Rights and Responsibilities
After reading the blog entry "Big Doctor is watching you" at http://angrydr.blogspot.com/
it reminded me of something that I came across during my study.
In Australia, diabetic patients are given brochures that list out their Rights and Responsibilities :
"As a person with diabetes, you have rights to...
Professional health services and treatment with access to diabetes educators, dietitians, podiatrists, eye specialists and diabetes specialists plus confidentiality of your personal health care records.
Easily accessible diabetes information, educational support and appropriate medical supplies.
Free syringes and pen needles, and significant savings on testing strips through the National Diabetes Services Scheme (NDSS).
A clear explanation of your condition and ongoing health professional support with access to an interpreter service if required.
A second medical opinion about your diabetes treatment if so desired.
A career of your choice, appropriate job training, life and health insurance cover and most civil licenses and permits. If these are denied, contact Diabetes Australia or your doctor to check whether the exclusion is justified. (Some restrictions apply in certain lines of work that may place you and others in danger in the case of hypoglycemia).
Specialized diabetes care when in hospital for other health problems and when medical or surgical procedures are planned or performed. In such an event, ask to see a diabetes specialist and a diabetes educator.
Be responsible for your own insulin injections and blood glucose monitoring when in hospital, with supervision or assistance if required.
Make the final decision to accept recommended treatment from a health professional.
Your responsibilities are to . . .
Take charge of your own diabetes management with the assistance of your health care team at those times when you have concerns or need advice.
To register with the National Diabetes Services Scheme (NDSS) through Diabetes Australia to be eligible to receive free syringes ,pen needles and savings on the purchase of testing strips.
Record and remind your general practitioner when your follow-up visits for regular checkups are due (listed above).
Declare your diabetes when applying for insurance, licenses and permits. Failure to do so may render your insurance policy or driving license invalid.
Declare your diabetes to your employer. Failure to do so may render you ineligible for workers’ compensation.
Dispose of sharps (syringes, needles and lancets) responsibly and safely. Contact Diabetes Australia, your local council or pharmacy about free services now available in many localities and more information about sharps disposal. "
You would never find such things in Singapore. Singaporeans are just not mature enough to take any responsibility for themselves.
I went home and told my daughter that at home she has rights eg the right to go to the toilet unrestricted, the right to go to her room whenever she wants, etc, but she also has responsibilities eg to prevent things from being damaged, to keep the house clean etc. My 4 year old daughter predictably replied "I don't understand what you are saying Dad." But at least she was willing to listen to me explain further.
Most grown men and women that consult me, would go "I am a layman I don't understand such things" and then refuse to learn further.
And then they are the ones who would complain that they have no rights and that the doctor dictates what they do, what medicine they take. But yet when it comes to taking responsibilities, they respond like a 4 year old.
Looks like we can't win em all.
posted by Dr Oz bloke @ 6:14 PM
20 Comments:
OZ,
With all due respect, I think you are deluded with the thinking that the informative brochure put out in Australia for Diabetics will result in all Aussies following it to the letter.
I really wonder whether you have ever practised medicine in Australia or for that matter am a graduate of an Australian medical college.
All doctors encounter different types of patients. From the well informed to the truly clueless. So it is incumbent upon you to program your treatment methodology to suit the exigencies of the occassion.
No kidding.
Just today I had this encounter:
Patient: Har? Must I do all that?
Me: It's up to you; it's your own body and we can't force you.
Patient: How can you say that!
Dear uglybaldie,
You are obviously not a doctor and don't know much about seeing patients and counseling them.
For one it isn't as easy as you make it out to be. For one in Singapore we have a problem of having to translate our advice into mandarin, malay, hokkien, teochew, cantonese etc. Many things are lost in translation. Most of the time folks who only speak in those dialects don't even have the basic knowledge and vocabulary to allow for meaningful discussion.
Of course not all Aussies will follow the borchure to the letter. I'm not naive. But the point here is that the brochure IS THERE. Can you find such things in Singapore? I certainly don't see MOH or HPB printing such stuff.
Of course it is incumbent on me to develop programs for the individual. That is what I do. But it isn't easy trying change long standing bad habits and beliefs. And unfortunately the culture in Singapore seems to be prevalently one of ignorance and irresposibility.
Now I'll say you have made it clear many times that you are NOT one of these people and I certainly believe you. It is both kudos to you and I am sure your doctor loves you as his patient. I'm not sure, but I kinda suspect you may actually be a patient I know.
There are patients who are keen to learn, and take responsibility for their own health. However I would say they are still the minority here.
The other factor is that the majority of doctors unfortunately are not progressive and keen to educate. Many older doctors I have met would tell me "you're wasting your time talking to the patients so much. Singaporeans just want to take their medicine and not think too much"
I refuse to go down that road. But it's a uphill struggle when MOH is not interested, neither is the HPB and neither are the majority of GPs and Specialists in Singapore.
I have always known that your displeasure with Singapore doctors is not totally misplaced, but have refused to express it too. You're right.
Won't you agree with me that having the brochure printed by the relevant support group be better than not having it EVEN if the patients might not follow it to the letter?
That's the point Angry Dr was trying to make about "Big Doctor is watching you"
The doctors can be monitored but then what about the patients? Shouldn't we do more to educate them too? Shouldn't more patients be more involved in the management of their medical problems?
You disagree?
It's not a matter about whether Australia is better than Singapore or not, but we learn from exposures to different systems and try ad improve. Just like your relatives doing their PhD in Oz to gain more experience, why shouldn't we look at what is good in Oz and see if we can apply it in SG?
Similarly Oz should also follow and learn from other systems.
I had a talk with a patient today and again their complaints about Singapore's health system is this
1) Too expensive (but aren't we noted for affordable health care not requiring insurance?)
2) waiting in waiting room too long (they forget that waiting time for appointments are nearly negligible compare to say USA, Australia and Canada)
patients don't complain that their doctors are not explaining to them and edcating them, because I know many are not interested. For every new patient I see, I usually spend at least 30 minutes with them. Those who like my style stay, those who don't leave and don't return.
To each his own. Some people like a fast doc, quick in quick out, get MC and off they go. Some like to discuss.
Cheers!
Leaflets are so fabulous and useful. I could spend half an hour lecturing my patients on their disease and what to do about it and they won't remember squat. I give them a leaflet, at least they can read it their own time and remember some of what I said to them.
A little patient education goes such a long way...I hope MOH does print out leaflets soon because it would be great.
On another note, Dr Oz, you get to spend 30 minutes with each patient?! In Singapore? I thought that's a luxury that Singaporean doctors couldn't afford. I heard that clinic times tend to run at 10 patients per hour to reduce waiting times.
Well let's just say my clinic is a bit different even though it is in Singapore.
I have spent 1 hour with one patient before.
And the consultation fees was still $10.
It's a luxury my boss can afford and I am all happy for it.
" No kidding.
Just today I had this encounter:
Patient: Har? Must I do all that?
Me: It's up to you; it's your own body and we can't force you.
Patient: How can you say that!"
Yes, how can you say that? And can you repeat that in front of the Hospital's administrator or the Chairman of the SMC disciplinary committee?
There are really better and more subtle ways to put across a message and the above "incident" certainly smacks of the "I Know Better" pysche. Presumably, the good doctor encountered a plebeian. It was his/her lucky day.
Printing of leaflets to explain is fine but you must be aware that a sizeable portion of our older generation cannot read even the most rudimentary of languages. If you are practising in say an HDB neighbourhood, you really have no choice but to explain verbally in simple terms to your patients who would even cough out that few dollars to see you for a simple cold . If you are practising in districts 9, l0, then you really don't have much explaining to do. Just write out the damn prescription so that your well educated and well heeled patient can bring it down to Guardian to have it dispensed. The public health system here is geared towards providing affordable health care for more than 80% of the population who live in HDB flats, so quite rightly, they may have felt that some discourse by general practitioners would be the way to go. Having said that, perhaps you are not aware that in most of the government hospital pharmacies, pamphets are available on various medications and medical conditions for those who are interested.
Admittedly, it would do the brief encounter a world of good, if the patient is able to speak on almost equal terms with the doctor. Simple terms like "contraindications" "concomitantly" "in vitro" makes a world of difference to the discussion. That scenario will come but perhaps another 15 to 20 years down the road. Remember, we are a YOUNG first world nation, a wannabe who made it. So patience my friend, patience.
For me, every visit by me to my doctor is a welcomed respite for him. It is not he who will shoo me out but his receptionist who will mumble to herself, "Please god, make it quick, I want to go home!" He will also take the opportunity to get quick tips on how to increase his cash flow. Every trip to his clinic is a treat for him and for me to increase my medical knowledge or to CONFIRM something that I need an expert opinion upon.
Nope, I don't think you are my doctor unless you hold a masters in internal medicine but chose not to practise as a specialist.
Gripes by Singaporeans about the health care costs is nothing new. By now, I thought you were already immuned to it. These are the people who have never been out of this country more than a 1000 mile radius.
One parting shot. Wait until you practise in OZ and have to face an Abo. Then you'll say, wow, singaporeans are really likeable patients!
Yeah that would be a learning experience for me. But if I learn how to handle Abos I'm sure I would also learn skills that would help make me a better communicator and doctor too.
Perhaps I am bored speaking in very simple vocab to the majority of my patients. It's not too bad in my practice, I have my fair share of patients who I can have a good discussion with. What I am curious though is working in a setting where other doctors are also as communicative.
I find it strange when patients tell me to shut up and talk less because most doctors don't talk. Weird.
Good for you that you found a very well qualified specialist to discuss your medical problems with and good for him that he can get financial market advice from you.
I suspect you are a much more likeable and less abrasive person in real everyday life.
For instance you are most likely not even bald! :)
Hope you can keep it between us ok?
There must be some bad guys to make a discussion look real and interesting and what better way to make it sound that it's coming from an ugly mug with a bald plate that couldn't even respond to a dose of finasteride!
Cheers! Hope I'll get a hole in one today!
I guess it also depends on whether the bald guy truly has androgenetic alopecia or not, if not it is little wonder that there was no response to finasteride.
Hmm so you play the bad guy? Does that mean I'm the good guy?
Gee, I'm used to playing the role of bad guy so much over at the forums!
Keep this between us ok? Don't want to lose my reputation over at sammyboy.
I am typing this with a mild headache. Pardon me if anything doesn't sounds right. Having to work in Singapore before, I still believe public education is vital towards the treatment program. For me, I don't care whether if the patients listen to me or not. The bottomline is at the end of the treatment, I'll reassured that I've given them the best advice and it's up to them to follow through.At least, I know that I've done my best in any aspect for their problems. And of course, I'll make my patient education short and sweet plus simple to understand so that no other time is wasted unnecessary.
Ok, need resting now.
Dear flatfeet, I agree totally with you. That is also partly how I approach it. But I do go one step further.
I think my job as a doctor is to give the patients results. And thus when they don't get the desired results, then I have failed. But I do realise that sometimes I need the patients to do most of the work and that is where it is ironic.
The worst are the patients who don't listen, don't return for follow ups, cite prohibitive costs and all sorts of excuses for not coming for follow up and taking their medication regularly when I call them over the phone to remind them and then come back when they are not feeling well and say my treatment sucks.
I can think of little more I can do. But I still have to put up with their complaints.
But well that's life I guess.
You're a podiatrist aren't you?
OZ,
You are welcomed to the role of the "good" guy. I have neither the interest nor the inclination to appear "good" at the expense of putting across a message.
Frankly, what good is a net discussion if everyone is busy patting each other on the back. As I've said before, there must be a rebel rouser to make things interesting. Otherwise sites like yours will be as quiet as a graveyard.
Incidentally, I met a retired doctor on the golf course who had his own practice in an HDB neighbourhood. I asked him whether he was very busy when he had his clinic and he laughed and replied that he didn't even have the time to fart literally. I was just wondering, doc why you appear to be very free the whole day. It is almost as if you were as free as me, a retiree. Wow, I never thought that it was so pleasant to be a doc. having the time to rant and rave and scour the net for confucian teaching to boot!Care for some elucidation OZ???
Have a good weekend with the family.
Well, let's just say that it's a combination of luck, preparation and keeping my eyes open for opportunity that led me to this "dream job".
Sit around see a few patients, spend good pleasant and stimulating discussions with some of them, and quick short ones with others. And there's lots of free time to rant and rave on the net, and I still get paid on the job.
In truth, my friends and relatives all don't understand why I'd want to leave this job. There are growth opportunities to which I aluded to earlier regarding increasing my earnings.
Well let's just say that at my age, I'm keen to experience life in another country. I make enough money as it is and more money is not really top of my lists.
PS : have you ever considered the possibility that I enjoy debates and rabble rousing as much as you do? Which is why we happen to be the 2 most active guys on the 2 blogs? Argument for the sake of argument. Disagreeing for the sake of keeping the debate going and lively. I mean if we kept agreeing with each other, what fun would there be right?
PSS : keep this between the 2 of us ok?
"Oh what a beautifoool mornin', Oh what a beautifooool day,........"
Thanks for the explanation to satisfy my curiosity OZ.
But remember though that your patients should take top priority and you should give them sufficient time and attention before turning your grey matter to "duelling" on the net. Some doctors I know, spend lots of working time on monitoring the stock market. I guess you spend your time monitoring forums to articulate your views ;)At the end of the day, I think you are better off than the stock speculators. At least, your money is still in the kitty!:-O
I would like to take this opportunity too to tell you why I generally don't like local doctors save for my GP and some first rate specialists (at least ex assoc. professors). Most doctors in Singapore do not think about their patients' medical problems after the so-called "consultation". Typically, treatment is symptomatic for the short term. But the danger here is that ignoring nature's signals may sometimes end in death. There are countless cases reported of doctors failing to heed all the signposts that are pointing to a particular disease and yet, no further investigations were done to confirm a correct diagnosis. Now, you know that no matter how skilful a clinical diagnostician you are, an ordinary doctor is no match for the lab. and digital imaging.
You're absolutely correct.
In today's day and age, we are going towards objective assessments versus clinical ones.
Evidence based medicine (let's not debate the fine point about it) is the way to go.
It's not just about diagnosing. It's also about the quality of follow up. I find that in Singapore we leave it to the patient to be proactive. Few doctors for example don't give their patients a call to check how they are. I mean a friendly call does no harm and in fact lots of good.
And we hardly have reminders for defaulters. Patients who don't turn up or disappear are just left to be. We assume they have found another doctor (given the high rate of doctor hopping), justify that we have no time to call them to find out what's happened etc.
I am personally trying to do all of the above myself. Many of the patients actually like it. For every surgery I do for example, I give the patient a call the next day just to see how they are.
If I do a blood test, I'll personally call them to explain the results and advise them what the next step is.
I guess I have the privelege of doing that because my patient load is not high compared to other GPs and specialists.
However, having said that, after I've stablized the problems and managed them properly, many patients would choose to go to the polyclinic to buy their medicines and continue their follow up there. It is cheaper. There is unfortunately no communication between the Polyclinics and private GPs. Essentially we lose the patient. I have quite a few who come to me 6 monthly just to consult, but the medicines they get from the polyclinic.
In other words, it's common I "lose" patients. I'm not so concerned about the loss of income, but it disrupts the plan of management and follow up schedule that I adhere to. Makes things neither here nor there. And when something goes wrong (and it has happened) then we start all over again.
Which is why in certain ways I want to experience what working in Oz is like. Where patients stick to usually 1 doctor as it is difficult to find a doctor in the first place. My predecessor at my current job also went to Oz last year and she is very happy there. She says everything can be done systematically, patients can be followed up properly, there is good communication between specialist and GP (via phone or email) and generally a more professional medical working environment.
It's an experience I want to have. Whether I like it or not is another matter. But to stay here, would do nothing form my personal development as a doctor.
You are an exceptional doctor then. Perhaps, you can afford the luxury of doing what you do but some of those I know consciously refuse to do the right thing because they want a conveyor belt type of practice and also mainly to balance their books.
To digress, the man reason why I like to frequent your blog and that of Angry Doc's is because both of you write entries that interests me and gets my "combative" juices flowing. Note that I use the word within inverted commas so as not to stoke up the fire again! :-)
A lot of blogs I've visited talks about their daily lives and what size their wives panties are even! what the heck! Who in heavens name is interested in what you ate for lunch or dinner or for that matter, what your child's favourite toy is!I like blogs that gives an intellectual discourse of various topics with a Singaporean Flavour. And most certainly, I dislike reading blogs written by juveniles with endless repetition of the four letter word. They may think it's cute. It isn't. Their behaviour invariably reveal the kind of family background they come from.
That's why I was quite disappointed with Angry Doc for him/her to link his/her blog to something totally alien to the pursuit of mentally challenging discussion. You are what company you keep!
Hmmm...you are what companhy you keep....
That's true. One of the things I learned about life in general was the importance of the company you keep.
Businessmen hang around other businessmen. Their children tend to become businessmen after mixing with all these "Uncles" who are businessmen.
Doctors hang around doctors. They marry them too. Or other health related professionals eg nurses.
So for people who want to move out of their trades and do something new, probably the first step is to change their circle of contacts and influences.
It isn't easy though.
Intellectually stimulating? Well I guess it depends on the individual. Not many people bother about politics or current affairs anyway. Many of my fellow doctors and ex-JC classmates have only one pursuit in life. Money. Little wonder why they can't care less about anything else.
"You are an exceptional doctor then. Perhaps, you can afford the luxury of doing what you do but some of those I know consciously refuse to do the right thing because they want a conveyor belt type of practice and also mainly to balance their books."
I am far from being "exceptional". That comes with experience and age. I have lots more to learn.
And yes I have the luxury of doing that while other doctors may not. I think Singapore's health care system also plays a part in allowing doctors to use that "excuse".
But there are always pros and cons. Which is why I want to experience more systems eg Oz and learn from it.
Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.
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