Angry Doctor

Thursday, March 27, 2008

Stop using that word!


Not surprisingly, there are a few letters to the press on the recent announcement on aesthetic 'medicine'. What angry doc does find surprising, however, is this letter from the SMA:


SMA lauds ministry's clarification, criticises ST

I REFER to the spate of articles on aesthetic medicine that has been published in The Straits Times since March 19.

The Singapore Medical Association (SMA) welcomes the clarification made by the Minister for Health last Sunday on the position of the Government on this matter, in particular, the emphasis on self-regulation of aesthetic practices by professional bodies.

We are also heartened by the circular issued by the Director of Medical Services to all medical practitioners last Monday which spelt out the principles of safeguarding medical standards in Singapore as well as the press release, 'MOH clarifies position on aesthetic medicine', dated the same day.

The vast majority of doctors in Singapore, including those that provide aesthetic services, are ethical professionals who earn an honest day's living by caring for their patients. Even if some of the mentioned aesthetic practices are not grounded in the most robust body of scientific evidence, the use of the term 'snake oil' is insensitive to many in the medical profession.

Repeated use of this term by The Straits Times, notwithstanding that it was, as we understand it, uttered on a single occasion by a person of authority, is hurtful to doctors and regrettable. It does little to raise the standard of discussions on this difficult issue of regulating aesthetic practices.

Doctors understand that with great powers and trust vested in them by the public, come greater responsibility and accountability. Likewise, we hope that the local media will exercise better discretion going forward so that readers are better served with more constructive reporting.

Dr Raymond Chua
Honorary Secretary
48th SMA Council


EDITOR'S NOTE: We reported accurately the quote in question and used it whenever it was relevant to the stories we ran. We fail to see how being factual in our reporting can lower the level of discussion on this issue. That must depend on the quality of the arguments used by doctors, which is entirely in the hands of the profession.


Whiner.

Dr Chua calls it "aesthetic practices [that] are not grounded in the most robust body of scientific evidence", angry doc calls it unproven therapy. To angry doc's mind, and no doubt to those of many of his readers, unproven therapy that is touted to be able to deliver more than what it can do *is* 'snake oil'.

More importantly, Dr Chua does not challenge the "person of authority" who "uttered [the term] on a single occasion", nor does he provide any justification for why he thinks that the term had been wrongly applied, but expects the press to stop using that term simply because it is "hurtful".

Well, boohoo.

angry doc thinks it's laughable that Dr Chua expects the press to be 'sensitive' to doctors. angry doc thinks that the press doesn't owe it to us to be 'sensitive', but to be honest. angry doc thinks that doctors owe it to their patients to be honest too.

Unless the press had lied about the facts presented in their report, and unless he can provide evidence that that is the case, angry doc thinks it is disingenuous on that part of Dr Chua to try to blame the recent fiasco facing doctors on unconstructive reporting on the part of the press: if you want them to shut up, prove that what you are selling is not snake oil, or just stop selling it.

Labels: ,

17 Comments:

  • The issue is whether the public would be led to think that all doctors are unethical. This is including those working for the best interests of their patients and making an honext living. Can't tar all with the same brush :)

    By Anonymous med stu, At March 28, 2008 12:55 am  

  • "Can't tar all with the same brush :)"

    You & GDoc know that; but the public sometimes doesn't, and the press doesn't seem like it cares.

    Strange, the public and press can indeed be fickle. Seemed like a short while ago when the press was portraying aesthetic practitioners (specialists and otherwise) as celebrities. Anybody remember the big articles in colour splashed all over the "Life" section?

    In retrospect, GDoc feels that the authorities should have stepped in much earlier, and implemented some form of guideline. A guideline that can be expanded and modified in accordance to the changes in the field of aesthetics. Yes, GDoc does not think that aesthetics is going away anytime soon as the demand is simply too great (and growing).

    Professionals are expected to place their clients' (read: patients') interest before personal gain.

    Performing elective procedures of questionable value, and lacking in robust clinical data can only expose a self-regulating profession to criticism.

    Trouble now is, too many doctors (according to recent reports) have their fingers in the aesthetic pie, to the tune of SGD$200 million per annum, if these reports are to be believed.

    Some doctors may be practicing aesthetics exclusively, while others may be using aesthetics to supplement an otherwise, financially unsustainable practice.

    Due to the extent that aesthetic medicine has penetrated many practices, prohibiting certain aesthetic procedures at such a late stage can, and will be met with fierce resistance.

    Again, GDoc feels that most of this difficulty in regulating aesthetics could have been avoided with timely and decisive intervention. Hindsight is indeed 20/20.

    By Blogger GuinnessDoc, At March 28, 2008 1:46 am  

  • It's been brought up before, but I don't see how the ministry's stand (or rather, Prof Satku's stand) that "Aesthetic medicine is not evidence-based medicine" is congruent with setting up a TCM Center in the heart of SGH.

    Perhaps because Aesthetics doesn't have as powerful a lobby group within the ministry?

    By Anonymous Medik, At March 28, 2008 8:57 am  

  • "It's been brought up before, but I don't see how the ministry's stand (or rather, Prof Satku's stand) that "Aesthetic medicine is not evidence-based medicine" is congruent with setting up a TCM Center in the heart of SGH."


    GDoc has always wondered about the rational behind that decision as well.

    GDoc has nothing against TCM. GDoc believes that TCM is a potential source of new compounds that can be put into trials for their efficacy. Nonetheless, GDoc feels that TCM should have been kept seperate from the practice of modern medicine as TCN is not evidence based medicine.

    GDoc suspects that TCM practitioners have long been attempting to legitimize themselves in the eyes of the public. Being accepted and associated with modern medical facilities/practices is one manner of accomplishing this. Being allowed to set up TCM facilities in hospitals was a major coup for TCM. Notice how TCM is now lobbying for the right to issue medical certificates.

    GDoc is not privy to the reasons behind the decision making process of permitting the practice of TCM on hospital premises. However, GDoc has always felt that it was a major mis-step on the part of the decision makers.

    TCM is represented by "practitioners". There is a chasm between their guidelines for best clinical practices and evidence based medicine vis-a-vis modern medicine. Again, no disrespect meant towards TCM, it's just the nature of TCM practice.

    Since such a discrepency of practice protocol exists between TCM and modern medicine. It would have been prudent to have kept them seperate (ie: evidence based medicine, and non-evidence based practices).

    By confusing the two, the authorities have set a rather unsettling precedence for other non-evidence based practices to follow the path taken by TCM. In this case, Aesthetic Medicine.

    First TCM, now Aesthetic Medicine, where does it all end? What next? "Snake oil"?

    GDoc's 2 cents.....

    By Blogger GuinnessDoc, At March 28, 2008 9:57 am  

  • MOH's stated position on TCM is, according to this letter from 2004:

    http://www.moh.gov.sg/mohcorp/mediaforums.aspx?id=4514

    "Science-based medicine, which is often called "Western" medicine, is the main form of healthcare in Singapore. Many Singaporeans also turn to Traditional Chinese Medicine (TCM) and other types of natural and herbal treatments as a complementary form of healthcare. The practice of "Western" medicine is evidence-based, in which the efficacy of medical treatments is tested and supported by scientific research and clinical trials that are subject to peer review and international scrutiny. Clinical trials were historically done in the west, hence the name "Western" medicine. Today, many of the clinical trials are international and Singapore hospitals have participated in some of the clinical trials.

    TCM and other complementary or alternative medicine therapies have not been studied in the same scientific manner.

    We would advise that consumers exercise discretion in evaluating the information available on the efficacy of TCM/alternative medicine products and therapies."

    I don't think TCM had suddenly become evidence-based over the past 3 years.

    By Blogger angry doc, At March 28, 2008 9:29 pm  

  • It'll be impossible to ban TCM... due to the fantastic public support for it.

    Patients like TCM due to the fact that symptoms of disease are easily explained away using layman language such as 'heaty' or 'cooling'. No need to know any pharmacology, anatomy, biochemistry or pathology. Everyone can differentiate hot from cold.

    Western med has an uphill task with regards to illustrating the actual pathophysiology of disease. Difficult to talk to the patient about autoimmune hemolytic anemia when he does'nt even know what are antibodies! That carries over to medication. Anyone who has tried explaining why 'evil' steroids are required in the management of severe asthma can attest to this.

    Who needs EBM when some uncle/aunty/grandmother has had her cough cured by a fistful of herbs from some neighbourhood shop - Patients are happy relying on anecdotal evidence rather than the latest meta analysis. How many of our patients know about confidence intervals or the significance of a 'p-value'?

    Therefore, as TCM is here to stay, all MOH can do is to regulate the industry and make sure that nothing is overtly unsafe. Onus is on the patients to guage the efficacy of treatment.

    Anyway we can't slag TCM off totally. Its impossible to patent a herb. Hence nobody provides the funding to do actual clinical trials. However, you can patent a chemical component of a herb. Then it becomes western medicine with all the associated mumbo-jumbo. No longer simple and 'cooling'.

    By Anonymous med stu, At March 29, 2008 4:23 am  

  • drs can only blame dr-selves. Patients look at us differently from the way they look at beauty saloons. Why lay the hands on somethings that drs cannot provide evidence for? Why does MOH take action only now?

    The other problem with MOH is instituting double standards. Allowing beauty saloons TO PRACTISE AESTHETIC MEDICINE.

    I'm also thinking how come it's so hard to ban smoking. Can tax, source of revenue for gov, so allow lah

    By Anonymous Anonymous, At March 29, 2008 4:47 am  

  • "We would advise that consumers exercise discretion in evaluating the information available on the efficacy of TCM/alternative medicine products and therapies."


    GDoc respects every individual's right to determine whichever therapy they feel is best for them, be it Modern medicine, TCM, Aromatherapy, etc...

    However, GDoc feels that the facilities providing these different modalities of treatments/practices should be kept seperate. That is why GDoc thinks that the decision of having complementary (ie: TCM or otherwise), non-evidence based forms of healthcare co-located on hospital premises, is a poor one.

    Look at it this way. It would be logical for a person to think "Hey, this facility is located on hospital premises, that implies that it is probably functioning under the auspices of the hospital authorities, ergo, treatments there should be efficacious". This only serves to confuse the public.

    By Blogger GuinnessDoc, At March 29, 2008 10:23 am  

  • "I'm also thinking how come it's so hard to ban smoking. Can tax, source of revenue for gov, so allow lah"


    Haha :) That certainly is food for thought!

    However, GDoc would like to point out that the monies that the doctors make on practicing aesthetic medicine are also taxable :)

    By Blogger GuinnessDoc, At March 29, 2008 9:51 pm  

  • "The other problem with MOH is instituting double standards. Allowing beauty saloons TO PRACTISE AESTHETIC MEDICINE."


    Actually, beauty saloons practice "aesthetics", not "aesthetic medicine". The difference albeit subtle, exists.

    Beauty saloons don't do invasive procedures. They are also unable to apply for a laser license. Doctors, on the other hand, can.

    GDoc has heard of some beauty saloon employing doctors to perform invasive procedures, thus circumventing the regulations.

    By Blogger GuinnessDoc, At March 29, 2008 9:55 pm  

  • People that follow this blog might be interested in a japanese medical drama called Team Medical Dragon (Iryu). They do depict many of the situation angry dr mentioned in his blog.

    Cheers,
    Ray

    By Blogger Ray, At March 30, 2008 10:39 am  

  • Hi,

    I am unable to find your email address on the blog and so I am posting it as a comment here.

    DoctorsHangout.com ( http://www.doctorshangout.com ) is an exclusive next generation social networking service for Medical Students, Residents and Doctors. DoctorsHangout.com social network can help you maintain existing personal and professional relationships and establish new ones by reaching out to Doctors you've never met before. DoctorsHangout.com makes it easy to find people who share your hobbies and interests, look for long lasting connections or establish new professional contacts.At DoctorsHangout.com, Doctors exchange clinical experiences, review their cases and share clinical knowledge. You can immensely benefit from the collective knowledge of DoctorsHangout.com members.

    Join now at http://doctorshangout.com/main/authorization/signUp

    If you like this, please do mention about it on your blog and link it in your blogroll. Thank you.

    By Anonymous Anonymous, At April 01, 2008 1:58 pm  

  • Let's see. According to the press, about 1000 doctors or 60% of GPs are practising some form of aesthetic medicine. If those procedures are baseless, without scientific merit and unethical, what does that say about half the medical profession?

    By Anonymous Anonymous, At April 05, 2008 8:44 pm  

  • "Let's see. According to the press, about 1000 doctors or 60% of GPs are practising some form of aesthetic medicine. If those procedures are baseless, without scientific merit and unethical, what does that say about half the medical profession?"


    GDoc is uncertain where or how the press derived those numbers. Nonetheless, let's assume those figures to be correct for this discourse.

    GDoc cannot accurately predict the motives behind every individual's action, but he can sure take a guess.

    Before we go any further, let us clarify the position here. The press reports also suggest that some specialists are also getting into the Aesthetics act, not just the GPs alone.

    Also, not all the procedures offered are "baseless". Laser resurfacing for acne scars, for example, does work. GDoc is skeptical on other treatments, such as micro-needling.

    OK, on with the discussion.

    Let's see. First off would be the financial motive. There are probably some enterprising souls who see Aesthetics as easy money.

    There are also some who have a genuine interest in Aesthetics, and would like to make a career out of it. How this conflicts with them being doctors is extremely subjective, and would depend on every individual's point of view.

    Then, there are the doctors who are running either poorly, or non-performing practices. The high rentals (sometimes even $15,000.00 per month), even in HDB areas, coupled with numerous competitors make life tough for GPs. Managed health care has also suppressed the consultation charges of GPs to ridiculous levels (GDoc has even heard of single digit consultation charges). GPs are working longer hours just to capture more patients. Some are forced to see lots of managed care (contract) patients paying low consults (high speed usually leads to poor quality work), in order to make ends meet. Given this situation, GDoc is not surprised that more and more GPs are either going into Aesthetics full time, or are supplementing their income with Aesthetic work.

    It's not GDoc's place to determine what is "right" or "wrong", but he hopes the reader puts him/herself in the doctors' shoes, and then form their own opinions.

    Faced with either running a late night/24 hrs/open on holiday clinic with a dwindling private patient pool, or running a managed care (contract) based clinic seeing lots and lots of patients (very much like a production-line operator) at high speeds with little or no time to know one's patients. Both options seem unpalatable. Along comes Aesthetic Medicine which offers significantly less patient load, less unsociable hours, no managed care operation demanding <$10 consultations, and a lot more money to top it off. Can anyone blame some GPs for dabbling with Aesthetics? Perhaps we should stop "short-changing" our GPs? GDoc will provide a link to an article written by a prominent member of the College of Family Physicians below:

    http://www.sma.org.sg/sma_news/3202/president_forum.pdf

    By Blogger GuinnessDoc, At April 06, 2008 1:00 am  

  • I do not quite buy GDoc's argument. If business is so tough for GPs who wish to practise medicine as it should be, then perhaps more of them should return to the public sector and work in polyclinics. That will certainly reduce the long waiting times.

    By Anonymous Anonymous, At April 13, 2008 1:36 pm  

  • "I do not quite buy GDoc's argument. If business is so tough for GPs who wish to practise medicine as it should be, then perhaps more of them should return to the public sector and work in polyclinics. That will certainly reduce the long waiting times."


    Don't take GDoc's word for it. The article via the link GDoc provided is written by Prof Goh Lee Gan (College of Family Physicians) who does have quite a good grasp of the situation on the ground.

    To answer your question, doctors leave the government sector for various reasons. Some of them remain in the field of medicine while others exit medicine altogether.

    Some of the reasons are as follows, feel free to pick and choose. Greater autonomy (wanting to be your own boss), less red tape, less politics, better financial compensation (sometimes this works out, at other times not), less patient load, no over night calls, etc...

    There was even a survey done, results were published in the Straits Times a few months ago. Admittedly, the number of responses to the survey could be better, however, it concluded that GPs' salaries have remained the same when compared to 1998 (10 years ago). What it did not take into account was inflation. Factor in approximately 3% per annum of inflation over 10 years, and you get the picture....

    Rentals have kept pace with inflation, and so have the pay of staff, and the costs of medicines and utilities.

    It may not be apparent, but there are clinics that close down every so often. There are also doctors who run practices that compensate them less than polyclinics.

    Some doctors who fail at their own practices run "Locums". They provide "stand-in" services when doctors go on leave, or are called back for reservist duties with the Army or Civil Defence.

    Yes, there are also doctors who return to polyclinics and the public hospitals after shuttering unsuccessful practices. However, most of these doctors prefer to stay outside the public service as Locum doctors (some even locum at polyclinics) because this offers them greater autonomy (no need to apply for leave. Don't feel like working? Just take off, don't accept locum bookings).

    Good locums can find slots easily. However, this isn't a reflection of a lucrative GP market. If a GP wants to take leave or gets called back for reservist, he either has to pay for a locum ($60-$70 per hour) to see his patients, or close the clinic for the duration. Some choose to close their clinics as they cannot afford the locum fees.

    By Blogger GuinnessDoc, At April 14, 2008 8:21 am  

  • You can't blame the doctors alone. After all, the patients have a choice as to who they choose to do their treatments with.
    Maybe they are comfortable with their own GPs who offer aesthetic medicine.
    While doing my research for my anti agin website, I realised that some doctors offer aesthetic treatments due to repeated requests from their patients.

    cheers,
    Pearlin

    By Anonymous Pearlin Siow, At June 17, 2009 10:16 pm  

Post a Comment

Subscribe to Post Comments [Atom]



Links to this post:

Create a Link

<< Home