She dies when doctors pierce her heart
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Yes, thumbs up! +1Originally posted by ShutterBug:I feel that if no compensation is automatically offered by the hospital;
1) the doctors involved, and the hospital should be answerable to the patient's death - family should sue for all damages plus legal costs.
2) All medical fees and or costs in hospitalisation of the deceased be waived completely
3) Funeral costs will also be paid by the doctors involved
This will bring closure.
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Oops, another can of worms.Originally posted by ShutterBug:Isn't it STUPID? Even UNFAIR/UNJUST?
Clearly, one of the two "doctors", had noticed the paitent's swollen heart but failed or omitted for reasons unknown, to inform the other doctor who will be doing the insertion.
What do you call this???
And by their names, aren't they Foreign Talents???
Talents? -
Unbelievable!Originally posted by nightzip:yAH, its not professional negligence, its professional IGNORANCE!!
Look at their age!! do they have any experience as a surgeon? in singapore you need to study 7 years, to be GP then another 4 years to be surgeon...you should be at least 35 years then!
25 year old puny, knows NUTs about operation!
What kind of "World Class" standards is this?!?!
How did they qualify to work in TTSH? Who qualified them?
It's like a pilot who has just gotten his license and flies an airliner with 400 passengers!
What happened to all those red-tapes, regulations, and stringent requirements? Are FTs exempted from hospital's prequisites to be doctors and or surgeons?
If the patient is some minister's family member, their heads will be rolling on the floor right now, instead of NO CHARGE.
What kind of judicial system is this??? -
Oops, another can of worms.Originally posted by ShutterBug:Isn't it STUPID? Even UNFAIR/UNJUST?
Clearly, one of the two "doctors", had noticed the paitent's swollen heart but failed or omitted for reasons unknown, to inform the other doctor who will be doing the insertion.
What do you call this???
And by their names, aren't they Foreign Talents???
Talents? -
People want cheap medical care what? Pay peanuts, get monkeys lor..Originally posted by ShutterBug:Isn't it STUPID? Even UNFAIR/UNJUST?
Clearly, one of the two "doctors", had noticed the paitent's swollen heart but failed or omitted for reasons unknown, to inform the other doctor who will be doing the insertion.
What do you call this???
And by their names, aren't they Foreign Talents???
Talents? -
These two doctors are far too junior to handle such a procedure. It is difficult to prove negligence based on the law of tort but there was clearly an error of judgment. The position of the pleural tap might have been ok in another patient but this patient had an enlarged heart, which led to the problems. Not having seen the X-rays myself, it is difficult to say but I suspect there isn't much of pleural effusion anyway. Her main problem was wheezing, probably due to heart failure rather than a big effusion. Duretics might well have relieved most of her symptoms although it is not wrong to do a pleural tap, just technically more difficult. It is therefore not an issue of negligence but one of erroneous judgment due to inexperience.Originally posted by ShutterBug:Unbelievable!
What kind of "World Class" standards is this?!?!
How did they qualify to work in TTSH? Who qualified them?
It's like a pilot who has just gotten his license and flies an airliner with 400 passengers!
What happened to all those red-tapes, regulations, and stringent requirements? Are FTs exempted from hospital's prequisites to be doctors and or surgeons?
If the patient is some minister's family member, their heads will be rolling on the floor right now, instead of NO CHARGE.
What kind of judicial system is this???
One doctor apparently had not performed the procedure before and the other is not even a trainee specialist. There are simple pleural taps and complex ones. Complex cases like this should have been handled by a more experienced doctor.
It's partly down to money. If you want more experienced doctors to attend to such routine procedures, you have to employ more specialists and be prepared to pay more for medical treatment. But Singaporeans are against that..some forumners like Atobe think you don't need higher skilled doctors at all...just get a Chinese physician
Btw, Shutterbug, there is no such distinction between professional and criminal negligence. Negligence is a tort, an offence in civil law although if the degree of negligence is high enough to warrant criminal prosecution, a charge of manslaughter or causing bodily harm can be brought. -
Irresponsible, Incompetent and Inexperience fellow
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Going around the whole thing in medical terminologies and legal technical terms, doesn't change the fact that one doctor DIDN'T inform the other about her enlarged heart, thus leading to this so called "error of judgement".Originally posted by oxford mushroom:These two doctors are far too junior to handle such a procedure. It is difficult to prove negligence based on the law of tort but there was clearly an error of judgment. The position of the pleural tap might have been ok in another patient but this patient had an enlarged heart, which led to the problems. Not having seen the X-rays myself, it is difficult to say but I suspect there isn't much of pleural effusion anyway. Her main problem was wheezing, probably due to heart failure rather than a big effusion. Duretics might well have relieved most of her symptoms although it is not wrong to do a pleural tap, just technically more difficult. It is therefore not an issue of negligence but one of erroneous judgment due to inexperience.
One doctor apparently had not performed the procedure before and the other is not even a trainee specialist. There are simple pleural taps and complex ones. Complex cases like this should have been handled by a more experienced doctor.
It's partly down to money. If you want more experienced doctors to attend to such routine procedures, you have to employ more specialists and be prepared to pay more for medical treatment. But Singaporeans are against that..some forumners like Atobe think you don't need higher skilled doctors at all...just get a Chinese physician
Btw, Shutterbug, there is no such distinction between professional and criminal negligence. Negligence is a tort, an offence in civil law although if the degree of negligence is high enough to warrant criminal prosecution, a charge of manslaughter or causing bodily harm can be brought.
In medicine, doctors are expected to diagnose patients ACCURATELY, not make any kind of JUDGEMENT, erroneous or otherwise.
So it looks like we're as well paying peanuts to our ministers who in turn, hired monkeys as doctors. -
You will be surprise how many doctor actually know how to use the Stereoscope...
Doctors here protect each other back.
unless in the state... we have more rights -
Lawyers who run away with money get struck off the bar and thrown into jail. Doctors kill ppl and get away scot free.
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Most of A & E doctors we see are junior doctors in their 20s , and they are inexpericenced and overworked... it all boil down to cost ... as the hospital mgt want to cut cost ..........of course the quality of care suffer ...
Sometime I think with all our surplus where does it go ... cant they subside healthcare abit .. something is really wrong .....but election is just over ...dun think the present term of garment will wake up to see this problem
I feel sorry for the patient RIP ... -
Yup, blame the hospital management for their policies, they shouldnt even allow junior doctors to perform such intricate surgeries in the first place...
all the Q#$@#$ cut cost measures...those management fools. -
Some observations:
1. Inexperienced doctors need to get experience - so how? Of course, some patient will always end up being the first case of some trainee doc. Doctor choice applies only to private full fee-paying docs. BUT please note that many consultants have not done procedures in years, so sometimes the best people are usually senior registrars or registrars in their 2 or third year!!
2. More importantly is the need to ensure adequate supervision.
3. Puncture of the heart is a known complication of thoracentesis and pleural biopsy - even in the best of hands, and even under radiological guidance.
4. In our restructured hospitals - they are also our training institutions. The aforementioned procedure takes approximately 1 hour to perform. It takes about 1 hour to organize all the pre-procedure blood tests and radiographs and to review the results. Post-procedure it takes half an hour to write the procedure note, get a post-procedure radiography and review the result. A trainee doc and a supervising doc if paid at locum rates (at least $60/hr) will put in about 2.5 hours getting this thing done (so labour cost - just doctors only not including ancillary staff) will be $300. The procedure equipment and peri-procedural tests etc would cost something. The last I was told way back in 1998 when I was helping out with these procedures was the private docs were charging about $1200 procedure fee.
So ..... I wonder how much this procedure would have been billed and what was actually paid by patient/medishield/medisave.
If you have truly instructor/clinical faculty supervision, who set aside time (ie, consultants, experienced registrar = time = >$200/hr), clearly medical training/education and procedure costs will be very high.
WHO WANTS TO PAY?
I did my graduate medical training in the USA for 6 years, estimated to cost the US government $100 000/year - all free. + Great lifestyle and freedoms in the USA. SINGAPORE CANNOT COMPETE!!!!
Now I am FT in USA ?!?!!? -
wtfOriginally posted by nightzip:yAH, its not professional negligence, its professional IGNORANCE!!
Look at their age!! do they have any experience as a surgeon? in singapore you need to study 7 years, to be GP then another 4 years to be surgeon...you should be at least 35 years then!
25 year old puny, knows NUTs about operation! -
actually, when u go through operations there's no 100% guarantee success.
i do agree that doctors make mistake. but can we do anything about it? the answer is NO.
u can sue the doctor but in the end, what does it benefit u???
dun give baseless and emotional replies if there's simply nothing to talk about.
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Originally posted by Dogtor:
Years ago, we first trained to insert chest tubes by practising on cadavers...there were lots of unclaimed bodies in the mortuary in those days. By the time we first performed the procedure under supervision on a live patient, we had already done at least 5 insertions on dead bodies. Obviously, you have to practise on simple cases before going on to the complex ones.
Some observations:
1. [b]Inexperienced doctors need to get experience - so how? Of course, some patient will always end up being the first case of some trainee doc. Doctor choice applies only to private full fee-paying docs. BUT please note that many consultants have not done procedures in years, so sometimes the best people are usually senior registrars or registrars in their 2 or third year!!
2. More importantly is the need to ensure adequate supervision.
3. Puncture of the heart is a known complication of thoracentesis and pleural biopsy - even in the best of hands, and even under radiological guidance.
4. In our restructured hospitals - they are also our training institutions. The aforementioned procedure takes approximately 1 hour to perform. It takes about 1 hour to organize all the pre-procedure blood tests and radiographs and to review the results. Post-procedure it takes half an hour to write the procedure note, get a post-procedure radiography and review the result. A trainee doc and a supervising doc if paid at locum rates (at least $60/hr) will put in about 2.5 hours getting this thing done (so labour cost - just doctors only not including ancillary staff) will be $300. The procedure equipment and peri-procedural tests etc would cost something. The last I was told way back in 1998 when I was helping out with these procedures was the private docs were charging about $1200 procedure fee.
So ..... I wonder how much this procedure would have been billed and what was actually paid by patient/medishield/medisave.
If you have truly instructor/clinical faculty supervision, who set aside time (ie, consultants, experienced registrar = time = >$200/hr), clearly medical training/education and procedure costs will be very high.
WHO WANTS TO PAY?
I did my graduate medical training in the USA for 6 years, estimated to cost the US government $100 000/year - all free. + Great lifestyle and freedoms in the USA. SINGAPORE CANNOT COMPETE!!!!
Now I am FT in USA ?!?!!?[/b]
Nowdays, young doctors do not have any dead bodies to practise on. What's worse is that many patients refuse to allow a junior doctor to do the procedure, which means we have medical officers who haven't even done a single chest tube insertion. In the past, housemen used to do 2-3 chest tube insertions every day!
With more patients refusing to allow our juniors to do procedures, we are just pushing the problem back. Our housemen do not perform any procedures and now we have more senior medical officers who are completely inexperienced with some procedures.
As for billing for this procedure, if the patient is a C class patient, they probably won't have to pay for the procedure anyway...their expenses are capped. -
That's not true. The ward consultant knew about the enlarged heart and it did not prevent him from asking a completely inexperienced MO to perform the procedure. So what if the other doctor knew about the enlarged heart, the MO still had to do the procedure.Originally posted by ShutterBug:Going around the whole thing in medical terminologies and legal technical terms, doesn't change the fact that one doctor DIDN'T inform the other about her enlarged heart, thus leading to this so called "error of judgement".
In medicine, doctors are expected to diagnose patients ACCURATELY, not make any kind of JUDGEMENT, erroneous or otherwise.
So it looks like we're as well paying peanuts to our ministers who in turn, hired monkeys as doctors.
If there is any fault, it lies with the consultant for improper delegation of the job, although it must be said that chest tube insertion should be within the competence of an MO. I do not know if the MO is a foreign talent (I suspect he is) but in any case, there are problems with training of junior doctors as I mentioned in an earlier post. Part of that fault lies with patients.
All medical diagnoses are an exercise of judgment. Based on your knowledge and experience, you make a judgment as to the most likely diagnosis. You hope to be right most of the time but NO DOCTOR IN THE WORLD IS EVER ALWAYS RIGHT.
One way to reduce errors is to involve other doctors to arrive at a consensus opinion. It is already a requirement in the UK for multi-disciplinary teams of experts to decide on treatment of various cancers, so it is no longer the knowledge and experience of a single doctor but a whole team of them.
Of course that is 'inefficient', takes a longer time and costs more. That is the price of quality. Unfortunately, Singaporeans are not prepared to pay more for quality healthcare..there are forumners who think that we do not need highly trained doctors and high-tech diagnostics. In this case, as suggested by the expert witness from Singapore Heart Centre, radiology guided chest tube insertion might have prevented the tragedy.
But Singaporeans will kpkb about the high cost of healthcare. As I said, you pay peanuts, you get monkeys. -
As always, Oxford Mushroom - you are quite right and wise - rendering you as one of the docs who is almost always right.Originally posted by oxford mushroom:All medical diagnoses are an exercise of judgment. Based on your knowledge and experience, you make a judgment as to the most likely diagnosis. You hope to be right most of the time but NO DOCTOR IN THE WORLD IS EVER ALWAYS RIGHT.
One way to reduce errors is to involve other doctors to arrive at a consensus opinion. It is already a requirement in the UK for multi-disciplinary teams of experts to decide on treatment of various cancers, so it is no longer the knowledge and experience of a single doctor but a whole team of them.
Of course that is 'inefficient', takes a longer time and costs more. That is the price of quality. Unfortunately, Singaporeans are not prepared to pay more for quality healthcare..there are forumners who think that we do not need highly trained doctors and high-tech diagnostics. In this case, as suggested by the expert witness from Singapore Heart Centre, radiology guided chest tube insertion might have prevented the tragedy.
But Singaporeans will kpkb about the high cost of healthcare. As I said, you pay peanuts, you get monkeys.
The dogmatic approach in Singapore with high and mighty consultants and a unchallenging junior doc class can sometimes result in poorer care.
Complex medical care requires a multi-disciplinary approach and the physician-in-chief of today should be trained to assimilate care options/opinions, which at times is quite lacking. The medical fraternity thinks it is a sign of weakness to ask for help or to use a team-approach?!?!? -
Ummmmmmm..... the last time I used a steroscope was examining a fungus during biology class in RJC in 1988 to 89 ......Originally posted by Isis:You will be surprise how many doctor actually know how to use the Stereoscope...
Doctors here protect each other back.
unless in the state... we have more rights -
Yes, you do have a point. However, I do not see the logic why ANY person in ill or good health, would want to or readily submit themselves to a YOUNG and or INEXPERIENCED doctor for any kind of invasive procedures?Originally posted by oxford mushroom:That's not true. The ward consultant knew about the enlarged heart and it did not prevent him from asking a completely inexperienced MO to perform the procedure. So what if the other doctor knew about the enlarged heart, the MO still had to do the procedure.
If there is any fault, it lies with the consultant for improper delegation of the job, although it must be said that chest tube insertion should be within the competence of an MO. I do not know if the MO is a foreign talent (I suspect he is) but in any case, there are problems with training of junior doctors as I mentioned in an earlier post. Part of that fault lies with patients.
All medical diagnoses are an exercise of judgment. Based on your knowledge and experience, you make a judgment as to the most likely diagnosis. You hope to be right most of the time but NO DOCTOR IN THE WORLD IS EVER ALWAYS RIGHT.
One way to reduce errors is to involve other doctors to arrive at a consensus opinion. It is already a requirement in the UK for multi-disciplinary teams of experts to decide on treatment of various cancers, so it is no longer the knowledge and experience of a single doctor but a whole team of them.
Of course that is 'inefficient', takes a longer time and costs more. That is the price of quality. Unfortunately, Singaporeans are not prepared to pay more for quality healthcare..there are forumners who think that we do not need highly trained doctors and high-tech diagnostics. In this case, as suggested by the expert witness from Singapore Heart Centre, radiology guided chest tube insertion might have prevented the tragedy.
But Singaporeans will kpkb about the high cost of healthcare. As I said, you pay peanuts, you get monkeys.
How doctors are trained in the medical industry either with a cadaver or a live patient, is an onerous issue for medical schools/universities. Otherwise, how could NASA train astraunauts to operate and undertake procedures in space on earth? Yes they have huge olympic sized pools, and hence I believe means of practice should be creatively developed for medical training as well.
On the issue of costs in healthcare here, all I can say is - our gov has made enough money, it's high time it starts making a little less and give public SAFE & decent healthcare that matches costs and not hide behind a slew of stats abd economic jargonic summary. -
Nobody wants an inexperienced doctor to perform a procedure on them, but you cannot gain that experience unless you practise it on your patients (albeit under supervision). Would you prefer that your surgeon operates on you having years of experience practising on pigs and rabbits alone?Originally posted by ShutterBug:Yes, you do have a point. However, I do not see the logic why ANY person in ill or good health, would want to or readily submit themselves to a YOUNG and or INEXPERIENCED doctor for any kind of invasive procedures?
How doctors are trained in the medical industry either with a cadaver or a live patient, is an onerous issue for medical schools/universities. Otherwise, how could NASA train astraunauts to operate and undertake procedures in space on earth? Yes they have huge olympic sized pools, and hence I believe means of practice should be creatively developed for medical training as well.
On the issue of costs in healthcare here, all I can say is - our gov has made enough money, it's high time it starts making a little less and give public SAFE & decent healthcare that matches costs and not hide behind a slew of stats abd economic jargonic summary.
The next best thing to live patients would be cadavers but hardly any Singaporeans would donate their bodies to science nowadays. If patients do not allow our junior doctors to gain experience with performing procedures, we will have more disasters like this one.
Creative means? Sure, we train junior doctors using simulators but the technology is very expensive but far from realistic. It's like learning to fly using a simulator only without real flying experience. Would you accept a pilot who passed the flying test on the simulator and allow him to fly a 747 passenger plane next? But that's what we are asking our doctors to do if they are not allowed to learn such procedures on live patients under supervison.
In the UK, patients generally do not object to young doctors practising such procedures as long as there is adequate supervision. One big reason is because they do not pay upfront anyway.
An experienced doctor is the result of learning from his many mistakes. As Edison said when he was asked about his success after failing 1000 times to invent the electric bulb, "I have not failed. I've just found 10000 ways that won't work."
If patients refuse to participate in the training of junior doctors, we will not have experienced doctors in future. Ultimately, it is the patient who suffers. -
In this case, as you have pointed out in much details, it would suffice to say that all trainee (or otherwise young and or new) doctors should/must be supervised when carrying out such procedures.Originally posted by oxford mushroom:Nobody wants an inexperienced doctor to perform a procedure on them, but you cannot gain that experience unless you practise it on your patients (albeit under supervision). Would you prefer that your surgeon operates on you having years of experience practising on pigs and rabbits alone?
The next best thing to live patients would be cadavers but hardly any Singaporeans would donate their bodies to science nowadays. If patients do not allow our junior doctors to gain experience with performing procedures, we will have more disasters like this one.
Creative means? Sure, we train junior doctors using simulators but the technology is very expensive but far from realistic. It's like learning to fly using a simulator only without real flying experience. Would you accept a pilot who passed the flying test on the simulator and allow him to fly a 747 passenger plane next? But that's what we are asking our doctors to do if they are not allowed to learn such procedures on live patients under supervison.
In the UK, patients generally do not object to young doctors practising such procedures as long as there is adequate supervision. One big reason is because they do not pay upfront anyway.
An experienced doctor is the result of learning from his many mistakes. As Edison said when he was asked about his success after failing 1000 times to invent the electric bulb, "I have not failed. I've just found 10000 ways that won't work."
If patients refuse to participate in the training of junior doctors, we will not have experienced doctors in future. Ultimately, it is the patient who suffers. -
[quote]Originally posted by oxford mushroom:
[b]
That's not true. The ward consultant knew about the enlarged heart and it did not prevent him from asking a completely inexperienced MO to perform the procedure. So what if the other doctor knew about the enlarged heart, the MO still had to do the procedure.[quote]
Beg to differ. If the medical officers are not competent enough to do the job, they should say so. "First, do no harm", isn't that right? Second, it is not a matter about them being inexperienced doing the procedure, it is about an X-ray that is available, that would give information about a part of the body that they are going to insert a tube into, and one did not pass on the information, and the second one did not bother to check. This is not just inability to perform a procedure, my friend, this is simple carelessness which have resulted in a family losing a loved one. -
it is a tragedy for the victim & family.
I am quite appalled that nothing was done for the victim, but just someone who probably have read more medical books have come out with a statement that covers everythng up.
I believe further investigation should be carried out.
yes, the aim is not to penalise but how to assure the public that a next victim won't be swept under th blanket again.
Given the current state of our medical, I question the flu exercise as more of a confidence blooster for the public than more functional exercises. -
Originally posted by sourketchup:
You missed the point. As the expert witness pointed out, it was not a requirement to view the CT scan before performing the procedure. Further, even if the second doctor knew of the enlarged heart, it would have made no difference. The ward consultant, who would have known about the enlarged heart, nevertheless ordered the MO to perform the procedure. The consultant was not sufficiently worried to order the procedure to be performed under radiological guidance.
Beg to differ. If the medical officers are not competent enough to do the job, they should say so. "First, do no harm", isn't that right? Second, it is not a matter about them being inexperienced doing the procedure, it is about an X-ray that is available, that would give information about a part of the body that they are going to insert a tube into, and one did not pass on the information, and the second one did not bother to check. This is not just inability to perform a procedure, my friend, this is simple carelessness which have resulted in a family losing a loved one.
MOs should be competent to perform chest tube insertions, a procedure that used to be done routinely by more junior housemen. The problem is that junior doctors now have little opportunities to gain experience because the larger numbers of private patients refuse to allow junior doctors to do the procedure.
Ultimately, young doctors have to learn and pick up experience. If they do not learn from patients with simpler conditions, their first case might well be a difficult case like this one.
As always with cases like these, I fear the hospital response will be to limit chest tube insertions to even more senior doctors. But that is only prolonging the inevitable. If housemen and junior MOs are not allowed to perform such procedures, in a few years, we will have senior MOs and registrars who will be doing the procedure for the first time.
This case has everything to do with error of judgment and experience. That is why the court did not find any negligence relating to the two MOs. Of course the Coroner's verdict does not prejudice any subsequent litigation the family might bring, but they will have a high hurdle to clear.