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Saturday, January 26, 2008

Culture shock #2

I am shocked to realise that:

Singaporeans are surprisingly ignorant about their own medical problems. One would think that, amongst such an affluent and highly educated population, there would be more awareness of health-related matters. But there isn't. My Singaporean patients seem to be quite disinterested in personal health. I feel like grabbing some of my patients and screaming, "Don't you care?! It's your life we're talking about here!!!"

Perhaps my expectations of patients are a little too high. I expect all my patients to be able to tell me or provide me with information regarding the following:

1. What sort of medical conditions they suffer from.
I am used to hearing my patients reel off all their various diagnoses, counting them off one by one on their fingers. In Singapore, patients need alot of prompting and encouragement to get them to reveal their medical history. Just asking them an open question such as, "Do you have any medical problems?" or "Do you have any heart problems?" is not enough. I have to be very specific and condense everything to simple closed questions like "Have you ever had a heart attack?". Even then, I have encountered Singaporeans who deny having serious heart problems but who have already had major heart surgery!

2. What surgical interventions they have undergone and why they took place.
Normally, this is a cue for my patients to tell me gruesome stories about 'going under the knife' and complain about post-operative pain and rehabilitation. Singaporean patients are very reticent about this subject and know very little about what exactly took place during their surgery or why surgery was indicated. Some of them will even outrightly deny that they have had any major surgery, despite having long train-track scars down the centre of the abdomen ("Dunno for what!").

3. What medications they use regularly for their ailments.
Even my most elderly and decrepit patients in the UK would carry a list of prescriptions with them, and if they didn't, they could at least tell me what the medications were for ("A small white pill for my bowels, doctor"). Over here, I'd be lucky if I get a response like "In the morning I take one tablet and in the evening I take five tablets". More often than not, I get no response at all, just a mournful shaking of the head.


Anonymous LH said...

maybe it's not that they don't care, but more of dont know what to do with their ailments/dont understand/afraid.

10:51 pm  
Anonymous Anonymous said...

i'm in the Singaporean healthcare system too and you are so right about the patients! however, Singaporeans who are highly educated and affluent are in fact mostly in the young to middle-aged group. in contrast, most of the patients seen in the public general hospitals tend to be in the geriatric age group.. and i find that the patients who don't know their medical history tend to be these older, less-educated, poorer patients speaking their mother tongue. those richer, younger, well-educated English-speaking patients generally tend to know their history better.

one patient had surgery for her medical problem 20 years ago and presented with similar symptoms again recently. when asked about her surgery 20 years ago and what it involved, she said she didn't know - that at that time she didn't know enough to ask the doctor questions, and didn't realise that she could/should ask questions. perhaps this explains why our older patients tend to be so clueless about their medical history. probably the UK was ahead of us 20 years ago in terms of patient education and awareness.

11:04 pm  
Blogger aliendoc said...

Amazing, isn't it? Your encounters sound very similar to mine.

2:53 pm  
Anonymous hamster said...

Just read this today:

You are not alone...

9:33 am  
Blogger tscd said...

lh: Well if they are, they are certainly not showing any interest in knowing more about their ailments! Most of my patients wave me away from their beds with a 'Yah lah yah lah I don't care just give me medicine'

anonymous: Actually, I would understand if there was a pattern between older/younger/richer/poorer patients, but there really isn't. The young and affluent patients appear know much less than the average UK patient from the ghetto and they don't seem to want any information, which is why I am so surprised.

6:17 pm  
Anonymous Anonymous said...

hmm interesting.. guess it is really a cultural thing.. singaporeans are an interesting people.

10:27 pm  
Anonymous lh said...

that's indeed frustrating. guess not many want to face it. probably to aid in your Q&A, you can ask more leading type of questions, so long as not the "what's wrong with you/ what's your problem"type.

1:47 pm  
Anonymous Anonymous said...

So VERY glad to have you back. Am ex Singaporean now living in Scotland who became addicted to your blog and have suffered serious withdrawal symptoms as a result. As for your experiences at the moment, am very surprised that you are surprised. This is a spoon-fed, shepherded society you are dealing with where it is better not to think too much as it might actually cause alarm when you might realise that having an affluent lifestyle is far less imprtant than freedom of thought.
Anyway great to have you back - I feel loads better already. Lots of luck for the next fortnight

9:28 pm  
Anonymous Anonymous said...

It helps to practise more patience in dealing with such local patients, and if you are planning on staying in Singapore long enough, expect what is to be expected. Afterall, the older generation came from China, India, other parts of the Archipelago and arrived as coolies etc. And many citizens in theirs 40s, although born locally, do not have much education. Afterall, Singapore was a third world country only 44 years ago.

From my experiences in Cambodia and Thailand, trust me, the ignorance, denial and apathy can be a lot worse and unimaginable.

10:12 am  
Anonymous Anonymous said...

some look at me irritatedly when i ask for their medical problems and say, 'It's all in the records!'

8:44 pm  

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