Military - Civilian doctors

An entry by Oikono caught my attention. This particular incident was first reported in the national press (I think) sometime in Oct 2003 and generated a number of eye-opening responses in one particular online forum. I do encourage you to read it in its entirety there. This blog post is to basically present views from the other side (which does NOT represent mine*) , in particular those doctors on the ground. It's a pity if these are to ever get deleted as what frequently happen for the forums. Case in point: The old Sintercom forums - gone forever.

Some parts archived here (hopefully) for posterity.

That ST article (and background):

Family sues NUH, 6 doctors
By K.C. Vijayan

THE family of a dead full-time national serviceman is suing six doctors and the National University Hospital (NUH), alleging that their negligence led to his dying two days after he was admitted for a pain in the right leg.

Two NUH doctors accused Corporal Chua of malingering "to avoid his army training".
The six include a consultant surgeon and an orthopaedic specialist who attended to 23-year-old Chua Ya Ta in June, 2001.

The dead man's parents, carpenter Chua Seow Cheong and housewife Tan Hong Eng, both in their early 50s, and his sole surviving brother, Ya Lin, 21, are behind the suit, which was filed in the Subordinate Courts late last month.

A spokesman for the family's lawyers, Oei and Charles, said that the firm is in the process of serving the suit.

Corporal Chua, who was a tank driver in the army, saw the doctor at his camp on June 15, 2001, when his leg started hurting, and was advised to go to hospital.

TWO YEARS AGO...

• June 15: Army doctor refers Cpl Chua Ya Ta to hospital as his leg hurts. He is admitted to NUH after a second visit.

• June 17: He has breathing difficulties; his condition worsens. He dies of an acute bacterial infection.

At NUH, he received treatment and was sent home.

But less than three hours later, he returned to the hospital complaining of pain and a fever that came and went, and was admitted.

In the next two days, despite suffering from the pain, he was accused by two of the doctors of malingering 'to avoid his army training'.

In fact, the morning after he was admitted, his girlfriend, IT administrator Gladys Seow, also 23 then, was told by a nurse that the hospital wanted to discharge Cpl Chua and was handed a bill for the medical charges.

He was not discharged as by then, he had difficulties standing without assistance.

At about noon, he fainted in the hospital toilet while showering.

There was also blood in his stool.

His condition worsened and at about 3pm the day after, he was given oxygen because he had difficulty breathing.

By this time, his fingers, toes and face had also turned slightly blue.

Distressed, his uncle, businessman Chua Kok Poon, who was visiting his nephew then, asked that he be transferred to another hospital.

At about 5pm, he received a note from a doctor assuring him that Cpl Chua was in stable condition and not in 'clinical danger'.

He was later transferred to the intensive care unit, where he died at 11.10pm of an acute bacterial infection.

The suit alleges that NUH doctors failed to take sufficient steps to diagnose the infection and prescribe early treatment.

Contacted on Thursday, an NUH spokesman said that the hospital had referred the case to the coroner in 2001 and had cooperated fully in the investigation.

She added that the hospital has always kept the lines of communication with the family open.

'We also offered them grief counselling, as well as our fullest assistance whenever appropriate,' she said.

A related thread in the same forum had an actual SAF (NSF) doctor commenting on the dual military - civilian roles that the medical professionals are subjected to. It is worth a read, and I reproduce it here:

cyke posted: Mon Oct 27, 2003 5:28 pm

I write with first hand experience as a SAF medical officer.

The way it works is that in SAF training as a MO we are told about pride, how to support the SAF , make it a fighting force etc.

When we get posted to the units , initially we are all gung ho. Try to push the men on etc. Then we get a couple of complain letters from parents through their MPs about how this son and that son cannot tahan and that we are torturing their sons.

The COs can either respond 2 ways. Most unit COs will support the MO and they will basically ask the soldier to sign a form saying that he wants a full inquiry, but if the inquiry yields results that are against him he will be charged. Most soldiers will back down.

The COs of schools eg BMTC have ISO certification standards to meet. I was told once when I was working on Tekong in a meeting with the instructors " Please MO no more complain letters can? We can only afford to have 2 complain letters per cohort otherwise we will fail ISO!" So the COs hate complain letters. They would rather not have them. But you realise that people complain about everything in Singapore. How not to get complain letter if soldiers suffer? So how? In the end give everyone MC lah!

So really it became a cycle. After a complaint letter, you would see recruits going home in the ferry loads. MO trying to be very safe and cautious. Good for recruit , good for parent. Bad for training, looks bad on CO , bad for his promotion. SO MOs get reprimanded again. Told about pride, how we must support SAF to be fighting force etc. So then we see less MC again. More stringent.

Then another complain letter, or a death occurs or something. Then again CO will blame MO. CO will say "I not doctor leh. I never interfere with doctor's decision."

It took me 1 year to realise in the end I better cover my *** and be a safe doctor. The SAF is full of nonsense and lies. In the end I realise after I ORD if I screwed up as a doctor, I can still get sued because after ORD I still doctor. If I screw up as an officer, so what?

I haven't even begun to talk about how they made us doctors see 100 patients in 4 hours!

And then, in the first thread, he talked about the difference between NSF and full-time regular military doctors:

Cyke posted Mon Oct 27, 2003 5:50 pm: To put the record straight, doctors in Singapore do not serve housemanship in Army.

Housemanship can only be done in the government hospitals. All SAF NSF MOs that you see have finished 1 year of Housemanship in the government hospitals as well as another year as a Medical Officer in the government hospitals before they go into NS again for the Medical officer cadet course.

So SAF NSF MOs are not totally inexperienced nor are they very experienced.

They are trying their best. But remember that as doctors they never became a doctor to tekan people. They became doctors to help people. However more likely than not it is because of pressure from COs or senior SAF regular doctors that they withold their full compassion.

It is also difficult to practise medicine properly when the soldier answers yes to every question. Sometimes you wonder how come young people can be so sick with so many problems only after they entered the army.

Interestingly, the regular SAF medical Officers who in the end become Major, LTC, COL, BG almost never get much experience seeing soldiers as patients in the SAF. After they pass the SAF MOCC, they get sent to mainly HQ type psoitions to do admin work. See maybe a few patients. So in the end they don't know the ground. They don't know first hand the difficulties of seeing patients in the SAF. It is easy for them to say "seeing soldier in SAF very easy one what, they all * geng not really sick one" what!" So regular SAF medical officers formulate policies and guidelines without knowing the ground!

In the SAF all regulars do things that will get them promoted. In the SAF medical corps the way to get promoted is to do projects etc. Not see recruits reporting sick. Hence no regular does these tasks. Go ask around. How often has any soldier below the rank of COL seen a SAF regular medical officer? Probably never!

So, how exactly are the SAF MOs?

cyke posted: Tue Oct 28, 2003 2:46 pm
If SAF was serious about the health care of their soldiers, they will hire more doctors who have better experience.

Right now what they have is a very cheap medical labour force made up of quite inexperienced young doctors with medics who are not nurses.

If the doctors were hired from private sectors, they would feedback how many doctors are actually needed. SAF should hire the recommended number that is needed to maintain a good standard of medical care. MINDEF should see the bill.

When MINDEF sees the bill and sees that they are spending more money on health care for SAF NSF than say several polyclinics, (trust me the amount will surpass the polyclinics) they will realise something is wrong with the system.

Money talks.

Rigth now everything is hush hush. We hide the truth from the top. Why? Because the COs want to look good, so that they will still get promoted and get their pensions.

When Tony Tan came to visit Tekong medical centre, the schools were told for that day alone please restrict report sick. And then all the soldiers were sent to 2nd level to hide. SO it looked like the medical centre was empty ie nobody report sick.

This is what happens. SO in the end all the problems on the ground are never highlighted or brought up to the top. Because if they did it refelcted poorly on the CO, and he wouldn't get promoted.

In SAF everyone does things to get promoted only.

There's also an interesting section on the abilities and training of the SAF medics. You can read it here.