10th Anniversary of SARS, 10 Years of Suffering Since

Ten years ago this month, SARS came to Singapore.  For those of us who lived through SARS as a frontline healthcare worker, SARS changed our lives forever, from the way we treated our patients, to the manner in which we saw ourselves. It was a defining moment; it cleaved the ornamental from the essential as many of us found ourselves locked in a daily and deadly gamble of life and death with the virus. Some of us lost.


Never before were healthcare professionals, and especially doctors and nurses brought so low. And never before did the professionalism and dedication of healthcare workers shine so bright.


The medical profession did not fail this nation. We stuck to our posts, from the SARS-struck tertiary hospitals such as TTSH and SGH to the GP clinic round the corner of the street, doctors did not leave their posts. As the battle of SARS was slowly won in the weeks after March 2003, doctors and other healthcare workers were lauded like never before.


If the arrival of SARS brought us to our knees, then the departure of SARS also raised us up like never before. Suddenly, doctors and nurses became community heroes. If there ever were a great time to be a doctor, it would be late 2003 and early 2004. We could do no wrong. Even my mother-in-law thought I was a great guy.


But what happened since then till now? I would say I think there are forces out there that want to make lives more and more difficult for doctors. They have forgotten that by far and large, doctors are decent  (forget heroic) folks who want to earn a living trying to help patients. I suspect some people think doctors are by default crooks and everyone is a crook until proven otherwise. They want to clamp down on us, regulate us and contain us like the SARS virus.


Let’s take a walk down memory lane on what has happened in the last 9 years or so since SARS and remember some of things that have been foisted on the medical profession. This hobbit is getting old and senile and he can only remember the ten items mentioned here. There are probably more.


Removal of GOF (2007)

They branded SMA a “trade association” and made the Guideline of Fees (GOF) illegal. The GOF had to be withdrawn and we lost our ability to advise doctors on how to charge. The result: all the overcharging issues we see now rearing its ugly head.


Administrative Guidelines on the Prescribing of Benzodiazepine and Other Hypnotics (2008)

Other than relevant specialists, every doctor can only prescribe a grand cumulative total of 8 weeks of benzodiazepines to patients, regardless of how long the patient has been seeing you. For a GP patient seeing you more than 10 to 20 years, this is almost impossible to follow and doing no one any favours (other than perhaps psychiatrists)


Big Brother Attempted To Get Our Psychiatric History (2011)

Remember the infamous “Application for Renewal of Practising Certificate” letter from SMC in Sep 2011? They asked us to declare if we had been treated or were undergoing psychiatric treatment? Unlike the Population White Paper, this is not a typo. The intent was clear. Luckily it was fixed just in time. But it was a very close call


Re-trial of SMC cases with no reasons given

And then in the last few years, there were several cases that went before SMC in which the doctors were found innocent. But the cases were re-opened and then the doctors were subsequently found guilty. No reasons were given as to why the cases were re-opened. The law provides for this re-opening and re-trial of cases but no one is the wiser why they happened.


Lawyers and Retired Judges on Disciplinary Tribunals (2009 and 2013)

Remember what was the main reason for having senior lawyers and retired judges when this move was introduced in 2009? A letter from DMS on 13 July 2009 stated that


“the  main reason for needing a chairman who is legally trained is for cases where “a prominent or senior medical practitioner, or someone known to the entire Council is the subject of the disciplinary proceeding”. DMS further clarified in his letter to us that having lawyers or judges chair the Disciplinary Tribunal adds value by “avoiding potential conflicts in the medical community in high profile cases”. Now fast forward to 9 Jan 2013 when SMC’s letter was published in The Straits Times Forum.


“SMC’s cases reported in the media recently were dealt with under the old Medical Registration Act (MRA) as the complaints were made before the amendments came into force on 1 December 2010. SMC is now no longer bound by law to appoint its Council members to the Disciplinary Tribunal. Experienced doctors and lawyers can now be appointed to the Disciplinary Tribunal as members or as the chair. As SMC continues to push for such changes, we hope that doctors will support this in the public interest.”


Interesting to see how the rationale has changed? Stay tuned for more and more lawyers in the work of the SMC. It’s like some people are very happy giving more and more work to lawyers….


SMC Investigators have more liberties than the police (2010)

In the last amendment to the Medical Registration Act effective 201, Section 60A was added. Please read it if you have the time, its on the internet.


SMC can appoint investigators. These investigators can enter your clinic during regular business hours, search your clinic and seize practically any thing from your clinic without a search warrant. Even the police needs a search warrant to search your house. Personally speaking, whoever thought of this is NOT my friend. It makes George Orwell’s 1984 look like Mickey Mouse Club.


Residency and Screwing BSTs and ASTs (2009)

The change from our traditional BST and AST system to the American-based Residency system sent our entire medical specialty training into convulsions. Enough said on this already.


Family Physician Register  (2012)

The setting up of the FP Register should have been a happy thing. But the requirement for an element of “currency of practice” meant that many well-trained GPs who did not work in GP clinics or polyclinics could not qualify to be on the FP Register. This made the whole FP register thing unnecessarily controversial. And the requirement to remove the word “family” from GP clinic signboards and clinic names if the clinic did not have a FP practicing there was downright high-handed.


Unsatisfactory Guidelines Regulating Aesthetic Practice (2008-2012)

The High Court in the ruling of Low Chai Ling vs SMC case already said as much in their judgment. No need to elaborate.


Doctors banned from practicing any form of acupuncture other than “needle” form, i.e. moxibustion, cupping etc. (2012)

This only affects a small group of doctors but it underscores the fact that SMC will intrude into those parts of lives that don’t really fall under SMC’s expertise. Maybe some day they will tell us what food to eat and whether we can go to casinos or not.


Akan Datang (2013-??)

Heard from the rumour mill – Licensing Exam? Revamping of CME framework to include log books and maintenance of competency? Revamping of SMC Ethical Code and Guidelines? Who knows what stuff they will think of next?


I thought doctors did some good during SARS. If that is so, why did we deserve all this in the ten years since? I don’t know about you, but I feel increasingly oppressed as a doctor since 2004.

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