Commentary: Our fears are driving us to the A&E but we can do better
FILE PHOTO: Healthcare workers in personal protective equipment at Tan Tock Seng Hospital's Accident and Emergency (A&E) department on Apr 30, 2021. (Photo: Calvin Oh)
SINGAPORE: Reading about Accident and Emergency (A&E) Departments at our hospitals being flooded by Omicron cases with mild or no symptoms made me think about medical dramas such as ER, Grey’s Anatomy, or, if you’re a K-drama fan, Netflix’s recent Hospital Playlist.
Showbiz A&E doctors and nurses are always rushing about, frantically dealing with patients wheeled in on gurneys, freshly unloaded from ambulances with sirens wailing full blast.
Showbiz patients need urgent medical attention so as not to suffer terribly or die immediately. Of course, in reel life, things are completely dramatised.
But there is something undeniably real even in these medical shows - everyone knows what “Accident” and “Emergency” mean.
CLOGGING UP THE A&E ARTERY
Can we say the same in Singapore? An A&E doctor said in a local media report that two-thirds of the patients she had attended to lately were either mild or asymptomatic Omicron cases, or Priority Level 3 cases (meaning sprains, minor injuries, minor abdominal pain, vomiting, fever, rashes and/or mild headaches).
Earlier this week, an emergency doctor from Raffles Hospital, Dr Devin Tan, gave an account of why people head to the A&E and the impact this has on healthcare workers.
Since Feb 6, the Ministry of Health (MOH) has advised the public to seek treatment at the emergency department “only for serious or life-threatening emergencies, such as chest pain, breathlessness and uncontrollable bleeding”.
Judicious use of emergency services allows those in urgent need to be attended to quickly and helps preserve hospital capacity for those who “truly need acute hospital care”, added the ministry.
It’s strange because the COVID-19 protocols 1-2-3 are pretty straightforward calls to self-isolate, self-medicate and self-test, or see a doctor only if unwell.
Nowhere do they mention the A&E.
And with Singapore having one of the highest vaccination rates in the world, experts agree that even if we do catch COVID-19, it’s unlikely to be severe.
One commenter on Dr Tan’s piece claiming to be a healthcare worker put it succinctly: “… everyone is entitled to go to the A&E but they are not entitled to immediate care.”
The reader went on to say those who show up with mild symptoms commonly had to wait for five hours, only to be given paracetamol and sent home.
The numbers bear this out: As of Mar 10, there have been 901,758 COVID-19 cases in Singapore.
About 90 per cent of the cases reported daily were mild or had no symptoms. 1,116 people died of COVID-19, or about 0.12 per cent of the total cases.
IS IT JUST OUR FAULT?
Perhaps this is a sign of a deeper “health anxiety”.
About a year ago, researchers at Duke-NUS Medical School found that one in three adults, particularly women, younger adults, and those of lower socioeconomic status, are experiencing psychological distress related to COVID-19.
And after another year of pandemic living, it’s unlikely our mental health has improved.
That’s not surprising. We’ve never had to deal with a global-scale pandemic before.
We’ve never had so much of our personal liberties curtailed, first with a lockdown, then a series of “guess what happens next” where some liberties were restored, rescinded, then restored but with tweaks, before having our chains yanked once again.
We’re trying to move towards endemic living. But we’re constantly reminded that we can’t let our guard down, should a more sinister COVID-19 variant be just round the corner.
And when fresh waves of infection come along, these old anxieties bubble up again.
The director of medical services Kenneth Mak acknowledged this when he said people end up in the hospital because they are worried and unsure what to do.
I too, understand this anxiety. Hospitals - open 24/7 and staffed with the best healthcare professionals - are comforting places when you don’t know what to do.
But perhaps, it is time to put our foot down on this, even as the Omicron wave appears to be subsiding.
The anxiety of some cannot get in the way of life-saving medical attention for others.
Priority Level 1 patients may be unconscious or critically-ill patients suffering from heart attacks, severe injuries and bleeding, shock, severe asthma attacks.
For such patients, every second counts; a literal matter of life or death.
And let’s not forget Priority Level 2 patients facing major emergencies, like major limb fracture or dislocation, moderate injuries and severe abdominal pain.
If you’ve ever experienced any of the above, you’ll know how every moment of agony seems to last an eternity and medical assistance could not come soon enough.
WHAT MORE CAN HOSPITALS DO?
Perhaps hospital management can look at how to manage COVID-19 cases who show up with mild or no symptoms.
More non-medical volunteers can be stationed outside A&E departments to manage those who don’t fall into any definition of emergency.
Could they provide an additional triage of mild COVID-19 cases who simply don’t know where else to go?
Guiding patients on concrete steps and instructions could provide reassurance and certainty.
They could help check, for example, if such patients are looking to officially record their infection and direct them to a Combined Test Centre.
I wonder though, if our overwhelmed A&E situation is indicative of a deeper issue about our expectations of A&E.
After all, there have been regular appeals to use emergency ambulance and medical services judiciously even pre-pandemic.
For instance, waiting for hours to see a GP or even a telemedicine doctor may lead people to believe the A&E will be a quicker way to solve their problems next time.
And what happens when we fall sick outside of business hours?
It doesn’t help that polyclinic operating hours are short and slots are snapped up almost as soon as they open every day.
Or during festive periods when many clinics are closed? Those unwell may feel like they have little option besides the nearest A&E.
Parents with young and unvaccinated children recording very high fevers in the middle of the night would likely default to what they perceive is the best and easiest decision - rushing to the nearest hospital.
Or how about other non-egregious scenarios of people needing help, such as when a 90-year-old senior with limited mobility has no means to bring his 86-year-old wife to the GP or the know-how to seek telemedicine consultations.
More can be done help to remind people that A&E shouldn’t be the default place when we are worried about COVID-19.
Grassroots organisations and community partners for instance can be roped in to help GPs or just to support anxious families with COVID-positive family members.
It was useful when more clinics opened up to cater to demand and polyclinic hours were extended too.
But such efforts are limited when people can just show up at the A&E.
Would it be inconceivable to have legislation that prevents and punishes abuse of A&E services during critical periods like during a pandemic?
Let’s hope that for the vast majority in Singapore, we don’t need to resort to such heavy-handed means to realise not burdening those who are working hard to care for the sickest among us is the right thing to do.
Tracy Lee is a freelance writer based in Singapore who writes about food, travel, fashion and beauty.
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