Can an organization such as the SMRT commit a Freudian slip? Of course...!

In psychology there is a term, parapraxis, that refers to the situation when you do something that was really not what was intended. In layman terms, this is often referred to as a 'slip of the tongue' when you say something unintended. We excuse ourselves through the maxim, 'a slip of the tongue is no fault of the mind'. This is of course quite untrue. Slips of the tongue often reflect a primary fault with the mind, and often betrays what the the speaker is covertly thinking, albeit subconsciously. At cocktail parties, we laugh at such Freudian slips when people chatter about meaningfully under the influence of alcohol. At other times, such Freudian slips occur when a persons guard is let down, or he/she is operating under duress.

So I was quite amused by the recent gaffe by SMRT when it sent out the message to taxi drivers during the breakdown of train services. "Income Opportunities" headed the message that the SMRT had trumpeted to taxi drivers. Quite insensitive and inappropriate. Of course the SMRT quickly came out and apologized for the message. It was a template message which had been wrongly used. Of course. In normal conversation, this is exactly what happens when someone says something unintended. He/she had used the wrong template message in his mind. It is nothing more than parapraxis. A slip of the tongue. A Freudian slip that revealed what the speaker had been thinking about.

So the SMRT really did have a Freudian slip. One could of course argue that an organization such as the SMRT, not being alive, does not really have a mind, and is incapable of committing a Freudian slip. But in reality it does have a corporate mind and a corporate consciousness. So the Freudian slip gave us a rare glimpse of the SMRT corporate mind. And the image is not at all attractive. "Income opportunities". Is that what it is all about? We know that SMRT has a duty to return shareholder value, but we should seriously question the SMRT about its raison d'etre.

At a broader level, we should be concerned that our society has become so preoccupied by "income opportunities". Sadly it seems like things are only worth doing if it has a clear potential for revenue generation. Tragically the practice of medicine seems to be rushing down that road too.

IVF errors, or negligence?

So it has now been revealed that not only the Thomson Medical Centre was sloppy, but the Gleneagles IVF and the O&G Partners Fertility also did not follow procedures. They did not comply with procedures, and did not provide for a second operator to counter-check.

I don't know..... to my simple mole-mind, this doesn't really qualify for a procedural lapse, or human error. Smacks of negligence to me.

Seems to me that we haven't taken such clinic audits and licensing seriously enough.

IVF "lapses"

I must say I was disappointed that the MOH could not bring itself to go beyond just identifying "lapses" as being the causes of the error. Though it's kinda expected. It doesn;t say very much. We all know that accidents are due to lapses.

What we want really to find out is why those lapses occured. Was there a systemic problem that increased likelihood of lapses. Were the quality assurance procedures adequate? Were there previous audit findings that were not remedied? Were weaknesses in the system identified before but left unattended to for too long?

Human error can often be the consequence of systemic failures.

Thomson Medical Centre - suspension of assisted reproduction activities

Well done, MOH!! The Thomson Medical Centre has been whacked with a suspension following the IVF mix-up. Iwould have prefered that the suspension had been immediate upon news of the mistake, but better late than never.

What is further required is a full and proper audit of all IVF facilities to ensure that procedures are not only in place, but that centres are in full compliance of procedures. In addition, regular annual audits should be implemented, perhaps with a way to monitor outcomes... for example routine genetic screening of babies to ensure babies are who the centres say they are.

Singapore's "first" IVF mix-up?

In the process of being taken over by billionaire Peter Lim, the Thomson Medical Centre gets this unexpected bombshell - a dreaded mix-up in the IVF procesure where the mother's egg had been apparently fertilized by the wrong sperms!

Previous posts had highlighted this error and asked for clarity on this issue with respect to the local situation. Now this dreaded error has been reported in Singapore. It is no comfort to say that the risk is very low. A single accident is one too many already. Patients deserve better.

There needs to be more public assurances about the practices procedures and processes in place that will prevent accidents of this sort.

I think a public 'fessing up of what actually went wrong is needed. Dr Cheng LC of Thomson Medical Centre was quoted to have said: ... the centre's operating procedures "meet all regulatory requirements, and are of the highest international standards".

All very vague. Just what are these regulatory requirements? And are they adequate?

The Ministry of Health should tell us how the various IVF units fare in terms of the procedures and procedural compliance. Or are they never ever audited?

Hospital errors - more details necessary

The Straits Times carried a disappointingly brief report about the reporting of hospital errors. A total of 401 errors over the last 7 years (since 2002); 339 of which was from public hospitals and 62 from private hospitals.

The fact that reports had been made compulsory by the Ministry of Health is an important one, and the Ministry should be given full credit for biting the bullet on this issue. But the question is why the need for secrecy here? This data is not found on the MOH website, and not in the public domain (unless I have been looking in the wrong places). If not for ST's report on this issue, we would not know. But ST's report is somewhat tentative and 'kiasu', for it says something, then goes silent. Why, for example, does it not report of the trend of such occurences over the last 7 years? Is it going up or coming down? These numbers should be reported for each hospital, and denominated by the hospital size so we know which hospital runs a tighter ship where error mitigation is concerned.