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

This bitter pill is why I won't work in Singapore

This bitter pill is why I won't work in Singapore
Friday • October 19, 2007
EMILY POH
I AM a Singaporean pharmacist trained and qualified in the United Kingdom, where I have been working for the last two years.
I have considered coming back but feel that the industry is not ready for me. Apart from a demoralising environment due to poor staff retention, there is also little recognition of the pharmacist's role as a drug expert.
The choice of medicine prescribed for a patient may be driven by the amount of incentives given to doctors by drug company representatives, instead of a guideline of what drugs are clinically proven to be efficient and cost-effective.
I have spent four years at university getting my degree and another doing my pre-registration year learning about clinical pharmacology, pharmaceutics and therapeutics. Yet I've noticed that Singaporeans would rather go to a doctor than a pharmacist for advice on their medications.
They feel they should get advice from the person who has written the prescription. But when they see a general practitioner (GP), they get their medications at the dispensary from someone who is not even a qualified dispenser. There is no one to pick up any drug interactions and dispensing errors at that point. Besides, the patient might be forgoing some professional advice regarding his/her medication.
How many patients have spent more than 15 minutes speaking to their pharmacists about their medication? Do the pharmacists even explain how the medicines work or suggest having their medicine use reviewed?
Being a pharmacist is not only about keeping the waiting time down. It is also about how to reduce drug-dispensing errors, picking up drug interaction as well as giving best advice about the medication and possible lifestyle changes to go with the treatment.
Most pharmacists are not given a chance to use their expertise. Most of the time — under pressure to keep down the long waiting times at clinics — the most they do is dispense the correct medication according to the prescription and not question it. They only have the time to tell you the dose and frequency of the medication to be taken — all of which is already printed on the label.
That is certainly not what pharmacy is all about. If that is the practice of pharmacy, it would be easier to get an accuracy-checking technician rather than a pharmacist. It would be far cheaper, too!
With the growing number of ageing Singaporeans, we have to look into problems with increasing drug interactions due to increasing aliments.
Furthermore, GPs, polyclinics and hospitals are not linked up properly to create a seamless access to the medical history of patients. As a result, some patients may end up in hospital due to polypharmacy, or taking too many different drugs.
The system is far from mature. The salary, other incentives and opportunities are just not attractive enough to woo me back to Singapore. It will take a long time for the pharmacist profession to be respected in the Republic. Copyright MediaCorp Press Ltd. All rights reserved. http://www.todayonline.com/articles/217509.asp

What makes these two tick?

KBW stressed, looses his Karma powers... His wavering in the means testing issue is showing... Will he resign soon?

But who wouldn't with an unsolved $2.03B p.a. 'economic albatross' around the govt's neck; LHL's parliament's moral weaknesses, Ng EH's policy of weak subsidising the strong, the continually increasing rich poor divide, the pressure of such prejudices will surely make any dignified Health Minister jump to his grave!

May his Karma be strong.

• "In Mr Khaw's case, his spirituality is often cited as a key to his success."
  
• "last November, Mr Khaw dropped hints of retiring as he recalled how entering politics was never his wish. He had said this might be his last term in the Health Ministry, a "very meaningful portfolio" from which he would like to retire from politics. ..."
  
  
  What makes these two tick?
  Weekend • October 20, 2007
  Christie Lohchristie@mediacorp.com.sg
  EVEN in a centralised, collegiate and behind-the-scenes style of leadership like Singapore's, a few individuals do stand out.
  They may not be seen as possessing the giant stature of past ministers such as Dr Goh Keng Swee and Mr S Rajaratnam — yet. But the qualities of an agent of change, helping to shape a nation's future, are already surfacing in a couple of today's ministers.
  One does it with his Zen-like nature; the other, with his business-like mien.
  Beyond these qualities, what is it that makes ministers Khaw Boon Wan and Tharman Shanmugaratnam tick?
  The two career civil servants were among the so-called "Super Seven" to have risen rapidly within the ranks — joining the Cabinet in August 2003, just two years after making their political debut in the 2001 general elections.
  Since then, the two names have become synonymous with the national agendas for health and education.
  Mr Khaw, 54, is a man fighting to keep medical costs low. Hence the online posting of charges by private and public hospitals to make it easier for patients to compare prices and choose the kind of treatment that best suits their pockets.
  Then, there's the ongoing reform of the 3Ms (Medisave, MediShield, Medifund) — aimed at ensuring that Singaporeans will have sufficient enforced savings for medical contingencies — an issue which Prime Minister Lee Hsien Loong once said Mr Khaw "lives and sleeps with every day".
  In education, Mr Shanmugaratnam, 49, has tackled areas that have long troubled parents and their children. Among the lauded efforts to make education less rote and less based on academic results are the scrapping of the 29-year-old system of primary school streaming and the introduction of more fun ways to learn the Chinese language.
  In short, what the two men set in motion concerns everyone from the cradle to the grave.
  "It is the importance of the ministry that defines the importance of the man," said political scientist Ho Khai Leong from the Nanyang Technological University (NTU).
  While health and education are big issues in any country, they have become major preoccupations in Singapore, where concerns over affordable health care for the elderly have grown in tandem with the ever-growing number of senior citizens; and where education is seen as the key to keeping Singapore a step ahead of competitors who are catching up faster than ever.
  But while the portfolios in themselves are high profile, the leaders put in charge have also certainly excelled in their jobs, observers said.
  "They answered the call," Assoc Prof Ho said of Mr Khaw and Mr Shanmugaratnam, who became Senior Ministers of State immediately after the 2001 elections. "They are meticulous, knowing the details of the issues."
  Such understanding is seen as closely linked to two things: The individual's mental agility and his pre-politics experience in policy-making.
  During Mr Khaw's 23 years as a civil servant, he spent 14 years in the Ministry of Health (MOH). There, he had conceived the idea of Medisave in 1983 when he was an administrative service officer working for then-Health Minister Goh Chok Tong, said a former colleague.
  After that, the high-flier went on from 1985 to 1992 to head three hospitals: National University Hospital, Kandang Kerbau Hospital (now known as KK Women's and Children's Hospital) and Singapore General Hospital.
  While the engineer-trained Colombo Plan scholar had never expected such a healthcare-centred career, the experience has certainly revealed his flexibility and given him the "intimate knowledge" necessary for him to "make things happen" as Health Minister, said an industry insider.
  The experience probably also played a big part in imparting the necessary confidence to act firmly as minister.
  Looking at his track record in MOH, it wouldn't be too much of an exaggeration to say that Mr Khaw had impressed Mr Goh enough to be invited to join the 2001 campaigning team of Singapore's second Prime Minister.
  For Mr Shanmugaratnam, his career at the Monetary Authority of Singapore (MAS) provided him with a similar opportunity to prove his mettle to another future Prime Minister, Mr Lee Hsien Loong.
  The MAS was where Mr Shanmugaratnam, a London School of Economics graduate, spent nearly his entire professional life, working as an economist. It was only from 1995 to 1997 that he hopped over to the Education Ministry as its Deputy Secretary (Policy).
  So, although he had not spent much time in education circles, Mr Shanmugaratnam was, like Mr Khaw, an old hand at crafting big plans for the nation.
  The chance to shine before one of the country's top men came in 1997 when Mr Shanmugaratnam returned to MAS at a higher position than before: Deputy managing director. It was from then that he had ample opportunities to work with and impress Mr Lee, who was Deputy Prime Minister at the time and concurrently appointed head of MAS in 1998.
  Mr Shanmugaratnam was later promoted to managing director and then invited to join the People's Action Party.
  Prof Ho believes Mr Shanmugaratnam's "professorial" quality is one reason why he has been an effective Education Minister — he is able to break down complex issues and policies such that the public understands him. It is a trait that Mr Khaw shares, Prof Ho said.
  Another of Mr Shanmugaratnam's strong points is the "ability to empathise with the anxieties, concerns and aspirations of the people", noted Mr Viswa Sadasivan, chief executive of public relations firm Strategic Moves.
  Such empathy may have something to do with the fact that this is one minister who knows what it is like to be on the wrong side of the law.
  In 1992, Mr Shanmugaratnam, an MAS economist at the time, came under intense public scrutiny when he was charged for breaching the Official Secrets Act. Because he had brought a confidential report — containing an advance estimate of Singapore's quarterly economic growth — into a meeting with journalists who went on to publish the figure ahead of its official release, the courts fined him $1,500 in 1994.
  "All these experiences have made him a well-rounded person," said Mr Viswa.
  In Mr Khaw's case, his spirituality is often cited as a key to his success.
  Several commentators have said before that the Buddhist never appears ruffled. He is always calm and, like Senior Minister Goh, is able to connect with people on a grassroots level.
  Mr Viswa puts it down to the Zen belief that people on the ground should be treated with fairness and dignity, thus lending Mr Khaw a certain "moral courage" to act.
  Perhaps, Mr Khaw's readiness to act — in terms of pushing for far-reaching changes in Singapore's health landscape — may also be related to his desire to retire from politics sooner, rather than later.
  In a Today interview last November, Mr Khaw dropped hints of retiring as he recalled how entering politics was never his wish.
  He had said this might be his last term in the Health Ministry, a "very meaningful portfolio" from which he would like to retire from politics.
  And for a minister, what can be more meaningful than to put in place reforms that would benefit the whole nation long after he is gone?
  No matter when he makes his exit, there is little doubt that Mr Khaw has left his mark in the ministry. Ditto for Mr Shanmugaratnam.
  But for all their outstanding performances, one thing should not be forgotten: That no minister, or his ministry, is an island.
  As Prime Minister Lee once said, his Cabinet is "a collegiate team", where ministers jointly work on issues, such as dengue or labour, which touch their portfolios.
  At the same time, those who oversee ministries that deal with more sensitive information, such as Home Affairs and Defence, may be less in the public eye, but they too are making big contributions behind the scenes, said political commentator Zulkifli Baharudin.
  The businessman and former Nominated Member of Parliament added : "The Singapore system emphasises less on personality."
  Except that of the Prime Minister.
  Said Assoc Prof Ho: "PM is the first among equals. He's the one making policy and the rest are overshadowed by his presence." Copyright MediaCorp Press Ltd. All rights reserved http://www.todayonline.com/articles/217671.asp

Why pharmacists resign ...

Now we know why...

Why pharmacists resign ...
Better work conditions, pay may help stem high turnover rate of these professionals
Friday • September 21, 2007
Letter from Darren Chong
I refer to the report, "MOH to recruit more pharmacists from overseas" (Sept 17). It was reported that of the 1,482 pharmacists on the register here, less than half are involved in direct patient care, such as practising in hospitals, polyclinics and retail pharmacies.
This is a worrying figure. While I applaud the ministry's efforts to recruit more pharmacists from overseas, it should also delve further into why pharmacists are not practising and find ways to stem the drain.
I know a pharmacist who has worked in a retail pharmacy and in one of the restructured hospitals. During her stint with the retail pharmacy, she worked from 10am to 10pm, with only half an hour's break for lunch and dinner. This included Saturdays and Sundays, when business is most brisk. Most times, she was the only pharmacist during that 12-hour stretch.
When she was working at a hospital, it was common to see her and her colleagues having lunch at 3pm, after they attended to the last patient from the morning crowd.
At times, she was called back to the hospital even though she was on leave. She worked till 3pm on Saturdays, even though the official knock-off time was 12.30pm. Sundays could become working days when duty called — working one Sunday per month is common.
Such is the life of a pharmacist, be it in hospitals, retail pharmacies or polyclinics.
Increasing demands on pharmacists without adequate compensation leads to many leaving the profession.
Perhaps it is time to review pharmacists' salaries. They are, after all, highly-trained medical professionals who run specialised clinics and make rounds with the doctors to ensure patients fully benefit from treatment.
Until we address the concerns of pharmacists and plug the outflow, increasing the number of pharmacists will not ease the crunch. Sourcing from foreign supply is but a short-term solution to a long-term problem.
http://www.todayonline.com/articles/212495.asp

Pharmacists urged to help keep drug costs low

Home > Latest News > Singapore
Oct 19, 2007
Pharmacists urged to help keep drug costs low
By Judith Tan
PHARMACISTS, with their knowledge and expertise in drugs, should act as the bridge between doctors and patients by offering cheaper but equally effective alternatives.
This, said the chairman of the Government Parliamentary Committee for Health, Madam Halimah Yacob, will help keep drug costs down.
She said drug use will increase with the ageing population, and more people will resort to self-treatment for minor ailments.
Pharmacists can play a role by helping to determine what medicines are needed, and what are not.
Speaking at the opening of the 19th Singapore Pharmacy Congress on Friday night, Madam Halimah said by doing this, medical bills will be cut and mistreatment or over-treatment can be avoided.
Citing the example of the drug used in treating high blood pressure, she said patients in a public hospital pay only 55 cents for a 60mg tablet of Nifedipine, compared to $1.63 a tablet for the original brand Adalat.
'This translates into a saving of $32.40 per patient per month - or $6.2 million in savings a year for patients in public sector institutions alone,' she noted.
According to the Pharmaceutical Society of Singapore, in 2006 alone, there were at least 100,000 documented interventions by pharmacists in public sector institutions.
These ranged from inappropriate dosage and duplication of therapy to advice on drug interactions.
This check and balance is critical in ensuring appropriate use of medicines.

http://www.straitstimes.com/Latest%2BNews/Singapore/STIStory_168516.html

Worst stroke possible but dad made to wait 6 hours

Aug 18, 2005
FULL HOUSE AT HOSPITALS
Worst stroke possible but dad made to wait 6 hours
I CAN empathise fully with Ms Rodziah Shaari ('Seven-hour wait at SGH for bed for sick dad'; ST, Aug 13).
I had similar encounters in Singapore General Hospital (SGH). My dad was sent to the A&E department three times in two months because of stroke and, each time, my family had to wait at least six hours before he was pushed to a ward.
I can understand that the hospital is short of staff and we have to wait for everything. But to make a patient wait hours for a bed is unforgiveable, especially when the patient is in critical condition.
The third time my dad was taken to SGH was also his last. When I drove him to SGH, he was already paralysed and could not speak. The A&E doctors were quick to attend to him because of the urgency of his condition.
They ordered an immediate scan to see how badly his brain had been affected by the stroke, after which he was left unattended in a corner to await the results.
I could see that my dad was getting weaker as time went by. About two to three hours later, when the results came out, the doctors confirmed that he had suffered a stroke again and had to be admitted.
It took another hour or two for the admission staff to tell us that my dad had to wait as no bed was available in the neurology ward.
When we checked on him in the observation area, he was in a serious state. He was having fits and barely conscious, and his mouth was foaming. No one attended to him.
It was only when we cried that a patient service officer quickly picked up my dad's file and called for someone to push him away.
When my dad finally got to the ward, it was past 2am. And we had arrived at the A&E department about 7pm; it took more than six hours before my dad was seen by a neurologist.
If my dad had been taken to the ward earlier and been treated by a neurologist, his chances of living might be higher.
The neurologist told us that my dad had the worst kind of stroke anyone could get. He also told my family to quickly consider having a special injection administered as his condition was deteriorating by the minute since the onset of stroke at 5.45pm at home.
We took no more than 10 minutes to reach a decision. And to think that six hours were wasted in the A&E department.
The image of my father lying there foaming and having seizures, with no one to attend to him, has been haunting me since. Sadly, he was pronounced brain dead the next day.
I appreciate the doctors in the A&E department for their sense of urgency, and the doctors in the neurology ward who tried their best to save my father.
But I did not detect the same sense of urgency in hospital staff who were at the front line, doing admission administration and ferrying of patients. I saw faces filled with weariness and reluctance rather than urgency and compassion.
I agree with Ms Rodziah that it seemed acceptable to the hospital for patients to wait hours for a bed - and specialised treatment and care. If Singapore wants to be a top-notch medical hub, how can we condone this kind of work attitude, and hours of waiting in the emergency department?
Tan Tze Yee (Ms)
http://forums.delphiforums.com/sammyboymod/messages?msg=80079.50