I have great empathy and sympathy for my ophthalmology colleague from National University Hospital (NUH) involved in the fracas over fee disparity (Fee disparity at different hospitals 'not uncommon'; Jan 27).
As a result of the modified Montgomery test - to determine if a doctor has been negligent in advising the patient in our local courts - I have taken to requesting documentation signed by my patients after making recommendations and discussing available options for their unique conditions.
While there are at least 26 options for the surgical treatment of cancer sited in the medial aspect of the breast, there are, to my limited knowledge, five approaches to dealing with screen-detected breast lesions: monitoring and four different types of biopsy.
Despite signing a document indicating that she understood my recommendations for monitoring such findings, a patient of mine recently went to a colleague for a second opinion and told her that I had advised removal of all the lesions.
Instead of giving me the benefit of the doubt and clarifying with me, my colleague took the patient's version at face value and told me she thought this was "a bit too much", and continued to defend this misunderstanding even after I provided a photograph of the signed document.
Two surgeons in the same field may offer different treatment strategies. This has implications for appropriate coding and cost.
There are no exact procedure codes for some operations which carry a higher degree of difficulty, and surgeons tend to use the closest description.
In a recent audit by the health authorities, I was asked to rectify such a code. Had they requested the patient's pathology report, they would likely have understood why the code was warranted.
In a similar vein, it was reported that the NUH ophthalmologist had apologised. What was his crime?
Was this apology for making the best recommendation in his experience? Or was it for not offering five or 26 different options to create confusion and misunderstanding?
Mona Tan (Dr)