More visiting A&E, many for mild complaints

SINGAPORE - When a fever or a bout of mild diarrhoea hits, who do you call?

For a growing number of people in Singapore, it's the Accident and Emergency Department (A&E) at the nearest hospital.

Visits to hospitals' A&Es have crept up steadily over the years, according to numbers from the Ministry of Health (MOH).

On average, attendances have climbed 8.7 per cent every year for the past six years, said an MOH spokesman.

That's 48,000 more visits every year.

Last year, there were 738,000 visits at six restructured hospitals - Singapore General Hospital (SGH),

Changi General Hospital (CGH), Khoo Teck Puat Hospital (KTPH), Alexandra Hospital (AH), National University Hospital(NUH) and Tan Tock Seng Hospital (TTSH).

Another surprising finding: More than half of the total attendances were for mild complaints, like acute gasteroenteritis (gastric flu) or muscle strain.

And fewer than 10 per cent of the patients had conditions serious enough for them to be hospitalised.

Younger patients account for many of the non-emergency cases at NUH, said Associate Professor Malcolm Mahadevan, head and senior consultant of the hospital's emergency medicine department.

He said: "Most patients fall within the 21-to-30 age group. They make up about 37 per cent of non-emergent cases."

Why the tendency to seek treatment at the A&E department?

Said Associate Professor Mark Leong, head and senior consultant of SGH's emergency medicine department: "Some come because they know that care is available round-the-clock, which takes away the guess work of whether the doctor is in.

"There is (also) a perception that A&E can provide comprehensive diagnostic and therapeutic options."

Perhaps they expect hospital-prescribed medicine to be stronger, or doctors there to give better diagnosis, added Prof Malcolm.

He noted that blue-collar workers tend to seek treatment for work-related injuries like cuts and sprains or fatigue, while white-collar workers worry about diarrhoea, fever or respiratory infections (like colds) that take several days to settle.

Some, like Mr Daniel De Costa, 28, are unsure about who to turn to for help.

Last month, the former administrative executive was on his way to buy lunch when he slipped on some wet tiles in a hawker centre.

An ambulance took him to hospital. He was discharged the same day.

Campaigns to raise public awareness about proper A&E use

MOH and the Health Promotion Board have been holding campaigns.

Their most recent effort was in June 2010.

While it's natural for parents and caregivers to worry when their children are unwell, they should consult the family doctor or polyclinic first.

For instance, children who have a long-standing problem with sensitive noses can seek symptomatic treatment.

They don't need to be taken to the emergency department, said Associate Professor Ng Kee Chong, head and senior consultant of emergency medicine at KK Women's and Children's Hospital (KKH).

He estimated that a fifth of cases at the Children's Emergency Department, which treats those up to 16 years old, are less urgent.

"We have seen a 10 per cent increase in less urgent cases since 2010," he added.

Lawyer Joyce Lim, 34, relies on a portable nebuliser machine to battle elder son Jed's asthma attacks.

"The first time he had an asthma attack, when he was two, I panicked because it was late at night.

"We rushed him to the A&E (at East Shore Hospital)," she recalled.

"But after two visits, we decided to buy the machine to help clear his airway. It's cheaper, instead of going to the A&E each time it acts up."

Mrs Lim said each visit to the A&E cost her almost $100.

She also keeps a list of nearby clinics that open on weekendsand close late during the weekdays.

Added SGH's Prof Leong: "Having an established relationship with a reliable family physician is the best way of getting the best treatment for an ailment.

"The family physician can refer appropriate patients to other services if required."

This article was first published in The New Paper.