10 mins tds, meal times of 20 mins bd..etc.
And no, I've been told we aren't allowed to have a union.
if we ever had a union, can we serve beer and not red wine?
ReplyDeletequack, feel free to come by my blog and rant too, man. I think the overbooking is universal lah.
ReplyDeleteHaving proper senior support is very important in clinics. When in ortho I had good support and teaching, confident to treat most cases and know when to ask for help, allowed to list cases under myself (OK, under SR but on the understanding that I'm responsible lah).
Then in GS kena left alone (as in NO reg next door!), blur like sotong, poor patients got to come back again and again...
Then I heard of this anaesthesia MO who was not allowed to run his own OR, and had one reg just to sit in his OR all the time (usually one senior runs two ORs each with an MO).
I too heard about the 'no union' rule. Wonder how true that is.
Og, beer is a waste of space. I'm too busy to take so long to get drunk. Give me the vodka now!
ReplyDeleteAiyah it is meant to be teaching hospitals lar.. if not how do the med students and new doctors learn their art and treat patients?! As it is, if u want consultant to see u, pay more lol! wat u want? Cheap and immediate and seen by consultants ah.. then u wait long long till the day u die also wun haf! Seriously think that singaporean patients mostly suck.. I getting sick of seeing horrible patients everyday. Irritants.
ReplyDeleteWah, anon, you more hiong than angry doc leh.
ReplyDeleteBut if we had a union, I think we won't need to blog to vent already.
*sigh*
anon..sick den quit loh..noone's forcing u to stay on..
ReplyDeleteIndeed the waiting time at our polyclinics are long and frustrating(I go to polyclinics). Compare to Britain's gahment hospitals and polyclinics. We should be thankful.
ReplyDeleteI worked in Australian public hospitals for a few years b4 i came to Spore. The hospital system is much the same lah. As a baby MO, I had to run "specialist" endocrine, diabetes, psychiatric etc clinics too. The lists were shorter but the patients there are more demanding. So there's no such thing as a 5 minutes consult. I think the lists are shorter because the GPs handle the bulk of chronic cases, so there's less chronic cases choking up the specialist clinics. Patients there don't mind going to GPs because it is subsidized too. There's no polyclinic in Australia.
ReplyDeleteAs for the anon who said foreign doctors get FULL registration after 1 yr, I think he or she is really mistaken. I'm a foreign doctor myself with Australian qualification, we need 6 yrs conditional registration before we can convert to full registration. Only as recent as April 2005, SMC changed the rule such that foreign doctors with locally recognised specialist qualifications can convert to full registration after 3 yrs of conditioned registration. Foreign doctors without locally recognised medical qualifications are on temporary registration.
It always amused me that Sporean doctors think Australia is paradise. They want to leave and yet at the same time, they look down on foreign doctors. So, what will happen to the patients?
hey Dr BL Og, i am a huge admirer of your writing, and get big laughs every time i read your entries.
ReplyDeleteif you're interested in writing an anonymous column for the SMA News ( if you deem us worthy of you haha ), drop me an email at ojj75@yahoo.com.
we're experts at protecting identities ( e.g. The Hobbit ), so hope you'll say yes.
if not, then keep up the good work, and ahem, link to me can? :)
( www.spacefan.blogspot.com and www.lingualnerve.com )
I am greatly honoured by ur request. The Hobbit has been a source of inspiration for me. But can I ge a waiver for the membership if i write? hehe. will email you!
ReplyDeleteget a waiver, typo
ReplyDeleteThis comment has been removed by a blog administrator.
ReplyDeleteHahah! I know who spacefan is liao!
ReplyDeleteSpacefan, you know you have reputation as "the houseman's whose name turns up on google search" or not?
I'll be sure to come over on your board angry doc/soulmate. =)
ReplyDeleteAnd yeah I know what you mean about having seniors nearby so you can ask questions...Ambulatory care and inpatient hospital care are two different ball games.
This is great validation for you Og! Invitation to write for the SMA. Before you know it, you may be given a guest column in ST as health affairs correspondent too; (the current one needs a spanking)! =) Please do, it'll be nice to see more (gasp! may I say) dissident views in the SMA heh.
And yeah this mth's Hobbit's article wasn't funny but it's way more incisive than many of the commentaries I've read in our esteemed national newspaper.
If we have a union would we be active you think? So many of us are apathetic...being used to not having a voice. I laugh whenever there're feedback sessions for junior staff in hospitals.
Boh bian one what.
ReplyDeleteWorking in restructured hospital is like that one lah.
Hi Dr Blog,
ReplyDeleteI'm a JC2 student thinking about doing medicine next year. Could you tell me the pros and cons about doing medicine overseas / in singapore?
Between US, UK and Aus, which one is better? And are foreign trained doctors that looked down upon?
- papertiger
hi dr blog suggest that you start putting up mp3 podcast so that we can enjoy your rants on the move.
ReplyDeletemaybe you will soon see a lot more singaporeans laughing to themselves in public areas.
hmmm, podcast, what songs do you suggest i sing then?? i have often been lauded fo my patriotic rendition of the national anthem!
ReplyDeletesing doctors life why so hard lor???? or why patients like popping their heads? your own composed song of doctor's life diary.
ReplyDeleteTo C F L L N
ReplyDeleteWho wants to read to me to help me sleep.
Sorry, I will only consider doctor who are:
-tall,
- dark,
- handsome,
- hopefully caring,
- doesn't criticise Singapore and slam patients
- Can cure my illness
- Drive SLK
To read me to sleep.
smtimes i see foreign med grads frm obsurce regions coming to register for degree courses.. and it scares me no end tat such pple hope to gain local qualifications to practice here.. y wud anyone in their right mind wanna put emselves in the hands of such pple.. no offence, but they can't even string coherent sentences tog.how to communicate with the patient? and the worst thing is, i hear that a certain cluster employs them by the busload....
ReplyDeleteoi....r u talking about singhealth?
ReplyDeletei think life as a doc isn't easy just as is the life of the nurses/or clinic assistants having been one myself. some patients are demanding want to rush to see doctor first. some patients dun ask everything in the consultation room then we have to pop our heads in when the doc is attending to another patient. haiz~ part and parcel of work i suppose. patients are ur clients...we can only hope to meet patients who are understanding.
ReplyDelete