What kind of healthcare does the public want?

I thank Dr Lim Wee Kiak for highlighting the danger of practising defensive medicine after a senior paediatrician was punished harshly for missing a relatively rare disease (MPs ask about defensive medicine after doctor is suspended for not diagnosing rare illness; ST Online, Aug 1).

No doctor wants to miss a medical diagnosis or be punished by the Singapore Medical Council with suspension.

Unfortunately, not all medical diagnoses can be established easily.

Take prolonged fever, for example.

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It can be caused by a diverse set of factors, such as infection, inflammation, cancer and drugs.

Within the category of infection, prolonged fever could be due to bacterial infection of the heart, syphilis, tuberculosis, sarcoidosis, abscess, HIV and so on.

Very often, even experienced doctors would take time and effort to clinch the diagnosis.

Sometimes the initial working diagnosis is incorrect, but with further tests and empiric treatment over time, doctors can usually make the correct diagnosis.

In order not to miss a diagnosis, doctors may opt to do a comprehensive set of investigations for all patients, refer patients to other medical colleagues for second or even third opinions, or simply reject any difficult cases. Any of these measures would have serious consequences for our healthcare system, such as increased cost, exposing patients to unnecessary radiation and procedure risks, and prolonging waiting time at clinics and other hospital facilities.

No doctor, no matter how senior or intelligent, would dare to say they have never missed a diagnosis in their career.

Punishing doctors severely for missing a diagnosis would change the way doctors practice.

In order not to miss a diagnosis, doctors may opt to do a comprehensive set of investigations for all patients, refer patients to other medical colleagues for second or even third opinions, or simply reject any difficult cases.

Any of these measures would have serious consequences for our healthcare system, such as increased cost, exposing patients to unnecessary radiation and procedure risks, and prolonging waiting time at clinics and other hospital facilities.

The public ought to ask if this is the kind of healthcare they desire.

I hope the Ministry of Health can address this very serious concern.

Desmond Wai (Dr)

A version of this article appeared in the print edition of The Straits Times on August 03, 2017, with the headline 'What kind of healthcare does the public want?'. Print Edition | Subscribe