Sometimes I so envy the HOs

Pre-reg pharmacists can pull hair out some times. Suicidal thots lurking.

We got vivas, projects, presentations for individual topics, group discussions after work, journal club, case presentations.

Nearly fainted when my HO friend just call their stint day-to-day. No tests, no project, just evaluation by consultant once the rotation finish... The pharmacy people are being pushed to the limits for the miserable pay packet.

Being on-call has no difference to me since I've been sleeping 4-5hours a day eversince I stepped into pre-reg. Also stay until so late in the hospital that it make no sense to leave it when you only reach home close to midnight. Well, at least the HOs got their duty room to zzz. Too much research, too little time.

Had to camp in DDMs quite a while to clear my casenotes for my antibiotic study.

Poor time management is also on my part where I do not know how to prioritise. Too much effort on my project to the point where I lose contact with my core topics. Compounded with the LOS that is making lose my memory. More forgetful as the days pass - try to memorise more then get LOS then try to memorise more the LOS then forget everything again. Memory getting so bad that I some times forget who I worked with at the last rotation.

For the miserable 1.2 k take home pay after sloughing for 4 years in the uni, I wonder if it was the right path to start with. Too much effort for too little material returns, even though it is psychologically fulfilling at times. But then , no one works for free. Home at 2330 and out by 0730 - where got time for social life?

Weekend verli the busy

But doesn't involve courting - sianz sianz

Today got jabbed, tomorrow work then go hospital DnD, day after go into baking frenzy because of Female Onco support group food fair.

So this month no volunteer @ botanics because of DnD then next couple of weeks cannot donate blurd.

Also still in midst of completing my antibiotic tables and readings zzz

I WAN MAPLE LIAOZ. Haven't whacked some monster in ages.

Surviving on 4-5 hrs of zzzz is no joke. Some times I dunno what the docs are saying in the ICU. It's like swimming in alphabet soup with all the abbreviations.

Oo

Saw her again when I went upstairs. She also went up for her rotation about the same time as me. She said hi, I said hi. I said bye, she said bye. Too many people around =(

My preceptor decided to toss me to do bedside counselling oreadi. Did a few on Friday courtesy of my ICU pharmacist. Luckily my OP training quite thorough - action packed counselling. I was reputated to be a zhao cai mao. Every where I go seem to get flood. Now at upstairs my preceptor pointed out, " So it's you ar?! The other day I MC but my phone ringing non-stop that there's not enough beds!"

May be I should have worked for a big chain pharmacy instead? But then what for? Pay still the same.

I wan more pay:

Why pharmacists resign

TodayOnline Sep 21, 2007

Better work conditions, pay may help stem high turnover rate of these professionals

I refer to the report, "MOH to recruit more pharmacists from overseas" (Sept 17). It was reported that of the 1,482 pharmacists on the register here, less than half are involved in direct patient care, such as practising in hospitals, polyclinics and retail pharmacies.

This is a worrying figure. While I applaud the ministry's efforts to recruit more pharmacists from overseas, it should also delve further into why pharmacists are not practising and find ways to stem the drain.

I know a pharmacist who has worked in a retail pharmacy and in one of the restructured hospitals. During her stint with the retail pharmacy, she worked from 10am to 10pm, with only half an hour's break for lunch and dinner. This included Saturdays and Sundays, when business is most brisk. Most times, she was the only pharmacist during that 12-hour stretch. When she was working at a hospital, it was common to see her and her colleagues having lunch at 3pm, after they attended to the last patient from the morning crowd. At times, she was called back to the hospital even though she was on leave. She worked till 3pm on Saturdays, even though the official knock-off time was 12.30pm. Sundays could become working days when duty called — working one Sunday per month is common.

Such is the life of a pharmacist, be it in hospitals, retail pharmacies or polyclinics.
Increasing demands on pharmacists without adequate compensation leads to many leaving the profession.

Perhaps it is time to review pharmacists' salaries. They are, after all, highly-trained medical professionals who run specialised clinics and make rounds with the doctors to ensure patients fully benefit from treatment.

Until we address the concerns of pharmacists and plug the outflow, increasing the number of pharmacists will not ease the crunch. Sourcing from foreign supply is but a short-term solution to a long-term problem.
-------------------------------------
Letter from Darren Chong

Link: http://www.pss.org.sg/main/content/view/558/2/

I was told now that's now a drought at OP because one of my fellow pre-reg is a DCG. If not, every Wed can collect at least 20 interventions liaoz.

I missed the big space for dispensing in OP - got dispensing bench for you. But now upstairs no space to display your wares. Totally messed up my routine - my asthma counselling very the messy liaoz. So more got TV distracting in the A class wards @@ Just 2 weeks no dispensing can be come ga-bra verli the fast.

<3 all the "P" prescribing licence holders who call to check dosing before prescribing. Lidat better for everyone. Dun shy, I wun eat you or scold you one. Afterall, that's what pharmacists are for - rational drug therapy.

Adventures in Coamoxiclavunate and Amoxicillin

Scene 1:
Doctor came in to fill own prescription due to an Infection. MO currently in paed round.

Dosed self with a very high (1250mg BD x 7/7) regime for Augmentin. My PT recommended to go down to the regular adult 625mg BD

Script sent in for typing and packing. I got to dispense it. Then the doc pulled out Frank Shann then point to dosing .... That's the problem with paed MOs trying to dose themselves - they forgot that they are adults and there's a different dosing regime. If doc gets 1250mg BD, I congratulate doc for making doc's potty doc's second home for at least 7/7

Scene 2:
Patient came in with prescription.
Can't see the weight clearly and called the patient. Thought 7.3 kg, turned out to be 73kg (for a 9 yo!!!)
Doc wrote Augmentin 500 mg TDS 14/14. Thought he must have confused with amoxi and augmentin. So called up and ask whether want to change to adult dosing for augmentin - 625mg BD. He gives ok.
Patient called. "Hi, got any drug allergy?" "Amoxicillin" @@
Called doctor, "Hi did the patient tell you he's allergic to amoxicillin?" "He neber tell. So what's the matter? "He's allergic to amoxicillin and you prescribed augmentin." "Augmentin corect loh" @@
Later changed to clarithromycin 500mg BD

Scene 3:
Doc wrote script for self. I got to dispense. I saw Amoxicillin 500mg TDS 10/7. Got worried because of compliance issues and doc doesn't look so bad. I asked doc whether wan to continue with such a long course - doc shoots back "I will keep the rest of the meds when I feel better. I AM A DOCTOR!!!" But I think this doc doesn't behave like one - problems with sitting in clouds tsk tsk. But then got meet one super nice doc, only thing is that doc not ready *sad sad*

"I'm a doctor"/"I'm a nurse"

Well, it doesn't tell me that you can do a grab and go. It tells me that I can use jargon during my drug counselling.

It's my responsibility to do drug counselling and I appreciate that the other medical professions accept that. Unless you are doing some abusive bulk buy to lug overseas, I'll find it pointless to do drug counselling as how much can you remember from a list of 10+ drugs?

A lot of pharmacists are doing a "so since you are a nurse/doctor, so you know how to take your medicine hor?" Lidat, aren't they relieving themselves of the duties of a pharmacist? We educate patients - if we allow grab and go-es, won't patients want that too? It really brings the locally accepted point that we are shopkeepers and not drug therapists. In this way, more doctors will give drugs without our intervention and drug counselling and the same goes for the nurses who may do not feel a need for us as pharmacotherapists.

Even if they filled in blank cheque for their medicine, I make it a point to clarify their medications, serious A/E, potential hazards and right way of taking. Don't be surprised that some doctors and nurses will have their eyes opened wide wide during such counselling sessions. Same applies for pharmacists who are not familiar with the medication dispensed.

So, even though you are a doctor or nurse, do me a favour by not merely saying that "I'm a doctor/nurse. I know how to take my medicine." Let me do my job and give you a thorough and full drug counselling - unless it's a repeat prescription or you have been taking it for a nong nong nong time then would I stop short of a fullblown counselling session.

As pharmacists, we ought not to be pushed over by such statements but exercise our right to professional judgement and professional execution of tasks that are specific to our profession. In this way, take full responsibility in hope that it will become our right.

NUS Pharmacy Class of 2007 video

Nice hor? TY to YSW, DTCT, TYZ, EY, etc for all the hardwork.

Safe handling of cytotoxics (ASHP)

Interesting pharmacy video

Dispensing errors

A lot of patients here want to do a grab and go - they want to be the drug therapists themselves. They will yell at you as they believe that we must dispense no matter what (we have a right not to).

And nurses thought drug counselling is trauma counselling by a psychologist (it happened to me when I told the staff nurse it would better for us to do a group counselling for their prophylatic drug - they thought it was something eyes =/)





But then hor, waiting time rules everything. It's hard to balance things out.

The role of a pharmacist

WRT the medical health team

Pharmacists are a special breed of healthcare professionals which belong locally to the Allied Health Division. Pharmacists stand in a position where there is a need to grasp what the Medical and Nursing divisions are doing to help the patient get the best out of their drug therapy and make sense of their medication. When in comes to medication, doctors usually have a rough gauge of what medication to use on patients. Nurses know how to administer the medication. Pharmacists have to know accurate dosing, manufacture, storage, stability, interactions and accurate dosing in certain age groups and co-morbidities in addition to the doctors' intentions in treatment as well as the methods of administration of the medication in order to safeguard the rational use of drugs as medical therapy and the patients' health.

We do not just give out medications on requests or just on doctor's orders - we have to ensure that anything given out is rational, safe and effective. We are not shopkeepers. We are drug therapists. We are all part of the healthcare team. We look forward to helping you get well soon and maintaining good health in you.

Med. Dinner and Convo

Just finished the Medical Dinner and going to Zzzz before I go for convocation/commencement in 14hrs in my fleeting lilac and blue gown. Very outstanding.

Met my army mates 2 the Medical dinnerr today. Sat with one of them today. At our table was a registrar (endocrine), M2 student and a GM MO. plus one AH pre-reg and one CGH pre-reg. I remembered being very blunt and my dear classmates are trying to tone me down.

Felt very deprived - in OP, got no access to eMR yet, so have to kah lo-goon all the time. Dunno how my other 2 classmates managed to get access. TMDKKJ.

Food was ok. Verli healthy. Chockful of veggies and ended with sinful mango pudding. To TYC: Awwwwwwwww.

The old alumni (approx85yo) was very interesting. Very blunt and true. I like the bluntness of elderly on the stage where facts become jokes. Can't remember the jokes clearly as we were also chatting amongst ourselves to make up for the loss of contact.

As usual, MDs are not clear of the role pharmacists play, but some like SA are yearning to find out. Which I find quite pleasant. It's for us to complement one another to make things work out for the patients. PS, if more nursing and allied health join MA, may as well rename to Healthcare Alumnus.

Reached one late at night and while walking past a freshly completed condo, spotted a 1.5 m long python. Must warm mom when bringing the puppy out for walk walk must be careful. Westies are traditional ratters and can be very curious.

Wah scary

http://www.straitstimes.com/ST%2BForum/Story/STIStory_134414.html

June 30, 2007

Cough syrup should have been allowed after checks
WE
REFER to the letter by Ms Ong Seok Hwee, 'Airport needs to be clearer about
medication' (ST, June 26). We have contacted Ms Ong to address her concerns and
would like to thank her for her feedback.

Since May 8, restrictions have
been implemented on the amount of liquids, aerosols and gels that can be taken
in hand-carried luggage on flights from Singapore. Liquids, aerosols and gels
must be in containers with a capacity of less than 100ml each. These containers
are to be placed in a transparent re-sealable plastic bag of a capacity not
exceeding one litre and presented at the security screening point. Liquids,
aerosols and gels in containers larger than 100ml will not be accepted, even if
the container is partially filled.

Medications in liquid, aerosol or gel
form (such as insulin, cough syrup or nasal sprays) in quantities needed for the
flight are exempted from the restriction. A doctor's letter or prescription,
while not mandatory, would help to facilitate the security screening. If the
medications are in containers of a capacity of less than 100ml, passengers are
encouraged to place them in the re-sealable plastic bag. If this is not
possible, or if the medications are in containers larger than 100ml, the
medications will be subjected to further checks at the security screening point. Passengers may also be asked to taste their
medications. We encourage travellers to visit Changi Airport's website
http://www.changiairport.com/to find out more about the guidelines.

In
Ms Ong's case, the security screening staff should have allowed her to take on
board her cough syrup in the 125ml bottle, after making the necessary checks. We
regret the inconvenience caused to her. We would also like to reassure her and
the public that our screening procedures allow for flexibility without
compromising security.

Phillip Mah
Head (Aviation Security)
Civil Aviation Authority of Singapore


Toh Boon Ngee
Assistant Director
(Media Relations) (covering)
Singapore Police
Force

I think the following "Passengers may also be asked to taste their medications." is rather scary.
-The sample taste is of an unknown quantity - may lead to O/D
-The timing of tasting may be close to previous dose - may lead to O/D
-There may not be an experience doctor on the flight - so patient may die of O/D
- If bottle not handcarried may break in cargo hold, patient no med to take - patient may get a U/D.

What are they thinking!? They think that medicine as mere sugary placebos?! They are potent drug substances where a little will trigger a therapeutic effect and a little more may kill. I soooo dun wan to be at the scene where the patient is told to sample liquid digoxin.

Wah liaoz ehz

Yyyyy today so siong?! All the chewren shoulda gone back to school. Then one huge mob of gynae patients flood in =.=

Hit about 500 by noon. Constant stream of people - losing voice until one momma had to lean close to me to listen to me.

Bad time for me to do triage - couldn't cope with the mob. Had a whole bunch of people asking for OTCs and I'm still a bit noob with OTCs. I think tomorrow I should take a break from triage and do the extempo liaoz. Need to do at least 2.

One patient wanted return but then meds > 3months post dispensing liaoz. Even the meds changed colour liaoz.

May be I'm the zhao cai mao - I stand there scripts come in. Eeeeee

Brain's busted until so many people said I looked tired when I was collecting my gown - lilac purple trimmings ^^. So special. My fave crochet cotton colour.

Reminders:

Vagifem ok for lactating ladies as it's localised in vagina.
Dimetapp as an antihistamine mix (brompheramine + pseudoepi) but polaramine is the preferred knock out drug
Gentamicin in chewren infusion approx 2-3 mg/kg
Promethazine syr can be used up to tds although it stated bd

Was it a right choice?

A lot of flowers are coming out soon -mainly shades of yellow. I've no preference for flowers, as long they look pretty and have some substance.

After the letter published in ST, several people wondered if I've made the right choice in choosing my degree course and profession. My choice was made long time ago to be in health care. I want to treat people but not potong them financially or physically - so medicine is out. Some of my JC teachers asked me to try getting into medicine, but i've no interest. Pharmacy was on top of the list. It is a specialised degree with a very broad horizon.

Most challenging profession with the lowest salary - more incentives should be given to encourage shorter queuing times and better individual drug counselling. Not many like the profession as they have an innate thinking that pharmacists are shopkeepers instead of DRUG THERAPISTS. I treat doctors as DIAGNOSTICIANS, tell me the disease, I'll try to source for a suitable individualised treatment.

If Greg House can have a Dept of diagnostic medicine, can I have a Dept of Pharmacotherapeutics and CAM? More fun. "He finds treatments for diseases that the others can't treat"

If everyone wants a job with high returns and low educational requirements - be an investor. But then you realised that if everyone's an investor, so who's gonna create the investments?

Clinical pharmacy is something I'm very much interested in and I'd to get very much involved in patients' treatment (while maintaining some form of social life - maybe have to get a really independent and supportive spouse in the future =p). No doubt about it, although I am slowly seeing myself faultering in certain things which I wished I could have done better.

Some of my colleagues in the hospital didn't know I'll be joining them for another nine months because my pass says "Temp. staff". I've not introduced myself adequately (as usual - the forced extrovert).

Packed my first script for Ritalin yesterday (sees a lot of people nodding their head signalling I may need it too - sounds like a very rare case of adolescent-onset- ADHD). Filled in CD register and checking stocks carefully - each mistake will make the book a mess - pressure pressure but then someone has to do it eventually =p

Some people asked me if the hospital was my first choice. Honestly speaking, I take things as they come. The hospital gave me the green light in the shortest length of time - it's a hint that I'm wanted. Quite a few people were shocked at my decision to turn down a big practice, and some were equally shocked that I was accepted at the bigger practice. I felt that my value to the bigger practice would be lesser as they took 15,000 times longer to get back to me. I prefer to go to places where I can be a value to, so i can further value-add, even though, I'm currently a bit damaging.

Distance-wise, it can be a bit far as I spend more than 3 hours a day travelling. However, I enjoy my time and the camaraderie of the staff i work with, it sorts of offset the hassle. Some more, working 4km a day can be good for me since I've not started climbing stairs to reach the in-patient wards (Psst, I still can't find the stairway!!! I love stairs) Perhaps after I progressed some what I can bring home enough dough to take taxi every day home. Eating dinner so late at night can be fattening.

Now, i've to make up for my deficiencies and my memory inadequacies, picking and packing is good opportunity. Shoulda started early since year 1, but then pharmacotherapy can be a breeze and yet a pain if you know something the examiner does not know. Anyone still up for the "Promethazine can onli be used in ages 2 and up?"

From ST forum 2nd June 2007

Did son just miss the mark or ...?

I WAS disappointed when my son, with As in all four subjects (three sciences and mathematics) and distinctions in two 'S' papers (one of which was Chemistry) and a B4 in the General Paper, could not obtain a place in the pharmacy course at the National University of Singapore (NUS).

But I was more disappointed with not knowing by how far he missed obtaining a place or whether he should not have applied for the course in the first place because, with his results, he had 'no chance'. I wonder what the A-level scores of the last qualifying student for the pharmacy course were.

It seems far easier for an O-level student to 'know' why he did not qualify for a polytechnic course. I have seen the polytechnics provide booklets with information on the aggregate O-level score of the last student to be admitted to each course in the previous year. Special
requirements needed (e.g., minimum score for certain subjects) were also included.

There is also the Joint Admission Exercise booklet for secondary-school students with similar information.

I urge the local public universities to come up with the same. The universities should not refrain from doing so on the grounds that admission criteria change from year to year. The polytechnics do caution that the information they provide is meant as a guideline but the data remains very useful for students and their parents.

If there are non-academic criteria and other preferences for certain
courses, lay them out too. It cannot be too difficult.

Tan Tor Seng

Wah !!! This year intake so siong ah!!! Reminder to self - avoid having chewren in Dragon year.

First day at work

Starting off as a part time med. packer at my pre-reg centre.

Quite impressed with the camaraderie - the Pharmacists actually sat together in the pantry to makan and chit chat during lunch! Too bad no cooking facilities except for microwave and toaster oven, if not can whip up something *shhhh - acts lazy*.

The PP @ the retail pharmacy very gungho and siao-onst. Young looking some more!

Pray that I do not make any more mistakes with packing - I keep forgeting to initial one: until my last stint, the PT wanted to institute a fine for me =p.

- Pasting labels is an art. A lot of craft needed. Must judge where to paste label. I was deemed a corner person due to my preference to align my labels to the edge instead of making it centralise horizontally.

- Peds dosing a bit new to me. A bit of wastage of meds here and there. And it seems that there is a limit for paracetamol dispense - usually the amount is more than enough to control fever as compared to use as a long term painkiller - if not patient would be hording paracetamol at home! Must remember to zap the standardised dosing table.

- The thorn discovered that the roses that work there have snorkling hols!!! @@

- Must remember to zap the special form for claims that come with certain prescription

- Must remember to check for partial fill before vandalising the script =p

- tablet counter special formula = (n^2 + n)/2 where n = row number.

Propofol coma vs ES

Wah heng ah. Got read this abstract before exam.

A. Borgeat1 , O. H. G. Wilder-Smith1, P. Jallon2 and P. M. Suter1

(1) Department of Anaesthesiology, Geneva University Hospital, 24 Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
(2) Department of Neurology, Geneva University Hospital, 24 Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland

Abstract Status epilepticus is one of the most frequent neurological emergencies in the intensive care unit. Standard treatment includes intravenous barbiturates, benzodiazepines and phenytoin. However, drug coma is sometimes necessary to control refractory status epilepticus. We report such a case, successfully treated by intravenous propofol coma to EEG burst suppression

Intensive Care Medicine Volume 20, Number 2 / February, 1994 0342-4642 (Print) 1432-1238 (Online)

Blog response: Wenky's eye drop misadventure

http://wenkyland.blogspot.com/2007/04/amidst-swelling.html#comments

How to apply eye drops - the better way.

A lot of people apply eye drops using the following method:
1. Open eye
2. Drip the amount stipulated
3. Close eye
4. Shake head

- This will cause poor adsorption/absorption and some of it will run down into your mouth.

Proper methods should be used to instill eye drops especially those on anti - HTN and have glaucoma as well. I.e. Patients using timolol eye drops may experience drug-induced heart failure or orthostatic hypertension as the drug starts working systemically instead of just within the occular region.

The correct way:

1. Place thumb and index finger at the top of your nose.
2. Press down on lower eye lid and pull gently down
3. You may be able to see a tiny hole in the edge of the eye lid (in the mirror), that is a duct which you should press on if not the drug will flow into your mouth instead of staying on your eye.
4. Practice a few times holding down your lower eye lid to form a cup for holding your eye drop while maintaining a good amount of pressure on the duct.
5. When applying eye drops, always apply only 1 drop every 5 mins - this is the max amount your eye can take at one go.
6. Carefully drip one drop into the cup you form from the lower eye lid and slowly close your eye. If you close too fast, you may extert too much pressure, causing the eye drop to spill out.
7. Move your eyes through 6 cardinal points while closing your eye to distribute the eye drop evenly.

You may wish to do this one eye at a time and remember - only 1 drop per eye per 5 minutes while pressing on the duct.

With the eye drop flowing down the throat, the taste would be usually horrendous as the formula for eye drops do not allow flavourings or masking agents. =.=.

Let the public take control

THE Singapore Medical Association's announcement on the withdrawal of fee guidelines has sparked furious debate among the public.
This reflects the public's concern on health-care costs.

The Pharmaceutical Society of Singapore understands this concern and advocates the need for greater billing transparency and other checks and balances to reduce possible inefficiencies of the health-care market in Singapore.

Providing the breakdown of the bill to individual item level will at least allow consumers to compare the costs and assess the value of the services for which they are paying, much like a car workshop repair service or groceries bill.

When it comes to medications, consumers can discuss with their doctors if they prefer more cost-effective options like generic alternatives.

Prescriptions could also be offered to patients to allow them the free choice to shop around for their medicines.

This is particularly pertinent for patients with chronic disease conditions where long-term consumption of mediation is required. Prudent and cost-effective choice of medicines can therefore translate into direct savings.

Pharmacists can complement the services of doctors by adding value to the whole disease-management process through their expert knowledge in medication.

An accurately diagnosed and prudent treatment plan may be wasted when medications are used inappropriately.

Some of the value-added services provided by pharmacists such as identification of medication side effects/allergies, drug interactions and optimal dosages and choice of medication help to promote a safe and cost-effective delivery of health care to the consumer.

In Singapore, pharmacists are also trained to offer professional advice on minor ailments and the safe use of over-the-counter medicines.

Consumers should consult the pharmacist when self-medicating so that appropriate basic assessments could be made and, where necessary, the pharmacist would refer them to a doctor.

We encourage employers and insurance companies to consider reimbursing their employees/policy holders for medicines purchased at pharmacies to treat minor ailments.

This could greatly empower their staff/policy holders to take more personal responsibility towards their own well-being and, at the same time, improve the overall cost-effective utilisation of health-care resources.

Ng Cheng Tiang

President

Pharmaceutical Society of Singapore
______________________________________________________________________________

PS your pharmacist-friends are just a phone call/ sms / e-mail away

They forgot something after release from the guidelines

Beware spike in docs' fees
5 April 2007, Straits Times

THE dumping by the Singapore Medical Association (SMA) of private doctors' consultation fee guidelines effectively deregulates the service. Deregulation works best when the market adjusts prices continually through competition. Standards are forced up and price swings reduced as more optimists join the fray. Loss-making ones drop out in a self-correcting cycle to prevent loss of quality. In Singapore, a current example of deregulation that is still to be evaluated is the taxi service. Several smallish entrants that entered the sector have not troubled market leader Comfort. Neither has Comfort dared to try a big-bang reform by raising fares steeply to turn taxis from a cheap mass service to a boutique one, to eliminate inherent deficiencies while preserving cabbies' earnings. Competition, such as it is, is not improving driver responsiveness and peak-hour reliability.

Comparing doctors with taxis is mildly insulting. Unlike cabs, one cannot pump hundreds more doctors into private health care at a stroke of an administrative pen. But the SMA and the Health Ministry will want to be sure deregulation does not do violence to competition theory, which could happen if GPs and specialists start testing patients' toleration levels by charging markedly more for visits and tests. The guidelines, which had been in force for two decades, actually acted as an implied form of price control. Doctors did not diverge far from the ranges set, although experienced ones did set their own charges based on such factors as the complexity of the patient's condition and the level of medical expertise. The guidelines could not be said to amount to price-fixing. Uncertainty led to the SMA withdrawing them, for fear they could violate competition law. What irony. Not many people at any rate knew that a fee cap existed. With the restraints off, the SMA should require clinics to post charges prominently on nameplates and at the reception to help patients choose their care.

To be fair, GPs in HDB towns, where clinics abound and undercutting is common, are less likely to raise fees. They will, as before, depend on margins for dispensing drugs. But specialists are a different, richer breed. They bear watching. Their higher overheads on account of better-trained staff and central-location rents make it harder for patients to get a fix on fair pricing. The SMA's assurance it will publish doctors' fees is welcome. More useful would be for the ministry to do its own audit with a variation of the cost information on hospitals that it posts online. This could show average charges in each suburban location, for GPs, and perhaps by specific medical suites' locations, for specialist doctors.
___________________________________________________________________
How to avoid being overcharged
5 April 2007, Straits Times

Before choosing a doctor, shop around if possible.

Both the Singapore Medical Association (SMA) and the Consumers Association of Singapore (Case) recommend that patients call a few clinics to get an idea of how much the market rate might be for a certain treatment.

Check surveys of actual charges and bill sizes for an idea of what reasonable rates are.

The Health Ministry's website has information on average bill sizes for the 70 most common hospital procedures.

By the end of this year, it will also publish on its website the average bill size of treatment for chronic conditions like diabetes, high blood pressure, high cholesterol and stroke at private clinics.

Later this year, the SMA will publish results of its survey of charges in primary care clinics.

Next year, it will make public survey results for charges for more common procedures in private specialist clinics.

Check the clinic's counter, signboards or brochures for consultation charges.

Doctors have been advised by the SMA to display them prominently.

Whenever possible, ask your doctor beforehand for the expected range of costs for consultation, tests and treatment.

The SMA has recommended that doctors conduct financial counselling with patients.
___________________________________________________________________
Think doc has overcharged you? Turning to Case only recourse now
Judith Tan, 5 April 2007, Straits Times

Withdrawal of fee guidelines means patients can no longer complain to SMA

PATIENTS could be losing out, now that the Singapore Medical Association has withdrawn its guidelines for doctors' fees.

The withdrawal of the guidelines, which contravene fair competition laws introduced last year, means patients can no longer approach the SMA with complaints about overcharging.

During its annual general meeting on Sunday, the SMA voted to withdraw the guidelines, which its president Wong Chiang Yin said could be considered price fixing, 'regardless of the form it takes'.

The fee guidelines, which have been in place since 1987, were based on suggestions and feedback gathered from general practitioners and specialists.

A range of fees was given for a whole host of services, ranging from consultancy to surgery, and depending on the level of expertise, degree of difficulty, time required for treatment and whether it was an emergency procedure.

Speaking at a media briefing yesterday, Dr Wong said there will now be no point of reference for patients when it comes to how much a doctor should charge for any services.

This could have an impact on both the insurance industry and the legal profession, which could pass on added costs to consumers, he said.

'So it is with deep regrets and great reluctance that we withdrew the guide. It marks 20 years of institutional work by SMA and we are just putting it away,' he said.

SMA's fee guidelines were started in 1987 to introduce transparency into private medical fees and prevent overcharging.

The association receives an average of about 25 complaints of overpayment a year. Of these, an average of four to five patients get reimbursed by the doctors after SMA intervention.

'But the amounts are usually small - not above $100,' the SMA spokesman told The Straits Times.

Now patients who feel they have been overcharged have only one avenue open to them: the Consumers Association of Singapore (Case).

Case received 59 complaints about pricing by medical practitioners between January 2005 and December last year, but until now it has referred complaints of overcharging to the SMA, a Case spokesman said.

It is not clear if Case will now handle these complaints. Although doctors are now free to set their own fees, Dr Wong said they should create their own equivalent list of rates, which should be visible and easy to use.

However, family physicians and specialists alike told The Straits Times they will still use the SMA's defunct list as an informal guide.

Dr Prem Kumar Nair, general manager of Raffles Medical Group, said the removal of the guide 'is a surprising development, but Raffles will continue to use it as a guideline to remain consistent and transparent'.

But general practitioner Jonathan Chan said many clinics have been absorbing GST for a long time and will use the opportunity to raise prices.

'Higher fees will help them cut down on costs. But the Health Ministry will be monitoring the fees of clinics, so I think patients don't have to worry about drastic fee hikes,' he said.

Consultant obstetrician and gynaecologist Paul Tseng said he had always worked on the principle that 'our rates be displayed prominently so that patients come in with their eyes open'.

'Of course, that does not stop some from charging high too, but in time, their reputation will spread through the grapevine,' he said.

To ensure fees continue to be transparent, Dr Wong said SMA has conducted a survey among GPs on their charges.

'We are currently analysing the response and will put them up on our website. We will also survey the specialists for theirs too,' he said.

juditht@sph.com.sg
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Although it had been stated earlier that the cost of medicine only takes up 10% I supposed that includes the chronic and acute visits as well. Now the problem although they require doctors to publish their fees, how about the cost of drug products - this is not really feasible here as doctors will be asking their clinic assistants to dispense the medicine. A compensatory mechanism may be in place for the doctor to retrieve any loss made from a low-priced consultation fee.

Although CASE had made available pricing for chronic diseases drugs, how about acute illness for cold and cough etc? I was told that some doctors charge brand prices for generic items (true or not? I've not experienced yet - I patronise polyclinics). In such cases, the patient may be over charged on the occasion and they may just forget about it. Next time they go, they get overcharged again, then they forget then etc. It's a cycle.

I know some doctors will charge the patient an additional prescription fee on top of the consultation fees if they decide to go and get their medications in a retail pharmacy.

All patients who get their medication from a doctor's clinic may want to check the cost of their medication with a retail pharmacy to determine whether they are charged competitive prices. Do not just bring the name of the medication, bring along the drug itself as well - just in case there are dispensing errors or you are given a generic with a branded label >.<

I'm not out to flame doctors as I believe most of them are ethically bounded, I am more concerned about the patient.