September’s Scattered Thoughts

After the last two posts on Facebook which were kind of heavy going, it’s time to revert to something light and cheery again. This hobbit doesn’t have much of a choice. Peter Jackson has been reported to have chopped up the movie “The Hobbit” into only three parts. But the evil wizard has been rumoured to have asked the orcs working in the ivory building up the road to chop up this hobbit into 19 transverse sections. Gulp. The Hobbit is very scared.


The recent report about the several Korean plastic surgeons coming to town to “see” or “interview” prospective patients is kind of disturbing. It is disturbing for a variety of reasons:


  • Very soon, all our girls will look exactly like each other or like one of four famous Korean starlets now acting simultaneously in 2,614 serials with essentially the same plot.
  • The patients have probably done their sums – paying for a return airticket to Seoul and getting a nose job is still cheaper than going under the knife in Singapore.
  • People actually don’t mind getting plastic surgery from a country that gave the world PSY and the “Gangnam Style”. Good luck


In deference to all those guys on Nexium, Dormicum and Prozac up the road, I promise this column will have no adverse mention about the residency. This hobbit does not wish any old chap to kick the bucket with the cause of death stated as “Reading SMA Hobbit posting on FB”. So all you guys up the road, please relax – You can again go back to your usual state of denial and brainstem existence as you try to hatch your next evil plan to make lives more miserable for doctors.


Talent is everything and aside from the quality of residents, the quality of the people we choose into medical schools is also equally important.  Once we again, we have reason to believe that the medical school has always gotten the cream of the crop, even better than law schools. This can be seen by the case of the law student purportedly having sex and lavishing expensive gifts on her lecturer in exchange for good grades. It’s a lot simpler in medical school in our time. On the night before the exam, as per the advice of our wise seniors, we sent two female students to a male lecturer residing in the hostel. Don’t get me wrong, it’s not that the lecturer was into threesomes or other kinky stuff. These two girls were just sent there to cry (they are professional grade criers) and inevitably, the soft hearted lecturer would give the two a cryptic tip or two. And these two girls, in the true public spirited and selfless nature that differentiates medicine from the rest, then shared the tip with the other 132 classmates who were mugging away outside the medical library at 11pm in the night.


That’s it, no gifts, no sex and no corruption. Of course, sometimes the tip isn’t accurate or the girls were hard of hearing. “Angle of Louis” became the “Circle of Willis” and a quarter of the class had to take the viva or the re-paper for the 1st Pro. Sigh. In case the CPIB is reading this, let me state clearly that this happened in the very mythical Middle-earth Medical School which has got nothing to do with what’s happening or had happened in Singapore.


I think the main issue with men is that men can’t really think when women are involved. If the world’s greatest detective, aka Batman can’t figure out that Marion Cotillard is the villain until the last 15 minutes of a two and a half hour movie (and only after he was stabbed by her), how can we fault the law lecturer for not doing the right thing under such affection from the female student?


The biggest healthcare news that broke recently is that Singapore is the richest and healthiest country in the world. This is great news for everybody and sort of explains why we just bought those Brompton bikes when our founding father ministers refused to pay hotel laundry charges and washed their own briefs. But this Hobbit thinks we still need to renew this spirit of frugality by telling all senior civil servants and politicians that they cannot claim laundry charges when travelling. They should be issued with disposable briefs – one for each day of travel and an additional one in case of emergencies. This practice should continue until we have firm evidence that:


  • Patients in the private sector actually pay less for more without the Guideline of Fees when compared to the time the Guidelines existed (inflation-adjusted)
  • Our GDP per capita rises to that of the richest country in the Milky Way, surpassing the planets of Krypton, Alderaan and Vulcan.
  • All the management, training and exam design consultants the public sector have hired in the last 10 years actually contributed to better health outcomes for the population in a way that we could not have achieved by ourselves had those guys in the big offices only trusted us and actually gave us the money to do it.
  • Our total fertility rate (TFR) for Singaporean humans or wild boars reaches 2.1 (whichever comes first),


That brings us to the issue of assumptions. Everyone works on assumptions because our knowledge is incomplete and imperfect. But we need to revisit them when new information becomes available.


So beware the false prophets that make policy pronouncements about this and that when there is obviously no evidence to substantiate the claims. The profession has experienced a gut-wrenching, blood-draining and spirit-bashing ride in the last few years in terms of professional regulation, licensing and training. And for what? Where is the evidence that all this was necessary and the best option available? For example, are patients better off without the Guideline of Fees? Now according to SMC, there is an “ethical limit” to what doctors can charge and that you can’t charge rich people more because they are rich. But wasn’t the SMA GOF pretty ethical for the 20 years it existed but it was killed out of a legality (otherwise known as the Competition Act)? Law trumps ethics. As far as this hobbit is concerned, the lemon law IS the Competition Act.


Speaking of charging the rich, logic dictates that if you can’t charge the rich more, you can’t charge the poor less either. So like the Sheriff of Nottingham, we may have accidentally outlawed Robin Hood here. This is not a good thing because I know many doctors in private sector practice who have behaved a bit like Robin Hood pretty often. So after killing GOF, Dr Robin Hood may have to die as well.


So here, we see the tragic irony of law versus conscience. The GOF was originally put in place by the SMA after much persuasion by MOH in the eighties. Those old doctors running MOH then knew what they were doing. They left the issue of charging to the conscience of the profession. The SMA’s GOF served the public well for 20 years because the unspoken message of GOF was to behoove doctors to be better beings in the matter of charging and that charging should be guided by a collective conscience as embodied in the SMA. When SMA’s GOF was outlawed, the issue of charging was forcibly removed from the collective conscience of the profession and now we see what we are seeing. It’s difficult to put Humpty Dumpty back together again.


Today I was listening to radio station 93.8’s program “Talkback” which featured doctor’s fees and the subject of overcharging. It is interesting that most lay folks who called up favoured guidelines of some sort. So while we are trying so hard and maybe going around in circles trying to curb overcharging now, can someone just eat humble pie and admit they screwed up and let SMA bring back the GOF? Is pride so important?


Anyway, let’s close off on a lighter note. The London Olympics just ended. One sport that struck me as particularly pertinent for those guys up the road is synchronised swimming. Synchronised swimming has much in common with bureaucracy –


  • They don’t listen very much because they spend a lot of time submerged
  • They can literally turn their whole beings upside down when submerged
  • When they are visible, they all have this plastic smile, glazed look and do the same thing, just like how all bureaucrats give the same answer when they are questioned
  • Once in a while, for effect they do a spectacular stunt like throwing someone up to do a somersault
  • But seriously, seconds after they all leave the pool, the pool returns to its usual self and whatever the synchronized swimmers did had no lasting impact on the waters, other than dirtying it.


I think all the guys up the road will be very good at synchronized swimming. Other than table tennis, we may yet get another medal from synchronised swimming in the next Olympics.


4 Sep 2012

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