The Serious and the Mucus Musings of October

These are exciting times in the local healthcare fraternity. We are not talking about groundbreaking research being performed by A*STAR whales or the renovations that are underway in the Most Expensive Old Hospital so that doctors can admit their patients to the Most Expensive New Hospital.


We are talking about the reproductive process. At the Singapore Gonad, sorry, I mean, General Hospital no less. We have ex-senior civil servants purported having sex in a carpark somewhere on the hospital campus. Now this is a true mystery to me. The Hospital is a 24-7 place where there are busy people working on shifts and family members and friends visiting patients round the clock. And the car-parks are reasonably well-lit, even for the multi-storey carpark located in the equivalent of Siberia within the campus. How do you have coitus discretus in a hospital carpark? Unless it’s the one in the mortuary…..or the one across the street behind the big white building. Some of those guys working in that building are so brain dead that they wouldn’t notice two humpback whales humping in the carpark if they walked past them. Your only worry is if a helicopter suddenly lands next to you.


And there is also this mention about a carpark near a women and children hospital. You may want to deliver your baby there, but seriously, you don’t need to “do the do” near it. Personally thinking, I think the carpark at IMH has the best ambience. But that’s the psychotic side of me speaking.


You would have noticed that the carparks at private hospital have been ignored by the SP and chip folks. That’s because at the rates the private hospitals are charging, you might as well check into a room in a six-star hotel.


So much for the mucus stuff. Now for the serious.The SMC elections are underway again. Please remember to vote.


Anyway, I know a chap who is so disillusioned with the whole thing he voted “00” three times. I am more optimistic. I voted for the person I didn’t know so that should I ever need to appear before SMC,  at least there is one SMC doctor who can chair the disciplinary tribunal instead of getting a senior lawyer or retired judge. Then they can’t all claim they know this Hobbit and stuff me with a lawyer chairperson.


Speaking of SMC, it’s has been in the news recently. And if I may say, for the wrong reasons. Some of its work has been described as “legally embarrassing”. As a doctor, this hobbit has absolutely no clue what is “legally embarrassing”. But I can give examples of what I think are “medically embarrassing” situations:


  • You prescribe Propecia to a bald monk
  • When a female patient complains of urinary urgency, you attempt a per rectal prostate examination on her
  • You certify someone as dead and he/she comes back to life


In most medically embarrassing cases, I think the doctor will waive their fees or at least offer a big discount. I am not sure what applies in “legally embarrassing” situations. Maybe the lawyers can advise us.


Anyway, the SMC just issued a press release stating that the two cases that had been cited as controversial were processed under the old Medical Regsistration Act (MRA) and new cases will come under the new and better MRA that was amended recently. I have read through the press release and this Hobbit is still unsure how these new changes in the amended MRA will prevent similarly legally embarrassing situations from happening again. They said having a retired judge or senior lawyer on the Disciplinary Tribunal (DT) will improve things. Maybe they will. But how are these learned ladies and gentlemen going to prevent legally embarrassing charges from being drafted? Are they supposed to help in the drafting of charges and also to judge the case as well? I hope not.


I am no great fan of aesthetic medicine. Having said that, the SMC action to apply to the High Court to set aside the Disciplinary Committees’ previous decisions on two doctors practicing aesthetic medicine is to be welcomed. The next question that should be asked is who should pay for the legal costs of all parties of what are now legally embarrassing efforts? It would seem grossly unfair if the two doctors have to pay. If SMC pays, it means all registered medical practitioners end up paying and perhaps increase in subscriptions if SMC cannot balance its books. Guess who gains from these legally embarrassing cases?


Finally, the SMC press release stated a Review Committee will be formed. It will be chaired by a senior doctor and assisted by a senior legal practitioner and will comprise senior doctors and other legal practitioners. That’s good news. This hobbit has a few serious suggestions to make:


  • The doctors, especially the Chairman on this Committee should be doctors in active practice, in touch with what is happening, especially in the private sector, since many SMC cases involve the private sector.
  • The doctors in this Committee should not be current or recent SMC Presidents, Registrars, Secretaries, members or even SMC lawyers. You can’t review yourself objectively. They should be at best resource persons
  • This Committee should present its findings and recommendations publicly
  • The ultimate decision to accept or reject the Committee’s recommendations should rest with the Minister for Health and not anyone now in SMC.
  • All new SMC members must undergo substantial training in ethical principles of medicine and legal processes. All our trainees and residents take a two day ethics course organised by the SMA before they can exit. How many days of training do these new SMC members get?
  • Maybe we should get the Legal Service to permanently second a legal officer with DPP experience to help SMC draft charges and SMC can stop relying on law firms to do so. The legal officer is probably more experienced in drafting charges and cheaper.

As readers of this column will know, this Hobbit rarely if ever says anything serious. But things in SMC are really at the cross-roads now and even this super –idle hobbit feels compelled to make these serious suggestions.


Finally, a word on residency. All of you know how this Hobbit feels about the residency that we have adopted from the American system. To underscore how hugely complex the American residency is, the latest Nobel Laureate in Economics actually wrote a landmark 49-page paper on how residency applicants are matched with training positions in the USA: “The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design” by Alvin E. Roth (one of two of this year’s Nobel Laureate for Economics) and Elliott Peranson (American Economic Review, Vol 89 (1999) pp 748-780). It is a fascinating read on how complex things can be in America. I think I will just settle for the good old days when Chee Yam Cheng and his PA settled all HO and MO postings in a small corner of MOH. Maybe we should nominate him for Nobel Prize for Economics and Medicine next year. Simplicity and elegance:- We don’t see that often nowadays.

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