The Saga Continues

Unless you've been living in a mountain cave these past few months, you would've read the newspaper reports about Dr. Susan Lim's troubles. After a month's adjournment, the sensational headlines are back in full force, starting with a claim that SingHealth CEO Prof. Tan Ser Kiat, who was appointed head of the newly set up SMC disciplinary committee, bears a 30-year-old grudge against her, after allegedly being romantically rebuffed. Of course, other factors were also mentioned, but who the hell cares when watercooler gossip has something so much juicier to latch onto? Casual conversation with medical colleagues - one of whom hails from SGH orthopaedics - reveals a unanimous sympathy vote for Prof. Tan. And it is certainly interesting that his version of events from that fateful evening 3 decades ago is poles apart from Dr. Lim's account. I'm curious as to whether an independent witness will come forward, especially if what Prof. Tan describes as a 'party' attended by others holds true. Isn't it sad that legal proceedings have degenerated to this level? Again, the colleagues I chatted with feel that Dr. Lim's legal team is overzealous in its attempts to undermine her opponents. While she no doubt has the financial means to engage top attorneys as she furiously defends her reputation, the tactics used glaringly border on desperation, and have probably earned her a fair number of enemies within the medical profession ( of which members of the SMC likely form a large proportion ). If rumours that she stepped on a lot of toes on her way up the hierarchy are accurate, then this is a perfect example of 'what goes around comes around'.

Doctors and Politics (Local)

In the run-up to the Singapore general elections, up to three public sector doctors may possibly be fielded as new candidates for the ruling party. Dr Janil Puthucheary (KK Hospital) was introduced fairly recently, while presumably Dr Tan Wu Meng (National Cancer Centre) and Dr Abdul Razak (National University Hospital) will get their turn in the spotlight soon. I presume Dr Tan and Dr Razak will get less heated online discussion upon introduction compared to Dr Puthucheary, but that may not be a bad thing.

I have had the opportunity to speak to two of the three on occasion, and they have always struck me as being bright, full of good ideas, eager to help others, and (as far as I can tell) idealistic. It seems a shame to lose good doctors to the political arena, but perhaps they have a different calling and will achieve that higher potential. Certainly the current Education Minister, however many more millions he may have made each year as a private breast surgeon (although the gap seems to be closing), did not command the level of respect and authority then that he does now. And he would have had neither those millions nor the authority had he remained as a general surgeon in our public sector hospitals.

Browsing through the blog posts on this site as well as the many comments, one might come away with the impression that most doctors led privileged lives and blame the system or their patients (but hardly ever themselves) when things don't go right. And they complain about their earnings despite the vast majority being above the 80th centile in terms of income. The public can hardly be blamed for thinking that the SMC is opaque and doctors flock together to protect their own (irrespective of whether an actual wrong had been committed) when so many distinguished names in the medical community appeared to have stepped forward to protect Dr Susan Lim (the Director of NCC, one of the most respected and brilliant surgeons in the country, issued an explanation but it was undoubtedly too late). It must seem to many that our doctors "just don't get it".

Let's hope that these young doctors entering politics will help to give the medical community a better reputation, if only by proxy, at least locally.

How 'Informed' Is An Informed Consent?

A recent headline put this topic in the spotlight again.

And a Google search served up this article from a 1992 issue of the SMJ.
Despite being published almost 20 years ago, the basic principles have not changed.

However, when you consider the amount of information involved, and the need to factor in Q&A if the patient has queries, one wonders how adequate this process is, especially in a public hospital setting where consultation times rarely exceed 5-10 minutes.

A detailed explanation alone, even for simple procedures, may take up to 15 minutes if the patient isn't highly educated, if there's a significant language barrier, or if the patient / spouse / relative has additional questions.

And I take serious issue with Prof. Eu's patient's lawyer saying that "the patient is not obliged to seek out further information on the risks, benefits and possible complications of the procedure on his own".

So, in typical Singaporean form, the doctor is expected to shoulder all the blame, even though the patient, Mr. Ang, is a businessman whom I assume is (1) not illiterate, (2) Internet-savvy, and (3) not mute or terrified of Prof. Eu to the extent that he is unable to verbalize his concerns about surgery.

I've always groused about Singaporeans' lack of interest in their own medical care. They seem to expect others to take charge of their health, then get upset when something goes wrong or they're slapped with a hefty bill.

While not all the facts of this particular case are available to the public - and who knows whether the press has presented a truly unbiased view - it looks like Prof. Eu may have gotten the short end of the stick here.

So the next time you're kept waiting 4 hours at a public hospital's specialist clinic, it's probably because the doctors are furiously documenting every consultation.

Thank you, Mr. Ang.

Arrogance of ignorance 2

This letter to the ST Forum prompts me to ask: Which tests do you have in mind, Mr Lim?


Allow use of Medisave for more screening tests

IT IS heartening to learn of Health Minister Khaw Boon Wan's announcement ("Medisave can be used for cancer checks"; March 5). However, this is applicable to only two types of screening tests - colonoscopies, which detect colorectal cancer, and mammograms to screen for breast cancer.

Can Medisave not be extended to other types of cancer screening for a person over 50 years of age? Why restrict it to only these two?

Diagnostic screening is, in most cases, a necessity to determine the health condition of an individual. Why not extend the use of Medisave to cover all cancer screenings as well as all tests to detect heart disease?

To many people, the costs of these tests are a big burden.

Arthur Lim


Now I think the question: Why restrict it to only these two? is a very valid one, and I am pretty sure MOH will very soon come up with a reply on why these two tests were chosen.

What bothered me was how Mr Lim was so keen to promote "the use of Medisave to cover all cancer screenings as well as all tests to detect heart disease" before he has received an answer to his first question.

The truth is not all screening tests are equal, and more importantly, even when a screening test is accurate (yes, I chose to use this term because I am lazy) and we are able "determine the health condition of an individual", it did not necessarily mean that it was cost-effective to screen the population at large, or indeed a specific patient. Unfortunately, if someone was in a position that "the costs of these tests are a big burden" to him or her, an accurate diagnosis may just be the beginning of more financial burden...

But the cost-effectiveness of screening tests are really quite a technical issue that we cannot expect laymen (or even all doctors) to understand - that's not what bothered me about this letter. What bothered me was how a layman can think that a bunch of doctors and statisticians sitting in MOH can be blind to the benefits of "all cancer screenings as well as all tests to detect heart disease", which are so obvious to him.