Angry Doctor

Wednesday, March 08, 2006

Edited

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

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

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


Practice of medicine at the crossroads

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

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

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

The practice of medicine is at the crossroads.

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

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

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

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

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

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

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

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

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

For the Hippocratic Oath, see www.pbs.org

Dr Huang Shoou Chyuan
(Specialist in private practice)

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

Labels:

22 Comments:

  • This proves to you that there is no uniform policy on letter editing, a matter generally perceived to be decided and wielded by an unseen hand.

    Letters are abbreviated and or edited due to space constraints.

    You are too paranoid.

    By Blogger uglybaldie, At March 08, 2006 1:21 pm  

  • Just as the public needs to understand the considerations a doctor has, u should also try to be more understanding of what newpaper editors have to do, given their constraints.


    Bl

    By Anonymous Anonymous, At March 09, 2006 2:17 am  

  • And what exactly is it that newspaper editors in Singapore do?

    I spoke to a former journalist of Straits Times who left Singapore for Australia many years back.

    His comment was that there is no real journalism in Singapore. The reports and commentary is only what the government approves of.

    So why stop the buck at only what the government approves of? Why not also to what we doctors approve of?

    It's so clear for all to see how the editors handle complaint letter to KKH vs say SGH or private clinics.

    Constraints? I can understand the predicament you guys have. There's a lot of pressure from somewhere.

    So please newspaper editors out there. Please know that printing hate letters against doctors is like printing someone's hate letters against a race. You want to spread hatred and incite riots against doctors? It all begins like that. One letter one dissenting voice and then it grows.

    And it doesn't help when the health correspondent herself fans the flames with false accusations and fake quotes.

    If you want censorship in the name of responsible protection of the people and society, that's fine. But who draws the boundaries?Responsible reporting or publishing should not be confined only to government or racial issues if that's the case.

    By Blogger Dr Oz bloke, At March 09, 2006 6:44 am  

  • "The reports and commentary is only what the government approves of."

    Another paranoiac.

    But it's really a good thing that the current spate of controversial medical issues is brought into the open.

    Now we know that things are not that rosy and like used car salesmen, there are the good and bad ones. But then again, the used car salesmen never had to take the Oath. In fact, their unofficial oath is never to let a fool go unscathe by not selling them a dud.

    By Blogger uglybaldie, At March 09, 2006 10:19 am  

  • Hmm I wonder if it would help if doctors just stopped taking an oath?

    Same with Ministers admitting that they earn a lot of money for their work rather than they making lots of sacrifices and losing money personally just for the nation?

    Of course there are good and bad ones in every field. Even within the religious clergy the situation is the same. Heck Lucifer was one of God's angels.

    Yes we should let things be reported so that things are in the open. But why draw the line at some places and not at others?

    Double standards can never be good.

    Anyway I don't buy the Straits Times. Not even the online edition. Don't need it. Get enough through the grapevine of forums and blogs.

    Besides those sources represent the real underbelly of things better than the 140th.

    By Blogger Dr Oz bloke, At March 09, 2006 10:36 am  

  • Editors edit. That's what they do and I have no problem with that (my 'problem' is the way facts are not verified before an account is published). Whether they have a hidden agenda or what that hidden agenda is, I do not know.

    My point here is that forum letters are edited and readers should take that into account and not be too hasty in drawing conclusions on a writer's original tone and intentions from them.

    By Blogger angry doc, At March 09, 2006 11:30 am  

  • Facts are not verified until publication unless it affects the civil service and government departments. I know for a fact they do refer to the department for a response prior to publication. I know that because I had to scramble for a response when I worked in the army.

    I agree with Dr Huang, incidentally. I think it is anachronistic to talk about the Hippocratic Oath when doctors do not get the respect and gods the reverence due in an earlier age. It takes two habds to clap. If radiologists can lose their jobs overnight due to financial considerations and patients consider doctors as nothing more than another service provider for their money, don't blame the doctors who consider medicine nothing more than just another business. If medical students pay 18k a year for their studies, they would be thinking of doing cosmetic surgery and injecting botox, not radiology and injecting antibiotics.

    By Anonymous pathdoc, At March 09, 2006 4:44 pm  

  • I believe the cause of the current level of respect the profession is (not) getting is multi-factorial and may need to be tackled from several angles, but I agree with Dr Huang that taking back the moral highground by self-regulation is one of those angles.

    In fact, I believe that every frontline doctor is a part of this fight; every doctor's actions determines to a small part the public's perception of the profession - the patient is not going to visit every GP or say dermatologist before arriving at an opinion of 'doctors nowadays har...').

    To borrow an over-used phrase:'If you're not part of the solution, you're part of the problem'.

    By Blogger angry doc, At March 09, 2006 5:06 pm  

  • Allowing professionals to advertise was a mistake. Particularly in the context of doctors. How can someone who is respected and possibly "revered" suddenly became a purveyor of just another commercial product or service?

    We cannot ape the West. There are certain values that we still hold dear and one of these is the perception that the doctor is seen as someone who, with his skill and knowledge, will hold your hand and deliver you from despair and hopelessness like an angel of mercy. How can this be achieved if like any commercial outfit, they started employing PR consultants and advertising gurus to market their services? How can doctors be seen as the good guys if they are as mercenary and greedy as anyone else?

    By Blogger uglybaldie, At March 09, 2006 6:08 pm  

  • Advertising is not the cause of the problem. It is the solution to attract foreign patients(customers) and earn tourist dollars.

    Singapore need to be a medical hub and doctors either accept it or move elsewhere where they are well respected like witch doctors.

    Problem why patients complain so much is because they do not want to pay for what they think is their entitlement.
    The solution is simple:
    Eyeball the patient.
    If he can pay spend as much time with time and charge him what u deserve.
    If he can't pay, pls quickly see him and not add to his misery by charging more than he can afford.

    The greatest tragedy is charging a poor man what u would charge a rich man and vice versa.

    Is it ethical?
    Probably not.

    Doctors are truly on our own

    By Anonymous Ang Yee, Gary, At March 09, 2006 6:16 pm  

  • Dear Gary (future medical administrator)

    "If he can't pay, pls quickly see him and not add to his misery by charging more than he can afford.

    The greatest tragedy is charging a poor man what u would charge a rich man and vice versa."

    I'm sorry but I don't think you say that with realism and a good feel of the ground.

    There are no doctors who do what you have said. It is foolish and doctors know that.

    So what should we charge the poor man for consultation? What can he afford?

    I'll tell you that the price of consult in the poor man's mind is $0. To him it's not a matter of what value her perceives it to be but a matter of how much money he can save with everything he needs. And the best is to save every cent!

    Even $10 is expensive to them.

    So what should we GPs do? Waive charges for the poor? Is eyeballing a fair means test? If so why doesn't MOH implement an eyeballing scheme for the hospitals?

    Or perhaps we should do what the government likes to do. Steal from the rich and give to the poor? A class? B class? C class?

    I think you must spend some time in active clinical practice before becoming a medical administrator. No wonder we have problems seeing eye to eye. Sad to say, the medical administrators have the upper hand.

    By Blogger Dr Oz bloke, At March 09, 2006 10:45 pm  

  • Don't see the poor.
    Ensure they pay first like in polyclinic.
    Even the polyclinic expects u to pay b4 seeing the doctor.

    If u want to see for free or charge peanut, then it is yr own business and don't spoil market.

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

  • Future medical administrator,

    Hello... now you don't have to pay first before seeing a doc in polyclinic.

    By Anonymous Anonymous, At March 10, 2006 11:46 am  

  • "Ensure they pay first like in polyclinic.
    Even the polyclinic expects u to pay b4 seeing the doctor"

    You didn't answer my question Gary. You are misdirecting us.

    Just to refresh your memory and get back on track...

    You said "If he can't pay, pls quickly see him and not add to his misery by charging MORE than he can AFFORD.

    The greatest tragedy is charging a poor man what u would charge a rich man and vice versa."

    So I told you the problem of how do you decide what is the amount a poor man can AFFORD?

    Mind you that's going to be your problem in MOH.

    And I'm frankly disappointed you chose to misdirect us into talking about the timing of payment.

    Answer the question please.

    By Blogger Dr Oz bloke, At March 10, 2006 12:26 pm  

  • What is the question??

    The problem with medicine nowadays is that doctors make a living out of the suffering of others.
    Thus it is immoral to charge even one cent as a doctor job is to heal the sick.

    To solve the problem, doctors should all be financially independent with passive income covering their expenses and thus can afford to treat for free.

    Guess this is why medical tuition fees are going up to exclude the poor who can not afford to see patients for free.

    If Durai was a doctor, he can afford to see patients for free because 600K to him is peanuts.

    Morale of story:
    If u choose to make a living as a doctor, u have to accept criticism
    from others who expect doctors wo work for free.
    If u charge a lot, people complain about you.
    The solution is to probably work in a field where it is a want and not a need, eg plastic surgery, dermatology and earn a living.

    Regards.

    By Anonymous Ang Yee, Gary, At March 10, 2006 4:08 pm  

  • means testing is a political subject and can break or make our party

    Should probably discuss after GE.
    KBW already told us likely to be implemented next year.

    I thought there is a Primary Care Physician scheme where patients who really need help can present a card?

    If a person can't afford, ask him to queue at the polyclinic.

    Even when govt gives up free food, u still have to queue.

    By Anonymous Ang Yee, Gary, At March 10, 2006 4:13 pm  

  • "means testing is a political subject and can break or make our party

    Should probably discuss after GE.
    KBW already told us likely to be implemented next year."

    "Our" party?

    Last I checked you are an RC member, not a member of the PAP. Or is Mr Chan lying when he says PA does not equate to PAP?

    By Blogger Dr Oz bloke, At March 10, 2006 6:41 pm  

  • I am not a RC menber, just a member of young pap.

    By Anonymous Ang Yee, Gary, At March 10, 2006 11:44 pm  

  • My experience with people association with RC, CC, PA and PAP has shown that they talk as if they ARE the government.

    They always talk like they are the authorities.

    Perhaps it is justified.

    By Blogger Dr Oz bloke, At March 11, 2006 10:22 am  

  • This is again a political issue and should not be discussed.

    As to what doctors should do when they are not financially independent. They should strive harder and if they can't help the poor in their lifetime, maybe their children can.

    At least leave a legacy to always remind our descendents that it is important to help those less fortunate when one is financially independent.

    That's why Singapore is so successful.
    Build up a country reserve then talk about welfare and not the other way around.

    By Anonymous Ang Yee, Gary, At March 11, 2006 1:38 pm  

  • So according to gary, I suppose children of poor families should not study medine, since they do have 'passive income' to allow them to treat patients for free. Medical school must be reserved for the wealthy elite?

    By Anonymous pathdoc, At March 12, 2006 6:25 am  

  • It seems unfair but with the increase in medical school fees, who do u think they are attracting medical school, the rich or the poor.

    I don't agree with raising school fees but if raising school fees can help to subsidize the poor patients in hospitals, who am I to disagree with this policy??

    The best doctors are those who have no financial interests in their patients and thus no conflict of interests.

    I dont' create this world, I don't control this world. I just try to live in it. If one day, I have a chance to change this world, I will make it a better place.

    A reasonable adapt himself to the world. An unreasonable man adapt the world to suit himself. Just make sure u have what it takes to change the world (Gates in eradicating malaria)

    By Anonymous Ang Yee, Gary, At March 12, 2006 1:23 pm  

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