Tuesday, May 23, 2006

On Mediation

In another letter to the papers today:

CJ right to urge aggrieved patients to talk to doctor rather than sue

INDEED, it was heartwarming news - 'Getting aggrieved patients to talk to doc, not sue' (ST, May 20).

Occasionally, precious lives are lost due to hospital mismanagement and doctors' negligence. Sadly, many people do not have the financial resources and knowledge to take legal action against health-care professionals and medical institutions.

With Chief Justice Chan Sek Keong's new protocol, many people will find solace, and closure of their grief so they can move on with life.

From my observation, consultation time allocated to each patient is relatively short and doctors rarely have enough time to conduct proper patient examinations and assessments/examinations. Owing to time constraints, they may be in a hurry to move on to the next patient, leading to oversight or dismissal of obvious symptoms.

Therefore, to protect the interests of both doctors and patients, the Ministry of Health should review and improve the present practice in medical institutions.

The new protocol will pose a great challenge to mediators, and all parties concerned.

One kind doctor shared with me the following:

As doctors we can only pray that God guides our hands to do the right thing. And, if we do wrong, to have the courage to admit it. And pray that the patient's relatives will be forgiving. What more can be done? Not all people we meet or deal with are forgiving.

There are some (fortunately a few) who make excessive demands of compensation. The world is like that. Fortunately, the majority are willing to close the chapter without 'killing' the doctor.

Lee Soh Hong (Miss)


I wish I was as optimistic as Miss Lee. Being the skeptic that I am as far as human nature is concerned (especially in the local context, where materialism seems to be so prevalent), and having spent some time dealing with such cases, I really do not think that “the majority are willing to close the chapter without 'killing' the doctor”. Not yet, anyway.

Don’t get me wrong, I think mediation is a great idea. But you will need a drastic change of culture for it to succeed. Right now, with the culture of blame (on the patients’ part) & the culture of shame (on the medical professionals’ part), there will need to be a lot of careful meandering through the landscape of medical jargon & potential litigation, peppered with emotions like grief, anger, & even the occasional desire for vengeance. Even in the first paragraph of Miss Lee's letter, one can see that the assumption made when something goes wrong & a patient dies, is that it is due to "hospital mismanagement and doctors' negligence".

The process of mediation will have to involve a team comprising of medical professionals (be they doctors or nurses), lawyers & highly skilled counselors/psychologists to help both parties through a difficult process. Let us also not forget that the victims are not just the patients & their kin, but also the healthcare worker who has been implicated in any case of alleged negligence or wrong doing. The resulting guilt (whether real or implied) can be devastating & may even impact their ability to carry on with what they have been trained to do.

I don’t mean to belittle the anguish which a patient or his family go through when an adverse event occurs resulting in disability, injury or even death. But I hope that both sides of the story will be presented – after all, isn’t that what mediation is about?

1 comment:

Dr Oz bloke said...

I too do not share Ms Lee's optimism.

In fact, in my opinion, the safest route for the medical profession to go is via the legal route. At the moment we are at the mercy of the judicial system. If they one day decided to withdraw support for a fair legal system and open the floodgates to multi-million dollar type lawsuits as seen in the west, we will all be dead at the end of the massacre. (Most likely this would happen if a senior political figure decided to press charges against a doctor)

One way is to get lawyers to work with us to draw up forms and forms for patients to sign with lots of fine print terms and agreements before any doctor touches or sees a patient.

All industries do this. Buy a house and see what you need to sign. Buy a car and see the terms you have. Take up a loan, open a bank account, heck join an online contest and there is a T&A for you to read and acknowledge that you understand and agree to it.

But for doctors......there is no such thing. Even the consent forms for operations are basically useless documents in my eyes.

Why should we allow ourselves to be so vulnerable legally? After all the patients do not appreciate any of it.

One of the terms I would have included is "Doctors are not God. They are human beings. Human error is a definite possibility although steps would be taken to minimize such occurrences"

But then again, I'm not a lawyer. It is best to get the lawyers to draw something up that is suitable for us.