By Ong Chooi Peng and T Thirumoorthy
About ten percent — the range is five to fifteen from various studies — of hospitalized patients suffer a medical adverse event from treatment. Of these, about half are preventable; one in ten may end in death. Prognostic science in medical practice is weak.
When patients suffer injury or die whilst in medical care, they and their families suffer physical, psychological and financial loss. This leads to despair and doubt, and erosion of trust in the profession and the healthcare system. Healthcare professionals also suffer despair and doubt, and loss of confidence in their capabilities.
Treading on Eggshells
The climate of practice has changed. In the past couple of years the medical fraternity has faced suits and penalties for cases of missed diagnosis, adverse reactions to treatment, and inadequate informed consent. Even doctors who have practiced impeccably may not be spared the wrath of a dissatisfied patient.
The patient’s interests remain unquestionably paramount. Nevertheless, many doctors now feel they are practicing on eggshells and are just waiting for cracks to appear.
This is a lamentable situation for us to have ended up with, both as doctors and as patients.
—-Dr Ong Chooi Peng
Commentary
When our patients’ losses and doubts are not appropriately addressed, they and their families feel disrespected and abandoned. Long-standing and apparently good relationships can be ruptured. The big elephant in the room that needs to be managed is the implicit swirl of emotions.
The entire healthcare team, and not just the doctor, must have a comprehensive and well-understood protocol. The tasks are to institute timely remediation of the medical condition, and to manage the loss and grief of the patient and family. The latter task involves prompt acknowledgement of the adverse event, open disclosure, a clear explanation, and, if appropriate, an apology and early offer of financial settlement.
The therapeutic relationship can be strengthened and trust restored only by upholding the primacy of the patient’s welfare with respect, empathy and sincerity.
——- A/Prof T. Thirumoorthy
Ong Chooi Peng practices in a polyclinic and also in a community hospital. She counts it her blessing to have been part of Fanily Medicine in Singapore through a time of formation and growth.
T. Thirumoorthy is the Group Chief Medical Officer with a private healthcare group who also teaches at Duke-NUS Medical School. He is a dermatologist and the founder director of the SMA Centre of Ethics and Professionalism.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
