Angry Doctor

Friday, March 31, 2006

Memo to Officer-in-charge

Dear Sir/Madam,

Thank you for sending the patient back to us for an update of his condition. He has informed us that it is your department's policy that memos from doctors are only considered valid for six months from the date of issue.

As indicated in our last memo, the patient is blind in both eyes and has had a below-knee amputation of his left leg. We regret to inform you that he had not sprouted new eyes nor has his leg grown back. As such, he is still classified as 'disabled'.

We would like also to inform you that it is unlikely that he will grow a new pair of eyes or a new leg, and so his 'disabled' status is unlikely to change in the conceivable future. Kindly consider exempting him from the stipulation of having to obtain a new memo every six months.

Thank you.

angry doc

Tuesday, March 28, 2006

The Silent War

Tan Tock Seng Hospital has put up an e-book on their site to commemorate 'Singapore's 3rd SARS-free year' .

The contents page is here. You can read the various chapters by clicking on the respective headings.

Friday, March 24, 2006

Gongxi Facai

Once in a while an appreciative patient will wish angry doc well with a 'Have a nice day, doctor' or a 'God bless you, doctor'. And then once in a while a patient (usually the little old ladies) will wish him 'facai' (make lots of money), as one patient did today.

Patient: Thank you, doctor. I hope you 'facai'.

angry doc: No lah, doctors make money off sick people; we cannot 'facai' lah.

Patient: But you should - otherwise your heart will not be in it. If you get fame and fortune from your practice, then your heart will be in it.

angry doc: Er... OK. Thanks.

I'm still not sure what to make of what she said...

Saturday, March 18, 2006

Your Courage Fund at work

Thursday, March 16, 2006

Purple Heart

Tuesday, March 14, 2006

Comparative Advantage 2

Mr Koo, whose letter I featured in a previous entry, has made a comment on this blog. Now this is probably off the usual scope of the blog, but he argues his case well and I thought I should reproduce it here:


I am zhixuan. I am stimulated by some of the arguments you've made against mine. Many are very relevant (or perhaps over-used) arguments that are present today against globalisation as a whole.

First and foremost, I am not one who supports globalisation or cross-border trading of goods and services without restraint. I believe there should be a certain amount of regulation. The consequences of not doing so would be disastrous (the point you made of the rich getting richer and the poor being poorer). As it is in Kofi Anan's opinion, 'Globalisation is not an objective reality, but an ideology of predatory capitalism'. I believe this sums up your arguments against the outsourcing of the radiology profession. And this is absolutely true in the world today. The breakdown of the Cancun trade talks in 2003 allowed the world to finally understand the frustration felt by Third World countries

But to see these obstacles and cease taking this path is suicide. In fact, my reply to Dr Low's comments should not be seen as an idealistic advocation for greater liberalisation of free trade in all industries. My reply is simply an attempt to rationalise what I've observed in the real world today. That is to say, while we are still here debating and bickering about what should or should not be 'globalised', millions are already embracing this revolution. Not just the rich, but the poor are beginning to come to terms with it as well. Globalisation, in my opinion, is no longer an ideal concept, but a prevalent phenomenon that will continue to impact all industries and professions. How much we progress will not be determined by whether we accept the realities of globalisation, but how we employ them to our advantage.

The cost of the Industrial Revolution was more than the costs of buying and maintaining machines. There was also exploitation of the workers in the forms of child labour, hazardous work conditions, and poor or absent benefits. Even today many workers in factories in Developing Countires work under such conditions. We may be beneficiaries, but let's not forget there are also victims when we 'move forward'

A gentle reminder would be that the exploitation of workers is an act of injustice prevalent since the birth of commerce. No doubt that before, during and after the revolution, the exploitation of workers was always an issue. Even today, it can be found in the most closed up regimes (North Korea etc). Similarly, it can also be found in socities promoting the free market economy (USA, UK etc). Yet it is in the very process of moving forward, opening up to other countries that these injustices can be brought to light and be condemned by the international community.

Perhaps not explicitly explained in my original post, the people whom i claimed obstinately opposed the Industrial Revolution were simply using the 'costs of buying and maintaining machines' as an excuse. These were workers who couldn't accept the fact that they had lost their jobs to machines, which could perform the same duties so much more cheaper and efficiently. Instead of accepting the change and finding out how they can adapt and be valuable to the new economy, they went around committing acts of terror, i.e. setting fire to factories, killing industrialists. Forgive my impudence, but if you scale their actions down a few times, they would very clearly resemble those who are against the outsourcing of radiology today.

...If a poor man who has only 20 cents wants to buy the last loaf of bread from a baker to feed his family, would you offer the baker 50 cents for that loaf of bread just because you don't want to spend a dollar getting it from your usual baker?

The answer is yes. In the free market, I, as a consumer, am obliged to choose the lowest available price for any given good/service. (To the hyprocrites who say no, i suggest you stop wearing clothes and consuming food imported from foreign countries. For I can assure you that many people 'suffer' too for every new Giordano T-shirt you put on, every bite of that MacDonald's burger in your capitalistic hands). I understand, however, that in giving this baker 50 cents, I will be making him richer than if he had sold that loaf of bread to the poor man. And with this 50 cents, the baker will turn around and look at the poor people around him. He sees the poor man who wanted to buy his loaf for 20 cents and decides to use the 50 cents to buy the vegetables the poor man sells for a living. Not out of compassion, but because this baker wants and can now afford to eat vegetables. This poor man is now 50 cents richer. He might not have the bread he originally wanted, but using the 70 cents he now rightfully possess, he realises he is able to feed his family much more sufficiently than he had been before.

If you have read economics, you wouldn't look at the above as idealism, but a classic analogy of the multiplier effect of macroeconomics. Perhaps we are all, at times, guilty of the mistake of putting ourselves above economic mechanisms (The engines of which are the assumptions of consumer rationality and individual rights). Perhaps it is time to start trusting the Invisible Hand, and instead of interrupting a win-win situation by our self-imposed moral high ground, we should allow the market to take its own course. When 2 parties are willing to come together to trade, allow them! Who are we to put a halt to this? As Adam Smith so aptly concluded, 'It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest'.

I wonder how happy Mr Koo will be when the day comes that Singapore becomes a successful medical industry exporter and when all our best and brightest doctors have been exported to work in Developed Countires, and Singaporeans themselves cannot get adequate or timely healthcare. Import cheaper doctors from overseas? Well, why would them want to work for you when there are obviously higher bidders who have already bought your doctors?

The problem with many Singaporeans today with regards to the issue of globalisation is the failure to have a paradigm shift. Many see globalisation as a threat to a small country like Singapore. Considering our size, what future would there be for us if we open up and allow billions of foreigners to compete for our jobs? Instead of fearing that 6 billion would want to squeeze and compete with 4 million, I would choose to see the opportunities that can be reaped when 4 million are brrought to a market of 6 billion. If this isn't your perspective, you have certainly not understood the problems facing our economy today-which is one reaching saturation point; graduates are having difficulties getting the jobs they want; the government urging us to expand abroard; the government's desperation in signing Free-Trade Agreements (to that extent that they can support imperalism-US' war against Iraq) etc etc. Perhaps before worrying about emptying our supply of local doctors in the event where we export all of them (an unrealistic presumption by the way, just look at the ratio of number of people applying for medicine vs number of people studying medicine. Once again, trust the market forces! If Singapore would become such a powerful medical hub, the number of medical students will definitely increase proportionately!), we should worry instead that if we allow the medical profession to be immune to the forces of globalisation, so too will the other professions and the industries want to follow suit. And if you do not think others have a case like yours, the next time you meet a retrenched plumber, try explaining to him that he deserve to lose his job to cheaper foreign workers but not doctors because doctors are more important than he is in serving the local population.

Back to my first point regarding the Cancun trade talks, the poor aren't against globalisation as we might so think. They are against double standards set by the developed countries. For example, when they follow the rules set by WTO by allowing firms of developed countries to build factories on their land to exploit cheap labour, they feel betrayed when these countries erect tariffs as a form of protectionism against their relatively cheap exports. It is not globalisation that harms the poor, but the denial of the advantages they rightfully deserve to enjoy. Ban the outsourcing of radiology, ban the takeover of US ports by Dubai-based firms, you will safeguard the jobs and income of the local population, but do not, DO NOT expect those of the Third World countries to be grateful.

If you want to know more of where I stand, you might consider reading Thomas Friedman's 'The World is Flat' and Richard Florida's 'The Flight of the Creative Class'.

Thanks for allowing my article to appear on your blog. I am honoured. All the best to you! :)

Thank you, zhixuan.

Understanding that capitalism can be 'predatory' and that globalisation may not always be fair to all parties involved does not mean that one automatically has to reject capitalism and globalisation. This is a false dichotomy. As you have said, it is not the concept of globalisation that is wrong, but the way it is being practised. Globalisation can be more than just exploitation of a poorer nation's labour or resources, it can also be tempered with regard for the needs of other nations.

We, as consumers, are not helpless victims in a grand scheme that is inexorable or irreversible. We make our voice heard every time we excercise our choice and vote with our wallet. We are not 'obliged' to go for the cheapest or fastest goods or services. We can pick the ones that come from a business where workers are treated fairly, or that which harms the planet less. We may spend more, or have to put up with less efficiency, but we have a choice.

What I am advocating is an awareness that efficiency do not always equate to happiness, and that profit do not always equate to good.


I battled SARS and all I got was...

... S$2?

OK, enough doctor-bashing.

This week, let's remember the healthcare workers and their contribution during the SARS crisis three years ago.

(Thanks to K for supplying the pictures for this series.)

Friday, March 10, 2006

Comparative Advantage

angry doc is angry today. Angrier than usual, that is.

I count five letters on the issue of teleradiology on the ST Forum today.
One in particular asks a very relevant question: if the purported reason is to save moeny, where is the savings to the patients?

But the letter I want to rant about today is
this one.

I will interspace my comments within the text.

Comparative advantage at work in teleradiology service

I REFER to the letter 'Isn't it cheaper and better to have in-house radiologists?' (ST Forum, March 3) by Dr Shoen Low Choon Seng.

Teleradiology is not something new. Many advanced countries are practising it and this signals the fact that this trade is profitable and sustainable. Medical industries are often highly regulated and it is unthinkable that the governments of these advanced countries would invest in a form of trade that is as unprofitable as described.

Addressing Dr Low's first concern, I would like to point out that the overhead costs of any new business or trade dealings will always be high. To reject this path because of the $2.3 million initial cost resembles a minority who rejected the initial stages of the Industrial Revolution because of the cost of buying and maintaining machines. Thanks to the majority who believed in moving forward, today we stand as grateful beneficiaries of the revolution.

The cost of the Industrial Revolution was more than the costs of buying and maintaining machines. There was also exploitation of the workers in the forms of child labour, hazardous work conditions, and poor or absent benefits. Even today many workers in factories in Developing Countires work under such conditions. We may be beneficiaries, but let's not forget there are also victims when we 'move forward'.

The sum of $2.3 million might not seem so high if medical practitioners in Singapore are willing to utilise and support this system, for in so doing the cost per X-ray reported will be decreased. Spending this amount of money might also be justified if we understand 18th-century economist David Ricardo's theory which states that 'each country should specialise in producing the good for which its comparative cost is lower'. Comparative advantage is the main basis for most economists' belief in free trade today. The idea is this: A country that trades for products that it can get at lower cost from another country is better off than if it had made the products at home.

Clearly, the comparative advantage (cheaper labour costs in India, the allocation of local radiologists to more promising industries) will outweigh the $2.3 million cost.

I'm not sure the practice of medicine should be viewed merely as a tradable commodity. In fact, I suspect a better strategy would be for each nation to be at least self-sufficient in its own basic healthcare needs, inasmuch as that is possible in this day and age of globalisation.

It may be nice to see that we are saving money when we employ cheaper radiologists, or import nurses from the Philippines, but perhaps we should also stop and think of all the patients in India who now have to wait longer for their X-rays to be read, and all the patients in the Philippines who can't get healthcare, because their nurses (and even doctors) have gone overseas to work as nurses there.

Should a nation sell its bread to its richer neighbours when its own people do not have enough to eat?

Or to put it in another way: If a poor man who has only 20 cents wants to buy the last loaf of bread from a baker to feed his family, would you offer the baker 50 cents for that loaf of bread just because you don't want to spend a dollar getting it from your usual baker?

Dr Low's second concern of whether the radiologists in India are legally liable to our laws or medically well-trained is a relevant one.

As a medical industry, the overriding principle that the welfare of patients is maximised must be enforced and cannot be compromised for the sake of profit. From this perspective, many might see a dead end to the path of globalisation for this industry. However, I see an endless spectrum of opportunities.

For isn't this the best time to export our legal and medical professions, and in so doing make Singapore both a medical and legal hub in this region?

Koo Zhi Xuan

I wonder how happy Mr Koo will be when the day comes that Singapore becomes a successful medical industry exporter and when all our best and brightest doctors have been exported to work in Developed Countires, and Singaporeans themselves cannot get adequate or timely healthcare. Import cheaper doctors from overseas? Well, why would them want to work for you when there are obviously higher bidders who have already bought your doctors?

We live in an interesting and exciting time when technology allows us to have better things faster, often at a cheaper price. I have nothing against teleradiology or importing of doctors to work locally per se, but I am uncomfortable with the idea that this is the solution to all our healthcare problems and that it is 'good' just because we can save some money. Let's not forget to count all the costs behind this convenience and economy, and wonder what it will be like if the shoes were on our own feet.


Thursday, March 09, 2006

Better, Faster, Cheaper 2

Teleradiology cheaper, faster and of good standard

IN THE letter, 'Isn't it cheaper and better to have in-house radiologists?' (ST, March 3), Dr Shoen Low Choon Seng asked if it would be cheaper to station a radiologist at Ang Mo Kio (AMK) Polyclinic, rather than outsource reading of X-rays to Bangalore, India, via teleradiology. It would not be cheaper. With 700 X-rays per month, his proposed arrangement would cost AMK more than $30 per X-ray just to cover the radiologist's salary. This is much more than AMK pays India.

As a trainee radiologist, Dr Low should know teleradiology has a proven track record and has brought sustained benefits to many patients in hospitals in the United States. It is not merely cost savings, but more important, faster turnaround time and often even better quality reports. Our brief experience so far has already demonstrated these benefits.

Dr Low raised the issue of legal liability. This is important in any outsourcing arrangement. It was fully and satisfactorily addressed in the US, even within the strong culture of medical litigation there. The key is to ensure that the appointed provider is appropriately accredited.

In this case, an assessment was carried out thoroughly. The Ministry of Health appointed the College of Radiologists as the accreditation body to determine the provider's suitability. The college conducted a site visit in Bangalore to assess the facilities and processes, and found them to be good. The college also noted that the provider was accredited by the Joint Commission on Accreditation of Health Care Organisations, the largest accrediting body on health care in the US. The college further tested the provider's proficiency and was satisfied with its standards.

The National Healthcare Group, which runs AMK Polyclinic, is legally accountable to its patients for the quality of its radiological services, including X-ray reports that are outsourced. Indeed, doctors are not new to cross-border consultation. Occasionally, doctors send tissue samples overseas for reading by foreign pathologists. Doctors who do so remain accountable to their patients here.

The delivery of health care will continue to be further globalised as a result of technology and the Internet. This opens up many opportunities. We should be alive to such opportunities, so we can bring such benefits to our patients, as pointed out by Mr Paul Chan Poh Hoi in his letter, 'Outsourcing is the right way to cut costs' (ST, March 4).

Teleradiology and any kind of outsourcing need not necessarily take place across borders. Our public hospitals and polyclinics will readily outsource reading of X-rays to local radiologists, when they can offer a similar or higher quality service as Bangalore at lower cost. Such competition will be good for our patients.

Karen Tan (Ms)
Corporate Communications
Ministry of Health


Globalisation of healthcare in the form of teleradiology and employment of 'foreign' healthcare workers has a very real human cost.

When you build a factory or an industrial park in a Developing Country, you provide employment for people who might otherwise be unemployed. When you employ trained healthcare workers to work for you rather than their own countrymen because you can pay them more, I think ethics come into the picture.

You are getting cheaper X-ray reports, nurses and doctors, they are losing essential healthcare workers.

Dr Crippen calls it 'exporting our healthcare problems'. It doesn't sound as grand as 'globalisation', but I think it gives a new perspective to 'progess'.


Wednesday, March 08, 2006


A letter by Dr Huang Shoou Chyuan ws published in Today a few days ago and reproduced in the comments left on another post by gary.

Dr Huang and I seem to share the same sentiments, and I didn't dedicate a post to his letter as I thought we were really harping on the same points.

Interestingly, Dr Huang's letter was published again today, this time on the ST Forum. Now assuming they were the same letters to begin with, you can actually tell which were the parts that were edited out by the editor at Today. I reproduce the letter as it was printed in the ST Forum, with the bits edited out by the Today editor in blue:

Practice of medicine at the crossroads

THERE has been much debate about the medical profession in recent weeks and it is timely that we reflect upon some issues pertaining to it.

Medicine is a noble profession and the public has high expectations of those who have chosen this path. And rightly so too, as those who have gone before us included legendary men and women like Hippocrates, Galen, Lister, Pasteur and Marie Curie, just to name a few.

In Singapore, our early torch-bearers included giants like professors Gordon Arthur Ransome, Seah Cheng Siang, N. Balachandran and Chao Tze Cheng, all of whom belonged to an earlier and nobler era. It is incumbent on us to pass on their legacy to our more junior colleagues.

The practice of medicine is at the crossroads.

Unlike before, when a specialist doctor in private practice could be referred to only as a 'specialist in private practice' in the local press and a doctor risks being dragged before the disciplinary committee of the Singapore Medical Council for 'unprofessional conduct' if his photograph gets printed in the newspaper, the pendulum has now swung to the other extreme.

Many now strut around like some centrefold media superstar in the most unlikely magazines. 'Glam' sells and these coffee-table tabloids naturally fly off the racks.

I suppose for some doctors, 'any publicity is better than no publicity', so long as some financial benefits are to be had. Contrast these with other role models like Drs Tan Lai Yong (Yunnan, China) and Andrew Ng (Niger, Africa) who, without publicity or fanfare, use their professional skills to lessen the sufferings of mankind.

The tragedy with the mantra, 'Medicine is now just another business', is that some among us are beginning to believe that it is true. How can we blame them when our medical watchdog authorities appear to stay silent even when there are doctors who unashamedly proclaim in the media to the effect that they would pander to the patients' requests for procedures even if these were professionally unwarranted?

Not all of us are anachronistic dinosaurs who nostalgically pine for the 'good old days' when things were simpler. Most recognise that globalisation is indeed irreversible and that we have to learn to grapple with both the good and the bad that it entails.

The challenge facing us is how the medical profession is going to harness the tools that modernity affords us and, by self-regulating moderately, ensure that the 'outliers' in our profession do not tarnish the good reputation that our forebears had so painstakingly built over the centuries.

Only in this manner can we stay true to our noble roots, and ensure that the public continues to have deep trust in the integrity of our profession.

Fortunately, hand on heart, I can vouch that most doctors I know (both GPs and specialists alike) are dignified and remain true to their vocation.

Practising medicine helps to bring home the bacon, but it is more than just a business for them. They probably no longer swear by 'Apollo Physician and Asclepius and Hygieia and Panaceia' as enshrined in the classical Hippocratic Oath, but they most certainly apply their knowledge 'for the benefit of the sick according to (their) ability and judgment'.

For the Hippocratic Oath, see

Dr Huang Shoou Chyuan
(Specialist in private practice)

Granted the main points of the letter have not been changed, but it's stuff like that that make me wonder each time I read a forum letter what exactly had been edited out.


Monday, March 06, 2006

Maintenance of Parents Act

Dr Crippen wrote about a patient of his, an old man who is in need of a carer but whose estranged son would not take up the duty.

I made a comment about the Maintenance of Parents Act we have here in Singapore, and Dr Crippen, a lawyer himself, was keen to know more about it, so I googled it up and had a read myself.

Now Dr Crippen commented that the issue must be a 'minefield', and it seems the persons wording the Act expected 'trouble' too, as evident from the following clauses:

"The Tribunal shall have the following powers:

(a) to dismiss frivolous or vexatious claims at a preliminary stage on the basis of the affidavits and other documentary evidence;"

"Any person who —

(a) assaults, wilfully insults or obstructs the President, a member or an officer of the Tribunal or any witness during a sitting of the Tribunal or while the President, member, witness or officer is on his way to or from such a sitting;

(b) assaults or wilfully insults or obstructs any person in attendance at a sitting of the Tribunal;

shall be guilty of an offence..."

I remember the media buzz around the issue when the Bill was being debated in parliament, but frankly I don't know of any of my patients who had applied for maintenance under the Act, nor do I know how many persons have applied for maintenance successfully.

I did have many patients who came to the various clinics I sat in alone or accompanied by only the maid, and it could be hard at times to communicate effectively the information required for the care of the patients. The appointment could be as infrequent as once every three to six months, and the date be fixed as early as three to six months in advance too, but their children would never be free to accompany them. The only time you would see the children was when something had gone wrong and they wanted to lodge a complaint, and then each would try to prove himself the more filial child by outdoing the other in the vehemence of his indignation.

All of a sudden they had time to come to the clinic.

These patients were not literally abandoned by their children, nor did they lack the money to pay the medical bills, but I've always felt they were neglected.

Well, I guess the law can compel one to give money to one's parent, but not care.

Friday, March 03, 2006

Hubris and Nemesis

I was thinking that the Hippocratic Oath was too one-sided, in that it demanded too much of doctors, but offered them little protection.

But perhaps I was wrong.

The Greeks were a smart bunch of people, and perhaps Hippocrates foresaw the state we would be in today all those centuries ago, and gave us this warning:

If I keep this oath faithfully, may I enjoy my life and practise my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

(Notice that the SMC Physician's Pledge does not contain an equivalent clause.)

Perhaps the colleagiality and blameless conduct demanded in the Oath were in themselves the best protection doctors could have against attacks on our profession.

Perhaps what our profession needs is not 'progress', but a regression to a more traditional ethos, when we saw colleagues as brothers instead of competitors, and patients as vulnerable people who needed our help, and not as clients or customers.

Perhaps angry doc is just too philosophical today, after learning that a senior colleague had willfully gone against a policy that compromised patient care, at the risk of his own career advancement.

Perhaps I should just lay off the sherry...


Doctors' Charter?

In her letter to the ST Forum published on 28 Feb, Dr Helen Tan wrote:

"Patients complain about doctors all the time. But is there an avenue for doctors to address their grievances? Who can we complain to?

We need a doctors' charter to look into the rights of doctors."

I didn't write on this topic because I thought it wasn't necessary to have a Charter, since we supposedly have the SMA fighting for us. But this letter in the ST Forum today made me thin about the issue again.

Why do doctors need a charter when they have taken Hippocratic oath?

I FIND it strange that Dr Tan Hui Mien, Helen should call for a doctors' charter ('Need for a doctors' charter', ST Online Forum, Feb 28) when doctors take the Hippocratic oath before they start to practise.

The profession of healing and saving life is different from the work of trading goods. Teaching, for example, is a noble profession that commands high esteem. No teacher would ask for a teachers' charter to look into the rights of teachers.

The relationship between doctor and patient is similar to that between teacher and student. Both professions call for compassion and understanding.

Patients and students always respect doctors and teachers respectively as people of high moral standing. The laws of the country protect both sides. A charter is required only when the laws are not favourable or not adequate for one party.

If a doctor cannot establish a good relationship with his patients, he needs to reflect on what is missing and not what is needed to protect his interests.

Should patients require a charter to look after their interests too?

Paul Chan Poh Hoi

Now that's like asking why women need the Women's Charter when they already have their wedding vows.

Why do we need laws to protect the battered wife when the husband has already promised to love and cherish the wife till death do them part?

Saying: 'If a doctor cannot establish a good relationship with his patients, he needs to reflect on what is missing and not what is needed to protect his interests' is like asking a battered wife to reflect on why she deserves to be beaten. Just as not all husbands are loving and non-violent, not all patients allow a good patient-doctor relationship to be formed between themselves and their doctors.

In any case, nothing in the Hippocratic Oath says the doctor cannot defend himself against unfair accusations from the patient, which was Dr Tan's main worry.

Mr Chan himself had written: A charter is required only when the laws are not favourable or not adequate for one party. I believe it is exactly this sentiment that prompted Dr Tan and others to write to the Forum, and for Dr Tan to call for a Charter.

The reason why there was a need for legislation on domestic relationship is because of the fact that the family relationship has broken down such that we cannot rely solely on traditional sense of obligations and duties to protect all parties in a family. Has the patient-doctor relationship come to that stage?

The legal responsibilities of the doctor to his patients has existed since the first laws of Mesopotamia had been engraved in stone, and malpractice today is a field of its own in legal practice, so I don't think we need further legislation to protect the patients or to detail doctors' obligations.

What we seem to be lacking is the sense and awareness of the patient's duties and obligations. So maybe Mr Chan's idea of a Patients' Charter, in which is spelled out a patient's rights and obligations in a patient-doctor relationship, including what the limitations are on liability on the part of the doctor in case of the patient's non-adherence and non-compliance to treatment, as well as what forms of complaints on a public forum against a doctor may be held as defamatory and not covered under 'special privilege', has its place too.

Will it happen?

I think it will eventually, if we do not address this perceived imbalance in the rights and obligations between patients and doctors felt on the part of the doctors.

Do I want it to happen in my life-time?

Well, let me put it this way: do YOU ever want the Women's Charter to be invoked in YOUR marriage?