Heart-attack care: Transparency the best policy

ST letter by Ms Lee Wei Ling
ST link

IN MY column, ‘Righting a wrong comes from the heart’, last Sunday, I described the status of treatment of acute myocardial infarction (AMI) in the public health-care sector. I stated the facts which were accurate up to Jan 1 this year. I felt that both the public and general practitioners (GPs) should have the relevant information about the capabilities of all our public-sector hospitals.

I wrote about it because my medical school classmate, a GP, was flabbergasted when I told her that Tan Tock Seng Hospital had no round-the-clock capability to open up obstructed heart arteries by ‘ballooning’ on an emergency basis.

Another medical school classmate, a specialist in the private sector, was forced by the SCDF ambulance to have her mother admitted to Tan Tock Seng last month and there was no doctor capable of doing ballooning on an emergency basis until she found one to do so.

Alexandra Hospital had no such capability and my classmate advised all her patients to go to the nearest hospital if they suspect AMI. She subsequently obtained feedback from other doctors that the ballooning service at Changi General Hospital was not great. I chose not to mention Changi General Hospital in my column, nor did I say that ‘only the National Heart Centre and National University Hospital are able to handle heart-attack patients after office hours’.

But in yesterday’s report, (’Most hospitals offer 24/7 heart-attack care’), Tan Tock Seng Hospital, the Ministry of Health and the Singapore Civil Defence Force seem perturbed by what I wrote.

Instead of looking forward to improving care of AMI patients, all three organisations expressed unhappiness about this public disclosure.

My view is that the public will be understanding and forgiving if they know this is the best service the Government can provide, given the various constraints. Giving the public the knowledge means AMI patients can make an informed and wise choice when deciding where to go for treatment.

Prof Lee Wei Ling

Most hospitals offer 24/7 heart-attack care

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THE Ministry of Health (MOH) has refuted a remark that only two public hospitals are able to handle heart-attack patients after office hours.

Responding to a claim made by Dr Lee Wei Ling, head of the National Neuroscience Institute, the ministry said all its acute hospitals, except for Alexandra Hospital (AH), are equipped to treat heart-attack patients at such times.

In a commentary in The Sunday Times this week, Dr Lee wrote that neither Tan Tock Seng Hospital (TTSH) nor AH is ‘in the position to give patients the best chance of surviving heart attacks’.

In the column, she cited the case of a colleague, a doctor whose mother was rushed to TTSH last month and was seen only by a cardiology registrar (specialist trainee). The doctor had to personally call a cardiologist she knew to attend to her mother.

Dr Lee added in the column that she has convinced the Singapore Civil Defence Force (SCDF) ‘to agree that when their ambulances pick up patients with AMI (acute myocardial infarction), they would bypass Alexandra and Tan Tock Seng, and go only to National University Hospital (NUH) or National Heart Centre (NHC)’.

However, in a joint statement yesterday, MOH and SCDF said: ‘There has been no change in the policy that SCDF ambulances take heart-attack patients to the nearest public acute hospital.’

Contacted late last night, Dr Lee said she had discussed the change with the ‘incoming SCDF chief’ who, she said, would take over only next month. Thus, she said, the policy has not been changed yet.

She also forwarded an e-mail message from Professor K. Satku, MOH’s director of medical services, who agreed that heart-attack patients should be diverted from AH to NUH.

Yesterday, TTSH’s head of cardiology, Dr Ho Kheng Thye, said his hospital is equipped to deal with emergency heart-attack patients, day or night.

He affirmed that – as is the practice at NHC and NUH – his hospital has a cardiology registrar at the hospital 24/7. If necessary, senior doctors are called in, and are expected to arrive within 30 minutes.

But he admitted that the move to do immediate ‘ballooning’ – a procedure to improve blood flow – for all heart-attack patients started only this month.

Previously, only very sick patients were given immediate ballooning. Others were given medicine first, and ballooning was carried out only during office hours.

Dr Lee repeated last night that this was not in the patients’ best interests. She added that she was not aware of the recent change to 24/7 by TTSH, since no announcement had been made.

She was upset that the public was not told that until recently, only NUH and NHC provided such a service, and argued that without immediate ballooning, patients might suffer from damage to the heart.

She said she had raised the matter with MOH two years ago, but nothing was done.

Dr Lee said it would be better for a patient to take 7-8 minutes more to get to a hospital that provides a 24/7 service.

MOH said last night that such services have been available at NHC since 1999, NUH since 2002, Changi General Hospital since 2006, and TTSH from this year.

Meanwhile, doctors at TTSH said that since Dr Lee’s column appeared, patients had been asking a lot of questions about the hospital’s standard of care.

One, interventional cardiologist Eric Hong, said he has had patients asking if they have arrived at the ‘hospital from hell’.

Added Dr Ho, the hospital’s head of cardiology: ‘All of us feel very passionately about providing the best care to our patients. How can we answer to a patient’s relatives if we don’t give them the best? Tomorrow, the patient might be our own parents.’

Mr Gabriel de Silva, a patient, said he had no complaints about the treatment he received at TTSH.

He suffered a massive heart attack on Saturday and was rushed to the hospital in an SCDF ambulance.

He remembered a lot of shouting as hospital staff rushed to get him to the operating theatre, and said he was impressed by their sense of urgency.

Mr de Silva, 50, a business consultant, said he had previously been admitted to Gleneagles Hospital and NHC for heart emergencies, and rated TTSH tops.

salma@sph.com.sg