Dreams vs Reality

[ FYI, the title of this post is a playful tribute to the National Museum's current Impressionist painting exhibit. ]

Yes, dear readers, Singapore MD is attempting to resurrect itself from a 6-month-long slumber.

And no, our silence is not the result of The Powers That Be shutting us down. That usually entails an actual deletion of the blog, which clearly hasn't occurred here.

Still, one requires some form of inspiration in order to keep a blog running, and I found mine today.

Ironically, thanks to the MOH, muah-ha-ha-ha-ha... :)

A fellow colleague who worked the afternoon shift in the A&E yesterday described a bizarre phone conversation with someone who identified himself as part of the MOH administration's $$$ department. ( p.s. The symbols $$$ were chosen semi-randomly. )

Mr. $$$ asked what our waiting times were like, because he was contemplating arranging for our department to "help see Hospital X's A&E patients". Hospital X being another public institution belonging to the same cluster, but located in another corner of the island, i.e. far far away.

When my friend answered the call, she was up to her neck in cases, with patient trolleys crammed into every available nook, including the corridor just outside the P2 area. She very wisely told Mr. $$$ to speak to our HOD, after which she didn't hear from him again.

Here're a few burning questions for Mr. $$$ and/or the MOH:

1) Why didn't the query go through "proper channels" - i.e. boss to boss? Who in the world is this mysterious Mr. $$$, and why did he call the busy senior doctor on duty, when he should have called an administrative staff ( e.g. our HOD, or at the very least, department manager ) instead?

2) Shouldn't our hospital's own Powers That Be be consulted as well? Shunting A&E patients from one place to another doesn't isolate the problem to the A&E. What if they need admission? Surgery? High dependency or intensive care management? Do we have the capacity to accomodate transfers when we're already bursting at the seams?

3) Does the MOH really think waiting times accurately reflect an A&E's ability to handle patient loads? Short waiting times don't equal low attendances. Perhaps the turnover rate is high because our doctors are pushing themselves to the limit, skipping meals and toilet breaks in order to clear the queues? Most patients who have been seen don't leave the department quickly either. They hang around waiting for test results, specialist consults, procedures, admissions, and the A&E doctors who first attended to them also need to stop their queues frequently for reviews.

Plus, the limited space poses a huge problem for those in the P2 / critical care area. Such cases are usually seen within an hour, but once the observation ward fills up - trust me, this happens daily - the trolleys have nowhere to go, and walking routes become non-existent.

4) What is the exact reason Mr. $$$ feels compelled to ask us to help Hospital X? What is the casemix of the backlog there? P3 walkers, P2 trolleys or P1 sickies? If it's the first, make them wait! If the second or third, redistribute your MOs and make the P3 cases wait even longer ( or just tell them to see their GPs / polyclinics if their complaints are minor ). Or how about sourcing for ward MOs to come down and help? Short of a mini-mass casualty or worse, diversion should be considered the last resort.


MOH and our cluster / hospital's Powers That Be, for your attention please.