25 February 2006

The Doctor Speaks ...

A few posts ago, Mr Wang featured the Case of the Overly Expensive & Possibly Unnecessary Drugs. The doctor in question has now written to the Straits Times Forum to clarify his position. His reply is convincing and clear:
ST Forum Feb 25, 2006
Clinic did not overcharge patient

THERE are two issues in the letter by Mdm Gan Siok Wah in 'High prices for common drugs in HDB heartland' (ST, Feb 21).

First, the alleged overcharging. I would like to clarify that the $80 bill includes both the consultation fee and the medication prescribed to her daughter.

Her daughter was billed $22 for consultation fee for a visit at 9.20pm, when the Singapore Medical Association's recommendation to all clinics is $25 to $55 for consultation between 9pm and midnight.

With regard to the five tablets of Klacid MR 500mg costing $37, the price charged at our clinic adheres closely to the recommended retail price set by Abbott Laboratories (S) Pte Ltd. Mdm Gan is at liberty to confirm the price with them at customer.services.sg@ abbot.com.

Second, unnecessarily expensive medication.

As Mdm Gan has chosen to breach doctor-patient confidentiality by going public with her daughter's medical condition, I would like to highlight the fact that she omits to mention that her daughter had the symptoms for five days prior to the consultation in my clinic and that she had been treated elsewhere for similar complaints without improvement.

It is medically prudent to treat a patient with second line medication if the patient shows no improvement after treatment with first line medication. This was why her daughter was prescribed such medication by our clinic.

I stand by the fact that our clinic did not overcharge Mdm Gan. Nor was her daughter given any unnecessary treatment.

I would be most grateful if you can publish this to clarify the misconception that Mdm Gan's letter has created in the minds of the public.

Dr Low Jin Kheng
Clinic Manager
Street 11 Clinic
Mr Wang just wishes to make one minor point (not that it is really relevant to the real discussion). The good doctor mentioned:
As Mdm Gan has chosen to breach doctor-patient confidentiality by going public with her daughter's medical condition, I would like to highlight the fact that she omits to mention that her daughter had the symptoms for five days prior to the consultation in my clinic and that she had been treated elsewhere for similar complaints without improvement.
Actually Mdm Gan didn't breach any confidentiality. In the doctor-patient relationship, the duty of confidentiality is on the part of the doctor, not the patient (nor the patient's guardian).

14 comments:

angry doc said...

I tend to agree with your view - the fact that they threw the first stone doesn't mean you can throw one back at them. This is one reason why doctors' hands are tied when it comes to stating the facts.

I think a:

'We have reviewed our casenotes and are satisfied that the doctor involved had acted in a professional and satisfactory manner. In the interest of medical confidentiality, we will not reveal the facts of the case on a public forum, but would like to invite Mdm Gan to contact us for further clarification. We would also like to advise Mdm Gan to cease and desist from making further defamatory statements about our clinic. Thank you'

would have been safer, even if lacking in 'transparency'.

hugewhaleshark said...

Nah, so no shiok right. This is one case where what is right by the law is less satisfying.

A.Ball.of.Yarn said...

i noticed that too in the letter - and frowned. strange doctor.

Mr Wang Says So said...

I don't think it's a big deal. The original letter-writter specifically named the doctor's clinic - that's not very nice for the doctor either. The doctor would want to clear up the allegations against his medical practice.

Besides the woman's kid probably just had some bacterial flu bug or something. Not as if she had AIDS or something. So it's a breach of confidentiality, yes, aiyah but who cares.

angry doc said...

"So it's a breach of confidentiality, yes, aiyah but who cares."

Hahah. You apprently cared enough to highlight it in your post...

Mr Wang Says So said...

Yeah, well, I did say it was a "minor point" and wasn't really "relevant to the real discussion".

chrischoo said...

The circumstances behind the situation are central to the argument presented by the clinic. If the clinic had instead said that "we have reviewed our casenotes..." some people would remain skeptical of the clinic. Since Mdm Gan had already wrote to the press about the matter, she has publicized the case, revoking any right(?) to "privacy". The doctor involved was left with no choice but to present his side of the story to substantiate his actions.

I'm not sure of the legal grounds surrounding medical confidentiality, but in any other situation this type of response is the best way to go.

moomooman said...

I just wonder....

a. Mdm Gan knows that her daughter's health is not improving after normal medication, after 5 days.... thus expecting stronger dose of medication.... and yet decided that she was overcharged eventhough a stronger dose was indeed prescribed which will help her daughter....

yet she decided that she need to spend time and effort to share her grief to the Forum.

Why?

b. She went on to talk about the total amount spent plus the cost of the most expensive medication but glaringly miss out another major component which is the consultation after normal hours, but yet the Doctor in question took effort to explain the consultation fee which was not even brought up by Mdm Gan.

Why?

I think there is more than meets the eye.

bamboo said...

When the good thing about this whole saga is that we must always listen to both side of the story before we even try to judge :)

angry doc said...

Patient confidentiality is both a matter of the law and ethics for doctors.

The fact that the illness was minor or common is mostly irrelevant; if you steal $1 from a millionaire who woulnd't miss it, it still makes you a thief.

Doctors are only allowed to breach confidentiality when required by the law, or when permission is given by the patient. One may argue that Mdm Gan's account contained only the facts she was willing to reveal, but did not imply that she gave consent for all the other facts to be revealed by the doctor.

The situation may not be fair to doctors, but I believe that when you disagree with a law, you challenge it, you don't break it.

Mr Wang Says So said...

I shan't bother to look it up, but intuitively I'm fairly confident that there is some species of "qualified privilege" under the law of confidentiality which would allow the doctor to say what he says. Briefly it would run along the lines that if the patient chooses to do some act affecting the doctor's own interests, then for the sake of defending those interests, the doctor is allowed to talk about details of the patient's case.

Same thing happens in lawyer-client relationship. Eg if client complains to the Law Society that the lawyer has been negligent etc, the lawyer is at liberty to disclose the details of the client's case and how the lawyer had handled it.

Oh and if you stole $1 from a millionaire, I really don't think anything much would happen. Police might say, "You naughty boy, next time don't do it again," and then tell you to go home.

angry doc said...

Be a dear and do look it up, Mr Wang!

Certain cases like legal investigations and SMC inquiry require a doctor to reveal information, but then only to parties which 'need to know'. I doubt splashing the information on the forum page qualifies?

http://www.med.nus.edu.sg/sur/lecture3/medicalconfidentiality.htm

As for not being prosecuted for stealing a dollar - well, it still makes the stealer a thief, doesn't it?

angry doc said...

Well, Mr Wang, I just posted something on this subject on my blog.

Do come over and share your views.

Thanks.

paraspreeti said...
This comment has been removed by the author.