Respect the patient's rights
The death blow to Yeoh Eng-kiong's career as health minister came at the press conference in which Sars survivors and relatives of those who died told of their pain and misery, and demanded that he quit.
But does Dr Yeoh's departure, while a salve to the victims' emotional wounds, resolve their problems? Does it correct the mistakes that led to their illness and the deaths of their children, mothers, fathers, wives and husbands?
No. In each case, the reason for anger and suffering varies a little. For those who recovered, there are questions about their treatment - whether it caused some of their ongoing, debilitating symptoms. Others, who caught the disease while in hospital, or while working there, are still angry about the circumstances under which they contracted Sars.
Relatives of those who died suffered the terrible trauma of having a loved one taken from them, often under dramatic, emotionally violent circumstances. The relatives themselves were kept in quarantine, suffering social stigma from their neighbours, with police regularly checking on them. During their grief, they were given little or no support from a society still shocked and terrified by the disease in its midst. So it is hardly surprising that their pain is as sharp and the hurt as bitter as a year ago.
Dr Yeoh's departure will not change the circumstances that caused that pain. If another epidemic strikes, the same procedures that have been effective for hundreds of years will be put in place. Patients will be isolated and they will die separated from those who love them.
But more attention could be paid to patients' rights. At present, the chances of having your rights recognised within the health system are entirely dependent on the culture, attitude and demands on your health attendants.
If you happen on someone who has time to discuss your case, answer
your queries and deal with problems that may seem minor to a doctor or nurse, but are major to a patient, your rights will be respected.
But if you find yourself caught up in a crisis or are managed by someone with 'old-school training' - those who consider patients should not ask questions - then your rights will not be part of the equation.
With Sars, even the best and most thoughtful attendants had to put patients' rights to one side to protect staff and other patients. So how can this be improved?
One option is to provide a patient advocacy service, where someone can answer patients' or relatives' questions, deal with problems or simply listen to people having a good whinge if need be. Medical social workers partly fill this role, but without the title 'advocate' they may be unable to persuade doctors to answer questions properly.
Currently, the Society for Community Organisation, a very effective social advocacy group, is filling this need for Sars victims. But offering such a service in every hospital would defuse a problem before it becomes impossible to solve.
Another option is to set up a complaints unit or a medical ombudsman's office. Patients, relatives, health-care staff - in fact anyone who feels a problem has not been resolved satisfactorily - would be able to make a complaint to the body and expect it to be investigated. The emphasis here has to be on negotiation; the ombudsman should not be seen as a medical policeman, but instead someone who can find common ground between the system and those who feel they are its victim.
A number of western societies have developed similar systems, some as a response to rising litigation. Here in Hong Kong, we are seeing a rise in medical negligence litigation and a drop in people's trust for the health-care system. With no one to turn to, it is understandable that patients will take the hardest and most expensive solution: legal action.
Margaret Cheng is a Hong Kong-based medical writer