We would like to clarify that when patients are listed for investigative procedures at National Heart Centre (NHC) Singapore, the doctor at the clinic would brief the patients and their accompanying family members about the procedures. During this discussion, the doctor would also gather more information on the patients' current medical condition and pre-morbid status. A pamphlet to reinforce the information and instructions given earlier would also be given. If patients or their family members need clarification, they could approach our clinic staff who would arrange for them to speak to the doctor if necessary.

In Mr Tong's case, he was recommended for a transesophageal echocardiogram procedure where a probe is introduced through the mouth to assess his heart condition and is unsuitable for patients with swallowing difficulty. As there was no record on the case-notes that Mr Tong has swallowing difficulty, the doctor found out only during the consultation. For the patient's safety, the doctor cancelled the procedure and suggested an alternative one.

The doctor also advised Ms Tong's sister that the anti-coagulation drug should be stopped at least three days before the procedure and INR (which measures clotting tendency of the blood) would be measured to ensure that it is safe to proceed with the procedure.

Besides the briefing by the doctor during the consultation, the patient would be briefed again on the day of the procedure. The doctor would take consent for the procedure and run through a checklist for contraindications with the patient to ensure that he does not have any contraindications and is suitable to undergo the procedure.

The list of medications patients take is available on the Electronic Medical Record System. The doctor had asked Mr Tong about the medications that he was taking to verify that he had taken those medicines prescribed to him as there were instances where patients did not take the medicines prescribed to them.

However, I agree that the doctor could have been more discreet when checking with the patient. We apologise for that and the doctor has been reminded to be more mindful when communicating patients' medical information during consultation.

We thank Ms Tong for her feedback.

A/Prof Koh Tian Hai
Medical Director
National Heart Centre Singapore