Category: Humour

Could We Or Covids Have Done Better

The Covid-19 White Paper was released on 8 March 23. This hobbit thinks this was a very commendable effort to look back at what happened that was led by a former Head of Civil Service that is known for his frankness and clarity of thought.

It correctly identified the two major shortcomings made by the government – the U-turn in mask policy and the blow-up in cases that happened in foreign worker dormitories. And this in itself, is a win for transparency and humility. Two very rare commodities in the world nowadays. It is also noteworthy that the two errors arose from essentially the heuristic error of anchoring. Just because the coronavirus in SARS was infectious only when the patient had fever doesn’t mean that another coronavirus will behave likewise. We were anchoring on our past experience with the SARS virus and hoping the Covid-19 virus will behave likewise.

But enough big talk. Now for the small talk that regular readers of this column seem to enjoy much. There are some episodes during the pandemic that are worth remembering but not mentioned in the White paper, just for laughs, if nothing more. These include:

The Virus Vanguard. These are official superheroes no less, since they first appeared in government Facebook webpages, albeit for about only a day in April 2020. We remember our disappeared champions – Circuit Breaker, Care Leh-Dee, Dr Disinfector, Fake News Buster and the (drumroll please) MAWA Man (Must always walk alone, the very antithesis of Liverpool fans). This hobbit hopes that they have NS liabilities, so that in the next pandemic or epidemic we can serve the SAF100 on them to return.

Pivot to F&B Sector. The KTV cluster in 2021 was a result of several KTVs that have “pivoted” to the F&B sector (with assistance and sometimes even grants from the relevant  authorities). A good and well-meaning idea in itself except that these newly pivoted F&B outlets did not have any commercial kitchens. So obviously they had to cook up something else on these premises which resulted in the cluster.

Strangers Sharing Same Hotel Room during Quarantine. At the start of the Omicron wave around December 2021, some folks were made to quarantine in the same hotel room with complete strangers. Naturally, this nutty idea was quickly panned by many. Between a full-height walled cubicle in Singapore Expo and sleeping with a stranger in the same hotel room for about 7 to 10 days, most folks will prefer the former. C’mon, even in an SAF exercise, I have my personal basha tent. This hobbit thinks the guy who came up with this probably liked Frank Sinatra’s “Strangers in the Night” a little too much.

CB and Tightened CB. Kudos to the wordsmiths who were always on top of the word game during the pandemic. These include calling a lockdown a circuit breaker or CB in short. This evolved to a Tightened CB later on. And at about the same time, the government was putting out Chinese-dialect short videos to get the message out to the elderly in the Chinese community. Whoever came up with the tightened CB bit should also be sent for some dialect classes.

Die Another Day. This incident arose also in late 2021 when a MOH Director said mortuary directors could handle dead bodies when the cause of death was Covid-19. This was refuted by the Secretary of the Association of Funeral Directors’ Singapore the next day in The Straits Times Forum which stated clearly that MOH guidelines prohibited them from handling such bodies outside of hospitals. This is clearly NOT a case of Everything Everywhere All At Once as the left hand didn’t know what was happening with the right hand. It is also nice to know the Association was given a President’s Certificate of Commendation for exceptional effort and significant contribution to fighting Covid-19. Incidentally, organisations such as SMA, CFPS, AMS, SNA, SDA and PSS weren’t. Obviously someone either forgot about or doesn’t like these guys?

Let us now get down to the White Paper proper and move back into the serious stuff. What really hit home for this hobbit. The White Paper really had their finger on the pulse when it stated on Page 67:

“However, some of the (i.e. SMM) measures were overly elaborate, difficult to operationalise and explain, and therefore confused the public. Re-opening the economy in phases while limiting the spread of community infections turned out to be a more complicated, and emotionally affecting, journey than expected. All this highlights the need for us to exercise greater flexibility in a crisis, go for broader brush but more implementable measures, and to guard against the instinct to aim for unrealistic standards of perfection”.

On Page 74, the White Paper essentially put out the same message again:

“With future pandemics, we will also need to exercise more flexibility. During COVID-19, at times we allowed the perfect to be the enemy of the good, for example the over-calibration of some SMMs and treatment protocols. In striking the right balance between achieving precision and ease of implementation in our public health protocols, we should guard against leaning too much in the direction of the former”.

Very important points that were most eloquently articulated. Beyond these wise words, this hobbit would like to draw attention to this graphic that was put out in late 2021 by Lianhe Zaobao which told vividly how wrong can matters get:

https://www.zaobao.com.sg/news/singapore/story20211004-1199797

Like what this hobbit has said before, you don’t have to know Chinese to appreciate the ludicrous complexity the “system” had become before thankfully someone decided to implement Protocols 1, 2 and 3.

It is perhaps importantly to go one-step further to discuss why the “system” went off the cliff in terms of complexity and impossibility (rather than ease) of implementation, especially in the area of public health and healthcare.

First, let us remember, whether we like it or not, that protocols, circulars, instructions, directives etc, are written and put in place by people (i.e. real humans, not halflings, elves and orcs). And what drove these people to do what they did? This hobbit can proffer several possibilities:

  • The people who wrote these protocols really have no real on-the-ground experience running healthcare facilities such as hospitals, nursing homes or clinics. They probably grew up in a nice white building; from sitting behind a desk to sitting in a cubicle, before finally being holed up in an office and adorned with a personal assistant to show they have arrived. Hence, just armed with a little theoretical knowledge and no frontline experience, they write protocols the way novelists write fantasy stories.
  • These people are more afraid of losing their jobs more than solving real-life problems, and think that the best way to keep their jobs is to cover their backsides and to write protocols and directives that cover every possibility and exception without thinking how the people on the ground will cope. Never mind you cannot possibly comply with what they wrote. That’s your problem, not these people’s.
  • They are just plain stupid (which is unlikely, since they can write such complicated protocols. Maybe they have spectrum disorder, but they are probably high-functioning ones rather than stupid).
  • Various combinations and permutations arising from the above three possibilities.

There are of course other possibilities, but it would be impossible to explore all of them in the interests of time and readers’ attention. Of course, this hobbit is NOT about to excoriate old wounds, start a new round of fault-finding or try to settle old accounts. But it is important to state that these people have written and issued protocols and directives that have caused untold grief and profound degradation of morale among front-line healthcare workers during the pandemic. This hobbit thinks the morale hasn’t quite recovered fully even now. Quite a few people are still scarred and angry.

So, in the name of all that is good and true, this hobbit beseeches those that are in the high places of power that they do not assign very important tasks such as writing of protocols and directives to these same dangerous people again. Put them somewhere else where they can still earn a living off taxpayers’ money but do less harm, like dress them up as MAWA Man, Care-leh-dee and Dr Disinfector etc and send them to Cosplay conventions. Better still, we can put them onto a Chingay Parade float that has a big overhead banner which has the words “CBs”.

Hobbit Awards 2022

A Happy New Year to the readers of this ridiculously irrelevant column. 2021 has been a year of shattered hope (that we would have gotten the pandemic under control) and realised fears. Delta and Omicron bookended 2021 and the world spent another year in a surreally sad state of ( albeit milder) lockdowns, social distancing and masks.

We now look back at the year that has passed and we dish out various awards to folks who gave colour to 2021, through the eyes of a halfling who is stuffed with beer and suffused with melancholy….

First World to Third Award

Recently, it was reported that close contacts of patients who had contracted the Omicron virus were quarantined in hotel rooms. Many of them were made to share room with complete strangers. Seriously, after spending billions on disease control for the pandemic, we have to save on such stuff? We have to bear in mind this is more than a one-night stand and complete strangers are made to share rooms for several nights. Maybe folks such as Singaporean boys who have done NS and slept in army bunks can accept this, but how about other folks?

Sharing a room with family members and friends is probably OK. But complete strangers?Whoever thought of this needs to get his mind checked (to see if any brain is present in the first place). The foreign press took us to town for this and perhaps justifiably so.

Best Cultural Advancement Award

For centuries, humankind has frowned on nose-digging, especially in public, as a uncouth, distasteful act. Now we have to do it twice weekly in the form of regular ART tests. Now, it is not only public but if you return from VTL flights, it is supervised nose-digging. Trust this hobbit, most people can dig their nose pretty well, with their fingers or with a swab. They don’t need supervision. I actually think these chaps have a strange job – all they do is watch people dig their nose, day-in, day-out…..

No Reality Check Award

This goes to the unknown genius that believed that KTV lounges/clubs etc will willingly pivot to become food establishments without any hanky-panky business. This of course we know became the KTV cluster later on. This is made all the more incredulous when it was discovered that many of these “pivoted” food establishments do not have kitchens to do any serious cooking.

Fat Cats Award

In 2020, Integrated Shield Plan (IP) providers collectively made S103.75M. This hobbit thinks 2021 will likewise be a bumper year for them. Will they pass any of these earnings to the policy holders? Will premiums not rise as such? Will they stop threatening to raise premiums at every call for increasing doctor panel size or improving reimbursement rates for doctors? This hobbit is not holding his breath for this. They are the big winners of this year’s Fat Cats Award.

Stealth Award

This goes to the Life Insurance Association (LIA) of Singapore. For years they have been singing the familiar tune that private healthcare costs are increasing unsustainably because patients are overconsuming and healthcare providers are overservicing and overcharging. This will lead to premiums likewise increasing at an unsustainable rate.

Well, it turns out that for the Integrated Shield Plan (IP) sector, from 2016 TO 2019, Gross Premiums (i.e. total premiums collected) went up by a compounded annual growth rate (CAGR) of 10%; while Gross Claims (money paid out to policyholders who made claims) increased by 11%, while Management Costs went up by 16% and Commissions by 15%!

In other words, the main causes of unsustainability is that the amount of money these IP providers are paying themselves is increasing at a far faster rate than that of premium growth! And all this while, nobody really noticed until recently.

LIA wins the Stealth Award (quietly and invisibly)

Circular King Award

Current DMS wins this award for the second time running. 244 circulars were issued in 2020. 192 circulars were issued in 2021, slightly fewer. But this hobbit thinks that 192 may be an underestimate because a new practice may have emerged. Quite a few circulars were re-issued with updates and amendments and given an alphabet suffix; e.g. Circular 188A/2021 and so on. So the actual number may be around 200 or so.

Not all circulars apply to all doctors. But let’s say we halve that number – to 100 circulars. That would mean that an average of 2 circulars a week require my complete understanding and compliance. That’s pretty scary isn’t it?

Common Sense is Uncommon Award

We allow passengers to take public transport (such as buses MRT trains) with practically no social distancing. But till now, we continue to have alternate urinals and wash basins taped up so that no one can use them.

In some toilets, we even see every other toilet cubicle with full-height partitions likewise adorned with signs that state they cannot be used in order to maintain adequate social distancing.

Do the folks who implement this realise Covid-19 cannot spread through full height partitions, and also one spends considerably less time at a wash basin or a urinal (unless you have serious prostate problems) than in a bus or train ride?

The persistence of such practices reflects what my professor taught me long ago, “common sense is uncommon”.

Complexity Award

Up till early Oct 21, before the introduction of the simplified 3 Protocols, the country’s policies and regulations on Covid-19 quarantine, treatment and recovery were so complex it was really impossible to understand, let alone remember. This was best encapsulated in a flow diagram published in Lianhe Zaobao on 4 Oct 21. You don’t have to understand any Chinese, just look at the diagram. Adjectives such as “bewildering” and “befuddling” are but euphemisms in this instance:

https://www.zaobao.com.sg/news/singapore/story20211004-1199797

Kudos to the folks who contributed to the vast array of policies and regulations that controlled our lives for a few weeks. Even bigger kudos to the Zaobao team for understanding them and compressing all that into one single expansive flow diagram. They are the deserved winners of this year’s Complexity Award.

Road to Endemicity Award

This goes to the Delta variant for breaching our defences at the Jurong Fish Port shortly after the KTV cluster. After these two clusters there was no turning back for us. We were truly well on the road to endemicity…..

Clueless Award

Online commentator Calvin Cheng on 22 May 21 posted, “What are GPs? They are general practitioners who got a degree in medicine, who then either chose not to specialise in a certain field, or were not good enough to be chosen to be specialists. So they became GENERALISTS. They look after small every day illnesses, and once an illness or disease is too complex for them, they refer them to the real experts, a specialist”

Enough said about this guy. He likes to be heard I guess. Even for the worst reasons. He gets this year’s Clueless Award hands down.

Contrast this to what the Prime Minister said at the recent celebrations of CFPS’ 50th Anniversary on 3 Dec 21:-

“As family physicians, you are specialists in your own right. Hospital specialists see patients for a specific condition, but you see patients holistically as a person, across their range of conditions”.

The Facepalm Award

This is a new award category. It is given to the folks who make the most ridiculously embarrassing actions in the previous year. The inaugural award goes to a small bunch of anti-vaxxers who do the silliest things. There was one chap who claimed on social media that he can be contacted via DMS. That was another one who threatened to sue people, including the DMS, the prime minister’s wife and a prominent infectious disease specialist.

By all means, be an anti-vaxxer if you so choose. But don’t do or claim things that make you look stupid or even looney. This is no way to heal any divide….

The Grinch Award

This hobbit thinks Omicron is like the character Grinch in Dr Seuss’s book – How the Grinch stole Christmas. It appeared in November and literally took out the festive spirit in December, just when many people all over the world believed we had the Delta strain under control, and were prepared to travel for holidays and take part in end of year festivities. Maybe we should rename Omicron as the Grinch variant.

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!