Relooking at our public hospitals
On Friday night, the husband had a sore throat which suddenly developed into a really high fever. Fed him Panadol but the fever didn’t seem to subside at all and he started having these really bad chills that he never had before so I took his temperature and it turned out to be 39.5°C.
The nearest hospitals to us were Mt Alvernia and Tan Tock Seng and I checked TTSH’s website which showed the waiting room conditions and it looked quite empty so we decided to rush him there.
I was previously admitted to TTSH’s A&E for food poisoning which I was attended to rather promptly and left me singing praises about our country’s efficient and affordable ($105 for Singaporeans) public health care to just about everybody.
But unfortunately, I can’t say the same for the husband’s experience.
You see, the website showed the main waiting area which was indeed very empty. We arrived and registered him and when I asked the nurse about approx waiting time, she told me “He is next.”
He was called into a room next but as it turns out, it was merely a preliminary medical examination by a nurse to diagnose the symptoms and direct the patient accordingly to the next “waiting zones” where they would then see a doctor.
Based on the boy’s symptoms, we were asked to head to the Pink zone. I’m guessing it’s meant for people with flu, fever, cough etc.
There were 6 consultation rooms and only 1 doctor on duty. So I asked the nurse there how long would it take, she replied “6 more patients.”
Because the boy and I had a lot of faith in our public health care, we genuinely thought it wouldn’t take long. I mean, even at our neighborhood clinics, it wouldn’t take more than an hour to see 6 patients right?
So he sat there shivering, while I watched Nicholas Cage on the telly.
One hour passed, and then the movie ended and the next thing we knew, we have been there for 2.5 hours and it was still not our turn.
The nurse came over to take his temperature which read 39°C and even said, “Wah so high ah” and then walked back to her desk. I asked her how much longer would it take and she replied, “2 more hours at least.” She wasn’t rude but neither did I sense any compassion in her - it was very matter of fact.
What I do not understand is, why do you need almost 5 hours to attend to 6 patients?!
I’m not blaming the doctor, I trust that he was really working but there was only 1 doctor on duty despite having 5 other consultation rooms empty. Based on my observation of the doctor by sitting outside the room which you could look in almost very clearly, after seeing a patient for about 5 - 10 minutes, the doctor had to spend about 20 minutes typing away on his computer (I trust that he is handling some paperwork and not on Facebook la) and then another 20-30 minutes walking here, there and all around the hospital delivering some documents around.
We then asked the nurse if he could have some medicine at least to which she replied, “Sorry, cannot. Must see doctor then can.” and promptly made him sign an indemnity form when we decided to head to another hospital.
We ended up at Gleneagles where he was attended to within 10 minutes. But of course at a much higher price tag of $260 - I think it would have been free for him at TTSH since he is an active serviceman.
The thing is, everybody I have told this story to all told me the same thing, “Public hospital mah. No choice what.”
But this is Singapore we are talking about. We are supposed to be all about efficiency, productive workflow, strategic planning isn’t it?
Because it seems that now, there are only two options available for Singaporeans, either a) wait hours at a public hospitals or b) pay a much higher price at a private hospital which if you ask me, $260 is quite a steep price for most Singaporeans.
I did a quick search on Google - I might be wrong - but it appears that Singapore is ranked 6th in the world for our healthcare. Which is appalling that for such a high ranking, we need 5 hours to attend to 6 patients.
Shouldn’t there be better workflows in place, forecasting and planning by management? I’m guessing that the SOP is that after seeing patients, the doctor must first do tasks a,b,c,d,e before he can see the next patient which probably explains all the typing away and walking about.
Also, the high number of patients waiting with only one doctor on duty is simply just extremely bad resource allocation. The doctor to patient ratio really needs to be revised and better calibrated.
I also couldn’t help but notice signs placed around the waiting rooms, informing patients to respect the hospital staff and action will be taken against those who hurl verbal abuse at nurses. I’m taking a guess here but logic tells me that most people do not go around with the intent to hurt verbal abuse (unless you got problem la wtf) and most of the time, they tend to get agitated and then angry because of the long waits. I could imagine myself getting angry too to be honest, especially since the nurse on duty had a very you want you wait lor attitude.
That’s the thing with Singapore - everybody in every sector encounter customer service problems every day. I get customers screaming at me every other day la -_- But what I’ve realised while the ideal is to do a root cause analysis and work on improving things with necessary corrective and preventive actions, the way most companies (and our public sector mostly) tend to react is to quickly put indemnity everywhere - like the form the husband was made to sign, like the signs plastered around about verbal abuse - and hope the problems will go away.
I mean, I do not expect the nurses to be Miss Singapore Airlines all happy smiles and all, but it was saddening to see zero emphasis on customer service. Every patient there was merely treated as a queue number. They seemed to have forgotten that people were there in A&E because they were sick and weak :/
So ya… I think it’s time we relook into our public hospitals!
As for the husband and me, I guess we won’t be heading to a public hospital anytime soon. (Not that we so free nothing better to do keep going hospital la!)
Edited to add:
I have received some comments that made me realize I was too quick to post this and missed out some points.
Some mentioned heading to the 24h GP - I agree that the 24h GP is a much faster and cheaper option. We usually just head to Silver Cross near our place - I’ve only been to the A&E once (that was last year because it was on CNY Chu Yi and we didn’t know if Silver Cross would be open) and this is the husband’s first A&E visit too - only cause we had received notification from NEA about our neighbourhood being a high alert zone for dengue fever and that his 18 month old nephew was warded in hospital 12 hours prior for suspected dengue. Which is why we chose to head to the hospital directly instead of going to the GP to get referred to a hospital.
I also agree that people who require quick medical attention based on age and seriousness should get attended to first - which was why the preliminary examination was conducted to get patients “zoned” according to their symptoms etc.
What I was unhappy about is specifically the 5 hours needed to attend to 6 patients in the pink zone. Like I said, I do not fault the doctor too but I believe the workflow and SOP set by the hospital management ought to be looked into - especially if every doctor needs 40 - 60 minutes to write prescription, records and miscellaneous paper work after seeing every patient.
There was also no bumping up or down the list for these 6 patients (in the pink room, based on the 2.5 hours that I was there). I feel that when in comes to Singapore, nurses shouldn’t bump up or down because it is honestly not easy to do so especially since Singaporeans can be a difficult bunch of people. In fact, there was a girl in her late teens who was there to see a doctor with her boyfriend because she just discovered she could be pregnant and they were happily bouncing up and down the corridor and I had no issues at all about them being attended to first.
And yes, I love Singapore too - our low tax rate, public transport system and all but in this case, just miffed about this inefficiency ;)