Friday, November 14, 2008

Blaming Doctors

It seems the first thing people want to do when something goes wrong is look around for somebody to blame. When it comes to doctors, I think we tend to assign blame more than usual because we expect them to know everything. Here's a news flash: They don't.

They learned about the human body and diseases from going to classes and reading books - the same way I learned about French deconstructionist philosophers. That doesn't make me an expert on the topic; it just makes me more of an expert than you. Doctors get their training and practice the same way a car mechanic does - by learning on the job. And doctors hone their skills the hard way, just like the rest of us do - by learning from their mistakes. Every patient a doctor has adds to his body of knowledge and experience. You are his learning aid.

People tend to put doctors on a pedestal. Maybe it's those fancy certificates written in Latin hanging on their waiting room walls. Maybe it's their air of authority or even bossiness as they order their nurses and other staff around. Maybe it's their medical language that excludes civilians from their secret society and gives them an aura of special insight and knowledge - like saying "pleural effusion" instead of "fluid in the lining of the lungs" or "dyspnea" instead of "difficulty breathing".

But the bigger they are, the harder they fall. And as authoritative and infallible as doctors may seem, when they do make a mistake, the blame and criticism is as severe as the reverence was strong while they were on the pedestal.

Do yourself and your doctor a favor. Don't raise him up so high that he'll crush you on his way down. Be realistic and work with him. He wants you to live. You want you to live. Work toward that common goal.

19 comments:

Ronnie Ng said...

CLICK HERE

ANGEL said...

Well, I guess it is human nature to want to find someone else to blame. I guess it is because when things go wrong, deep in us, we all blame ourselves first but because it feels so terrible to be guilty, we try to push the blame to someone else so that we can feel better.

I think many times, people also forget about ACCOUNTABILITY. We are the ones who are accountable for our lives and ultimately, we call the shots. No matter what the doctors say or do, we have the choice to listen to them, to follow them... OR NOT : )

If we choose to TRUST the doctors blindly and they end up making a mistake, we are accountable for it too... because we CHOSE to believe them in the first place.

Yes, we are not experts like them, and they ought to know better. But we CHOSE to believe them and follow his suggestions. No one forced us to do so.

E.g., a few years back, there was an infamous case of an artiste who had to go to court because he sold some slimming pills to a fellow artiste who ate them and then suffered liver failure.

I actually felt it was quite ridiculous to solely blame him for the whole episode because he was not an expert, and neither did he know about the side effects of the pills. And most important, the female artiste wanted to buy them and wanted to buy them from him herself. She consented to buying and no one forced her to take those pills. She was the only one who could decide to take or not to take the pills.

Our life is in OUR HANDS... not others' hands. Doctors provide great help and great knowledge. But our lives are in our hands : )

Anonymous said...

Hi Shin.

I agree with you. I have been learning to be more understanding and empathetic but it is through the HARD AND HURTING ways. All these years, I've been brought up to be empathetic, but I keep being hurt by people, even those close to me, because of my naive thinking. Yes, I keep thinking of excuses for people who hurt me and giving chances, and yet got scolded for being stupid for being that (by the recipients!). So I have been very depressed these few years because I just couldn't get out of the contradicting thoughts and struggle inside me.

Recently I have been thinking it is due to my own naive belief that people won't be selfish, bad, ruthless, unscrupulous (though I'm slowly learning that they are... am I right?). But when I read your post, I thought yes, maybe it is because we always have expectations of others, especially the "professionals" or "idols" that we fail to accept as ordinary humans like us. Yet, I thought, why then are they not behaving like us?

Anyway, I have been thinking recently, "What if I only had one day to live?" Would I react or live differently? It is tough, I guess, but I saw that you are really very amazing and strong and optimistic because you FORGET that you are a cancer patient and don't know how long your life is and live "normally and happily" (though I believe you may change in some ways or another, I mean better.). And I think many parents in your position would just pamper the children but you didn't, which is not easy for you when your little ones may not be able to understand at this tender age. But I understand you are doing that for their sake. : )

It is really good that you posted this to make us realise and see things from another angle. I also blame the doctor when I hear cases of misdiagnosis, etc., and normally will just flood my brain with thoughts of why the doctor is like that, shouldn't he be professional, etc.

Thanks Shin, and I hope to learn from you and share your thoughts. : )

Falcot Scott said...

Dear Shin,

Being in the medical field for more than a decade, I regret to say that my field is TOO commercialised!

True, we should not blame doctors, you are right, but at the end of the day, when the patients get billed they are often clueless about what they paid for. And worse, these medications that they paid for are not effective despite the heavy price tag that are attached.

That is why I quit practising commercial medicine and packed my stuff and set up my clinic in far flung places to help those who are in dire need of medical help.

Since I was called to be a doctor, why not be a really good one both in skill and spirit.

I might earn a bit less but at the end of the day I am happy.

I am reading your blog and following your progress, Shin!

Falcot Scott

Shin said...

Falcot Scott,

People have said I'm their hero, but it's people like you who are the heroes that make a difference to this world.

I have the greatest respect for you and others who follow their talents and calling in life with genuine, beeline focus, without being distracted by the money and glamor of the profession.

You chose to be a doctor to save lives and that's what you're doing.

You are MY hero.

Leighbee said...

Super post from Ronnie Ng!

Falcon Scott said...

Dear Shin,

When patients go to a commercial clinic, more often than not, they have NO CHOICE! They are not in a bargaining position with the commercial medical establishment and it is truly heart-breaking to see that they have to fork out most of their life savings just for the HOPE of getting cured or even feel better at the end of the day if they are NOT cured. Everyone blames it on the drugs being in the experimental stages, the brunt of the costs are borne by the patients, be it experimental or not and that to me is not really fair.

I had enough and I just quit. I can't betray the spirit that called me to be a healer and a comforter in the first place. The rest are just frills.

I am very happy tending to the medical needs of villages and children. They might pay me in the form of a chicken or eggs or just a simple home cooked meal but I am happy. I have seen too much misery to continue, simply too much!

I am no hero, Shin. I just want to have a peaceful sleep at night, knowing that I have been of help rather than a curse.

Falcon Scott

Anonymous said...

Hi Shin,

Reading through your blog brings back many sad memories for me. The issues with the doctors and the list of chemo drugs sound so familiar. I lost my husband to cancer in Dec 2006, 3 months after he was diagnosed with Stage 4 stomach cancer in Sep 2006. It was a very painful journey for him and for me. Even now, I wonder when I will ever heal from the pain. Just want to thank you for this blog and how you have encouraged so many people. Anything else I say now would just be empty words, so I shall end here.

Ronnie Ng said...

[Angel quote]
If we choose to TRUST the doctors blindly and they end up making a mistake, we are accountable for it too... because we CHOSE to believe them in the first place.
[Angel end quote]

Angel, I understand that we should be responsible for our choice. But the daily transactions of life often come cross-bundled in a package, & frankly we're not left with a straightforward piecemeal choice, i.e., when you buy a mobile phone, you're paying for the contractual lock-in period and the products/services tie-ins that come with it.

Under a company insurance scheme, employees can only choose from a list of approved hospitals/clinics under this insurance coverage. I think the ease of choice is unlike that of switching brands in a supermarket. Even so, products and services are now interlaced together like a huge sticky web, and we often have to pay for the things we don't need in order to utilise the stuff we really need. And I think this is also happening in health care expenditure.

sm said...

Angel,

I agree with what Anonymous said. Whilst it is not right to put all blame to doctors, I believe that there is a basic duty of care, just as many other trained professionals (e.g. lawyers, other healthcare workers) have on those who are serviced by them.

Complacency is not an acceptable trait in certain professions, and doctors and most healthcare workers are amongst some of them. Of course the list can go on to politicians, defense ministers, etc, etc...but let's not go there.

Another important factor that underlies your comment is that... you are assuming that all patients have sufficient education and means (both financial and time resources) to be able to make informed choices without relying on doctors' advices.

Many Singaporeans still do not have the privilege of at least a college education to obtain sufficient capacity to understand difficult medical terms. Whilst some others are too busy making ends meet besides having to cough up excess money for the exorbitant medical bills.

Hence, to say that people always have choices and accountability in this aspect is not true.

I think at times, there are some choices that we are 'forced' to give up by choosing another more basic need - e.g. survival.
When all you want as a a patient is to live, sometimes, you really feel that you are at the mercy of the doctor, who may, in the midst of his or her busy schedule, have too little time to explain all the medical terms well. If you are not convinced, go ask someone who is not educated and see if they understand half of what doctors have to say.

Of course, I'm not saying that all doctors are out to be negligent. In fact, I believe most are not.
I'm sure most of us have come across good ones as well as not so humble ones.

I think this episode serves as a very good reminder to all that no matter what profession we are in, so long as we have some responsibility to another human being or even animals, we need to be cautions in our actions.

Ultimately, I would tend to agree with Shin's comments that a collaboration between patients and doctors is the best mode of operation - assuming that doctors do not talk down to patients and treat patients as worthy individuals who have their rights to understand and decide their own treatment options.

On the brighter side, I think things are slowly changing and this is very encouraging.

At the end of the day, there needs to be a good balance of involvement between patients and doctors; but doctors should, first of all, not assume that patients are not interested to be more autonomous.

Meri said...

Hi Shin.

Hope everything is fine.

I was overseas when Channel 8 featured you on TV. I would really love to watch it. Do you have a copy of it? Is it possible to upload it into your blog?

Best Regards,

Meri

Shin said...

Meri,

Thanks so much for your interest. The producer has said she would give me a copy at the end of the month, when she returns from her leave. However, I'm pretty sure I won't be able to upload it onto my blog, due to copyright issues.

The surest way to get access to it is probably to go to the MediaCorp Web site and e-mail them your request.

Maybe if enough people request it, they will make it available at least on their site, if not on mine.

Thanks!

ANGEL said...

Ronnie and SM: My point was about being accountable for our lives and the things that happen in it.

I was not really talking about how people should make their own medical decisions if their doctors aren’t very helpful or even useful:)

When I say accountability, I mean that we take responsibility for all the experiences that we experience in our lives, because they are a result of our own choice.

It is of course possible to have unpleasant experiences because of other people’s actions and words.

Eg, a doctor might still make a mistake and cause lots of unpleasantness for us… but even at that stage, we have a choice in how we want to react to it.

We can choose what to eat, what to wear, what to learn, what to do and who to live with. Even if we are sick or poor, even if the choices seem scarce, we can still choose our own attitudes towards these events.

Peto said...

I totally agree with Shin's advice that doctors may not know everything, but unfortunately, we often only realize it after some bad experience. You should consider yourself lucky because some unlucky ones are left to regret their own ignorance for being mislead by a know-it-all attitude.

I first learnt about Patent Ductus Arteriosus from the Web five years ago when my colleague told me his 5-day-old son was diagnosed with PDA and Septal Defects or simply, a hole in the heart's wall. Luckily, my friend's son’s PDA was detected early by chance during his treatment for jaundice. I spent the whole night gathering info from the Web for him before his son’s operation and I kept some of the symptoms in mind as we were expecting Natasha soon.

Some of the visual symptoms are:
- Heavy & irregular breathing. Chest and stomach area sort of popping irregularly when breathing.
- Heavy perspiration and out of breath during feeding.
- Sort of a “thrill” feeling around the heart area.
- Heart murmur.

Coincidentally, Natasha was born with a slight heart murmur, but fortunately, hers closed a day
after and I cannot recall if she was given any medication. If there were any, it would have been Indomethacin, according to a medical book I’ve read recently.

Then came Nadya, whom I observed having all these symptoms: heavy, irregular popping breathing, all sweaty after breast feeding and trouble sucking from a bottle.

I informed the nurse before Nadya’s discharge from the hospital that her breathing seemed heavy and irregular but she assured me that “this is normal for newborn”. I requested that Nadya stay for one more night for jaundice treatment so that the doctor could confirm the suspected PDA. She said the doctor said it was not necessary as they had already checked and certified she was ready for home and we could follow up the jaundice blood test in the polyclinic.

For the next three nights while waiting for the polyclinic follow-up, I was worried by her heavy irregular breathing and each time she finished her feed, she would be sweaty all over. I had not observed this during Natasha’s infant hood or from my baby niece recently.

When we went to the polyclinic for the jaundice level blood test follow-up three days later, I raised the PDA concern to the doctor but she assured me that the breathing looked perfectly normal to her. She didn’t even want to use her stethoscope just to allay my concerns.

I raised the PDA question again to another doctor at the next jaundice level blood test but again was told the breathing looked normal. When I told him to listen for the murmur, he plainly told me not to worry, as he was sure that it had already been done before the hospital discharge.

Being a man of short fuse, I saw no point insisting and arguing further but had to wait for the one-month check-up, which to my surprise was scheduled for two months away. I brought it forward to one month after telling the nurse that saying no doctor was available was not a valid reason to me, and she had the nerve to ask me to consider A & E if I could not wait.

During her first-month check-up, I immediately requested the hospital pediatrician to check for PDA and she exclaimed, “Mr. Ong, why are you so concerned about PDA? We would have checked for that before discharging a baby.”

This time around, I stood my ground, letting my “parental overreaction” take charge and told her to just use her stethoscope. After listening to Nadya’s heart, her face drooped with concern and she asked me if she could x-ray Nadya. What could I say but agree, fearing the worst. I asked her how the murmur was and she told me it was quite loud.

I told her about my past requests for a PDA check during Nadya’s day of discharge, as well as the1st and 2nd visit to the polyclinic, and she now sang a different tune: “Actually, it is not easy to detect the murmur during the first week of life”.

First I was assured there was no PDA and then this “not easily detected during birth”. If so, shouldn’t doctors pay more attention and respect the parent’s observation concerning a newborn’s breathing? To me, all these could have been avoided if not for complacency and the know-all attitude.

After the x-ray, Nadya was scheduled for an echo-scan. I asked why she needed an x-ray if they had already scheduled a much more effective echo-scan? The nurse then exclaimed, “Oh ya hoh! I think it is standard procedure lah!”

My heart sank when I was told that Nadya not only had PDA but also had a tiny hole in the heart and a mitral valve leakage. All three problems produce heart murmurs and I wondered why they were not detected before? And why was the heart rate not noted to be fast before birth?

“Mr. Ong, may I know what is your profession?” asked the pediatrician.
“Just a technician, any matter?” I retorted.
“Oh! I think your observation is very sharp and just want to let you know that you have made my job much easier.”
“I rather be a fool then?” staring at her coldly.
“Why do you say that?” asked the pediatrician, astonished.
“Because! If I were a fool, I would have thanked you for your diagnosis and wouldn’t be feeling so dxxx angry right now!” As my inner thoughts went on like… x#20@#___ But to be fair, I was not sure if she was the one who had certified Nadya fit for home.

My blood boiled further after I learnt that Indomethacin closes the defects in 80% of cases and is more effective if given during the first ten days of birth.

I have been watching Nadya’s heart every time she sleeps ever since her birth and still watch her even after the operation.

Rachel said...

Hi Peto,

I really really can emphathise with your situation. As I read your story, my blood started to boil again!

I curse any doctor that is negligent in their medical practice. I don't care if doctors are human and humans err.

My baby girl suffered for six weeks before she was diagnosed with a cleft palate by a second pediatrician. The first doctor at the hospital discharged my baby girl fit and healthy.

Cleft palate is something that is obvious when seen with our naked eye. The doctor just had to open the baby's mouth to see that the palate inside her mouth was separated.

I also blame myself for letting my girl suffer so wrongly. I should have known something was wrong. I was stupid to trust the doctors. I have learnt my lesson.

My baby couldn't latch on or suck her bottle and milk kept coming out of her NOSE when/after she drank. She kept crying so pitifully during feeding. She was always so breathless when she drank. And all thanks to that doctor!

After the cleft palate was discovered, I was referred to KK Hospital and advised on the correct feeding method and the use of a special milk bottle. It was such a big relief for us.

If the cleft had been discovered much later (after 1 year), my girl would not have been able to speak properly and may have had hearing loss!

Can you imagine the consequences? What kind of medical standards are all these?

Bloody pissed.

lisacc said...

I don't think it is doctors being at fault so much as the limits and budgets they have to work in.

We have been told that there is a high occurrence of bowel cancer five years after breast: if so, why wasn't my mother scanned more closely? But that's the National Health System for you. Maybe a "high occurrence" is still only a few percent and not worthwhile spending $$$ to save one or two, who knows? Maybe they can't scan for it. We just have so many unanswered questions, and feeling some anger and blame towards a monolithic "system" helps a bit.

The individual doctors have been wonderful though. But even then: the main guy went on leave, and we had to wait nearly a month to get scan results back as he had to read them. Those may not be life and death weeks, but it's still a long, agonising wait for potentially terrifying news.

It turned out to be on the encouraging side: several tumours had shrunk, but during the wait my mother's pain had increased, therefore she needed a lot more morphine, therefore she was exhausted all the time and her appetite went again and she stopped eating and had to go into a care home for some days to get stabilised. And I cannot help feeling that the added stress of not knowing contributed to her physical breakdown.

I guess no system is perfect but when it's your friend or relative, you desperately wish it was a damn sight more near perfect than it is.

zorop said...

We need to pay:
1. for tickets to enter a cinema
2. for a bowl of noodles
3. deposit for a condo
4. for a piece of clothing etc

We also need to pay for hospital bills! The difference is we can vent our anger and dissatisfaction on-the-spot at the above 4 vendors but must avoid scolding a doctor or nurse like "hey, you silly pig, can't you see how painful I'm feeling now?" The doctor may probably poke a few more holes in your arm on the pretext that he can't find the vein!

In a sense we don't have the rights or priviledge to file on-the-spot complaints as we are very much at their mercy because "they know what's best".

I believe anyone who aspires to be a doctor ought to possess some passion for human lives and not think of the medical profession as a lucrative one. But it's only an ideal not a reality.

I was once sent to a specialist due to a persistent tummy ache. He then made me go for all kinds of tests only to tell me that there was nothing serious. In total I spent only about 5 minutes with him but it cost me $560.00 mainly for some damned test. Fortunately, the pain went away but I thought these so-called specialists were merely "map readers".

Another case was, I used a four-letter word in a hospital because they delayed attending to my father when he had an emergency. Anger toxic was dispelled from my body but my dad could have suffered in our absense. He died eventually due to heart failure anyway. So friends, keep yourself healthy is all I can say.

Another day Shin... umph.

Anonymous said...

You have good doctors, you have arrogant doctors, you have bad doctors, you have doctors who make mistakes. I think that Singapore has too many of the second category. When my Dad had a stent put in to relieve a 90% blocked artery, he went back to his Dr 10 days later to tell him that his symptoms were the same as they were before the operation. The response "you must be imagining it"

My Dad was a top lawyer but had a mistrust of doctors. It took his friend (also a lawyer) to take him to the hospital. The night before the operation he was very scared. With good reason. A month later he died of a massive heart attack, and all because he was "imagining it"

Doctors need to listen to their patients. We don't all "imagine" our symptoms.

E xx

Shin said...

E xx,

I'd find it very hard to trust doctors again after your experience.

Since being diagnosed with cancer three years ago, I've become a big believer in second, even third or fourth opinions.

I have two oncologists, two gynecologists and the kids have two pediatricians and a GP. I'm not taking any chances any more.