Assorted MAYhem

After a very eventful March, April was a relatively quiet month. You know it’s quiet when two pandas trying to have sex hit the headlines.  Apparently, the male panda Kai Kai doesn’t know how to have sex because there was no older male panda acting as a “role model” to show him. I am not making this up. This is from Dr Cheng Wen-Haur, Chief Life Science Officer of the Wildlife Reserves Singapore (WRS). WRS owns the River Safari that houses the pandas.

Maybe this also explains why the Total Fertility Rate of Singapore is about 1.2 –the guys don’t have older male role models to show them how to have sex.  On top of that, the female panda Jia Jia is on heat only once a year. Take note, once a year. This hobbit thinks Singaporeans have more in common with pandas that we care to admit.

The other big news is that former USA Olympic Decathlon Gold Medallist Bruce Jenner (remember the guy who played The Incredible Hulk on TV in the 80s?) has come out as a transexual. I mean, can you image the Hulk wearing panties? And if you think that is really incredible, his 88 year old mother, Esther Jenner actually said, “I have never been more proud of Bruce for what he is”. I hope Bruce (or what’s her name now) gives his/her mum a big Mother’s Day hug soon. But please be careful with those humongous biceps and pecs – they can easily suffocate 88 year-old ladies.

Anyway we digress. Since we are on the subject of making babies, even if Singaporean males do successfully get their women pregnant (without role models demonstrating), delivering babies have just gotten a lot more expensive here.

With MPS providing only claims-made (CM) medical indemnity plans with grossly inadequate tail cover (only assured for 5 years), the majority of OGs have to really price in the litigation and indemnity risk and self-insure themselves. And of course, this has to be eventually born by the patient.

It’s now nice to hear that public hospitals have stepped forward to say that they will cover the indemnity tail of those OGs that retire from practice. I really hope all this is inked somewhere so that many years from now, future public hospital administrators will remember this commitment.

One must also ask then, what about they those that do not retire from public hospitals? Will the “tail” be covered by the public hospital if they leave for private practice? For example, an OG works until 40 years old and goes into private practice. Will the tail of his OG work up till he quits the public sector be covered by the public hospital? This hobbit hopes so. If not, the younger OGs may have to choose now that he will commit to public sector for the rest of his professional life. Which may be even longer than many marriages.

The other flip side is that the public sector share of the obstetric market will inevitably grow. This is not a bad thing if this is truly the government’s intention. Obstetrics in Singapore differ from other specialties. It is one of the few specialties that the private sector has the larger share. By some estimates, about 60 to 70% of all babies are delivered in the private sector even if the public hospitals have an 80% share of all acute hospital beds. As obstetric services prices go up, many patients at the fringe of affordability who can barely afford private services previously will swing back to the public sector.

“Every system is perfectly designed to get the result it gets” 

This phrase, which is widely used in management and business circles nowadays, was actually coined by Dr Batalden, a professor of paediatrics with regard to patient safety.

So when we allow a patient to sue 24 years after he is born and when the public hospitals indemnify OGs who retire in these hospitals, we will probably see OG costs go up and patients going back to the public sector for obstetric services. This hobbit is just not so sure if this is truly the result the government wants even thought the ”system” may have been inadvertently put in place.

Since we are on the subject of systems, let’s talk about what is very fashionable nowadays – “multidisciplinary” system of care. These are buzz words. Anything that is “multidisciplinary”, “team-based”, “holistic” must be good!

But two recent case studies have made this hobbit wonder, is the “multidisciplinary” team approach all it’s cracked up to be?

One is an American case where a teenage patient was served 38 times the correct dose of antibiotics, due to a tragic comedy of errors. It involved a big team of many professionals including the resident who had to convert the patient’s usual dose of one tab BD to xxx mg per kg body weight; the pharmacist who caught the first error, but then assumed that it was corrected; the computer which was assumed to be a failsafe but instead was an essential part of the downfall; the nurse who was new to paediatric ICU care and had no one to ask for help as it was near changing shift; and the patient himself (or rather, the parent of the paediatric patient) who trusted in the team and system to keep the patient safe.

The other is a doctor who used a intravenous medicine without dilution which was reported in the press locally.

I do not question the courts’ decision that the doctor is not guilty of professional misconduct. In fact, as a fellow doctor, I am happy for him that it is so. But nonetheless, a mistake had been made and the patient suffered greatly. The mistake was made by both the transfusionists and the doctor because the hospital did not have a “system” of ensuring that the intravenous medicine would be safely diluted or administered. “The system” was poorly designed and hence performed poorly to horrendous consequences.

When I was a houseman, (which is about the time when The Incredible Hulk wore pants and not panties and housemen had to give IVs, do hypocounts and were paid nothing for calls) “everything” was my fault. No matter how tired from having gone 36 hours without sleep or facing some kind of personal crisis (like being dumped by your girlfriend for the 7th time) – no one cares. An error made by you was your fault, suck it up, apologise, and fix it. If that means a delay in training, failure to enter a training program, well, too bad- you screwed up. Now, it seems to be a trend for everyone to place blame on “the system”: the calls are too busy, the doctor is too tired and mistakes happen… It could have happened to anyone… There are too many patients, etc

Now, it is a great idea to improve systems to decrease these problems, and decrease the likelihood of fatigue causing someone to make a mistake. But it cannot be an excuse to absolve an individual of all responsibility! No matter how tired, you were the doctor on the spot, and it was your duty to do the right thing for the patient.

This hobbit may sound like an unfeeling old coot shooting off his hip. But I just wish to invite everyone to think hard and be more critical of yourself, instead of “the system” or whatever reasons we can think off.

Just like when Kai Kai failed to “do the do” with Jia Jia, he basically screwed it (or rather – he didn’t – which is the problem). Since when were sex “role models” needed for the survival of a species?

Seriously, River Safari, we don’t need role models for Kai Kai. Maybe all he needs is some panda porn. And whatever happens, do not, and I mean, do not ever get Bruce Jenner, aka the Incredible Transexual Hulk to be a “role model” for Kai Kai. Try the Kungfu Panda instead.

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