Q&A: Why don't you visit a GP?

Hi guys. I'd like to deal with an issue that my family just don't get and I think it boils down to cultural differences. You see, here in the UK, we tend not to go see a doctor unless you're really ill - it's not that doctor's are not available or that we can't afford them, but rather we only go see a doctor when we have a serious ailment or we don't know what is wrong with us (and thus don't know what medicines to take). But when we know what we are suffering from, we tend to simply turn to our medicine cabinets (or drawers or wherever you choose to keep your medicines) and self-medicate. Sometimes, I may go down to the pharmacy and seek some advice, but would hesitate to go see a doctor if I am pretty sure I know what is wrong with me. I have just recovered from a nasty bout of winter flu - unfortunately, that was how I spent the last 7 days over Christmas: high fever, really bad cough, sore throat, congested head, headache, aching muscles and bones along with a runny nose. In fact, in most probability, I got the dreaded Aussie Flu since I fell ill within 24 hours of my partner returning from Australia. When I Skyped my family, I told them I was ill and everybody's first reaction was, "go see a doctor", to which I replied, "whatever for?" My parents seem to think that I will be dead by the end of the week because I have a audacity to refuse to go see a doctor and self-medicate - glad to say I'm still alive here, not dead yet! But for now, let me try to look at this cultural phenomena behind Singaporeans' over-reliance on doctors.

It is winter flu season here in Europe.

Many Singaporeans don't understand how antibiotics work

Now one aspect of medicines that has shocked me was the way my parents would demand antibiotics from the GP even for the most minor ailments. They seem to treat antibiotics like candy or vitamin C pills that are to be taken whenever you feel slightly poorly - I've lived in the UK for 20 years and in this time period, have only taken antibiotics once for a very serious eye infection. Otherwise, when I get bouts of flu and fall ill - sure there are days when I can feel like crap (when I am running a fever and my throat feels so sore), but the fact is antibiotics don't work for viruses like colds and the flu and I always recover without antibiotics. Yet many Singaporean GPs routine prescribe antibiotics as a whole package of medicines that the patient gets from the doctor and if you don't get antibiotics, then the patient feels 'cheated'; like, "hey I paid my $30 but where are my antibiotics? Why didn't I get them? I won't go to see this doctor anymore, I know that if I go see Dr Tan, then Dr Tan will never refuse me antibiotics". This hideous overuse of antibiotics not only creates an antibiotic resistance and these 'super-bugs' which cannot be treated with antibiotics, they also create a situation whereby relatively harmless bacteria can develop resistance to multiple antibiotics and cause life-threatening infections.

Singaporeans often put doctors on a pedestal.

The fact is antibiotics should be used only in very specific circumstances, yet many Singaporeans do not question whether their doctors are prescribing antibiotics correctly. I suppose it is because they have this trust of doctors that is so deeply ingrained in their Asian culture that they would never dare to question the doctor's judgement - however, doctors can be flawed and can make errors of judgement as well. There is quite a huge gap between a kind doctor who is good at his job and the status that comes with the pedestal that Asians have put the doctor on. I would like to think that this is a problem primarily associated with the less educated older generation like my parents - I would hope that the younger generation is far more apt at looking up information on the internet and have at least become a lot more enlightened.

I wouldn't put a doctor on a pedestal if I were you.

The huge local private clinic market in Singapore

Many Singaporeans gladly spend some money to go see a private doctor at a GP clinic whenever they are unwell - the routine is simple: you call up for an appointment. You may wait a little during busy times but the appointment system run by the nurses is quite efficient. You'll probably get no more than a few minutes with the GP when the GP will examine you, ask you what is wrong and then tell you what medicines he is prescribing you. Within minutes, you're back out in the waiting room whilst the nurse is putting together your prescription. The nurse then calls you over and explains once again which medicines to take and how often, before handing you your bill. The system at the polyclinic is quite similar, except the waiting times are often a lot longer - Singaporeans who are impatient will go for the private GP option. Now how does this compare to what happens in the UK? Everything is similar right till the part you get your prescription: you are handed a list of medicines to buy at your local pharmacy - you do not get to buy  your medicines at the clinic for good reason.

The huge conflict of interest in a clinic selling you medicines

This is when people like my parents are going to scream, "what? How inconvenient is that? I am already sick and you want me to walk from the clinic to pharmacy to get my medicines? How evil are these Angmoh doctors?" Well, I wouldn't have it any other way. You see, when the private GP in Singapore sells you a bunch of medicines, do you ever finish all your medicines? Are you given more than you need?  Ever wondered if the doctor would sell you stuff you wouldn't otherwise need, such as a dose of antibiotics for a mild sore throat or a huge dose of painkillers you don't really need as you're not in that much pain after all. It is not hard for a GP to justify selling you a lot of 'medicines' to make you feel better but I have been in a situation whereby I have taken a prescription from my GP with a dose of realistic advice, knowing that whether or not I actually purchase every single item on the list doesn't benefit him financially at all. Sometimes I am told, "yeah you can try taking some of these things I'm going to prescribe you, but to be quite honest you'll probably feel better anyway by the end of the week whether you take anything or not. I'll just run down to Lidl and get a pack of paracetamol for £0.19". I just can't imagine a Singaporean doctor giving you the same kind of good advice.

Do you really trust your doctor not to rip you off?

Whereas when you have a family GP in Singapore directly selling you the medicines as part of that clinic's business operations, there is clearly a huge conflict of interest - but somehow, that just doesn't bother Singaporeans at all.  After all, wouldn't you like to know the real cost of the medicines you're paying for? How much of it do you actually need anyway? Do you have a drawer full of unconsumed medicines you never really needed? What really upsets me is the way uneducated folks like my parents would give in to the kiasu-sentiment, "it is better to get more medicine than you need, just in case you run out and you're still ill." My simple response to that is to simply go to the pharmacy and get some more if it ever came to that. However, because uneducated, older folks have become trained to think it is normal to get more medicine than you need, the pharmaceutical industry then exploits them by selling them far more drugs than they really need - the patients pay for pills, capsules, eye drops and ointments that end up sitting in their drawer for month only to be eventually thrown away. It is a massive waste that only profits the pharmaceutical industry whilst nobody is confronting the doctors about their role in this scam and the less educated older folks are not asking any questions. I look at the amount of unused medicine my parents hoard and it is just insane how much waste there is.

The best prescription is free: rest!

But that's not a word that Singaporeans want to hear. Singaporeans often work hideously long hours and they don't want to rest - on some days when my sister is just too ill to go to the office, she is lying in bed with high fever still answering work emails on her phone. Sometimes when you come down with the dreaded flu, there's little you can do but to stop working and allow your body to take as long as it takes to recover. Sometimes, that can take one or two weeks for a nasty bout of flu to completely clear but who wants to be sick for up to two days? Now if only there's something the doctor can sell us to help us get better sooner. Well, that's the problem with a lot of people: they are unprepared to accept the fact that they will be out of action for at least a week. In Singapore, typically, doctors would write you an 'MC' (medical certificate) for one day and if you get one for two days, that means you're like seriously ill. The medicines given to you for flu are no more than symptomatic treatment: that means they help you deal with the symptoms of the flu, but they do not make the flu go away. So if you have a congested head from the flu, the doctor can give you a decongestant to help alleviate the effects of that for a few hours but once that wears off, you're back to square one. Trying to work whilst you're ill whilst popping loads of pills to deal with the symptoms of flu would probably make you even more sick and it'll take you longer to recover but the Singaporean doctors seem more interested in selling you more pills.

There's a good reason why you need to rest when you're ill.

Whereas in the UK, we have quite a different attitude towards sick days. If someone at work gets the flu, we just accept that the person is going to take at least a few days off to recover as we all know how nasty flu can be. Managers hardly ever ask for an MC or sick note from one's doctor - no, we simply work on the basis of trust. Wagamama (an East Asian fast food restaurant chain) recently got into a lot of trouble when it tried to stop staff from calling in sick during the busy festive season because of fears they will be shorthanded - this led to a public outcry, even call to boycott the restaurant chain over concerns of their lack of disregard for health and safety. Would you like your food to be prepared or served by a worker who is constantly sneezing and coughing? How unhygienic! It is one thing for say, my sister to respond to her work emails whilst feeling unwell - at least she is doing it from the comfort of her bedroom away from her colleagues. So even when a rogue restaurant manager tries to force sick people to work during a busy period, you can be sure there will be a public outcry and apology to follow. Now imagine if a Singaporean noodle restaurant tried to force staff to work during the busy festive season, would there be as much public sympathy? Heck, nobody in Singapore would care.

Putting a value on something you don't pay for?

There are some other factors that do stop us from going to see a doctor over minor ailments in the UK - did you know that for us, going to see a doctor at our local NHS clinic is free? Yes, the consultation is free but you need to pay for your own medicines. Now here's the weird thing about human psychology - when you need to pay for something, you tend to attach a lot more value to it. But if you are given something for free, you may take it for granted, even if it is the exact same thing so the only difference is whether or not having access to this service has cost you any more or not. Let me give you a simple analogy: imagine if you went to Spain and bought a lovely bottle of wine, you'll be quite hesitant to give it away. Not only did you spend money on it, but you also took the trouble to bring it all the way back from Spain without breaking that bottle, so you'll probably want to save it for a special occasion to drink it. But imagine if a colleague went to Spain and brought back that same bottle of wine for you, you probably wouldn't hesitate to use that bottle as a last minute Christmas gift. "Ah I'm sorry, I forgot to get your aunt Amanda a gift, well I hope she likes Spanish wine." Yeah in the UK, we have come to take our doctors for granted given how we don't have to pay to see a doctor, whereas in Singapore, if you've paid good money to see a doctor, you're going to take their professional opinions a lot more seriously and unfortunately, that also means you're more than likely to pay much more for all their expensive medicines.

Are Singaporeans putting too much trust in their doctors?

The urban-rural divide

When Singaporeans first venture out of the crowded capital London, the first thing that strikes them is the vast expanse of space as soon as you get like an hour outside London. The landscape alternates between fields for grazing, land under cultivation, forests, hills and lakes. If I really wanted to go see my GP, she is about a ten minute walk away but if someone lived way out in the countryside, visiting one's GP may mean a trip to the nearest town and that could be over an hour away by car. Heck, if you lived in some of these rural places, anything from attending a yoga class to visiting a Chinese restaurant to finding an optician may mean a long journey like that away. Thus for many people who live in more rural locations, they become a lot more self-sufficient and in this age, it often means using technology to access what you need without having to leave your home. So if you want to buy that nice new pair of shoes, you get Amazon to deliver it rather than drive all the way to the nearest mall. Likewise, there are plenty of ways to consult a doctor in the UK without actually visiting a clinic: you can do so over the phone and online - the doctor would ask you the same questions if you were in the same room and the next step would usually be to give you a prescription (which you can get online and delivered to your doorstep) or if it sounds really serious, then yeah they'll still ask you to go to the nearest hospital. Contrast that situation to a city state like Singapore, whereby you're never too far away from a private clinic.

"But what if it turns out to be something far worse?" 

Oh I can imagine my parents saying something like that. Well, there's little you can do about it if say your flu symptoms are just flu, but the onset of something far more serious like leukemia. The fact is, the chances of your average flu turning out to be something like leukemia are so low that most doctors would just take a look at you and say, "you've got the flu" rather than start speculating what else you have. Nonetheless, there is a huge difference between having a fever and constantly having fever for many days - it is only when you have one of these symptoms that keeps returns despite treatment that the doctor would start thinking about what else you may be suffering from. It is usually only at this stage when us Brits start visiting the doctor - if you are rich enough to pay for a doctor to run all kinds of tests on you the moment you have a mild sore throat, then go ahead, waste your doctor's time and your money but otherwise, most doctors would probably tell you to go fuck yourself (well they'll be more polite than me) if you demand any kinds of special tests for flu like symptoms. No, in most cases, you're not dying of some rare disease - you simply have the flu.

"Doctor, I want you to test me for every single virus and disease..."

"Isn't your national health service in a mess? Is that the real reason why you don't go see a doctor?" 

Oh you may read a lot of sensation headlines about the NHS being in a mess and one of my readers Choaniki will be working in the healthcare sector, so he is often worried by such headlines. Yes you have stories about NHS waiting lists hitting the headlines but here's when perspectives really matter: in the UK, if you get a rare form of cancer, you can turn up at a government hospital and demand treatment. As long as you are a legal resident of the country, it is your right to get that treatment free of charge and imagine the stress of being told you have cancer; well at least in the UK, you don't have to worry about paying for your treatment. That's the good news: the bad news is that there may be a waiting list to start your cancer treatment and that's where you have the scandals of waiting lists that you read in the newspapers. Compare this to the US where you need to have private health insurance or else a short stay in an American hospital can literally bankrupt you. So America doesn't have the same kind of waiting list scandals because the government doesn't really care if you are too poor to afford cancer treatment. Now that's an easy way to solve the waiting list problem: tell just tell poor sick people to fuck off and it is their fault they are going to die of poverty. Likewise, Singapore has a range of mandatory healthcare-saving schemes (Medisave) whereby citizens are forced to save for their own medical expenses should they ever need treatment at a hospital - and if you're really destitute, then the government may step in to waive your fee but not before you've gone round begging various charities for their help first. Bear in mind that Singaporeans can pay between 6.5% to 9% of their incomes into Medisave, so this isn't that different from the American system.

There are far fewer countries in the world that try to provide an NHS type "free at the point of access" health service - take the example of Tunisia for example: yes Tunisian citizens are in principle able to get receive treatment at all state hospitals and clinics free of charge, but waiting lists are painfully long, conditions at hospitals can be poor in rural areas and some hospitals can lack everything from trained staff to equipment to medicines: just because you can access treatment for free doesn't mean that the 'treatment' on offer is going to be good enough to keep you alive. Such is the reality in North Africa, but at least in the UK, whilst mistakes do happen within our NHS system, we still by and large believe in the principle of universal health care and that nobody should die of poverty in this day and age unlike say, in America. Why the UK still believes in maintaining such a system demonstrates that most European countries are still extremely left-wing compared to what has become the norm in America, well that's another long debate for another time. Why would the UK choose to hold on to the NHS system when it can switch over to an American-style system then? Well, no political party would be able to win an election with that as their mandate - the voters just wouldn't let it happen.

But let me tell you this story: there was a hotel who had a swimming pool and sometimes, they have to close the pool for cleaning - trust me, I've a friend who has worked in a hotel and he's seen the guests do everything from poop to throw up to bleed in the pool and no amount of chlorine is going to be enough to deal with it. Closing the pool from time to time for emergency cleaning becomes a part of their routine. So imagine you turn up at this hotel with your booking, having heard of their magnificent pool and you see a big sign that says, "We are sorry to inform you that our pool is closed today for emergency cleaning." Disappointed, you bully the manager into canceling your booking and you take your bags to the next hotel across the road. You look around the reception area for any similar signs about the pool being closed - so far so good. When you meet the receptionist, you can't wait to tell her about your disappointment with the previous hotel. You finally ask her if something like that will ever happen at her hotel and she replies, "no, because we don't have a pool at this hotel, so we can't ever have problems like that." So what would you rather have? A hotel with a pool that may be closed sometimes - or a hotel without a pool at all? You could argue that a lot of the negative headlines associated with the NHS were brought upon itself with such ambitious targets, but such is a system more concerned with lofty ideals.

So fine - what is stopping you from visiting a GP when you're down with the flu then? 

Well, I just don't see the point. I think the GP will take one look at me and say, "you've got the flu, go home, go to bed and stop wasting my time. Fuck off." Well that's what I would tell anyone who goes see a GP over something like flu because there's precious little a GP can do for you. People like my parents, they're woefully uneducated, they don't know what the flu is or how the body is affected - so they run to the doctor in blind panic. Yeah so when an uneducated old woman runs to her doctor over something trivial, the doctor will be more forgiving. Whereas for myself, I'm highly educated and I have much better judgment: I know when I need to seek help, when I can take care of myself. Furthermore, I also know that there is nothing the GP can give me to make me get well any sooner - flu is nasty, it will take time to run its course for a week or two. Furthermore, there could be other older, more vulnerable patients at the clinic who may need to see a doctor a lot more desperately than me, taking up the doctor's time out of no more than a 'kiasu' whim seems like a rather immoral thing to do. Oh in Singapore, if you wanna pay a doctor a lot of money for his time and medicines you don't need, then that's your problem - you pay for all that. But in the UK, our healthcare is free so ordinary citizens like us are obliged not to abuse the system by visiting the doctor over silly, minor ailments like the flu. Furthermore, the flu is quite infectious - I should not be in a waiting room at the local clinic, infecting all the other people there, giving them this particularly nasty strain of flu. I've stayed home all this time, effectively putting only my partner at risk but he seems to be fine. So far so good. It has been a week and I think I'm about 80% better already. Such is winter flu for you unfortunately.

So that's it from me for now. It's a shame that I had to spend practically all of the holiday season feeling so ill - I fell sick during my last day at work, just before I started my festive break would you believe that. But anyway, I'm just relieved I'm much better already. What about you? Do you insist on seeing a doctor when you are not well? Or are you happy consulting a GP online or on the phone? What about just talking to a pharmacist? How reliant are you on antibiotics - do you take them regularly or not? Do you feel exploited by the doctors? Leave a comment below, many thanks for reading.