<TABLE cellSpacing=0 cellPadding=0 width="100%" border=0><TBODY><TR>A day in the ER
</TR><!-- headline one : end --><TR>Doctors and nurses are attentive and vigilant with each patient, even the non-urgent cases </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Mavis Toh
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The work never lets up. Nurses set the cast and bandages of a patient (2nd picture) who suffered a dislocated left ankle, while medical officers attend to an unconscious elderly man in the resuscitation room at Tan Tock Seng Hospital (pictured). -- ST PHOTOS: DESMOND LIM
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<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->Dressed in a dark blue scrub suit and track shoes, Dr Foo Chik Loon, 35, was bent over an unconscious man in the resuscitation room, trying to locate a vein in his neck.
It was 10.11pm last Thursday and the middle-aged man had just been sent by paramedics to the Tan Tock Seng Hospital's (TTSH's) emergency department. In the resuscitation room, DrFoo, together with a medical officer and three nurses, was working to control the man's violent convulsions. Once he located the vein, he gave him an injection.
<TABLE width=200 align=left valign="top"><TBODY><TR><TD class=padr8><!-- Vodcast --><!-- Background Story --><STYLE type=text/css> #related .quote {background-color:#E7F7FF; padding:8px;margin:0px 0px 5px 0px;} #related .quote .headline {font-family: Verdana, Arial, Helvetica, sans-serif; font-size:10px;font-weight:bold; border-bottom:3px double #007BFF; color:#036; text-transform:uppercase; padding-bottom:5px;} #related .quote .text {font-size:11px;color:#036;padding:5px 0px;} </STYLE>Who are the A&E regulars?
Genuine case: Usually an older person with a spectrum of symptoms, from dizziness and chest pains to difficulties in breathing and fever.
Trauma case: People who have been seriously injured in accidents or assaulted, usually with profuse bleeding.
</TD></TR></TBODY></TABLE>Outside, at least 30 patients, in various states of discomfiture, were awaiting their turn to see one of the eight doctors on duty.
In the first half of this year, a record 398,167 patients sought treatment at the emergency departments of Singapore's six public hospitals - a 5 per cent jump over the same period last year. This is the highest tally since 1970.
At TTSH, 80,452 patients came in the first six months of this year, making it the country's busiest emergency department. The average daily attendance has climbed from 382 in 2006 to 427 last year and 442 this year.
Last Thursday, The Sunday Times spent 12 hours at the hospital, shadowing doctors and nurses on duty.
Because of its central location and links to major expressways, doctors and nurses said, TTSH is often the hospital of choice for ambulances.
Dr Gregory Cham, 43, a senior consultant at the emergency department, said: 'We're busy throughout the 24 hours, even at night. At any time, there's always someone waiting to be treated.'
But not all are emergency cases.
According to the Ministry of Health, of the 398,167 patients in the first half of this year, 211,972 - or more than one in two - were non-emergency cases.
They had non-life-threatening problems that could have been handled at a polyclinic or a private clinic.
At TTSH, of the 80,452 emergency-department patients in the first half of this year, only 47,358 - or about 59 per cent - were classified under 'critically ill and require resuscitation' and 'major emergency'.
During our visit, we took note of the patients who turned up. There were foreign workers with leg fractures, the elderly with breathing difficulties, men who had heart attacks and a number who suffered from fits.
Some came in ambulances while others were rushed there by friends and family. Most were aged above 50.
Then, there were those who arguably could have sought help elsewhere. At 4.20pm, for instance, Dr Foo saw a 20-year-old national service man with 'back pain'.
Wearing a look of pain, he said he needed painkillers and a medical certificate (MC) to excuse himself from camp duty.
Earlier in the waiting area, we had seen him laughing and joking with a female friend. He later left, visibly dejected after being given some pills but not an MC.
Senior nurse manager Tham Chui Mun, 49, who has worked in the emergency department for 15 years, said NS boys often show up on Sundays. 'Some come in laughing and holding their girlfriend's hands,' she added.
But the nurses and doctors do not shirk their responsibilities. 'For every 10 boys faking it, there could be one real serious case so we have to be careful. But we know when not to give MCs,' said Dr Foo.
The Sunday Times also came across a teenage girl who came seeking help for 'headaches' and an Australian tourist who wanted ear candling wax stuck in her left ear removed.
Mr Andrew Tan, 52, turned up with his wife who had a week-long cough.
'The two general practitioners we've seen were not of much help. We don't know where else to go to, so we came here,' said Mr Tan, a marketing manager.
Family members of a number of patients also said their earlier visits to clinics had proven ineffective.
Others said they did not know of any 24-hour clinics in their neighbourhood and found the hospital more accessible.
A 26-year-old self-employed woman, who wanted to be known only as Ms Loo, said doctors at 24-hour clinics are mostly inexperienced housemen.
She lost her trust in them after one doctor diagnosed her brother who had gastric flu as suffering from malaria.
'Very often, people don't know where else to go to so we turn to the A&E,' she said.
This rise in the number of patients also comes as the population ages - 8.5 per cent of Singapore's population of 4.5 million last year were 65 and above, up from 7.3 per cent in 2000.
Which means waiting time to see a doctor has lengthened.
Nurse Tham said nurses at the triage counters, where patients are assessed, will prioritise them according to the severity of their condition.
While those with life-threatening conditions are attended to as soon as possible, a TTSH spokesman said patients with stable conditions will generally have to wait between one and three hours on busy days before seeing the doctor.
Mondays and Sundays are busy days and peak periods are from 10am to 4pm and 9pm to 1am.
The hospital charges $85 for consultation.
Tempers sometimes flare and patients hurl vulgarities at nurses. 'Sometimes, we're even threatened; they say 'be careful if I see you outside',' said Nurse Tham.
Dr Cham said complaints about the long wait had even gone to MPs. 'A lot of people get annoyed that they have to wait for a very long time. But we have little choice because we're attending to the sicker patients first,' he said.
The waiting area for walker (those who come in walking) and trolley-bed patients is usually packed.
The observation room is sometimes so crowded that trolley-bed patients are housed in an area near a walkway.
Calls for doctors, nurses and even cleaners crackle over the announcement system every few minutes.
As doctors attend to patients, nurses are also kept on their toes, checking patients' vital signs and wheeling them from room to room.
If a critically-ill patient is coming in a Singapore Civil Defence Force ambulance, it alerts the hospital using an ultra-high frequency radio.
'Fifty-four-year-old Chinese man..., estimated time of arrival 10 minutes,' the radio buzzed.
Nurses and doctors wait for the ambulance at the 'standby' area and wheel the patient into the resuscitation room immediately upon arrival.
It usually takes about four hours - from screening to consultation and observation - before a patient is discharged.
Even as the nurses and doctors change shifts - they work for about eight hours - the buzz never stops.
Dr Cham said packed ERs is a worldwide phenomenon. One reason is their easy access, leading to congestion.
But he is careful not to dissuade people from coming.
'A cough could actually be pneumonia. But there's definitely scope for less serious cases to go to family doctors first,' he said.
[email protected]
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Do you go to the A&E for minor ailments? Log on to straitstimes.com to vote
</TR><!-- headline one : end --><TR>Doctors and nurses are attentive and vigilant with each patient, even the non-urgent cases </TR><!-- Author --><TR><TD class="padlrt8 georgia11 darkgrey bold" colSpan=2>By Mavis Toh
</TD></TR><!-- show image if available --><TR vAlign=bottom><TD width=330>
</TD><TD width=10>
The work never lets up. Nurses set the cast and bandages of a patient (2nd picture) who suffered a dislocated left ankle, while medical officers attend to an unconscious elderly man in the resuscitation room at Tan Tock Seng Hospital (pictured). -- ST PHOTOS: DESMOND LIM
</TD></TR></TBODY></TABLE>
<TABLE><TBODY><TR><TD>
</TD></TR></TBODY></TABLE>
<!-- START OF : div id="storytext"--><!-- more than 4 paragraphs -->Dressed in a dark blue scrub suit and track shoes, Dr Foo Chik Loon, 35, was bent over an unconscious man in the resuscitation room, trying to locate a vein in his neck.
It was 10.11pm last Thursday and the middle-aged man had just been sent by paramedics to the Tan Tock Seng Hospital's (TTSH's) emergency department. In the resuscitation room, DrFoo, together with a medical officer and three nurses, was working to control the man's violent convulsions. Once he located the vein, he gave him an injection.
<TABLE width=200 align=left valign="top"><TBODY><TR><TD class=padr8><!-- Vodcast --><!-- Background Story --><STYLE type=text/css> #related .quote {background-color:#E7F7FF; padding:8px;margin:0px 0px 5px 0px;} #related .quote .headline {font-family: Verdana, Arial, Helvetica, sans-serif; font-size:10px;font-weight:bold; border-bottom:3px double #007BFF; color:#036; text-transform:uppercase; padding-bottom:5px;} #related .quote .text {font-size:11px;color:#036;padding:5px 0px;} </STYLE>Who are the A&E regulars?
Genuine case: Usually an older person with a spectrum of symptoms, from dizziness and chest pains to difficulties in breathing and fever.
Trauma case: People who have been seriously injured in accidents or assaulted, usually with profuse bleeding.
</TD></TR></TBODY></TABLE>Outside, at least 30 patients, in various states of discomfiture, were awaiting their turn to see one of the eight doctors on duty.
In the first half of this year, a record 398,167 patients sought treatment at the emergency departments of Singapore's six public hospitals - a 5 per cent jump over the same period last year. This is the highest tally since 1970.
At TTSH, 80,452 patients came in the first six months of this year, making it the country's busiest emergency department. The average daily attendance has climbed from 382 in 2006 to 427 last year and 442 this year.
Last Thursday, The Sunday Times spent 12 hours at the hospital, shadowing doctors and nurses on duty.
Because of its central location and links to major expressways, doctors and nurses said, TTSH is often the hospital of choice for ambulances.
Dr Gregory Cham, 43, a senior consultant at the emergency department, said: 'We're busy throughout the 24 hours, even at night. At any time, there's always someone waiting to be treated.'
But not all are emergency cases.
According to the Ministry of Health, of the 398,167 patients in the first half of this year, 211,972 - or more than one in two - were non-emergency cases.
They had non-life-threatening problems that could have been handled at a polyclinic or a private clinic.
At TTSH, of the 80,452 emergency-department patients in the first half of this year, only 47,358 - or about 59 per cent - were classified under 'critically ill and require resuscitation' and 'major emergency'.
During our visit, we took note of the patients who turned up. There were foreign workers with leg fractures, the elderly with breathing difficulties, men who had heart attacks and a number who suffered from fits.
Some came in ambulances while others were rushed there by friends and family. Most were aged above 50.
Then, there were those who arguably could have sought help elsewhere. At 4.20pm, for instance, Dr Foo saw a 20-year-old national service man with 'back pain'.
Wearing a look of pain, he said he needed painkillers and a medical certificate (MC) to excuse himself from camp duty.
Earlier in the waiting area, we had seen him laughing and joking with a female friend. He later left, visibly dejected after being given some pills but not an MC.
Senior nurse manager Tham Chui Mun, 49, who has worked in the emergency department for 15 years, said NS boys often show up on Sundays. 'Some come in laughing and holding their girlfriend's hands,' she added.
But the nurses and doctors do not shirk their responsibilities. 'For every 10 boys faking it, there could be one real serious case so we have to be careful. But we know when not to give MCs,' said Dr Foo.
The Sunday Times also came across a teenage girl who came seeking help for 'headaches' and an Australian tourist who wanted ear candling wax stuck in her left ear removed.
Mr Andrew Tan, 52, turned up with his wife who had a week-long cough.
'The two general practitioners we've seen were not of much help. We don't know where else to go to, so we came here,' said Mr Tan, a marketing manager.
Family members of a number of patients also said their earlier visits to clinics had proven ineffective.
Others said they did not know of any 24-hour clinics in their neighbourhood and found the hospital more accessible.
A 26-year-old self-employed woman, who wanted to be known only as Ms Loo, said doctors at 24-hour clinics are mostly inexperienced housemen.
She lost her trust in them after one doctor diagnosed her brother who had gastric flu as suffering from malaria.
'Very often, people don't know where else to go to so we turn to the A&E,' she said.
This rise in the number of patients also comes as the population ages - 8.5 per cent of Singapore's population of 4.5 million last year were 65 and above, up from 7.3 per cent in 2000.
Which means waiting time to see a doctor has lengthened.
Nurse Tham said nurses at the triage counters, where patients are assessed, will prioritise them according to the severity of their condition.
While those with life-threatening conditions are attended to as soon as possible, a TTSH spokesman said patients with stable conditions will generally have to wait between one and three hours on busy days before seeing the doctor.
Mondays and Sundays are busy days and peak periods are from 10am to 4pm and 9pm to 1am.
The hospital charges $85 for consultation.
Tempers sometimes flare and patients hurl vulgarities at nurses. 'Sometimes, we're even threatened; they say 'be careful if I see you outside',' said Nurse Tham.
Dr Cham said complaints about the long wait had even gone to MPs. 'A lot of people get annoyed that they have to wait for a very long time. But we have little choice because we're attending to the sicker patients first,' he said.
The waiting area for walker (those who come in walking) and trolley-bed patients is usually packed.
The observation room is sometimes so crowded that trolley-bed patients are housed in an area near a walkway.
Calls for doctors, nurses and even cleaners crackle over the announcement system every few minutes.
As doctors attend to patients, nurses are also kept on their toes, checking patients' vital signs and wheeling them from room to room.
If a critically-ill patient is coming in a Singapore Civil Defence Force ambulance, it alerts the hospital using an ultra-high frequency radio.
'Fifty-four-year-old Chinese man..., estimated time of arrival 10 minutes,' the radio buzzed.
Nurses and doctors wait for the ambulance at the 'standby' area and wheel the patient into the resuscitation room immediately upon arrival.
It usually takes about four hours - from screening to consultation and observation - before a patient is discharged.
Even as the nurses and doctors change shifts - they work for about eight hours - the buzz never stops.
Dr Cham said packed ERs is a worldwide phenomenon. One reason is their easy access, leading to congestion.
But he is careful not to dissuade people from coming.
'A cough could actually be pneumonia. But there's definitely scope for less serious cases to go to family doctors first,' he said.
[email protected]
<HR width="50%" SIZE=1>
Do you go to the A&E for minor ailments? Log on to straitstimes.com to vote
