Subsidised or not, treat all patients equally By Dr Lee Wei Ling (NNI Director)

Those who have been reading my columns regularly will know that my health has been uncertain. Perhaps for that very reason, I feel keenly the ill fortunes as well as triumphs of my patients.

Today, as I write this, I feel like a “104-year-old”, a term that my friends would understand. It means I feel 50 years older than I really am.

But I have patients to see. Many among them would have taken leave or made special arrangements to be accompanied by a parent or caregiver in order to see me.
I could, of course, get another doctor in my department to see them, for most of my patients are subsidised and thus not allowed to choose their own doctors. But I treat my subsidised (B2 and C class) patients no differently from my full-paying (A and Bl class) patients and provide all with the same quality of care. I also insist that all the doctors at the National Neuroscience Institute NNI do the same.

This ethos of caring for patients regardless of whether they are subsidised or not is sometimes absent in our hospitals, even in cases of subsidised patients with complex problems. Sometimes such patients are assigned to junior doctors.

Recently, a friend telephoned me one evening, very distressed. Her husband had had a severe head injury. I asked her who was the doctor in charge. She said she did not know. I told her to write down my name and mobile number on a piece of paper and pass it to the most senior doctor there and ask him to call me.

The moment the doctor saw the note, he telephoned his head of department. My friend had never seen or heard of the head of department before that. Other doctors in the hospital asked my friend: “Who are you and how are you related to Professor Lee Wei Ling?”

An hour later, the head of department called me to give me the medical details sounding as though he had been in charge all along. The next day a bouquet of flowers from the hospital appeared in the room of my friend’s husband. A senior doctor took care of my friend’s husband and performed every operation on him personally. My friend’s husband had been admitted as a subsidised patient because all emergency admissions are categorised as “subsidised”.

Our system must find an effective way of ensuring that senior doctors also treat subsidised patients. At present it is in the economic interests of senior doctors to focus on paying patients rather than subsidised patients – and it is not always the case that doctors look beyond their economic interests. Thus we get incidents like the one I have just described. My friend’s husband should have been treated by a senior doctor as a matter of course without my intervention.

At NNI, a subsidised patient with a complex medical problem would be seen by a senior doctor or at least a junior doctor under a senior doctor’s supervision. My doctors know that I would come down on them like a tonne of bricks if I found they were not providing the same quality of care to subsidised patients as they were to paying ones.
Back to today: I had four glasses of ice-cold kopi-o and made it to the clinic to see my patients. I have just finished seeing all my patients and decided that doing so was the best medicine I could possibly have.

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