"In Singapore, within half-an-hour, you would be in SGH (Singapore General Hospital), TTSH (Tan Tock Seng Hospital) … and within one-and-a-half to two hours flat, you'd know what went wrong." SM Lee KY.
A tall expectation given this: 'Shortage of Drs in SG'?
Lee Sr and the eye-opening trauma in London
Today - November 3, 2003
SINGAPORE
http://www.singapore-window.org/sw03/031103to.htm
By Val Chua
EMOTIONS ran high on a balmy Sunday night as the normally stoic Senior Minister Lee Kuan Yew nearly broke down while recounting the ordeal his wife went through in London recently.
The troubles that the couple faced — including joining a queue in a free hospital — when Mrs Lee was hit by stroke two Sundays ago, revealed how differently two systems worked.
"I cannot tell you how restless and unhappy we felt," he said at a community event in Jalan Bukit Merah yesterday.
"We run a (healthcare) system where you have to co-pay … but you get the attention. There, no attention, just join the queue," he said grimly.
The first sign of trouble was that there was no private hospital with CT scan facility at night in London, he told residents and community leaders.
So, Mrs Lee had to go to the NHS hospital nearest to the Four Seasons Hotel where they were staying — a free facility called the Royal London Hospital — and join the queue.
"We waited 45 minutes for the ambulance for a 10-minute drive," said Mr Lee in his first public appearance since the couple returned on Friday.
"In Singapore, within half-an-hour, you would be in SGH (Singapore General Hospital), TTSH (Tan Tock Seng Hospital) … and within one-and-a-half to two hours flat, you'd know what went wrong."
When Mrs Lee reached The Royal London Hospital at 12.30am, it happened to have three cardiac arrest patients.
Mr Lee was told his wife's brain problem was "not as important" as the cardiac arrest cases, he recounted solemnly. She would have had to wait till 8am the next morning for her CT brain scan if 10 Downing Street had not intervened to get her early attention. High Commissioner Michael Teo had sought help from 10 Downing Street at 2am on Sunday and she received treatment at 3.30am on the night itself.
"Once upon a time, it was a wonderful hospital. But after 40 plus years … the system cannot deliver. There's no connection between those in the system and the patients," he said.
But it's the way free healthcare systems work, he added, noting that Singapore must not go down that path, even though there are calls for free C class wards in public hospitals here.
"It's how the system works … They did not discriminate against us," he noted of his London experience.
This contrasted sharply with how quickly Singaporeans — including national carrier Singapore Airlines — reacted to the situation.
Even though doctors initially advised that Mrs Lee stay put in London for three weeks, Mr Lee decided fly her back once her condition stabilised.
And then there was the big worry that she would get a spasm onboard, he recounted.
But he needn't have worried. Within 48 hours, SIA had fitted out SQ321 with medical support of oxygen tanks and other fixtures for a drip.
"No other airline would have done this," Mr Lee said, looking visibly touched.
On board were also two Intensive Care nurses from Changi General Hospital, two doctors, as well as officials from SIA who made sure all the equipment worked.
"Everyone knows his job," said Mr Lee. "Within 12 to 13 hours, we'd reached Changi Airport. It was a big relief," he said. "Twelve to 13 hours. Your heart stops beating sometimes. We landed at Changi Airport. Great relief. I had my granddaughter (Li Xiuqi) with me. She is very fond of her grandmother. She was so relieved."
Mrs Lee was whisked off in an ambulance to Singapore General Hospital, where she is recovering.
"I think this experience has changed my granddaughter's view of Singapore," Mr Lee said.
The overseas ordeal has made him even more assured that Singapore has what it takes to succeed, despite the downturn. "It's how we respond in an emergency that determines how we fight back. And I have enormous confidence that we can fight back."
The Singapore system — with its efficiency and fighting spirit — must be kept, he said.
"You slacken, you choose the easy way, and you'd be finished," he said.
Choking back tears, he added: "I have immense confidence that in an emergency, our people respond …If we can do that, we can succeed."
Tuesday, April 15, 2008
"Inefficient or too thorough?"
"Inefficient or too thorough?"
Tuesday • March 11, 2008 (Hosp reply is below)
Patient: Exhausted after 7 hours in clinic
I am writing about my experience at the KK Women's and Children's Hospital's 24-hour clinic.
I recently went there because of a lower abdominal pain and spent more than three hours in a waiting room with only two rows of seats. Some patients were forced to stand while waiting.
There were only two doctors on duty. I was surprised at the chaotic situation in the consultation room. I submitted some samples for laboratory testing. While I was still on the examination couch, an impatient nurse asked me to confirm my address on the specimen tube labels. Before I could do so, she concluded they were correct and took the tubes.
I was then asked to go for an ultrasound. The person performing the scan told me she was not supposed to answer my queries. I had to wait to be brought to the consultation room again, when I could have brought the report myself.
I had to wait one-and-a-half hours for the doctor to interpret the scan. I was tired after making several trips to different floors.
When I asked the doctor to clarify the report, he seemed impatient and left the impression that he wanted to dismiss me quickly. He also wanted to prescribe medication without waiting for the final laboratory report, which would have been available three days later. When I refused the prescription, he seemed dissatisfied.
I left the hospital after paying substantial medical fees and spending about seven hours there. Can the management clarify if this is a normal scenario at the clinic and how it intends to improve the situation.
Ho See Ling
------
Hospital: Didn't want to risk patient's health
I refer to Ho See Ling's letter on her wait at the KK Women's and Children's Hospital (KKH) and her feedback about our staff.
She came to KKH's 24-hour clinic on Feb 25 at about 10am and had an initial assessment of her condition by a nurse about 15 minutes later.
She was found to be stable with no medical emergency. She saw a specialist one-and-a-half hours later at about 12pm. She presented with symptoms of lower abdominal pain that was not explained by her earlier medical condition.
Although not a medical emergency, these symptoms could represent serious infection as well as diseases that could have severe longer-term consequences if they were not diagnosed and treated promptly. The diagnosis of this condition required a detailed ultrasound scan and other investigations, which were specially arranged on the same day to save her the inconvenience of having to return to the hospital on another day for the tests.
We wish to assure Ho See Ling that the doctor's diagnosis of her condition was not only accurate, as supported by the ultrasound scan and subsequent test results, but also his offer of prescriptions was precise. However, she declined the medications on the day of her visit. She was promptly recalled and collected her medication after the latter results confirmed the specialist's initial diagnosis.
With regard to service from staff, we would like to inform Ho See Ling that the sonographer who conducted her scan was not able to answer her queries on her condition as this can only be done by a doctor once a radiologist has reviewed the scans and written a report.
We hope she understands that some medical conditions may not be apparent at the onset and thus, a rigorous review by doctors is required to ensure the condition is properly diagnosed, and appropriate treatment is rendered.
This may take more time than patients expect. We also hope Ho See Ling will accept our apologies for any inconvenience she may have experienced during her visit, especially if staff have been perceived as impatient. KKH takes patient-care seriously and thus, we are vigilant about giving the best medical treatment possible. We are also constantly seeking new ways to enhance patients' comfort and convenience.
We take this opportunity to wish her a speedy recovery.
Assoc Prof Tay Eng Hseon
Chairman, Medical Board, KK Women's and Children's Hospital
Copyright MediaCorp Press Ltd. All rights reserved. http://www.todayonline.com/articles/242192.asp
Tuesday • March 11, 2008 (Hosp reply is below)
Patient: Exhausted after 7 hours in clinic
I am writing about my experience at the KK Women's and Children's Hospital's 24-hour clinic.
I recently went there because of a lower abdominal pain and spent more than three hours in a waiting room with only two rows of seats. Some patients were forced to stand while waiting.
There were only two doctors on duty. I was surprised at the chaotic situation in the consultation room. I submitted some samples for laboratory testing. While I was still on the examination couch, an impatient nurse asked me to confirm my address on the specimen tube labels. Before I could do so, she concluded they were correct and took the tubes.
I was then asked to go for an ultrasound. The person performing the scan told me she was not supposed to answer my queries. I had to wait to be brought to the consultation room again, when I could have brought the report myself.
I had to wait one-and-a-half hours for the doctor to interpret the scan. I was tired after making several trips to different floors.
When I asked the doctor to clarify the report, he seemed impatient and left the impression that he wanted to dismiss me quickly. He also wanted to prescribe medication without waiting for the final laboratory report, which would have been available three days later. When I refused the prescription, he seemed dissatisfied.
I left the hospital after paying substantial medical fees and spending about seven hours there. Can the management clarify if this is a normal scenario at the clinic and how it intends to improve the situation.
Ho See Ling
------
Hospital: Didn't want to risk patient's health
I refer to Ho See Ling's letter on her wait at the KK Women's and Children's Hospital (KKH) and her feedback about our staff.
She came to KKH's 24-hour clinic on Feb 25 at about 10am and had an initial assessment of her condition by a nurse about 15 minutes later.
She was found to be stable with no medical emergency. She saw a specialist one-and-a-half hours later at about 12pm. She presented with symptoms of lower abdominal pain that was not explained by her earlier medical condition.
Although not a medical emergency, these symptoms could represent serious infection as well as diseases that could have severe longer-term consequences if they were not diagnosed and treated promptly. The diagnosis of this condition required a detailed ultrasound scan and other investigations, which were specially arranged on the same day to save her the inconvenience of having to return to the hospital on another day for the tests.
We wish to assure Ho See Ling that the doctor's diagnosis of her condition was not only accurate, as supported by the ultrasound scan and subsequent test results, but also his offer of prescriptions was precise. However, she declined the medications on the day of her visit. She was promptly recalled and collected her medication after the latter results confirmed the specialist's initial diagnosis.
With regard to service from staff, we would like to inform Ho See Ling that the sonographer who conducted her scan was not able to answer her queries on her condition as this can only be done by a doctor once a radiologist has reviewed the scans and written a report.
We hope she understands that some medical conditions may not be apparent at the onset and thus, a rigorous review by doctors is required to ensure the condition is properly diagnosed, and appropriate treatment is rendered.
This may take more time than patients expect. We also hope Ho See Ling will accept our apologies for any inconvenience she may have experienced during her visit, especially if staff have been perceived as impatient. KKH takes patient-care seriously and thus, we are vigilant about giving the best medical treatment possible. We are also constantly seeking new ways to enhance patients' comfort and convenience.
We take this opportunity to wish her a speedy recovery.
Assoc Prof Tay Eng Hseon
Chairman, Medical Board, KK Women's and Children's Hospital
Copyright MediaCorp Press Ltd. All rights reserved. http://www.todayonline.com/articles/242192.asp
Warming up to better service
"Less satisfied, however, were those who ranked Singapore's two healthcare clusters, the National Healthcare Group and SingHealth, near the bottom of the overall list. For instance, in terms of polyclinic service, they scored 60.5 and 64.7 respectively. With the issue of long queues having repeatedly made the news... "
'Queue' Mar08, Dec07, older/ source
Warming up to better service
First nation-wide index on customer satisfaction here is a start
Tuesday • April 8, 2008
Alicia Wong: alicia@mediacorp.com.sg
YOU'VE heard or experienced it all, the good and the bad that service in Singapore has to offer. Now, here are credible statistics to back the anecdotes — and the numbers paint a picture of a somewhat satisfied customer.
Based on a new, comprehensive measure of customer contentment, the city of the smiling Singa scored a "healthy" 68.7 out of 100 on the national average satisfaction scale. Other developed countries scored in the 70s.
A first in Singapore, the Customer Satisfaction Index of Singapore (CSISG) — developed by the Institute of Service Excellence (Ises) and the Singapore Workforce Development Agency (WDA) — includes the views of both residents and tourists, on eight key economic sectors.
Of the individual entities that stood out, the national carrier took pride of place. Thanking its customers, a Singapore Airlines spokesperson told Today it had invested "substantial resources in training" its staff to keep customers happy and was "honoured to have topped the survey".
Less satisfied, however, were those who ranked Singapore's two healthcare clusters, the National Healthcare Group and SingHealth, near the bottom of the overall list. For instance, in terms of polyclinic service, they scored 60.5 and 64.7 respectively.
With the issue of long queues having repeatedly made the news, consumers like band instructor Goh Koon Chuan, 36, were not surprised polyclinics fared badly. "Their waiting times are long," he groused.
While the transportation and logistics sector was ranked third, one of its sub-sectors — public buses — scored a low 64.3. SBS Transit said: "We are of course disappointed that we did not do better and this will definitely spur us to do better."
Most consumers were not surprised at the sector rankings, especially with tourism coming in first. But market researcher Eugene Fok, 25, did not expect telecommunications to take bottom place, while housewife Ms Cynthia Sin, 47, felt the scoring for public buses was harsh. "I depend on public transport, and I think it is quite efficient," she said.
While Singapore's national average is healthy, there is some catching up to do, said Ises director Caroline Lim. South Korea and the United States, which use the same model, scored 72 and 75 respectively.
South Korea had scored 58.8 when it launched the index in 1998 but has moved "steadily upward" since, said Ms Lim, adding that Singapore can do likewise.
Interestingly, tourists gave higher scores than residents did. Most tourists came from Indonesia, China and Australia, said Ms Lim, and when they compare against their experiences at home, "they would rate Singapore higher".
That Singaporeans could have higher expectations was also a "possibility". Even so, only 6.3 per cent of respondents had complained to a company at least once in the last three or six months — compared with the US' 14 per cent.
This could be due to US consumers being more vocal, or there being more well-established feedback channels and a faster service-recovery culture in the US, said Ises, which comes under the Singapore Management University (SMU). The key to customer satisfaction, findings showed, depended on how well a company handled the complaint.
The CSISG is an international gold standard based on the American Customer Satisfaction Index, said Ises, which co-funded the $1-million survey with the WDA. Data was collected through face-to-face interviews with 10,229 households and 2,159 tourists between May 1 and July 23 last year. The survey took into account how customers' expectations and the quality of products or services affected their satisfaction.
Acting Minister for Manpower Gan Kim Yong said good service skills will become a critical asset and a competitive advantage for Singapore. "The CSISG is not just a barometer of customer satisfaction. It is a diagnostic tool that allows companies to understand, compare, improve and monitor their customer service over time," he said, challenging companies to score above 70 within three years.
The results will be posted at www.smu.edu.sg. Data collection for CSISG 2008 will begin in mid-year, and will expand to include other sub-sectors, such as insurance.
Copyright MediaCorp Press Ltd. All rights reserved.
http://www.todayonline.com/articles/247162.asp
2008 Press Release [7 April 2008]
ISES@SMU releases findings of Singapore's first national level customer satisfaction study
'Queue' Mar08, Dec07, older/ source
Warming up to better service
First nation-wide index on customer satisfaction here is a start
Tuesday • April 8, 2008
Alicia Wong: alicia@mediacorp.com.sg
YOU'VE heard or experienced it all, the good and the bad that service in Singapore has to offer. Now, here are credible statistics to back the anecdotes — and the numbers paint a picture of a somewhat satisfied customer.
Based on a new, comprehensive measure of customer contentment, the city of the smiling Singa scored a "healthy" 68.7 out of 100 on the national average satisfaction scale. Other developed countries scored in the 70s.
A first in Singapore, the Customer Satisfaction Index of Singapore (CSISG) — developed by the Institute of Service Excellence (Ises) and the Singapore Workforce Development Agency (WDA) — includes the views of both residents and tourists, on eight key economic sectors.
Of the individual entities that stood out, the national carrier took pride of place. Thanking its customers, a Singapore Airlines spokesperson told Today it had invested "substantial resources in training" its staff to keep customers happy and was "honoured to have topped the survey".
Less satisfied, however, were those who ranked Singapore's two healthcare clusters, the National Healthcare Group and SingHealth, near the bottom of the overall list. For instance, in terms of polyclinic service, they scored 60.5 and 64.7 respectively.
With the issue of long queues having repeatedly made the news, consumers like band instructor Goh Koon Chuan, 36, were not surprised polyclinics fared badly. "Their waiting times are long," he groused.
While the transportation and logistics sector was ranked third, one of its sub-sectors — public buses — scored a low 64.3. SBS Transit said: "We are of course disappointed that we did not do better and this will definitely spur us to do better."
Most consumers were not surprised at the sector rankings, especially with tourism coming in first. But market researcher Eugene Fok, 25, did not expect telecommunications to take bottom place, while housewife Ms Cynthia Sin, 47, felt the scoring for public buses was harsh. "I depend on public transport, and I think it is quite efficient," she said.
While Singapore's national average is healthy, there is some catching up to do, said Ises director Caroline Lim. South Korea and the United States, which use the same model, scored 72 and 75 respectively.
South Korea had scored 58.8 when it launched the index in 1998 but has moved "steadily upward" since, said Ms Lim, adding that Singapore can do likewise.
Interestingly, tourists gave higher scores than residents did. Most tourists came from Indonesia, China and Australia, said Ms Lim, and when they compare against their experiences at home, "they would rate Singapore higher".
That Singaporeans could have higher expectations was also a "possibility". Even so, only 6.3 per cent of respondents had complained to a company at least once in the last three or six months — compared with the US' 14 per cent.
This could be due to US consumers being more vocal, or there being more well-established feedback channels and a faster service-recovery culture in the US, said Ises, which comes under the Singapore Management University (SMU). The key to customer satisfaction, findings showed, depended on how well a company handled the complaint.
The CSISG is an international gold standard based on the American Customer Satisfaction Index, said Ises, which co-funded the $1-million survey with the WDA. Data was collected through face-to-face interviews with 10,229 households and 2,159 tourists between May 1 and July 23 last year. The survey took into account how customers' expectations and the quality of products or services affected their satisfaction.
Acting Minister for Manpower Gan Kim Yong said good service skills will become a critical asset and a competitive advantage for Singapore. "The CSISG is not just a barometer of customer satisfaction. It is a diagnostic tool that allows companies to understand, compare, improve and monitor their customer service over time," he said, challenging companies to score above 70 within three years.
The results will be posted at www.smu.edu.sg. Data collection for CSISG 2008 will begin in mid-year, and will expand to include other sub-sectors, such as insurance.
Copyright MediaCorp Press Ltd. All rights reserved.
http://www.todayonline.com/articles/247162.asp
2008 Press Release [7 April 2008]
ISES@SMU releases findings of Singapore's first national level customer satisfaction study
WHAT's HAPPENING TO MEDICINE?
"GPs face hard times with their high rentals and overheads and so some opt for aesthetics practice to supplement their medical practice ... six out of 10 doctors, according to a Straits Times report, choose aesthetics rather than their usual medical practice.., ... Which doctor would want to be involved in such healthcare programmes which give him $300 per Medisave account per year, compared to an aesthetics procedure that pays between $150 and $500 per visit?"
"polyclinics will then be even more overloaded..., ... One possible consideration is to let the patient carry his subsidy from the public to the private sector for the chronic disease programme."
Dr Tan is right: "Warming up to better service"
http://www.todayonline.com/articles/247162.asp (pictures)
Public hospitals need better queue system
WHAT's HAPPENING TO MEDICINE?
More stringency needed in managing aesthetics
Weekend • April 5, 2008
Dr Tan Cheng Bock
THE recent debate on aesthetics and medicine has prompted me to write this article.
I write out of concern for the future of medical practice, and how changing medical practices can affect our National Health Programmes and the management of infectious diseases in future.
I do not perform aesthetic procedures, I only practise medicine.
Aesthetics is a lifestyle industry, it is not medical practice. It does not heal but only enhances appearances. The practitioner of aesthetics is not treating sick patients but healthy individuals who want to change and improve their looks. Hence, we have procedures, for example, to remove fat and pimples and whiten the skin.
An aesthetics practitioner need not be a doctor or go through medical school. He relies on machines and creams to do the job.
However, there is a big demand for aesthetics because of the growing wealth and expectations to look slim and flawless. This big lifestyle industry, which has developed and spread rapidly in the region, is worth about $200 million.
Aesthetic practitioners used to be beauticians who conducted minor procedures. But with newer and more advanced equipment, the more complicated and difficult procedures were beyond them. Doctors were then roped in to assist in the complications.
However, doctors — both general practitioners (GPs) and specialists — were soon caught up in this wave and started providing such services to meet the demands. In doing so, they shifted their emphasis from healing the sick to undertaking this more lucrative practice where returns were very good.
GPs face hard times with their high rentals and overheads and so some opt for aesthetics practice to supplement their medical practice.
This is a worrying trend. If six out of 10 doctors, according to a Straits Times report, choose aesthetics rather than their usual medical practice, it begs the question: Why train such doctors who end up doing so little medical practice?
This will have an impact on the national healthcare programmes, such as the current chronic disease management of diabetes and high blood pressure.
Which doctor would want to be involved in such healthcare programmes which give him $300 per Medisave account per year, compared to an aesthetics procedure that pays between $150 and $500 per visit?
Moreover, since the Chronic Disease Management Programme requires doctors to follow a strict protocol of management before payment, my concern is that, in time, many GPs will opt out of the programme. The polyclinics will then be even more overloaded if GPs' participation rate is low.
Of greater concern is in the event of an acute infectious disease — such as bird flu or Sars — how are we going to get support from GPs involved in aesthetics care? They are likely to close their clinics to avoid the risks as they are not prepared to manage such a situation.
GPs giving up their medical practice is another likely scenario if the Government comes down too hard on these doctors, especially if they find that offering aesthetics procedures provides them with more than enough income to maintain their lifestyle without struggling with the daily medical practice which pays relatively very little.
I can see why some GPs give up their medical practice. But a doctor is trained to treat patients. What happened to the Hippocratic Oath they took?
All students enter medical school with a noble calling to serve their patients. But as the realities of life hit home when they start practising and have to cope with financial needs to meet the rising cost of living, many doctors will find their calling slowly eroded.
Life was much simpler for my generation of doctors who practise medicine. People were content to lead a lifestyle without a need to change the shape of their nose, have double eyelids or an implant to augment their physical assets.
But with affluence, patients no longer see doctors just as healers but also as practitioners who can improve their physical assets.
Doctors' attitudes also start to change; they now advertise their services, which was not allowed when I became a doctor. Worse, the Government started calling medicine an industry.
I remember protesting against this term "medical industry" because if medicine is an industry, then like any industry, a doctor is just a worker and has to conform to industry norm, working the stipulated hours.
That impinges on the Hippocratic Oath doctors take. The Oath becomes less binding because the "medical industry" shifts the emphasis from practising medicine to being just a worker in an industry. Moreover, the bottom line in an industry is making money while medicine's bottom line is caring for patients.
The Government calls medicine an industry because it wants to promote Singapore as a medical hub. But this drive is so over-emphasised that the cost of medical care has increased as every medical institution, private and public, has to meet the bottom line — an industrial norm especially for those listed on the Singapore Stock Exchange.
How do we manage the situation? We have two pressing issues to be on the lookout for.
One is the management of chronic diseases such as diabetes and hypertension. It is very important to involve the medical community, both private and public, because the debilitating end stage side-effects like stroke, blindness, kidney failure and amputations will deplete the patients' savings as institutional care in hospitals will be very expensive.
Two, if we are not sufficiently prepared, epidemics such as Sars will have serious consequences for the country.
In managing the current trend of aesthetics care, we need to consider:
1) The role of doctors in the aesthetics industry. Identify the procedures that GPs and specialists can or cannot do. Under the Medical Clinics & Hospital Act, which regulates what constitutes a medical clinic, can doctors conduct aesthetics in their clinics? Are doctors who do so complying with the regulations?
2) The role of operators of beauty spas and salons. What are the limits to their work procedures?
3) The role of doctors in our National Health Programmes as the emphasis of medical practice shifts. How can the Ministry of Health encourage GPs to stay on these programmes in the light of the aesthetics factor? One possible consideration is to let the patient carry his subsidy from the public to the private sector for the chronic disease programme.
The writer is a GP and former Member of Parliament.
Copyright MediaCorp Press Ltd. All rights reserved.
http://www.todayonline.com/articles/246707.asp
"polyclinics will then be even more overloaded..., ... One possible consideration is to let the patient carry his subsidy from the public to the private sector for the chronic disease programme."
Dr Tan is right: "Warming up to better service"
http://www.todayonline.com/articles/247162.asp (pictures)
Public hospitals need better queue system
WHAT's HAPPENING TO MEDICINE?
More stringency needed in managing aesthetics
Weekend • April 5, 2008
Dr Tan Cheng Bock
THE recent debate on aesthetics and medicine has prompted me to write this article.
I write out of concern for the future of medical practice, and how changing medical practices can affect our National Health Programmes and the management of infectious diseases in future.
I do not perform aesthetic procedures, I only practise medicine.
Aesthetics is a lifestyle industry, it is not medical practice. It does not heal but only enhances appearances. The practitioner of aesthetics is not treating sick patients but healthy individuals who want to change and improve their looks. Hence, we have procedures, for example, to remove fat and pimples and whiten the skin.
An aesthetics practitioner need not be a doctor or go through medical school. He relies on machines and creams to do the job.
However, there is a big demand for aesthetics because of the growing wealth and expectations to look slim and flawless. This big lifestyle industry, which has developed and spread rapidly in the region, is worth about $200 million.
Aesthetic practitioners used to be beauticians who conducted minor procedures. But with newer and more advanced equipment, the more complicated and difficult procedures were beyond them. Doctors were then roped in to assist in the complications.
However, doctors — both general practitioners (GPs) and specialists — were soon caught up in this wave and started providing such services to meet the demands. In doing so, they shifted their emphasis from healing the sick to undertaking this more lucrative practice where returns were very good.
GPs face hard times with their high rentals and overheads and so some opt for aesthetics practice to supplement their medical practice.
This is a worrying trend. If six out of 10 doctors, according to a Straits Times report, choose aesthetics rather than their usual medical practice, it begs the question: Why train such doctors who end up doing so little medical practice?
This will have an impact on the national healthcare programmes, such as the current chronic disease management of diabetes and high blood pressure.
Which doctor would want to be involved in such healthcare programmes which give him $300 per Medisave account per year, compared to an aesthetics procedure that pays between $150 and $500 per visit?
Moreover, since the Chronic Disease Management Programme requires doctors to follow a strict protocol of management before payment, my concern is that, in time, many GPs will opt out of the programme. The polyclinics will then be even more overloaded if GPs' participation rate is low.
Of greater concern is in the event of an acute infectious disease — such as bird flu or Sars — how are we going to get support from GPs involved in aesthetics care? They are likely to close their clinics to avoid the risks as they are not prepared to manage such a situation.
GPs giving up their medical practice is another likely scenario if the Government comes down too hard on these doctors, especially if they find that offering aesthetics procedures provides them with more than enough income to maintain their lifestyle without struggling with the daily medical practice which pays relatively very little.
I can see why some GPs give up their medical practice. But a doctor is trained to treat patients. What happened to the Hippocratic Oath they took?
All students enter medical school with a noble calling to serve their patients. But as the realities of life hit home when they start practising and have to cope with financial needs to meet the rising cost of living, many doctors will find their calling slowly eroded.
Life was much simpler for my generation of doctors who practise medicine. People were content to lead a lifestyle without a need to change the shape of their nose, have double eyelids or an implant to augment their physical assets.
But with affluence, patients no longer see doctors just as healers but also as practitioners who can improve their physical assets.
Doctors' attitudes also start to change; they now advertise their services, which was not allowed when I became a doctor. Worse, the Government started calling medicine an industry.
I remember protesting against this term "medical industry" because if medicine is an industry, then like any industry, a doctor is just a worker and has to conform to industry norm, working the stipulated hours.
That impinges on the Hippocratic Oath doctors take. The Oath becomes less binding because the "medical industry" shifts the emphasis from practising medicine to being just a worker in an industry. Moreover, the bottom line in an industry is making money while medicine's bottom line is caring for patients.
The Government calls medicine an industry because it wants to promote Singapore as a medical hub. But this drive is so over-emphasised that the cost of medical care has increased as every medical institution, private and public, has to meet the bottom line — an industrial norm especially for those listed on the Singapore Stock Exchange.
How do we manage the situation? We have two pressing issues to be on the lookout for.
One is the management of chronic diseases such as diabetes and hypertension. It is very important to involve the medical community, both private and public, because the debilitating end stage side-effects like stroke, blindness, kidney failure and amputations will deplete the patients' savings as institutional care in hospitals will be very expensive.
Two, if we are not sufficiently prepared, epidemics such as Sars will have serious consequences for the country.
In managing the current trend of aesthetics care, we need to consider:
1) The role of doctors in the aesthetics industry. Identify the procedures that GPs and specialists can or cannot do. Under the Medical Clinics & Hospital Act, which regulates what constitutes a medical clinic, can doctors conduct aesthetics in their clinics? Are doctors who do so complying with the regulations?
2) The role of operators of beauty spas and salons. What are the limits to their work procedures?
3) The role of doctors in our National Health Programmes as the emphasis of medical practice shifts. How can the Ministry of Health encourage GPs to stay on these programmes in the light of the aesthetics factor? One possible consideration is to let the patient carry his subsidy from the public to the private sector for the chronic disease programme.
The writer is a GP and former Member of Parliament.
Copyright MediaCorp Press Ltd. All rights reserved.
http://www.todayonline.com/articles/246707.asp
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