Eye surgery - cannot drive

[Spidey10]

On 6/1/2023 at 6:15 PM, 13177 said:

What scary things need to prepare?

Basically nothing, just go and register and on diet for 12 hrs.

😂 but the thot of all the equipment being shove into yr nose..😂

after that the stent removal process… 

Go see the tube on this..😂

[13177]

On 6/2/2023 at 5:57 AM, Lala81 said:

The less u know the better. Truth is ignorance is bliss. 

Personally, elective surgery I would rather do in private. When your outcome is very highly dependent on the skills of 1 person. Even simple routine surgery. 

Emergency then of course LL. 

What is consider elective surgery? You mean for such surgery, better to do it at private than govt hospital, how come le?

[13177]

On 6/3/2023 at 9:29 AM, Spidey10 said:

Basically nothing, just go and register and on diet for 12 hrs.

😂 but the thot of all the equipment being shove into yr nose..😂

after that the stent removal process… 

Go see the tube on this..😂

Got hearsay the scary of doing nasal surgery. This is why i also scare to do it even though i have narrow nose canal which sometimes give me blocked nose problem.

[mersaylee]

On 6/2/2023 at 3:49 AM, BanCoe said:

Subsidized patient , Ins paid full , same doc did it ( was random…… yearly check up ) and they found some drainage issues in one of them …… it’s a simple procedure and  consultant was introduced also as I requested  to meet him also …..Mine was CGH ( SNEC) ……. But still gotta wear glasses as I have astigmatism ( usually whilst driving ) play safe especially at night …. Did one eye at a time……slept thru procedure ( ha ha ) wife dropped me and hospital called her also once procedure was done also ( nice of them ) and like picked me up about 2 -3!hours later …… smooth 

Brudder, may I right to say you oredi have myopia with astig before the cacteract surgery, now still wear glasses thereafter becos of astig but no more a need to correct the myopia? 

I is borderline cacteract...doc said (few years ago) it's too soon and too thin to go for potong...😁

[Lala81]

On 6/3/2023 at 9:45 AM, 13177 said:

What is consider elective surgery? You mean for such surgery, better to do it at private than govt hospital, how come le?

The best surgeons are in private. Overwhelmingly. Cos the pay and the admin bs gets to everyone. 

The majority of senior surgeons who stay in public, either want to climb the administration ladder or are just lazy to do more. Either way you aren't getting surgeons who just want to do more operations. Obviously the skills will get worse even if they were good in the first place (which often they are the weaker ones in the first place).

All surgeons got ego one lah. There must be a reason they willingly accept lower pay or don't want to establish their own name out there. 

Not saying the public surgeons can't get good one. But just lower chance lor. 

Does it mean you are going to suffer bad complications? Not necessarily. But maybe your surgery recovery will take longer. Your joint movement is worse than it could be if the surgeon was more skilled. Time under anesthesia or tourniquet is longer. 

What is acceptable vs what is good is very big for the one going under the knife. 

You know the less established private surgeons go back to public hospital maybe few times a month to 'keep their hands warm' or to help their old department. 

 

[Lala81]

On 6/3/2023 at 10:24 AM, mersaylee said:

Brudder, may I right to say you oredi have myopia with astig before the cacteract surgery, now still wear glasses thereafter becos of astig but no more a need to correct the myopia? 

I is borderline cacteract...doc said (few years ago) it's too soon and too thin to go for potong...😁

No need glasses. Can be completely corrected. U can put progressive lenses replacement. But of course make sure your Lao hua is stable. 

Actually above 50 can go for cataract surgery liao especially if you are short sighted and lao hua etc. Save you a lot of marfan over the 50-70 years old age group. The lenses nowadays are better than last time. 

 

Edited June 3, 2023 by Lala81

[Lala81]

On 6/3/2023 at 9:45 AM, 13177 said:

What is consider elective surgery? You mean for such surgery, better to do it at private than govt hospital, how come le?

Anything non emergency. 

[BanCoe]

On 6/3/2023 at 10:24 AM, mersaylee said:

Brudder, may I right to say you oredi have myopia with astig before the cacteract surgery, now still wear glasses thereafter becos of astig but no more a need to correct the myopia? 

I is borderline cacteract...doc said (few years ago) it's too soon and too thin to go for potong...😁

Can’t remember the myopia thingy but astig was there …..  but I can go about doing normal things without glasses on …. Only at night I wear them ( ok in the day too as my work is outdoor and the transitions help) a little instead of having sunglasses….. kinda used to them ….. like feel naked without them 🤣🤣

Edited June 3, 2023 by BanCoe

[13177]

On 6/3/2023 at 10:39 AM, Lala81 said:

The best surgeons are in private. Overwhelmingly. Cos the pay and the admin bs gets to everyone. 

The majority of senior surgeons who stay in public, either want to climb the administration ladder or are just lazy to do more. Either way you aren't getting surgeons who just want to do more operations. Obviously the skills will get worse even if they were good in the first place (which often they are the weaker ones in the first place).

All surgeons got ego one lah. There must be a reason they willingly accept lower pay or don't want to establish their own name out there. 

Not saying the public surgeons can't get good one. But just lower chance lor. 

Does it mean you are going to suffer bad complications? Not necessarily. But maybe your surgery recovery will take longer. Your joint movement is worse than it could be if the surgeon was more skilled. Time under anesthesia or tourniquet is longer. 

What is acceptable vs what is good is very big for the one going under the knife. 

You know the less established private surgeons go back to public hospital maybe few times a month to 'keep their hands warm' or to help their old department. 

 

No wonder hearsay go private still better than govt esp if kena big health issue, example like cancer. The medicine they used, the surrounding, the service etc aid in better recovery and the feeling of getting the treatment is more comfy. But the money spend would be scary also.

I have a colleague tio cancer, went to one of the best surgeon in private. And can see that my colleague recovery rate very good and back to work quite fast. Lucky my colleague has comprehensive insurance coverage.

[mersaylee]

On 6/3/2023 at 10:45 AM, Lala81 said:

No need glasses. Can be completely corrected. U can put progressive lenses replacement. But of course make sure your Lao hua is stable. 

Actually above 50 can go for cataract surgery liao especially if you are short sighted and lao hua etc. Save you a lot of marfan over the 50-70 years old age group. The lenses nowadays are better than last time. 

 

But how to ensure the stability of the lao hua yan? Mine need a change of lens every year 😭

[mersaylee]

On 6/3/2023 at 11:02 AM, BanCoe said:

Can’t remember the myopia thingy but astig was there …..  but I can go about doing normal things without glasses on …. Only at night I wear them ( ok in the day too as my work is outdoor and the transitions help) a little instead of having sunglasses….. kinda used to them ….. like feel naked without them 🤣🤣

Naked you say? Can see through people one hor 😁

[Lala81]

On 6/3/2023 at 11:35 AM, mersaylee said:

But how to ensure the stability of the lao hua yan? Mine need a change of lens every year 😭

Lao hua usually worsens the most at the first few years. Once it's stable. It's not really going to change tt much anymore. From what I understand. They may make u sacrifice a bit further vision for better near vision. Basically a good eye doctor will see what you prioritize and make allowances for it. 

[therock]

On 6/3/2023 at 10:39 AM, Lala81 said:

The best surgeons are in private. Overwhelmingly. Cos the pay and the admin bs gets to everyone. 

The majority of senior surgeons who stay in public, either want to climb the administration ladder or are just lazy to do more. Either way you aren't getting surgeons who just want to do more operations. Obviously the skills will get worse even if they were good in the first place (which often they are the weaker ones in the first place).

All surgeons got ego one lah. There must be a reason they willingly accept lower pay or don't want to establish their own name out there. 

Not saying the public surgeons can't get good one. But just lower chance lor. 

Does it mean you are going to suffer bad complications? Not necessarily. But maybe your surgery recovery will take longer. Your joint movement is worse than it could be if the surgeon was more skilled. Time under anesthesia or tourniquet is longer. 

What is acceptable vs what is good is very big for the one going under the knife. 

You know the less established private surgeons go back to public hospital maybe few times a month to 'keep their hands warm' or to help their old department. 

 

No offense bro, but I beg to differ..

IMHO, the answer is far more complex and not so clear cut.

Allow me to share

The public system is made up of many facets, and in a sense, yes indeed, because of training, the average trainee levels are likely to be less experienced

But the devil is in the details and here we are talking about eye, but some disciplines, I would say, public is definitely better, and I'll get to that.

TLDR, but I beg to disagree

 

 

In a public system, you get trainees, you get junior specialists and senior consultants. In the university system, eg NUH or even SGH now with Duke, you will get Professors.

Lets start from the most junior.

These are indeed doctors with the least experience, and will need supervision at various levels:

- direct hand holding, surgeon is scrubbed up

- supervision at the microscope, surgeon is scrubbed up

- indirect supervision, surgeon is in the OT watching the monitors, and every OT will have at least one or two monitors watching the surgery and they are all recorded unless otherwise stated

- close by or in the building, these are usually reserved for the junior consultants or senior trainees, where you want a certain level of freedom such that they know they can get help, but like your younglings trying to fly, they need space to do so

There are definite steps to pass to get from one stage to the next and they are all audited.

So what about the specialists and 'private' care in institutions?

Again there are levels.

Basically, any specialists who has exited the final exit exam can take so called private cases, which are essentially named patients in an institution, who are directly under their care, pre, during and post surgery. There is a premium and the more senior the doctor, the higher the premium. I guess like A class, C class, E Class and S class Mercs.

But the level of experience will differ. So yes, you may say for the private patients, the surgeons who are in true private care may be more experienced if you compare to a junior consultant.

However do take note

When you leave for private practise, you are at the peak of your skills or should be unless you were forced to leave. If you get someone who a mid tier consultant or senior consultant who has left an institution, he / she may have a log of a few hundred to a few thousand cases, depending on how long he / she has been in practise. He/she will also carry the state of the art skills - At The Moment Of Leaving. This point is very very important.

Because once you go private, your quantum of cases actually drops. Yep, you may dispute this, but the majority operate much less. Simply because the volume for the average private surgeon is a lot less. He / she want quality time, not volume but charges more so the margins help negate the difference and let the private guy enjoy better hours and life. Sure you may have the super popular ones who operate non stop, but let's take the mean / median.

Also, your machines used for surgery don't change as often. Everything is about overheads, and unlike public, you need to amortise and that private hospital may not carry the latest machine, unless it has a large margin.

So if there's a special machine which can do something spectacular, the corp comms in the private may buy this expensive machine, put out ads / get reporters or tell the surgeons to inform their patients, but eg if the ultrasound is working well, you're not going to spend more buying another.

Now in public institutions, there is a replacement cycle, and you can get equipment, even when it doesn't make money - it's not true that there's no P&L, but the justifications are less financial in nature and you can get state of the art, experimental if your HOD can swing it.

As for volume, again it depends, those who are academically inclined, much older eg the Full Professors or A/Profs who are HOD or division bosses or are into research will do less volume. But you can sieve through and get info on this.

So yes, these may be older, do less work - hata kaki? 

Now the HOD is also not always the top surgeon. The Head is the admin head and holds the department together.

But the sub-speciality head is different. Sure again they can be the admin head, but say in SNEC for example, the head rotates after two terms. And typically, the clinical service head Is the Top Dog. That means he / she is the last line. 

What that means is he /she does anything, does the most difficult and also, those that the private can't handle. Some cases get referred back to institution when the private person assesses it's too difficult, too hard and is likely to have complications. Or if the patient cannot afford the complex surgery and the after care. Don't forget the after care, and yes, even for eyes there can be after care for cataracts especially if things are not simple.

So if you take the big top gun, they will be fit, experienced and also high volume, because institutions do far more ops. And not all care about just money. You can get a decent living in public, maybe a smaller home, smaller car, but teaching and also helping the poor does matter. Idealistic? Well there are still some..

 

So in summary, yes, you may be right that the average head to head private to public comparo may show the private guy to be more experienced if you take all ranks into account, but the top dog is in public. The trick is to find who is this top dog and he may be the S3, not the CO, who is the admin head..

 

I personally know a few Profs who dedicate their lives helping others  

Apologies if we differ, but my 2c worth. 

 

As for oncology, there are more experimental work, more senior doctors in public at the cutting edge.

Just that for all specialities, the waiting time, the lack of special service ala SIA is the difference. You can get urgent or stat care in private much more easily, but it will cost you.

However if you have complicated glaucoma, cataracts with glaucoma etc etc, public - at the hands of the most senior and experienced surgeon is, IMO the way to go.

If you go for subsidised care, there's no guarantee as to who sees you, that's the blind date part, but I am proud to say that our local hospitals do a very decent job. Sure there will be complications especially if the junior is new. But if you compare to the standards abroad, I would say, we are world class or even near the best. Do the right comparision.. not sub vs private, not trainee vs experience private surgeon, but apples to apples.

The subsidised care has a very long waiting time, but say in Sydney, it can be up to two years, and if my classmates tell me correctly, we are nowhere near that. Is it short or responsive enough for the anti PAP / government ones, I can't answer that. But for the cost, the care is very decent. 

Eg in China, if you want the same care, you will pay more. So if you also want high quality non public care, even across in M'sia / Thai, it is cheaper, but the private to subsidised care is also about the same ratio and their waiting time is even longer than us. 

As for private, again not everyone stays static and some will continue to improve too as they try new stuff - you also want to be seen to be using the latest techniques too  

Just want to dispel the idea that public is full of old foggies who only collect paychecks and get senile 😅 

Cheers

 

 

Edited June 3, 2023 by therock

[Lala81]

On 6/3/2023 at 11:13 AM, 13177 said:

No wonder hearsay go private still better than govt esp if kena big health issue, example like cancer. The medicine they used, the surrounding, the service etc aid in better recovery and the feeling of getting the treatment is more comfy. But the money spend would be scary also.

I have a colleague tio cancer, went to one of the best surgeon in private. And can see that my colleague recovery rate very good and back to work quite fast. Lucky my colleague has comprehensive insurance coverage.

Medical conditions can go government. Like I did my chemo at ncc also. Cos there are guidelines to follow. It's not like surgery whereby if the surgeon drink too much coffee that morning... 

[Lala81]

On 6/3/2023 at 1:21 PM, therock said:

No offense bro, but I beg to differ..

IMHO, the answer is far more complex and not so clear cut.

Allow me to share

The public system is made up of many facets, and in a sense, yes indeed, because of training, the average trainee levels are likely to be less experienced

But the devil is in the details and here we are talking about eye, but some disciplines, I would say, public is definitely better, and I'll get to that.

TLDR, but I beg to disagree

 

 

In a public system, you get trainees, you get junior specialists and senior consultants. In the university system, eg NUH or even SGH now with Duke, you will get Professors.

Lets start from the most junior.

These are indeed doctors with the least experience, and will need supervision at various levels:

- direct hand holding, surgeon is scrubbed up

- supervision at the microscope, surgeon is scrubbed up

- indirect supervision, surgeon is in the OT watching the monitors, and every OT will have at least one or two monitors watching the surgery and they are all recorded unless otherwise stated

- close by or in the building, these are usually reserved for the junior consultants or senior trainees, where you want a certain level of freedom such that they know they can get help, but like your younglings trying to fly, they need space to do so

There are definite steps to pass to get from one stage to the next and they are all audited.

So what about the specialists and 'private' care in institutions?

Again there are levels.

Basically, any specialists who has exited the final exit exam can take so called private cases, which are essentially named patients in an institution, who are directly under their care, pre, during and post surgery. There is a premium and the more senior the doctor, the higher the premium. I guess like A class, C class, E Class and S class Mercs.

But the level of experience will differ. So yes, you may say for the private patients, the surgeons who are in true private care may be more experienced if you compare to a junior consultant.

However do take note

When you leave for private practise, you are at the peak of your skills or should be unless you were forced to leave. If you get someone who a mid tier consultant or senior consultant who has left an institution, he / she may have a log of a few hundred to a few thousand cases, depending on how long he / she has been in practise. He/she will also carry the state of the art skills - At The Moment Of Leaving. This point is very very important.

Because once you go private, your quantum of cases actually drops. Yep, you may dispute this, but the majority operate much less. Simply because the volume for the average private surgeon is a lot less. He / she want quality time, not volume but charges more so the margins help negate the difference and let the private guy enjoy better hours and life. Sure you may have the super popular ones who operate non stop, but let's take the mean / median.

Also, your machines used for surgery don't change as often. Everything is about overheads, and unlike public, you need to amortise and that private hospital may not carry the latest machine, unless it has a large margin.

So if there's a special machine which can do something spectacular, the corp comms in the private may buy this expensive machine, put out ads / get reporters or tell the surgeons to inform their patients, but eg if the ultrasound is working well, you're not going to spend more buying another.

Now in public institutions, there is a replacement cycle, and you can get equipment, even when it doesn't make money - it's not true that there's no P&L, but the justifications are less financial in nature and you can get state of the art, experimental if your HOD can swing it.

As for volume, again it depends, those who are academically inclined, much older eg the Full Professors or A/Profs who are HOD or division bosses or are into research will do less volume. But you can sieve through and get info on this.

So yes, these may be older, do less work - hata kaki? 

Now the HOD is also not always the top surgeon. The Head is the admin head and holds the department together.

But the sub-speciality head is different. Sure again they can be the admin head, but say in SNEC for example, the head rotates after two terms. And typically, the clinical service head Is the Top Dog. That means he / she is the last line. 

What that means is he /she does anything, does the most difficult and also, those that the private can't handle. Some cases get referred back to institution when the private person assesses it's too difficult, too hard and is likely to have complications. Or if the patient cannot afford the complex surgery and the after care. Don't forget the after care, and yes, even for eyes there can be after care for cataracts especially if things are not simple.

So if you take the big top gun, they will be fit, experienced and also high volume, because institutions do far more ops. And not all care about just money. You can get a decent living in public, maybe a smaller home, smaller car, but teaching and also helping the poor does matter. Idealistic? Well there are still some..

 

So in summary, yes, you may be right that the average head to head private to public comparo may show the private guy to be more experienced if you take all ranks into account, but the top dog is in public. The trick is to find who is this top dog and he may be the S3, not the CO, who is the admin head..

 

I personally know a few Profs who dedicate their lives helping others  

Apologies if we differ, but my 2c worth. 

 

As for oncology, there are more experimental work, more senior doctors in public at the cutting edge.

Just that for all specialities, the waiting time, the lack of special service ala SIA is the difference. You can get urgent or stat care in private much more easily, but it will cost you.

However if you have complicated glaucoma, cataracts with glaucoma etc etc, public - at the hands of the most senior and experienced surgeon is, IMO the way to go.

If you go for subsidised care, there's no guarantee as to who sees you, that's the blind date part, but I am proud to say that our local hospitals do a very decent job. Sure there will be complications especially if the junior is new. But if you compare to the standards abroad, I would say, we are world class or even near the best. Do the right comparision.. not sub vs private, not trainee vs experience private surgeon, but apples to apples.

The subsidised care has a very long waiting time, but say in Sydney, it can be up to two years, and if my classmates tell me correctly, we are nowhere near that. Is it short or responsive enough for the anti PAP / government ones, I can't answer that. But for the cost, the care is very decent. 

Eg in China, if you want the same care, you will pay more. So if you also want high quality non public care, even across in M'sia / Thai, it is cheaper, but the private to subsidised care is also about the same ratio and their waiting time is even longer than us. 

As for private, again not everyone stays static and some will continue to improve too as they try new stuff - you also want to be seen to be using the latest techniques too  

Just want to dispel the idea that public is full of old foggies who only collect paychecks and get senile 😅 

Cheers

 

 

You think you know. But you don't really. That's just the helicopter view looking in. You have to really hear the gossip within the department/fraternity. 

You ask any of my surgeon friends whether they would let their family members be operated upon in public. The answer is only if it's a named surgeon. Every hospital surgical department has subpar surgeons. That's just a fact.

Similarly in private. Just because the guy has good eq and very friendly = a good surgeon. 

Someone who can write a lot of academic papers and is highly regarded professor can be a subpar surgeon. Haha got quite a lot of  examples. 

Yes volume load is another key factor. Some pte surgeons are not that good as well. 

I don't pretend I know who's really a good surgeon. Even us doctors mostly only Tia gong.

Only those who work in the same OT or under them before really know. 

surgeons are big gossip kings/queens lol. Since they spend most of their lives in hospitals. 

 

[therock]

As for quality of service 

not just medical surgical skills

it’s much clearer I guess

if you pay more, you get your appointment much earlier, your exact dates and even type of lens and obviously type of surgeon 

I know some private surgeons employ the best looking staff who are also very competent and if you see far less cases in a day, you’ll definitely be far less harassed and also more likely to pick up that phone and also answer extremely politely 

NUH for example has this incredible care motto but ultimately if the queues are incredibly long, the quality of service has a higher likelihood of falling short

And this will apply to the cases considered private in institutions too. 
so when you pay a lot more, there are certain perks of going private and check your insurance 

just understand that the best medical care, latest technologies etc be it in Singapore or even USA, often comes at teaching institutions 

just that the waiting, service and such are nowhere near private levels 

peace 

[therock]

On 6/3/2023 at 1:56 PM, Lala81 said:

You think you know. But you don't really. That's just the helicopter view looking in. You have to really hear the gossip within the department/fraternity. 

You ask any of my surgeon friends whether they would let their family members be operated upon in public. The answer is only if it's a named surgeon. Every hospital surgical department has subpar surgeons. That's just a fact.

Similarly in private. Just because the guy has good eq and very friendly = a good surgeon. 

Someone who can write a lot of academic papers and is highly regarded professor can be a subpar surgeon. Haha got quite a lot of  examples. 

Yes volume load is another key factor. Some pte surgeons are not that good as well. 

I don't pretend I know who's really a good surgeon. Even us doctors mostly only Tia gong.

Only those who work in the same OT or under them before really know. 

surgeons are big gossip kings/queens lol. Since they spend most of their lives in hospitals. 

 

Sir I totally agree

That’s why getting some head or Prof may not be the best idea if the top dog is what you want.
And certainly you’ll need to tease out who to ask to perform the surgery..

institutions have many tiers of experience so you’ll need to do some homework 

absolutely 👍 

just that I feels that private isn’t always the best and if the case is complicated, I would say get the best in public and get that person as a named surgeon 

peace out 

[Lala81]

On 6/3/2023 at 2:03 PM, therock said:

Sir I totally agree

That’s why getting some head or Prof may not be the best idea if the top dog is what you want.
And certainly you’ll need to tease out who to ask to perform the surgery..

institutions have many tiers of experience so you’ll need to do some homework 

absolutely 👍 

just that I feels that private isn’t always the best and if the case is complicated, I would say get the best in public and get that person as a named surgeon 

peace out 

That's why the most effective referral is always word of mouth. 

Having a surgeon friend always help. 

Anyway best is to get 2nd opinion. Some pte surgeons also like to chop everything. There's always pros and cons in every system.