Angry Doctor

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.

Labels:

77 Comments:

  • sigh. sad. resigned to fate.

    By Blogger Dr Oz bloke, At March 10, 2006 1:30 pm  

  • "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."

    OK...sounds reasonable enough... But then, he goes on to say:

    "However, I see an endless spectrum of opportunities."

    In other words, '$$$ *ka-ching* $$$'.

    So are we surprised then, that Medicine is becoming somewhat like a previously untapped goldmine?

    By Blogger aliendoc, At March 10, 2006 3:45 pm  

  • Doctors should wake up their ideas that they are nothing better than highly paid (??) workers that add little to the economy unless u are bringing in money to Singapore.

    The real world u live in is simple.
    U are paid by how much money u bring in unless u are in public sector. That's why the day doctors got kicked out of the public sector is the day when the public starts to think that doctors do not add enough value to be paid so much (???) in their eyes.

    Thus NUS should consider starting MBBS with MBA to produce doctors who can speak the language of finance (ROA, ROE, time value of money, Internal rate of return) and thus help the govt levage on healthcare and export top quality healthcare to the world.

    In a highly competitive world, it would be wise to exploit others rather than get exploited yrself. It is actually a good idea to hire foreign doctors but a bad idea to pay them the same salary.

    As always add value in what u do rather u are a remiser or a doctor or nobody is spared from losing their livinghood.

    Less I end on a morbid note, there is still hope for surgeon especially plastic surgeon and hopefully they can show the poor radiologists and physicians in future the meaning of adding value and why they can charge a premium over others in Singapore.

    By Anonymous Ang Yee, Gary, At March 10, 2006 4:23 pm  

  • shucks..i was still considering radiology as something maybe i could specialise in..
    i think maybe i should go and sell cables so that we can receive more medical advice in the future from our friendly overseas doctor who are more cheaply employed..

    By Anonymous med student, At March 10, 2006 5:51 pm  

  • U can still do interventional radiologist. As long as u can stay relevant, u won't be out of a job.

    It is people who stick to their morales and those who think the world owes them a living and that being a doctor is a sacrifice they are making and thus their livelihood is secure who will find it difficult to survive in future.

    To finish first, u must first finish.
    To be able to help others, u should be able to support yrself first.
    Are medical students becoming selfish. Answer is probably but graduating with 90K of debts and starting pay of 2460 is no joke especially for those who borrow money who the course.

    Thus stay relevant and be on yr toes. Iron bowl are for soldiers and civil servants. Doctors aren't civil servants and take good care of yr financial health b4 u even intend to treat patients for free.

    By Anonymous Ang Yee, Gary, At March 10, 2006 5:55 pm  

  • Drug trials: unethical practices continue

    By DANIEL ALTMAN

    FOR drug companies, globalisation has brought a double boon: new markets and new testing grounds for clinical trials. Better information technology and transport infrastructure have made monitoring the ethics of those trials somewhat easier, but experts say problems are still proliferating.

    Eye-opener: The release of The Constant Gardener drew extra attention to the issue of unethical testing in developing countries. The film is based on John Le Carri's novel about a company using Kenyans as unknowing guinea pigs for a tuberculosis drug
    One Swedish-Tanzanian trial of an HIV vaccine seems to be doing things right, however. The issue of unethical testing in developing countries received extra attention with the release last year of The Constant Gardener, a film based on John Le Carri's novel about a Western company using Kenyans as unknowing guinea pigs for a tuberculosis drug. But real-life cases of questionable behaviour have been popping up with increasing frequency, too.

    Pfizer, which is based in New York, tested a meningitis drug called trovafloxacin in Nigeria in 1996, during an epidemic of the killer infection. Later, Nigerian families sued the company in the United States, saying their children had been entered into the study without their consent. The cases collapsed last summer over technical and jurisdictional details.

    More recently, the American military's Walter Reed Army Institute of Research and GlaxoSmithKline of Britain came under fire for testing a hepatitis E drug on Nepalese soldiers. The researchers first tried to test the drug on civilians, but rumours of bribes led to protests.

    Later, experts started asking whether the soldiers - many of whom may have been illiterate - could have understood the consent agreements they had signed and whether the effective but expensive drug would ever be available to Nepalese.

    'Companies in the later clinical phases of drug development are increasingly going to developing countries, for example India, where it is basically cheaper to do it,' said Dr Hans Hogerzeil, director of medicine policy and standards at the World Health Organisation in Geneva. 'You have a huge number of treatment-naove patients who have never been treated before and a lot of highly educated people and good infrastructure.'

    India is not the only popular destination for Western drug companies, however. Eastern Europe, Thailand, China, Brazil and Argentina are also favourite locations for trials, said Peter Lurie, deputy director of the health research group at Public Citizen, a US watchdog organisation.

    'Before, you couldn't get back and forth to these countries the way you can now,' he said. 'You couldn't share data electronically the way you can now. Even if people had the temptation to go overseas before because of less regulation, more compliant populations or study designs that they couldn't pull off locally, logistically it was not possible until recently. That's where globalisation comes in.'

    Need for guidelines

    Globalisation has also made monitoring overseas trials easier, Mr Lurie added, but the problem is still a long way from being solved. 'A given study in Malawi is easier to monitor now than it was before,' he said. 'Still, the ability to monitor what's going on in Malawi is so poor that, overall, the ability to monitor the totality of studies that are going on in the world has gone down.'

    That is why it is important to have clear international guidelines, with national laws backing them up, Dr Hogerzeil said. India has been making especially good progress in this area, he added. Yet even when those standards exist, practice does not always follow policy.

    Mr Lurie said even drug trials undertaken by public and non-profit agencies sometimes fell victim to ethical problems. Still, he said, these trials almost always meet one important criterion that often is missing from corporate trials: that the local population would actually be able to buy and benefit from the drug if it proved successful.

    A clear example is the Swedish-Tanzanian effort to develop a DNA-based vaccine against HIV. A prototype vaccine was tested first on Swedish citizens to make sure it did not have harmful side effects. But the prototype is not intended to treat HIV in Sweden; it is aimed at the subtypes of HIV that are most prevalent in East Africa. Later, the researchers may use the same platform to treat other subtypes.

    A decade ago, the research project, which received generous funding both from Sweden's official aid agency and from the Walter Reed institute, approached a group of Tanzanian policemen to gauge the prevalence of HIV, which was higher than in Sweden. Now, after lengthy consultations in Tanzania, the researchers have contacted the same group again to test the vaccine.

    Transparency has been a hallmark of the trial, said Eric Sandstrom, a professor in the department of infectious diseases at Karolinska University Hospital in Stockholm and a director of the study. He noted that the research offered no guarantee of medical benefits.

    'We are very clear on that point,' he said. 'Anybody who volunteers for the study does it for the good of the development of the vaccine. There is no reassurance that any vaccine today can offer any protection.'

    The trials, part of a 20-year history of cooperation between the two countries, are also intended to build infrastructure. 'It is as much a capacity-building exercise as it is a vaccine exercise,' Mr Sandstrom said. 'The trial will not be performed as many others, that we take the specimens back to Sweden or any other country. They will be performed locally, and the local investigators will be performing the test.'

    Pharmaceutical companies may not be quite so altruistic, but they may still have a powerful reason for sticking to ethical practices. 'It's not in anyone's interest to do anything that would ultimately result in a drug being recalled,' said a spokesman for Pfizer. 'You wouldn't spend a billion dollars if you're going to cut corners and it's going to ultimately be recalled.'

    'You're going to go into places where you can hold up to standards that are international,' she said. 'There is no easier, softer way. There just isn't.' - IHT

    By Anonymous Ang Yee, Gary, At March 10, 2006 6:11 pm  

  • So Gary, what's your point? What's your goal?

    Financial freedom? Financial wealth?

    Correct me if I am wrong. But you have no issues with quashing morals or compassion that comes between you and the pursuit of profits?

    I guess that's one way to go about it. I still find it strange that you chose to go the path of the medical adminsitrator as a way to solve your 90K of debts and starting pay of 2460 problem.

    So how much do they pay medical administrators?

    Granted the future in your mind is to become a businessman or CEO. Leverage. Good.

    But I guess not every doctor out there is as cold as you. As objective as you. As profit orientated as you.

    I suppose if you were on the board of interviewers looking for new medical undergraduates your criteria would be family financial background and a sense of business.

    Your very words reinforce my view of medical administrators.

    I sincerely hope your loved ones do not get some disease that falls into one of the less "lucrative" specialties like Renal Medicine and then find that there are no doctors skilled in that field at all.

    You see health care and relieving suffering are not just simple service businesses. You might not know it as a medical student, and perhaps never know it because you might never practise medicine. But when relatives bring their loved ones who are suffering to you, the last thing they'd expect is the doctor to view them as red colour dollar signs or black colour dollar signs.

    I would like to see how you fare as a patient in the future that you wish to create.

    By Blogger Dr Oz bloke, At March 10, 2006 6:30 pm  

  • At the end of the day, doctors should not be naive to hold on to ideals and speak from moral high grounds. We must not forget the realities of economics.

    But I do not think the way to go is to change our practice into a pure business transaction.

    From my experience that is not what patients and relatives want in the time of need. If your loved one is suffering, emotions overwhelm, you want the best, your loved ones deserve only the best. Anything less would be a tragedy in your mind.

    So the human touch is still very important. Just because you become an administrator does not give you the right or indemnity to shirk from those emotional expectations of patients.

    A balance must be struck.

    By Blogger Dr Oz bloke, At March 10, 2006 6:36 pm  

  • Dr Oz Bloke: Touche. I've found it increasingly difficult and scary to read Gary's replies, especially when he'll be joining our ranks soon. I hope his views are not reflective of his peers or what has been ingrained in the students because of the med school syllabus.

    By Anonymous Dr Quack, At March 10, 2006 8:12 pm  

  • Dear Dr quack,

    Strangely, Gary is actually quite enlightened to the negative aspects of medicine. Which is not entirely bad in itself. He is not the typical idealistic medical student out to change the world.

    Medical school does not actively go out to disillusion the undergraduates.

    However I am concerned because Gary does not acknowledge that being a doctor is not totally the same as being a businessman, even though business and economics are a part and parcel of life.

    The fact that he says he is going straight into medical administration and from what I've gathered recently, harbours high hopes to join the ruling party in politics worries me.

    He will fit in well there and be free to unleash his fury against us doctors trying to balance our duties as medical practitioners and the economics of survival in today's new world order.

    Terrifying.

    By Blogger Dr Oz bloke, At March 10, 2006 8:21 pm  

  • It's a sad, sad world...

    Forget about radiology...even therapeutic radiology is not a good option for those starting out...the field will be cramped with senior radiologists who have to make the switch. The other cluster will also follow suit soon..they have to justify the million dollar investment in the infrastructure..

    Juniors and medical students will stay clear of radiology. Diagnostic radiologists who are already in it will switch to therapeutic radiology. Very senior radiologist in their late forties and early 50s may find it too late to make the switch. They will have to consider emigrating...the NHS is still short of radiologists...

    By Anonymous pathdoc, At March 10, 2006 11:17 pm  

  • U all don't seem to get it.

    If we are rich like Bill Gates, 50 billion, we can actually eradicate malaria.

    So who is more noble Bill Gates or a doctor on a moral high platform.

    Money is so important that one should use it for good when one is financially independent.

    Warren Buffett (40 billion) is leaving almost everything to charity after his wife Susan died last year.

    These are yr role models in life.
    Become very rich and help those in need.

    The worst thing of all is to help others at the expense of yrself, yr family (90K for what? help patients who don't hestitate to sue if something goes wrong?)

    Become financially independent and then I can truly treat those in need and charge them either nothing or a nominal fee.

    Look at
    Name : Chong Weng Chiew (Member of Parliament)
    Constituency : Tanjong Pagar GRC
    Party Affiliation
    People’s Action Party

    Educational Qualifications
    1976-1985 PSLE, GCE 'O' Level (Catholic High School)
    1986-1987 GCE `A' Level (Hwa Chong JC)
    1988-1993 M.B.B.S. (National University of Singapore)

    Present Occupation/Appointment
    Jan-2003 30-Jun-05 CEO, Ang Mo Kio Hospital
    Jul-2005 Chairman, Compass Welfare Foundation Ltd

    Member of Parliament
    25.10.2001 Tanjong Pagar GRC

    He was asked to run for politics after he realised that there is little he can do on his own and he can do much more by joining the PAP

    Last but not least.
    Why do doctors think they are so important?
    People are starving in developing world and the true saints are those who invest in these countries and providing jobs for the natives.

    Mr Lee Kai Shing is also another great man who was recently criticised by "noble" doctors when he donated money to the HK medicial school.

    When will doctors learn that they are not the centre of the world. The really important people in this world are world leaders, world richest men, religious heads.

    They should be our role model.

    By Anonymous Ang Yee, Gary, At March 11, 2006 12:01 am  

  • They should really relook into the criteria for choosing medical students.

    If u are poor, and owe 90K in debt like me, is it so wrong to want to pay off the debt??

    If u are rich, and do not need to worry about the debt, will u understand what it is like to starve for days and not have enough money to see a doctor when sick.

    There comes a time when mankind come to a crossroad.
    One lead to utter destruction, the other to extreme depression.
    Let's hope they choose wisely.

    Paraphase from Woody Allen

    By Anonymous Ang Yee, Gary, At March 11, 2006 12:06 am  

  • http://home.austin.rr.com/austintxmd/Pages/intro.html

    A website to show what medicine could generate into if doctors do not seize power and learn how to manage their practice instead of relying on managed care.

    THE NEXT GENERATION OF DOCTORS
    Medicine used to be a noble "calling" that drew the best and brightest; but managed care is rapidly turning it into "just a job", and not a very good job at that.

    We work 50-70 hour weeks, nights and weekends without being paid any overtime or "shift differential" (heck, we don't get paid anything extra for being available 24 hours a day, 7 days a week).
    There's no pension plan except what we can manage to save for ourselves - and these days, that's nothing.
    There's no free health insurance paid for by our employer, because our employer is us.
    There's no paid vacation - our income goes to zero the minute we leave the office.
    The stress never stops.
    We're now forced to argue over the phone and justify our actions to people who barely graduated from high school.
    We're each responsible for the health of no less than 1,500 people - make even one little mistake, and the malpractice lawyers will be on you in a heartbeat, ready to take whatever you've managed to save.
    AND the pay is rapidly becoming downright lousy.
    Ask yourself if you'd be willing to go to school for 8 years after college for a job like that.

    Will We No Longer Reward Excellence?
    In this country we have always rewarded excellence, and that is precisely why we have so many excellent doctors. What will happen to the quality of health care in the future if the best and brightest college students decide they cannot make a decent living as doctors and therefore elect to go to law school or get an MBA instead? Why would a superior student consider putting himself/herself through all those years of punishing medical training and commit to a career that will always require long, stressful night and weekend hours if the future income potential is only marginal and declining? Do we really want our medical schools to be filled with mediocre students who could never have made the cut when all the very best college graduates were competing for those spots?

    Is that the kind of doctor you would want treating your family?

    By Anonymous Ang Yee, Gary, At March 11, 2006 12:22 am  

  • A/Prof Goh Lee Gan's Sharing
    (1) There are three Gs in this world: goodness, glory, and gold. Each of us tries to find a meaning in life in one or more of the three, hopefully in all three. The one that lasts longest and the hardest to live with is the first one -- but of course even Shakespeare is skeptical of that -- the "the good is interred in their bones".

    (2) I believe in the alignment of vision to do good. If the 3 Gs can be aligned, then the need to have pots of money to be a meaning in life will hopefully be muted a bit -- anyway, I am quite clear -- money is transient, effervescent, and to some extent, meaningless by itself.

    (3) Good doctors are those who despite the big odds, strive to serve mankind, without the promise of money. God eventually rewards them with a happy heart, a sunny smile, good health and a positive meaning in life: these are gifts and best rewards we can have. We will die happy.

    By Anonymous Ang Yee, Gary, At March 11, 2006 12:40 am  

  • Maybe somebody should forward this Gary Ang Yee's postings to the Dean. Then we can see if the medical schools administrators' views really coincide with his.

    I really hope I don't get this guy as my houseman. Or worse, my MP.

    By Anonymous Worried MO, At March 11, 2006 5:29 am  

  • I think gary is speaking as someone who is rather frustrated with the system. If u think about it rationally about some of the points he made, it sounds morally wrong but it is more truth than what most people would want to acknowledge.

    You do realise in this country a lot of decisions are made based on money alone. A lot of things are refurbished or built to attract foreign/tourist dollar and not really to improve the citizen's life per se. The latter is really a secondary concern.

    The real reason why the teleradiology thing emerged may very well be a part of fulfilling the free trade agreement we signed last year in India.

    By Anonymous Anonymous, At March 11, 2006 9:10 am  

  • The govt asks us to think out of the box and u want all medical students to think like medical school administrators.

    The goal of medical school is to produce good houseman to solve the problem of shortage in the public hospitals and then good specialists to solve the problem of a huge exodus to the private sector.

    The problem arises when specialists become more interested in money than helping their patients.

    In the past, doctors have pensions and need not worry about retirement. Now, they have to fend for themselves and no wonder many leave if they have higher pay in the private sector.

    THE MANPOWER QUESTION
    The question of how many doctors should be trained is not easy to predict. The perceived shortage of doctors in Singapore today is largely applicable to the Government sector.

    A survey of medical officers who left for the private sector in 1996 showed “poor pay”, “little or no career prospects” and “long hours of work” to be the top three reasons for leaving. “Poor treatment by superiors” was another reason for resigning.(1)

    Both specialists and medical officers are attracted to the private sector. The relatively free market sentiment in the private sector means doctors will charge what they can so long as the patients can and are willing to pay. The result is the workload per doctor in the private sector is smaller compared to that in the public sector and yet the doctors are able to earn more. They can therefore work at a comfortable pace. Doctors in the public sector face a domino effect. With each doctor leaving the public sector, the remaining doctors need to carry an increased load per person and the desire for the remaining doctors to stay is diminished.

    The focus on subspecialisation also means that as each specialist develops to a marketable value, there will be forces to induce him or her to leave for the private sector. The number of doctors who can provide training to younger doctors is thereby reduced. Without training, many medical officers in turn find that it is not useful to stay in the service.

    The Ministry has instituted several measures to retain its doctors and to increase its number. The promotion exercise did not stem the tide for the public sector doctors to leave. The new norms for promotion did not go down well with many doctors. In a system short of doctors, numbers are more crucial than excellence. Also, at the medical officer level, the level of competence are not widely different from one doctor to another. By delinking qualification and pay, a new problem is also created. A less qualified but better paid doctor may be supervising one that is more qualified but lesser paid.

    Perhaps there is a need to continue to link pay and promotion with qualification. It is generally correct that the more able doctors are those more likely to have higher qualifications. There are of course doctors who do not have higher qualifications but have exemplary performance. These generally are well recognised by their peers and are easily identified for promotion. What the majority in the public sector require is more a pay adjustment to narrow the differences between private and public sector rather than promotion.Hence the Minister’s recent announcement of the Ministry’s intention to narrow pay differences is a step that will be welcomed by the public sector doctors(2).

    Will foreign doctors take up the offer to join? It will not be a clear ”yes”. Foreign doctors are probably used to a less hectic workload. With the exception of Hong Kong, the number of patients seen in a session at the Government polyclinic certainly exceeds that seen in the United Kingdom and in the Australian setting. The number of in-patients per doctor may also be larger locally compared to overseas. To attract them to work in Singapore, terms may need to be generous. This may upset the local doctors. At the end of the day, it may be more workable to narrow the pay differences between the public and private sectors and look into the factors that will hold doctors in the public sector.

    In the short run there is a need to see how the existing manpower could be encouraged to stay. The fragmentation into subspecialties in the hospital probably add to the number of medical officers required to keep the units running. The small units that come with subspecialisation run the risk of being poor training grounds for doctors who want to have a broad view of the specialties. Merging subspecialties together under a bigger department will be a plus in more than one way: there can be cross coverage of the medical officers and in this way, reduce the shortage of manpower; by having the subspecialties together, the learning experience of the younger doctors will be more varied and enriched; subspecialists too can become wider in their professional view and interests.

    There is press announcement of bigger emphasis on training and to reward doctors for doing that. What is important is not only to reward individual doctors but also the whole unit to bring back the ambience of training as an institutional culture. Also, the efforts of senior staff to encourage and guide younger colleagues on their careers will help to reduce the pull factor into the private sector.

    There should perhaps be a larger allocation of doctors in the polyclinics. The heavy workload makes it difficult to do a good job under the present circumstances. There is no protected time for training. Narrowing the difference between the consultation charges in the public and private sector may reduce the attraction of patients to the polyclinics. These, such as company patients can be served by the private sector.

    There is a need for a systems approach. The number of doctors needed is dependent on how they are deployed. It is also dependent upon the motivation to stay. Reorganisation, revision of the pay structure, recognition of public sector doctors, good training and career guidance are some forces that may hold the doctors back in the public sector.

    Goh Lee Gan

    By Anonymous Ang Yee, Gary, At March 11, 2006 9:46 am  

  • I have said it before and I will say it again.

    Gary is not totally wrong. Yes it is the truth that money makes the world go round. He likes to quote rich and famous people. These are all signs of someone who reads a lot and it is good.

    Yes he is frustrated with the system. I too am frustrated with the system. I too would like to be financially free and then have the resources and time to do more for society.

    But we have to understand this. The reality is that the majority of people are not going to be financially free. The majority of doctors are not going to be financially free. This is the reality. We can dream yes, but in the meantime what do you do?

    I totally agree with Gary. Doctors are NOT the centre of the world. I also feel many doctors are too caught up with their own egos.

    But you see everything begins with me. And Gary should say that too.

    Does the world need doctors to treat patients competently, ethically and with compassion? I believe the answer is yes. Regardless of the financial situations, when a doctor treats a suffering person he should treat him with dignity and compassion. That is the basic reciprocity in human kind. We talk about money later.

    What I find disheartening is that if you look at it carefully, Gary blames the system, is angry with society, is angry with everyone but HIMSELF. He blames the system for giving him a 90K debt and only a 2460 starting pay. He justifies his outbursts by saying wouldn't anyone in his position want to pay off their debts.

    It's about him all the time really. He wants to be the Bill Gates and Warren Buffet.

    You see, the point at the end is what kind of a person are you? I was once like that too. Money money money. Financial freedom. Especially after I had read "Rich Dad Poor Dad"

    But in life there are many goals to pursue. Financial health is one aspect of life. Of course money is the ANSWER to everything because it frees up your time, and gives you resources to do what you desire. You can read 'THE ANSWER" by Brian Tracy as one of the MANY books on this topic. I don't want to bore you with long quotes which nobody reads.

    Anyway Gary, to be honest, there will never be a time when patients will welcome a doctor who talks like you. About money, financial freedom, profits, economics, etc. That's not what you EXPECT from a doctor when you see him.

    That is the other reality that perhaps Gary does not like.

    Well that's the thing. Medicine is now like this. If you don't like it so much, then don't be a doctor at all.

    Which is why I will reiterate what I had said much earlier to Gary. Why bother to finish medical school? When did Gary realize his mistake? Why continue with a 18K a year mistake then?

    Quit, move to business school and be done with the whining.

    On the other hand to become a "doctor" and then go into medical administration with utter disrespect for the medical work that we doctors do to serve our patients is definitely condemnable.

    By Blogger Dr Oz bloke, At March 11, 2006 10:17 am  

  • Just a word of advice to Gary, seeing that he is a member of Young PAP and probably harbours hopes to go into politics one day.

    You should be careful what you write in public forums and blog comments.

    You never know there might be people who might copy what you have written or request from angrydoc archived copies of your comments. These could be used against you in future.

    Just my two cents.

    By Blogger Dr Oz bloke, At March 11, 2006 10:47 am  

  • Ang Yee, Gary, please go into the finance industry instead of inflicting yourselves on poor patients like me. I'm sure you can make much more money there to pay off your debts. You've confirmed me in my belief that they are many power and money-hungry types joining Young PAP.

    Here is a doctor I admire:

    www.methodistmessage.com/feb2006/drtan.html

    Of course to you Gary, he would only be a stupid fool. I can only hope that if there is a heaven, he would get his just rewards.

    By Anonymous Angry Patient, At March 11, 2006 12:05 pm  

  • Dr Tan regularly write for the SMA newsletter.

    Here is the original account from himself that inspired the article linked by angry patient.

    http://www.beyond.org.sg/StaticBeyond/pdf/Views-01.PDF#search='Dr%20Tan%20Poh%20Kiang'

    It all begins with me. And everyone can do their part. You don't have to join politics, become multimillionares BEFORE you can start helping others and yourself.

    It starts as soon as you CHOOSE to start helping.

    Cheers!

    By Blogger Dr Oz bloke, At March 11, 2006 12:21 pm  

  • http://www.beyond.org.sg/StaticBeyond/
    pdf/Views-01.PDF#search=
    'Dr%20Tan%20Poh%20Kiang'

    By Blogger Dr Oz bloke, At March 11, 2006 12:25 pm  

  • People don't seem to understand what I am trying to say.

    There is nothing wrong in giving free treatment to patients. But that should be done not at the expense of oneself.
    First become financially independent, then help the poor.

    The dr u are talking about is what I hope to become AFTER my debt is paid off and I am financially independent.

    By Anonymous Ang Yee, Gary, At March 11, 2006 1:15 pm  

  • Quiting is easy said than done.

    Once u quit u get nothing except what u came with A levels.
    If u switch couse, u pay full fees. I am 26 already.

    To angry patient, if I can I will go into the finance industry. And after becoming financially independent, set up free clinics for needy patients.
    But I can't because a MBBS is pretty useless.

    People must be realistic, nobody will donate a heart when they are still alive. Blood probably.
    It is better to help others when one is rich than not to help others when one is poor.

    A rich man donating 1% of his salary compared to a poor man donating 100% of his salary.
    The poor man may be considered a saint but the amount of money is truly peanuts compared to 1% of a rich man.

    Problem in society is not because the poor like us don't donate. It is because the rich don't.
    Cause they know the importance of money and may truly be blind to it.

    By condemming doctors in debts for "overcharging" is barking the wrong tree.
    Try condemming the rich for not donating enough to the poor. That is the real problem.
    Then again, they are taxed higher and thus they may think they need not donate already.

    By Anonymous Ang Yee, Gary, At March 11, 2006 1:33 pm  

  • f*ck u lah dont think u r so noble everyone loves money

    By Anonymous happy mo, At March 11, 2006 3:38 pm  

  • I really think that Gary is right... in the papers recently, NUS reveals that doctors have the 2nd highest paid salaries of $3,911. That will of course attract those who want to have large bank accounts. Anyway if you want to make doctoring sound so noble, that is doctors must serve mankind and all that idealistic nonsense, all doctors must be willing to work at low salaries, and sell off their cars and private houses because there will always be a patient who is more poor and more miserable than he is.

    That is true altruism.

    For Gary's case he is disappointed with the system. But he can be a superb administrator. And he would likely contribute more to medical care than many of you.

    By Anonymous Sammer, At March 11, 2006 4:41 pm  

  • i had a church service today and the person sharing said that many times people say they want to reach out to tens of thousands of people.
    yet when asked to so something simple for someone, they say they got no time.

    what makes you so sure that when you are rich and famous, or at least financially independent, you will remember to give back to society?

    the rich and famous quoted, warren buffet, li ka shing, they are perhaps the few who give back.

    i haven't seen famous singaporean plastic surgeons starting some charity for burns victims, or children with cleft lips, etc.

    it's easy to say now that "next time when i am rich and make big money, then i am able to help the poor".
    because, yes, when you are rich you have the ability to help others in need.

    but it's not whether you are able or not, it's whether you actually get down to doing whatever you promised to do.

    having that bit of $$$ doesn't hurt.
    but the thing is that,
    even if you don't have the $$$, you still can help patients.
    maybe you can't afford to give them free treatment or help them pay for expensive drugs,
    but i believe you can show that bit of compassion and people do appreciate it.

    not everything has to revolve around money.

    maybe i can't contribute as much to medical care as gary, in that i probably cannot do "big things" like tweak the system here and there.

    but i think the little things count too.

    Luke 21
    The Widow's Offering
    1As he looked up, Jesus saw the rich putting their gifts into the temple treasury. 2He also saw a poor widow put in two very small copper coins. 3"I tell you the truth," he said, "this poor widow has put in more than all the others. 4All these people gave their gifts out of their wealth; but she out of her poverty put in all she had to live on."

    maybe you think she's stupid or that her paltry donation won't help as much as the rich, but she gave from her heart.

    sometimes it's not how much you give, but how you give it?

    cheers

    By Anonymous M2, At March 11, 2006 9:57 pm  

  • Gary, how come you sooo freaky free to write so much here ??? You have completed your Surgery Track preparations arh ???? To the rest of the M5, good luck and may God bless us for the coming Surgery Essay/OSCE/MCQ !!!!!

    By Anonymous Ultraman Nexus, At March 11, 2006 10:26 pm  

  • There are always two sides to everything in life, including this issue being discussed here. All i can say is, to each his own, including Gary.
    However in the end, we should all strive to do the best for people in need be it in groundwork or administration. I will probably be one of those doing the little things, helping patient whereever i can but the reality is money is power. Money is everything in this current world imho, sad but true.

    By Blogger minimana, At March 11, 2006 11:10 pm  

  • If we are not careful, they will lose respect like doctors in America.

    Should You Charge Your Patients for "Free" Services?
    Some family physicians are charging for refills, forms - and even phone calls.

    Leigh Ann Backer

    Stung by rising medical malpractice insurance rates and declining reimbursements that have them working more and earning less, family physicians are looking for new sources of revenue. Some have responded by finding niche services to offer their patients. Others are simply finding ways to earn more for the work they're already doing - by charging patients directly for services payers won't reimburse them for.

    Completing forms, responding to patients' telephone calls, refilling their prescriptions and e-mailing with patients are just some of the services that family physicians are billing to patients - and getting paid for.

    "My time and expertise are valuable, and if I don't value it, no one else will," says Anette Mnabhi, DO, a solo family physician in Montgomery, Ill., who has been charging patients for phone consults and various other services for more than a year.

    Kathy Saradarian, MD, whose solo family practice is in Branchville, N.J., has a similar rationale for the fees she began billing patients for earlier this year. "I was staying hours after the office was closed, with staff, just responding to messages and requests. My medical opinion is my job; why was I giving it away for free? I just felt it was time that those patients creating the extra work and costs should start having to pay. No other professionals give it away for free involuntarily. And how many of my patients would stay late and work "off the books" for their boss?"

    This approach is not without its risks. Billing patients for services they're not accustomed to paying for is sure to strain doctor-patient relationships that are already stressed by payer-imposed requirements. On the AAFP's practice management e-mail discussion list, where this is a frequent topic of conversation, family physicians worry that if they were to start charging patients for the extra services they provide, their patients might make life even more difficult than usual for their staff, or leave the practice, or complain to their health plans.

    But physicians who charge for these services say that nearly all their patients have paid without question. For example, Alan Falkoff, MD, of Stamford, Conn., says 98 percent of his patients have accepted the policy he instituted in his four-provider practice in June 2003. Falkoff charges patients for a comprehensive list of services on an a la carte basis, as well as an annual administrative fee and a per-visit malpractice surcharge.

    By Anonymous Ang Yee, Gary, At March 12, 2006 1:37 am  

  • Dear Editor
    I have worked as a part-time GP in a relatively poor HDB community since 1984. My patients are a mix of neighbouring families and contract workers from dormitories in the converted, vacated blocks. During these years, the clinic has tried very hard to keep its charges affordable, helped in large part by having a reasonable patient-load to spread the cost of practice over. But our consultation charges are not low, if recent letters in the press are anything to go by. All of us, at one time or another, have waived part or all of our consultation fees for the needy – sometimes, even collecting just a token sum for dispensed medicine. Charity and subsidy are both good. But apart from these minority (if important and meaningful) instances, I believe that it is critical for the average consultation fees for remaining patients to be charged at areasonable level. In recent weeks, there has been a lot of debate about “how low should doctors charge, because they should think of the poor”,although many of the letters to the press have put it in slightly different terms. I would like to share a different point of view - that it is actually possible for doctors to charge professional fees that are so low, that it harms some of their patients. Let me explain. What is a reasonable charge? Beyond covering the costs of practice (rent, salaries, utilities, and so on), it must also fund adequate patient-doctor time. Charging an $8 consultation when there is no subsidy, and breaking even by seeing many patients for three to five minutes each on average, is possible – but not good for the patient. The doctor can restrict his history to stating symptoms, doing a cursory examination that covers the basics relating only to them, and have him out of the consultation room within a few minutes. For example, it is possible to see a patient for a headache, examine him without considering pathologies beyond a benign headache, and charge him only $8 for consultation. For nine out of ten patients, this may actually make no difference, because these patients indeed have no underlying condition to miss.But one in ten may have something more sinister, which a detailed history and good examination can uncover, and this patient’s life may be enriched or even saved as a result. An impending neurological event, hypoglycaemia from poor diabetic control, migraine that can respond to better medication, angle-closure glaucoma, or even simple undiagnosed hypertension -these are just some of several treatable conditions that I would probably miss if I were to give him fair time for an $8 consultation. I ask myself: would the patient want such a saving of a few dollars, if he knew what he were risking? It is human nature to feel pleased when one pays less for the same service. “Cheap and good” is the definition of a good deal.But how would a patient know what is an adequate clinical consultation? Recent letters in the press have ignored that good service for a low fee is possible only because of either subsidy or charity. In real life, $10 haircuts in nice barbershops are acceptable, because the worst that can happen is that the client does not like his look, and vows not to go back. But $8 consultations are different, because most patients will not know when an examination is cursory or inadequate – and that what they have paid for is not good enough, until too late. $8 consultations, unless they are subsidised or arise from personal charity, cheat only the patient (who suffers as a result) and society (who pays for managing the complications arising from cases ofmissed diagnoses).We have seen letters in the press asking “why not cheap consultations?” Perhaps this is understandable, as they were written in ignorance. But we, as GPs, should ask ourselves if we are cheating our patients and society, when we offer consultations too cheap to pay for adequate doctor-patient time, seeking to break even in our practices only by cutting corners. If we do, for sure we cannot plead ignorance, because we know what we are doing, and will be reminded every now and again by a missed diagnosis. But do we realise that by quoting charges that can only be sustained by poor medical practice, we are putting pressure on our colleagues to do the same? Even if the doctor manages to break even (or even sometimes prosper) from unrealistically low consultation rates, it is his patients, his colleagues, and eventually society as a whole, that pays the price.There is a big difference between “cheap” and “affordable”. When will more of our GPs have the courage to move from merely“cheap”, to what is sustainable medical practice, that is good for the patient? When will most of the HMOs realise that while the schemes that they are offering is profitable for them, they are not good for their enrolled members? And when will more GPs have the courage to say to their patients: “Don’t delude yourself – cheap is not necessarily good for you”?Yours sincerely
    DR LEE PHENG SOON

    By Anonymous Ang Yee, Gary, At March 12, 2006 1:52 am  

  • Dear Gary,

    I implore you to serve as a clinical doctor for several years before moving into medical administration.

    Medicine and patients are not digits and dollars.

    I would like you to experience first hand and face to face, patients that you will have to reject certain treatments even though you know is needed and much better because they are poor. See how the patients react. Deal with the emotions. Gain the experience.

    Perhaps it would allow you to better understand why medicine will always be debated as to whether it can be treated as a straight business.

    Frankly I'm just very sorry to hear that you are such a cold and unwavering person when it comes to health care economics.

    In case you did not know, there are numerous free clinics around Singapore. They are not well publicized. They are also not well supported by the government.

    I work at one of these clinics on occasions to help out. There are very few patients. Now I'm not suggesting that we advertise the clinics, but perhaps the governemnt can work together with these services (which run on charity from groups eg religious groups) to help the poor have access to medical care.

    I understand your theory about taking care of yourself FIRST before helping others. It is perfectly logical. However I don't think it is right to condemn those who choose to help in the now to their best of their OWN abilities for the people who need help NOW.

    If everyone took your approach, many would die.

    Simply put, if we put your philosophies into practice, many poor people should be denied treatment, because the MOH has been running a deficit and needs 5-6 years wooing the foreign medical market to build up a reserve before they can provide a service to people who can't afford medical services.

    So we let people die?

    I say again. A balance should be struck.

    There is one thing that is EXTREMELY valuable, in fact PRICELESS that all people can donate. That is TIME.

    TIME can be used in a variety of ways.

    Anyway I guess your focus is to become financially free FIRST before you consider anything else.

    Good luck. But I don't think you should impose such values on a national level.

    I would be the first to campaign against such money orientated health policies.

    By Blogger Dr Oz bloke, At March 12, 2006 9:38 am  

  • Dear Gary,

    the more I read your posts the more I realize about you. Correct me if I am wrong. But the following is you.

    1) You entered medicine because you thought it would be a lucrative field to go into.

    The reality : It is a profession in decline both in reputation, respect and earning ability.

    2) AFTER entering medical school, you started reading self help books that changed the way you saw the world. They enlightened you on how the world worked. How money was best earned. The power of leverage.

    The reality : Medicine is a profession where you are an employee or at best self-employed as a practising doctor. Hardly the ideal ways to gain financial freedom with practically no passive income on the horizon.

    3) As result of 1 & 2 you have become disillusioned with being a doctor, saddled with a 90K eventual education debt and a low starting pay of $2460, you have decided that the best path to go is the business route. Start a biotech company. Or at least become a CEO leveraging off the work of the numerous employees.

    4) You have decided to go into medical administration. You understand that in order to achieve 3 you need to get experience running companies, handling administration, meeting politicians and playing the game. As such you have decided that you will go into medical administration. This is more so because there are few routes to take for a young doctor. Most paths lead to clinical work which you find useless bearing in mind 3. So the next best solution is Medical administration. You try to follow the paths of Drs Chong and Tan. Become CEOs or start a set up. Go into politics (they give MPs a monthly allowance of $13500 a month to help people) what better way right?

    5) You sincerely regret going into medical school. An MBBS is useless to you. You never want to practice medicine. Yet you are stuck because you are too far down the path of medical school already (final year).

    6) As a result of 1-5 you hate yourself because you realize you have made a bad mistake. You also extend that sentiment to other doctors in Singapore. You feel that they too are fools.

    7) Ultimately your focus is not to solve Singapore's health sector problems (because they are not solvable). Your focus is to take care of yourself FIRST ie become financially free and independent with enough passive income to cover your wants and needs BEFORE you even consider doing anything else.

    8) In truth 1-8 shows that you are focused merely on yourself.

    So please spare us all the talk about being a medical administrator, how to improve the system etc. In the end you are no different from many people in Singapore, you just want to concentrate on becoming rich. Not the country, not other people, but yourself.

    Cheers!

    By Blogger Dr Oz bloke, At March 12, 2006 9:59 am  

  • "When will doctors learn that they are not the centre of the world. The really important people in this world are world leaders, world richest men, religious heads."

    Wa, my kind of guy!

    But with him possibly running one of our hospitals in the future, I don't see a bed of roses for the poor.

    "In Singapore, you cannot afford to be sick. It is easier and cheaper to die." may soon no longer be a joke!

    By Blogger uglybaldie, At March 12, 2006 10:21 am  

  • OZ,

    Let's face it. ALL young doctors have at one time or another regretted going to medical school.

    After the idealism honeymoon is over, the reality hits them like a ton of rocks.

    You are one of them. See your blog archives.

    My memory is still vely vely excellent ok?

    By Blogger uglybaldie, At March 12, 2006 10:32 am  

  • Yes, I too am disillusioned. I still am.

    But I still feel that it is my choice if I want to sell my soul to the dollar or continue my best to be a good doctor serving patients.

    Nobody forces you to do anything at the end of the day. Of course some decisions and outcomes are beyong your control. But we make the best of what we have.

    I am not a medical administrator. I am a practising doctor. I am lucky because I no longer have these medical adminsitrators controlling how I practise day in day out.

    But I am concerned that the future medical adminsitrators will perhaps formulate policies focused solely on the monetary returns ( if they are not alreayd doing so)

    Uglybaldie, at the end of the day what are we if all we care about are ourselves?

    Is selfishness the way to go?

    By Blogger Dr Oz bloke, At March 12, 2006 10:38 am  

  • One of the most silly things I used to hear when I was in the hospital was this :

    1) Group CEO says that the group did not do well financially for the financial year XXXX hence bonuses for staff would be less

    2) Group CEO says that we must minimize the cost of medical care to all patients regardless of class A B or C or A&E. This is in line with MOH requirements to control the overall cost of health care.

    Now how do you increase profits and business and at the same time keep costs low?

    What do you want the staff to do frankly? Generate profits or not?

    I am aware of (although humbly acknowledge that I do not understand fully) the sensitivities of economics in the government health sector.

    But if we doctors all subscribed to Gary's philosophy, take care of yourself FIRST before bothering about others, then we should be sucking every cent and profit from every patient especially in the A class and B1 class (why is B1 class susbsidized I do not understand), make the group earn record profits and then go home with fat bonuses.

    Who cares about what MOH says right?

    So I strongly believe that eventually Gary would be singing the tunes of both sides on occasion and be utterly confused as to what the priority is.

    By Blogger Dr Oz bloke, At March 12, 2006 10:49 am  

  • "Now how do you increase profits and business and at the same time keep costs low?"

    This sentence in itself betrays your lack of understanding of business and economics.

    I better let Gary, our MBA wannabe and future administrator explain to you..................

    .........if he is not busily reading some junk stuff on how to be a zillionaire!

    By Blogger uglybaldie, At March 12, 2006 11:19 am  

  • "Now how do you increase profits and business and at the same time keep costs low?"

    Yeah looking at that statement I made I must say I am an idiot.

    What I meant to say was this. Are the government hospitals profit making organizations or not-for-profit organizations?

    That is what I was trying to say. The government has never made that clear to us.

    Sorry lah I am not a businessman. Say wrong things :)

    Keep costs low and still have profits....yeah there are prefectly good business decisions that can do that.

    Thanks uglybaldie for highlighting my mistake. I cock up lah :P

    By Blogger Dr Oz bloke, At March 12, 2006 11:35 am  

  • If one's promotion in administration depends on one's ability to make money for the govt, it will be run to make money for the govt.

    In the past there was profit sharing if cluster was profitable. Just looking at the finances of AH make one wonder when the next profit sharing will occur.

    One should realise that it is the rich who can create jobs for the poor and not the poor creating jobs for the rich.

    Many people resent the rich not knowing that they pay lot of taxes, they create jobs for the poor, they donate money to chartity (100 million for faculty of medicine), they are the villians in the eyes of the publuc because of envy.

    To become rich, instead of envying them, ask yrself how they became rich. Money gives birth to money and thus the world is better off that Buffett keeps most of his money at work now as he plans to give it all when he dies.

    I don't condemn those who help now instead of later. I condemn those who condemn those who choose to help later rather than now. These people are just filled with envy (7 sins) and don't realise that there is a huge difference with helping later rather than now.

    Do u want a 5 year old kid to help u now or wait till he is older to help u later. U decide.

    Ever heard of Robin Hood.
    Our great health minister who is a buddist and once contemplated to be a monk says that drugs at polyclincs may not be cheapest. They are earning money from cheap drugs to subsidize the expensive drugs.

    The Class A patients are subsidizing the class C patients. What in the world is wrong with that??? U want class C to subsidize the class A meh???

    Many companies (maybe not in Singapores) gives to charity out of their profits. U want them to give even if they are loss making???

    Basic economics should be taught to all students less they grown up with heart (hopefully) but no logic. Poor JBJ was never a threat according to President Nair because of his lack of financial knowledge.

    Dr Goh Keng Swee is the true hero of Singapore because he formulated sound economic policies that allow SIngapore to grow. If Singapore had given money freely in the early years, would Singapore ever have a foreign reserve that generates passive income for Singapore.

    By Anonymous Ang Yee, Gary, At March 12, 2006 1:16 pm  

  • i think nobody has the right or authority to judge who is right or wrong in this issue. who is to say what gary should or should not do? is it wrong to achieve financial freedom via a career in medical administration? perhaps it is wrong to be idealistic in today's world, expecting every doctor is expected to be truly concerned about the wellbeing of the citizens, when medicine is in fact run by money today.

    do not judge others or others will judge you. an idealist versus the realist. it is a neverending argument.

    By Anonymous Sammer, At March 12, 2006 2:20 pm  

  • haha why r we reading comment from a lowly **GP** who is rejected EVEN BY AUSTRALIA ???

    lol

    By Anonymous happy mo, At March 12, 2006 2:21 pm  

  • Special Projects Index Selling Drug Secrets
    A special report by Luke Timmerman and David Heath · August 7, 2005
    Selling Drug Secrets home

    Drug researchers leak secrets to Wall St.
    By Luke Timmerman and David Heath Seattle Times staff reporters

    Doctors testing new drugs are sworn to keep their research secret until drug companies announce the final results. But elite Wall Street firms — looking to make quick profits — have found a way to harvest these secrets:

    They pay doctors to divulge the details early.

    A Seattle Times investigation found at least 26 cases in which doctors have leaked confidential and critical details of their ongoing drug research to Wall Street firms.

    The practice involves doctors at top research universities from UCLA to the University of Pennsylvania, and powerful financial firms including Citigroup Smith Barney, UBS and Wachovia Securities.

    In 24 of the 26 cases, the firms issued reports to select clients with detailed information obtained from doctors involved in confidential studies. The reports advised clients whether to buy or sell a drug stock.

    Thomas Newkirk

    Trading stock based on secret information bought from medical researchers is illegal, say legal experts who were told of The Times' findings.

    "That's a good way to go to jail," said lawyer Thomas Newkirk, former associate director of enforcement at the Securities and Exchange Commission (SEC).

    Whether they are paid or not, medical researchers who talk with Wall Street about their ongoing research violate confidentiality agreements they sign before drug companies allow the drug testing to begin.

    Until now, the selling of drug secrets has been hidden from securities regulators and the public, but biotech and Wall Street insiders said the practice is widespread.

    "Everybody does this.... It's now common practice," said the chief executive of California biotech company Valentis, Ben McGraw, a former Wall Street analyst.

    Listen to interview excerpts: The practice of selling secrets
    The practice of selling drug secrets, The Times found, is being driven by hedge funds, the largely unregulated investment pools that cater to the super-rich. Hedge funds can make money with aggressive strategies that exploit quick price swings in stocks, and the volatile biotech industry provides many such opportunities.

    A single drug's prospects can determine whether a small biotech company's stock soars or plummets, so any inside information provides a potent investing edge.

    Such information is so valuable that elite investors pay up to $1 million a year to firms known as matchmakers, which pair Wall Street firms with doctors involved in ongoing drug research. Gerson Lehrman Group, the largest matchmaker, claims to have 60,000 doctors available to speak to Wall Street, double the number from three years earlier.

    How Wall Street gets the inside scoop on drug testing
    Matchmakers typically pay doctors $300 to $500 an hour to talk to elite investors. Some doctors said they can make tens of thousands of dollars a year from such talks.

    Drug-company executives say they know about the practice but can't crack down on the doctors they rely upon for conducting patient testing.

    Ordinary investors are victimized when inside information is leaked to select investors. Those who know in advance whether a drug is going to succeed or fail can buy stock low or sell it high to those who don't know, making quick fortunes by taking advantage of unwitting investors.

    Arthur Caplan

    And there is a broader cost to society: Leaking details about ongoing research can introduce bias into drug trials and possibly halt development of potentially life-saving drugs, biotech executives said.

    "It appalls me, I must say," said Christopher Henney, a Seattle biotech pioneer who co-founded Immunex, now part of Amgen. "It's absolutely outrageous that they [researchers] would allow themselves to be corrupted in that way."

    "The practice is a moral cesspool," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "It really just seems to me to be the last straw in the corporatization of American medicine."

    Doctors who divulge

    Elite investors gained when doctors on a drug trial dropped the word that the drug was failing.

    Excitement was building in fall 2002 at Isis Pharmaceuticals, a 300 employee Carlsbad, Calif., company, as it wrapped up a study of Affinitak, an innovative drug to treat lung cancer.

    Unknown to the company, however, analysts had started making calls to doctors testing the new drug. Despite confidentiality contracts, the doctors were talking.

    By late November, Isis' stock price was plummeting on heavy trading; it lost 20 percent by early December.

    A bombshell fell Dec. 6, and suddenly the drop made sense. Andrew Gitkin, an analyst at UBS, a big brokerage firm, issued a research report with a shocking revelation: Doctors on the Affinitak drug trial had talked to UBS and divulged that the drug was not working.

    Gitkin's report sent Isis stock spiraling down even further.

    Timeline
    UBS inside report sparks sell-off of Isis stock
    Later that day, a news report confirmed that word of Affinitak's failure had "spread across Wall Street's biotech trading floors" for more than a week. Gitkin said in an interview that he believed he "wasn't the only analyst or investor" who had called the doctors.

    Analyst report on Isis
    That would explain why investors were selling Isis shares, driving the price down. Investors who knew the trial results in advance could have shorted Isis stock — a way to make money when its price falls — and made a quick 30 percent profit.

    Isis chief executive Stanley Crooke, an M.D. with a Ph.D. in pharmacology, was furious.

    "We were very shocked that somebody would try to do an analysis like that, shocked that any investigators would talk to an analyst and give him impressions and lead him to specific conclusions," Crooke would say later.

    Crooke complained to UBS. He also questioned the doctors testing his new drug, trying — without success — to find the leak, he said.

    Three months later, Isis released its Affinitak results and Gitkin's information was proved correct — the drug was a dud.

    Gitkin said he did nothing wrong. "I don't know who does and who doesn't sign confidentiality agreements. ... I would assume that if they signed a confidentiality agreement they wouldn't talk to me."

    Sometimes, hedge funds and brokerage firms pay one well-informed doctor to be quizzed by investment managers in a conference call. But other times, their approach to gathering valuable secrets about drug trials is more sophisticated and wide-ranging.

    Timeline
    Analysts foretell Eyetech's fall
    Recently, Citigroup Smith Barney penetrated a major study to see how an experimental drug fared against a just-approved drug for treating macular degeneration, an incurable eye disease and the leading cause of blindness in the elderly.

    Analyst reports on Eyetech

    The brokerage talked to 26 eye doctors, but they weren't just any doctors. Twenty of the 26 had researched the experimental drug; 23 of the 26 had researched the other one, meaning that more than half had worked on both. The doctors were able to give Smith Barney valuable comparative information.

    Nearly all agreed that the drug still being studied, a product called Lucentis from biotech powerhouse Genentech, would prove vastly superior to the drug that recently had gone on the market, Macugen, made by Eyetech, a smaller company.

    But the doctors were more explicit than that. Based on its survey, Smith Barney predicted remarkable results: 97 percent of patients on Lucentis would have stable or improved vision, as measured by how many lines of an eye chart they could read. Smith Barney summarized those findings in a report to select customers May 5.

    As it turned out, the numbers were almost exactly on the money. On May 23, not long after Smith Barney's report, Genentech announced results from its Lucentis study: 95 percent of patients had stable or improved vision — just as predicted by the doctors Smith Barney talked to.

    The announcement battered Eyetech's stock, which lost nearly half of its value in a day. Any hedge fund or other investor who had acted on Smith Barney's research by betting against Eyetech would have made better than a 40 percent return in just three weeks.

    Dr. Scott Pendergast, a lead researcher in the Macugen study who said he doesn't speak to investors, was shocked when told of the Smith Barney report.

    "That's definitely inappropriate," Pendergast said. "They're getting information that was not publicly available."

    The Seattle Times interviewed 15 of the lead doctors on the Macugen and Lucentis research, many of whom acknowledged accepting money to talk to Wall Street firms. None specifically recalled talking to Smith Barney, but they said they had talked to many investors during the time Eyetech's stock price was in a steep decline.

    All 15 doctors insisted they didn't reveal confidential or valuable details.

    "People will call and ask 'Do you think this drug is working?' I'm just being asked to give my gut feeling," said Dr. David Boyer, a Los Angeles ophthalmologist.

    "They'll ask what I can't answer," said Dr. Richard Rosen in New York City, who said he talked on the phone or face to face with investment firms about twice a day for $300 to $500 an hour.

    "They're looking for results of trials that aren't out yet," Rosen said. "I can't answer that. I can just answer from my personal experience in how patients seem to respond to certain therapies."

    Even so, Rosen acknowledged his experience can be valuable. "If you treat 20 patients you can get some sense of where a trial is going," he said.

    Some medical researchers say they refuse to talk to hedge funds or stock analysts because they know the aim is to get confidential information.

    Dr. Steven Nissen, a cardiologist at the Cleveland Clinic involved in half a dozen ongoing research studies and chairman of a federal Food and Drug Administration (FDA) advisory panel making recommendations on new drugs, said he gets "zillions" of calls from investors who say they simply want to talk about a certain disease.

    "As soon as I hear the pitch I know what's going on," Nissen said. "The impressions of somebody on the trial are relevant to whether the trial is likely to succeed."

    Dr. Ron Garren, who runs a small hedge fund in Carmel, Calif., and works part time as a cancer doctor, knows this. He said he can score confidential details about ongoing drug research in his conversations with doctors.

    "They really aren't supposed to talk because of confidentiality," Garren said. "But a lot of times it's a slip of a word here and there. You can generally tell from body language if a person running a trial likes the drug or doesn't. You can generally ferret out, if you're good, the safety issues."

    One experienced research analyst at a major brokerage firm said he's studied "elicitation techniques" taught to FBI and CIA interrogators.

    "We get them to talk about the weather, or the Mariners, then you pop in your one innocent question you want to know about," said the analyst, who spoke on the condition that his name not be used. "Then you switch back to whatever it was you were talking about before. When the doctor hangs up, he thinks he's had a nice conversation about the weather or the Mariners."

    Hedge funds explode
    A rapidly growing form of investment ramps up the pressure to gain inside information on drug research.

    Powerful economic forces are driving the trend to pay for secret information. Years of a raging bull market were good to mutual funds. But when the good times on Wall Street ended in 2000, money began pouring into hedge funds in search of better returns.

    Though barely a blip on Wall Street 15 years ago when they collectively managed less than $40 billion, hedge funds now manage close to $1 trillion — doubling in size in just the past five years, according to Chicago-based Hedge Fund Research.

    Unlike mutual funds, hedge funds aren't regulated and can take big risks, such as buying a stock with borrowed money or shorting a stock, a way to profit when its price falls. Hedge funds aren't satisfied keeping pace with an up-and-down market. They expect to make profits even in bad times and have a powerful incentive to do so: Fund managers get to pocket 20 percent of their funds' profits.

    With such big payoffs for fund managers, the number of new funds has exploded, intensifying competition.

    "As soon as money gets involved, it attracts people, and people go to greater and greater lengths to get an edge on their competition," said Joe Edelman, portfolio manager of Perceptive Life Sciences Master Fund, a $600 million biotech hedge fund in New York.

    The way to get an edge on Wall Street is with better information, Edelman said.

    "If everybody has the same scoop, it's not a scoop," he said. "People will go to great lengths and throw a lot of money around to outdo the next person."

    The need for scoops has driven Wall Street firms to pay medical researchers to divulge secrets, said David Miller, who digs up information for his Seattle-based newsletter Biotech Monthly, but refuses to pay doctors.

    "It's becoming standard practice" for hedge funds and brokerage firms to pay doctors, Miller said. "A couple years ago, this is something you would have seen as unusual. Today it's not."

    Miller said the practice taints the biotech industry, allowing some with inside information to get rich at the expense of individual investors.

    "What this has to do with is people who are so greedy in the market that they are willing to break all the rules to make money," Miller said.

    Hedge funds have become some of the most active traders on Wall Street, accounting for as much as half of the trading volume in the New York Stock Exchange, according to Credit Suisse First Boston. Brokerage houses now scramble to woo hedge funds and their massive trading business. Not only do these funds buy and sell enormous amounts of stock, they do more complicated trades that are lucrative for brokerages, such as shorting stock.

    One way brokerage houses attract the trading business of hedge funds is by offering them valuable research they can't get elsewhere, said Paul Latta, research director for the brokerage firm McAdams Wright Ragen in Seattle.

    Even the best research analysts at brokerage houses agree it's difficult to keep up with the information that hedge funds are able to collect. Many hedge-fund managers are doctors themselves, some from the same elite medical schools as the doctors they are calling.

    Quynh Pham, with Delafield Hambrecht in Seattle, was ranked by Forbes magazine this May as one of the top 10 research analysts in the country. Yet Pham, a microbiologist with an MBA, said when it comes to gathering information, "I really can't hold a candle to the hedge funds. They're able to do things that are unethical."

    Delafield Hambrecht makes it a policy not to pay doctors for information, Pham said. But she talks to hedge-fund managers who do it all the time, she said, citing a recent example involving Seattle-based Cell Therapeutics.

    Research on Cell Therapeutics' experimental lung-cancer drug was nearing completion early this year. Dr. Corey Langer, an oncologist at Fox Chase Cancer Center in Philadelphia, was in charge of testing, which included many patients in Eastern Europe. In the months leading up to the results being released, Langer was "hounded" by calls from the Wall Street firms seeking information, he said.

    Read the pitch
    Through the firm Gerson Lehrman, Langer began charging $500 an hour to answer their questions. "I decided I'd rather get paid for giving my time," he said.

    When he talked to elite investors, Langer said, he told them he couldn't divulge results of the study before the company announced them in March because he had signed a confidentiality agreement.

    But he did share one critical insight with the investors who paid. Earlier, Cell Therapeutics had announced promising news that patients on the study were living longer. But during calls, Langer said, he cautioned investors that this early result might not be due to the drug, but rather to patients in Eastern Europe not being as sick as originally thought.

    Word spread quickly. In Seattle, Pham at Delafield Hambrecht got calls from hedge-fund managers to see if she had dug up anything on the Cell Therapeutics study. One hedge-fund manager told her he already had called 20 medical centers in Eastern Europe, Pham said.

    In the end, Langer's warning was right. On March 7, Cell Therapeutics announced its drug failed to prolong lives. Its stock plunged 48 percent that day. Any hedge fund shorting the stock after talking to Langer would have scored big.

    Langer said he didn't know what his Wall Street contacts did with his information. "They don't tell me, and frankly I don't want to know," he said.

    Enter the middleman

    A new industry rounds up influential doctors who'll talk to investors — for a fee.

    Hedge funds and mutual funds don't have to track down doctors on their own. There is now an industry built around paying influential doctors — referred to as "thought leaders" — to talk to them.

    The pioneer in this field is Mark Gerson, who co-founded Gerson Lehrman Group in 1998 when he was 29 and attending Yale Law School. By then, he had already written a book on neoconservatism and was the subject of a flattering George Will column about Gerson's brief experience teaching at an inner-city Catholic high school.

    Gerson used his networking skills to start Gerson Lehrman's "Council of Advisors" and now says its numbers have climbed to 60,000 physicians. Advisers agree to talk to hedge funds and mutual funds for an hourly fee, usually around $300 to $500 an hour.

    Some doctors charge more. Dr. Celestia Higano, an oncologist at the University of Washington, said she raised her fee to $1,000 an hour to discourage investors from calling. After that, Gerson Lehrman sent her assistant an e-mail, urging that she lower her rate.

    "At this rate Dr. Higano would become a reserved advisor, and therefore would be used more sparingly since her rate is above $500/hr," the e-mail said.

    Gerson told The Times he charges investors a basic rate of $60,000 for six months of access to the firm's doctors. But hedge funds pay Gerson Lehrman up to $1 million a year for its most premium service, he said.

    Brokerage firms also serve as matchmakers for their best clients by setting up conference calls with medical researchers. Typically, brokerage firms invite 10 to 40 hedge-fund or mutual-fund clients to participate in these calls, said Fariba Ghodsian, an analyst at a hedge fund in Los Angeles. Small investors don't have access.

    Listen to interview excerpts:
    Gerson on confidentiality
    Gerson on reputation
    In an interview, Gerson said his firm reminds doctors to honor their confidentiality contracts. He said he has never heard of doctors leaking confidential information through his service. Gerson said he does not believe they would do so because the doctors and his clients want to protect their reputations.

    "Nobody that we've ever met wants to succeed financially in a way that would not honor their reputation," he said.

    Tactics defended

    Some involved say they're doing nothing wrong and are, in fact, performing a useful service to advance "promising therapies."

    Defenders of the practice contend that most conversations with medical researchers are not efforts to ferret out secrets about clinical trials. Hedge funds and other investors said they often are collecting information on how doctors will use drugs in the market.

    Albert Sebag, CEO of Clinical Advisors in New York, another firm that hooks up doctors and Wall Street firms, said physicians don't have any inside information from the companies.

    "They just put patients on the study. They don't know what the patients are necessarily getting. The data is typically analyzed by a third party," Sebag said.

    Many studies are "blinded," meaning that patients and in some cases doctors don't know who is getting the experimental drugs or something else, such as a placebo.

    But hedge-fund managers said it often is possible to find out from doctors how a study is progressing, even when it is "blinded." That's because drugs can have obvious side effects that patients receiving a placebo won't get.

    ImClone's Erbitux for colon cancer, for example, causes rashes. During ongoing studies, said Garren, the hedge-fund manager, he took advantage of that, calling cancer physicians who had experience with the drug.

    Garren said he paid many of the physicians to talk and asked the same question: How many patients with rashes had their tumors shrink?

    After talking to doctors at a few medical centers that enrolled the most patients in the study, he came away believing the drug would be a hit. However, Garren said he didn't act on the information until after the Erbitux results were publicly known.

    Sometimes the Wall Street firms can hit the jackpot, getting details from a doctor who is not "blinded" at all and has access to complete safety data.

    That happened in February, when clients of the brokerage firm Fulcrum Global Partners were invited on a conference call with two doctors involved in research for Encysive Pharmaceuticals, a small Houston biotech.

    Timeline
    Investors get an early scoop on Encysive
    One of the doctors, Harold Palevsky of the University of Pennsylvania, sat on the study's data-safety-monitoring board, a group meant to protect patients. Board members aren't "blinded" and get complete safety data while a study is in progress, because their job is to shut down a study if patients start to suffer from dangerous side effects.

    Analyst reports on Encysive
    Members of data-safety-monitoring boards are sworn to secrecy to protect the integrity of the research. Yet, according to notes of the call later released by a Fulcrum analyst, Palevsky offered investors new and valuable information.

    Encysive was testing a drug called Thelin for pulmonary hypertension, a rare and potentially fatal disorder of the blood vessels in the lungs. Earlier studies raised concerns that Thelin might be linked to serious bleeding or that it could damage the liver.

    But, according to the analyst's notes, Palevsky assured investors that "the overall incidence of major bleeding events is rather low" across several Thelin trials.

    Five days later, Feb. 14, Encysive announced the study had succeeded. Patients on the drug had no serious bleeding episodes.

    That day, Encysive's stock surged 13 percent on the busiest trading volume in its history. Fulcrum analyst Patrick Flanigan boasted in a report that the results "are consistent with statements expressed by our physician consultants on a conference call we hosted last week."

    Uzi Rosha, compliance director at Fulcrum, said the firm did nothing wrong.

    "It was the doctors who had agreements with the company," he said. "It was their responsibility to make sure the conference call didn't contradict their confidentiality agreement."

    Palevsky said he didn't reveal anything confidential, even though Fulcrum's report said Palevsky talked about information that had not yet been published.

    "I am not responsible for what they say," Palevsky said "I spoke about data which had previously been published. Period."

    Critics say drug-safety monitors such as Palevsky, with access to patient results, shouldn't talk to anyone, let alone Wall Street, about the research.

    Palevsky defended his decision to talk to Fulcrum: "Why should I have not?"

    Because talking about what you know as a safety monitor, said Penn bioethicist Caplan, is "about as big a no-no as you're going to get."

    Breaking the law?

    Courts have ruled that analysts can't coax someone to divulge company secrets.

    Wall Street analysts argue they're doing nothing wrong. The U.S. Supreme Court ruled in 1983 that because analysts don't owe allegiance to the companies they research, they are free to gather valuable information and pass it on to their customers. Analysts also are free to collect tidbits of data that, when pieced together, may amount to valuable information not available to the public.

    However, the court also has ruled that analysts can't coax someone to divulge company secrets, which it called "misappropriating" nonpublic information.

    John Coffee, an insider-trading expert and law professor at Columbia University, said that it is clearly illegal to trade stock based on information obtained by paying doctors to leak confidential material about research they are doing for drug companies. Paying 20 doctors to answer the same question about the same drug trial is not the same as collecting tidbits of data, Coffee said.

    Misappropriating company secrets violates federal securities laws. And the practice of selling secrets is illegal for all parties involved, including doctors, hedge funds and research analysts, legal experts say.

    The Securities and Exchange Commission, told of The Times' findings, said it had no comment.

    Newkirk, who left his post as the SEC's associate enforcement director for a private law practice late last year, said he had not known about medical researchers selling confidential information to investors until The Seattle Times told him about it.

    He knew of no SEC investigation of the practice. However, he said the examples uncovered by The Times were the kind of insider-trading cases he would have pursued at the SEC and the kind of cases the agency would pursue now if it knew about them.

    Newkirk said the SEC should investigate the practice of selling drug secrets for a simple reason:

    "Because people ought to know better. People in the securities industry ought to know better than to do things like that. Doctors who've accepted confidentiality agreements — they are the kind of educated people who ought to keep their word."

    Note: This article has been revised from the original version to reflect information that appeared in a published clarification in the newspaper on Sept. 11, 2005. Here is that clarification:

    An Aug. 7 article reported that Dr. Ron Garren, who runs a hedge fund in Carmel, Calif., admits he pays doctors in an effort to get confidential details about ongoing drug research. Garren's statements were apparently misunderstood. He discussed the practice of hedge funds -- including one for which he formerly worked -- paying doctors, including some involved in ongoing clinical trials, as consultants. But Garren says the firm he owns and operates now, Biotech Insight Management LLC, does not do so.

    The Aug. 7 article reported that The Times found at least 26 cases in which drug researchers involved in clinical trials leaked confidential details of ongoing research to Wall Street firms. The total is accurate because Garren was not among the 26.

    By Anonymous Ang Yee, Gary, At March 12, 2006 9:50 pm  

  • "happy mo said...

    haha why r we reading comment from a lowly **GP** who is rejected EVEN BY AUSTRALIA ???

    lol "

    Dear Happy MO,

    You're right. I'm a loser. Thanks.

    Don't listen to me. Nobody is forcing you.

    By Blogger Dr Oz bloke, At March 13, 2006 9:15 am  

  • haha u r welcome
    dont think so much and remember to stock up your panadol

    LOL

    By Anonymous Happy Mo, At March 13, 2006 10:39 am  

  • Panadol?

    Oh no I've run out liao. USe what ar?

    Can advise happy MO? I forgot all my medicine liao.

    By Blogger Dr Oz bloke, At March 13, 2006 11:08 am  

  • gary should just be expelled from the medical sch. he doesn't deserve to be in medicine at all.

    By Anonymous Anonymous, At March 13, 2006 1:28 pm  

  • How the f##ks did he get into medical school? My fond friends in the pharma profession would surely like to ask.

    The panel of three wise men don't impress me at all. Other than the interview, I suggest a psychological test(including a lie detector test) for aspiring medical students to weed out the money and power hungry parasites and let the more altruistic and deserving students do the course. Those who are arrogant and detected with a propensity for bad bedside manners should also be shown the door.

    Public's money down the tube if you ask me.

    By Blogger uglybaldie, At March 13, 2006 1:54 pm  

  • "happy mo said...

    haha why r we reading comment from a lowly **GP** who is rejected EVEN BY AUSTRALIA ???

    lol "

    that is like kicking a dog when he's down. i sure hope u r not a doc, happy MO.

    ya, why r U reading dr oz's comment? i read coz he is a doctor with a heart who even goes to the trouble of advising gary even though he knows that most likely his advice would go unheeded.

    By Blogger grace, At March 13, 2006 2:13 pm  

  • Should all medical students become doctors??

    IS Yong Loo Lin wrong to become a businessman instead of a doctor after graduating from medicine?

    Is Dr Vivian Balakrishan wrong in giving up opthamology to become Minister?

    Is Dr Ng wrong in giving up full time surgery to become Manpower Minister?

    Is Dr Mahattiar wrong in giving up medicine to become PM of Malaysia?

    Is Dr Sun Yat Sen wrong in giving up medicine for revolution??

    What Makes a Good Doctor - Views of Non-Medical Professionals
    T Koh, C Chiang, Myint Soe, J K Candlish, H Lim, H Ko, A Yeo, K H Phua

    A good doctor should have three qualities: knowledge, empathy and philosophy.

    First, a good doctor should be knowledgeable and should keep abreast of developments in his or her field of expertise. A good doctor should be a skillful diagnostician. A good doctor should neither under-prescribe nor over-prescribe medication to his patients.

    Second, a good doctor should have a high Emotional Quotient or EQ. When I was at the Singapore Embassy in Washington, we had two doctors on our panel, a younger man with a high tech practice and an older man with a low tech practice. I noticed that most of my colleagues chose to go to the older man. Why? Probably because he had a warmer personality, was a better listener and communicator and was able to inspire his patients’ confidence in him.

    Third, a good doctor should also be a good philosopher. A good doctor should treat his patients in a holistic way. He should counsel his patients on their diet, exercise, and stress management. A good doctor should understand the limits of efficacy of western medicine and should have an open mind to what is called ‘alternative medicine’. A good doctor should be wise and humble not dogmatic and arrogant.

    Professor Tommy Koh
    Ambassador-at-Large
    Ministry of Foreign Affairs


    --------------------------------------------------------------------------------

    I thought the answer would be straight forward. A good doctor is someone who knows his or her field, makes the right diagnosis of an illness and recommends the best treatment towards recovery.

    When I posed the question to friends and relatives around me, what stood out during the conversations and in my own recollection of the numerous contacts I have had with doctors, was not their medical knowledge or skills. Not that skills and knowledge do not matter. They are vital.

    What seems more important to a patient during a medical crisis however, is the attitude of the doctor. I learnt in coping with my parents’ illnesses that doctors may be sure of their diagnosis but among different specialists, their treatment recommendations can vary. Ultimately the patients and family members have to decide how they want to manage the illness of their loved ones and their process of dying. Which means, they have to remain rational and clear despite being traumatised by the sad news of an illness.

    It is under these circumstances that a doctor’s ‘human touch’ becomes significant. His patient-focused sincerity in taking time to explain to a patient his or her condition reflects a doctor’s compassion, concern and empathy. It is simply caring for another fellow being. These attributes have been seen as hallmarks of the medical profession. Some observers lamented however that the increasing commercialisation of the profession has led to some doctors setting themselves up as tradesmen, driven more by financial considerations than by noble ideals of service to humanity with honesty, integrity and compassion. As a result doctors become callous and careless, spend limited time with patients, over-prescribe expensive drugs, recommend unnecessary investigation and treatment modes, prolong hospital stay, and so forth, all for personal gains.

    If this commercialisation ethos is a perceived threat to the profession, then a sincere, compassionate, caring and empathetic doctor who spends significant time with patients and their families to explain to them the illness and prognosis and attends to their fragile emotional states, will be a doctor that makes the difference.

    Personally, I need a doctor who is clear and logical in thinking, warm with a sincere heart, skilled with his hands for surgery, easy to reach in an emergency, empathetic in his communication patterns to restore in me a level of calm and confidence and makes me feel ‘he is there’ for me, does not over-charge me and is discreet by not talking about my condition to others. I would like my doctor to be humble and confident enough to collaborate with other specialists in the medical community to tackle an illness which he or she is uncertain about, in order to offer to me best practices in management and treatment. Fortunately, I have seen a lot of such ‘good doctors’ in my life-time, to whom I am grateful.

    Ms Claire Chiang
    Nominated Member of Parliament


    --------------------------------------------------------------------------------

    Picture : Faculty of Medicine, National University of Singapore, 1980 - present

    For a layman, this question must depend on the meaning of the word ‘good’. The Oxford Dictionary surprisingly devotes a full page on this word. Thus it means; inter-alia: (a) having the right qualities (dedication, knowledge etc); (b) commendable; (c) morally excellent, virtuous; (d) kind, benevolent; (e) agreeable; (f) reliable; (g) amiable; (h) soundness of judgment, and (i) practical wisdom.

    Thus, first of all, a doctor must be professionally competent. This would cover knowledge (education), soundness of judgment and practical wisdom. Thus GP’s should have all-round knowledge. They should literally know something of most of the ailments that inflict humanity. Thus, he should be able to distinguish malaria from flu, though malaria may not be common in Singapore.

    At the same time, knowledge without soundness of judgement or wisdom (good professional judgment) may not be adequate. It must be remembered that there are too many variables inherent in the treatment of human beings and it is difficult to capture all the alternatives in a single decision. Doctors should not practise defensive medicine; at the same time the mere saving of costs should not affect his clinical judgment.

    A doctor who has all the above qualities will still be inadequate if he has bad traits or bad character. Thus, a doctor must be ‘caring’. He should therefore be kind and benevolent. He should also be reliable, agreeable and amiable. An ill-mannered doctor or a doctor who does not turn up in emergencies is likely to drive away patients, and also find himself before the Singapore Medical Council.

    Last but not least, a good character is required. One can hardly pardon a doctor who has an adulterous affair with a (married) female patient. A person who abuses his position for sexual gratification should be treated with contempt. There is of course another problem of interpretation. Is there anything wrong with the "character" of a homosexual male doctor or a lesbian female doctor?

    Dr Myint Soe
    Barrister-at-Law


    --------------------------------------------------------------------------------

    A good doctor is sincere, dedicated and courteous. He is able to complement his medical knowledge and clinical judgement with humanistic qualities of integrity, respect and compassion. He sees his patients as fellow human beings and not as a ‘case’ with an illness. A good doctor is one who not only demonstrates professional competence, but also one who manifests personal qualities of patience, maturity and confidence. He listens attentively to his patients’ complaints and tries to answer all their questions to the best of his knowledge. With his older patients, he does not attribute their medical problems to old age and equate aging with mental and physical decline. He is sensitive to his patients’ special needs, particularly their emotional needs and general well-being. He avoids robotic prescription of drugs but rather, helps his patients identify the underlying causes of their problems. His patients are comfortable about discussing even their sexual problems with him. Last but not least, he treasures his relationship with his patients based upon mutual respect and open communication.

    Mr Henry Lim
    President
    Gerontological Society of Singapore


    --------------------------------------------------------------------------------

    I suppose I cannot speak as a member of the public in the normal sense as I have taught in several medical schools, worked in hospital laboratories and sat on numerous medical boards and faculties (albeit in minor capacities) so I have a good idea of the range of doctors’ duties and some appreciation of the difficulties they face. At least in the academic milieu they are grossly overworked but then almost any successful professional in this part of the twentieth century would claim the same. In response to the question as to what makes a good doctor, one is tempted to muddy the waters by asking: what kind of doctor? An argumentative person might maintain that the attributes most essential in say, a surgeon, differ from those in, say, a psychiatrist. Avoiding this perhaps sterile track, I would like to suggest what constitutes the bottom line. There is the old story, is there not, about a beautiful actress fainting in a restaurant and the sound system asking whether there was a doctor in the house? A lone medical doctor was beaten to the star’s languishing form by a doctor of philosophy, a doctor of music, and a doctor of divinity. The PhD was a mine of pathophysiological knowledge, the musician had superb powers of communication, and the divine had unsurpassed compassion, but the medic was able to elbow them aside because, in that situation, he had the relevant competence. And that for me is the crunch. Competence above all, please!

    A/Prof J K Candlish
    Department of Biochemistry
    National University of Singapore


    --------------------------------------------------------------------------------

    Picture : National University Hospital

    The Collins Reference English Dictionary defines a doctor as: (1) a medical practitioner; (2) treat medically, and (3) repair, mend etc. But what makes a good doctor? If I were the patient, what attributes would I like my doctor to possess? I believe that the qualities of a good doctor can be summed up by the word ‘ASK’.



    A is for Attitude

    The attitude of a medical practitioner to his work, his profession, the patients he sees is of utmost importance. To me, a good doctor is one who genuinely cares for his patients, who possesses a deep compassion for them and is committed to alleviating suffering. He is motivated by the well-being of his patients rather than material or other gains, such as fame or status.

    He is empathic, placing himself in the positions of his patients and seeing it from their points of view. He asks, seeks clarifications and listens actively to their woes and difficulties, and not assume that he knows them. He then decides on the diagnosis and treatment modality.

    Since he has had the privilege and benefit of medical education, he recognises his obligation to society. He thus serves not only the individual patients that he sees, but the wider community in various ways eg. committees, public education programmes.

    S is for Skill

    Another very important quality of a good doctor is skill. He is skilled and competent in his trade, able to make accurate diagnoses and treat his patients appropriately to ensure the best possible recovery, without having to put them through a series of unnecessary and/or expensive tests, resulting in unnecessary suffering and hardship. This instills confidence in his patients.



    K is for Knowledge

    I believe that skills and the right attitude must be undergirded by sound medical and professional knowledge. A good doctor should keep himself abreast of latest research findings and developments that would enhance his professional practice as this would affect the quality of care that he provides to his patients. In addition, he should be adequately informed about the services that are available in the community. He could then make appropriate referrals for his patients eg. continence hotline, cancer support groups and day rehabilitation centres, to enhance their total well-being.

    Ms Helen Ko
    Director
    SAGE Counselling Centre


    --------------------------------------------------------------------------------

    It is no mystery that people who consult doctors, whether a general practitioner or specialist, are often helped in their healing or empowered in coping with physical ailments, by the way they are treated.

    Physical ailments are no longer regarded as having merely physiological origins. Both medical and psychological opinions tend to hold similar views that there are multiple factors leading to illness. Other factors such as life events, interpersonal relationship, environment and the interaction of the individual and these factors contribute to the vulnerability of the person.

    It is also increasingly recognised that direct medical treatment can be supplemented with other means of healing. In recent times, there has also been an increasing practice of alternative medicine as well.

    If adopt this holistic perspective to diagnosis and treatment of physical ailments, it is fairly obvious that medical practice should not be offered in a mechanical manner. It is a human service which has to be offered with a great deal of human touch.

    In this we way, one would expect that a good doctor would not only adopt such an orientation to people and medical practice but also possess general qualities that enhances the doctor-patient relationship.

    This relationship would be one that exudes a warm, empathetic and personable approach to patients. The effect of such an approach would lead the doctor to listen carefully to patients and their stories connected to their complaints of physical ailments. It will also lead to an attempt to listen to other related difficulties in their lives.

    If a doctor can offer this relational approach to medical practice, healing may be experienced beyond the physical dimension.

    Mr Anthony Yeo
    Clinical Director
    Counselling & Care Centre


    --------------------------------------------------------------------------------

    Ultimately what makes a good doctor would reflect a combination of the individual’s background and personal qualities, including past training and continuing education, peer influences and professional relationships, and the values and standards imposed by the external environment and society in which the doctor lives and works in. Assuming that the selection process has chosen the best and brightest to enter the ranks of the ‘noble profession’, it would be appropriate that education and training should not only meet the requirements of their vocation, but also the changing expectations of the community at large. Rising pressures on the profession to provide higher quality and yet affordable healthcare would create tremendous tensions. The doctor must continue to do the altruistic best for individual patients, while justifying professional and personal interests against a climate of increasing regulation and cost-containment. As greater specialisation and utilisation of high technology medicine contribute towards fragmented, complex and dehumanising forms of practice, the more will be the need for the doctor to emphasise the ‘softer’ skills to provide personalised, integrated and continuing care. Doctors will also be hard-pressed to communicate better with a more educated and discerning population who demands the best and latest, and is only too keen to complain or sue for perceived deficiencies or malpractice. The future nature of medical education and supply of doctors will have to respond to such community expectations and demand (Phua KH and Jeyaratnam J, Family Practitioner 9:1, 1986).

    An authoritative WHO publication gives the following qualities of the Five-Star Doctor:

    1) responds to the patient’s total health needs

    2) makes optimal use of new technologies

    3) promotes healthy lifestyles

    4) balances patient’s and societal expectations

    5) works efficiently in teams

    The Five-Star Doctor is one who improves the quality of care by responding to the patient’s total health needs with integrated preventive, curative and rehabilitative services while considering the patient as an integral part of a family and a community. The Five-Star Doctor makes optimal use of new but cost-effective technologies, bearing in mind ethical and financial considerations and the ultimate benefits as well as costs to the patient and society. The Five-Star Doctor promotes healthy lifestyles by effectively communicating with individuals and groups and empowering them for their own health protection and well-being. The Five-Star Doctor reconciles individual and community health requirements, striking a balance between patients’ expectations and those of society at large. The Five-Star Doctor works and functions efficiently and effectively in teams, both within and across the health sector and other socio-economic sectors influencing health (Boelen C, WHO Bulletin No. 3, 1992).

    Such a balanced and holistic approach would require that the doctor’s primary training and continuing education are based on a sound foundation in both the clinical and social aspects of medical care. Thus the good doctor is expected to have a more complete understanding of healthcare systems and health economics, socio-cultural and behavioural patterns of the population, ethical and legal issues of society which have an impact on healthcare and medical practice. Since healthcare and medical education are becoming monumentally expensive and have to be heavily subsidised by public funds, pressures can thus be expected to produce the right kind of doctor to serve the community in the most efficient and cost-effective ways (Yeoh TS, Curriculum Development in Medical Education, NUS, 1981).

    A/Prof Phua Kai Hong
    Health Economist
    National University of Singapore

    By Anonymous Ang Yee, Gary, At March 13, 2006 2:31 pm  

  • happy mo

    I think your remarks are very uncalled for.

    For starters, I think Dr Oz is a compassionate doc who gives advice to people like angry patient and gary based on his own experience.

    Secondly, he definitely has great passion for his work.

    Thirdly, I really hope that you are not a doctor.

    Back off and get lost.....

    By Anonymous Anonymous, At March 13, 2006 6:59 pm  

  • 2 of u hope that im not a doctor... oh PLEASE do you think you are a superb doctor? Who knows you are a lousy chicken rice seller. as if you know what it takes to be a good doctor. i am an excellent doctor and all my patients love me. and im not a lowly GP who thinks he is sooooo high up in society and is fit to give advice and make judgement of others. plus i really despise people who whine about their failures when they do not have the capacity to achieve in the 1st place. like we are soooo interested. i dont want to read his comments, just that they are here and its taking up space so i have to scroll down.

    By Anonymous happy mo, At March 13, 2006 10:51 pm  

  • You're right Gary.

    Medical students do not need to become doctors.

    You're right Happy MO, I'm a loser. I'm not even a doctor. I'm a GP!

    You're right I am not qualified to have an opinion. I am not good enough to post here too.

    I hope to get more advice from you. What should I be doing, since I should not be posting here, I should not blog about my life because it's whining.

    So what should I do?

    Please advise.

    Thanks!

    By Blogger Dr Oz bloke, At March 14, 2006 8:05 am  

  • Dear Grace and anonymous, thanks for your support!

    I don't think I'm that compassionate nor do I have that much passion for my work. I'm just trying to do my best that's all.

    But happy MO has a point. I certainly have never thought of myself as sooo high up in society.

    In fact in many of my posts I have been extremely despondent as to the status of doctors in general. Remember me saying that I was a "chihuahua tied to a tree"?

    But I guess just because I tried to convince Gary that money is not the end all and be all to everything, and hoped he could consider policies that help the poor patients and allow doctors to do their jobs (even if it sometimes means losing money but is good for both patients and doctors), happy MO construed it as me being arrogant.

    For the record I don't have any ego. I don't even have much self esteem frankly.

    So I'm sorry if I caused any offence to anyone.

    I guess in Singapore the elite are the only ones allowed to speak. And I am far far far from being even anywhere close to sniffing the elite.

    Have a good day all :)

    By Blogger Dr Oz bloke, At March 14, 2006 8:40 am  

  • " i am an excellent doctor and all my patients love me. "

    Huh? With your character, your patients may just be thinking of asking you to bend down, back facing them so they can give you a few good whacks before they say bye bye.

    KNN

    You may not even be a doctor come to think of it.

    By Blogger uglybaldie, At March 14, 2006 9:01 am  

  • Aiyah OZ,

    Why waste your breath with a nincompoop like this. Just ignore him and he will go away, like an itch.

    By Blogger uglybaldie, At March 14, 2006 9:03 am  

  • "I guess in Singapore the elite are the only ones allowed to speak. And I am far far far from being even anywhere close to sniffing the elite."

    Clappy Mo an elite? Hee Hee. He is only fit to sit behind in the lorry on the way to the garbage dump.

    By Blogger uglybaldie, At March 14, 2006 9:07 am  

  • happy MO wrote
    "plus i really despise people who whine about their failures when they do not have the capacity to achieve in the 1st place. like we are soooo interested. i dont want to read his comments, just that they are here and its taking up space so i have to scroll down".

    hmmm happy MO, wonder where u read that? surely not dr Oz's blog, i presume since it's beneath u to read his comments what more his blog. then i wonder where coz no where did i read his 'whining' here when i scrolled down?

    By Blogger grace, At March 14, 2006 9:24 am  

  • OZ,

    While chewing on my toast, It just struck me that you should snap out of your despondency FAST for the sake of your patients.

    With the state you are in, you may make a wrong diagnosis and you may not empathize with the plight of your patients.

    Dangerous.

    By Blogger uglybaldie, At March 14, 2006 9:31 am  

  • Oh don't worry uglybaldie,

    I have perfected the art of seperating personal emotions from my work.

    I greet every patient with a big hearty SMILE whenever they walk in. Followed by a BIG "HI HOW'RE YOU DOING TODAY!!!!"

    And 90% of the time I get "Fine thank you!" And then I say "Then you should be here to see me!"

    And we have a nice short laugh before we get down to biz.

    The more patients I see, the happier I become.

    Ralph Waldo Emerson said it before. Feeling and action go hand in hand. While it is difficult to change feeling, it is easy to change actions. And actions influence feelings accordingly. So it is extremely difficult to remain unhappy if you keep smiling!

    Of course having practiced this principle for over 15 years now, I do realize that it can result in the soul being empty despite this excellent practice.

    I must say I'm finally getting the hang of it. Being a GP. It's not about being a doctor. It's not about being a quack. It's about being....a GP!!!

    Cheers!

    By Blogger Dr Oz bloke, At March 14, 2006 9:49 am  

  • "Followed by a BIG "HI HOW'RE YOU DOING TODAY!!!!"

    Just my kind of doc. Not some asshole thinking too highly of himself by saying:

    "What's wrong with you today?"

    When I walk in and I hear that greeting, I know it's you, OZ. :-)

    By Blogger uglybaldie, At March 14, 2006 10:18 am  

  • Haha!

    Yeah all these greetings problems...what do you say to patients right?

    If you say "Yes so what's wrong with you today" Some patients would reply "I don't know doctor, you tell me!" or "There's nothing wrong with me I just came to get my immunization jab/work permit checkup *glare like kena offended*"

    If you say "How are you" they might go "HOW AM I? OF COURSE BAD LAH! Wah lau eh you so insenstive ask such stupid questions"

    Unfortunately I don't say that hi thing to everyone, only the patients I know well.

    I do SMILE and then usually say "Hi how can I help you today?"

    I found that to be the most politically correct, safe, non-offensive greeting to patients.

    By Blogger Dr Oz bloke, At March 14, 2006 10:43 am  

  • My doc. greets me with:

    "How's the market?"

    Huh?

    What kind of a doc(g). is that?

    By Blogger uglybaldie, At March 14, 2006 11:08 am  

  • Hey ug (sorry that's the best non offensive nickname I can give you),

    didn't know that you looked like a fish monger!

    *just kidding lah*

    By Blogger Dr Oz bloke, At March 14, 2006 11:17 am  

  • I would be offended if you didn't call me "uglybaldie". I've grown used to it and actually quite like it.

    The doc. was fishing for some tips to instant cash.

    Now I'm beginning to know why he's especially nice to me, although I look and act like a fishmonger. KNN!(this wonderful hokkien expression, courtesy of flatfeet)

    I'm off to see a matinee at senior citizen's discount. I pay 4 friggin' bucks! What about you? "Brokeback Mountain". Wondering what the fuss that this flick should have won the Oscar is all about.

    By Blogger uglybaldie, At March 14, 2006 11:41 am  

  • Uglybaldie,

    the doctor you are referring to is which one? The one with the MMED Int Med or the neighbourhood GP?

    Maybe you should refer to the MMED INT MED one as POWER doc.

    Movies? I usually exchange my UOB rewards points for movie tickets. I got so many points can never use finish. This was cos of the MLM biz lah. Buy stock with card get points, sell stock for profit = free points! A lot leh.

    Of course got place online to order DVDs from across the causeway. They actually will deliver to your doorstep, so no hassle with customs and all! $6 per DVD. Still more ex than you senior citizen rate of course.

    Cheers! Have a good day at the movies. Brokeback? err not my kinda of movie lah.

    These days I watching anime like crazy. Currently watching Gundam Seed Destiny and Full Metal Panic. Going to go on to Berserk soon.

    Cool stuff!

    By Blogger Dr Oz bloke, At March 14, 2006 12:07 pm  

  • so old still watching cartoons? i can see why you became a GP, and fuss about how to greet patients.

    By Anonymous happy mo, At March 14, 2006 1:52 pm  

  • Dear Happy MO,

    told you already, don't read my comments!

    I'm a fucking piece of putrefying feces lah. What to do?

    Lucky you are not me.

    All the best in your endeavours.

    By Blogger Dr Oz bloke, At March 14, 2006 2:04 pm  

  • Hi.

    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! :)

    By Blogger ~[z][x]~, At March 14, 2006 2:49 pm  

  • Absolutely right.
    Capitalism is cruel but so is the natural world where the strong preys on the week.

    As long as Singaporeans stay on their toes and continue to keep themselves relevant and add value, there is little fear but fear itself.

    Are we exploiting the Indian radiologists or are we increasing their GDP?

    The PAP believe in India and China as the two driving forces in future. Thus, stay on yr toes and never be complacent cause the tortoise may have invented the bicycle to overtake u the hare

    By Anonymous Ang Yee, Gary, At March 14, 2006 4:37 pm  

  • happy mo

    you claimed to be an excellent doc but you have nothing nice to say about anyone.

    i wonder if you are one of those type of docs who whine and gossip behind your patient's back.

    By Anonymous Anonymous, At March 14, 2006 8:11 pm  

  • To dr oz bloke:

    "Movies? I usually exchange my UOB rewards points for movie tickets. I got so many points can never use finish. This was cos of the MLM biz lah. Buy stock with card get points, sell stock for profit = free points! A lot leh."

    Exchange the points for tickets then sell them cheaper online at yahoo auctions or ebay = more money.=)

    By Blogger JY, At March 14, 2006 10:06 pm  

  • Well I still watch movies anyway. So do my parents. So do my siblings.

    So I give some free tickets to them as well on occasion. In the end selling on e-bay I get a lower value although it means cold cash. But I don't need the cash at this point in time. :)

    jy, you got blog or not?

    By Blogger Dr Oz bloke, At March 15, 2006 10:31 am  

  • "But I don't need the cash at this point in time. "

    Donate it to Gary then. :P He's heavily in debt because of the wrong choice he made.

    Yup i do blog.

    By Blogger JY, At March 15, 2006 7:41 pm  

  • "But I don't need the cash at this point in time. "

    Donate it to Gary then. :P He's heavily in debt because of the wrong choice he made.

    Yup i do blog.

    By Blogger JY, At March 15, 2006 7:41 pm  

  • There are people out there who need the money more.

    I am currently giving tuition to slowly pay back my debt.
    800 a month probably take 100 months.

    By Anonymous Ang Yee, Gary, At March 15, 2006 11:10 pm  

Post a Comment

Subscribe to Post Comments [Atom]



Links to this post:

Create a Link

<< Home