Angry Doctor

Monday, January 09, 2006

Big Doctor is watching you

As I promised andrew, here's the link to the SMC Newsletter 2005.

The article I was referring to is Prof Chee's article, titled "Medicine 2010".

Regarding the use of computerised medical records, he has this to say:

"So by 2020 with our IT infrastructure in place... information would flow seamlessly. That which is confidential would be guarded by the patients (with access granted to the providers only when they give permission) and other information available would be for education, training, research and quality or performance indicators."

and

"... as regards the clinical competency, clinical outcomes and practice patterns of doctors, the Ministry of Health would be in a very good position to access all necessary data warehouses available when Medicine in Singapore is fully computerised... All will be done once doctors key in patient data into their computers, which would be nationally linked. From these data, the SMC will know more about the clinical practice and patient care of its doctors. Frightening? No. Just becoming more transparent which is what patients and the public expect."


I am a little disappointed he didn't address the issue of patients' responsibility. I doubt patient expectations will change drastically over the next five years or so. Come the time when every doctor's every move is under scrutiny, patients may find their doctors becoming less willing to accommodate their every wish/request/demand. How will patients come to terms with this new paradigm where doctors aren't really truly free to do what they want anymore?

We live in interesting times.

26 Comments:

  • I'm afraid this discussion becomes political for me.

    I'd say that this is the prevailing tone in SG's society.

    Leave everything to the government. Let the government handle it. It is the government's responsibility.

    It is never the individual's responsibility. Even in the "largest civil emergency exercise" it was "leave it to the authorities to do everything, you just keep still"

    That's the reality we'll have to face as Singaporean doctors in the future. At the moment I'll be honest that many "requests" from patients are acceded to by GPs. Like you rightly said, if you don't agree to their requests, they'd kick a fuss.

    And Singaporeans tend to get what they want when they kick a fuss.

    That's what our government has taught as anyway.

    The imbalance however is that the medical profession ie Us, have no way to "kick a fuss".

    Our SMA is pretty incompetent in that respect. As such we become the whipping boys.

    Be afraid. Be very afraid.

    As a member of the public, I'm all for the move to scrutinize and be "transparent" (where have we recently heard that mentioned so many times only to be untrue?)

    But the patient's have to play a part too. There are rules and regulations and sometimes patients are the ones who request for things that go against these rules just for their trivial benefits.

    They would then ask me the doctor "why you all go and have such STUPID rules?" And they don't accept it when I reply "I didn't make the rules!"

    But it's true. As a humble doctor I am ordered to be a worker bee in the bigger scheme of things. Any differing views will not be tolerated and will be severely dealt with.

    Be afraid. Be very afraid.

    By Blogger Dr Oz bloke, At January 09, 2006 9:26 am  

  • "where doctors aren't really truly free to do what they want anymore?"

    Free to do what? Free to practice more quackery?

    That's precisely what the public wants to know. Incompetent doctors and conniving administrators covering up a boo boo and lives are lost.

    I look forward to the day when patients' records are all captured on a central database to weed out the junkies and the quacks.

    A peer review is available instantly by someone more deserving to be a doctor.

    It may upset some doctors but in the greater scheme of things in Singapore, it is done always with the greater good of the population in mind.

    Way to Go!

    By Blogger uglybaldie, At January 09, 2006 9:43 am  

  • What then is the responsibility of patients? Doctors have to account for their actions, yes, no doubt. What about patients who indulge in high-risk behaviour? For example, can we have a network set up to monitor smokers? Those who smoke will be accorded a lower priority in subsidies compared with non-smokers. After all, health insurance companies are already doing that, making smokers, motorcyclists and other "high risk" customers pay more premiums.

    Some quid pro quo is in order here.

    By Blogger andrew, At January 09, 2006 10:07 am  

  • seems like singaporeans like to measure everything. Rank everyone. Clinical outcome is a complex multi factorial equation, so I don't know why it should be tagged to the doctor's competency. Does the doc who prescribe the most potent concotion of medicine when he first sees the patient qualifies as a good doc. The patients certainly would think so :)

    By Anonymous Anonymous, At January 09, 2006 4:35 pm  

  • What a frightening society you live in !

    Orwell is turning in his grave...

    By Anonymous Dr Epicurus, in Oz, At January 10, 2006 9:18 am  

  • Living in a allegedly "orwellian" society is much better than living in a drug infested country with an ineptly run health system supposedly "free" but supported by crushing taxes. To quote a PR living in that country :

    "For instance,(' I heard') there are patients in the public hosp waiting more than 6 months just to get a hip replacement done. So what can the patients do nothing except popping NSAIDS pills to kill the pain in the meantime."

    Also she said this of that country:

    "To me, the healthcare system seems either to favour the ang moh specialists or exploit the fresh grads from overseas."

    For the uninitiated, "ang moh" is local slang for the white man.

    There you see, the grass is not always greener at the other side.

    Well you can afford to be slack because yours is a supposedly "lucky" country. No one needs to work if he doesn't want to. There is always the cows for milk, the chicken run for eggs and poultry, the sheep for meat etc.

    To understand why we need to be a "controlled" society, you have to understand the country's size and lack of natural resources thereof.

    By Blogger uglybaldie, At January 10, 2006 10:28 am  

  • "To understand why we need to be a "controlled" society, you have to understand the country's size and lack of natural resources thereof."

    Pros and cons I guess.

    Some people may prefer to stay in a well controlled, orderly little dot on the map, where there is "regulated freedom".

    Some may prefer to live in a continent that respects "nearly unregulated freedom" that brings some chaos.

    To each his own.

    By Blogger Dr Oz bloke, At January 11, 2006 9:48 am  

  • Hello oinkle OZ,

    You're back from holiday? Without you, this place is as cold as the temperature outside my cozy house.

    Without question, I would prefer to stay here with its warts and all. "Regulated freedom"? What's that? Aren't you speaking freely and ranting without fetter on the net? In some other countries, the imbecilic morons who calls themselves local politicians could be bumped off in the middle of the night. But not here. You can say what you want but be prepared to face the consequences if what you say is libelous.

    Chaos in a "nearly unregulated freedom" country? The felon defended by an able and charismatic lawyer and supported by a sympathetic press need only face a slap on the wrist before a corrupted judiciary. No thanks. I want my children to grow up with a healthy respect for the law and walk the right path.

    By Blogger uglybaldie, At January 11, 2006 10:09 am  

  • "I want my children to grow up with a healthy respect for the law and walk the right path. "

    And the right path seems to be to strive to show you have high IQ. It is increasingly being shown that the way Singapore judges a person is solely on IQ. We've seen all these people who great qualifications in office but sorely lacking EQ and INTEGRITY.

    "The felon defended by an able and charismatic lawyer and supported by a sympathetic press need only face a slap on the wrist before a corrupted judiciary. No thanks"

    And you prefer the Singapore judiciary system? Where it has been proven to be wrong in the NKF case.

    And now they ask for "whistle blowers" but will not give them legal protection.

    Isn't that hypocrisy?

    Again to each his own. I do know that sometimes being in an environment "too safe and coddled" is not the best way to develop character either. Singapore's answer to that is the SAF.

    It all makes me laugh. But again to each his own. I respect your views.

    By Blogger Dr Oz bloke, At January 11, 2006 11:35 am  

  • mr "uglybaldie",

    My what an interesting viewpoint! We certainly disagree on issues of civil liberty and the concept of freedom. Good for the 'aristocrats'...

    I am surprised that you call our healthcare inept (throwing in what sounds like a racial epithet as well)...I suspect angrydoc might differ in your opinion as to the merit of your system over there. But it is comparing apples to oranges really.

    But we obviously differ greatly in political ideology, and I respect your opinion, as much as I disagree with it obviously - that's one of the good things about places like Oz, we can express our opinions, as anti-government as they may be. And we can do it openly, not needing the anonymity of the net.

    I'm intrigued - what kind of area do you work in ? Have you lived in any countries outside Singapore ?

    And here's a curly one - if one of your own children was a drug addict, would you turn them in to the police so they could be executed ?

    By Anonymous dr epicurus, in oz, At January 11, 2006 12:38 pm  

  • Dr epicurus wrote : "My what an interesting viewpoint! We certainly disagree on issues of civil liberty and the concept of freedom. Good for the 'aristocrats'..."

    Good observation. Singapore is really designed as a place for the rich, the politically powerful, and the foreigner.

    The "aristocrats". Uglybaldie belongs to that group and thus his opinions.

    What about the blue collar worker Singaporean popoluation? Well unfortunately, they have no voice.

    Interestingly, Singaporeans who harp about racism are usually the ones looking for it too. Everything negative involving some white person becomes a racist issue. But if it involves a darker skinned person what is it then?

    They should just admit it too.

    As for Singapore's health care system. I'd say it is VERY VERY good. It is affordable compared to other first world systems (without aid of medical insurance), waiting times are short ( the waiting time to get an appointment, not the time you spend at the waitin room). AND YET.....Singaporeans living in Singapore complain on and on about the system.

    Most common complaints :

    1) Too expensive
    2) Waiting too long in the waiting room for the doctor

    You can't please everybody. And then the doctors are working their socks off already, accepting forced in appointments into their overbooked appointment schedules.

    Appreciation? That is a taboo word here.

    By Blogger Dr Oz bloke, At January 11, 2006 1:10 pm  

  • What a refreshing breath of fresh air to have a view from down under flawed as it may be and skewed with the "we know best" bigotry.

    "And we can do it openly, not needing the anonymity of the net". You are either kidding yourself or is a computer illiterate to understand that if the powers that be wants to know your identity, it's a walk in the park. So no one is invisible or annonymous in that respect.

    When the stomache is full, the mind becomes fertile and the rants become that much more clamorous. That's what is happening down here. You can talk all you want about freedom of speech and democracy your style, but at the end of the day, it's survival and a full stomache that matters. Yes, you are spot on. You cannot compare apples with oranges. To bring this analogy down to the kindergarten level, you are the orange and we are the apple.

    But like you, I do respect your view points which I too may not subscribe to. Like Dr. OZ says, to each his own and to each country their own system of governance. Remember however, that it is easy for you to speak about the so-called "freedom" from a continent isolated from the maelstrom that is South East Asia.

    "I'm intrigued - what kind of area do you work in ? Have you lived in any countries outside Singapore"
    This is a really good one. I have been to so many places that I can safely say to you that I have seen the world many times over. In return, might I ask whether you have been any where else other than OZ or for that matter have stepped ashore in Singapore? The reason I ask is because you seem ignorant of our narcotic laws. We do not execute drug addicts. We try our best to reform and rehabilitate them. We only execute drug traffickers, the purveyors of mass misery and death. Oh yes, in the most recent case, the Viet deserved to die no two ways about it. And your judiciary kept secret the fact that his brother was convicted of assault with a deadly weapon, in this case, a samurai sword. The victim is still lying in hospital.

    Finally, for your further information, I have relatives in Perth and Melbourne and I live with them for 6 months of the year if I have nothing better to do here or I just feel like it.

    The only thing about your country that interests me is the open space and well endowed natural resources.

    By Blogger uglybaldie, At January 11, 2006 1:18 pm  

  • Hi uglybaldie,

    Just some comments regarding your recent comments posted

    "We only execute drug traffickers, the purveyors of mass misery and death."

    The key difference I think is that Singapore's definition of a drug trafficker is very abitrary. There would be many drug abusers who might be accused of being traffickers based on that definition. How can we be so sure of how much drug (in weight) this drug abuser has at home? We may actually be sending them to their deaths when we report them. Singapore is very strict when it comes to drugs, which is a good thing, but as a doctor I would say it becomes very painful for me to turn these guys in. But I have to. Pros and cons. Good to reduce drug abuse and trafficking as a deterrent, but terribly heartless when caught.

    From

    http://www.cnb.gov.sg/enforcement/index.asp?page=9

    "The Presumption Clause under Section 17 of the Misuse of Drugs Act (MDA) stipulates that anyone caught in the possession of a certain amount of a controlled drug is presumed to be trafficking in the drug and the onus is on him to prove that the drug found on him is not for the purpose of trafficking.

    Under the MDA, a person is presumed to be trafficking in a controlled drug if he possesses more than:

    2g of heroin;
    3g of morphine;
    100g of opium;
    15g of cannabis;
    10g of cannabis resin;
    30g of cannabis mixture;
    3g of cocaine;
    25g of methamphetamine; or
    10g of any or any combination of the following:
    N, a-dimethyl-3,4-(methylenedioxy)phenethylamine;
    a-methyl-3,4-(methylenedioxy)phenethylamine; or
    N-ethyl-a-methyl-3,4-(methylenedioxy)phenethylamine "


    Uglybaldie wrote :"Finally, for your further information, I have relatives in Perth and Melbourne and I live with them for 6 months of the year if I have nothing better to do here or I just feel like it."

    What in the world are your relatives doing in Perth and Melbourne then? Why can't you convince them to come settle in Singapore?

    By Blogger Dr Oz bloke, At January 11, 2006 1:35 pm  

  • On the issue of the drug quantities and the presumption of guilt based on possession, I have to agree with you. Some reforms may be in order.

    My relatives are in Singapore. It's only their children who are staying in their Australian houses which also functions as a holiday home for our big extended family. Both of them are doing their Phds in the UWA and UM respectively. They will be back when they finish their studies and the houses will still be holiday homes.

    By Blogger uglybaldie, At January 11, 2006 2:13 pm  

  • "On the issue of the drug quantities and the presumption of guilt based on possession, I have to agree with you. Some reforms may be in order."

    You bet! 2g of heroin? Gee...I'd think almost every heroin addict would be a trafficker!

    "My relatives are in Singapore. It's only their children who are staying in their Australian houses which also functions as a holiday home for our big extended family. Both of them are doing their Phds in the UWA and UM respectively. They will be back when they finish their studies and the houses will still be holiday homes. "

    Hmm why didn't their kids do their Phds in the National University of Singapore? Isn't it better?

    By Blogger Dr Oz bloke, At January 11, 2006 2:29 pm  

  • Hey uglybaldie,

    are you an Australian PR? Or your relatives?

    It might explain why you stay 6 months there on and off. To satisfy the PR renewal requirements?

    But it's good to have Oz PR and SG citizenship. More options. I'm sure that if SG allowed dual citizenship, many of us would take it.

    By Blogger Dr Oz bloke, At January 11, 2006 2:31 pm  

  • Hi OZ,

    Just finished my lunch and have to go for my karaoke session with my buddies.

    To answer your questions:

    They did their masters in Singapore and on my suggestion are pursueing their studies in OZ to add breadth and international exposure and recognition to their specialised fields.

    Yes, I have OZ pr years ago. I will only give up being Singaporean over my dead body. For you, you should do likewise. You never know what these Gwailous are up to.

    Gotta go. Talk to you another time.

    Cheers! Burp! ZZZZZZZZZZ

    By Blogger uglybaldie, At January 11, 2006 3:36 pm  

  • Hello uglybaldie,

    This scintillating repartee is blinding :)

    "skewed with the "we know best" bigotry."
    - I beg to differ. I am simply proferring my opinion, as you are. I have not as of yet mentioned that I personally think our govt here has grossly mismanaged health. I personally believe in free and equitable health care for all, and we are currently heading towards a US-type health care system...with different standards of healthcare for rich and poor. I personally find this a very disturbing trend. But that is just my opinion. And our waiting lists are far too long in the public system - but not for those who can afford private health insurance. Not good.

    Plus I would imagine a propensity for more "clamorous rants", as you so delicately put it, when one is ravenously hungry! :)

    I have travelled to about two dozen countries, including 3 in SE Asia (not singapore, though), and worked in 3 different countries. I have Singaporean friends..but that makes me no expert...

    "Finally, for your further information, I have relatives in Perth and Melbourne and I live with them for 6 months of the year if I have nothing better to do here or I just feel like it."

    Sounds as though you don't have to work too hard yourself, lucky fella! :) You are awfully disparaging, I must note, for somewhere you choose to live half the time, and where you send your children for education !! ;)

    BTW, you haven't answered my questions....??

    I do not think either Oz or Singapore is better or worse, to make it very clear. Just different. I just enjoy this humorous blog, and enjoy the intelligent discourse that springs from it.

    One last thing...what are "Gwailous" ?

    By Anonymous dr epicurus, in oz, At January 11, 2006 4:06 pm  

  • "Gwailous" is cantonese for caucasians. Literally it means "Ghost/monster men".

    It's a racist remark. Other common racist terms used to refer to caucasians are ang mohs (red hairs) hong moh gwai (red hair monster).

    To uglybaldie : Actually the only reason why I won't give up my Singapore citizenship is because I want more options. I would much prefer to be a Singapore PR than a citizen though.

    Can you explain to me what the advantages of being a Singapore citizen over a PR? I know that there are many disadvantages most notably National Service and reservist liability, but can't think of any significant differences between Singapore PRs and citizens besides that.

    Oh and of course the voting privelege is a waste of time since I have never even had the chance to vote before. Most elections are walk overs in my GRC.

    I doubt I'd feel any different as a Oz PR vs SG citizen. Probably would never have to cast a vote my entire life! :)

    By Blogger Dr Oz bloke, At January 11, 2006 4:30 pm  

  • Come to think of it an Oz PR has more privelleges in Oz society than a Singapore citizen in Singapore!

    By Blogger Dr Oz bloke, At January 11, 2006 4:31 pm  

  • Dear Dr. Epicurus,

    After a late night out with the boys exercising my vocal chords singing Bee Gee hits, I'm back this late morning to exercise my mental chords with a philosopher!

    Incidentally, the Bee Gees were the best thing that ever came out of Australia.

    First thing first, I think you are hankering for an answer to your question as to whether I would turn my children in if they are drug addicts. Actually, for me, this question is academic. So as not to digress, I will answer your question straight: Yes I would turn them in to be rehabilitated instead of indulging in a lifetime of misery, possibly culminating in death. Any parent who says otherwise just don't have the courage to face the truth, unpleasant though it may be. The question whilst curly, deserves a straight answer and you just heard it. Ours is a very Eastern orientated family with strong confucian values.

    I respect your views greatly. I am privileged to have the opportunity to share some views with a disciple of Epicurean values.

    If you read my earlier comments carefully, the opinions of your country's health care system were not mine but someone else which I quoted. Here, I would like to offer my apologies for not asking her permission before quoting. I have never had an occassion to use any of your country's public health benefits so I truly in all honesty don't know how good or bad it is. But I can tell you this. Here in Singapore, a hip replacement if urgent enough can be surgically done within two weeks within the public health care system. A private Orthopaedic surgeon when faced with the same request would ask you whether you can get ready the day after tomorrow. We don't claim to be the best but in my mind, we are up there amongst the clouds.

    Whilst you can say I sound "disparaging" the intention is anything but. Having said that, I must mention that my family and I are to an extent Australia's benefactor insofar as her country's invisible exports are concerned. The houses, cars and postgraduate studies costs money. Inflows of that money from Singapore and other countries such as Hong Kong provide partially, the benefits of employment and the health system to Australians.

    And I can hardly stand idly by when you infer that my country is orwellian. Since you fired the first salvo, I can hardly be a disinterested bystander. That's cricket mate.

    One last salvo across the bow:

    Whilst I enjoy your country's open spaces and resources at a cost, I would never live there permanently. Australia still has a long way to go before becoming a truly multi racial, multi ethnic society. Of course, some Australians are the exception but the road to full status as a true Australian for the minorities is not just round the corner, it is way into the outbacks.

    If I really want a nice place to live out my twilight years, Lijiang in Yunnan province, China, close enough to an area that Westerns call Shangrila would be that place.

    By Blogger uglybaldie, At January 12, 2006 12:35 pm  

  • Hey uglybaldie just out of interest, did you ever serve national service?

    Do reservist in camp training? Are you still active in NS?

    By Blogger Dr Oz bloke, At January 12, 2006 1:01 pm  

  • Uglybaldie (and dr oz bloke whose comments I also find intriguing0 -

    Thank you for your erudite and considered comments - I agree that my Orwellian comment was a tad insulting, although meant largely in jest, and I apologise in retrospect. And we both seem to agree the BeeGees were a great export ! It actually sounds to me as if the timeliness of healthcare delivery is much superior there to here.

    BTW I am not an advocate of Epicurean philosophy - how I came to use the moniker is a very long story indeed that I won't bore you with. Suffice it to say I am not a believer in a hedonistic lifestyle in the sense that some interpret epicurus, I also think his views on skepticism relative to sensory input bollocks...but I shan't inflict my views any more beyond saying I interpret one of his fundamental tenets as the pursuit of happiness in the altruistic Buddhist sense as something I value. Enough of my waffle !! Such rampant digression...but one last thing..I would be interested in reading more about Confucian philosophy, any good sites/refs you could point me to ??

    Cheers mate (as we say here!)

    By Anonymous dr epicurus, in Oz, At January 12, 2006 1:32 pm  

  • Dear Dr. OZ,

    Sorry, I had to spend some time with my granddaughter as she was calling for me.

    I was born the year after the Japs learnt a lesson they still remembered till today so regretably I didn't enjoy the privilege of bearing arms for my country and training under the Israelis who are in my view, the finest soldiers in our era. They have to be. They are fighting for the right to live. Same for this country although many don't realise it.

    I had to satisfy myself with a .38 smith and wesson sidearm whilst serving in the Special Constabulary.

    I really can't advise you about the advantages or disadvantages of citizenship in Singapore or Australia because it was never ever a consideration for me and my family when we got our pr. Actually come to think of it, the application was done more for the fun of it than anything else. We are Singaporeans and we will die as Singaporeans. Period.

    By Blogger uglybaldie, At January 12, 2006 2:40 pm  

  • Hi Doc Epicurus,

    Well we seem to finally share the consensus "To Each His own". And we agree to disagree. Thank you.

    I am sure you will find sites aplenty when you google the word "Confucius" so I shall leave the enlightenment to the net.

    However, be aware that it is a philosophy of human conduct from ancient China so the only true texts are written in Chinese. A translation to English, no matter how expertly done will never ever capture the essence of the Sage's teaching. Our family is effectively bilingual. Besides, its values are handed down from generation to generation so it is not something that can be encapsulated in a reading or two.

    But good luck to your search for learning philosophy from the sages. Their teachings along with other philosophers will endure till the end of time.

    I have great admiration for individuals who value the teachings of those who passed before them.

    By Blogger uglybaldie, At January 12, 2006 3:47 pm  

  • This won't succeed in actual fact, that is what I believe.
    do not forget 2 | this 4 | look 2 you may check | also 6 | nice check check 2 | also 8

    By Anonymous Anonymous, At January 04, 2013 9:02 pm  

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