Pharmaceutical Society of Singapore - Why those long polyclinic lines pose a health threat

Why those long polyclinic lines pose a health threat

Today Online Thursday • June 29, 2006 by Tan Hui Leng

THINK queuing up for a copy of this newspaper is a drag? Try joining a similar queue when you're sick — outside a polyclinic.

The wait could stretch for hours, and might go some way towards explaining exactly why the frazzled staff at Clementi Polyclinic ended up giving the wrong dosage of heart medicine to an 88-year-old woman, who eventually died.

While recording an open verdict on the case, the State Coroner on Tuesday heard testimonies from pharmacy staff who spoke of the daily crush they faced.

Even when a doctor changed a prescription, they could not afford to wait for the amended slip to reach them. Instead, they issued the medicine first — the amended slip could take up to two hours to reach them.

"Of course we'd prefer to wait," said Mr Ja'al Maaruf. "But we can't force the doctor (to hurry up) and we serve hundreds of patients."

Even though the possibility of a mistake in such situations cannot be ruled out, the staff have no choice as patients clamour to be served. The culprit, it appears, is the sheer load the polyclinics face.

Officially, they open at 8am.

"The queue starts before the clinic opens for registration," a former polyclinic doctor told Today. "It's like queueing for National Day Parade tickets at some polyclinics — people leave their slippers or belongings to 'chope' (reserve) the spot, go for the coffee, get a newspaper and then return nearer to opening time.

"It's not just in the morning. When we close for lunch, we see people queueing for the afternoon session."

Patients who arrive later are often subjected to long queues and the wait can be as long as four hours.

Official figures from SingHealth Polyclinics show that bigger polyclinics see about 930 patients a day with 15 doctors serving them; this works out to 62 patients per doctor a day. At smaller SingHealth polyclinics, it's about 56 patients per doctor a day. At the National Healthcare Group (NHG), this number is 60.

The numbers are higher than the average of 40 a day at a busy private GP practice.

During peak seasons, some doctors said they could see up to 100 patients a day — all within seven-and-a-half hours.

The pharmacy staff were equally hard-pressed. Serving more than 900 patients each day at the bigger SingHealth polyclinics are 10 to 12 pharmacy employees.

They are supposed to be the second line of defence in checking a doctor's prescription. But sometimes, sheer numbers can overwhelm them. Communication lines can get crossed.

In the case of Madam Koh Ah Tow whose case was heard by the coroner, the doctor said she had changed the dosage after a call from the pharmacy. However, two pharmacy technicians who packed and issued the medicine denied receiving the instruction. Madam Koh died 10 weeks later.

At SingHealth Polyclinics, some two to three amendments are made per day at each polyclinic. At the NHG, there are two to four a day at each polyclinic.

In an email reply to Today, SingHealth said that alterations are documented in the prescription and endorsed by the doctor. They are also recorded in the patient's case notes.

Over at NHG, doctors now need to make amendments in black and white and not just over the phone. But as patients refuse to wait for the amendments to arrive in writing, it is possible for the wrong dosage of medicine to be dispensed.

"We are humans and there is a limit to how much you can do with just one hand, one mouth and one pair of hands," said the former Polyclinic doctor.

"But you just can't turn patients away if they are there to see you."

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