I would like to thank Dr. Chong Yeh Woei and Prof. Goh Lee Gan for their eloquent Forum Page rebuttals to Ms. Salma Khalik's recent editorial in The Straits Times.
This isn't the first time a journalist - usually from ST - has written a piece like this. It seems doctor-slamming rears its ugly head from time to time, especially after an epidemic has died down ( another good example: SARS ).
Lack of other newsworthy topics?
Part of some incomprehensible ST protocol that gets recycled every few months?
Or a certain senior correspondent's compulsive need to assert journalistic power by making sweeping statements about something she knows little about?
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22 comments:
I think Salma Khalik's editorial was fair comment. I always find it strange that articles like these are labeled "doctor-slamming". It seems as if nothing bad can and should be said about doctors at all. Condemn/expose a few bad apples, and suddenly, it seems as if the whole barrel is threatened.
The reply by the SMA president certainly left a bad aftertaste.
When you think about it, the local profession as a whole has never earned the right not to be criticized (SARS is not an exception). In fact, there is much that is negative, and more that can be improved. This is not to say that there isn't much that is good, but merely that there are spots in the sun.
There are too few regulations that can be enforced, and too little accountability by doctors to their patients or to society as a whole. The conscientious ones belong to the majority and do well. The few crooked ones, well, usually they do better...
I tend to agree with anon.
I respect both men, but I find their letters too defensive. As an individual I have never felt threatened by expose of errant doctors, since I am quite clear how I practise my profession, and on the 'professional' front I am willing to admit that we have black sheep who stray far from accepted standards of practice (and angry doc does have pretty low standards...).
Nah, I agree that Ms. Khalik's article slams doctors. She and other ST reporters have done this before, and while she's free to voice her opinions, she does it in a manner which I find offensive.
The rebuttals defensive? I applaud Dr Chong and Prof Gan for conveying what many of us feel - Prof Goh's letter also mentions receiving feedback from other medical colleagues.
It isn't a case of not being able to say anything bad about doctors in general, but about how it's said. If <0.2% of doctors here are guilty of prescription misconduct, turning the entire prescribing process upside down is hardly the answer.
The local medical community has never asserted any right NOT to be criticized, but a line has to be drawn somewhere.
Seemed to me like the two Presidents' main line of defense was just to cry foul. Evil woman that Salma Khalik. But callous and unpatriotic? What sort of defense is that?
It also seems clear that the profession is in a state of denial. Why can't our profession face up to the fact that doctors in the market place not only over-prescribe but do so often in less than responsible ways and probably much more often than we want to admit?
We say, the patient-consumer wants it so we are obliged to supply. Really? That's being responsible and professional?
Yes, the practitioner out there faces a lot of pressures. Unfortunately a large part of it is the pressure of the market place. Sadly many try and their noblest but many do succumb. The dispensary is a major source of revenue for the GP clinic. That is without dispute. But the reality is that the practice does create significant financial conflicts of interests which actually work against the professional objectivity of the practitioner.
So time to remove our blinkers and do something about it?
local doc,
Read the first sentence of Salma Khalik's article.
She didn't just "voice her opinion", she also reported facts.
The 0.2% statistic quoted by Dr Chong does not tell us that only 0.2% of doctors prescribe inappropriately - it tells us that 0.2% were successfully hauled up before the SMC. Tip of the iceberg and all that.
Changing the current prescription model is not turning it upside down - the current model *is* upside down.
Do you honestly think that the doctors complained to Prof Goh because their feelings were hurt, or do you think they felt their wallets threatened? Honestly.
As for "The local medical community has never asserted any right NOT to be criticized", well this is not the first time the SMA reacted defensively to an expose of unethical practices. See my previous entry here:
http://angrydr.blogspot.com/2008/03/stop-using-that-word.html
I seriously considered joining the SMA after meeting Dr Chong in person earlier this year, but after the publication of this letter I feel that I do not want to be associated with the SMA.
Let's just not forget the much good that many doctors do without much recognition and thanks. It's not an easy job, even though it pays well.
Aiyo u doctors are just greedy and cause healthcare costs to rise every year.
Can die but not fall sick in Singapore.
Give slimming pill then liver damage like that actress
then need liver transplant and earn from patients who are suffering/dying.
Stop thinking that u do good when you are highly paid for it.
All protect one another when drs make mistakes and kill patients. Always blame patients and never blame themselves.
It is a good thing that we have journalists like Salma who expose all of u greedy doctors!
The harsh reality is this: the GP practice market is over-saturated and underutilized. Is it any wonder that survival tactics employed include aesthetic medicine and questionable prescribing?
The polyclinics and emergency departments are bursting at the seams, with the latter treating a large number of cases that could've been managed by a family physician.
Despite the intense competition, many still leave public practice to set up shop as GPs. Honestly, what is the point of having "enough doctors" on paper, when the patients aren't even seeing them?
Re: angry doc's comment about the SMA, the demographics of its Council members may provide clues about the association's agenda. And I have a feeling the GP community has quite a lot of say in the SMA's press statements.
gigamole: Love your comment about the "evil woman". :)
Well anon, Andrea de Cruz took non-prescription medication, but your point is noted.
You don't accuse a hawker for making money off hungry people, so why would you accuse doctors of making money off the sick?
If you believe that doctors shouldn't make money off sick and suffering people, then you are welcomed to become one yourself and treat them for free. I put in effort to become a doctor and continue to put in effort to make sure I keep up with current medical practices. I don't think I am 'doing good' when I practise medicine - I think I am doing a job which I am paid to do well, and I expect to be paid well for it. If that makes me greedy, then you can call me greedy. I don't owe anyone my services for free.
And if you truly believe that in Singapore one can die but not fall sick, you are free to put that belief into practise too.
Perhaps the challenge for normal people is to be able to tell the difference between duty-bound doctors like yourself and those who are less scrupulous. Any tell-tale signs that people should watch out for?
Other anon,
I think unfortunately Salma Khalik has been a part of the local medical scene for so long she invokes a knee-jerk reaction from SMA every time she writes something... The article is really quite factual and innocent, but I guess the authorship makes SMA respond with all the 'history' in mind.
SA,
Flattery will get you anywhere... :)
It's hard, of course.
It's a bit like going to a mechanic: how do you know you need to do all that servicing and replace all those parts he tells you you should? How do you know the prices he quotes you are fair?
I dunno...
Even amongst doctors you can't really tell unless you see the person practise day after day - a once-off impression can be misleading.
angry doc,
i agree with you whole heartedly. medicine has become a service industry, with pts very readily threatening to speak to teh CEO/CMB etc to complain about their case. so IMHO, if patients are so willing to complain, then we should have no qualms about using every method possible to earn money. because we try our best to help patients, but i've been yelled at by patients, treated rudely by nurses, and responsibilities that are not mine pushed to me by the paramedical people. at the end of the day, it's hard to care for patients when you can barely care about yourself.
which is sad, becuase like you said, we put in so much effort in getting into med school, passing it, and practising medicine.
in the end, to be honest, it's a thankless job.
maybe ms khalik would like to comment on that...
I dunno about Ms Khalik, but I would be hesitant to criticise doctors. You never know when you're going to see one next.
The last time someone did a minor op on a family member of mine, I remembered to thank the nurse as well as the doc. I was glad I did it. I suspect very few people do. I sincerely felt grateful for what they did for my loved one, and in IMO, they were very professional; I was there in the very room where they did it.
So doctors are definitely not all bad, they have to stare at death and disease all day. I imagine it's takes someone mentally strong to do all that.
See, I'm good at flattery.
No, passerby, I don't think that we should use "every method possible to earn money".
What I am saying is that I don't feel guilty for getting well-paid for doing my job well. If people value their health, then they shouldn't complain that they have to pay good money for healthcare.
Healthcare is expensive, but it is still affordable if you don't spend that money on a pack of cigarettes a day or two bottles of beer each evening. (Do the math and you will see it's not a small sum.) People budget for food, for utilities, housing, and transport - why shouldn't they budget for healthcare too? If you know that you will likely need several thousands for chronic or degenerative disease care later in life, should you really be going on a trip to Korea or Australia every year? Should you really upgrade to a more expensive home instead of setting aside some cash?
No one would spend on those things to the point where they cannot afford to pay for food and will starve to death. So why should they expect differently for healthcare? Is not healthcare equally essential?
At the same time, I am against people (not just doctors) making money *fraudulently*, or at the expense of other people's well-being. To sell treatment that do not do what we claim they do is fraudulent. To offer treatment that harm the patients with no possibility of good is, well, plain evil.
SA,
I think it's equally foolish to judge all doctors by one or a few encounters as it is to judge all mechanics by one or a few encounters.
I personally judge all doctors on two scales: niceness and competence - the two don't always correlate. Generally though all new doctors who come into the department are assumed to be nice and competent until they prove themselves otherwise...
"I seriously considered joining the SMA after meeting Dr Chong in person earlier this year, but after the publication of this letter I feel that I do not want to be associated with the SMA."
Really? Please do so. SMA would be better off without you anyway.
"SMA would be better off without you anyway."
Really? That's not what Dr Chong said.
just find it hard how a certain reporter always reports the bad stuff (sometimes rather inaccurately, as in the case of the ethics of local grads), but fails to touch on the good stuff. whatever gets the paper to sell i guess. but IMHO, SMA shld just keep quiet. after all, its one of the lowest ranking papers in the world (http://www.rsf.org/en-classement794-2008.html) vs one of the better healthcare systems (http://www.photius.com/rankings/healthranks.html, http://econlog.econlib.org/archives/2008/01/singapores_heal.html)..
May I offer my humble opinion.
My initial feel after reading the article was that Ms Khalik's main point was to push for the separation of prescription from the sale of meds.
However, i doubted this thought as Ms K chose to have a title that shifted the focus to "greedy" doctors, went on to seemingly acknowledge that only the minority of them are "greedy", and then proceeded to make sweeping statements like "doctors have protested vehemently against the proposal since they get a large chunk of their income from selling medicine."
Her "evidence" to support that Drs are greedy (and perhaps to push for her stand to separate prescription from meds sale) was half-hearted and felt like a primary school project. Instead of spending time "testing out" Drs, why didn't she look up the current systems that actually have separate prescription from sale of meds, and tell us objectively what are the true advantages of such a system? I am sure there are many more complex factors in deciding for such a system, and the supposed greed of all Drs can't be the main/only factor..
As to the furry of responses in defence of the medical profession, I can understand why so many pple are upset abt the criticism of the profession, where the Drs aren't exactly having an easy time. I can also empathise with the official responses by Dr Chong and Prof Goh in terms of preserving the morale of Drs. I do follow the good principles when practising medicine like angrydr, but the feeling of being maligned can't be denied when pple who are not in the field point fingers at us in such a manner.
I would like to conclude that such an article should not been treated too seriously. At the end of the day, it should be up to the population to discern for themselves if Drs are really greedy, Drs themselves to prove to everyone that they indeed aren't, and for newspapers readers to pay attention to such attention grabing headlines, but at the same time read widely and around it to truely make any real judgement.
Hi moderators,
Wondering if we could have a discussion on The Practice of Medicine (eg Parson's Sick Law) vs Service Quality and Standards (eg ISO) vs cost and the conflicts they present?
Personally I feel that the deliver of medicine is not the same as the delivery of service in other industries eg hospitality or airlines.
Secondly, the expectations and cost factors.
For example, while there is always this drive towards "service excellence" in every organization, the quality of the service is different depending on the price you pay for that service.
However the management do not look at it that way. They look into every complaint in the same way in every organization.
It seems to be left to the customer to decide what his expectations will be (sometimes this can be tempered if he is paying a low price). But it seems that in health care, free seems to be the price everyone wants to pay so no luck having any pared down expectations subsidized or not.
Case in point. How do the management of SIA and Singhealth see weigh their quality standards? I bet they both want "service quality excellence".
I don't see SIA rates being cheap though. Same with ShangRi-La Hotels.
It is extremely difficult if the government does not control the expectations of the people when it comes to subsidized health care, and yet want to control cost.
The system is extremely taxing on the staff who provide the service. They are sandwiched between trying to give "world class service excellence", but keeping costs low.
That's an interesting topic, old friend.
I am up to my neck with work now, but hopefully in a few weeks I can find the time to write about "Why Subsidised Healthcare Must Fail"; hopefully one of my fellow contributors will disagree with me and write "Why Subsidised Healthcare Must Not Fail" in reply. :)
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