Subsidised or not, treat all patients equally

[Askmelah’s Note: this is an old article that I happen to chance upon in my paper cutting collection. So I have included here for sharing. Kudos to Dr. Lee who was born with a silver spoon and yet remain humble and down-to-earth in treating her patients, rich or poor. Her experience of a “subsidised” patient in Singapore is very real and is a problem with our healthcare system.]

Source: The Straits Times  16 Dec 2009

By Lee Wei Ling

THOSE who have been reading my columns regularly will know that my health has been uncertain. Perhaps for that very reason, I feel keenly the ill fortunes as well as triumphs of my patients.

Today, as I write this, I feel like a ‘104-year-old’, a term that my friends would understand. It means I feel 50 years older than I really am.

But I have patients to see. Many among them would have taken leave or made special arrangements to be accompanied by a parent or caregiver in order to see me.

I could, of course, get another doctor in my department to see them, for most of my patients are subsidised and thus not allowed to choose their own doctors. But I treat my subsidised (B2 and C class) patients no differently from my full-paying (A and B1 class) patients, and provide all with the same quality of care. I also insist that all the doctors at the National Neuroscience Institute (NNI) do the same.

This ethos of caring for patients regardless of whether they are subsidised or not is sometimes absent in our hospitals, even in cases of subsidised patients with complex problems. Sometimes such patients are assigned to junior doctors.

Recently, a friend telephoned me one evening, very distressed. Her husband had had a severe head injury. I asked her who was the doctor in charge. She said she did not know. I told her to write down my name and mobile number on a piece of paper and pass it to the most senior doctor there and ask him to call me.

The moment the doctor saw the note, he telephoned his head of department. My friend had never seen or heard of the head of department before that. Other doctors in the hospital asked my friend: ‘Who are you and how are you related to Professor Lee Wei Ling?’

An hour later, the head of department called me to give me the medical details, sounding as though he had been in charge all along. The next day, a bouquet of flowers from the hospital appeared in the room of my friend’s husband. A senior doctor took care of my friend’s husband and performed every operation on him personally. My friend’s husband had been admitted as a subsidised patient because all emergency admissions are categorised as ‘subsidised’.

Our system must find an effective way of ensuring that senior doctors also treat subsidised patients. At present, it is in the economic interests of senior doctors to focus on paying patients rather than subsidised patients – and it is not always the case that doctors look beyond their economic interests. Thus we get incidents like the one I have just described. My friend’s husband should have been treated by a senior doctor as a matter of course, without my intervention.

At NNI, a subsidised patient with a complex medical problem would be seen by a senior doctor, or at least a junior doctor under a senior doctor’s supervision. My doctors know that I would come down on them like a tonne of bricks if I found they were not providing the same quality of care to subsidised patients as they were to paying ones.

Back to today: I had four glasses of ice-cold kopi-o and made it to the clinic to see my patients. I have just finished seeing all my patients and decided that doing so was the best medicine I could possibly have.

Two of my patients were young men who had been under my care for about 20 years each. One was an engineering graduate of the National University of Singapore, and the other, a polytechnic graduate; both are now gainfully employed. Two other patients were severely handicapped, and seeing them reminded me that I had no right to whine about my fate.

Another patient came with her mother. She continues to have seizures but less frequently now compared with her previous visit.

Three patients did not come. Instead, their elderly parents came and I asked the parents how the patients were doing. I knew all three well and their parents knew me well. I understood the difficulty of elderly parents having to take their handicapped adult children to the hospital by public transport.

My best reward of the day was a lady with epilepsy who has been under my care for 12 years. I casually asked her whether she was still employed.

‘Yes,’ she replied, ‘I am in the same company I was working for when I first saw you. Don’t you remember, when the person in charge of me asked for a medical report from you, you said that she could contact you personally? She never did, perhaps because she was frightened of you, so I am still working in the same company. During the recent retrenchment exercise, she lost her job and I have been promoted to take over her duties.’

If that superior had contacted me and the patient had granted me permission to release her medical information, I would have done so. Since her seizures had been brought under control within six months of her coming under my care, and since there is still much social stigma attached to epilepsy, I would have told the superior that the seizures were well controlled and would not affect my patient’s ability to carry out her duties.

When I walked out of my clinic after attending to all my patients, I felt psychologically like a 44-year-old, 10 years younger than my actual age. Which medicine can make you feel 60 years younger? More importantly, I felt I had contributed, in a small way, to human welfare.

Today was worth living though it had started badly and I am still stiff and tired. I will do my best, though at times my best is not good enough, for my patients’ medical conditions are too severe for current medical science to cure.

The writer is director of the National Neuroscience Institute. Think-Tank is a weekly column rotated among eight leading figures in Singapore’s tertiary and research institutions.