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A 28-hour wait for a bed at the Singapore General Hospital

Posted by theonlinecitizen on April 2, 2008

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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55 Responses to “A 28-hour wait for a bed at the Singapore General Hospital”

  1. sarek_home said

    I know of three cases where children with fever are hospitalized for days and weeks and the doctors never found out the cause.

    This particular case seems to be an indicator that hospital capacity is stretched to its limit. Few possible causes:

    1. increasing population size raise the demand.
    2. more people getting sick and taking longer time to recover due to multiple environmental factors, new diseases and more drug resisting virus etc.
    3. more hospital space is designated to serve medical tourists.

    It also show a problem hospitals face: what is the right mix of different types of wards. There might be a Class A or Class C bed immediately available, but both would not be an option for Esther. If that is the case, a capacity-demand mismatch play a part in this waiting game.

  2. familyman said

    I do wonder what is SM Goh paid to do in the cabinet? Pass such facile remarks about his ministers? It is a bloated cabinet, making demands of our taxpayers money. If we need a Khoo Teck Puat to reduce the jams at our hospitals, it shows that Khaw and all the cabinet is doing a poor job indeed. And if our only way to improve services to is to pay more, than I think we do not need ministers that ‘care’ for the citizens that way, not when billions are sunk into UBS bank and such.

  3. Eveline said

    It does not help when politicians tie the building of hospitals at certain areas to electoral votes (viz Woodlands hospital). Healthcare needs should be provided regardless of electoral support. A gahmen that uses essential services like healthcare to hold the people ransom is not a good government; it’s an unethical, power hungry, and irresponsible one.

    That mentioned, I also understand that we are under great strain to obtain professionals to man the hospitals. So we can have the beds but no nurses to look after the patients. However it does seem that the problem illustrated by this particular post is that it’s the lack of beds that’s the problem.

    The increase in population and the proportion of aged folks is not unpredictable. What does this say – that our million dollar gahmen have no foresight?

    The sad thing is the gahmen is now trying to run hospitals like a profit centre. C class lose money, so we introduce means testing to force people to take higher class. The same has happened to transport and electricity (which I believe will be worse once the three generating companies are divested to overseas owners).

  4. Mun Kit said

    it highlights again, how disconnected the PAP ministers are. The other time MM Lee boasted our public transport can get you from anywhere to anywhere (in Singapore) within 30 minutes…

  5. Gary Teoh said

    All are propaganda, they are VIPs, if they go to hospital, no need wait half an hour.We common folks have no choice but to queue up.And the poor gahmen dare not increase the number of intakes for doctors.Poor planning, use upgrading to threaten us!!!

  6. Singapore Resident said

    >>C class lose money, so we introduce means testing to force people to take higher class.

    http://www.channelnewsasia.com/stori…332540/1/.html

    MP for Bukit Gombak GRC, Ang Mong Seng has called for Class C wards in hospitals to be re-named.

    Speaking in Parliament on Monday, the Mr Ang noted that ‘C’ sounds like ‘die’ in the Hokkien dialect, which is a sensitive issue in oriental societies.

    Mr Ang also narrated the story of an old man who would only say he was in the ward with many people instead of a Class C ward. This was because the man believed that saying it out loud would only bring bad luck.

  7. Singapore Resident said

    >>The other time MM Lee boasted our public transport can get you from anywhere to anywhere (in Singapore) within 30 minutes…

    http://www.dnaindia.com/report.asp?newsid=1130820
    “The maximum time to reach any corner of Singapore is 20 minutes as traffic is not allowed to flood the roads..”

  8. Singapore Resident said

    From one who got promoted on days ago…sigh

    “The main thing for us is to just carry on with life as normal.” Minister of State S Iswaran (on price hike for rice)

  9. What’s new?

    I was told you have to wait up to 4-6 months for a specialist consultation if you were referred from a polyclinic.

  10. Robert HO said

    RH:
    1. Stupid people are stupid only in small ways but clever people are stupid in stupendous ways. LIE KY LHL PAP are clever people who are Stupid in Stupendous ways.

    2. For example, in this perennial problem of hospital beds shortage, long complained of for years [not only in blogs but also in PAPaganda media Letters Pages] but does the LIEgime listen? Or solve problems? No. They are cloaked in the Cloak of Invulnerability because we cannot penetrate them since they rig elections and hence, need no mandate from us citizens, and hence brush off our complaints. Slaves make no impression on their masters.

    3. How did this years-long shortage of beds result? “Since 2001, the number of foreign patients visiting Singapore has grown by 15 per cent annually to more than 400,000 in 2006.” Huge efforts are being made by the LIEgime to reach 1m by 2012. This alone puts enormous strains on beds, doctors, nurses, equipment, other specialists and processes. You can simply, easily and almost instantly bring in hordes of foreign patients but providing for them requires years since hospitals and staffs need years to create. Imports of foreign staffs is an option so you find strange foreign, maybe underqualified, doctors in the unprestigious polyclinics tending to our poor, who pay low fees at the polyclinic, wait interminably, and get poorer care but cannot complain because they have no money for better. Strange foreign nurses are now the norm in all hospitals, who cannot speak the languages/dialects of the old, who make up a big portion of the patients.

    4. Compounding this Stupendous Stupidity of our clever ministers and cabinet is the equally stupendous wholesale imports of foreign workers to Singapore: “If we did not have some foreign workers to average down the wage cost for the employers, are you sure the employers can survive in Singapore?” LIE Hsien Loong said pointedly. Today, 1 in 4 of people on this 42km x 23km islet is a foreigner squeezing with us for everything from bus and MRT seats and even standing space, to foodcourt seats, driving up prices, crowding our roads with, not only cars [the richer foreigners] but also open pick-up trucks for their precarious rides to and fro worksites and of course, the huge increases in buses, trains and taxis to accommodate. The entire system and maybe even society is straining towards a breakdown. Of course, foreign workers also get sick and so squeeze our beds. Doctors have long had to persuade patients to discharge, even before they are ready, to make way for new patients. Again, foreign workers, like foreign patients, can be imported in days but accommodating their needs often requires years to develop facilities.

    5. To add to this ‘perfect storm’ is the ageing of the population, personified by the 84/85 year old Senile Minister who himself requires a whole panoply of medical services and care to stay alive, so he can mouth more imbecilities and obviousities and regurgitations of what he has read, to pass for wisdom and ‘insights’. It seems that with death and oblivion a daily possibility, he is desperately trying to continue to immortalise himself, impress Americans, shape things and to concretise his little thoughts into perpetual permanence. Of course, an ageing population also squeezes hospital beds and resources.

    6. There is also the Ultimate Stupidity of LIE KY LHL PAP. KHAW Boon Wan said it himself recently, when he regurgitated LIE KY longtime stricture that ‘hospitals should always UNDER PROVIDE rather than over provide so resources can always be most efficiently used at maximum capacity’. Ha, ha, ha! You can do this to say, hotel rooms, where if there is a shortage, the tourist simply holidays elsewhere or room rates skyrocket to reduce demand. But hospital beds? Ha, ha, ha! Thus, the stupid, unthinking adoption of obvious ‘efficient policies’ to healthcare is actually killing some of our people and creating much more [unnecessary] suffering, my sympathies to Esther and thanks to Andrew LOH for highlighting this problem for us to discuss.

    7. Why the need to maximise and ‘efficientise’ hospitals? I can understand hotel rooms but hospital beds? Gosh! Such geniuses! From LIE KY and nepotees and cronies without any single 1 of them even thinking about it! It is not that we don’t have money. LIE KY LHL gave the corrupt Americans US$3 billion in 2005 for essentially NOTHING, to be repeated every 2 years and even increased [but complete news blackout in 2007 so we never know]. LIE KY LHL PAP HC also lost billions of our monies to bail out failed American banks so Americans will be grateful for such help and simultaneously gloat at their Stupendous Stupidity. Morgan Stanley got billions in return for some millions to LIE KY on their Board. Smart. Stupid. So there is money aplenty. So it is the height of Stupendous Stupidity to ‘maximise efficiency’ by deliberately UNDER PROVIDING hospital beds and resources.

    8. There is the further point that every now and then, about every decade or so, there is a pandemic of some sort like SARS that stretches hospital resources to breaking point. It may even be the everpresent Dengue, too, or etc. So the OBVIOUS and SMART thing is to OVER PROVIDE rather than to Under Provide for just such unexpected pandemics. Because you never know. And hospital beds are not like hotel rooms. Under Providing simply because of a stupid policy, not because we don’t have the money, is another of the Stupendous Stupidity of the clever. There are many such examples. When clever people screw up, they sure screw up BIG. LIE KY LHL PAP KBW screwed up, not because of no money, but because of a stupid, idealogical, NOTION of ‘efficiency’ and ‘intelligent public policy’. Thus, they screwed up BIG, far bigger than stupid people can. GOD save us from clever people like them! This is 1 of the tragedies of being ruled by ‘clever’ people. Thanks, Andrew.

  11. Gary Teoh said

    Khor Boon Wan is the best Health minister, said Goh CT, so the other colombo scholar, former health minister is no good ? Mahathir chose a wrong successor.

  12. […] Healthcare or Heck care – The Online Citizen: A 28-hour wait for a bed at the Singapore General Hospital […]

  13. sevenleleven said

    Health Care? It’s Hell Cares. My Mrs was detected to have liver and kidney problems because of some steroid medication due to skin problems. Upon completion of the prescripe dosage, the problems shows. She had therefore visited a company doctor who refered her to SGH for some test. The appointment? 2 months. She therefore opted for a specialists instead. The wait narrowed down to 3 weeks. However, 1 week into the wait, the SGH reception informed that the doctor had to go on leave for some seminar and we had to wait for another 3 weeks.

    What else could we do? We had to wait. If it is because of all the waiting that diagnosis and medication was delayed and cause her health to detoriate, who can we point the finger to? Maybe ourselves for not begin able to afford private care

  14. Alan Wong said

    If you need a referral by a polyclinic in order to enjoy subsidised hospital care at our restructured hospitals, the chances of seeking a quick recovery is inversely proportional to your ability to pay. If your ability to pay is higher for eg. as a private patient, the period of suffering can be made much shorter. And vice versa if you cannot afford to pay for your hospitalisation. The wait can be as bad as 6 to 9 months. In the meantime you can wait to die. Who cares.

    That is the current sad status of hospital care that is made available to us Singaporean peasant in contrast to the ready availability of SIA-chartered services reserved for our elite like LKY and his family members.

    So my advice to our Minister of Health, please do yourself a favour to be aware of the real facts before you start to boast about the level of care made available at our restructured hospitals. Otherwise you are just making a fool of yourself!

  15. familyman said

    It is sad to read Robert Ho’s reminder of what Khaw said – to underprovide the number of hospital beds. until we manage to get a new hospital from the kind contribution of Khoo Teck Puat’s estate. On hind sight, what has the current ministers done to help Singaporeans – they have only made their stat boards more profit oriented and revenue based:
    Health – Means testing
    Transport – ERP and COEs
    National Development – $10 lucky draws for Build and design
    Water and power – higher tariffs
    Trade and industry – higher price of staples, including rice price rising at NTUC
    All this underpined by the fact that ministers salaries and bonus are linked to short terms GDP figures. We are screwed as citizens.

  16. PM Lee said

    our PM indicated that with all the pay rise, it is still tough to pick a new leader – so huat ah…..another pay rise for ministers on the way…

  17. ZL said

    If that’s true, why Khaw Boon Wan is still considered as the Best Health Minister in Singapore’s history?

    I’m confused.

  18. Andrew Loh said

    Esther just reminded me that on the afternoon of Day Two, she was wheeled out on her bed and left to rest in the corridor of the IW as more critical patients were brought in. They needed to be near the monitoring devices more than her. Also, the room was meant to hold only 4 patients but were being used to hold (squeeze) 7 patients into each room.

    I sometimes really wonder if our ministers – be they the transport minister, health minister, education minister, etc – really know what is happening on the ground.

    From hospital patients to teachers, from public transport commuters to hakwers, everyone is being squeezed – sometimes literally – as a result of govt policies.

    Also, I wonder if paying the ministers so much in order to attract “top talents” is bearing the right fruits and benefits for us citizens.

    When was the last time Khaw Boon Wan visited, incognito, a hospital’s A&E, I wonder.

  19. Andrew Loh said

    Last week, I think it was, there was a letter in the ST Forum Page complaining about the same long waiting time at SGH as well.

    The SGH replied in yesterday’s papers, giving a long lengthy answer which I didn’t bother to finish reading.

  20. familyman said

    I believe the ministers KNOW what is happening on the ground. More fees, more revenue, more surplus – they all get a higher performance bonus. Meanwhile help will be targetted at the poorest of the poor only, but will not be doled out to all. So, more revenue, lesser outlay in terms of subsidies and more budget surplus. Walah – higher performnace bonus all around for cabinet. I am sure the ministers KNOW what is happening at the ground – it feeds into their bonuses. PS you think the decision on F1 and casino were meant for the citizens? I think not. And they claim to be God fearing people – who voted with the whip. Sigh,

  21. funny said

    Seriously if Khaw boon Wan visits incognito and sees the negative things, what do you think he will say? What our dear PM says – “it happens, what to do?” Hahaha!

  22. Daniel said

    “ZL Says:
    April 2, 2008 at 6:04 pm

    If that’s true, why Khaw Boon Wan is still considered as the Best Health Minister in Singapore’s history?

    I’m confused.”

    Why are you confused ? If you ask LKY, he will say Nathan is still considered as the best President in Singapore’s history abeit no doing anything but collect $4 millions dollar paycheck per year.

    I still recall reading the ShitTime about LKY and his running dogs so full of praise of Nathan when Nathan was re-elected as president because he doing something heroic or moronic in 1960 or 1970s terrorism incident. Of course, if you ask me what this incident going to do with the role of president, well, it is nothing to do with president but that’s how LKY treat the moronic and voiceless Singaporean. If such a thing can happen publicly, how about thing that happen behind the scene ? Remember the case where auditor general did not do do his job for 4 decades auditing HDB ?

    They just do as they please, as and when they feel like it as they know Singaporean is still chicken-hearted.

    Don’t ever try to be rational with dictator because dictator will always make a fool of citizen. Like father like son.

  23. funny said

    can papa really hear me?

    http://www.mrbrown.com/blog/2008/04/some-good-news.html#more

  24. Hi Andrew,

    Thanks again for highlighting another shameless act of chutzpah.

    Why talk so big? So ‘how lian’ for what?

    You quoted a guy who also said, “Between being loved and being feared, I have always believed Machiavelli was right. If nobody is afraid of me, I’m meaningless.” – 6.10.1997.

    With what’s written here and other blogs, I’m afraid you are not helping him make his life more meaningful. Are you? 😉

    And with Chee siblings, Seelan, Martyn, Chia T L and lately Melanie Lee of Reuters, life is getting to be more meaningless!!!

    So much power, so little meaning. So very sad for obscenely rich old man.

    Well, if they can spin an ’embarrassing negative’ like losing limping Selamat to a ‘positive song & dance’ of capturing Rijal Yadri, what else can they not claim?

  25. Weijia said

    all this talk… i hope it translates into some action in 2011 😉 if not we can continue to talk for another 5 years.

  26. sigh said

    I have worked in SGH and now work in an American hospital.

    My observations may shed some light why “Esther” waited 28 hrs at SGH A&E:

    (1) Singaporeans love hospitals : Lots of patients prefer to see specialists rather than GPs. They think specialists are better and sometimes, specialist (if patient is subsidised) is cheaper than GP!

    (2) When admitted, Singaporeans love remaining in hospital. Despite the lousy food and lack of privacy, they feel well-taken care of and often enough, when it is time for discharge, elderly patients request to stay till weekend so their children need not take leave from work to bring them home. And that happens even if it is only monday and saturday is 5 days away….(so esther,dear girl, you could end up waiting 5 days!)

    (3) Some investigations like MRI cost almost $400 even for subsidised patients. They have to pay cash for it to be done in outpatient since medisave cannot be used. Patients thus ask to be admitted so they can use medisave, or they will refuse the test…so what is the doctor to do?

    (4) For patients who need nursing homes, these places actually cost more than hospitalisation and not as nice, since there is often no subsidy and they are run as a business. So if you are a patient and it costs $52 (daily B2 rate) to stay in hospital (with doctors and nurses to see you daily) and $80/day to stay in nursing home with less specialised staff, where are you going to choose? And since Singaporean hospitals have no skid rows and do not dump patients on the streets, the patient is kept unneccessarily in hospital till relatives realised good deal does not = right deal…so who’s thinking of esther and her long wait for bed??????

    I can go on forever…but i have to go now to attend to my 90 yr old patient whose 65 yr old son had driven 6 hours to get her into clinic of our university hospital…and like before, i know they will have a nice big smile for me….

    I am proud to be singaporean, but sometimes i feel ashamed…

  27. Andrew Loh said

    Dear sigh,

    Answers to your points:

    Point 1: Nope, Esther hates being in the hospital, I assure you.

    Point 2: Nope, as above. Esther hates being in hospital. What she would love is to be back at work again, soon as possible.

    Point 3: Esther did not ask to be admitted.

    Point 4: Doesn’t apply to Esther’s situation.

    Hope your 90 year old patient is ok. 🙂

  28. Yi-Long said

    I think Sigh has got good points there.

    But I think the bed crunch was due to a lack of foresight on our leaders’ part. A plan to boom our population without planning for all the necessary infrastructure. Sad case.

  29. patriot said

    To those who blame SM Goh Chok Tong for claiming that Kaw Boon Wan is the best Health Minister, may I say that WHOEVER believes the SM and any other leaders should be the fool.

    As almost all of us are awared that window dressings and self praises are the fortes of our leaders who tend to lack conscience in spouting propaganda, why are their words taken as gospel?

    To those who bank on 2011(the Next Election), do not be too hopeful, the Rulers know how to make sheeps out of the people.

    Reading this, many would then ask me what is the solution then, very honestly and candidly, I can only say; ‘Please wait for disaster to change our fates’. Flame me if you like but frankly it is difficult to deal with monsters.

  30. jack said

    don’t blame the ministers for their leadership and policy cos you chose them.you give them the mandate to kill you slowly and softly.you allow them to have GRC, you are afraid to kick out not performing Minister, you allow MP to enter parliament without any election thru GRC. you allow them to represent you without them coming to beg you to vote for them. you allow them to use upgrading of estate as carrot to lure you to vote for them, you allow them to any how put ERP gantry to squeeze ourselves,you allow them to have no accountability to whatever mistake they made, you allow them to be civil master rather than civil servant, singaporean, don’t complain. tak boleh tahan !!!

  31. spacefan said

    This problem has been occurring intermittently for years, but recently became more frequent and severe.

    I work at the department mentioned in your entry, and would just like to highlight the fact that the A&E has done its best to minimize ward admissions by implementing the following measures:

    1) vetting of all ward admissions by senior doctors on shift ( previously, medical officers had a free hand when deciding on admissions )

    2) starting an Emergency Observation Ward which recruits patients for protocols lasting between 8-23 hours. These include a large number of conditions like chest pain, gastroenteritis, stable head injury and asthma.
    Previously, patients with gastroenteritis, asthma and stable head injury contributed significantly to the number of cases admitted to the ward ( with most being discharged the next day ). Now, they are being managed successfully within the A&E.

    Statistics have shown a good reduction in A&E admissions, but this hasn’t alleviated the lodger problem. I shall leave you to ponder the reasons behind this discrepancy.

  32. 40s said

    If you’ve walk pass Khoo Teck Puat construction site, the picture of the hospital shows 2 main buildings (Awards) one is stated subsidied wards, the other private wards.

    It make me wonder is this hospital build to take care and improve healthcare for the people or is it build for profiteering?

    Does that means, if there is not bed space in the subsidied wards you need to go to the private wards and pay full fees?

    Seem like at the end of the day $$ still speak louder than anything else.

  33. shoestring said

    I don’t quite understand what Sigh is ashamed of. The patients?

    Personally, I feel that the 4 reasons listed are perfectly valid ones especially for those who have to count their pennies. We are talking about lack of beds in the lower class wards. Not A class ones. So patients are not that rich and they are understandably more price-sensitive.

    It simply points to the fact that there is something that needs to be ironed out in terms of demand, supply and pricing in the healthcare sector. Why blame the patients?

    The Americans have something to smile about perhaps because they have better welfare benefits.

    Far from loving it, I dread being hospitalized.

  34. Sigh said

    Dear Andrew and all

    I don’t mean to say that Esther (or all singaporeans) want to go to/remain in hospital. Lots of us do not want to, on the other hand, as healthcare workers, we have observed many individuals who do not use healthcare appropriately and everybody else (Esther including) suffers as a consequence.

    Going away and working away from home opened my eyes to many things, some of them conflicitng:

    I see PM/SM/MM/Health minister being criticised for not doing enough for healthcare “Hell Cares”. In some ways that is so wrong cos there is no where else in the world that good quality healthcare is so easily accessible (geographically and financially) to so many people.

    Shoestring says the American smile because they have better welfare benefits. That is not always true cos per day of hospitalisation in the USA costs USD$1000 (or S$1400) (just for the bed and board!) And if you have no insurance or medicare — you are on your own.There are many ills of the American Healthcare system — watch Sicko for details
    Compare it to $26/day c-class, $52 B2 and $250-300 A class bed in S’pore….
    If you are foreign and you are in S’pore during F1 season and you can’t find a hotel bed within your budget, try a hospital bed!

    So our leaders have actually made healthcare rather affordable but the very affordability leads to abuse by some at the expense of others. Usage of medisave for hospitalisation also leads to abuse cos people either fail to see that as their own money, or they see it as a way to “unlock” their money from the govt.

    Waiting times are another sore point. There are only so many doctors and nurses (say X)
    That’s not going to change in the near future cos it takes 5-10yrs to fully train a medical personnel.

    Next time you visit a specialist outpatient clinic, ask your doctor to show you the appt list. You may see something like this:
    9.00am Tan Ah Kow
    9.01am Lee Ah Swee
    9.02am Ho Bee Bee
    9.10am Lim Bo Bo
    etc etc usu till 12.30pm with 5 0r 10min interval between patients and at least 1 or 2 patients with 1 min appointment!
    (1)How can any doctor see any patient in 1 min? (2)Why does the hospital do this? (3) What are the consequences?
    Answer (1) No! (2) Because patients complain about having to wait too long (definition of long in singapore = 2-4 weeks) to see their specialists so they are squeezed into a list that is already squezed (3) Your appointment time says 9.10am but you will only be seen at 950am/10am cos your doctor has 3 patients before you; and he can’t see them in 1min. You will of course complain about having to wait the whole morning to see the doctor…

    So how? Waiting times will not change cos there are simply not enough doctors now to meet the demands of all the patients who need/want to be seen. Earlier appt dates = long waiting times in clinics. No waiting time in clinic = further appt dates.

    I say i am ashamed cos singaporeans are actually really spoilt. I am too and i am struggling daily to deal with inefficiencies in the US. The flight here on SQ was fantastic (cos that is singapore on air) but once you are in US domestic airports and airlines, it’s one hell after another. And no one complains, cos that’s life!

    And i realise that lots of things in singapore that we take for granted as standard are actually a premium product in the rest of the world. But sometimes we don’t see that and we complain and demand for a premium product as if it was standard.

    Living away from Singapore opened my eyes to how spoilt we have been by our govt, but they are not to be thanked cos now we are in trouble and they lack the political will to tick us off and re-adjust our expectations.
    As singaporeans, we mustn’t expect expect expect..we also must ask ourselves how can we give back.

  35. thanks said

    I thank sigh for her / his insight. I have a colleague from philipines and Malaysia and they both smile when I complain about the Singapore govt, telling me how little I know of how much worse things are. Still let us not rest on our laurels and blindly accept worsening conditions without questioning. Still, sigh gives us a reason to pause, think and then – let us demand what our ministers demand of us – world class standards, and ask why their million dollar pay does not deliver that….

  36. ordinaryman said

    dear sigh, some how i feel dat u are telling half truth…(i’m sure most share my tot)don mean to argue wit u.. Hear tis, most of the ppls.here are very intelligent n shrewd.but one thing for sure they r coward just like me…hahahaha.please no offend ,just speak form my heart.

  37. sigh said

    Dear ordinaryman

    I tell the truth,the whole truth and nothing but the truth…swear and cross my heart…i also coward otherwise put my full name already 🙂

    I just want to speak up because things are so wrong and everybody expects everybody else to do something .I feel that is counterproductive and in fact everybody has a part to play.

    In healthcare:
    (1) Govt must provide enough resources to ensure that people who need healthcare gets healthcare in a timely, appropriate manner. They must review policies that are out of date and fix problem areas such as abuse of medisave or hospital beds. They must invest in primary healthcare such as community hospitals and nursing homes for our aging population and make sure there are more affordable options than staying in hospital. There should not be blanket promises like “all patients get seen within 1 hour” etc and so little spending on healthcare that hospitals are forced to make money from rich Indonesians and aesthetic medicine, nurses and doctors leave for private practice because they feel stressed and under-appreciated and stuck in between patients’ expectations/govt’s promises and lack of resources. And they must not be afraid to take the tough stance and lose votes if it is the right thing to do.

    (2) Doctors and other healthcare workers must see themselves as, and act as guardians and gatekeepers of our healthcare system; and not practice defensive (and costly) medicine just to keep out of trouble (with patient/relatives/govt). They should communicate and spend more time educating and explaining to patients why X is X and why Y is not urgent and why there is no need for hospitalisation/antibiotics, rather than adopt the “i-konw-everything-and-you-don’t-so-leave-it-to-me-and-don’t-ask” attitude. They must remember they are professionals with moral and ethical obligations to patients and not businessman serving “customers” and making $$$$ from these “customers”.

    (3) The people of Singapore should understand that you are the best person to take care of yourself. Everyone of us should try our best to stay healthy, to educate ourselves on the medical conditions that we have (getting well is not the doctor’s job but our job!).We should always think about how our actions/choices may affect the greater population and not just take as much as we can.
    It is not a buffet and even with buffets, there is decorum.
    We should try to trust and respect the people who work for us (that includes our govt/doctors/teachers/waitresses etc) and not always fault-finding….in a nutshell, quit being so “ngeow”!

    Easier said than done but i think self-reflection on everyone’s part is better than finger-pointing.

    My 2(hundred)cents worth…

  38. shoestring said

    Your last comment sounds more agreeable. Totally agreeable. But we should not assume that everyone is only complaining and not doing anything.

    I have had first hand experience where doctors ordered routine tests that aren’t necessary at all. And their aids blindly follow instructions until I questioned them on the rationale.

    Perhaps our expectations are proportionate to the cost of maintaining our leaders compared to that of other countries. Just as consumers would expect better performance from a more expensive product.

  39. Seni Budi said

    I just wonder out loud, if the patient in question can be treated as an outpatient with daily visit to the specialist instead of taking a bed in the hospital.

    The hospital should be more aggressive in discharging patients from the hospital and have them come in for follow up. More beds can then be freed for more urgent cases.

    And the decision whether to require a pateient to stay in a hospital should requested a more detail justification, and reviewed by senior doctors.

    SB

  40. Andrew Loh said

    Hi Seni Budi,

    Esther’s fever was irregular, comes and goes. Thus, the doctors wanted to admit her for further tests. It would not be quite good to send her home and make her come so often for her blood tests, which happens quite often (almost everyday they’d take blood from her). Esther has since been scheduled for an operation.

    Thus, I feel that the doctors were right to admit her.

  41. Pondering said

    I’ve had a bad experience with SGH a few years back when my mum have to be treated at the A&E due to burn. She have accidently spilled boiling hot cooking oil on her hand. Being the ever frugal mother, she have decided to self treat it. Late into the night about 10pm she have finally give in to the pain and self-suggested that we bring her to a hospital.
    We drove her to SGH and immediately get registered. Pay $80 upfront (mind you..you have to pay before you see the doctor) and waited for our turn to be call on. The 1st wait was not long. The doctor simply ask a few question, do the routine of checking blood pressure, ask if you have any illnesses and then stare at the wounded hand. Then they whisk you off to the next waiting area.
    At the next waiting area, we waiting for at least an hour and finally we are being brought into a room. I insisted on following my mum everywhere she goes as she does not speak english and is not comfortable if we leave her alone. In the room, the doctor again ask the same few question and do the same stare at the wounded hand. Then…..we are again whisk to another area.

    There…we wait again..for another hour or so before told to follow a nurse. The nurse push my mum (who is now seated on a wheelchair) to a room, left her outside the room and walk in. No instruction was given. I thought she wanted to go into the room to leave something or pick up some stuffs before coming out again. We waited for half an hour outside the room. I couldn’t care less and make my way into the room. To my amazement, I can’t find anyone in the room. Yes..the nurse went in and spoof…disappear. (must be some connecting door thing and this nurse forgot she left a patient behind)

    Then I have to barged into the the previous “station” where we were from to re-do everything. Then we are successfully brought into another room. Now, this looks promising because I see two doctor..after a while…it doesn’t look promising..because it’s two young doctor. Asking my mum the same standard question but this time…putting their hands at work, causing great pain. Then I heard the two of them discussing. They are arguging over the “doneness” of my mum’s hand. Basically one said it’s 1st degree and the other said it’s 2nd degree. After like 10 minutes of argument (I swear to god..it’s argument)..they ‘ve decided to call up someone (I supposed is their teacher) and seek help. If I had knew that things work this way, I’d have call up this person 3 hours ago. Diagnosis over the telephone..isn’t it a wonder?

    After the diagnosis, we are told to wait while we will be again whisk off to another place. We are then being ask to go to this place where they will dress my mum’s wound. This..they disallow me to follow. My mum came out of the treatment room with a shrinkwrap hand. If anyone don’t know what’s shrinkwrap, basically think of vacuum packing. It’s ridiculous.

    A day later, the hand start to give out foul smell. We went to a skin specialist and get it treat.

  42. vincent said

    i suffered from slipped disc last year and was not able to raise my torso more than 90 degree. I went to a poly clinic which referred me to NUH orthopedic. it was scheduled for 2 months away. What was I gonna do in the meantime? take a 2 month outpatient mc? so I went private, got a consultation the next day, got it diagnosed, evaluated the options and the option to go for surgery available within 2 days.

    Set me back by almost 10k. I was young (26), hitherto been in the pink of health and uninsured so it was in cash. But I count my blessing and thank God I could afford my treatment. So advice for everyone, pls get your hospitalisation insurance and get the highest tier you can afford (covers private). coz you don’t really want to take your chance with the public healthcare system when it is life and limbs.

    and i feel darn angry when these disconnected politicans go on and on about how world class and affordable our healthcare is. the world class bit is not affordable (to at least 60% of our pple) and the affordable bit is not world class.

  43. Seni Budi said

    Andrew

    Thanks for the clarification.

    Pressure on Bed in Hospital would not diminish. I used NUH, There it took up to 20 hours for a bed to be available. And it also depends on the ward you are goin in for.

    I was warded in NUH 3 times, varied in length from 2 week to 4 weeks, all for infection of the right leg.

    After the last admission a few years ago, I had similar infection several time, on all occassion, I obtained the necessary courses of anti-biotic from my GP. The arrangement was if after two courses (over 10 days), if the infection persits, I would get myself admitted. On all such occassion, I was cured without the need to stay in hosiptal.

    SB

  44. KC said

    It’s no secret that our hospitals / health care system were under heavy strain from large number of patients inflow everyday. Population aging, misuse of A&E, staffing problem, abusing of the healthcare fund ( You see well-off people declared they can’t afford to pay for their families’ bills).

    Most of the singaporeans are highly educated nowadays and expected to get “respect” and “world class services” in places like hospitals ( that’s why u see signage displayed in hospital asking patients not to abuse the nurses and staffs etc haha).

    Here’s some pointers that we can help (a little ) towards better health care system

    – Go to a family doctor before you rushed down to A & E
    – Be nice and courteous towards the nurses, doctors, and even the billing officers 😛
    – Don’t be a cheapo and look for social worker to foot the bills when you are earning good money
    – Voluntary to donate bloods once or twice yearly
    – Don’t overstay
    – Don’t dump your old parent in the hospital
    – Many many more….

    BEST ADVICE : Stay health, exercise regularly, eat healthly

  45. Seeking Salvation said

    The whole health system is going down the tube. The cost cutting and means testing by our so called foreign talented Khaw Boon Wan (notably called the best health minister) If u imagine the amount collected from the tobacco tax, liquor tax is not channel back to health care but to line their fat pockets with bigger salaries and spending on expensive toys such as anti riot vans, vehinicles, chinooks helicopters , submarines. The whole joking government who had let mas selamat out and waste so much manpower, costs printing leaflets ought to be sack. I know it takes 3 to 4 mths wait to have a normal dental scaling job done at the polyclinic, half a day’s wait to consult a general practioner. People of Singapore wake up and vote out the hopeless overpaid creeps

  46. sigh said

    I wonder if i can take a poll:

    (1) When you go to a doctor (say GP or polyclinic) for a cold (just to get mc and some meds) or follow up an exisiting problem (eg diabetes), what quickly do you expect to bee seen?

    (2) If your family member started vomiting in the middle of the night (and is otherwise OK, conscious and talking) and you suspect it is food poisoning, do you (a) go straight to A&E (cos GPs are closed) (b) wait to see GP the next day cos this is neither accident nor emergency (A&E)

    (3) If your GP think the blood in your stools can be cancer and he wants you to see a specialist, how quickly do you think you should be seen?

    (4) Relating to (3), how quickly do you think cancer grow/spread?

    (5) If you have a breast lump and you are young and at low risk of cancer, and your GP has told you it is unlikely to be cancer, would you still want to see a specialist?

    (6) Which is worse about waiting in a hospital?
    (a) The “wasting” of time? You could be working/shopping/sleeping..
    (b) The uncertainty of what’s happening? The fact that nobody is telling you what is happening

    Just interested to see what people think…

  47. Ian Furst said

    My wife and I came to lecture your National Health Care Teams in Singapore in 1999. My wife for paediatric trauma and myself for Oral Surgery. When we compared you’re system to the Canadian model the facilities were more modern, the workers more engaged and the procedures just as up to date. The concept of truly socialized medicine is something that seemed to be deeply valued by Singapore’s citizens when we where there. This, I’m afraid, will cause a downward creep in either quality or access to care. Because the simple truth is that pay expectations, drug costs and technology are accelerating at a rate that no rational governement can allow if it wishes to stay in power. So the only options are to rationalize care, increase efficiency or allow privitization. Since the latter seemed to be deeply distrusted, you’re left with rationalization or changes in efficiency. If the UK and Canada are examples, you have a long road ahead. You should be proud of you’re system however. We learned a lot while there a gained a new respect for a socialized system.
    http://www.waittimes.blogspot.com

  48. Fever Guy said

    sigh,

    How to compare a big nation to a small fry nation when health care is used as a benchmark? New York vs Singapore? Small nation can be more efficient than big one. Is our health care system now being efficient? I seriously doubt so. With so many foreigners coming ashore and rich tourist patients occupying our beds, and growing aging problems and SARS, Dengue and HFMD always around the corner are our health care system able to take the shock? When the gov open doors to many more foreigners have they ponder and think that all these visitors(are they superman cannot fall sick is it?) will need to see doc someday? Why the whole planning is not done ahead…building more medical care facilities, staffs and hospitals to address the shortcomings. Million dollars pay ministers are short sighted…their mouth talks big about long term but they are really not that smart as you think. Now they talk about Jurong redevelopment….guys think about punggol and sengkang 10 years ago when holy goh brag about it. Nowadays talk is so cheap especially coming from million dollars minister.

    This health care issue is going to get worst not better and who suffers? US. What to do? It has happen already! mentality of the GOV will not stopped. Why “Sigh” works overseas and not in Singapore? Too Stressful or too much compeition with the foreign talents? Isnt it better to work in your own country?(since it is so superior to US system). Here our system corrupts and become complacent that must be the reason. or maybe other reasons we might not know. But i can sense that the grass at our own backyard is not greener. A socialise system breeds elites who are crap leaders but a democratic system make good ones.

    Time to ponder again for singaporeans vote them out and save millions of tax payer monies. Are they worth every cent?

    fever

  49. sigh said

    Dear fever,

    You are right that our healthcare system is not efficient and it should be since we are small and everything else is.

    And there is definitely a lack of foresight/failure of planning with regards to healthcare where our govt. is concerned, but my point in this whole thing is that WE ALL have an important part to play, not just the govt.

    And everyone – govt, medical community, patients/singaporeans should think hard about what we, as an individual, can do to improve things…then work with the other parties to make it work…

    Anyway i am in the US to train and i will definitely be back in Singapore to serve….trust me, there is NO better place on earth than singapore.

  50. patriot said

    Dear Sigh;
    i await for your return and please do not emigrate elsewhere later, we, the people need Singaporean like You! It is Singaporean like You that will sincerely care for the healths of your fellow citizens. You are great!

  51. Awaken Citizen said

    Dear Sigh,

    Why do you call yourself “Sigh”? You gave me the impression that
    you are very positive and patriotic, so why must you sigh?

    Are you in the US on Singapore Govt’s scholarship, using
    taxpayers’ money, or are you using your father’s money?

    And why must we trust you? We don’t even know who you are!

  52. sigh said

    Dear Awaken Citizen

    I sigh cos i read the postings and feel that everyone is just angry and quick to put a blanket blame on the hospital/the govt; and that is not the answer to the problem at all.

    I sigh because that is even more counterproductive to solving the problem; and the reason i write so much is to share my (?insider) perspective that this is everybody’s problem and everyone is part of the problem AND the solution.

    I am definitely patriotic but patriotism to Singapore does not equate blind support for the PAP govt.

    There are problems with our govt, which is why i am sorry but i can never say my real name (By my employment policy i am not even supposed to express an opinion about health care without approval from our public relations office! So you can write to the forum pages about what you feel about hosp/doctors/nurses etc, i can’t…or at least i can’t say what i really think).

    I don’t think we are truly democratic and i certainly fear the repercussions of opposing the authorities, but let’s not say everything they do is bad, just like not everything they do is good!

    At the end of the day, all my spew is not about supporting the govt but trying to be “fair”.

    And of course you should not trust me or anyone else completely! But be open-minded, think about it, and check it out on your own…

    I am on govt scholarship of some sort but the taxpayers money allocated to me is inadequate and i have to “tampa” with my own money.I am also bonded for more years and for more money than the scholarship is worth…so if your concern is that i am wasting taxpayer’s money, i can say with full conscience i am not.

    Thanks patriot for your comments. I am not great, or I am only as great as any other typical singaporean; who despite not having anything, put our little red dot on the world stage. And i am also as ugly as the next singaporean who gorges at buffets and litter in JB.

  53. fan of sigh. said

    sigh, you are cool. Like you, I think singapore is great and can become greater and not everyone need to be pro PAP for that to happen.

  54. Fever Guy said

    Sigh,

    I hope your return to sg will provide some relieve to our overly stressed health care system. As a health care worker your inputs and contributions are of great importance and if u see that something is done wrongly of the system, i truly hope people like you can voice out and be firm in your stand. I do hope singaporeans help singaporeans if not we are doom as this gahmen only help if it doest cost money to them. After all we singaporeans are not asking for world class medical treatment but good enough medical care at affordable prices. I am disappointed a rich gahmen we have cant even provide the free medical care to the very poor and everything cost so much for the middle class singaporeans. Where are we heading > Japan ‘s standard of living then we are all facing trouble times ahead and it could well happen in a few years or so.

  55. Globalhealth Standard said

    To determine the quality of health service,one must compare the standard as follows:

    1) the number of hospital beds per 10,000 population
    2) the number of doctors per 1,000 population
    3) the number of nurses per 1,000 population

    currently most A&E Departments are centrally located at the central locations of the island and the catchment areas are not evenly distributed thus it jam up the A&E Departments.

    Currently, we do not know the standards, the authority failed to inform us or even no such standards
    The authority must set a standard based on world standard as the performance indicator.

    We need more hospitals for the northern and eastern sectors to meet with the higher dense population demands and also to fulfill the ambulance response time for critical accidents,so as to ease the heavy workload for the A&E Departments.

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