Thank you, medicalgrounds, for your suggestion. I've emailed our ID physician blog member to seek his response.
With regards to the H1N1 vaccination exercise, MOH has ordered a million doses of the new vaccine, of which 20% are set aside presumably for 'essential' government personnel. This translates to 200,000 doses at approximately $30 each, which comes to about $6 million, paid for by the government (excluding manpower and logistics/administrative costs).
H1N1 fatality rate: 0.007 to 0.045% (comparable, or less than an average seasonal flu according to the Reuter's report linked below).
Medifund disbursement for the needy (FY 2008): S$1.66 billion
Qn: What do you feel is the most prudent/cost-effective way of spending $6 million of taxpayer's money in light of the above?
a) Vaccinating all essential government staff (including low risk groups)
b) Vaccinating only essential government staff at risk of H1N1, save the rest of the money.
c) Spending the money on other healthcare initiatives (eg Medifund)
d) Others (feel free to elaborate)
References: http://sg.news.yahoo.com/cna/20091025/tap-650-singapore-receive-batch-h1n1-vac-231650b.html
http://www.reuters.com/article/healthNews/idUSTRE58E6NZ20090916
http://www.moh.gov.sg/mohcorp/hcfinancing.aspx?id=308
Thought I'd put this comment up as a separate post.
My thanks to DrFire for his/her input.
I trained in Canada and am now working as an attending here, having left Singapore in 2001 for med school. I think if Singapore switches to the US residency program, it will have to modify its medical school training to reflect the degree of clinical exposure that US/Canadian medical students get to the "system" even before graduating.
Here, in a 4yr program, the 3rd and 4th yrs are entirely clinical. The students are designated as clinical clerks. Typically they carry a maximum load of 4pts - and they are expected to know those patients in and out. They do an average of 1-in-7 call, which is less than the intern's average - but it is the same 36hrs of torture.
The Canadian system is similar to the US system except for the ACGME rules on work hours. There are no such rules here. The typical call is 1-in-4, 30hrs or so. But judging from what I've heard from my friends back home, the key difference has been that a lot of the scut that you guys deal with isn't something we had to worry about as much.
We have lab techs drawing the bloods, nurses starting IVs. Resp techs draw blood gases and can even intubate should the need arise. Don't get me wrong - you have plenty of chances to become good at doing all these things, since you are expected to do these throughout the senior years of medical school. And in the intern year, you're called if - God forbid - the techs/nurses are unable to obtain the line or gas. You get first dibs on all procedures - but after the 100th IV you've placed, it is a huge help to have ancillary staff who can look after the scut, who don't view it as scut.
Is this system better? I don't honestly know. What I do know is that I am happy that I finished my residency when I was 26, passed my boards at 27 and I don't feel the worse for having done it the unconventional, quick route. But the biggest issue I foresee with changing Singapore's UK-based system into a US-based residency is that one must be very careful as to how it is done, especially taking care that the medical curriculum is also changed to provide medical students with greater clinical exposure.
I would say that when I was going through clerkship, chatting with my friends gave me a greater appreciation of just how vastly different the two systems are. In the 5th yr in a UK med school, they were placing IVs - by the end of my 3rd year, I had placed IVs, 3-4 central lines, arterial lines, and more.
Did that make me better-trained? No. The expectations of our respective training models were different. In the end, it is not an issue of which system is better, but more an issue of whether the training is adequate for what lies ahead. To implement a residency system for which the medical student has not been prepared would be dangerous and a disservice to one's training, I believe.
Just my two cents' worth.
1) Doesn't know the actual names of the medications s/he takes.
2) Thinks telling the doctor, "It's a round, white pill" actually helps.
3) Tolerates even the most severe symptoms ( e.g. chest pain ) till the weekend or public holiday period is over before flooding the clinics and ERs, hence the dreaded Monday surge.
4) Has lots of concerned relatives who don't communicate with one another and hound you constantly for repeated updates.
5) Has relatives who would rather spend 15 minutes chasing nurses than bring the patient to the toilet themselves.
6) Signs consent forms for procedures and retains less than 50% of the information given.
7) Thinks by taking diabetes / hypertension / hypercholesterolemia meds, this entitles him/her to eat whatever the heck s/he wants.
8) Thinks waiting an hour warrants a letter to the Forum Page.
9) Thinks the Forum Page is a great way to scare healthcare workers.
10) Assumes that "all my medical records are in your computer, what."
