Angry Doctor

Saturday, January 31, 2009

The Rightful Place

"We will restore science to its rightful place and wield technology's wonders to raise health care's quality and lower its costs."

Barack Obama, Inauguration Address

angry doc was moved by Obama's inauguration address, and that line in particular brought tears to his eyes. He believes he is not the only one.

Over at ScienceBlogs the folks are so excited by this promise, they have started a project to discuss the idea of
The Rightful Place of science.

Many science bloggers have contributed their views, and it is well-worth a read.

angry doc identifies with Cortonix's take:

If you walk into a room and flip a switch and the light does not come on, what do you do? I doubt that you throw yourself on the floor in fear, speaking in tongues, praying, blaming the Aliens or asking the Government to help you. You calmly go about dissecting the problem into pieces: is there electricity in the house? If not, did you pay the bill? If yes, should the fuse be flipped or replaced? If not, perhaps the light bulb burned out: replace and see what happens. If that does not work, perhaps replacing the socket will work. If not, checking the wiring may help. You go through the problem systematically, testing each element, until you find the problem and fix it. You do the same if water is dripping in your kitchen sink, or your car is running funny.

But when it comes to bigger problems that affect the broader society, some adults forget their inherent scientific mindset and let indoctrination and ideology take over. As the problems become more complex, and the science behind it more difficult to understand, other social influences tend to take precedence. See: global warming denialists, HIV/AIDS denialists, anti-vaccination crowd, Creationists of all stripes, New Age proponents, medical quackery believers, animal rightists, and so on. Faced with complexity that goes against the dogma received by parents, teachers, priests and media, people shut off their natural scientific mindset and go with what "feels" right to them, instead of with reality.

We are not in America, but as you can see from the links angry doc embedded in the quote above, we too need ask ourselves what the rightful place of science in our society is.

angry doc believes that science does not always provide the answer, and that it is merely a tool - although a very reliable one. The problem, as Cortonix pointed out above, is that too often when it comes to questions that can be answered by science, or questions to which science can provide us with a lot of data to base our decisions on, people choose not to use that tool but rely on "indoctrination and ideology", tools (if you can call them such) which are untested and unchallenged (and becoming increasingly unchallengeable).

angry doc may not be able to do much to put science back in its rightful place, but he hopes that with the help of his fellow Clearthought bloggers and his readers he can do his bit. He hopes you will join him in his efforts.

Thank you.


Saturday, January 24, 2009

To write is to sit in judgement on oneself

A comment on the previous post on the issue of "decorum" set angry doc thinking about his blogging.

As a young doctor angry doc was taught never to "run down" (yes, that was the exact term used) another doctor in public. The Singapore Medical Council's Ethical Guidelines advises that:

"A doctor shall refrain from making gratuitous and unsustainable comments which, whether expressly or by implication, set out to undermine the trust in a professional colleague’s knowledge or skills."

It seems to angry doc that the SMC's position is more enlightened than the "you don't talk about the Fight Club" rule he grew up with - one should be allowed to criticise if one can substantiate one's criticism, and if the primary aim is not to undermine a colleague.

Our knowledge is imperfect, our system is imperfect, and we ourselves are imperfect; it is inevitable that healthcare professionals will notice when things fail or go wrong, and it is unrealistic to expect them to not speak up while requiring them to provide safe and high-quality patient care. The question then is what setting, what platform should a doctor utilise to voice his or her concerns?

Prof Lee chooses the print media as her platform, and angry doc has chosen a blog.

There are literally hundreds of topics angry doc can blog on, so how does he decide what he blogs on?

angry doc thought about it last night, and he concluded that he writes about things that:

1. He is interested in. Of course; why bother otherwise?

2. He can substantiate. Rants and opinions aside, angry doc tries to gather information and check his facts before he writes on a topic, and he invites readers to correct him where he is wrong.

3. He can get away with. The point that the commenter alluded to at the beginning of the post made, angry doc believes, is that Prof Lee may be able to get away with saying certain things when others may not. angry doc doesn't know if Prof Lee can get away with it, but he certainly thinks there are topics which he cannot get away with criticising.

So at the end of the day, angry doc may be better judged on what he doesn't blog about, rather than what he does blog about.



Thursday, January 22, 2009

The heart has its own reasons...

No, this is not another post about true love, but a follow-up to a question posed by angry doc's teacher in the previous post:

What do you think about the changes in SCDF policy in today's ST re: pts with Acute myocardial infarcts?

angry doc did not read the story mentioned, but an article in Today today gives the background to the issue:

"Dr Lee Wei Ling, the director of the National Neuroscience Institute, wrote in a Sunday Times column that the two hospitals did not have the resources after office hours to handle heart attack patients."

"In her article, Dr Lee wrote that she had engaged ambulances under the Singapore Civil Defence Force, NHC and NUH, and got them all to agree to bypass the two hospitals if they pick up acute heart attack patients."

So is it a good policy to send all patients with acute heart attacks to NHC or NUH?

Management of acute heart attacks is not angry doc's area of specialty, but in general where both options are available, primary anigoplasty ("angioplasty operations... as a first course of treatment if needed") is superior to thrombolysis ("just medication to break up or dissolve blood clots").

In the event that primary angioplasty is not available at the nearest hospital and the nearest centre that does provide the service is several hours away, thrombolysis may be a valid option (feel free to correct angry doc if you know he is wrong); but is it a valid option in the local context?

angry doc does not have the answer, but it is not important, because Prof Lee's article (reproduced on this page) wasn't really on the availability of cardiac specialists in certain hospitals after office hours, but her belief that:

If there is something wrong that we know of, I believe we should try to set it right whether or not it is our business to do so. Not to do so implies we condone the wrong and hence we would be guilty of committing the wrong too.

So even though Prof Lee's recommendation for all patients with acute heart attacks to be brought to NHC or NUH may have been rendered moot by changes which have taken place, angry doc cannot fault her reason for speaking out.

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Thursday, January 15, 2009


OK, time to get back to the less important things in life...

The Ministry of Health is "conducting a six-week public consultation exercise from January 14 to February 25 to get feedback on proposed amendments to the Medical Registration Act".

You can find out more about the proposed amendments at the ministry's website here, and give your opinions here.

angry doc will be giving the proposed amendments a read and plans to submit his opinions, and he urges his readers to do the same - after all, we are not here to just talk about 'true love' are we?

angry doc's main interest amongst the many changes proposed are with those concerning professional self-regulation and disciplinary proceedings. Regular readers will know that angry doc holds a conservative opinion when it comes to the issue of self-regulation; will the proposed proviso for "appointing a judge, legal officer or senior lawyer as chairperson" of the Disciplinary Tribual delegate professional knowledge to a less important place than "legal issues, both procedural and substantive"? angry doc is concerned, and he thinks all doctors should be too.

Whether or not you agree with angry doc's view on professional self-regulation for doctors, if you have concerns regarding the issue, or regarding the competence of your family doctor or newly-registered doctors, or whether existing regulations ensure that your doctors are made to keep up with the latest developments in the field of medicine, this is the time to voice them and perhaps make suggestions on how you think MOH can do better. It will probably have more effect than commenting on this blog...

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Tuesday, January 13, 2009

Good Morning


Friday, January 09, 2009

Lover's Dilemma

(Warning: No Science Content)

angry doc should be blogging about how paranoia is causing outbreaks of measles across Europe or the HPV vaccination programme in the Marshall Islands, but instead he and fellow-Clearthought blogger Leng Hiong have a more important question to focus their minds on, namely:

can you accept that statement "I will love you till I die" as "fact" when someone (especially someone as hot babe as Katie Melua) says it to you?

Fortunately, angry doc has never been faced with that situation in real life. But one could always speculate...

In the hypothetical situation where 'hot babe' does pledge to love angry doc till the day she dies, angry doc could of course consider employing the aid of an MRI machine or a lie-detector, but such equipment may not always be available during the moments when that statement is likely to be made.

Even if one could confirm the veracity of the statement with the use of sophisticated equipment, what is there to ensure that the statement will be true each time it is made? Plus, there is always the chance that she cheated the machine by actually thinking about her ex-girlfriend when she said it...

The only thing that angry doc can be reasonably sure of really is whether or not *he* will love 'hot babe' till the day he dies; but that statement - let's face it - may not always be true either.

It seems to angry doc that if he was going to be in a relationship where he was always doubting if 'hot babe' will always love him or if he will always love 'hot babe', knowing very well that one does not always ensure the other, he might not be a very happy man at all.

And to make things more complicated, 'hot babe' may also be harbouring the same doubts about angry doc and herself.

All this seems like a perverse version of the Prisoner's Dilemma: you know the outcome (true love or heart-break and disappointment) will depend on the choices made by each of the two parties, yet you cannot know for sure how the other party will choose - so how will you choose?

angry doc cannot know if 'hot babe' will love him till the day she dies; he can only know if he *wants* to *try* to love 'hot babe' till the day he dies.

So he can either not commit to love 'hot babe', or pretend to commit to love 'hot babe', or commit to *try* to love 'hot babe' till the day he dies.

And he can choose to either live with no commitment from 'hot babe', or to not believe 'hot babe' when she says she will love him till she dies, or he can believe her (or that she will at least *try*).

You can put that in a 3 x 3 matrix, and ask yourself which combination will make you the happiest.

angry doc knows which combination he will choose, because if you're not going to believe that you can give and receive true love that will last till you die, then what's the whole point?

Monday, January 05, 2009

And you know that I will love you till I die

angry doc began the year by asking fellow-Clearthought blogger Leng Hiong a question whose answer had eluded scientists for centuries:

If you're not going to believe in true love that will last till you die, then what's the whole point?

angry doc's answer to his own question was this:

I think 'the whole point' is to attain a neuro-chemical state in our brains that tells us that we have achieved all that which our genes have 'determined' are 'good' for us.

What 'all that' is may be different for each individual, although we know that 'love' is (or rather a few different types of love are) encoded in our brains.

We might be able to objectively see true love on an fMRI or something, but like I said, what then is the point?

Now Blinkymummy tells us that 'a group of scientists from New York has found the meaning of 'true love'!'

Fascinating stuff. Sure it's all just chemicals in our brains, but it's as real as it gets.

So we now know that 'love that will last till you die' does exists - it is a thing we can't deny, like the fact that there are nine million bicycles in Beijing...

Whether or not it is 'the whole point' is still debatable, but it's nice just to know that it exists, isn't it?