Health Minister apologises for overcrowding situation at hos
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He removed part of lung for nothing
14-12-2009, 08:17 AM
By Hedy Khoo
A TISSUE sample report showed the cysts in his lung were not cancerous. But it wasn't relief or elation that this patient felt.
What should have been good news left Mr Muhammad Jafri, 53, confused instead.
This was because a small part of his left lung had already been surgically removed before the detailed results of the test was available.
He is now wondering if the surgery was for nothing. Was it a mistake?
He had been referred to a cardiothoracic surgeon at the National Heart Centre Singapore (NHCS) after a CT scan on his pancreas in May 2007.
This had revealed cysts in his lungs.
He agreed to have a tissue sample removed for investigation (biopsy). He now claims he had not given his consent for any other procedures or for the surgeon to remove any part of his lung.
A spokesman for NHCS, however, said: "The cardiothoracic surgeon had in fact met the patient prior to the procedure and explained the nature of the biopsy, and specifically informed the patient that if there is a positive finding of lung cancer, there would be a need to remove part of the lung."
Mr Jafri claimed he understood that nothing else would be done until "the full histology (study of the structure of tissue) results... were obtained, which usually takes two weeks."
He is now claiming he did not give consent to the removal of part of his lung.
The biopsy was done under general anaesthesia on 18 Jun 2007 at the Singapore General Hospital (SGH).
The next day, Mr Jafri said the surgeon informed him that during the surgery, the cysts were found to be cancerous. The surgeon had then removed the affected upper left lung.
Shocked but grateful
"I was shocked to hear I had cancer, but felt grateful to the doctor for saving my life," he said.
However, a few days later, the final report from the biopsy showed that the cysts were not malignant.
He learnt that during the surgery for the biopsy, a tissue sample was also sent for a procedure called frozen section.
This can give a provisional diagnosis during the surgery itself to determine if cancer is present. Based on this provisional diagnosis, surgeons will decide on the next course of action.
Mr Jafri's tissue sample sent for frozen section had been reported to be cancerous.
Based on this, his surgeon had decided to remove the affected part of his lung.
The NHCS spokesman explained that there are valid and important reasons a surgeon may need to perform surgery in the same anaesthetic setting based on frozen section results rather than wait for the formal histology report from the biopsy.
"Very often and especially in cancer cases, deferring surgery to be done on a subsequent occasion can jeopardise sterility, and subsequent surgery may also become more technically difficult at the site of where previous surgery was performed," said the spokesman.
"There are conditions where the cells are highly reactive and can closely mimic cancer cells and the true nature of the diagnosis may only be clarified with the availability of formal histology results.
"Hence, this case is not a case of an actual error in diagnosis, but rather it demonstrates that there are inherent limitations with certain investigations."
The spokesman added that when the surgeon believes a cancerous tumour has been found, it may become important to conduct immediate surgical excision to minimise the risk of cancer cells from the biopsy site spreading to other areas.
The NHCS spokesman said that Mr Jafri retains about 75 per cent of normal lung function after the operation.
"This should not affect most normal daily activities to any significant extent."
Followed rules
In a joint reply, NHCS and SGH explained that the biopsy and frozen section had been done in accordance with well-established practice.
A spokesman for NHCS and SGH said the published accuracy rates for intra-operative frozen sections range between 85 per cent and 98 per cent.
"Despite the inherent risk of false positive or false negative diagnosis associated with frozen section, they are nevertheless an important diagnostic tool in that they provide the surgeon with an 'on table' diagnosis in cases where a decision on surgical intervention may have to be made within the same surgical setting," she added.
"When the formal histology report eventually established that there was no malignancy in the lung lesion, the finding was readily made known to the patient on the very day itself."
The spokesman said Mr Jafri should not require medication all his life but he does have many pre-existing medical conditions unrelated to the removal of a part of his lung.
The recovery period varies but would range from one to three months.
She added that he will have to continue regular check-ups to monitor the growth of the pancreatic tumour as well as his other medical complaints.
Mr Jafri is now claiming that even if he had cancer, he would have sought alternatives to surgery.
He said he spent almost a month recuperating in the hospital and gets breathless easily now. He had previously undergone five operations on his spinal cord.
Mr Jafri said he had only enough money to hire a lawyer to write to the Singapore Medical Council (SMC) to complain about the matter.
The SMC declined to comment on the case. But according to its written reply, dated 5 Nov, to Mr Jafri's lawyer, the Complaints Committee decided that no formal inquiry was necessary.
It said there was no evidence of professional misconduct by the doctor in charge of reporting the pathological specimens, but noted that the doctor could have taken greater care to report the degree of certainty in his diagnosis.
What was done is the accepted treatment for early stage lung cancer, and the surgeon had acted upon the diagnosis provided by the pathologist, it added.
It also noted that the surgeon could have taken greater care in the way he explained and took consent for the procedure.
Both doctors were issued letters of advice from the committee reminding them to be more prudent in future.
Mr Jafri is not satisfied with the response and has lodged an appeal with the Ministry of Health. He is waiting for a reply.
Mr Jafri said: "I lost my job as a lab technician in April this year. After the operation, I am always having to take medical leave."
Doc: It is the standard form of treatment
WHEN lung cancer is suspected, a biopsy and a frozen section in view of a lobectomy (removal of a part of the lung) is a standard form of treatment, said a cardiothoracic surgeon in private practice with 20 years of experience.
Should the frozen section indicate that cancer is present, the surgeon will usually do the lobectomy.
The surgeon, who declined to be named, said the procedures and course of action to be taken during the operation are usually explained to the patient to seek his prior consent as he will be under general anaesthesia during the surgery.
"Most patients will agree to have a frozen section with the view of proceeding to a lobectomy," said the cardiothoracic surgeon.
He said there are patients who choose not to have any lobectomy performed based on the frozen section diagnosis, but this is rare. They prefer to wait for the full histology report.
Lawyer Adrian Wee, from Characterist LLC, said it is necessary to ask if a pathologist and surgeon had acted in accordance with the standard line of treatment.
If so, negligence is unlikely.
Source: http://health.asiaone.com/Health/News/Story/A1Story20091212-185491.html -
next time they might remove the brain also
......
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Originally posted by noahnoah:
next time they might remove the brain also
......
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Originally posted by noahnoah:
next time they might remove the brain also
......
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Now Govt hospital practise in such
a way that they forever ask u back
for review one..
Take X ray , blood test and all kind of test
can imagine pay 400/actual damage is 800
for MRI , and ring u up again .
Sorry the system failed to captured those images..
can u come back again!
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Originally posted by noahnoah:
Now Govt hospital practise in such
a way that they forever ask u back
for review one..
Take X ray , blood test and all kind of test
can imagine pay 400/actual damage is 800
for MRI , and ring u up again .
Sorry the system failed to captured those images..
can u come back again!
10 yrs ago, my mri s$795 exclude misc and appt
f****** expensive
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Originally posted by noahnoah:
Now Govt hospital practise in such
a way that they forever ask u back
for review one..
Take X ray , blood test and all kind of test
can imagine pay 400/actual damage is 800
for MRI , and ring u up again .
Sorry the system failed to captured those images..
can u come back again!
for MRI , and ring u up again .
Sorry the system failed to captured those images..
can u come back again!
really f****** up might be done by ft
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Originally posted by John Penn:
for MRI , and ring u up again .
Sorry the system failed to captured those images..
can u come back again!
really f****** up might be done by ft
Bingo You are right!!two staffs were FT
LoL
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Originally posted by noahnoah:
Bingo You are right!!two staffs were FT
LoL
thank you.see it's the "work of foreign aliens" again
this is called "cheaper, faster and better"
these buggers made your pocket burn hole
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don't forget, there's this HOTA thing
wow lah.
my organ, they also want
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how come this MRI machine so exp
$800/30 mins/just to scan here and there
is the same price as an air ticket
Dont tell me this MRI machine is the same cost
as a airplane?
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Originally posted by noahnoah:
how come this MRI machine so exp
$800/30 mins/just to scan here and there
is the same price as an air ticket
Dont tell me this MRI machine is the same cost
of one Airplane?
is it philips brandsomemore, got musics
the radiation can develop cancer
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Originally posted by noahnoah:
how come this MRI machine so exp
$800/30 mins/just to scan here and there
is the same price as an air ticket
Dont tell me this MRI machine is the same cost
as a airplane?
got to ask their cost accountants
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Originally posted by John Penn:
is it philips brandsomemore, got musics
the radiation can develop cancer
yep heard tis Big machine canproduce radiation...
The music sounds so terrible!!
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Originally posted by noahnoah:
yep heard tis Big machine canproduce radiation...
The music sounds so terrible!!
yes, channel 8 newsf****** musics
my asuumption - might be the 2 ft talking and didn't capture your image
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What to apologise? Can't our leaders foresee this when you planned the increase in population of Sg. Overcrowding is also seen at polyclinics. Nowadays, every where you go in Sg, be on weekday or weekend, there are crowds. I would like to suggest that our leaders take public transport or walk instead of driving or be driven to work , to see the crowds.
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aiyaaaa, you all dont know meh?? the hospital hor crowded cos of you all lah, everyday come here complain complain about gahmen this gahmen taht, meanwhile the world just pass u by....
dont vent your spleen so easily lar...take life easy...then wont go to hospital, can live long long. But if need to go hor...must go to correct one lah.....dont overcrowd tan tock seng if you think it is hougang chalet that u need to check in, ok?
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A 28-hour wait for a bed at the Singapore General Hospital
Wednesday, 2 April 2008, 7:00 am | 1,627 views
Andrew Loh
“In Singapore, within half-an-hour, you would be in SGH (Singapore General Hospital), TTSH (Tan Tock Seng Hospital) and within one-and-a-half to two hours flat, you’d know what went wrong.”
- Lee Kuan Yew, TODAY, November, 2003
Recently a friend of mine (we’ll call her ‘Esther’) was admitted to the Accident and Emergency (A&E) department of the Singapore General Hospital (SGH).
Esther had earlier seen her GP who recommended that she consulted doctors at SGH to determine the cause of her illness.
Day One
Registration – 8.40pm
The registration at the triage section of the A&E’s Isolation Ward (IW) was smooth and swift and went without a hitch. The triage nurse was courteous, friendly and apparently highly efficient. We thanked her and took our seats at the waiting area for Esther’s number to be called by the doctor on duty that night.
It was about 8.40pm.
The consultation with the doctor eventually took place at around 10pm – after some 1 hour 20 mins later. Esther was told that she had to be admitted for overnight observation so that more tests could be done to ascertain the cause of her illness.
So, we returned to the waiting area and waited for Esther to be assigned a ward and a bed. In the meantime, a nurse told us that they would find a bed in the IW for Esther to rest temporarily, instead of sitting on the chairs in the waiting area, which was an exercise in endurance for someone who is ill.
It turned out to be a frustrating, excruciating and a very long wait indeed.
At 12.20am, some 3 hours and 40 mins after Esther had registered at the A&E, I approached the triage nurse and asked if they were aware that Esther was waiting for a bed in the IW. (In all those 3 hours 40 mins, we were not informed or updated about when a bed might be available.)
The nurse was very understanding and explained that there were no beds available and that there was nothing they could do. And so the wait continued.
12.50am – 4 hours 10 mins
At 12.50am – 4 hours and 10mins after registration – we were finally informed that a bed was available in the IW’s Fever Zone. The relief – and exhaustion – on Esther’s face was evident. She would be able to rest her tired self finally.
The “Fever Zone”, where the temporary beds were, is a small section within the Isolation Ward. It has two rooms – one for male patients and one for female patients. Each room could hold about 6 to 7 beds. The Fever Zone is the place where patients who have to be warded are temporarily placed while waiting to be admitted to the wards of their choice.
Esther had opted for a B2-plus ward (5 patients in an air-conditioned room).
We were hopeful that we wouldn’t have to wait just as long for Esther to be assigned a bed in the B2-plus ward. The IW ward has its television and lights on 24-hours and patients are wheeled out to the wards and new ones wheeled in, a situation which doesn’t really allow one to rest properly amidst the noise and the comings and goings.
Our hope was misplaced.
The long wait was to last till the next day.
Day Two
9pm – 24 hours 20 mins
At about 9pm on Day Two – 24 hours 20 minutes after registration – Esther was informed that a B2 bed was available and the nurse asked if she wanted it. As a B2 ward is non-air conditioned, as opposed to a B2-plus ward, Esther declined. (See here)
The reason why she declined is because we suspected that Esther might have to stay quite a while in the hospital (as she already had 2 previous unsuccessful blood tests, one at a private hospital and the other with her GP) and because of her constitutional sensitivity to warm temperatures we decided to wait for a B2-plus bed.
Thus, we waited a further 3 hours.
12.50am – 28 hours 10 mins
At about 12 midnight, a nurse informed us that a B2-plus bed was available. Preparation was then made to transfer us to the ward. Esther was put on a wheelchair and wheeled to the corridor of the IW. We were so tired from all the hours of waiting. It was only 15 minutes later that we heard the nurse informing the ward, through a phone call, that Esther was ready to be transferred. A further 12 minutes later, a male nurse arrived to wheel Esther to the B2-plus area of the hospital. Esther had waited for about 30 minutes in the corridor.
It was 12.50am on Day Two before Esther finally managed to put her head down on a bed in a B2-plus ward.
All in all, from registration to being admitted to a B2-plus ward, it took 28 hours and 10 minutes.
Nurses were patient, courteous and professional
Now, before you think that my frustration is directed at the nurses on duty that night, let me say that they were very patient, courteous and professional in their duties.
Although they could have done better in some areas – such as keeping us informed of the situation with the availability of the bed – it is understandable as the A&E is a very busy place to work in. The nurses also had to tend to many patients.
I would like to mention, particularly, the nurses at the IW’s Fever Zone. They were compassionate and understanding. This is especially commendable when one considers that most of the patients in the IW that night were elderly and weak.
One of the nurses explained to Esther that the situation has been such since the Chinese New Year. She also said that the wards in Tan Tock Seng Hospital were fully occupied and patients were being directed to SGH. Hence the shortfall of beds there.
A serious problem
Esther was not the only one who had to wait so many hours for a bed. But perhaps she is luckier than others who had had to wait in wheelchairs in the waiting area for hours and hours on end that night we were there – for even the number of beds in the IW is limited.
While MM Lee may be right that “within one-and-a-half to two hours flat, you’d know what went wrong” (even though in Esher’s case the cause of her illness is still unknown 5 days after admission to SGH), the other important thing is the availability, or the squeeze, on the number of hospital beds.
According to the nurses there, this is not a sudden or a temporary hiccup. It has been like this since the Chinese New Year, as earlier mentioned.
While we trumpet the excellence of our clinical healthcare service (and I don’t disagree with this), it is what happens on the ground to each patient that needs to be looked at.
Waiting for more than 28 hours for a bed is simply unacceptable.
I hope that the Minister for Health, Mr Khaw Boon Wan, will put some effort into solving this problem – especially now that he has been called “the best Health Minister Singapore has ever had” by none other than SM Goh himself. (Straits Times)
When you are sick and weak, you shouldn’t be made to endure a frustrating and excruciating 28 hours just for a bed.
And I am sure that Esther is not the only one who has had this experience.
Perhaps the new Khoo Teck Puat hospital in Yishun, scheduled to open in 2010, will help to alleviate the situation. But that is left to be seen.
One can only hope that Singapore’s healthcare system will not become what MM Lee said of the system in the UK, where he experienced “restlessness and unhappiness” when waiting for 45 minutes for an ambulance:
“There’s no connection between those in the system and the patients..”
- MM Lee, (TODAY)
From Esther’s experience, one could say the same for Singapore’s system as well.
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keep apologising no use.
preventive thing to do is to avoid having to appologise.
we do not accept mediocre not that there is any mediocre.
just a figure of speech.
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A long wait for certainty
Monday, 24 August 2009, 4:16 pm | 1,500 views
Andrew Loh
Mr Joseph Lee (not his real name) had his bi-annual medical check-up on 13 February this year. The doctor, a general practitioner (GP), found blood in his urine and scheduled him for a second test – on 27 February. Thereon, he was asked to return for a third test on 14 March.
Mr Lee, 57, was told that blood in the urine may indicate a presence of kidney stones, or cancer. However, he was also told that the chances of it being indicative of anything serious were slim. Mr Lee felt it was best to be certain.
He then made an appointment with the polyclinic to get a referral to the hospital because it would be cheaper as he would be able to make claims for the cost with his company. Such referrals also entitle him to receive subsidized rates for his medical needs.
Mr Lee went to see the polyclinic doctor on 6 April and was given an appointment with Tan Tock Seng Hospital (TTSH) for the 29th of June – some two and a half months later.
At his consultation with TTSH on the 29th, he was told by the attending doctor that he will have to have an x-ray done. He may also have to have an endoscopy performed to determine the seriousness of his condition. Mr Lee returned the next day to have his x-ray taken.
His endoscopy is scheduled for the first week of September.
All in all, from the first detection of blood in his urine in February to the endoscopy in September, the entire process would have taken seven months.
According to a check with TTSH, we were told that the average waiting time for such tests was “one month plus”. This, we were told, was because of the long queue for subsidized patients. For “private patients” (non-subsidised patients) the queue was shorter. Does this mean that those who were willing to pay more would receive not just better but also faster treatment? Our query with TTSH seemed to indicate so, which was also what a nurse at TTSH had told Mr Lee.
“The waiting time is too long,” he said. When he asked the nurse at TTSH about this, he was told that it was because he was a “subsidised patient”.
While the medical cost is not a worry for Mr Lee as he receives government subsidy and is able to make claims with his company, it is the length of the waiting period which upsets him.
Mr Lee’s case throws up several questions about Singapore’s healthcare system.
One, how do hospitals prioritise patients’ needs?
Two, are patients who have more serious medical conditions also made to go through similar lengthy waiting periods like Mr Lee?
Three, are hospitals advised by the governing authorities to delay treating “subsidised patients”?
Four, is it true that hospitals have to collect enough fees from non-subsidised patients to cover the costs of subsidised patients?
Five, has Singapore’s spending on healthcare at about four per cent of GDP, which is one of the lowest in the world, contributed to the above issues?
Six, with the share of private spending to public spending on healthcare ratio at about 75: 25, which I understand is also one of the highest in the world, will the burden of healthcare affordability continue to be transferred gradually to individuals?
It is not hard to imagine the anxiety someone in Mr Lee’s position would go through, waiting – for months – to find out if his condition is a serious one which would warrant further treatment.
While it may not be easy or simple to resolve the problem of long waiting periods, it is nonetheless imperative that our hospitals look into this.
With Singapore being one of the fastest ageing nations in the world, the healthcare needs of senior Singaporeans must be a priority. And this should not only apply to the area of affordability but also, perhaps more importantly, in providing peace of mind for them through a more efficient processing system.
In 2003, Minister Mentor Lee Kuan Yew said this of Singapore’s healthcare system:“In Singapore, within half-an-hour, you would be in SGH, TTSH and within one-and-a-half to two hours flat, you’d know what went wrong.”
While MM Lee may have been referring specifically to emergency services, one hopes the same standards will also be set for other aspects of our healthcare system.
Mr Joseph Lee would certainly welcome them.
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With thanks to Leong Sze Hian. -
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Apologise?? WAs he sincere in his apology? This is a problem in almost every public hospital. Always short of beds. Wanna charge so high for medical yet cannot deliver, what a shame! Boo!
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Originally posted by storywolf:
He openly admit he and his ministry make a mistake -and working hard to fix it. That a good and great man.
Better then a lot other - which never admit they make mistake, and waste their time fixing opposition parties then fixing problems.Wish we have more of good people like him.
hahahaha cos erection arnd the corner bro they start to pop up to say srry everywhere liao...get out of my elte uncaring face -
NOt many know that those public hospitals received accrediations. I think they don't deserve it.
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I salute to the people working in trauma centres, wards, laboratories... and those professionals whom had took the oath and put their charges before themselves....
Well, the rest... I feel very bitter.