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

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!