Another doctor in trouble

[Lala81]

14 minutes ago, Lotr said:

I might be wrong, but I think there are doctors in A&E and special wards like  ICU and HDU

The final details will be out when the SMC releases it's final verdict on whether there was misconduct.

 

[Ash2017]

21 minutes ago, Lotr said:

I might be wrong, but I think there are doctors in A&E and special wards like  ICU and HDU

You have to understand the operation of private hospital is completely different from public hospital.

 

[Lotr]

12 minutes ago, Ash2017 said:

You have to understand the operation of private hospital is completely different from public hospital.

 

Yes, I know that.  For private, I have seen doctors in A&E and HDU and they seem to be working for the hospital.  Whereas, in private hospital wards, only the consultant/specialist of the patient shows up.

[Ash2017]

3 hours ago, Lala81 said:

Based on what my friends say, you can damage the artery during a TKR.
But it's extremely uncommon if u are skilled. And from reputation wise, i don't think he has a skills problem. And he definitely has done enough volume.

Beyond that, can't really comment. 

Doc

TKR

- for a patient to subsequently needing blood transfusion, necessitates further looking in to as to the cause, especially if the surgery was uncomplicated with minimal or no unusual blood lost to account for

- he accidentally cut a tendon during surgery and the surgeon needed help by calling another surgeon to help with his error, as reported by ST, an experience orthopod would have easily fixed a cut tendon in theatre

- damaging artery is possible in any surgery but in some the possibility is extremely small, further more the surgeon severed both the artery and vein supply the lower leg which many have never heard of before in SG

- the current system is such that the day you get your specialist license, even if you had done only 5 TKR or 1000 TKR, you can choose to go private any time. Here lies the difference between basic competence and experienced competence.

 

 

On a side note: If you have to choose who to embalm someone, would you choose me a license embalmer or an embalmer who had been doing embalming for his entire life (undertaker)

 

 

Edited September 19, 2019 by Ash2017

[Lala81]

I dunno the details or exact timeline of what happened. Neither am I an orthopedic surgeon. So I'll just wait for the final ruling and the statement.

[Atrecord]

20 hours ago, Philipkee said:

If I remember correctly, payments to doctors and hospital are separate in private sector. Patient pays doctor directly or via clinic.  Hospital charges are separate.  Of cos there are many variations so sometimes hospital collects on behalf of doctor or there is a team.  Like one clinic got two doctors who are friends/ husband and wife etc who cross cover but in a nutshell, you cannot compare the practices of a private hospital with that of a public hospital.  

 

Thanks for sharing.

Only on the part of payments, our experience when wife delivered our kids in TMC, was that we only paid one bill, one time, on discharge (apart from when signing up the package at the onset).

We didn't pay the ward charges/consumables and the doctor's fees separately leh.

Then my mother had her TKR ops at TTSH, she was under private care, and we also paid the hospital only. But of course, in RHs, all the doctors work for the hospitals, so it's different from in private hospitals...

[Atrecord]

36 minutes ago, Ash2017 said:

Doc

TKR

- for a patient to subsequently needing blood transfusion, necessitates further looking in to as to the cause, especially if the surgery was uncomplicated with minimal or no unusual blood lost to account for

- he accidentally cut a tendon during surgery and the surgeon needed help by calling another surgeon to help with his error, as reported by ST, an experience orthopod would have easily fixed a cut tendon in theatre

- damaging artery is possible in any surgery but in some the possibility is extremely small, further more the surgeon severed both the artery and vein supply the lower leg which many have never heard of before in SG

- the current system is such that the day you get your specialist license, even if you had done only 5 TKR or 1000 TKR, you can choose to go private any time. Here lies the difference between basic competence and experienced competence.

 

 

On a side note: If you have to choose who to embalm someone, would you choose me a license embalmer or an embalmer who had been doing embalming for his entire life (undertaker)

 

When my mother had her TKR ops, she also had blood transfusions after the ops. This was cos there was (must be quite a bit of) blood loss during and after the op. But the hosp kept us informed, and she was kept under close monitoring. I thought - but can't be sure whether - that was normal...

[Philipkee]

9 hours ago, Beregond said:

this is something new,

all private operate this way?? or only a small %?

those private hospital cannot employ their own doctor??

Private hospital can and do employ their own doctors  but they are medical officers.  Specialists choose to set up clinics there so technically they are not employed by the hospital.  It's like shop owners are not the staff of the building management cos they rent the shop space in the building.

11 hours ago, Sdf4786k said:

seems like what you describle like a used car sales man on commission ...

So operations and surgery comms based? If so, I no longer have the same respect as I used to if this was the behavior that led to the demised of the woman.

 

 

It's not commission based....  Let's say I am a heart surgeon.   YOU came to the private hospital specially to look for me to operate.  I earn from you.  It's how a doctor earns from his patient. Commission based would be I am a staff of  hospital and I am told for every operation I do I get money.   Situation is different.  

It's like taxi.  You are my passenger.  I earn from you.  You are not paying me commission.   You are just paying for service rendered.  If I am employed by the taxi company to drive around (with basic pay) and get $10 for every passenger, then you can say I earn commission. 

Private doctors as in specialists dont get any salary from the hospital.  In fact they pay the hospital in terms of office rental.  As far as I remember anything they earn is from patient.

9 hours ago, Kusje said:

Thanks for sharing. From what you described, it is a systemic problem. 

How can the life and death of a patient be linked to whether their doc is on MC or not?

System is broken and needs to be fixed.

It's not a system broken.  It is how it is.  Unless it becomes mandated that the doctor must reject a patient if he is going on leave and not squeeze him in for surgery or there must always be specialist coverage if dr is not around.  Tricky.  Dunno doable.  It's not just the money but to the patients perspective patient paid for this doctor only cos they wanted the doctor.  Unless like it's a team in a clinic which is rare but happens.

It's like @Atrecord, would you be willing to let another specialist examine your wife after delivery if the first specialist had to take urgent leave suddenly?

Edited September 19, 2019 by Philipkee

[Voodooman]

19 hours ago, Lotr said:

Speaking from experience, I see that there are ward doctors in government hospital who will be there round the clock but for private, the specialist will only come in once or twice a day.

Patient care in government can be more holistic as they have allied health care staffs to help patients on diet, physio etc.

 

Yes, the ward doctors plus experienced nurses are really good reasons to go govt hospital for certain standard high volume procedures.  The problem is the long wait time.

For child birth, I always recommend people to go KK.  The doctors and nurses are real specialists and have seen most types of complications, the institutional knowledge is probably second to none due to the patient volume.  They also have all the speciality equipments, more than a private general hospital.  

And these days, the TLC is not lacking as well.  

[Vratenza]

My 2 cts. 

Most specialist will get out of govt hospital into private practice to be their own boss when they have garnered enough experience, reputation and opportunity presents itself. 

So most private practice specialists have no lack of experience. 

On the other hand, public hospital is where all the specialist training takes place. 

Those that choose to remain in public hospital have other focus/interest such as teaching, research or management. 

 

Edited September 19, 2019 by Vratenza

[Karoon]

2 hours ago, Philipkee said:

Private hospital can and do employ their own doctors  but they are medical officers.  Specialists choose to set up clinics there so technically they are not employed by the hospital.  It's like shop owners are not the staff of the building management cos they rent the shop space in the building.

It's not commission based....  Let's say I am a heart surgeon.   YOU came to the private hospital specially to look for me to operate.  I earn from you.  It's how a doctor earns from his patient. Commission based would be I am a staff of  hospital and I am told for every operation I do I get money.   Situation is different.  

It's like taxi.  You are my passenger.  I earn from you.  You are not paying me commission.   You are just paying for service rendered.  If I am employed by the taxi company to drive around (with basic pay) and get $10 for every passenger, then you can say I earn commission. 

Private doctors as in specialists dont get any salary from the hospital.  In fact they pay the hospital in terms of office rental.  As far as I remember anything they earn is from patient.

It's not a system broken.  It is how it is.  Unless it becomes mandated that the doctor must reject a patient if he is going on leave and not squeeze him in for surgery or there must always be specialist coverage if dr is not around.  Tricky.  Dunno doable.  It's not just the money but to the patients perspective patient paid for this doctor only cos they wanted the doctor.  Unless like it's a team in a clinic which is rare but happens.

It's like @Atrecord, would you be willing to let another specialist examine your wife after delivery if the first specialist had to take urgent leave suddenly?

interesting. the private hospital is seen purely as a lucrative real estate commercial enterprise. Top landlord.

like they say, build and they will come.

[RogerNg_185295]

1 hour ago, Vratenza said:

My 2 cts. 

Most specialist will get out of govt hospital into private practice to be their own boss when they have garnered enough experience, reputation and opportunity presents itself. 

So most private practice specialists have no lack of experience. 

On the other hand, public hospital is where all the specialist training takes place. 

Those that choose to remain in public hospital have other focus/interest such as teaching, research or management. 

 

The salary gap i read online between private and public hospital doctors is very huge.  That's why a lot of doctors jump ship. 

[Sdf4786k]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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11 hours ago, Philipkee said:

Private hospital can and do employ their own doctors  but they are medical officers.  Specialists choose to set up clinics there so technically they are not employed by the hospital.  It's like shop owners are not the staff of the building management cos they rent the shop space in the building.

It's not commission based....  Let's say I am a heart surgeon.   YOU came to the private hospital specially to look for me to operate.  I earn from you.  It's how a doctor earns from his patient. Commission based would be I am a staff of  hospital and I am told for every operation I do I get money.   Situation is different.  

It's like taxi.  You are my passenger.  I earn from you.  You are not paying me commission.   You are just paying for service rendered.  If I am employed by the taxi company to drive around (with basic pay) and get $10 for every passenger, then you can say I earn commission. 

Private doctors as in specialists dont get any salary from the hospital.  In fact they pay the hospital in terms of office rental.  As far as I remember anything they earn is from patient.

It's not a system broken.  It is how it is.  Unless it becomes mandated that the doctor must reject a patient if he is going on leave and not squeeze him in for surgery or there must always be specialist coverage if dr is not around.  Tricky.  Dunno doable.  It's not just the money but to the patients perspective patient paid for this doctor only cos they wanted the doctor.  Unless like it's a team in a clinic which is rare but happens.

It's like @Atrecord, would you be willing to let another specialist examine your wife after delivery if the first specialist had to take urgent leave suddenly?

services rendered from a patient is a nicely put way of earning a stipend from the professional service. Sales man sells a service for a contract. that customer is the company.

Doctor sells a service the customer is the patient. Its only where the cashflow comes from.

 

The system is not broken, But it could be better improved upon to prevent the behaviour of cross profit or loss in this case. A sales person would be upset if after a service rendered, he is not paid or worst a dilution of paid service.

A woman life should not be involved in a situation of ownership of account but rather ownership of a care should be the main concern.

[Wind30]

I think Singapore is pretty good in a lot of aspects but the cost or quality of medical care is not as good as our neighbouring countries like Taiwan Australia.

government is not focusing enough in cutting the medical costs.

It is sad when your residents need to go overseas todo dental work....

i am not poor but I have experienced if I want to see a specialist in public hospital got to wait for months. Private is Insanely expensive even for me.

https://www.channelnewsasia.com/news/singapore/dental-treatment-cost-johor-bahru-bangkok-singaporeans-11913880

Edited September 19, 2019 by Wind30

[Lala81]

15 hours ago, Atrecord said:

Thanks for sharing.

Only on the part of payments, our experience when wife delivered our kids in TMC, was that we only paid one bill, one time, on discharge (apart from when signing up the package at the onset).

We didn't pay the ward charges/consumables and the doctor's fees separately leh.

Then my mother had her TKR ops at TTSH, she was under private care, and we also paid the hospital only. But of course, in RHs, all the doctors work for the hospitals, so it's different from in private hospitals...

When u do operation in pte hospital ot. The hospital charges u on behalf of the surgeon. U can think of it as payment going thru the hospital which later surgeon, anaesthetist will get his/her cut.

If its a simple procedure that can be done in clinic, the surgeon will bill u directly. Also if u do blood tests within the clinic, u can pay the clinic directly, even though sometimes u go to the lab services downstairs to take your blood. The clinic will pay back the hospital later for their cut. 

A pte surgeon may operate in two different hospitals at times depending on pt preference, so he seldom have two clinic facilities (though they usually prefer to operate at one place usually) 

 

[Lala81]

15 hours ago, Atrecord said:

When my mother had her TKR ops, she also had blood transfusions after the ops. This was cos there was (must be quite a bit of) blood loss during and after the op. But the hosp kept us informed, and she was kept under close monitoring. I thought - but can't be sure whether - that was normal...

Blood transfusion for post tkr older or frail folks is common. Some surgeons may even do it almost routinely. 

I used to check the blood when I was a house officer. 

Edited September 19, 2019 by Lala81

[Atrecord]

12 hours ago, Philipkee said:

It's like @Atrecord, would you be willing to let another specialist examine your wife after delivery if the first specialist had to take urgent leave suddenly?

Yah, i know what you mean.

Doctor-patient relationship is a very private one for some patients. My wife was lucky that her gynae was a very dedicated doc recommended through word of mouth, and she's always been around when my wife needed her care.

I've heard from friends that their wives' gynaes were not around when needed on occasions, one of which was when the mother was going to deliver... She was late as in on EDD still not yet showing signs of baby coming out, and the gynae was going away (can't remember was for work or leave) and so they were given a choice of whether to have caesarian or to have another gynae take over the delivery when the original gynae was away... They were not too happy about it.

[Atrecord]

11 hours ago, Voodooman said:

Yes, the ward doctors plus experienced nurses are really good reasons to go govt hospital for certain standard high volume procedures.  The problem is the long wait time.

For child birth, I always recommend people to go KK.  The doctors and nurses are real specialists and have seen most types of complications, the institutional knowledge is probably second to none due to the patient volume.  They also have all the speciality equipments, more than a private general hospital.  

And these days, the TLC is not lacking as well.  

Apart from long waiting time, govt hosps or RHs also have resource constraints. TTSH for example, prob has the most load of all hosps. occupancy rate likely hovers around100% 99% of the time. I remember many years ago, TTSH actually leased ward space from KKH (which is maybe 5 min away) as KKH was bo business (birth rate declined, remember?) for a while.

And for the subsidised wards, i suspect nursing care could be quite stretched, as even for the private wards, also sometimes it takes a long time for nurses to respond to calls for assistance.

KK is the default for child birth, but I know in the past, TMC was very popular as they sold it as different from other hospitals, in that normally, people (esp. older gen) used to shun hospitals as in the olden days, go hosp almost always meant got problems, and often mean bad news and even bad outcomes (or never come out... 😓)... So while all other hospitals have got A&E, where unfortunately, loss of life is not unheard of, meaning there can be 'sad' scenes, TMC sold the story that it's a place of life, so only had 'happy' scenes. But i think the reputation was tarnished somewhat when the IVF blunder came out...

Oh, almost all the gynaes who set up clinics in TMC, were experienced ones who had handled countless deliveries over the years. And because it's a dedicated woman and children hosp, most if not all the staff there are also very well trained.