Another one from the same thread:
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In plain english.
Doctoring, unveiled.
Doctors reach their diagnosis quite often before they lay a hand on
you - or rather, they reach a small handful of diagnoses. They do
this by asking you what has happened, and then whittling down the
nature of your pain, or your sickness with a lot of other
questions.
When they do lay a hand on you to examine you, they are looking for
signs which fit with the picture they have interpreted from the
words you have given them.
By the time they order tests eg blood tests or X rays most of them
already know the diagnosis, or at least 2 possible diagnoses, and
the tests either nail the coffin in the lid, or else help to cut
from 2 possible diagnoses down to 1 diagnosis.
So as you can imagine, if you present a garbled history to the
doctor, the whole process gets messed up
If you get a chao-kenger (It does happen, even in the civilian
sector, and I remember idiots blocking up the sick bay back in my
recruit days waiting to be seen with a 40 degree fever, who could
walk perfectly well until they were within line of sight of an MO
whereupon they suddenly and miraculously developed pronounced
limps) who won't really say what is wrong with him, then your
doctor is forced to adopt a closed line of questioning.
If the patient says yes to everything, eg have you got abdominal
pain, chest pain, finger pain, headache, toothache, etc
then the doctor can't hone the rest of the process down. And if by
the time he has examined the patient he still doesn't know what is
going on -- imagine how many examinations he has to choose from. X
ray? Where of? Blood test?? which one? (there are well over a
hundred if you count esoteric and rare tests for rare conditions)
CT scan? MRI?!?!
Now, if someone does have a weird and wonderfully rare condition,
then it is sensible to take a "I dont know what is wrong here,
let's refer it on to a more senior doctor who might" approach, and
if even the specialist doesn't know what is wrong, then pulling out
all the stops and doing hundreds of tests to arrive at a conclusion
is sensible.
However, how can you tell the difference between someone who has
something really weird going on within him, from someone who looks
that way because he has intentionally messed up the process by
giving a history of made-up signs in the first place?
And the answer is... you just go by feel.
The service WOULD collapse if all the malingerers were referred on
to specialists in NUS because the MOs decided that everyone had to
be treated as a genuine case.
And now loop back to the fact that MOs are generally clinically
quite young in their careers, being fresh from their
housemanship.
Their version of "by feel" may not be quite as accurate as their
seniors. And so once in a while something will slip by the
net.
(and the truth of the matter is, reading what the docs at sgdrs
have been saying... MOs are actually really conservative because
they're like all of you - Singaporean. They'd rather play it safe
than compromise their careers, and overinvestigate recruits they
think are malingering, than underinvestigate)
The answer to the problem here is not, as modeus suggests, a public
crucifiction. Or even to make an example of an isolated case, or a
single MO. Because that will just be lost in the mists of
time.
What you, the public should want is reassurance that this will not
happen again - by the implementation at an official level of
safeguards and measures to ensure that this is so.
I would suggest :
1) Harsher punishments for the True malingerer. by which I mean the
patient who has absolutely nothing wrong with him, who is making up
his symptoms. Of course it will be next to impossible to actually
pick out someone like this, rather than someone with a weird
problem, unless he was caught out when he told his mates how clever
he is at cheating the system. This would, in theory at least, deter
malingering.
2) Official referral pathways being drawn up, devised by top
specialists in those fields. Eg referral pathways for chest pain -
must meet certain criteria, tick off a list and if they score X out
of Y points then they MUST be referred, or if they display any of
the signs listed below, A. B. C. etc
3) Punishments for non medical staff in the SAF who try to goad
medical officers into turning away sick patients, or returning them
without any MC or meds. The SAF medical corp must be given teeth to
bare at the establishment if it is to maintain its professionalism.
MOs must be reminded that they are first and foremost doctors, and
if they have the ability to raise charges at staff that compromise
their abilities as doctors for non-medical reasons, regardless of
rank or position, that would help greatly.
4) re-educating SAF staff who feel that an Attend B is a chao-keng.
There is a reason the painkillers are prescribed along with the
attend B. Which is to help reduce pain. And help the soldier ease
back into training. The meds mean something is wrong, but not
critically wrong. Hopefully, with the meds, it will become okay
again. No soldier should be punished for having something genuinely
wrong with him.
Therefore punishments meted out for being attend B - even
unofficial ones - should be met with equally harsh punishments. I
would love to see an SAF captain or sergeant continue to hand out
extra duties or weekends only to have his pay docked to next to
nothing. I bet that would stop it in a hurry.
Counterbalancing the threat of too many soldiers chao kenging to
get attend B would be the fact that if they were caught chao
kenging then they would themselves be punished.
5) re-educating the SAF MOs to have a low threshhold for referral.
If they don't know what is going on, consult with someone who does,
eg a consultant. If need be, simply be telephone, prior to formal
referral.
There is no harm in asking for knowledge, but quite a bit, in
medicine, in soldiering on in ignorance.
If a consultant agrees that the patient is probably malingering,
then what has effectively happened is a second opinion has been
sought.
If a consultant wishes to see a patient who may be ill, then well
and fine.
