Patient Rejected By 3 Hospitals
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I just feel that our gov is often quick to declare standards in Singapore as "Hub", "World Class", "Number One", "The First" etc. But in a real situation such as a sudden pneumonia outbreak, suddenly hospitals are short of beds - which doesn't look very "Hub", "World Class" or, "Number One" after all.Originally posted by dragg:because there are no beds. all because of pneumonia!!
arent we a medical hub?
I mean, if you wanna label a public service as WORLD CLASS or HUB, please, live up to that title, and not just charge World Class fees. Because public expectations will be WORLD CLASS also. -
That must be the commotion over Lee Kuan Yew's wife.Originally posted by lwflee:Hahaha - I still remember someone criticising the British NHS a few years ago.
he paid hundreds of thousands for a airplane to be installed with medical equipments to fly from Singapore to Britain and back again. His wife had a stroke.
Money makes people move(or fly).
Really, i don't know about this, I'm rather proud that Singapore has such efficiency, but is this service rendered to ALL level of social groups? -
Depends on how much you are paying..if you have good medical insurance, you get immediate and top class treatment in the US. If you do not have insurance, I dare say you will be rejected by more than 3 hospitals. In the UK, if you have a stroke in the middle of the night, you will not get an emergency CT scan outside office hours, even if you are the wife of a foreign ex-Prime Minister or Senior Minister. Singapore is just following the standards of these first world nations...I suppose that's world class practice tooOriginally posted by ShutterBug:I just feel that our gov is often quick to declare standards in Singapore as "Hub", "World Class", "Number One", "The First" etc. But in a real situation such as a sudden pneumonia outbreak, suddenly hospitals are short of beds - which doesn't look very "Hub", "World Class" or, "Number One" after all.
I mean, if you wanna label a public service as WORLD CLASS or HUB, please, live up to that title, and not just charge World Class fees. Because public expectations will be WORLD CLASS also.
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Worldly Class or otherwise, saving of lives shouldn't be tethered to such politics. It is pure politics you are talking about, and I do not believe that in countries where Human Rights are embraced, double standards like these are the norms.Originally posted by oxford mushroom:Depends on how much you are paying..if you have good medical insurance, you get immediate and top class treatment in the US. If you do not have insurance, I dare say you will be rejected by more than 3 hospitals. In the UK, if you have a stroke in the middle of the night, you will not get an emergency CT scan outside office hours, even if you are the wife of a foreign ex-Prime Minister or Senior Minister. Singapore is just following the standards of these first world nations...I suppose that's world class practice too
Here in Sg, where the hell do average people on the street have enough to set aside for Medcial Insurance? Don't reference MediShield or Medisave, they're as much an illusion as CPF.
As said, declaring our healthcare Wolrd Class, is rediculous when in need there aren't enough beds!
An emergency patient SHOULD NOT have to be made to wait several hours for medical attention to be rendered, nevermind the friggin bed!
I mean what the hell, if a passing boat has no space to rescue someone in the ocean, at least throw the fella a life-saver then tell him or her to wait for the next passing boat!
What's the matter? Red Tapes over-ruled common sense of administrators in hospitals??? -
Dare i not insuinate it, but one of our ministers managed it, and in UK as well, despite counter-claims from their cabinet to the contrary, even managed to milk a SIA airline into a flying ambulance (no doubt he foot the bill, but that's beside the point).Originally posted by oxford mushroom:In the UK, if you have a stroke in the middle of the night, you will not get an emergency CT scan outside office hours, even if you are the wife of a foreign ex-Prime Minister or Senior Minister. Singapore is just following the standards of these first world nations...I suppose that's world class practice too 
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Really? So USA certainly does not respect human rights thenOriginally posted by ShutterBug:Worldly Class or otherwise, saving of lives shouldn't be tethered to such politics. It is pure politics you are talking about, and I do not believe that in countries where Human Rights are embraced, double standards like these are the norms.
The Institute of Medicine (IOM) says the American emergency medical system is in crisis - it is seriously short of resources, fragmented and splitting at the seams. Ambulances are commonly turned away from emergency departments, it is not unusual for patients to have to wait for hours and/or days for a bed. The whole system would fall apart if it had to deal with disasters or outbreaks.
According to Dr. Rick Blum, President, American College of Emergency Physicians, the IOM report stresses issues which have been around for a long time. The main problem facing emergency medicine in the USA is reimbursement, overcrowding, ambulance diversion and lack of on-call specialists.
For 40 years there has not been an in-depth study of America's emergency medical system, said Gail Warden, head of the Hospital Based Emergency Care Committee, IOM.
Among the list of problems in the report, are:
-- Emegency rooms are seriously overcrowded
-- Patients have to wait for a long time to be admitted
-- Ambulances are often turned away from emergency departments
-- A chronic shortage of specialists to provide care many emergency rooms
-- Ambulance transport to emergency medical services is generally fragmented, chaotic and inconsistent
-- Emergency rooms are badly prepared for children
The report stresses that money has to be allocated for emergency departments so that the number of specialists can be boosted and overcrowding reduced. It also says emergency medical services need to cooperate more so that the whole system operates more like a team.
As the number of cases attended rises, the number of hospitals with emergency departments has been falling. In 2003 emergency departments received 114 million patients, 26% more than in 1993. However, in 1993 there were 703 hospitals and 425 emergency departments which were closed down by 2003.
Emergency departments have become the safety net for the growing number of America's uninsured. Emergency departments are often not paid for treatment carried out on uninsured people.
Although emergency departments do and are expected to play a major role in dealing with disasters, they only received 4% of the £3.3 billion the Dept of Homeland Security awarded in 2002.
As the number of uninsured people in the USA approaches the 50 million mark, emergency departments are having to care for a disproportionate number of uninsured cases. About 50% of emergency care is uncompensated. No other developed country has such a large percentage of its population without any medical cover at all. In the UK, for example, the number of people without medical cover is zero - the same in most of the European Union and Canada.
The situation in emergency departments has become so dire that health professionals and administrators are no longer concerned about long term issues and planning - all the focus is on coping with the day-at-hand as resources dwindle and patient number rise.
It is not uncommon in America today for hospitals to simply close down their emergency department - not to have one at all. (http://www.medicalnewstoday.com/healthnews.php?newsid=45279) -
WASHINGTON — The nation's emergency medical system — from the 911 centers that take phone calls for help to the emergency rooms that have become primary treatment centers for millions of Americans — is in a dangerous state of crisis, says a new series of landmark reports.
The Institute of Medicine on Wednesday released the Future of Emergency Care reports, which were prepared by a 40-member board after a two-year investigation. The IOM advises the government on science, medical and health issues.
The reports warn that the U.S. lifesaving system is not only failing to handle daily emergencies but also could break down in the face of national disasters, including hurricanes, disease outbreaks or terrorist attacks.
"We are not prepared," says Brent Eastman, a board member and chief medical officer at Scripps Health in San Diego. "We struggle to survive day-to-day."
Nels Sanddal, board member and president of the Critical Illness and Trauma Foundation in Bozeman, Mont., agrees. "To ramp up" to treat high numbers of patients, he says, "we have to have backbone."
The reports say that, on average, in every minute of every day an ambulance carrying a patient is turned away from a hospital on "diversion," when an emergency room says it's too full to take more patients.
That must end, says Arthur Kellermann, director of the Center for Injury Control at Emory University School of Medicine in Atlanta. "We cannot let the most time-sensitive portal in the hospital get gridlocked."
The IOM reports detail how hundreds of thousands of lives are affected every year by EMS deficiencies that are not obvious. "What the public perceives and what is real, in many cases, there is a disconnect," says Gail Warden, president emeritus of the Henry Ford Health System in Detroit, who chaired the panel. "In most communities, there is a crisis under the surface."
Many emergency rooms barely can handle their daily patient loads, children don't always get good care, and the quality of rescue services is erratic, the reports say.
And geography determines survival.
"There is a wide disparity," says Shirley Gamble, a United Way board member in Austin. She cited a 2003 USA TODAY probe that found a 10-fold difference between major cities in cardiac arrest survival rates.
The reports say that by following the lead of those cities that save more lives, entire regions can raise the quality of their care.
Improvements to emergency medical services, Eastman says, "should be built on islands of excellence that exist today."
(http://www.usatoday.com/news/health/2006-06-14-er-care-report_x.htm) -
Almost a quarter of patients waiting for diagnostic tests, such as CT scans, have been left waiting for more than 13 weeks. The Department of Health has published waiting times for the 15 tests for the first time and said three quarters of them were carried out within 13 weeks from referral. But nearly a quarter of patients - 203,114 out of 799,594 tests - were waiting longer than 13 weeks.
The average wait for a non-emergency patient is seven and a half weeks for an MRI scan and two and a half weeks for a CT scan.
The NHS carries out 12 million diagnostic tests every week, said the department.
Health Minister Andy Burnham said: "The NHS is at last identifying and tackling these waiting lists.
"By revealing them, we have also identified the progress that NHS staff have already made in reducing waiting times for the 630 million tests they carry out every year."
Later Tony Blair will meet NHS bosses to discuss progress being made towards the Government's goal of a maximum 18-week waiting time for hospital treatment.
The diagnostic tests are seen as a key part of that target as delays can cause a major hold-up between referral by a GP and hospital treatment.
(http://uk.news.yahoo.com/12072006/140/pressure-nhs-waiting-times.html) -
Btw, do you know that the performance standard for waiting time in the A/E Department from the time the decision is made to admit the patient and the patient getting a bed is 12 hours?
Up to 12 hours wait is considered acceptable in the NHS.
http://ratings2005.healthcarecommission.org.uk/Trust/Indicator/IndicatorDescriptionShort.asp?IndicatorId=1006
Be thankful... -
I mentioned Human Rights, I didn't indicate SIZE of country.
For the size of America, it is quite execusable to be overwhelmed, overcrowded, thin on resources, etc.
We are a small island, what's the matter with our World Class healthcare standards?
Don't come and give me all this details about America's A&E shortcomings, they are huge we are but just one particle of a country.
There is REALLY no excuse for a country our size to be short of beds in hospitals - especially when we so called Developed, a Hub of many industries, and an "example" for many countries to follow.
That's all a lot of smoke, man... -
It is so laughable...Originally posted by oxford mushroom:Btw, do you know that the performance standard for waiting time in the A/E Department from the time the decision is made to admit the patient and the patient getting a bed is 12 hours?
Up to 12 hours wait is considered acceptable in the NHS.
http://ratings2005.healthcarecommission.org.uk/Trust/Indicator/IndicatorDescriptionShort.asp?IndicatorId=1006
Be thankful...
Try waiting 12 hours if one of your limbs were severed in an accident and you are bleeding like a fountain....
That would be a "Standardized" way to die for sure! -
It's down to funding, nothing to do with size...If you increase beds to deal with the occasional surges in demand, you will have lots of empty beds at other times. How's paying the salary of the healthcare workers?Originally posted by ShutterBug:I mentioned Human Rights, I didn't indicate SIZE of country.
For the size of America, it is quite execusable to be overwhelmed, overcrowded, thin on resources, etc.
We are a small island, what's the matter with our World Class healthcare standards?
Don't come and give me all this details about America's A&E shortcomings, they are huge we are but just one particle of a country.
There is REALLY no excuse for a country our size to be short of beds in hospitals - especially when we so called Developed, a Hub of many industries, and an "example" for many countries to follow.
That's all a lot of smoke, man...
How much do you pay for treatment compared to how much the Americans pay in health insurance and taxes?
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Personally, I feel paying higher tax, or taking up your own medical insurance, is better than paying taxes and yet face shortages of beds?Originally posted by oxford mushroom:It's down to funding, nothing to do with size...If you increase beds to deal with the occasional surges in demand, you will have lots of empty beds at other times. How's paying the salary of the healthcare workers?
How much do you pay for treatment compared to how much the Americans pay in health insurance and taxes?
America is America. I already said there is NO EXCUSE being a "Hub" and "World Class". -
If gov can 'make' less in healthcare for public, I'm sure healthcare workers can earn more.
Same with all other public services.
They just want more, more, and more.... -
You are absolutely right.Originally posted by googoomuck:Some time ago, doctors were leaving hospitals because of friction with the administration dept. They want to show doctors who's the boss or what?
The salary is not the issue. Some doctors not motivated by money.
Ask Khaw Boon Guan. He knows. -
actually... which one do u guys prefer??
1) very very "high" standard but only a few of them...??
2) average standard doc.. but alot more of them?
also why is health care so ex?
1) highly paid doc?
2) equipment? -
Mixture of both...you need the most experienced doctors to bring in foreign patients and make Singapore a medical hub. Shutterbug does not or refuse to understand that a world-class medical hub does not mean everyone will have access to it. Like in the US, what sort of service and treatment you get depends on what you can afford.Originally posted by I-like-flings(m):actually... which one do u guys prefer??
1) very very "high" standard but only a few of them...??
2) average standard doc.. but alot more of them?
also why is health care so ex?
1) highly paid doc?
2) equipment?
For the majority of citizens, we have to provide lower quality service at affordable prices. The problem is that Singaporeans want the best but at the lowest price. There is no way you can have both...that's a fact of life. You can have a wash and cut by your HDB hairdresser for $25 or pay celebrity hairstylist David Gan $600-800 each time. Obviously you cannot expect to have the same results from your local hairdresser as the Mediacorp actress who visited David Gan.
The high cost of health care is not at the primary healthcare level, where a visit to the polyclinic is dirt cheap. It is hospital care, lab tests and patented drugs that are expensive.
If you have cough and cold, treatment with panadol and antihistamines at your GP and polyclinic doctor should be less than $25..that's cheap. You do not need antibiotics unless you get a bacterial infection and even then, it's cheap if you get the non-patented, 'old' antibiotics. It may mean you have to get an antibiotic that has slightly more (but not dangerous) side effects, take two tablets four times a day instead of a capsule once a day...but it's cheaper 'cos the patent has run out (takes 20 years).
Lab tests and hospital treatment are expensive because equipment and reagents are purchased from Europe and US, who charge us the full rates. Equipment and new lab techniques are also covered by patents. Hospital consultants are highly trained professionals and have equivalent qualifications to those in Europe and the US. To keep such specialists, you need to provide adequate remuneration. As it is, the average pay of our senior doctors lag behind that of our senior lawyers. -
I do not totally disagree with what you said, but, my contention is that an EMERGENCY must be treated with URGENCY. Not wait several hours.Originally posted by oxford mushroom:Mixture of both...you need the most experienced doctors to bring in foreign patients and make Singapore a medical hub. Shutterbug does not or refuse to understand that a world-class medical hub does not mean everyone will have access to it. Like in the US, what sort of service and treatment you get depends on what you can afford.
For the majority of citizens, we have to provide lower quality service at affordable prices. The problem is that Singaporeans want the best but at the lowest price. There is no way you can have both...that's a fact of life. You can have a wash and cut by your HDB hairdresser for $25 or pay celebrity hairstylist David Gan $600-800 each time. Obviously you cannot expect to have the same results from your local hairdresser as the Mediacorp actress who visited David Gan.
The high cost of health care is not at the primary healthcare level, where a visit to the polyclinic is dirt cheap. It is hospital care, lab tests and patented drugs that are expensive.
If you have cough and cold, treatment with panadol and antihistamines at your GP and polyclinic doctor should be less than $25..that's cheap. You do not need antibiotics unless you get a bacterial infection and even then, it's cheap if you get the non-patented, 'old' antibiotics. It may mean you have to get an antibiotic that has slightly more (but not dangerous) side effects, take two tablets four times a day instead of a capsule once a day...but it's cheaper 'cos the patent has run out (takes 20 years).
Lab tests and hospital treatment are expensive because equipment and reagents are purchased from Europe and US, who charge us the full rates. Equipment and new lab techniques are also covered by patents. Hospital consultants are highly trained professionals and have equivalent qualifications to those in Europe and the US. To keep such specialists, you need to provide adequate remuneration. As it is, the average pay of our senior doctors lag behind that of our senior lawyers.
What kind of treatment or medication thereafter being admitted throuh A&E, is like you've explained, is another issue.
The whole point of the A&E is for people (injured or otherwise VERY ill) to receive medical attention PRONTO. Not made to wait & die.
Medicine and facilities are USELESS, if admission of A&E patients are wait-centric. -
I think the whole issue is that our ministry is trying to pay the minimum amount for healthcare costs. Why do you think there are so many foreign docs in the polyclinics?
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Because Singaporeans complain about high healthcare costs, so have to bring in more foreign docs.Originally posted by sourketchup:I think the whole issue is that our ministry is trying to pay the minimum amount for healthcare costs. Why do you think there are so many foreign docs in the polyclinics? -
From what I have read, the patient in question did not have such an emergency. If it was a life-threatening condition, he would have been accepted by TTSH to stabilize the patient, EVEN if the beds are full.Originally posted by ShutterBug:I do not totally disagree with what you said, but, my contention is that an EMERGENCY must be treated with URGENCY. Not wait several hours.
What kind of treatment or medication thereafter being admitted throuh A&E, is like you've explained, is another issue.
The whole point of the A&E is for people (injured or otherwise VERY ill) to receive medical attention PRONTO. Not made to wait & die.
Medicine and facilities are USELESS, if admission of A&E patients are wait-centric.
The fact is, having assessed his condition by trained paramedics and having his condition communicated to the hospitals, the decision was made to transfer him to other hospitals because his condition wasn't considered to be an emergency.
What a lay person considers to be an emergency is often not. A true medical emergency would be attended to urgently. Non-life threatening conditions can wait. -
Yes, this I am fully agreeable.Originally posted by oxford mushroom:From what I have read, the patient in question did not have such an emergency. If it was a life-threatening condition, he would have been accepted by TTSH to stabilize the patient, EVEN if the beds are full.
The fact is, having assessed his condition by trained paramedics and having his condition communicated to the hospitals, the decision was made to transfer him to other hospitals because his condition wasn't considered to be an emergency.
What a lay person considers to be an emergency is often not. A true medical emergency would be attended to urgently. Non-life threatening conditions can wait.
I understand that there are countless Singaporeans who consider themself a medical emergency when in actullity, they are just suffering from a bad case of indigestion, food poisining, or toothache for example.
But there were also case wherein the patient was clearly brought in still convulscing from a stroke, and made to lie on a gurney and wait for several hours. This, is definitely UNACCEPTABLE and UNBECOMING whatever the reasoning or excuse. -
Sg has shortage of hospitals.
We have 5 general hospitals to serve 4 million people!
SGH
CGH
NUH
AH
TTSH -
If the patient is having convulsions, urgent treatment can be given on a gurney while waiting for a bed. There is no compromise of medical care. Drugs can be injected to control the seizures and there is no difference to the patient whether he is in a bed or lying on a gurney. If necessary, oxygen can also be given on a gurney.Originally posted by ShutterBug:Yes, this I am fully agreeable.
I understand that there are countless Singaporeans who consider themself a medical emergency when in actullity, they are just suffering from a bad case of indigestion, food poisining, or toothache for example.
But there were also case wherein the patient was clearly brought in still convulscing from a stroke, and made to lie on a gurney and wait for several hours. This, is definitely UNACCEPTABLE and UNBECOMING whatever the reasoning or excuse.
In the Emergency Room of top hospitals in the UK and US, I have seen patients waiting for a bed for hours as well. The problem is not unique, if there is a spike in demand for hospital beds for whatever reasons, patients will have to wait for a bed.
In a national crisis, eg. avian flu epidemic, it is possible to create more beds by postponing all surgical operations apart from those that are needed for life-threatening conditions. Patients who are stable can be transferred to convalescent homes to create bed space in acute hospitals.
But apart from such national crisis, it is difficult for hospitals to ask patients who are recovering to go home earlier because others have a greater need for their beds.
Khaw Boon Wan made an interesting observation during the SARS crisis. At that time, TTSH was the SARS hospital and no operations were done. After the SARS crisis, he was expecting a sudden increase in cases due to the backlog of operations. However, they did not come. People were so afraid of SARS and going to TTSH that they carefully considered if they really needed to see a doctor and have that operation. Many decided against it. Khaw Boon Wan thinks that we are over-servicing our patients ie. many operations done were not really necessary and many patients could be treated outside of the hospital.
Singaporeans must recognize that resouces are limited and doctors have to do what they can given the resources. If we expect more, we must be prepared to pay more, but Singaporeans have made it clear they do not want to pay more for healthcare. -
I can tell you that for sure - for family insurance for self, and 2 or more dependents = US$ 700+/month for medical insurance premium.Originally posted by oxford mushroom:It's down to funding, nothing to do with size...If you increase beds to deal with the occasional surges in demand, you will have lots of empty beds at other times. How's paying the salary of the healthcare workers?
How much do you pay for treatment compared to how much the Americans pay in health insurance and taxes?
This is free to me as a clinical fellow at one of the best hospital systems in the USA. !!!
One of the perks of working in the USA.
c.f Singapore = I left as a house officer because restructuring meant that meidcal officers were employed by the restructured hospitals.
We were no longer division I officers of the Ministry of Health, ie, no A class medical treatment etc., NO health benefits.
Singapore pay for docs and professions is way too low - people who can cut it, leave it.
In the USA - people will take a lot of pay cut in order to have health insurance.
Despite the insurance above - I still have to do copays, etc, especially for newer patented drugs which can be costly since they do not come under the insurance carrier's standard formulary.
Junior docs don't get paid as much in the USA as in Singapore dollar for dollar - makes about US$ 40000 to 50000 (pre-tax) + benefits (healthcare is the substantive benefit).