Tuesday, July 15, 2014

When Professionals Fail

It came as a complete surprise to me when I read online that a Singapore lawyer was found liable for an invalid will which he prepared for his client to execute.  Apparently, he did not know that a will required two witnesses. The judge found to his horror that this was not an oversight on the part of the lawyer but a shocking ignorance of the law. The judge wrote in his judgment, "Cheo's negligence here is not an instance of mere inadvertence or lapse of concentration but, more troublingly, stemmed from his ignorance of the statutory requirement that a will must be executed before at least two witnesses." How any lawyer can display ignorance over such a basic point of law is shocking to me. Even those of us who have never done probate matters are perfectly familiar with this fundamental requirement for a will.

But however ignorant or incompetent or negligent Cheo had been, he is infinitely more upright and proper than those professionals who harm their clients intentionally for financial gain. Years ago, over dinner with some anaesthetists, I was regaled with horror stories of surgeons who deliberately harmed their patients for just a few thousand dollars. A construction labourer's four fingers of one hand were lopped off by some industrial machine and this anaesthetist was in attendance with the hand surgeon. She asked the surgeon if he wanted to call for three other surgeons - each surgeon could then stitch a finger back to the hand. Time is of the essence in such a surgery, as any delay could result in the body rejecting the fingers. But the surgeon was adamant that he would do all four fingers, one at a time. The surgery proceeded and again the anaesthetist urged the surgeon to get his colleagues to stitch up the other fingers. He bluntly refused. According to the anaesthetist, in the end, only one finger was saved and the other fingers dropped off because too much time had lapsed. She said that the surgeon would be paid under the labourer's workmen's compensation policy - I can't remember the figure but it was something like just a few thousand dollars per finger. Even though the three fingers failed to attach to the hand, the fact that he operated on them meant that he could earn the fees for having performed the surgery.

This story was told to me a long time ago but the enormity of the surgeon's wickedness made it hard for me to ever forget it.

I have also been informed by an ophthalmologist friend who works in a public hospital that she has seen many cases of LASIK being performed wrongly on patients.  Many of these patients had gone to private eye surgeons who apparently told them that they were suitable for LASIK. Years after LASIK was performed on them, they develop serious conditions that could lead to blindness and some have turned blind. Many of them then seek a second opinion and some of them go to public hospitals. My friend would then write to the surgeons to ask for the pre-op scans which would show whether the patients' eyes were suitable for the LASIK procedure in the first place. In one case I heard from another friend, the private ophthalmologist replied that the pre-op scan results had gone missing!

I'm not saying that all doctors and surgeons in private practice are unscrupulous. There are many fine upright doctors in private practice who don't go about harming their patients or exposing them to unnecessary risks for filthy lucre. But there are many rotten apples too and they are not only surgeons even though I've only given examples of surgeons so far.

I will now turn my attention to those who are not surgeons. Oncologists come readily to mind. Surgery to a surgeon is chemotherapy to an oncologist. My best friend who died of cancer a few years ago went through the hands of many oncologists. Before he died, he told me something that turned out to be a piece of gem to another friend of mine.

He said that many oncologists would, at the drop of a hat, order chemotherapy for their patients. That's because there's money to be made in chemotherapy. It's the most lucrative part of an oncologist's job scope. It's like surgery to a surgeon. And you usually can't go wrong even if the chemotherapy is needless because who is to argue that a cancer patient doesn't need chemotherapy? But chemotherapy has a lot of horrendous side effects including the development of secondary cancer in other parts of the body. Of course if chemotherapy is useful in the healing of whatever cancer the patient has, he must go through with it. Nobody quarrels with that. But the latest studies seem to indicate that not all cancers respond well to chemotherapy. And there are cancers which seem to have a statistically higher chance of relapse when chemotherapy is administered.

But if you are an unscrupulous oncologist and knowing which side your bread is buttered, you aren't going to bother with new studies that suggest quite strongly that chemotherapy is not the way to go. You will want to stick to the old view and administer chemotherapy on every cancer patient.

Some years after my friend had died, I got a phone call from another friend whom I had not met for some time. She was crying when she called me up. She said she had been diagnosed with breast cancer and her oncologist (who was famous and highly respected) had scheduled her for chemotherapy. She felt she needed a second opinion.

I told her I had just the person for her. But I needed time to check the person's name so I promised to call her back and I immediately googled a name. You see, when my friend (the one who's died of cancer) told me about the most competent, most honest oncologist who was also a ministering angel (he was that effusive when he spoke of this doctor), I wasn't interested in her name. But I remember him speaking of her as "Dr Yap-Hwang" and he told me that her name was spelt in a funny way. So I googled her name and sure enough I found the person I was looking for - Dr Yap-Whang.  It's not "Hwang" but "Whang". I called my friend back and gave her the contact number.

Today, that friend of mine who had breast cancer is now in the best of health. She's also done a most exhaustive research into breast cancer and she tells me there are two kinds of breast cancer (it could be more but I only remember two). One kind requires chemotherapy while the other does not respond at all to chemotherapy. In fact chemotherapy would harm such a patient terribly. You have to use another method of treatment (which I don't remember now but if my memory isn't totally faulty, I think it's a kind of hormonal treatment). She said Dr Yap-Whang could have asked her to go for chemotherapy and she would have complied but instead of suggesting something that would have benefited her monetarily, Dr Yap-Whang did a test on her which confirmed that she had the kind of cancer that didn't require chemotherapy. She had read up so much on breast cancer that she knew all about the latest findings and she said Dr Yap-Whang really kept abreast with the latest developments in cancer research which she insisted her previous oncologist knew nothing about. To this day, she maintains that if she had gone for chemotherapy, she probably would have had a relapse.

Before I go on, let me assure my readers that the people whose names I give in this post eg Dr Yap-Whang, are people I do not know and who do not know me. This is not a sales pitch. I do not know Dr Yap-Whang from Adam and she doesn't know me and thank God for that because the day I know her will be the day I have cancer and am in need of a good oncologist who won't give me chemotherapy unnecessarily. I don't have cancer and I hope I don't ever have it and Dr Yap-Whang will forever be no more than just a funnily spelt name to me. But if you do have cancer and your oncologist has asked you to go for chemotherapy, surely it won't harm one bit if you sought a second opinion? I truly hope that when my time comes, Dr Yap-Whang will still be around and in practice.

So far I have only spoken of specialists, whether they are surgeons or physicians. What about GPs?

When it comes to a GP, my criteria are no different from my choice of a specialist or surgeon. I want a GP who is honest and competent and who does not have an obsessive love for money. The moment I suspect that a GP has an inordinate love for money, I will never see him or her for the rest of my life. I have an old-fashioned perspective of the job of a medical practitioner. To me, a medical practitioner must have as his primary objective the healing of diseases. This is how I judge a GP and I'm not saying my method is fool-proof but I think I'm right anyway.

If I see that a GP has veered from the path of healing diseases into a money-churning enterprise, I drop him or her completely out of my list of doctors. The greatest money-churning enterprise in medical field today is aesthetics. I have nothing against plastic surgeons - it's a valid discipline and I'm sure there are many competent and honest plastic surgeons. But I'm not so comfortable with a GP who turns his practice into an aesthetic business - and his clinic no longer sees coughing and feverish patients because he only has time to treat his patients with Botox and fillers injection or worse, he's busy with liposuction (a patient died in the hands of one such GP some years ago). Many of them have become glorified beauticians and their establishments (we can't call them clinics any more) are merely boutiques that market and sell facial creams which cost an arm and a leg and they have all kinds of packages and deals just like the combo meals you get at KFC.

But there are many GPs who are still true to their original calling and are noble medical practitioners.  I just saw one this morning.  Again, I don't know him and he doesn't know me. He probably won't recognise me even though he saw me this morning. He was first recommended to me by my wife who told me that he was doctor who was true to his medical calling. He used to treat her grandmother after she had a stroke.

A month ago, I tried my hand at a bit of gardening and I accidentally brushed my right leg against some bushes with rough leaves. I felt an itch on the side of my leg but I didn't think much of it. A few days later, that part of my leg itched but I didn't think it was serious.

Recently, I felt some itch again and this time, I saw that there were red marks on the surface of the skin which are almost imperceptible but they're there if you look close enough.

This morning, I went to Dr Tan Kok Soo's clinic very early to get a queue number. His clinic is notoriously popular and if you arrive after the doctor has come in, you will probably have to wait until after lunchtime to see him. I was at the clinic an hour before official opening time and I took a queue number. I was number 4. I went off for breakfast before returning to the clinic. No. 2 was being attended to when I got to the clinic. Soon the patient emerged from the consultation room. She was an elderly woman and she went to the cashier to collect her medicine.

"You don't have to pay," the cashier told her in Hokkien as she handed to her a bag containing her medication. The old woman repeated what she was told, "Don't have to pay?" The cashier nodded. She then told the cashier to thank the doctor for his kindness. You may think I was eavesdropping but then they were speaking quite loudly and I was seated quite close to them. I quickly reached for my phone and managed to take a photo of the old woman and the cashier (see pic on the right).

That really warmed the cockles of my heart. After having to listen to one story after another of unscrupulous doctors who would sacrifice their patients at the altar of Mammon, it is such a welcome change to see a compassionate doctor who really has the interest of his patients at heart.

It was soon my turn and Dr Tan was very professional. He examined my leg and explained to me that it was a fungal infection. He spoke about the nature of the broad-based anti-fungal cream he was prescribing and how often I should apply it. Now that I already had evidence of his compassion and generosity, it didn't surprise me in the least when I was told by the cashier to pay an amount that was even less than what I would have to pay if I had bought the same anti-fungal cream from a chemist and without the benefit of a consultation too.

I'm not saying that all doctors must charge as little as what Dr Tan Kok Soo charges or to waive their fees as Dr Tan did for the old woman. After all, there is a polyclinic not far from his clinic and patients who have no money can always go to the polyclinic which is a government-subsidised clinic for the poor. What I would like to see one day is a world where doctors will stop behaving like businessmen and more like the noble members of the medical profession whom they themselves once looked up to when they first joined medical school. The health and well-being of their patients must always be above their own selfish financial interest. Doing a botched-up hand surgery just to collect more fees and because a foreign construction labourer won't take legal action anyway is not just unethical; it's criminal. Subjecting patients to unnecessary surgery or chemotherapy because you want to collect your surgical fees or there's a lot of money to be made from chemotherapy is equally criminal. Turning your GP practice into a beautician's shop is disgraceful. I doubt very much whether there is any patient however feebleminded he may be who does not know the real reason why any GP would convert his clinic into a beauty salon.

I have said many times before that perhaps something should be done to make the medical profession less attractive to those who worship Mammon. But how do we effectively weed out money-grubbing folks from the profession? Not everyone is a Dr Yap-Whang or a Dr Tan Kok Soo. Perhaps there will never be an easy way out and we will always have in our midst those who care more about how much they can make than how their patients will fare. That's the reality of the world we live in.

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