My reply to TTSH's reply on H1N1 issue

Original thread to TTSH Patient Services:

Hi,

I am writing with respect to my A&E bill for H1N1 screening.

The background of this was that I contacted a friend (let's call her A) who had direct contact with 4 confirmed H1N1 cases on 21 Jun 09. We were at a dance competition on that day and I only got to know of this at night. After watching a movie, I developed a bad cough, and together with another friend (let's call him B) who had the same symptoms, I got worried that we both might have contracted H1N1.

After much pondering, I decided to be socially responsible and go to Tan Tock Seng for a check up. I also convinced my friend, who was going overseas in a few days to go check. This was despite my having to work the next day and that he didn't want to waste his money on a holiday if he were to be tested positive for H1N1.

At the hospital, the nurses who attended to us were in a flurry, and it seemed that they were at a loss as to what to do. After some time, our temperatures got checked and then we were registered to see the doctor.

We waited for over an hour before we were seen. During the course of my consultation with the doctor, I repeated and stressed my need to get H1N1 screening as I was coughing badly and could even taste some blood in my throat. However, as the doctor mentioned that, as I didn't have direct contact with the confirmed cases, I would not be screened.

My primary reason to come to A&E at TTSH was for a H1N1 screening.

I am now trying to figure out why if I didn't get such a screening, should I pay for the A&E fee?

I think it is not right to 'punish' a socially responsible citizen, especially in light of those H1N1 cases that ran about doing their own errands, watching movies, going clubbing and MOH "publicly shaming" such behaviour.

I would also like to highlight that your hospital did not make it clear that non-direct contacts of H1N1 cases will not be screened. If it were the case, I would not have wasted my time, as well as my friends', to have continued waiting for more than 1hour (and sacrifice my sleep in the process) and at 1am!

Previously over the course of the past few weeks, I have called up your billing hotline, but was rejected for such a waiver twice. I am disappointed that your replies have been standard ones that A&E charges are standard charges.

I hope you can look into this and revert soonest.

Looking forward to a satisfactory reply.

Thanks.

Regards,

Clarence

=========

---

From: "*****@ttsh.com.sg"
To: *****@yahoo.co.uk
Cc: Patients_Relations_Services@ttsh.com.sg
Sent: Thursday, 23 July, 2009 9:47:53
Subject: Reply


XXXX/xxx/xx

Mr Clarence
Via e-mail
(*my email*)


Dear Mr Clarence

Thank you for your email on 22 Jul 09. I appreciate that you have come forward for H1N1 screening as part of good social responsibility.

We seek your understanding that in view of the situation at that point in time, our Hospital performed tests in a judicious manner on patients who displayed flu symptoms. Our doctor had assessed your condition and history taking during your visit and as you were not at risk of H1N1infection, a swab test was not required. As medical care was rendered accordingly, we regret that we are unable to waive the Emergency Department (ED) fee of $85.

Should you require other assistance, please contact me at 6357 2510.

Yours sincerely

XXX YYY (Ms)
Patients Relations Services
Tan Tock Seng Hospital
DID: 6357 2510
Fax: 6352 4436

=================

Hi Ms Chang,

I think you must be mistaken.

What the doctor did was just to ask a few questions about my status.

1. Was I in direct contact with H1N1 cases? - No

2. Was the person who I contacted that had contact with these H1N1 cases showing any symptoms of H1N1? - No

From these questions put to me, the doctor evaluated and said that I didn't qualify for any H1N1 screening.

The million dollar question here is, can these above-mentioned questions NOT be asked by the nurses or any orderly at the "welcome station"?

Must I really pay $85 to get asked by a doctor to evaluate on these "tough" questions?

I take issue with the fact that TTSH did not put up signage that non-direct contact H1N1 suspect cases will not be screened. Since it is so straightforward, your hospital should have put up signs, or got the nurses to do the pre-evaluation, so that I could have went home to sleep. I waited for more than 1 hour in vain!

I strongly refuse to acknowledge any form of help that TTSH rendered in this whole process. I told the doctor on duty and the nurse at the cashier that I didn't want the MC or the medicine - please NOTE this.

In fact, I wish to state for the record that I wasted my petrol driving to TTSH, and also that your nurses should have been more properly educated.

I am disappointed that TTSH, being at the epicentre of the H1N1 saga, has no proper process to inform to-be patients of what to expect. I hope this is not how your hospital generates revenue for itself.

Regards,

Clarence

P.S.: I don't have issue with the money to be paid. It is the whole principle of NOT paying for something which I didn't get.

I didn't come down to your hospital in the middle of the night to get cough medicine!

If u want me to pay, please convince me that I did get some service.

Postnote: TTSH is now offering to waive charges.

What price - social responsibility?

So, if you've not had contact with a H1N1 case, you might well pass it off as a joke.
H1N1 has been the subject of many of my colleagues' jokes, like, "how I wish I can be quarantined and work from home".

Well not now, at least not for me.
To be clear, I've had proxy contact only. A friend (let's call her Friend A) who was with a group of exchange students for a meal (or something). She learnt yesterday that 4 of the group of exchange students were confirmed H1N1 cases, but still proceeded to a local dance competition with some friends and myself (no symptoms what!) One could well argue, how irresponsible, but I won't go into that now, as this is not the point I want to make in this post (at least not from this angle).

==========

WHAT HAPPENED

I developed a bad cough last evening ard 7pm, with another friend (let's call him Friend B) who was in the group. We both sat through dinner with a group of friends, and then a movie at Cineleisure, not really suspecting anything yet. On the way home, I suddenly remembered Friend A told me on the same morning that she had direct contact with the H1N1 case, and asked her about it again (was fetching her home as well). Friend B then exclaimed he just developed a bad cough too and that was my "freak-out" point.

After many painful minutes of sitting and thinking it through, I decided that I wanted to be responsible and head down to TTSH, so I asked Friend B if he wanted to follow. He was hesitant, as he had a overseas trip which he already paid for coming up on Wednesday. But he made the decision to join me as well. So off we went. Reached TTSH, couldn't find the A&E entrance (OK so I admit I am an idiot), so in the end, I called the 993 hotline.

This is where the infuriating part of the night started.
"Sorry all our customer service officers are busy now. We will get to u as soon as possible". I heard this for over 7 minutes. I mean, this is supposed to be a epidemic hotline, I'm not exactly sure what is the service level availability for calling this number, but surely you can't tell me that so many people are calling this hotline at 12 midnight on Sunday? Was the CSO sleeping or what? Anyway, after the CSO picked up, she proceeded to give me a mumbo-jumbo about the procedures.

I asked a casual question: how long would the screening take?
CSO: "A while".
Me: So after that, how long do they need to confirm the results.
CSO: 24 hours, and u can go home first, the results will be informed to u 24 hours later. (not in exact words but the meaning is the same.)
Me: SO I AM SUPPOSED TO GO BACK TO INFECT MY FAMILY MEMBERS FIRST THEN U TELL ME THE RESULTS?????????
CSO: .....er....

I am really against speaking to idiots on important matters like these; they give you crap info and if u execute according to their plan, results will highly likely be disastrous. Anyway, during the time I spoke to her, I managed to find my way to the A&E entrance, and I told her I didn't need her anymore.

Went to the A&E entrance, got us some masks to wear then went to register ourselves as possible H1N1 cases. I could see the surprised look in the nurse's eyes, and it seemed for a moment that she didn't really know what to do on her own. She called a number quickly after, then after confirming a few points (did we travel? - no; did we have direct contact with H1N1 case? - no; did the proxy who contacted with the H1N1 case develop symptoms? - no), told us to register at the A&E counter.

There was a flurry of activity, nurses who knew about our cases gave us the eye, and we were "kindly" referred to as, "ohhhh, those cases ah.." After 10 minutes we were herded into a tent area, after which we proceeded to wait for about 40 minutes for a doctor to see us. OK, I may be a layman, but I really thought that H1N1 would be more scary than it sounded, and we deserved urgent attention? Or maybe the doctors didn't know what to do with us, so they had to consult each other in that meantime.

After I got called into the doctor's room, he told me that since I had no temperature and no other symptoms than a bad cough, I would not get H1n1 screening as I only had proxy contact. Meaning I didn't have direct contact with suspected H1N1 or confirmed cases. OK, fine.
Then I asked, so, do I have to pay the A&E fee then? Doc replied if u return within 24 hours for the same condition, the fee would be waived. What utter rubbish.

If u come to my shop to buy something (say X), and I gave u something else, say Y, and told u to pay the same price (especially if u thought that Y was supposedly cheaper), would you? I didn't come all the way to A&E to get cough medicine at 2am!!

After I got the bill, I went to the payment counter and said I refused to pay. To her credit, the nurse on duty said that it wasn't within her call to waive charges, and said the bill would arrive at my house after a few days. I would have to contact the business officer for waiver of the A&E fee.

========

My question now is, does social responsibility come with a price tag? I could have been like those irresponsible few (and it would have been SO MUCH EASIER!), did things as per normal, go eat dinner at crowded places, watch concerts, and only check myself in when the symptoms ACTUALLY stopped me from doing things I do normally. And then what? A whole new cluster of cases? Is that what the SG government wants?

If proxy cases will not be screened, then jolly well communicate this right from the start, at the registration booth. I didn't really have to go to TTSH at almost 1am, sacrifice some very good (and well needed) sleep and waste the other A&E cases' time for this. And after that, be demanded to pay up for something I didn't get?!

Grand plans are only such, unless the execution is properly done. The Health Minister should look into what is ongoing at hospitals, and especially at Tan Tock Seng Hospital, where the heart of the action is supposed to be? I heard yesterday that I should have gone to the Communicable Diseases Centre. My bad, but my understanding is still that first stop is TTSH. I hope that this article will bring some attention that it is the CDC that people should go to if they suspect they have any H1N1 symptoms.
Symptoms include vomitting, shortness of breath, coughing, fever.
(As I write this, I heard that a friend from the same dance group got a high fever - God protect him.)

And that, don't bother to go to check up if u don't have direct contact with H1N1 cases.
Don't waste your time, and petrol and money.

Minister makes another gaffe

I keep telling myself that, in face of insurmountable evidence, Today MUST have gotten it wrong. But no, it stared out at me blankly. (See yesterday's version of Today for full report.)

Minister of Manpower, Gan Kim Yong, made a very interesting statement in a dialogue with students when he was telling them that they shouldn't be choosy about jobs. He even told them that they should try out blue collared jobs, just so that they wouldn't be "seen as inflexible by employers".

He gave an example of himself making do with one of his dreams:

"I always wanted to be a teacher, but the closest I got [to being one] was being Minister of State for Education."

To say I am confounded and flabbergasted would be an understatement.
Couple this with Mas Selamat's escape and our dear Home Affairs Minister saying things like, "Mas Selamat is either in Singapore or not in Singapore" some time this year (or was it last year?) I am worried about the current batch of politicians representing Singapore. I hope LKY lives forever. Maybe we will still have some semblance of a brain within the government.


Please don't arrest me for this article. I am just airing some opinions.
Surely this doesn't count as slander, right?


Well, how about a wisecrack from the student audience.
"The closest I got to being a blue collared worker was standing next to one!"

Credit Crisis: The end of Capitalism?

Further to the previous post, this will be on a more serious note.

Greed. 
If there was one word to sum the whole credit crunch up, that would be it.

I am not about to espouse overly academic notions on the abovementioned topic, but rather more "layman" views. (As layman as my brain allows anyway...) Before we start, let's take a step back in time to when Karl Marx, Father of Communism, was still alive.

Karl Marx, Das Kapital, wrote in 1867:

"Owners of capital will stimulate the working class to buy more and more of expensive goods, houses and technology, pushing them to take more and more expensive credits, until their debt becomes unbearable. The unpaid debt will lead to bankruptcy of banks, which will have to be nationalised, and the State will have to take the road which will eventually lead to communism..."

Isn't this interesting? That Capitalism, fuelled by greed, can actually stimulate a turning tide against itself and resurrect the old ghost of Communism which all but died about half a century back. BBC reported some time back that Karl Marx was gaining popularity in this present crisis.

What USA is doing now, whilst bailing out the big "un-faileable" companies, is extremely short-sighted. Most recessions undergo a normal period of decreasing demand of goods and services, followed by a gradual stabilization that brings about a bottoming out of the financial markets, and recovery follows soon after (see told you this is a layman article). Not this time.

Because of the interference in the markets, the US of A effectively ensures that it will have a long lingering problem of bad loans and lousy leaders that will be sitting around long after the actual crisis is over. Recovery will take an extremely long time, because companies which are not healthy are going to be surviving, barely, for an extended period of time.

And in a capitalistic world, we would all do well to know that it is always the survival of the fittest that brings about evolution of the species. If these dying humungous companies with bad management are allowed to linger past their prime, does not that cause an inbreeding of bad ideas (e.g. poor risk management, concept that government will always bail you out if you are big enough etc)?

Being a layman, I see things very simply. If you are sick and you need to puke, put your fingers into your mouth to induce vomiting. If you are afraid of spilling your guts out, you will only feel sick for a longer period of time. The same analogy can be applied to the state of the economy now. The government needs to decide to allow other institutions or corporations to buy the failures out instead of stepping in to interfere. Also, for the bailed out companies, the leaders NEED to go. It is extremely surprising and disturbing that 9 of 10 top honchos in the troubled companies that have been around since 2006 are STILL in their hot seats!

Short-term wise, there will be pain in doing so, and in this present climate, the pain will be intense and akin to extracting a bullet from your tummy. However, if you don’t do so, the “bullet” will cause the wound to fester, and you eventually die. Which do you choose?

Actually, both Communism and Capitalism concepts have their merits when executed in the way it was intended to. Unfortunately when you add in the human factor, things don’t always turn out the way they are intended to. For Communism, it conveniently ignores that laziness is a natural human trait, and for Capitalism, greed.

But well, that’s life. Nothing is perfect.
Neither is this article. I have left many gaping holes for you to poke at so that I can have a discussion with great minds.

A real letter from a boss to his employees

To All My Valued Employees,
 
There have been some rumblings around the office about the future of this company, and more specifically, your job. As you know, the economy has changed for the worse and presents many challenges. However, the good news is this: The economy doesn't pose a threat to your job.
 
What does threaten your job however, is the changing political landscape in this country. Of course, as your employer, I am forbidden to tell you whom to vote for -- it is against the law to discriminate based on political affiliation, Race, creed, religion, etc.
 
Please vote who you think will serve your Interests the best. However, let me tell you some little tidbits of fact which might help you decide what is in your best interest. First, while it is easy to spew rhetoric that casts employers against employees, you have to understand that for every business owner there is a back story.
 
This back story is often neglected and overshadowed by what you see and hear. Sure, you see me park my Mercedes outside. You've seen my big home at last years Christmas party. I'm sure all these flashy icons of luxury conjure up some idealized thoughts about my life. However, what you don't see is the back story.
 
I started this company 12 years ago. At that time, I lived in a 300 square foot studio apartment for 3 years. My entire living space was converted into an office so I could put forth 100% effort into building a company, which by the way, would eventually employ you.
 
My diet consisted of Ramen Pride noodles because every dollar I spent went back into this company. I drove a rusty Toyota Corolla with a defective transmission. I didn't have time to date. Often times, I stayed home on weekends, while my friends went out drinking and partying. In fact, I was married to my business -- hard work, discipline, and sacrifice.
 
Meanwhile, my friends got jobs. They worked 40 hours a week and made a modest $50K a year and spent every dime they earned. They drove flashy cars and lived in expensive homes and wore fancy designer clothes. Instead of hitting the Nordstrom's for the latest hot fashion item, I was trolling through the Goodwill store extracting any clothing item that didn't look like it was birthed in the 70's.
 
My friends refinanced their mortgages and lived a life of luxury. I, however, did not. I put my time, my money, and my life into a business with a vision that eventually, some day, I too, will be able to afford these luxuries my friends supposedly had.
 
So, while you physically arrive at the office at 9am, mentally check in at about noon, and then leave at 5pm, I don't. There is no "off" button For me. When you leave the office, you are done and you have a weekend all to yourself. I unfortunately do not have the freedom. I eat, ****, and breathe this company every minute of the day. There is no rest. There is no weekend. There is no happy hour. Every day this business is attached to me like a 1 day old baby.
 
You, of course, only see the fruits of that garden -- the nice house, the Mercedes, the vacations... You never realize the back story and the sacrifices I've made. Now, the economy is falling apart and I, the guy that made all the right decisions and saved his money, have to bail-out all the people who didn't.
 
The people that overspent their paychecks suddenly feel entitled to the same luxuries that I earned and sacrificed a decade of my life for. Yes, business ownership has is benefits but the price I've paid is steep and not without wounds. Unfortunately, the cost of running this business, and employing you, is starting to eclipse the threshold of marginal benefit and let me tell you why:
 
I am being taxed to death and the government thinks I don't pay enough. I have state taxes. Federal taxes. Property taxes. Sales and use taxes. Payroll taxes. Workers compensation taxes. Unemployment taxes. Taxes on taxes. I have to hire a tax man to manage all these taxes and then guess what? I have to pay taxes for employing him. Government mandates and regulations and all the accounting that goes with it, now occupy most of my time. On Oct 15th, I wrote a check to the US Treasury for $288,000 for quarterly taxes. You know what my "stimulus" check was? Zero. Nada. Zilch.
 
The question I have is this: Who is stimulating the economy? Me, the guy who has provided 14 people good paying jobs and serves over 2,200,000 people per year with a flourishing business? Or, the single mother sitting at home pregnant with her fourth child waiting for her next welfare check?
 
Obviously, government feels the latter is the economic stimulus of this country. The fact is, if I deducted (Read: Stole) 50% of your paycheck you'd quit and you wouldn't work here. I mean, why should you? That's nuts. Who wants to get rewarded only 50% of their hard work? Well, I agree which is why your job is in jeopardy. Here is what many of you don't understand; to stimulate the economy you need to stimulate what runs the economy. Had suddenly government mandated to me that I didn't need to pay taxes, guess what? Instead of depositing that $288,000 into the Washington black-hole, I would have spent it, hired more employees, and generated substantial economic growth. My employees would have enjoyed the wealth of that tax cut in the form of promotions and better salaries. But you can forget it now.
 
When you have a comatose man on the verge of death, you don't defibrillate and shock his thumb thinking that will bring him back to life, do you? Or, do you defibrillate his heart? Business is at the heart of America and always has been. To restart it, you must stimulate it, not kill it. Suddenly, the power brokers in Washington believe the mud of America are the essential drivers of the American economic engine.
 
Nothing could be further from the truth and this is the type of change you can keep. So where am I going with all this? It's quite simple. If any new taxes are levied on me, or my company, my reaction will be swift and simple. I fire you. I fire your co-workers. You can then plead with the government to pay for your mortgage, your SUV, and your child's future. Frankly, it isn't my problem any more. Then, I will close this company down, move to another country, and retire.
 
You see, I'm done. I'm done with a country that penalizes the productive and gives to the unproductive. My motivation to work and to provide jobs will be destroyed, and with it, will be my citizenship.
 
While tax cuts to 95% of America sounds great on paper, don't forget the backstory: If there is no job, there is no income to tax. A tax cut on zero dollars is zero. So, when you make decision to vote, ask yourself, who understands the economics of business ownership and who doesn't? Whose policies will endanger your job? Answer those questions and you should know who might be the one capable of saving your job. While the media wants to tell you "It's the economy Stupid" I'm telling you it isn't.
 
If you lose your job, it won't be at the hands of the economy; it will be at the hands of a political hurricane that swept through this country, steamrolled the Constitution, and will have changed its landscape forever. If that happens, you can find me in South Caribbean sitting on a beach, retired, and with no employees to worry about.
 
Signed, 

Your boss