Tag Archives: Patient

Avoid Glibenclamide for patients who are elderly or have renal failure

Finger prick meter

Photo credit:  Gualberto107/freedigitalphotos.net

Glibenclamdie (glyburide in America) is a common and useful drug for type 2 diabetes. It is effective and the blood sugar lowering effect long-lasting. However, the strength is also a weakness: it can sometimes be so powerful that the patient can suffer prolonged hypoglycemia (low blood sugar level).

The Health Sciences Authority of Singapore had looked at the data and found that in Singapore, patients who are above 60 or those with kidney failure have a much increased risk of severe and protracted hypoglycemia. They have now advised all doctors to avoid using glibenclamide in those patients.

There are many other alternative drugs in the same class such as gliclazide and they are also generics, available at a low price at our clinics.

If you are taking glibenclamide and had recently turned 60 or have renal failure, please do not stop your medicine immediately, but talk to your doctor about it.

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.

Fake Drugs in Bangladesh

Pills

Image courtesy of Baitong333 / FreeDigitalPhotos.net

A lot of Bangladeshi patients come to Singapore for medical treatment. Recently, I have noticed more patients asking to buy medication from Singapore as well. A check on the news show that selling medication that is counterfeit and expired is common in Bangladesh, and the government is finally doing something about it.

The pharmacists are fighting back. They are staging a strike, closing down all the pharmacies in Dhaka. The poor patients are the ones who suffer.

Eventually they will have to open again. Pharmacists have great responsibilities and they should uphold the highest standards in dispensing medication. Counterfeit medication is extremely dangerous and can cause patients to suffer side effects or even lose their lives.

I applaud the Bangladeshi government to take this first step to protect the patients. I am also glad that in Singapore, we can buy medication from any doctor’s office or pharmacy and be sure that the medication is genuine.