Lessons from 2011 for the New Year

 2011 was a tough year for the medical profession. Legal and ethical precedents were set which made the environment more difficult for doctors. Eventually this will impact on patients negatively as well. There were no winners in the long run. As we go into 2012, let’s look back and take stock of the lessons 2011 offered. It’s not a pretty sight, but we have to face reality. These are the lessons and values others are foisting on us. The younger doctors especially will probably easily come to accept these values as accepted and established norms of medical practice even as we old coots adapt to these – the “new normal” of healthcare


Lesson #1

It’s better to decide on the specialty before you graduate (if not why offer the option at all?).– What those big-shots say –  it’s only an opportunity for you to apply, you don’t have to apply for a residency before graduating if you are not sure of what you want and you can take your time – once you know what’s happening on the ground, you would know this argument is all rubbish and devoid of intellectual integrity. Take-home message – Kiasu-ism pays. If you choose later, all the places in the popular specialties may have been taken up. You also don’t want to be the non-resident doing all the unwanted postings (or even if you are working in the same posting as residents – to end up working harder than residents).


Lesson #2

It’s OK for residents to work less than non-residents. Take-home message – Those that are given more will be given even more. Again, the lesson is – be a resident! And be one fast! But should you end up in a specialty you don’t like, tough luck.


Lesson #3

If you have exceeded your workload limit as a resident, do not log-in the additional cases or hours worked. It’s OK to lie to the training auditors. After all, telling the truth may get your whole department into trouble. Take-home message – don’t rock the boat, and to hell with honesty


Lesson #4

Signed consent is not good enough, even when the patient actually gave consent after two consultations and had a cooling off period before the operation. Take-home message – maybe it’s advisable to make an audio recording of your consent taking with the patient. Basically, you can’t trust your patient not to screw you royally later on.


Lesson #5

It’s OK to reveal residents’ names even when guilt is not proven. Take-home message – the days of your boss covering for you and taking the bullet for you, the junior guy, are OVER.


Lesson #6

Consultants have to review patients in person and you cannot trust your residents to make a clinical judgment. Take-home message – there is no team-based responsibility in reality even if the big-shots pay lip-service to promoting team-based practice. Better go into private practice when workloads are lower and you can do everything yourself and don’t have to trust junior doctors. Also, when in any doubt, cover your gluteus – order a CT scan/MRI etc.


Lesson #7

CMBs and Division Chairmen going into private practice. Take home lesson – do your own career planning, if even the CMB or Div Chair hasn’t got a life in the public sector after being CMB, you certainly don’t have one in the public sector either


Lesson #8

As long as you tell the patients beforehand and they agree, there is no such thing as overcharging. Take home message – Free market fundamentalism triumphs over professional ethics.


Lesson #9

When a patient/family member is unhappy with a SMC verdict, he can always appeal to the Minister to re-open the case with SMC. There is a significant chance the Minister will ask SMC to re-open the case and the doctor then be found guilty by a second panel. Take-home message – patients have multiple bites of the cherry including SMC, appeal to Minister, appeal to courts, civil suits etc.


Lesson #10

SMC wants to know sensitive stuff about you – Be careful about your past – e.g. whether if you have ever seen a psychiatrist. And then there can be an abrupt change of mind with SMC. Take home message – flip flops are possible with SMC. Hold on tight for the roller coaster ride. And even if we welcome the change in mind from SMC, one must wonder, what was the thinking behind the initial act of even asking all those strange questions in the first place?


In Summary


They may say they want to promote stuff like doctor-patient relationship, team-based care etc but actual incidents seem to suggest otherwise. All these stuff require trust – trust between doctors and trust between patients and doctors. But people in power don’t seem to understand that. Or maybe they do, but they rather not stick their necks out to foster such an environment of trust. It’s easier to hang a chap than to stick out for someone, that’s for sure.


So we have to distinguish politically-correct hype from harsh reality. As a doctor, trust no one. You can’t trust your boss or the hospital administration, and you certainly can’t trust your junior doctors. You cannot depend on SMC for consistency and you certainly can’t trust your patient. Better look out for yourself more, even if it means being defensive in your practice. To quote former Intel boss Andrew Grove – “Only the paranoid survive”


2011 may well be remembered as the year trust quietly died in Singapore healthcare. Welcome 2012…

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