Doctors And Politics VII

The furious debates over healthcare issues affects me in 2 ways: first, as a physician in a public hospital, and second, as the only - and single - child of elderly parents with chronic illnesses.

As a healthcare worker, I am disappointed and appalled by how the MOH has managed the manpower issue.

17 years ago, it clamped down on the number of overseas medical schools with degrees which are recognized here, effectively preventing many foreign graduates from returning to Singapore to practise. Fortunately, I was one of the lucky ones, and was accepted at NUS after clearing the interview.

As time passed and the shortage of doctors became obvious, this restriction was gradually lifted. NUS began increasing its annual intake of medical students. Then Duke GMS materialized. Now a third medical school. Plus a huge influx of recruits from non-traditional sources ( e.g. the Philippines, India, Pakistan ) as the floodgates opened.

Prof. Tambyah echoes my sentiments that 'maldistribution' is the root of this problem. It has never been an absolute shortage, and I'm certain the MOH realizes this. But its strategy remains the same: plug the leak with more new graduates and foreign recruits, and everything will be fine.

Does the MOH wonder why there's a leak in the first place? Often, it is due to poor welfare for overworked and underappreciated doctors. Ridiculous patient loads in the wards, clinics and emergency departments. Minimal protected time for teaching and research ( unless you hold a fancy position like 'physician faculty' or 'clinician-scientist' ).

With 2 spanking new hospitals being constructed, the thinning medical workforce will only be stretched further, and more non-local HCWs roped in to fill the gaps.

KTPH opened without sufficient preparation, in an apparent attempt to pacify Singaporeans. Shortstaffed departments resort to pilfering specialists from other public hospitals to run their clinics, do ward rounds and supervise A&E medical officers. It may have come out tops in the recent patient satisfaction survey, but feedback from the ground is far from favourable.


Which leads to the next bane of my existence: those blasted surveys. I would like to get my hands on the forms used, and have a detailed explanation of the methodology utilized. How are respondents selected? Tell us every single KPI that was assessed. Do the patients' answers match objective data?

The last question deserves scrutiny, because my HOD informed us during a recent meeting that despite patients seen at our department complaining that waiting times are long, these do not reflect statistics collected from computerized records. In fact, our waiting times rank among the best of the lot, but patients' PERCEPTION is opposite to actual performance.

Instead, the Health Minister praises KTPH for maintaining its excellent service record ( transferred from AH ), and tells the rest to buck up.

Obviously, I don't work at KTPH. I belong to a department that has taken numerous measures to improve waiting times and patient care, and which is one of 3 important divisions that is regularly assessed in these hospital surveys. Do you know what such results do for our morale? It is gut-wrenching, especially when patients' ignorance is printed as fact, and facts are left out of the picture altogether.

We are indeed very fortunate to have a CEO who values clinical quality above such nonsense. Other institutions may not have such an understanding leader ( *cou-KTPH-gh* ).


Next, my role as an only child whose elderly parents have an assortment of chronic illnesses requiring long-term medication and assisted care. I do not have a maid, and thankfully, they are both still independent in most activities of daily living, though an unforeseen event ( e.g. an accidental fall, perhaps even a simple viral infection which develops into something much more serious ) could alter the situation drastically.

While they do have CPF reserves and personal insurance plans, in addition to my own Medisave funds as backup, benefits for singles are scarce. As a blog reader pointed out in a personal email to me, singles are not entitled to foreign maid levy relief, and eldercare leave is non-existent. The former is reserved for married couples, for the main purpose of allowing mothers to continue contributing to the workforce.

I contribute to the workforce on a full-time basis, compared to many colleagues who part-time for family reasons. Why do I not qualify?

Eldercare leave is also worth looking into, especially for those of us with less familial support ( no siblings, siblings who have migrated, etc ), parents who are home- / wheelchair- / bedbound, and/or require frequent medical follow-up for multiple co-morbidities or complicated diseases. I routinely use my off days to accompany my parents, but not everyone enjoys the luxury of a flexible schedule and 5-day work week. Caring for children may be challenging, but managing frail parents is no easy task either.

Last but not least, the use of Medisave for the treatment of chronic illnesses approved by the MOH. An annual withdrawal limit of $300 is allowed per account, and up to 10 accounts belonging to immediate family members ( spouse, child, parent, grandchild ) may be used. So again, since I am single and an only child, our options are markedly reduced.

My father has diabetes, hypertension, hyperlipidemia, renal impairment and severe DM retinopathy. He is fully compliant with medications and lifestyle restrictions, but still requires a fistful of drugs to ensure tight control. Despite all these measures, his vision continues to deteriorate. ( In case our doctor-readers are wondering, the retinopathy was already present upon diagnosis - not a result of poor compliance - so subsequent therapy was aimed at slowing progression, since prevention was no longer possible. )

A blanket sum limit of $300 is not enough for those with multiple co-morbidities, especially if disease control is a challenge. In such cases, more medications, or more powerful drugs - which are often also more expensive - are required, not to mention more frequent consultations involving multiple specialists. A one-size-fits-all approach clearly doesn't work.

Last but not least, as the mortals ponder their fate and suffer sleepless nights, I wonder if our well-paid politicians are subjected to the same policies they draw up and publicly support? Do they see polyclinic doctors? Do they consult specialists as subsidized patients? Do they stay in subsidized-class wards when they're admitted? Do they dig into their own pockets to pay for their medical expenses? Or do they choose only the best physicians and surgeons, skip the long queues for appointments and at crowded clinics, stay in A-class rooms, get treated like royalty and make the taxpayers foot the bills?

We can argue that government officials deserve medical benefits of a completely different scale. But how many government officials are paid such high salaries?

A few things the opposition should bring up in Parliament in the near future...