Ring Of Inevitability

While it is not enshrined in the Constitution, I consider it my fundamental right as a citizen to be able to sit down in a coffeeshop or hawker centre every morning and have my kopi-O. So when this is taken away from me, I take it that we are in lockdown mode.

Of course this lockdown is not as tough as last year’s CB and Tightened CB. It’s a lot looser this time around. I can still go to my barber, see my dentist and see a show at the cinema. It’s a very ‘loose’ (as opposed to tight or tigher) CB, if it is a CB at all. Unlike what some people say, you can still have a little fun with a very loose CB.

But somehow the wordsmiths have failed us this round by not coming up with something catchy to describe what we are in (like CB and tightened CB). Instead, they have come up with a term like “ Phase 2 – heightened alert”. (Face-palm++).

I take umbrage at the use of the word “heightened”. The use of this word is very insensitive to us short people. As a halfling, I feel I am targeted if not discriminated against whenever I see the word “height” or “heightened” being used. Why can’t people use other terms like “broadened alert” or “widened alert” or just  “light lockdown”? Which is why this hobbit really hopes this country will have a short(er) prime minister soon, who can stand tall, I mean stand-up, for us short fellows.

To avoid the use of this very vexing word “heightened”, I will call the current phase as “loose- lockdown phase” or “LL phase”. “LL” sort of describes rather well how I feel now.

Many friends have asked this hobbit how should we respond to this new LL phase. Well, it’s obvious – just follow law. Stay at home if you can. Cook at home, eat home, work from home etc. Don’t go anywhere unless necessary and if you do, wear your mask and bring your TraceTogether along.

But beyond legal compliance, others have asked – how should we respond intellectually and emotionally?

Some chaps ask rather difficult questions like –

  • Could this LL have been avoided?
  • Could we have closed our borders earlier to countries that were having an exploding number Covid-19 cases?
  • Could we not have this LL phase now?
  • Could we have diversified our foreign labour sources and not take just from one region in the world, just like how we now have four taps to meet our water requirements? Isn’t there just too much risk concentration?
  • Should we have segregated high risk and low risk travellers in Changi Airport like what a Straits Times Forum writer said a month ago prophetically (https://www.straitstimes.com/opinion/forum/letter-of-the-week-stricter-covid-19-measures-needed-for-inbound-passengers-at-airport. (hobbit’s postscript: obviously the writers of the official reply dated 21 April didn’t think so –https://www.straitstimes.com/opinion/forum/airport-takes-multi-layered-risk-based-approach-to-curbing-infection)
  • Should we have better anticipated double mutation strains like B.1.617 are far more infectious than the old Covid-19 strains, considering what was happening in their place of origin?
  • Do we really need to do Routine-Rostered Testing (RRT) for all healthcare workers (HCWs)? Do we not trust our PPE, infection control measures and vaccination to protect our HCWs?

In short, these nasty questions centre around two themes – what lessons can we learn from this setback and are we managing this current wave correctly?

One angsty dwarven banker even asked – between keeping foreign labour coming in to support the construction, process and marine sectors (and helping with economic growth), and now the LL phase – which has a larger effect on the economy and emotional, mental and social well-being of the citizens? What is the trade-off we are talking about? The dwarf remarked – these policy wonks love talking about trade-offs all the time, but somehow nobody is talking about trade-off between keeping the process, marine and construction sectors going and what we are suffering now for four weeks.

I will be honest, having grown up in a fun-loving, carefree, beer guzzling shire in Middle-earth, all these questions are terribly complicated and distressful to me.

But a wise elven wizard helped this hobbit see the light when he commented on this statement:

“These cases all originated from imports because all borders are porous. All it takes is one case to cause an outbreak, and no country can seal itself off totally. At the minimum, citizens and residents must be allowed to return home”. (MOH Facebook Page, 15 May 2021)

He said, “this means it was all inevitable. Just like the Mother of All Clusters (MOAC) in the dorms last year. That was nothing we could have done. MOAC would have happened anyway. Similarly here. It was pre-ordained that we need to have those foreign workers coming in to support the process, construction and marine sectors. Thus we need to take the risk of these imported cases coming in, even though we know that it takes only one case to cause an outbreak”.

He added, “It was also predestined that the super-infectious B.1.617 strains would have led to the Changi Airport and TTSH clusters and probably now the tuition centre/schools clusters as well”.

He concluded, “Everything was preordained and predestined and hence inevitable. We made the right calls, no error of judgment was made. This is the way”. (In an elven accent – not Mandalorian)

Yes, it was all inevitable. And once we accept this explanation, a lot of other questions are also answered or become moot as well. It’s like you are playing an online role-playing quest game, and your avatar discovers this powerful magic item (more like you paid bucket-loads of money for it) that gives your avatar enormous benefits. Example – you discover the Amulet of KNN – which renders your character immune to psychic attacks, -8 to mace attacks, +5 to dexterity score and +50 hit-points.

The elven wizard then introduced me to this magic item called the Ring of Inevitability. He fished it out of the pocket of his Cloak of Non-culpbability; the Ring burnished under the midday light and I was immediately desirous to obtain it.

He whispered to me that once the wearer has the great magic item called the Ring Of Inevitability, he will be immune to questions such as “if only we had….?”, “Could we have…?”, “Could we not have….?” etc., etc. from all those around him, including himself. Such tiresome questions become inconsequential once we wear the Ring of Inevitability.

And he was right. Once I bought the Ring of Inevitability from him and wore it, I was happier and more peaceable immediately. I no longer asked myself all these vexatious questions and could accept the current LL phase with the kind of equanimity that Sir William Osler described. I also dismissed such questions from those around me as irrelevant and even irreverent to me, the mighty Ring-wearer. I felt l have become invisible to obnoxious questions as they passed right through me. I no longer took umbrage to these questions anymore as I became as invisible to these questions as the Nazgul Ringwraiths of the Second Age in Middle-earth.

I didn’t even feel LL at all about this LL phase anymore. Gosh, I hadn’t felt so good since I was given fentanyl by my anaesthetist for a procedure years ago…..

Before he left, the elven wizard grinned and said, “You should consider taking the Cloak of Non-culpability as well. The Cloak makes all accusations against the wearer hollow and ineffectual. It goes extremely well with the Ring of Inevitability”.

Note: for the avoidance of doubt – this post is a satire.

2021 Hobbit Awards

2020 was a year with no comparison for healthcare. Of course, Covid-19 was the every visible elephant in the room but there were other memorable incidents and people that managed to share some of the limelight as well. This hobbit recaps this momentous year with the 2021 Hobbit Awards. And the winners are……

Circular King Award

A total of 244 Circulars were issued by MOH in 2020. They were issued by either our new DMS, Prof Kenneth Mak or his lieutenants. If you think about it, there are 366 days in 2020 (leap year), 104 weekend-days and 11 public holidays. That leaves us with about 251 working days (give or take a few). In other words, we had to keep abreast with about one new MOH circular per working day! That’s incredible. I think the current DMS has issued more circulars in one year than any of his predecessors. He is this hobbit’s choice for Circular King Award.

Superman Baby Award

In the beginning of every version of a Superman movie, the opening scenes invariably involve the parents of Superman putting the Superman baby into a spacecraft. The spacecraft then blasts off planet Krypton for Earth and within seconds Krypton explodes.

That about sums up the previous DMS, Prof Benjamin Ong. The first case of Covid-19 hit Singapore on 23 Jan 20. His last day in MOH as DMS was 31 Jan before the current DMS took over and MOH promptly exploded with the Covid-19 outbreak in Singapore. Prof Ong is a deserving winner of the Superman Baby Award.

Best Communication Award

This goes to our wordsmiths in the civil service and political leadership for coming up with the term “Circuit Breaker” in lieu of the commonly used “lockdown”. The acronym “CB” is now widely used. More interestingly, on 21 Apr 20, it was officially announced that CB measures would be tightened. Only in Singapore do we tighten already a very tight CB.

Most Useless Relic Award

Remember long, long ago, in a galaxy far, far away, there was this one colour code to rule them all – DORSCON? Well nobody talks about it anymore. Although it has a few colour grades to the Code, no one takes it seriously when we realised ‘Red’ is a hypothetical, mythological colour that will NEVER be used even when we faced the closest thing to Armageddon (aka a tightened CB – please see above) and more than a thousand new Covid-19 cases were popping up a day.

DORSCON should be thrown into the fires of Mount Doom to be destroyed forever like all useless relics.

Best Witchcraft Award

This prestigious award goes to the Ministry of Trade and Industry’s GoBusiness Portal for deciding in an incomprehensible and opaque way who is an essential worker and how many staff is a clinic entitled to. How is a GP clinic assistant deemed to be an unessential worker is just beyond this hobbit.

Animal Advocate of the Year Award

This goes to the genius that decided that “basic” pet grooming services could resume on 1 June 2020, even before the resumption of “human” aesthetic medicine.

Best Cartoon Comedy Award

This award undoubtedly goes to the folks who approved the Virus Vanguard, who existed for about a day before it was disbanded. Even so, the timeless superhero legends of Circuit Breaker, MAWA Man, Care-Leh Dee, Dr Disinfector and Fake News Buster will remain etched in the collective psyches of Singaporeans forever. It shows that some decision makers in the government have a (strange?) sense of humour/reality.

This hobbit confesses that he may still be suffering from Virus Vanguard’s Dissolution-related PTSD.

The Special Destiny Award

This goes to the Minister for Manpower and her team for pitching to us the seminal point that the outbreaks in our foreign worker dormitories were inevitable. This hobbit now believes that we were just fulfilling our destiny when 47% of workers (152,794) living in foreign worker dormitories were infected.

Best Educator Award

This definitely goes to Minister Chan Chun Sing for educating a younger generation of Singaporeans on the use of the term “sia suay”. Even an old coot like me hasn’t used that in a long time.

He also educated us on the unnecessary use of masks and hoarding of toilet paper, eggs and instant noodles, amongst other things.

Evidence-Based Infection Control Award

This very relevant and timely Award goes to the Elections Department of Singapore for demonstrating with strong evidence during General Elections 2020 what most healthcare workers already knew – you can’t put on gloves when your hands are wet with disinfectant/alcohol/water etc.

Best Voodoo Healthcare Award

This goes to the Health Insurance industry, in particular the Integrated Plan (IP) providers for

  • Not respecting fee benchmarks that were issued by MOH
  • Selling IPs to 70% of Singaporeans when the combined hospital beds market share of private hospitals and A and B1 bed classes restructured hospitals is only about half of that
  • Empanelling only about 20% of specialists in the private sector and not telling potential IP customers that they can only choose from a very limited pool of specialists.

On the other hand, they are still telling the public to buy more IPs when there is really no capacity to fulfil demand down the road.

If this isn’t voodoo healthcare, this hobbit doesn’t know what is.

Company of the Year Award

DoctorsXdentists (DXD) won this hands down. In this one year, they managed to achieve the following:

  • Misrepresented MOH compliance officials
  • Irritated the hell out of several professional bodies such as Academy of Medicine, SMA and CFPS
  • Used information from the SMC doctors’ directory without SMC permission

This is the most breath-taking healthcare company we have seen in a long time.

If…..Would Be……

Declaration: this article is completely 100% satire and opinion, and hence does not come under the purview of the Protection from Online Falsehoods and Manipulation Act (POFMA). Nowadays,  one cannot be too careful about such things…..

OK, here we go…..

If private hospitals were handbags…..

  • Mount Elizabeth Orchard would be a Birkin (The older tai tais’ favourite)
  • Mount Elizabeth Novena would be a Kelly (More stylish for the younger but equally rich tai tais)
  • Gleneagles would be a Chanel 2.55 (always reliably upmarket)
  • Raffles would be a Kwanpen (local and upmarket)
  • Mount Alvernia would be a LV
  • Thomson would be a Coach
  • Farrer Park would be a Kate Spade
  • Parkway East would be a Bonia

 

If recent healthcare events were like Marvel Comics Universe heroes….

  • Informed Consent would be Spiderman (Swinging from doctor centric to patient centric and very sticky)
  • Third Party Administrators would be Thor (getting fat by doing little or no work)
  • HIV data leak would be Loki
  • NEHR would be like the Avengers Headquarters (Always getting attacked & repeatedly destroyed)
  • MOHH would be Captain Marvel (missing all the action when half the universe died)

 

If SMC affairs were likened to Marvel Comics’ Universe Infinity Stones

  • Lawyers would be the Power Stone (makes all other stones more lethal)
  • MOH would be the Mind Stone (can make SMC ownself appeal against ownself)
  • SMC Disciplinary Process would be the Time Stone (Can make time stop and really delay you to no end)
  • The latest SMC ECEG would be the Soul Stone (controls all life)
  • The Modified Montgomery Tests would be the Space Stone (warps spatial realities and laws of physics and increases uncertainty)
  • Court of Three Judges would be the Reality Stone (Can override SMC-judgment realities)
  • SMC Leadership possesses the Pym Particles like Antman (nowhere to be seen when a crisis like The Snap strikes)

 

If Public Hospitals were Star Wars Planets

  • Toa Payoh would be Alderaan (completely destroyed)
  • SGH would be Coruscant (very crowded, crazy traffic and damn stressful)
  • NUH would be Naboo (since it has produced three Sith Lords in succession)
  • TTSH would be the forest moon of Endor (where the fuzzy cute teddy bears live)
  • CGH would be Mon Calamari (Where all the blur sotongs came from, like Admiral Akbar)
  • SKGH would be Hoth (Frozen and Forgotten in the North)
  • NTFGH would be Cloud City of Bespin (All the verandahs look like they are in the clouds)

 

If doctors were Lord of the Ring places

  • CFPS would be like Gondor
  • Academy of Medicine Singapore would be like Rivendell where the very cultured and elegant immortal elves rule (or so they would like to think)
  • The Alumni would be the Dwarven Moria in the Misty Mountains
  • SMA would be Hobbiton
  • COMB would be Barad-dur, and
  • Chee Yam Cheng would be Gandalf

 

If public healthcare were like the Game of Thrones

  • The public healthcare clusters would be like the kingdoms and households of Westeros
  • IMH doctors are like the Night’s Watch order (they guard The Wall and the rest of us don’t really know or want to know what’s beyond it)
  • MOH HQ is like the Targaryens in Pentos, Essos (Not really in charge anymore but still want to go back to the glory days, but be careful, they still own the dragons)
  • MOHH is like the House of Stark (it has taken over effective control over the running of King’s Landing)
  • Medisave, Medishield Life, Medifund, Fee Benchmarking, CHAS, Pioneer Generation Package, Merdeka Generation Package make up the Faith of the Seven

 

If Healthcare were like the world of Harry Potter,

  • Lawyers would be folks skilled in Parseltongue (A language that is associated with the Dark Arts)
  • Managed Care and TPAs would be dementors (They can suck the life out of you slowly)
  • Doctors who are senior hospital administrators would be Animagi (Can transform into animals once they are promoted to these positions)
  • Doctors who work in MOH HQ would be Metamorphmagi (who can change their appearance into something completely different once they work in MOH HQ)
  • Medical Concierges who ask for 15% or more of your bills can be considered as Death Eaters (like Voldemort)

 

If medical schools were like car brands

  • YLLSOM would be like Toyota (Cheap and Reliable, but boring)
  • Duke-NUS would be like Maserati (great engine sound, but performance-wise still cannot compete with the best)
  • TTSH would be like Nissan and Renault alliance (a bit confusing, considering its linkup with Imperial in the LKCSOM
  • Most Irish Medical Schools would be like Saab (no longer seen here)

 

If tertiary public hospitals were supermarket chains….

  • NUH would be Cold Storage (more atas)
  • TTSH would be Sheng Siong (Cheap and friendly)
  • SGH would be NTUC Fairprice (trying to be atas, like Fairprice Finest)

 

 

Emails To The Hobbit 2019

It’s been a long time since we published some of the letters this blog has been receiving. Actually, no one writes letters anymore and they send the blog emails instead, and so, we have re-titled this column as “Emails To The Hobbit”

 

Email 1

Dear Wise and Short One

Up Yours

I am a staff of a Wizard Malpractice Indemnity Scheme known as Am Pee Ass.

This is what happened: An elderly hobbit came seeking help from our indemnity scheme member, hereto known as “Brown Wizard”, to complain of bloatedness and blood in his poop. The Wizard told the hobbit he needs to do a full check up. The hobbit lay down, let Wizard touch his tummy, then followed instructions to lower his trousers and turn over. A digital rectal examination was done. Subsequently, the hobbit went home, and told his family what happened. Outraged, the family got the elderly hobbit to make a statutory declaration and demanded that the Council of Wizards explain why the Wizard did such an invasive check without consent.

Brown Wizard didn’t know what to say. And likewise neither do I. Do you have any advice? BTW, why are hobbits so anal? (pun intended)

Yours sincerely

Rectus Loquitus

Case Manager, Am Pee Ass

 

Dear Rectus Loquitus

Thank you for being so straight talking. The problem is that you did not adhere to the Modified Monty-Monty test which states clearly that you have to take into consideration what are the relevant factors for this elderly hobbit, and take a hobbit-centric approach. I hope this makes sense to you. Because it doesn’t make any sense to my simplistic mind.

 

Yours confusedly

Hobbitsma

 


 

Email 2

Dear Hairy Feet

It’s A Fine World

I understand that my Case Manager has contacted you already about the elderly hobbit who complained against me because I examined him per rectally without informed consent. Actually I have another problem that I wish to confide with you. I was busy tending to my many injured animal friends when suddenly  a magical raven came to deliver a message. “Hi, I came from Rosie, the hobbit Samwise’s wife. You know he’s always having an eating disorder, eat until so fat. Can I get a letter from you to certify that he has this illness, so that I can get the prescription refilled?” In good faith, I wrote the parchment and passed it to Raven to bring back. Unfortunately, it wasn’t Rosie the wife, but Samwise’s mistress the enchantress Lavender who wanted the parchment to pass to the wife, so that Rosie will divorce Samwise.

Samwise is now suing me for emotional distress and marital discord. Council of Elders have ruled that I was at fault, and must pay 50,000 gold pieces. The fact that Samwise’s family situation is complicated, or that Lavender impersonated as Samwise’s wife to get confidential information were discounted or even ignored. The fact that I was busy looking after many sick animals was also not a mitigating factor. They were of the opinion that I could have easily verified the identify with a few simple questions: Does Samwise snore in bed? What’s his underwear size? When was the last time he shaved his feet? And so on. I have been found solely responsible, because I did not ask verify the Raven to confirm that Raven is truly sent from Rosie  and the Raven is indeed who it claimed to be.

I just found out from my case manager Rectus Loquitus that Am Pee Ass doesn’t cover fines and I have to pay the 50,000 gold pieces out of  my pocket! I am now flat-out broke!

Please help!

Yours tragically,

Brown Wizard

 

Dear Brown Wizard

This is truly unfortunate. What I suggest you do is to stop treating all these poor injured animals and go into private practice where you can charge more. Generally, humans and elves pay more. Please consider starting up your practice in the posh Mount Expensive Hospitals. Either the Old or New one will do. Then the next time you get slapped with a big fine, you can still pay.

Yours Cynically

Hobbitsma

 


Email 3

Dear Ring Bearer

Survival Medicine

I need some reassurance. I am an ICU Associate Consultant in a public hospital. And I am your Survival Medicine’s Number One Fan.

A few days ago, an elderly man was found unconscious at the road side after a hit-and-run incident, in extremis. The ambulance crew brought him in, the emergency team intubated him and admitted him into ICU. The next day, 3 anxious people turned up. They claim they are the wife and children. I don’t believe them. I don’t dare to believe them. Maybe it’s the second wife and HER children who wanted his fortune. I demand to see the marriage certs, birth certs and IC of all three. As well as the man’s IC. They produce all. But, the man in the hospital bed now looks NOTHING like the photo in the IC. I don’t think this is the real family, I have no way to verify. The policeman says they found these anxious people at the site of the incident. Oh- maybe they are the driver and passengers of the car that hit the old man! I refuse to update any of them, and escalate every decision of care to the Ethics Committee. I feel good that I have protected patient’s confidentiality, and avoided paying a hefty fine in case I am guilty of not verifying a person’s identity. Do you think I will survive all this?

Yours sincerely

Dr Veritus Verify

Associate Consultant

Department of Vericationology

Wa Gia Si General Hospital

 

Dear Veritus Verify

You will definitely not just survive, but thrive in this new age. I hope your patient survives too.

Yours shortly

Hobbitsma

Emeritus Consultant Verificationalist

 


Email 4

Dear Katek,

Non-Clerical Referrals

I need your advice in a most delicate matter. I am a cleric specialising in the art of clairvoyance. Many fellow clerics refer patients to me for investigations because I can see things that other clerics cannot see and my work helps my colleagues diagnose better. These patients are referred to my department (i.e. Department of Diagnostic Clairvoyance) and my cleric assistants then take clairvoyance images which are later sent to me to read and interpret and report on. These reports are then sent back to the clerics who sent these patients to me for their follow-up. Recently, arising from a case of missed follow-up for a patient referred by a cleric accidentalist, the Lords of Judgement have decided that for referrals from accidentalists, the reports should not be routed back to the accidentalists. Instead, the clairvoyance clerics can decide the appropriate specialists that should follow up these patients referred to us, for example bone-setting clerics, heart clerics etc.

I am most distressed. I chose this specialty because I am rather allergic to physical contact with patients and I do not want to assume primary cleric-patient responsibility. I just like to read clairvoyance images with no direct patient contact. How do I decide who to refer to when I haven’t even met the patient or talked to him or examined him? Does it mean that for all patients referred by accidentalists I now have to take over as the primary cleric? A good and proper referral involves a lot of judgment and is not just looking at images and then performing a simple clerical (pun intended) task like filling a form

This is not what I signed up for. The Lords of Judgment are not trained in the Art of Healing like us clerics, can they change the way we clerics practise?

Yours sincerely

Robert Cork

Most Senior Clairvoyance Cleric

Mount Expensive Hospital (Old Branch)

 

Dear Cleric Cork,

I am so sorry. I really cannot help you there. As you know in the Realms we live in, whatever the Lords of Judgment say, we must comply, humans, elves, dwarves and hobbits included. We just have to suck it up. Only the House of Power can override what the Lords of Judgement say by issuing edicts. And it is not going to happen until the Fifth Age of Man (i.e. a few thousand years from now)

Yours Powerlessly

Hobbitsma

2018 Hobbit Movie Awards

It has been quite a few years since this Hobbit published the Movie Awards. It is once again the awards season and therefore the time to give out these distinguished awards again to worthy individuals, initiatives and figments of our imagination for stuff that captured our attention this the last year.

Best Honest Performance Award for a New Comer

This award goes to Senior Minister of State Chee Hong Tat for his great speech on 30 Sep 17 at the SMC Physician’s Pledge Ceremony. He basically said that JCI and Residency need serious relooks. In particular the Residency was implemented in a suboptimal way. His honest and sincere performance giving this speech moved this hobbit to tears and made his feet hair stand.

There were no other nominees for this award. Honesty, unlike residents and associate consultants, is a rare commodity.

Best Solo Performance

This goes to Solo the Movie featuring the Solo GP. He gets this award for working alone to get things done in the upcoming Solo the movie. His job is getting tougher too, given the additional demands that have either come or are coming his way. This include supplying information to the NEHR and meeting the demands of the new medico-legal climate. Of course he still doesn’t realise that once the law is passed, the Solo GP as the licensee of the clinic can be fined up to $50,000 and jailed for up to 12 months if he doesn’t contribute the required information to the NEHR. And you thought being suspended or struck off by the SMC was a big deal. That’s chicken shit compared to this.

Lifetime Achievement Award

Minister Gan Kim Yong gets this award. He has gotten most things right in his 7-year term as Health Minister – rolling back excesses of the previous era such as residency and putting back good stuff such as benchmarks/guidelines of fees. Setting in place new initiatives that benefit patients and doctors such as CHAS, PGP etc. His last big test is the NEHR. It’s like Luke Skywalker meeting the Dark Side in the swamps of Dagobah….will he survive the Big Test?

Best Sequel Remake Award

We have seen this before, like the tired Transformer franchise. Getting bigger but hopefully not worse. First there were 2 clusters then 6. Now 3. 3 makes sense, but it’s still bewildering for the folks in KTPH who were once in NHG, then out, then back in NHG again. Likewise for CGH and Singhealth. Hopefully this clustering and reclustering process has come to an end finally. More confusing than the ending of Inception.

Best Make-up and Costume Design Award

Outlawing the SMA Guidelines of Fees (GOF) has proven to be a bad idea after ten long and painful years. So GOF has to be brought back in some back without losing face for the bigwigs and powers that be. And so, the MOH Fees Benchmarks Advisory Committee was born. The aim is to essentially produce the same outcomes that the SMA GOF did for 20 years from 1987 to 2007, but to save face, it has been repackaged. This is great make-up and costume design for essentially the same face and body. This award without a doubt goes to MOH Fees Benchmarks Advisory Committee

Best Science Fiction/Suspense Thriller Movie Award

The Modified Montgomery Test (MM Test) wins in two categories. First, the MM test tries to impose a certain pattern of thinking which 99% of doctors will find alien. (By alien, this hobbit means the aliens in the Alien movie franchise – it will eat up our brains). It’s also a great thriller movie as many bewildered patients will find that their doctors no longer make any decisions or even recommendations and they themselves now have to make decisions based on the mass of ‘relevant information’ given. What great suspense as everyone awaits the patient to digest the information and make the best decision for himself.

After a wait of 10 years, some say the MM Test is a worthy sequel to the 2007 Jack Neo box office hit, Just Follow Law.

Best Movie Soundtrack and Score

National Electronic Health Record (NEHR) wins this hands-down. So far, the NEHR soundtrack only offers all the positive-feeling homilies like “connecting healthcare professionals for patient-centred care” and “achieves better health outcomes” and “raises patient safety”. The soundtrack and score is completely silent on “privacy rights of patients”, “increased medico-legal liabilities for healthcare professionals” and “what are the liabilities and responsibilities of the NEHR”. The silence of the official NEHR soundtrack and score is masterly deafening. A maestro is obviously at work here.

Best Supporting Actress Award

This award goes to the senior paediatrician who was suspended for misdiagnosing Kawasaki Disease. She was originally slated to get the Best Actress Award until some 1000 doctors signed a petition to MOH stating the punishment was too harsh.

Box Office Bomb Award

The biggest bomb of the season goes deservedly to the ACGME-I Residency Programme which is due for a major overhaul/reconstruction/remaking/dismantling (depending on how you look at it). The number of newly minted specialists with no  long-term  employment contracts continues to rise and some are already flooding the private sector market. These poor fellas look like the extras who are milling around the film studios looking for bit roles and part-time work. The big difference is that extras cost nothing to train but these specialists each cost the taxpayers hundreds of thousands of dollars to train.

Best Box Office Hit

This one is walking straight to the finishing line with big bucks. Third Party Administrators (TPAs) are making the big bucks with their arrangements with insurance companies and big corporates while being entirely funded by collections from participating doctors. Latest heard – TPAs want to claw back on money already paid to doctors because some of their clients claim to be losing money. Can doctors claw back from TPAs if they are found to be losing money from TPA contracts?

 Best Studio Award

 This goes to MOH for their acquisition of the functions, departments of another ministry (MSF – Ministry of Social and Family Development). MOH is now a mega-studio set to become even larger as it absorbs the social aged care functions of MSF. It’s like Disney buying up the Marvel and Star Wars franchise. Questions abound: – will MOH end up with severe indigestion after this exercise? Will Han Solo and Luke Skywalker be killed off in the exercise?

Best Actor Award

There were a few characters vying for the very prestigious Best Actor Award this year. But there was really no contest. The thespian performance by the private hospital orthopedic surgeon who apparently accidentally severed the popliteal artery and vein and the peroneal nerve during a Total Knee Reconstruction (TKR) and then flew off on a holiday leaving the resident medical officer to manage the patient was a once-in-a-lifetime experience. It was a once-in-a-lifetime experience because the patient died a few days later due to complications of the TKR and subsequent limb salvage surgeries.

Best Director Award

As usual, this was a contentious item on the Movie Awards List. This year the award goes to the haematologist who was appointed to be the director of a tertiary-level cancer centre. That’s like appointing an ENT to run the eye or dental centre or a psychiatrist to head the neuroscience centre. Not say cannot do, the disciplines are indeed a bit related, but still it looks a bit strange, lor…..no matter how you look at it…….

Best Film Award

This year goes to a surprise winner, the Finance Minister, for announcing the GST hike of 2% that will be implemented soonest 2021. This will undoubtedly spur “optional” healthcare consumption in 2019 and 2020 like aesthetic procedures to avoid the impending GST hike. This hobbit predicts that folks will rush to have their liposuctions, boob and butt jobs etc over the next two years. Huat ah!

Residency Revisited (1)

“I remember my former boss Mr Lim Siong Guan used to remind us that “implementation is policy”.  The effectiveness of a policy is not measured by how elegant it looks on paper, but how it is translated into reality during implementation. On this yardstick, we have to be honest and acknowledge that while the residency programme has its advantages and good points, some of the outcomes have not been as positive in practice as what we had originally hoped for. As with all major changes, what could have been better was a more gradual, step-wise implementation, with appropriate channels to acknowledge concerns of the medical fraternity, and to consider the impact of the changes from a holistic systems perspective.

After having some years of experience with the residency programme, the time is right for MOH to now review the programme. We want to retain the positive elements of the residency programme while taking concrete steps to address the problems we have encountered and improving the outcomes for our doctors.  For this effort to succeed, we need to work closely with our professional bodies and doctors to listen to your feedback and see what we can do together to enhance the system.  We need your help to work with us to achieve better training outcomes for our doctors and deliver quality care to our patients.  I hope we can count on your support to embark on this review together”.

Senior Minister of State for Health, Mr Chee Hong Tat

Speech at SMC Physician’s Pledge Ceremony, 30 Sep 2017*

 

There you have it. Someone very senior has finally come out to declare that the Residency under the ACGME-I framework was and is a bad idea. Or at the very least, the implementation of the American system almost wholesale really sucked. This took honesty, courage and clarity of thought. Well, it was not for want of trying by many senior doctors and this hobbit as well to try to get the message across, but of course no one senior in MOH was really listening then.

Many fellow doctors have opined that the decision to introduce the American-based ACGME-I residency system was the brilliant work of some scholar or admin officer. This cannot be further from the truth. This was the idea of doctors, implemented by doctors, for doctors. Completely self-afflicted.

In my humble opinion, the urge to build personal legacies has a power to blind and deafen even brilliant and confident people, let alone insecure and lesser mortals. Many innocent and sincere people who tried to give real and useful feedback around 2008 to 2010 were steamrolled over like mush on the road after heavy monsoon rains. Some of them have left for the private sector as a result. They are now vindicated. May their professional souls rest in peace. Many of the others that remain continue to struggle daily to do their best to keep this residency system going, some against their best instincts. Hats off to them as well.

As for the residents themselves, they are also struggling. Junior MOs struggle to get a residency place now, since the number of places on offer are now greatly diminished. Those that are already residents know they need to see more patients and work harder to be properly trained, yet are curbed by work limits imposed on them by the ACGME-I system and they struggle to pass the British exams which are still part of their lives. And many of those that have exited as registered specialists with SMC and SAB now find  themselves without jobs as Associate Consultants and have to settle for jobs with lower status and salaries in restructured hospitals. It is a lose-lose-lose situation that could have been entirely avoidable.

Anyway, just for old times’ sake, this hobbit reproduces two old articles about residency. The first is something he wrote which was published in the Nov 2009 issue of the SMA News (When he was still a regular contributor to the publication), “The Hobbit Residency Rap”. The second was a posting on this blog in Nov 2011, about a year after it had been  rejected by the SMA News Editorial Board: “Residency Turkey”.

Dammit, I was funnier then.

 

“The Hobbit Residency Rap” (2009)

We should and must support residency

Just like we support urgency, hesitancy and intermittency

Yo! Doctor, please don’t criticise

Trust me, your words may get you ostracised

Don’t question and don’t be negative

Some folks take things personally and are very sensitive

If some things don’t make sense to you now

Please tell yourself, “That is because I am just dull”

Hey, we need many more specialists fast!

So too bad, apprenticeship is a thing of the past.

Trust the Americans to get healthcare right!

The traineeship system can go into the night.

Let the residents see fewer patients

While the rest see more with pure zest and elation

Hey baby, I know it sounds paradoxical

And some may even whisper, “It ain’t practical…”

But remember brother, you must not oppose this change

Lest they call you inappropriate or strange

You can decide which facets of truth you want to see

Unlike with BPH, then surely you cannot pee

 

====================================================================

 

Residency Thanksgiving Turkey (written in 2010)

Thanksgiving Time

 As you read this, it’s near the end of the year and the holiday season is again upon us. Time flies. As with all things healthcare in Singapore recently (like Duke, JCI, Residency and Board Exams, the Hobbit goes American and celebrates Thanksgiving. For a start, here’s a recipe for a good Residency Thanksgiving Turkey:

Residency Turkey

One 7kg turkey, preferably caught from around College Road and slain by brute force with the bare hands of a simple-minded orthopaedic surgeon. If not, then get a frozen one imported from America that is suitably defrosted with naivety and bewilderment. Whatever the case, remember – remove the brain, heart and guts COMPLETELY! If not, this recipe will NOT work.

 Seasoning

Juice of 2 BIG Singapore lemons

5 tablespoons of stupidity

5 tablespoons of single-mindedness and myopia

One cup of deafness

One cup of blindness

 Stuffing

Mix the following:

One cup of hubris

One cup of white flour (Made from pure American Wheat)

Common Sense, boiled for 2 hrs, cooled, peeled and then finely chopped

National Pride – pounded violently and minced to paste

A finger of Local Tradition, grated to a fine dust

A sprig of parsley

One carrot finely chopped

One onion diced

Salt and Pepper to taste

 Gravy

A sprig of acceptance

A stem of blissful ignorance

3 tablespoons of cornstarch

2 cups of water

Salt and Pepper to Taste

 Instructions

Clean turkey. Remember to remove guts completely. Squeeze juice of two big Singapore lemons into cavity. Season skin and cavity with stupidity, single-mindedness and myopia. Stand for 30 minutes to soften muscle. Rub deafness and blindness onto skin and cavity liberally. Stand in roasting dish for 3 hours in the DARK. This is to ensure that when the bird is cooked, it is soft, compliant, tasty and quite divorced from reality.

 Stuff Turkey with Stuffing. Close neck cavity and tail openings with string (not Prolene sutures, you idiot!).

 Line roasting pan with lots of grease, preferably from Chicago or North Carolina. Roast Turkey in pan (breast-side down, to restrain/contain national pride).

For a 7kg turkey, 200C (or 400F, for the residents who are familiar with the American way of measuring things) for the first 30 minutes, then reduce to 175C (or 350F) for 2 hours, then reduce to 110C (225F) for next hour to hour and a half. Then raise temperature to 260C (500F) for 5 minutes to brown skin.

 Remove bird to cool. Collect Oil and drippings into saucepan, add cornstarch and other gravy ingredients, flavor (Not “flavour”) with ignorance and acceptance. Bring to a boil and over low heat, reduce to a suitable opaque consistency.

 Note – Residency Turkey usually tastes better when carved by senior medical administrators on footstools (never both feet on the ground). So do invite them for your next Thanksgiving Dinner!

 Things to give thanks for over the Residency Turkey Dinner

 We give thanks for

 The fact that, like their American counterparts, our house officers (or R1) can only work continuously for 16 hours (i.e. no more over-night calls) and other residents will be entitled to 5 hours of uninterrupted sleep. They can only clerk several cases a day on call. In other words, they will probably stop work at 3pm when their quota is filled up.

 And for all this, they will not get a pay-cut

 We also give thanks that somehow with the residency programme, productivity and efficiency will seemingly be unaffected and healthcare costs will not go up, even though USA spends 16% of their GDP on healthcare and we spend 4%. Presumably, consultants can pick up the slack for free.

 Finally, we also give thanks to the British training system that had more or less served us well but can now rest in peace.

 

*https://www.moh.gov.sg/content/moh_web/home/pressRoom/speeches_d/2017/speech-by-mr-chee-hong-tat–senior-minister-of-state-for-health-2.html

2103 Hobbit Movie Awards

Well, it’s the season of movie awards again and the Oscars have just been given out. No surprises other than the fact that Michelle Obama made a virtual appearance to give out the Best Motion Picture award to Argo.

 

Well, it’s been quite a few years since this hobbit has given out any movie awards. And if a movie about a movie that is used as a decoy to rescue Ben Affleck’s career from J. Lo and Pearl Harbour can win a best movie award, then its certainly about time this hobbit have out a few awards of his own again.

 

Best Adult Movie:

Ted

This runaway hit is about a foul mouth teddy bear that called nursing “low-skilled”. Stars Mark Walberg as Ted’s owner who had to do heck of a lot of damage control. Also has a pricelessly funny song about screwing thunder, which admittedly in the local context, can mean a lot of things…

 

No Backbone Movie/Worst Medical Evidence Award:

Dark Knight Rises

The masked crusader shows how one can reduce a spondylolisthesis spontaneously without spinal surgery. The auto-reduction obviously affected his great powers of deduction adversely and as a result, the world’s greatest detective only figures out who is the villain in the last 10 minutes of this long movie, and only after he gets stabbed by her.….?

 

Surprise Hit of the Year:

007: Skyfall

Resulting from the glitch of a obsolete IT system (No, we are NOT talking about town council here), all orc-healers are given a one-year reprieve from continuing education requirements. Literally drop down from the sky-kind of reprieve. Licensed to “ziam”….

 

Best Action Choreography:

Cold War

This movie is about two professional boards engaged in a cold war. On one side is the Orc-healers Conclave pitched against the Evocation Druid Council on another side. The Conclave has banned orcs who are dual-accredited (i.e orcs who are also trained as druids) from casting fireballs. The chief priest has decreed that orc healers are only limited to use the “needle” kind of evocation spell-casting, even though strictly speaking, evocation spell casting comes under the regulation of Evocation Druid Council. All these lines of regulation are clearly demarcated under the various ordinances of Middle-Earth. After all, the Evocation Druid Council is not a subsidiary of the Conclave, do how can it tell one how to practice evocation? The movie ends in one big shootout.

 

Worst Sci-fi Movie

Total Recall

A movie set in the near future where due to the introduction of the Family Orc-Healers Register, all clinic signboards that have the word “family” have to be recalled if the clinic does not have a registered family orc-healer practicing there.

 

Blockbuster of the Year:

The Avengers

The top-grosser of the year. This is about a secret small group of orcs and eleves who have been tasked to review the Orc-healer Conclave after widespread complaints about and dissatisfaction with the Conclave. Unfortunately, these are masked avengers and despite repeated questioning, the public and the profession do not know who is on this committee. We wait with bated breath as to when this review committee will be revealed. What can be engrossing than a top-secret review committee?

 

Most Expensive Local Movie:

Ah Boys to Men

This is a movie about growing up. A bunch of graduate medical students go through a very expensive foreign-brand name graduate medical school based locally only to discover the degree is not recognized in the lands it came from. On top of that, it is rumoured that the Chief Priest wants to hantam them with a licensing exam….They boys loose their innocence and grow up real fast…

 

Sequel of the Year:

The Expendables 2

This is a sequel to Expendables 1, where regulation was rolled out on medical devices that were so stringent many product importers pulled the plug on many medical expendables. Expendables 2 is a happier movie with the authorities back-tracking and loosening up on these requirements for low risk expendables. Let’s face it, Middle-earth is such a small market that it is expendable to the MNCs….

 

Worst Martial Arts Movie:

Tai Chi Zero

This is about the regulatory branch of the Ministry of Healing that regularly referred cases to the Orc-Healers Conclave. Unfortunately, Conclave judgments on several of these referred cases were subsequently overturned. Want to tai-chi but in the end backfire. Sigh…

 

Best Actress:

A Simple Life (Tao Jie)

Stars Deannie Yip as an old retired ma-chieh (domestic maid from China) suffering from dementia. Their kind bosses want to put her in a nursing home but they cannot find one because everybody doesn’t want a nursing home in their neighbourhood. A movie about the ugly phenomenon of Nimby (Not in my neighbourhood) and the pains of ageing. A stellar performance by Ms Yip and Andy Lau as her employer.

 

Longest movie award:

The Lady (not to be mistaken for Iron Lady)

About a female surgeon charged with overcharging. It’s a very long movie and the ending is not known. This is not to be mistaken for another movie called “Iron Lady” is about a paediatrician running a large healthcare cluster with an iron fist.

 

Flop of the Year:

The Three Stooges

A black comedy about three orc-healers who sat on a disciplinary committee. Their work was considered to be a tragic and complete waste of time when their Elven legal procurators drafted charges that were deemed to be embarrassing.

 

Best Horror/Action Flick:

Underworld: Awakening

This action movie is about the underworld of werewolves and vampires that have awoken to the fact that they are being continuing screwed by the evil wizard holed up in an ivory building. They hit back by casting 10,000 votes cast for no-one in a recent election. The underworld has awoken.

 

Best Comedy:

The Dictator

This is about a dictator writing a five-page letter to his subjects. It’s quite a funny letter because it mentions quite a few things that are laughable. Unfortunately not many read it and even fewer understood the rambling letter. Sacha Baron Cohen rocks in this one.

 

Best Actor Award:

The Grandmaster

This stars Tony Leung as the Grandmaster/Chief Priest. Tony develops a new kind of management art (not martial arts) which ensures a long stay (practically immortality) in a high office. This management art includes screwing up so badly that no one wants to take over from you and hence you get to stay forever in the job. The Grandmaster will in all likelihood last far longer that what it takes to make a Wong Kar Wai movie.

 

Best Disaster Movie:

The Hunger Games

Movie about how an up-market restaurant in a five-star hotel caused food poisoning for many customers resulting in the restaurants’ closure for a period. A lot of hunger here from the BO and vomiting.

 

Worst Disaster Movie:

MIB3

MIB stands for Mistaken Infant Botch-up and 3 is the number of staff that were disciplined in this incident in which babies were mixed up and a newborn was given to the wrong parents in Middle-earth. This is not to be mistaken for another movie Taken 2, which is stars Liam Neeson as the surgeon who “chopes” the last clinic space put on sale in Mount Expensive Old Hospital.

 

Best Animation

Ice Age: Continental Drift

A nice cartoon movie about a bunch of health workers caught in the formation of regional health care cluster when their old regional hospital was cut adrift when they separated from the huge tertiary hospital cluster

 

 

Worst Screenplay Award.

The Perks of Being a Wallflower

A movie about how a nationwide system for the GPs of Middle-Earth took many years to develop. In the end, there were few users of the system because it was too expensive to maintain and too complex to use. The user-interface was impossible to use and it truly deserves this worst screenplay award

 

Most Violent Movie Award:

Dredd

This is about how  Judge Dredd chairs the Disciplinary Tribunal of the orc-healers conclave. He is judge, jury and executioner. Just about blows up everything in sight. Not for the faint hearted.

 

Movie of the Year:

The Hobbit

Long movie about a short guy in Middle-Earth that seemed to court trouble wherever his hairy feet went. It is rumoured that the Chief Priest wants him – dead or alive. L

Chief Priest’s Epistle to the Orc-Clerics (Abridged and with Nonsensical Explanatory Notes)

Dear Orc-clerics of Middle-Earth

 

I have heard your recent grumblings all over the realms of Middle-Earth about how the Conclave of the Orc-Clerics has supposedly mishandled the Inquisition processes.

 

First of all,  the Conclave is subject to the ordinances of Middle-Earth and they were put in place by the various Elven legal procurators of old. Changing ordinances takes a heck of a long time. I am trying to change them (explanatory note: by allowing in even more elven legal procurators so that you buggers can’t squirm you way out of any inquisition)

 

The various inquisition panels are run independently of the Conclave. I am but the Chief Priest. I do not sit on any of these panels. (explanatory note: see how impartial and detached I am?). In addition, the Temple that pays me also has no hand in the panels as well (explanatory note: hand does not include fangs, feet and forked tongue).

 

Over the past several years, I have been trying very hard to change the ordinances to allow for a speedier inquisition process. These exclude using external inquisitors that are not members of the Conclave and bringing in learned Elves to even chair the panels (explanatory note: Elves know more about royally screwing orcs than we orcs). I have also put in place changes that allow junior inquisition panels to impose major torture methods that were allowed previously only for the senior panels. But it will take time for these junior inquisitors to be trained for these tasks.

 

The bloody nuisance orc-cleric association opposed the move to have increased elven input, especially getting an elf to chair the panels (explanatory note: But I still prevailed. I am the Chief Priest!).

 

Some wise guy from the association actually said we should learn from other realms. The other realms also allow elves, gnomes and halflings to chair their inquisition panels. (explanatory note: So he’s actually contradicting his own association. Ha!)

 

Now I will come to these specific inquisitions. Basically we used the wrong rack to punish them and the Elven Elders have said these orc-clerics should be set free. This will not happen again once I get the elves to chair these panels. These are exceptions. Actually we have done well so far and I will bury you with statistics to prove so. The Conclave remains an effective Machinery of Terror and Oppression.

 

You should perish the thought about getting more or all (Sauron forbid!) Conclave Members to be voted members. Having all voted members may result in less terror and oppression, which is not good. But you must all still vote. (explanatory note: if you cast blank vote(s) again, I will be very upset). In fact, consider it a privilege that all Conclave Members are still orc-clerics. Elsewhere, it is not so (explanatory note: Am I not benevolent?)

 

Running the conclave is bloody expensive. We actually receive subsidies from the Masters of Middle-earth, you cheapskates.

 

I welcome your input which are made in good faith and for betterment (explanatory note: You must first love me as Chief Priest – the content of your feedback is secondary, and I only offer you this olive branch under duress, you bunch of ingrates!).

 

I have also appointed a reveal committee to sort things out. (explanatory note: I have stuffed this committee with the usual suspects. Nothing will be revealed. Hence I cannot reveal to you who sits on the reveal committee)

 

Yours truly,

 

Chief Priest

Orc-Cleric Conclave

Middle-Earth