Tag Archives: medicine

2 Hour wait at Singapore Specialist Clinic

ImagePhoto credit: Ambro

A poor patient has been made to wait at the specialist’s clinic for 2 hours for every visit in a government hospital in Singapore. She did not even dare to go to the toilet for a break because she was afraid that she would miss her turn. The writer quite kindly pointed out that the doctors and nurses at the clinic were doing their best, just that there were way too many patients.

As a doctor I understand the doctor’s point of view, but I had also brought my wife to see her doctor before and we had to wait for 1-2 hours at that same hospital. That was despite the fact that the gynecologist and I were friends (we were made to wait just like everyone else and I thought that was the absolute right thing to do).

How long is too long? One should of course see what other countries are doing. Well researched data are however only readily available for America, where the average wait was 21 minutes. Patients described their wait as about 2 hours in Germany.

Patients feel disrepected when they are made to wait too long and that is the primary reason they would not recommend their doctor. It has gotten so bad that in America, a frustrated patient sued a doctor after waiting for 4 hours and won $250 in a small court.

There are many reasons of long waiting times. The primary reason is of course high demand (many patients) and low supply (lack of doctors/funding/doctors sick). This kind of problems can only be resolved by having more doctors and funding which many governments are reluctant to do because it means higher healthcare spending.

Sometimes patients are late for their appointment. When they arrive later, the doctor is already seeing other patients and they have to be “squeezed in” and this causes longer waits for everyone. On the other hand, it is difficult to expect patients to be on time when doctors make them wait…

Sometimes new medical problems occur. This happens when an appointment is booked for a routine visit lasting 15 minutes, but the patient has a new problem that needs to be addressed. Of course the doctor would need to tend to that problem as well, making other patients wait.

However, another reason is the practice of overbooking. Some patients do not turn up and do not have the courtesy to inform the clinic. To avoid letting the clinic and doctors left idle, it is a common practice for clinics to overbook their patients. However, that creates a long wait when everyone actually turns up. While we can ask patients to tell us early if they decide not to come, technology may be the solution. Most patients usually stick to their appointments, but some don’t. By analyzing past patient behavior, they can predict the total patient volume accurately 95% of the time. Hopefully this will let us manage our resources better and cut down on waiting time for patients.

Exercise versus Medicine

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Children love to exercise. Every day I am reminded by my kids how much exercise they naturally do every day. When we grow older, however, we become more and more sedentary.

Now a study has shown that exercise is as good as medication for the management of chronic disease: http://www.latimes.com/science/sciencenow/la-sn-exercise-drugs-20131002,0,2582449.story

The researchers had gone over 300 studies and compared exercise versus medicine in the prevention of diabetes, heart disease, strokes etc. Guess what? Good ol’ Exercise is just as good!

In my field, it has been shown actually long ago that exercise was better than the medication metformin in the prevention of diabetes. However, knowing that a lot of people would not be able to do exercise, the American Diabetes Association still allows for metformin to be used in the prevention of diabetes.

Should doctors prescribe exercise? Of course! I do not know any doctor who would not prescribe it! So what’s the point of this study?

The key is this: this study looks at structured exercise that is monitored by physical therapists/ certified instructors. In good quality research, that is often undertaken so that the research actually knows that the patients do their exercise. Self-reported exercise just won’t cut it…

Unfortunately, structured exercise is expensive. For diabetes, generic metformin in Singapore costs less than S$6 a month at the government-run polyclinics. A lesson with a certified gym instructor would cost S$90 a session!

Nonetheless we should all do exercise ourselves, most of the days!