Seeking Closure of Grief

Quite often, we learn that precious lives were lost due to hospital mismanagement and doctors' negligence. Sadly, many people neither have the financial resources nor knowledge to take legal action against healthcare professionals and medical institutions.

Indeed, I was very disappointed with the poor management of my late mother's illness and made complaints to the medical institutions - sending across the message to them, hoping they would not repeat the same mistake on other cancer patients. However, I refrained from lodging my complaint with the Singapore Medical Council as my mother would not wish to "break someone else's rice bowl".

It took me quite a while to "live and let live", and through CancerStory.com, I advised others to be pro-active and take charge of one's illness and emphasized that family support and care is of utmost importance because the patient is someone dearest and special to you.

However, I remain disturbed whenever I came to know about the loss of lives caused by poor management of illnesses. In April 2006, I received the following email message from a web surfer Mr Jonathan Tan, and decided to post this web page :

"My mum passed away from pancreatic cancer on 30 November 2005. Your site has proved its worth for helping individuals cope with their grief. I feel very disheartened by the methods administered by some of these medical practitioners since my mum started visiting their establishment since the beginning of last year. Alas, the government hospitals could not even detect the problem till it was finally too late. In spite of repeated visits to the hospital, they finally diagnosed her with gall bladder stones and had them removed. It was only in September last year that they finally diagnosed her with cancer. And in the midst of all her checkups, the doctors even assured us that it was 100% not cancer. When they finally concluded on the result, the tumour had grown and encompassed arteries that made surgery impossible. Could this late detection have been avoided, my mum would still be here today.

I'm sorry if this seems like a complaint about the medical people we have. But we are putting our lives in these people's hands, at least I would like to know that they are competent enough. No doubt there are deaths around us everyday, but to think that some of these deaths are the result of incompetence angers me. I'm very sure there are others around like myself. A community should be set up to fight back, discussions held on different hospitals and of the different cases they have faced. We should get these medical practitioners back on par with what they should be rather than continue to be complacent, that the public seeks their services for mere monetary exchange."

After my meeting with Jonathan, I feel sorry for him and his family. My concern is how to provide them with a closure of their grief and move on with life. I wrote to A/Prof Goh Lee Gan for guidance, and hope that his sharing will render some solace to them and other web surfers who are caught in such unfortunate circumstances.

A/Prof Goh Lee Gan's sharing

Yes, it is always a pain to perceive that our dear one has not been taken care of in the way that we wanted. There are choices that have to be made and that pain us further.

The decisions that have to be made are:

• (1) What needs to be done? (a) Leave alone? (b) Pursue the truth?
  
  
• (2) After you discover the truth what needs to be done? (a) Accept it because the medical team (doctors, nurses, and supporting staff) was not negligent after all -- it was the disease that killed the patient. (b) The medical team was negligent.
  
  
• (3) What needs to be done to the negligent party? (a) Leave alone (b) Seek redress
  
  
• (4) Should redress be sought? (a) Leave alone -- the juice is not worth the squeeze - after all the dear one has moved on. (b) Litigate and get the pound of flesh back.
  
  

In the real world, there are people that are found in each of the stops.

What is my wisdom? It is important to find out -- and the world is trying to tell the medical team to be open -- easy if one is not going to be hanged, harder if the risk of being hanged is high (normal human reaction). Anyway, one should find out to seek a closure. That was why I suggested the web surfer find out.

How do you do that? Contact the doctor in charge and say that you would want to know the circumstances of the case and if anything could have been done differently. Ask for a report. No one can refuse you that. If the case turns out to be due to the disease then there will be a closure of acceptance.

What if it turns out to be the medical team is negligent? This is where the thinking needs to go through to seek a closure. What do we know about grief and bereavement?

People go through the stages of grief which is well described by Kubler Ross (denial, anger, bargaining, depression, and acceptance) but not necessarily sequentially.

As a doctor -- I see anger reaction quite often and the patient's relative is at a destructive stage. We try to help them along. This is easier if one has not done any wrong. It becomes harder if one has done something wrong. I shudder to think of what some aggrieved relatives may sometimes do. There are doctors who quit medicine altogether as the outcome of the suffering they went through. I personally know of at least one.

So Soh Hong, we live in an untidy world. Pain and suffering is the norm. There is a whole range of emotions and possibilities.

As doctors we can only pray that God guides our hands to do the right thing. And, if we do wrong, to have the courage to admit it. And pray that the patient's relatives will be forgiving. What more could be done? Not all people we meet or deal with are forgiving.

There are some (fortunately a few) who make excessive demands of compensation. The world is like that. Fortunately, the majority like you are willing to close the chapter without "killing" the doctor. For a number, whether the truth is as they had perceived or something else, they chose to move on. That is one way. That was your way.

Hope the rambling leads you to somewhere in your helping hand for the grief stricken.

Post-event

Indeed, it was a heart-warming news - "Getting aggrieved patients to talk to doc, not sue" in The Straits Times of 20 May 2006.

There will be a new programme/protocol (yet to be finalized and announced within the year) that enables patients and their caregivers to seek redress without having to file a legal suit.

On 22 May 2006, I met up with a doctor and learned a new term - "Clinical Governance". It will be practiced by some medical institutions to ensure that patients are given quality care, and also allow them to share their bad experiences with the 'administrators' so that the doctors can learn about their mistakes, and strive for the betterment of patient care and public health.

Update : Negligence cases - Step by step (extracts from the Straits Times - 30 November 2006)

New procedural guidelines for medical negligence cases in the Subordinate Courts (effective 2 Jan 2007) :

• The affected patient or his relative submits a form stating the basis of his claim and requesting for a copy of the doctor's medical report. The doctor has six weeks to submit the report.
  
  
• The report should address key areas such as symptoms, cause of the condition or death, treatment details, risks and alternative treatments.
  
  
• On receiving the report, the claimant can write to the doctor or hospital to arrange for a meeting. The doctor or hospital has 14 days to respond to this request. The meeting must take place within two months.
  
  
• After this, both sides are free to continue negotiations or discussions.
  
  
• If the patient intends to proceed with a lawsuit, he has to give 10 days' notice to the doctor before he files one.