Patient Rejected By 3 Hospitals

sourketchup SG

Ah, but that is assuming that accreditation would definitely result in a higher standard of care. That is debatable, to say the least. But it does definitely result in lots of paperwork(to "prove" that the necessary steps demanded have been taken), which eats into time and effort that could have gone into proper care of patients.

oxford mushroom SG

Some accreditation is necessary but too many hampers proper hospital administration. One reason for these accreditation programmes is that US patients can be transferred here for treatment in JCI-accredited hospitals, paid for using their US-based medical insurance. The US is likely to be our biggest customer and they call the shots. If your hospital has JCI accreditation, they will treat your hospital like one of their own. If your lab is CAP-accredited, then they will accept your standards as equivalent and even allow your lab techs to sit for their examinations, since they consider someone working in your lab to have the experience as someone in a US lab.

It tends to be local private patients that go for the cheapest rates. US patients tend to be more discerning and certainly their medical insurance companies will be. That's why the private hospital in Bangkok has done so well after they got JCI accreditation ahead of Singapore hospitals.

The problem about accreditation in Singapore is that we have large public hospitals like SGH, TTSH and NUH who are already accredited with multiple organizations. Smaller private clinics, labs and hospitals do not have any accreditation at all and do not wish to pay the high price for signing up with one of these overseas accreditation schemes. So Singapore started running local accreditation schemes so that these smaller establishments will at least have some form of quality assurance. But the big hospitals are also required to sign up to local schemes in addition to overseas-based schemes. That is ridiculous and a waste of time and resources.

sourketchup SG

[quote]Originally posted by oxford mushroom:

Some accreditation is necessary but too many hampers proper hospital administration. One reason for these accreditation programmes is that US patients can be transferred here for treatment in JCI-accredited hospitals, paid for using their US-based medical insurance. The US is likely to be our biggest customer and they call the shots. If your hospital has JCI accreditation, they will treat your hospital like one of their own. If your lab is CAP-accredited, then they will accept your standards as equivalent and even allow your lab techs to sit for their examinations, since they consider someone working in your lab to have the experience as someone in a US lab.

It tends to be local private patients that go for the cheapest rates. US patients tend to be more discerning and certainly their medical insurance companies will be. That's why the private hospital in Bangkok has done so well after they got JCI accreditation ahead of Singapore hospitals.

The problem about accreditation in Singapore is that we have large public hospitals like SGH, TTSH and NUH who are already accredited with multiple organizations. Smaller private clinics, labs and hospitals do not have any accreditation at all and do not wish to pay the high price for signing up with one of these overseas accreditation schemes. So Singapore started running local accreditation schemes so that these smaller establishments will at least have some form of quality assurance. But the big hospitals are also required to sign up to local schemes in addition to overseas-based schemes. That is ridiculous and a waste of time and resources.[/qoute]

Never knew about all these, thanks, bro.

oxford mushroom SG

Unfortunately, that is quite true. When we finished medical school, Singaporean guys received a letter requring us to report for national service which had been disrupted, as we should. But our Malaysian colleagues received a letter inviting them to apply to be PRs and with the clause that they would be 'exempted from all forms of national service'. When we return from NS to the hospitals, these Malaysians are already two years ahead as registrars (junior specialists) and had been earning a higher salary over the two years when we were in the army.

To add insult to injury, married PRs could apply for HDB flats, whereas I could not because I was single and below 35. Local doctors also end up with a huge debt to repay after medical school, which they have no hope of paying during NS. It's each man for himself now...don't expect our young doctors to do their jobs for altruistic reasons...

sourketchup SG

When the Indian medical degrees are recognised, wouldn't it make sense for Singaporeans to study in India then? Much, much cheaper, and no bond to serve.

Dogtor SG

Correct - the assumption is that accreditation results in better care.

Let's break this down into several aspects of hospital accreditation.

1. Care itself - some are eveidence-based medical care and are standards heaped onto hospitals so that they can compare themselves with one another - eg. if you came in through the ER and was diagnosed as having penumonia -----> the standard will be expected to receive IV antibiotics within a certain time period, I think it's 4 hours - I forget 'cos Docs precribe as soon as they make a diagnosis. It is the hospital "process" of translating that management decision into action, ie. pharmacy gets order, process it correctly, sends the right drug to the right patient in the right location, have the nurse set the patient up for IV antiobiotics and then actually delivering it to the patient ......

So - accreditation also measures and improves care - when you have to report how many percent of patients presenting to ER with pneumonia receive antibiotics within 4 hours of arrival/diagnosis. If you suck - you will try to improve the process.

2. Documentation - things that get done or not done - no documentation means not done, right? Can argue until the cows come home but no proof - accreditation is done on hospital procedures.

3. Ethical aspects - how the hospital handles patient information, protect the patient from medical research studies, etc. So improves the patients' rights for care, not from exploitation.

4. Recommendations for standardized short-forms: many docs and ancillary staff use a lot of shortforms and these cause errors. Medical mistakes hurt or kill patients - these clerical errors also monitored by accreditation agencies. They have proscribed standard shortforms to avoid these erros and hospitals get ding on it because of personnel habit - thus training and education is needed. Things will change over time when newer docs/personnel are imbued with the right attitude and right training for this.

5. Training/accreditation - eg. CPR - BCLS/ACLS certification for essential personnel. Prior to accreditation many docs did not have routine Basic/Advanced Cardiac Life Support Training but I heard that JCHAO (or JCI for Singapore) monitors that so training invariably is conducted to satisfy the criteria for accreditation. Of course this does not mean that care improves but logically it should. Why if you don't know what you are doing then you don't know. If you were taught it before - at least if you encounter it the first time - you will have a basis to act and to know where to find the solutions to problems.

Accreditation is not the solution for all hospital ills but allows standards to be established for comparisons.

Some are evidence-based changes in hospital proceudures. I think inevitably some good comes off. Documentation is time-consuming, so costs will definitely go up. But is there any other way of moving into the next phase of development??

Dogtor SG

Yes - but language issue again.

I am not as talented with my tongue like my Tamil speaking colleagues Smile

Because people who fall sick are usually the elderly - they are more likely to be less educated and don't speak English - just like patients here in Singapore.

So it is harder to learn medicine when you can't communicate with your patients.

I would suggest that people go to Europe to do medial school (eg Ireland)

Borrow money and take out life insurance.

You would spend about S$300 000 in total.

Then go to the USA for residency and forever.

After Internal medicine residency (3years) you will be board certified and can work.

Starting salary US$100 000 to US$150000.

Sub-specialties start at >US$150 000.

You should be able to pay off your debt, and lead a comfortable middle-class existence and provide a happy home for your children and safeguard your children's future. And no need to really learn second language 'cos everyone speaks English.

SINGAPORE CANNOT COMPETE.

sourketchup SG

If there are language difficulties, why are the authorities planning to recognise these degrees. Shocked

If so, wouldn't it be much, and I mean MUCH cheaper to shut down our medical schools, and send our people to study there? Mr. Green

oxford mushroom SG

Many of these foreign doctors who come in to work in our public hospitals and polyclinics are not fully registered like our local doctors. Unless they come from very good medical schools overseas, these so-called non-traditional source MOs are given conditional or limited registration which means they can only work in the sponsoring institution and not other hospitals.

sourketchup SG

Aren't the authorities planning on changing that? Read somewhere that they would be giving Indian medical degrees full recognition.

Indian medical schools, here our young ones come! Mr. Green

Dogtor SG

BECAUSE SG people want it cheap

Of course cheaper to shut down medical school

Just that locally related medical research not done that's all

sourketchup SG

This is the whole cheap foreigne.....sorry, foreign talent issue again. Looking at it from a national perspective, there is no way we can stop all or even most foreigners from coming in. Heck, we have been having Malaysians for umpteen years. Add to the fact that now 1)our own people are not reproducing 2)they cost too much to employ 3)some do not have the necessary knowlegde or skills, and having a significant numbers of foreigners in our country is a must.

The difficulty, as usual, is in the details. Most of us true-blue Singaporeans feel strongly that these foreigners are getting in too easily. I, like a few brothers here, spent 2 and a half years of my life digging trenches, charging up hills, bashing through jungles, and getting verbally abused by the "enciks" in the army. Like Oxford Mushroom, i face the unpleasant fact that foreigners are ahead of me because they do not "waste" 2 and a half years in protecting their countries. They get the same pay. The same privileges. My company pays the same to train them. I have to serve my reservist, sorry NS(the new term), liability to protect my family, and them too. In a war, or when the s*** hits the fan, I will stay to fight. It is hard to imagine our grateful guests doing the same. I see them fighting for the same pie that my juniors are trying to get, except that my juniors have to serve the army first(to clarify, I have got one foot into the door) and hence may lose out.

We need them, no doubt. But more can be done for our own. Why are we giving out scholarships to the foreigners when our own people have to scrimp and save to study overseas? We should employ them on a contract basis, and if a Singaporean is equally qualified, then the local should get the job. That's what is happening in UK now anyway. Fill in the details, but the NHS(National Health Service) would employ an EU doctor over a foreign one, if both have equal qualifications and apply for the post.

And I don't buy the "we were once immigrants" theory. Our grandparents may be. But I have served my NS here(not to make it too dramatic, but all of us have heard of serious injuries and deaths to friends and acquaintances). We grew up here. Foreigners are welcome, but the locals should be treated better.

the Bear SG

okay.. a little bit off topic..

i heard horror stories about hospitals doggedly adhering to JCI standards.. what the heck are they?

there was a nurse who said that the ward insisted on a certain level of supplies of medication, fluids and whatnot.. and that the place CANNOT have over that amount... it wasn't a minimum stock they must have but rather, they cannot have more than a certain amount..

she also said that if there was a RTA victim who comes in with profuse arterial bleeding, he's doomed because they do not have sufficient amounts in the room or ward...

now, if this is JCI standards, please.. fetch me to a non-JCI standard hospital when i get mangled in a RTA Razz

ShutterBug SG

Some good points you have brought up, but I'd like to draw you people's attention to WHY, are 1)our own people are not reproducing 2)they cost too much to employ in the first place??

The answers I believe will be varied, but will be apparent & obvious; HIGH COST OF LIVING.

Having FTs saturating the employment market, lubricates the econ & commerce machine, but leaves society rotting away from the inside out...

Don't tell me, none of you agree to this?

[/b]

Dogtor SG

Check this site out for Joint Commission standards - it was initially US-based and of course now intellecutal property - international standards.

http://www.jointcommission.org/

Dogtor SG

Check this site out for Joint Commission standards - it was initially US-based and of course now intellecutal property - international standards.

http://www.jointcommission.org/

the Bear SG

if it's anything like ISO, it'll all end in tears Laughing

av98m SG

Originally posted by ShutterBug:

Some good points you have brought up, but I'd like to draw you people's attention to WHY, are [b]1)our own people are not reproducing 2)they cost too much to employ in the first place??

The answers I believe will be varied, but will be apparent & obvious; HIGH COST OF LIVING.

Having FTs saturating the employment market, lubricates the econ & commerce machine, but leaves society rotting away from the inside out...

Don't tell me, none of you agree to this?

[/b][/b]

Higher costs of living, plus our own increased expectations with regards to lifestyle is definitely a key factor why we do not want to have kids and are not willing to accept low paying jobs. The increased presence of foreigners and resentment against them for various reasons is also tearing our social fabric apart. If I ever have kids I will not want to raise them here nor want them to be Singaporeans even because I do not want them to serve national service. Not for this hotel. Even myself, I won't be very motivated to answer any mobilisation because nearly half the country is made up of foreigners. And most of these foreigners are not going to stick around long enough for their offspring to serve national service. Heck, national service is just one more reason why they do not want to stay. There is a ticking time bomb in the midst of all these and god help us when it finally goes off. I'm relatively happy with my lot but am not blind to these issues that our government is trying to ignore by burying its head into the sand.

av98m SG

I was quite shocked when first told about this. I've always thought that hospitals and heathcare providers were about saving lives first. But now I know better. "Standards" are more important. The patients can die as long as "standards" are ahered to. Shocked

ShutterBug SG

Precisely so.

It's the same with all other gov policies - for example CPF; you must be "bed-ridden" BEFORE they'd even consider giving you, YOUR money to help yourself.

Is this ridiculous, or is this RIDICULOUS?

They follow, uphold, and adhere to policies with BLIND determination totally void of human compassion...eg. you die early that's your problem,... we have guidelines to follow....

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