VOL. 49 NO. 1 january 2017 MCI (P) 034/01/2017. news

Transcription

1 VOL. 49 NO. 1 january 2017 MCI (P) 034/01/2017 news

2 3 PRIZES 1 LUCKY DRAW CHANCE SUBMIT YOUR NAME ONLINE BY 15 FEBRUARY 2017 AND STAND A CHANCE OF BRINGING HOME ONE OF THREE PRIZES! Nespresso Pixie Titan and Aeroccino Bundle with 150 capsules (worth $588) novita AirCare Pro Air/Surface Sterilizer NAS12000 (worth $1,899) TAG Heuer Connected Watch (worth $2,100) Thank you for your support and membership as we continue advocating for doctors, for patients in SMA Members can now pay your 2017 SMA membership fees online via PayPal or credit card through your membership portal*! All SMA Members in good standing, regardless of the mode of payment, can submit your name for the lucky draw at by 15 February If you are unsure of your eligibility for the lucky draw, log in to your membership portal to find out. Good luck! *Your Member ID for the membership portal at is the address you indicated upon your membership sign-up. You can reset your password at If you have any queries, please us at membership@sma.org.sg. Photos used are for illustrative purposes only

3 Vol. 49 No EDITORIAL BOARD Editor Dr Tan Yia Swam Deputy Editors Dr Tina Tan Dr Tan Tze Lee Editorial Advisors A/Prof Daniel Fung A/Prof Cuthbert Teo Dr Toh Han Chong Members Dr Chie Zhi Ying Dr Jayant V Iyer Dr Leong Choon Kit Dr Jipson Quah Dr Jonathan Tan Dr Jimmy Teo EX-OFFICIOS Dr Wong Tien Hua Dr Daniel Lee Hsien Chieh EDITORIAL OFFICE Senior Manager Sarah Lim Senior Executive Sylvia Thay Editorial Executive Jo-Ann Teo ADVERTISING AND PARTNERSHIP Li Li Loy Tel: (65) adv@sma.org.sg PUBLISHER Singapore Medical Association 2 College Road Level 2, Alumni Medical Centre Singapore Tel: (65) Fax: (65) news@sma.org.sg URL: UEN No.: S61SS0168E DESIGN AGENCY Oxygen Studio Designs Pte Ltd PRINTER Sun Rise Printing & Supplies Pte Ltd news Opinions expressed in SMA News reflect the views of the individual authors, and do not necessarily represent those of the editorial board of SMA News or the Singapore Medical Association (SMA), unless this is clearly specified. SMA does not, and cannot, accept any responsibility for the veracity, accuracy or completeness of any statement, opinion or advice contained in the text or advertisements published in SMA News. Advertisements of products and services that appear in SMA News do not imply endorsement for the products and services by SMA. All material appearing in SMA News may not be reproduced on any platform including electronic or in print, or transmitted by any means, in whole or in part, without the prior written permission of the Editor of SMA News. Requests for reproduction should be directed to the SMA News editorial office. Written permission must also be obtained before any part of SMA News is stored in any retrieval system of any nature. CONTENTS Editorial 04 The Editor s Musings Dr Tan Yia Swam Feature 05 Mobile Health in Chronic Disease Management Dr Yau Teng Yan President s Forum 07 FutureMed Experiencing Tomorrow s Medicine Today Dr Wong Tien Hua Council News 09 Highlights from the Honorary Secretary Dr Daniel Lee 10 AMS-CFPS-SMA Joint Opinion on Transactions with Managed Care or Third Party Administrators 11 WMA General Assembly Report Dr Bertha Woon 12 CMAAO Meeting Report Dr Chong Yeh Woei Event 14 Behold, a Rebellion Built on Hope Mellissa Ang 15 Launch of Singapore Medical Week by SMA and FutureMed 2017 Jo-Ann Teo Exec Series 16 Is Sir William Osler Really Dead? Dr Zubin Daruwalla 18 Handling Compromising Situations Dr Desmond Wai SMA Charity Fund 22 Reflection, Appreciation and Motivation: A Journey of Doing Good Jennifer Lee Opinion 24 Values That Work A/Prof Jason Yap GP Matters 26 Using Technology to Enhance Medical Practice Dr Choo Kay Wee Calendar 27 SMA Events Feb Apr 2017 From the Heart 28 The Diary of a Mountaineer Dr Foo Gen Lin Indulge 30 This Cold Heaven Dr Tan Su-Ming AIC Says 32 Your Easy Guide to Setting up a GP Practice Agency for Integrated Care CORRECTION On page 26 of the December 2016 issue, Quek Seng Lian and Tay Leng were omitted from the Members of Class of 1965, while Loke Khua Eu should have been listed under In Memoriam. This has been corrected in the online version. We apologise for the error.

4 editorial Who else remembers Minority Report (2002), where the lead (played by Tom Cruise) could view and zoom in on reports, and even get a 360-degree view of on-site events through gesturebased user interfaces? Or maybe the communicator pins and tablets featured in Star Trek: The Next Generation (1987)? The technologies displayed were only the stuff of imagination then; and yet, within just two decades, many of the devices are now here, available among the masses. Smartphones, fingerprint-recognition devices, voice-controlled lights, Facebook 360 videos, Pokémon Go; these are just a few examples of the elegant and brilliant technology that have made its way into our everyday life. We are also seeing more uses of technology coming into our field; some people embrace them while some are wary of them. SMA President Dr Wong Tien Hua paints a fantastical future in his column, mentioning current-day technology. He also emphasised that no matter how advanced technology gets, it is still essential for a doctor to connect with the patient, and for patients to take ownership of their own health. The feature article by Dr Yau Teng Yan is on the concept of mobile health, and he reviews some apps that help specifically in diabetes management. Dr Zubin Daruwalla writes on the importance of keeping our care patient-centric even as we embrace new technology, and Dr Choo Kay Wee summarises the pros and cons of using smartphone technology in his GP practice. Come August this year, SMA will be bringing you an exciting event Singapore Medical Week by SMA where different companies and players in technology within healthcare will be brought together. We hope that it will be a good platform for you to try out new gadgets and services, as well as to network. Dr Bertha Woon presents a short report on the World Medical Association General Assembly which was held in Taipei last October. There are two highlights that are especially relevant to our own healthcare system. Taiwan is utilising technology to allow better coordination of care for their patients, a concept similar to the local National Electronic Health Record. Meanwhile, Japan is focused on providing integrated care for the elderly and has set up a national taskforce comprising senior advisors, as well as younger doctors. They believe that the younger doctors would be more invested 20 to 30 years from now when they are in the prime of their career! Our regular contributor, Dr Desmond Wai, shares some of his personal good practice advice on dealing with certain difficult administrative and social situations. Finally, a team of Dr Tan Yia Swam is a consultant at the Breast Department of KK Women s and Children s Hospital. She continues to juggle the commitments of being a doctor, a mother, a wife and the increased duties of SMA News Editor. She also tries to keep time aside for herself and friends, both old and new. Yia Swam Editor orthopaedics doctors made a trip to the Everest Base Camp with Dr Foo Gen Lin in the lead. He reports on their journey, and reminds students and colleagues to never give up on dreams and aspirations. We wish you, readers and members, a good and fulfilling year ahead! 04 JAN 2017 SMA News

5 FEATURE Text by Dr Yau Teng Yan When I first entered medical school almost 15 years ago, no one had heard of the word smartphone. Our mobile phones (if we were lucky to own one) were clunky devices with a screen that was just useful enough to play Snake definitely not something you d call smart. In the same year I began my housemanship, the world s first iphone was launched. At that time, many people thought it d be a big flop it was way more expensive than other phones in the market (think Nokia and Blackberry). Plus, it didn t even have a keyboard! Fast forward to today more than 88% of adults in Singapore own a smartphone, according to a survey conducted this year. 1 In fact, Singapore has the highest smartphone penetration rate in Asia. It is thus inevitable that everyone will be using smartphones to guide our lives, from news to communication to social connections and health. Today, our patients consume and digest health information in ways that weren t available just a decade ago. The current health trend Mobile health (mhealth) is defined by the World Health Organization as the provision of health services and information via mobile technologies such as mobile phones. This lends itself to a compelling case for the use of mobile health in chronic disease management, where patient education and engagement is highly essential for good clinical outcomes. Let s take for example the case of diabetes. Globally, there are approximately 415 million people living with diabetes and the numbers are rising year after year. Singapore has the second-highest proportion of people with diabetes among developed nations, at 10.5% of people aged between 20 and 79 years, according to a report from the International Diabetes Federation. 2 An equally worrying trend is that, among Singapore patients, three in ten have diabetes before turning 40. It is clear that we have a big problem on our hands and it also suggests that the current way we practise healthcare may not be good enough. Diabetes is a very data-driven disease. Our patients need to make daily decisions around their food intake, their physical activity, how much insulin to inject, and many more. Their glucose levels are impacted by all these factors, including the less tangible ones like stress, mood and sleep. One of the promises of mhealth is that if we can capture all this data in a digital format, we will be able to layer on analytics that can provide a patient with personalised and actionable insights to better manage his/her condition. mhealth has the potential to encourage behaviour change by triggering patients to adopt new behaviours at the right time. For example, patients with diabetes often record their glucose readings in a paper logbook, which they bring to their doctor during their three- to six-monthly clinic reviews. If that information is synthesised and presented back to the patient in a timely manner, such as through reports or direct feedback, he/she would be able to take steps to correct it even before the clinic visit. Dr Yau Teng Yan is a digital health advocate and selfprofessed techie. He believes that one day, technology will finally fulfil its promise of making our lives as medical practitioners easier, so that we can spend more of our time on what matters most our patients. JAN 2017 SMA News 05

6 Apps in the market Here are a few apps that your patients with diabetes may be using: mysugr logbook ( com) is a popular app that allows patients to record all their diabetes data, including glucose, food, exercise, insulin and medications, in one place. It has a colourful and playful interface, in line with its goal of making diabetes suck less. They can set reminders, for example for a post-meal glucose check or to take medications. There are also daily challenges to complete, such as Vampire, where you get points for checking your glucose levels seven times within 24 hours. These features make it particularly appealing to those who use insulin as part of their diabetes treatment. GlycoLeap ( com) is a smart coach for people with prediabetes and type 2 diabetes. It supports them in developing better lifestyle habits to keep their glucose levels and weight in control. A unique feature is that patients get access to a real-life health coach through the app, who guides and motivates them to eat better and be more active. This is done via photo logging and text messaging. Patients also get access to interactive online diabetes selfmanagement lessons on nutrition, exercise, monitoring, medications and stress management. Last but not least, there is the Healthy 365 app ( sg/apps/25/healthy365) by the Health Promotion Board. While it is not an app specific for diabetes management, patients can use it to track their daily step count, food and drink intake, and calories consumed. It has a food database with over 1,000 local dishes and drinks. This app is used for the National Steps Challenge which incentivises patients to be active through rewards like vouchers based on their step counts. The downside There are several caveats to mhealth, of course. As it is a relatively new field, more scientific research needs to be conducted. There have been several pilot studies on mhealth interventions that are very encouraging. However, larger randomised controlled trials of longer durations are needed to establish the evidence for the safety, efficacy and cost-effectiveness of these tools. This allows us to separate the wheat from the chaff among the thousands of apps and programmes available, and use the tools that actually work. I believe this will happen with time. Also, most of the apps todays are in English and require basic knowledge of how to use a smartphone. Hence, they may not be useful for the elderly who are not tech-savvy and patients who do not speak English, are physically challenged, and/or with a lower socio-economic status. There are also some tricky issues that need to be worked through, such as who owns the health data: the patient or the software developer? Additionally, digital tools may be hacked by cyber attackers, which could result in inadvertent exposure of private health data. Conclusion mhealth can be a powerful tool in our arsenal as we strive to move upstream and keep our patients healthy and well. The next-generation doctor will be someone who is in touch with technology and is able to leverage on new tools in the right circumstances for the benefit of their patients. I ll end off with a quote from Dr Mike Evans, an associate professor of Family and Community Medicine at the University of Toronto: In the future, I ll prescribe you an app. One of our whiteboards will drop in and explain what high blood pressure is. The phone will be bluetoothed to the cap of your pills. I ll nudge you towards a low salt diet. All of these things will all happen in your phone. I see you two or three days a year. The phone sees you every day. References 1. We are Social. Special reports: digital in Available at: 2. International Diabetes Federation. IDF diabetes atlas 7th edition: across the globe. Available at: across-the-globe.html. Note a. Dr Yau Teng Yan guided the team in Singapore that created the GlycoLeap app. 06 JAN 2017 SMA News

7 FutureMed Experiencing Tomorrow s Medicine Today Text by Dr Wong Tien Hua president s forum Singapore Medical Week We launched the Singapore Medical Week by SMA and FutureMed 2017 at a reception on 3 November 2016 at The Star Loft, The Star Performing Arts Centre. Singapore Medical Week by SMA seeks to become the focal point for stakeholders in Singapore s healthcare industry, to facilitate critical discussions in vital topics of current importance, and to forecast future health trends, unique ideas and new innovations. In line with this, the 47th SMA Annual Medical Convention, which serves to provide timely insights into important health issues for both the medical fraternity and the public, will now be a key event during the inaugural Illustration: Dr Kevin Loy Singapore Medical Week by SMA, which is scheduled to occur in August The future of medicine Imagine a scenario ten years from today. It is the year 2027 and you wake up to the soothing voice of your digital alarm. She tells you that it is 7.30 am and that she has already activated the toast machine and coffee maker in the kitchen. You are reminded that you have a medical appointment later in the day, but you would not need to leave your office. Instead, you will be speaking to the doctor over a video call. You suffer from hypertension and hyperlipidaemia and you are on regular medication. The medication comes in a single pill that you take once a day, with the right amount of medication custom designed and compounded specifically based on your condition. The digital watch, or any wrist device for that matter, has long been out of fashion. Instead, a variety of embedded sensors some in your clothing and jewellery, some in your furniture, and others scattered around your home track your movement and statistics such as blood pressure, heart rate, body temperature, exercise, calorie consumption and hydration status, and these sensors are all seamlessly linked. If your body temperature goes up, the air conditioner is adjusted to be cooler. If your hydration level drops, the fridge automatically serves water. Medical data are collected, stored and presented in charts, giving you feedback on the daily averages. These medical data are transmitted to your healthcare provider. Your blood sugar is read through sensors in your contact lens that monitor the sugar level in your tears. The health of your blood vessels is monitored through 3D cardiac imaging. All these data are collected and, through the power of data analytics, you would know your personal risk of developing chronic disease in the future based on your age, gender and race. With these data, it is not necessary to visit the doctor for regular check-ups unless some unusual symptoms are present. Your insurance company wants to keep you as healthy as possible, and sends you regular reminders to keep fit and lead a healthy lifestyle, and you are incentivised to stay healthy JAN 2017 SMA News 07

8 because it translates to paying lower healthcare premiums. Some of these scenarios may sound familiar to you and some may sound quite futuristic. The reality is that all of these technologies are already available to us today. In a sense, the future of medicine is already here upon us. The question really is a matter of how we can assimilate new scientific discoveries with advancements in technology and the development of new medical products, and to integrate these various components of healthcare. Singapore is one of the fastest ageing societies in Asia. One in five residents in Singapore will be aged 65 years and older by the year 2030, 1 increasing the overall costs of healthcare and putting pressure on our healthcare resources. Technology can be deployed to reduce costs and improve productivity and patient outcomes. In particular, it can help to deliver a higher quality of patient care, shorten the time to deliver and receive care, and provide more choices for patients in the delivery of healthcare. Future trends What are some future trends that are in store? The first is a paradigm shift in mindset. We will move from a traditional medical model of medicine that focuses on disease treatment to a model of disease prevention, and ultimately, to disease prediction. Medicine today is reactive. Many of us think of healthcare only when we fall ill and we visit the doctor when we need a problem to be solved. This means that most of the time, we are reacting to an illness that has occurred. Some of us may go for regular health screenings, but again, we are only attempting to detect a disease after it has occurred. In the future, we will be able to provide patients with better and more sensitive diagnostic tools so that they can monitor their own health and detect disease even earlier. Technology will enable these tools to be used by the patients themselves, but in order to do this, patients will need to take ownership of and assume more responsibility over their personal healthcare. Healthcare literacy is about enabling patients to take control of their own health through education and mindset change. Shifting medicine from prevention to prediction will be possible with the help of big data, another important trend in medicine. We can use data that we collect to understand disease and how they affect large populations. We now have access to information on the impact of diseases in different social groups, cultures and regions, such that interventions can be designed and customised. Population health data has made it possible to come up with new ways to predict and tackle disease early. The Third Wave Steve Case, former chief executive officer of America Online, wrote about the Third Wave of the tech evolution in his recent book of the same title. The First Wave of the Internet was about building the infrastructure required for the network to connect and to convince the masses to go online. The Second Wave was about building on top of this momentum, with services such as online search engines (eg, Google), e-commerce (eg, Amazon) and social networking (eg, Facebook). It was also the era heralding the mobile smartphone, uprooting information from the desktop and planting them into the hands of millions of users. Steve Case believes that we are now poised for the Third Wave, when the Internet of things becomes the Internet of everything. This will be the era where ubiquitous connectivity allows companies to transform and disrupt established industries such as healthcare. Indeed, the healthcare industry is ripe for disruption it is huge, it affects everyone and it is slow in adapting to technology, thereby providing fertile ground for new ideas and experimentation. FutureMed The use of mobile technology and cloud storage means that data are integrated and can be shared between patients and healthcare providers. Wearables bring diagnostic tools into the realm of consumer electronics and the information that is collected communicates with mobile devices through apps. These data can contribute to medical records in a national electronic health database, translating to better efficiency, less wastage and, more importantly, to improved patient safety. It is thus apt that SMA's upcoming medical event is entitled FutureMed. It will be a platform to allow current developments in healthcare technology to be showcased, and the impact of future trends such as big data to be explored and discussed. FutureMed is envisioned to create a forum that will bring together developers of new technology and healthcare providers, who will either be the end users or the ones recommending them to patients. FutureMed is not about speculating what the future could be; it is about enabling us to experience the future of medicine today. References 1. Ministry of Health. Speech by Mr Gan Kim Yong, Minister for Health, at the SG50 Scientific Conference on Ageing, on 19 March 2015 [online]. Available at moh_web/home/pressroom/speeches_d/2015/ speech-by-mr-gan-kim-yong--minister-forhealth--at-the-sg50-scie.html. Dr Wong Tien Hua is President of the 57th SMA Council. He is a family medicine physician practising in Sengkang. Dr Wong has an interest in primary care, patient communication and medical ethics. 08 JAN 2017 SMA News

9 Highlights COUNCIL NEWS from the Honorary Secretary Report by Dr Daniel Lee Dr Daniel Lee Hsien Chieh (MBBS [S pore], GDFM [S pore], MPH [Harvard], FAMS) is Honorary Secretary of the 57th SMA Council. He is a public health specialist and Deputy Director of Clinical Services at Changi General Hospital. AMS-CFPS-SMA Joint Opinion on Transactions with Managed Care or Third Party Administrators On 13 December 2016, the Singapore Medical Council (SMC) issued an advisory on payment of fees to managed care companies, third party administrators (TPAs), insurance entities and patient referral services, to clarify Guideline H3(7) of the SMC Ethical Code and Ethical Guidelines (ECEG). SMC s advisory can be found at On 14 December 2016, the Academy of Medicine, Singapore (AMS); College of Family Physicians Singapore (CFPS) and SMA released a joint opinion (reproduced on the next page) on transactions with managed care companies and TPAs. The joint opinion also provided a possible way for our members to comply with the new ECEG. The three professional bodies subsequently wrote in to the Straits Times Forum to clarify that our joint opinion is complementary to SMC's advisory. The letter was published on 19 December 2016 in the Straits Times, and can be found at Feedback on HSA's proposed Regulatory Guidelines for Telehealth Devices SMA submitted feedback to the Health Sciences Authority (HSA) on 21 November 2016 regarding the proposed regulatory guidelines for telehealth devices. We highlighted concerns regarding confidentiality, integrity and accessibility of data transmitted from telehealth devices, and suggested referencing the Ministry of Health National Telemedicine Guidelines to ensure consistency of principles in guiding doctors clinical practice. Meeting with MPS on Medical Indemnity The SMA, AMS and CFPS met with officials from the Medical Protection Society (MPS) on 2 December 2016 to discuss various issues regarding medical indemnity. Prior to the meeting, MPS had published an FAQ on membership, subscriptions and other matters. This is available at Renewal of SMACF s IPC Status The Institutions of a Public Character (IPC) status for the SMA Charity Fund (SMACF) was successfully renewed for another two years, from 27 December 2016 to 26 December 2018 (both dates inclusive). SMA Members who donate to SMACF will continue to enjoy tax benefits according to prevailing tax rates. SMACF provides bursaries to needy medical students from all three medical schools, as one of its core programmes. Donations to SMACF can be made online at JAN 2017 SMA News 09

10 council news JOINT OPINION OF THE: ACADEMY OF MEDICINE, SINGAPORE (AMS) COLLEGE OF FAMILY PHYSICIANS SINGAPORE (CFPS) SINGAPORE MEDICAL ASSOCIATION (SMA) To members of the Medical Profession, TRANSACTIONS WITH MANAGED CARE / THIRD PARTY ADMINISTRATORS (TPAs) Guiding Principles 1. We refer to the Singapore Medical Council s Advisory On The Payment of Fees to Managed Care Companies, Third Party Administrators, Insurance Entities Or Patient Referral Services (Third Parties) dated 13 Dec The following sets out the collective opinion of AMS, CFPS and SMA on what may be considered acceptable standards when dealing with TPAs, in order for our members to comply with the ECEG. 3. First of all, the payment of administrative fees to TPAs is permissible so long as it is a genuine reflection of the services rendered to doctors rather than intended as a commission or fee-splitting or fee sharing. 4. The guiding principle is that doctors who pay TPAs fees must be prepared to justify, when questioned by the relevant authorities, why the fees paid reflect the administrative services being provided by the TPA, rather than constituting fee-splitting or paying of commission for the referral of patients. 5. Therefore, on grounds of prudence, we believe that administrative fees should, wherever possible, be based on a cost-plus methodology. The fees charged should include the costs incurred by the TPA for providing the services, plus a profit margin that is appropriate and not out of proportion to the costs of the services provided. 6. As the name Third Party Administrator implies, the main costs of a TPA relate to the administrative services it provides to facilitate the patient encounter. Hence it would not be ethical for a doctor to pay a TPA a fee based primarily on what the doctor charges, since the TPA s services may not bear any direct relation to the doctors eventual charges. 7. Under all circumstances, doctors should only work with TPAs that are prepared to be transparent with their fee structure, and are prepared to do the following: a) offer a breakdown of the TPA s fee to its major components to doctors and patients (i.e. itemised billing), when requested, as this will help to justify that the fee charged is based on a reasonable cost-plus methodology; and b) allow doctors to communicate to patients what are the approximate fees likely to be charged by the TPA at the end of the day. Guiding Principles for Fees based on Percentages 8. Our position is that TPA fees based on percentages of doctors fees is not the preferred way of charging as it may not reflect the actual work done by the TPA. 9. A fixed TPA fee structure which reflects the actual work in handling and processing the patients is ideal, preferable and in line with the ECEG. Having a fixed fee structure that is multi-tiered to cater to different scenarios or putting a cap on fees chargeable may also be useful to allay suspicions of fee-splitting. 10. Nonetheless, we acknowledge that a percentage TPA fee structure may provide a level of administrative convenience, and in very specific and limited circumstances might not be in breach of the ECEG so long as the way in which the percentage fee structure was derived is specifically based on a genuine estimate of the services being provided by the TPA. Thus, if the following very specific caveats/conditions are satisfied: a) The TPA fee represents a small percentage of the doctor s fee; and b) The doctor's practice is such that the vast majority (e.g. >80%) of bill sizes fall within a narrow range; a TPA fee that is based on a percentage of the doctor s fees may well be permissible. Yours sincerely, Dr Selan Sayampanathan Master Academy of Medicine, Singapore A/Prof Lee Kheng Hock President College of Family Physicians Singapore Dr Wong Tien Hua President Singapore Medical Association 10 JAN 2017 SMA News

11 1 COUNCIL NEWS WMA General Assembly Report Text by Dr Bertha Woon The World Medical Association (WMA) General Assembly took place in Taipei, Taiwan, between 19 and 22 October Our wonderful hosts, the doctors of the Taiwan Medical Association, organised a very efficient and tightly run meeting. Dr Wong Tien Hua, President of SMA, and all three SMA Council members who were in attendance, are alumni of the WMA Physicians Leadership Course programme. This WMA meeting was notable because the incoming President of the WMA, Dr Ketan Desai of India, and the President Elect, Dr Yokokura Yoshitake of Japan, are both from Asia. The theme for the Scientific Session this year was Healthcare System Sustainability, which is very pertinent to the situation in many countries. The WMA also issued the Taipei Declaration on Ethical Considerations regarding Health Databases and Biobanks. Two highlights of the scientific session that are of interest to Singaporeans were: 1. An overview of Taiwan s Roadmap for Better Healthcare by their Minister of Health and Welfare, Dr Tzou-Yien Lin, with the emphasis on long-term care planning 2.0 to integrate and finance home care 2 services; day care and community rehabilitative services; long-term care management systems; and acute and subacute care facilities with integrated transport services to bring patients, especially the elderly, to all these facilities. Another system, live since July 2013, was their PharmaCloud, a pharmaceutical records database that allows authorised medical practitioners to view real-time medication records with their patient s consent. 2. Sustainability of healthcare in ageing societies: The future of Japan s health system, delivered by Prof Dr Kenji Shibuya, Chair of the Department of Global Health Policy, Graduates School of Medicine, University of Tokyo. a. His Health Care 2035 Advisory Panel comprised i. members who would be in the elderly age bracket in 2035; ii. members of parliament and bureaucrats who know how to run the country; and iii. people from diverse expertise and backgrounds (eg, public and private sector, men and women), so that the long-term plan can be as comprehensive as possible. b. The two key questions posed were: i. How can we improve both quality and productivity given the increasing and diverse demands and limited resources? ii. How can we realise a health system that focuses on the care (not necessarily cure) and quality of death/dignity one wants? c. Their solution was to break away from the patchwork style of health policy-making and embrace comprehensive reform building to transform healthcare into a social system that engages all sectors through shared vision and values, instead of maintaining the status quo through basic cost share increases and benefit cuts. The overall plan of lean healthcare and life design while being a global health leader can be found in The Lancet (December 12, 2015). Dr Bertha Woon is a fulltime general and breast surgeon at her own practice, Bertha Woon General and Breast Surgery, at Gleneagles Medical Centre. She is an advocate and solicitor of the Supreme Court of Singapore, an associate mediator at the Singapore Mediation Centre, and one of the four Associates of the Medical Protection Society in Singapore. Legend 1. Writing well-wishes on traditional sky lanterns (from left to right): Sir Michael Marmot, Prof Wu Yung-Tung, Dr Chiu Tai-Yuan and Dr Ketan Desai 2. International medical associations representatives posing for a photo (from left to right): Dr Wang Pi-Sheng, Prof Wu Yung-Tung, Sir Michael Marmot, Dr Ardis Hoven, Dr Chiu Tai-Yuan and Dr Ketan Desai JAN 2017 SMA News 11

12 council news CMAAO Meeting Report Text by Dr Chong Yeh Woei Dr Chong Yeh Woei was SMA President from 2009 to 2012 and is a member of the 57th SMA Council. He has been in private practice since 1993 and has seen his fair share of the human condition. He pines for a good pinot noir, loves the FT Weekend and of course, wishes for world peace Legend 1. Bridge over River Kwai 2. Dr Chong Yeh Woei with Sir Michael Marmot When I attended the Confederation of Medical Associations in Asia and Oceania (CMAAO) meeting in Kanchanaburi, Thailand, last September, I was instantly transported back to my army training in the late 80s. I was then attached to the School of Combat Engineers as a medical officer and was sent by my commanding officer to be the battalion medical officer for a combat engineer battalion exercise. I remember boarding the chartered Airbus on the Paya Lebar Air Base tarmac with my battalion and landing at Kamphaeng Saen military airport in Nakhom Pathom. I recall a bone-jarring three-hour ride in a Land Rover from the airport to the army base. This time, the journey was very different with a chauffeurdriven SUV on the new highway from the Suvarnabhumi Airport to Kanchanaburi. For those who have no idea of the claim to fame of this farflung province of Thailand near the Myanmar-Thailand border, it is home to the notorious Death Railway. The meeting begins At the meeting itself, we were privileged to have the guest speaker, Sir Michael Marmot, deliver the Takemi Oration. The oration was named after the long serving president of the Japan Medical Association and visionary Dr Taro Takemi, who also has a programme named after him at the Harvard School of Public Health. Sir Marmot is a champion of social determinants of health. He is well known for being the leader of the second Whitehall Study conducted between 1985 and The first Whitehall Study launched in 1967 established the difference in cardiac risk for those in lower pay grades versus those in higher pay grades. Men in the lower pay grades (eg, messengers and doormen) had three times higher mortality than men in higher pay grades (eg, administrators). The second study had a cohort of men and women, and the study looked at the relationship between job grades 12 JAN 2017 SMA News

13 1 and prevalence of angina, ECG evidence of ischemia and symptoms of chronic bronchitis. Sir Marmot s oration highlighted the inequalities of money, power and resources that tend to breed conflict, which in turn tends to increase political, economic and social insecurity. These themes resounded with all of us as we are faced with the backlash from recent events such as the US election, Brexit, and nearer to home the rise of xenophobia, and extreme right- and left-wing movements in neighbouring countries. The printing of trillions of dollars in the post Lehman era has certainly not helped with inequality spiralling in many countries. Updates from the associations One of the important aspects of the CMAAO meeting is where member 2 countries share their perspectives on the various problems they face. Australia told us how their GPs are facing cuts in their incomes due to a freeze of inflation indices on their Medicare funding over the last few years. This is despite the fact that GPs continue to provide great value to the health system in terms of good outcomes. India wrestles with its imbalance of genders due to ultrasound sex determination. Bangladesh and Nepal told us about assault on doctors, and Japan informed us of their efforts in the recent Kumamoto earthquakes, while Nepal faced similar issues with earthquakes in Korea shared that conglomerates are lobbying the government to gain more access to the healthcare system via the legalisation of telemedicine. Malaysia continues to struggle with the oversupply of medical students amid the proliferation of medical schools. Myanmar told us how rapid democratisation in their country has led to higher expectations and demands on their healthcare system. However, medical defence protection is non-existent and there is also a shortage of healthcare professionals in remote regions. Thailand continues to struggle with its universal healthcare rolled out in The effect on massive surge of healthcare usage has led to funding issues and the resignation of rural doctors and nurses. After two intense days of meetings, presentations, discussions and hammering out a resolution, we finally took our leave and headed to Bangkok by car. Along the way, we stopped by the infamous Bridge over River Kwai. When I was there some 36 years ago as a young medical officer, I was taken by how surreal it was visiting the bridge with its calm and peaceful quiet in the bright sunshine, juxtaposed with the knowledge that inhumane atrocities had taken place in this picturesque setting. Back then, there was no one at the bridge save for the few of us who visited to pay our respects to a sombre yet iconic site. Today, a tourist town has virtually sprung up in and around the bridge with several hundred tourists clambering all over the bridge. This, coupled with fleets of tourist buses, multitudes of stalls hawking all manner of souvenirs, blaring Thai pop music and loud horns as traffic snarls, overwhelms the obviously inadequate road infrastructure. In short, we have learnt a lot about the various national medical associations predicaments and challenges; we have renewed our old ties and made new friends. I have also had a throwback to three decades ago and saw major improvements in the lives of the people in this distant outpost of the Kingdom of Thailand. As I return home to Singapore, I am yet reminded of the inequalities that exist between the provincial regions and the capital city of Thailand; the inequalities that contrast between us and our neighbouring countries; and even in Singapore, the inequalities between the different strata in our own society. JAN 2017 SMA News 13

14 Event Behold, a Rebellion Built on Hope Text by Mellissa Ang, Assistant Manager, Membership Services The Force was with SMA, and the Association was one with the Force on 15 December It's not what you're thinking though. We're not referring to the emergence of storm troopers, rebels or other warriors from the intergalactic world at 2 College Road. The Force was strong with the Association last month at Golden Village Great World City instead, as SMA Members enjoyed subsidised tickets to the premiere screening of Rogue One: A Star Wars Story as part of the fourth edition of our annual SMA Members Appreciation Nite. The Association also hosted our committee members and volunteers, in appreciation of their time and dedication to the work of SMA over the past year. Online registration for tickets to the SMA Members Appreciation Nite 2016 started in September 2016, as soon as we secured a cinema theatre for the premiere screening of this latest Star Wars movie. Within a few days after registration commenced, all 507 tickets to the premiere screening of, what was arguably the blockbuster of the year, were snapped up. On the day of the event, the level of enthusiasm among our members and guests was at an all-time high. As early as 5 pm, a ticket collection queue had already formed! Despite the overcrowded reception area due to two other events held concurrently, the queue swiftly dispersed, thanks to our cooperative members and guests as well as staff of the SMA Secretariat, who handed out those highly vied tickets in a timely and efficient fashion. After collecting their complimentary popcorn and drink combo sets, guests began entering the cinema hall at 6.40 pm. Excited chatter filled the spacious theatre as SMA Members and guests caught up with old friends. When the iconic Star Wars introduction appeared on screen, waves of applause and cheers broke out in the dark, with everyone highly anticipating what was to come. [Spoiler alert] As the movie wrapped up, loud gasps were heard from the surprised moviegoers when they found themselves face to face with none other than the young Princess Leia, who declared after receiving the Death Star plans that she had been handed HOPE!, sparking yet another round of cheers from the appreciative audience. Indeed, a rebellion built on hope had arisen out of the ashes! To our supportive members and dedicated committee members who helped make 2016 a great year for SMA, we say a big thank you! May the Force (continue to) be with you in 2017! SMA Members, committee members and guests collecting their tickets in anticipation of the latest Star Wars movie 14 JAN 2017 SMA News

15 Launch of Singapore Event Medical Week by SMA & FUTUREMED 2017 Text by Jo-Ann Teo, Editorial Executive Professionals in the healthcare industry will converge at the Singapore Medical Week by SMA and FutureMed 2017 this August, held at the Marina Bay Sands Expo and Convention Centre, Singapore. The inaugural trade event and conference aims to bring together market leaders and professionals for three days of networking and targeted showcasing of the latest trends and market developments in the medical industry. To officially launch the Singapore Medical Week by SMA and FutureMed 2017, a cocktail reception was organised at The Star Loft, The Star Performing Arts Centre, on 3 November The reception brought together close to 80 guests from various stakeholder companies and associations. After all our guests were seated, SMA President Dr Wong Tien Hua took to the stage to give his welcome address. He warmly welcomed everyone to the event and thanked all for their presence and support. He then asked the audience to imagine life in the year 2027: waking up to seamlessly linked wearables and data-driven gadgets taking charge of each one s health and medical habits in the most futuristic ways imaginable. Dr Wong highlighted that these technologies are in fact already available to us today and that the future of medicine is now. Following which, A/Prof Nigel Tan, Organising Chairman of the Singapore Medical Week by SMA and FutureMed 2017, shared with us that Singapore Medical Week by SMA aims to offer a comprehensive platform where medicine and technology meet for all in the medical profession and community. He also added that the FutureMed conference is set to be a global medical expo that caters to the professional needs of healthcare providers and industry players. The keynote speaker for FutureMed 2017, Dr Ogan Gurel, was then invited to address the audience. Dr Gurel is the founder and chief executive officer of NovumWaves, a company that seeks to advance and bring to reality terahertz innovation, and a visiting professor at the Samsung Advanced Institute of Health Sciences and Technology. He brings with him a wealth of expertise in medical devices, digital/mobile health, healthcare information technology, medical imaging and biopharma, and research experience in structural biology and terahertz medicine. He also teaches extensively on cellular and molecular biology, as well as neuroanatomy, bioinformatics and mathematical modelling. Dr Gurel shared with the audience his knowledge of terahertz technology and how technological 2 1 advancement can greatly impact the future of medicine. He also shared that given Singapore s diversity and high level of medical expertise, innovation and technology, we can play an impactful role in global medicine. Ms Jenny Lim from Conference & Exhibition Management Services Pte Ltd then took to the stage to brief the audience on the details of Singapore Medical Week by SMA and FutureMed 2017 events, including exclusive sponsorship opportunities that are available for grabs. She then thanked the audience for their attendance and announced the commencement of the buffet dinner reception. During the dinner reception, attendees mingled and networked with one another, exchanging ideas and gaining insights into the latest trends and developments in the medical industry. Preparation for Singapore Medical Week by SMA and FutureMed 2017 is in full swing and SMA hopes that all will give us their full support as we work together to enhance the future of medicine. Legend 1. Dr Ogan Gurel 2. Dr Wong Tien Hua addressing the audience JAN 2017 SMA News 15

16 Exec Series In 1889, Sir William Osler regularly led medical students in large groups along the winding spiral staircase of Johns Hopkins, known as the rotunda, rounding on patients at each floor. 1,2 The students would watch carefully as Osler examined each patient, listening to his every word and watching his every action. This is what many believe was the birth of what we know today as grand rounds where teaching through clinical experience became a cornerstone of medical education. Grand rounds today, while often include bedside teaching, also include lectures and/or round-table forums with or without real life clinical case discussions where visiting professors present cutting-edge research and brief case histories over PowerPoint. 2 In the coming years, it is not unlikely that virtual reality headsets will be given to medical students and trainees to simulate the real deal. Reading this, did you notice that the physicallypresent patient is disappearing in many of the present and future scenarios? It is as if Osler had a premonition. In his own words: He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. Let me pose another question to you. How many times did you look up from your computer screen, tablet or mobile device to speak to any of your patients during your consultations today? Just some food for thought: research has found that point-of-care systems increase documentation time by 17.5% and reduce face time with patients. 3? ISSir William Osler Really Dead Text by Dr Zubin Daruwalla At the same time, however, implementation of technology into daily medical practice has tremendous potential to improve workflow across multiple care settings, increase efficiency and productivity, and reduce costs. Technological innovations can help ease the pressure on health systems that stem from the ever-increasing disease burden and rising cost of healthcare. The burden of maintaining what I call the 3As (affordable, accessible and A+ quality care) is indeed a substantial one, with technological solutions being very appealing. And why not? Technology often allows care provision to be cheaper, easier, more convenient, and yet still ensures quality. However, we clinicians must become increasingly aware of how it can also be a doubleedged sword. While we focus on using technology to facilitate education, training and delivery of care, we risk alienating doctors from patients. The patient has always been and must always remain at the heart of compassionate and empathic care in the traditional practice of medicine. Socratic dialogue encouraged thinking and learning beyond a binge and purge approach. 4 In the present endeavours for highvalue, low-cost care, current approaches to technology are threatening to replace good medical practice. This has caused wariness among more senior clinicians when technology-driven solutions are being implemented in practice. For example, many healthcare professionals have been voicing their concerns over documentation time, and resisting the adoption of Electronic Health Record (EHR) or Electronic Medical Record (EMR) systems. Only 4% of ambulatory physicians in the US are reported to have a full-service EMR in place, while only 13% have a basic EMR. 5 This is in stark contrast to our local healthcare system, where almost all hospitals in Singapore are at around level 6, with Ng Teng Fong General Hospital recently becoming the first in Singapore and ASEAN to achieve level 7, of the Healthcare Information and Management Systems Society Analytics Electronic Medical Record Adoption Model. 6 Prof Abraham Varghese, physicianauthor at Stanford University School of Medicine, coined the term ipatient to describe how the influx of technology in medical practice today is increasingly distancing and isolating the patient from the medical doctor. It epitomises my concern as well as that shared by many other clinicians today: a concern that healthcare professionals are becoming increasingly remote and distant from their patients, whom they view as the product of countless investigations as opposed to fellow human beings. Is the digital era heralding the demise of the art of medicine? How do we stop our young colleagues today from allowing their patients to become ipatients? The way forward We should be proponents of ensuring that technology complements, instead Dr Zubin J Daruwalla is a director in PwC South East Asia Consulting and leads the healthcare consulting team in the region, while remaining a practising clinician with an interest in orthopaedics, as well as an advisor to a number of startups. A healthcare thought leader and strong believer in collaboration, Zubin hopes to bridge the gap between the clinical and corporate sides of healthcare. 16 JAN 2017 SMA News

17 of replaces, medical practice. Allowing technology to integrate into our clinical practice culminates in a holistic systems approach to care so that we can achieve the 3As. While technology is evolving at an exponential rate, we need not scale back or shun its adoption. Instead, we must embrace it by applying it appropriately to our patients needs with the aim of treating the patient and not just the disease. In an excellent example of appropriate integration, artificial intelligence and automation in radiology and pathology have begun to be regarded as complements rather than replacements. 7 While implementation will automate several processes and improve detection capabilities, the medical professional will have more time to communicate the result to the patient and ensure that the doctor-patient relationship remains intact. 7 As far as technology goes, the human-only traits of compassion and empathy, which are crucial to healing our patients, can and must only come from us. From a clinical perspective Medical education will play a crucial role in preparing our medical students of today (our doctors of tomorrow) cope in this fast-evolving environment and effectively integrate technology into their practice. There is a growing concern over medical students spending more time in front of monitors, diving into EMRs which are their gateway to consultative teams, the laboratory, radiology and pharmacy. While it allows them to quickly understand their patients cases, it is only supposed to serve them and support their decisionmaking process. Unfortunately, they 1 Image: are found spending most of their time analysing the data in the EMR, treating these records and ipatients as their real patients. If these ipatient interactions dominate, will medical simulations, virtual reality and data analytics aimed at better preparing future doctors to practise safe, quality and timely care delivery, ensure the same in reality? In an attempt to combat this trend, new pillars of medical education have arisen in many medical school curriculums worldwide, 8,9 particularly in the development of communication and soft skills to strengthen the doctorpatient relationship. Holistically treating patients often goes beyond just the clinical aspect. The elderly, for example, often come not only to seek treatment for their ailments, but also to feel included, cared for and be consoled. I will never forget the gleam in the eyes of my elderly patients in Ireland, whom I used to follow up with after a hip fracture, at the end of the consultation. Men and women alike would be dressed in their best. The women are often made-up, accompanying or being accompanied Legend 1. Pictorial depiction of technology as a double edged sword by their loving husbands. There was a gleam evident on them when I gave them a warm goodbye handshake and told them I would see them in a year's time. To which they would either reply, Yes, dear or Yes, young man. See you then. Thank you, doctor. If nothing else, these interactions gave hope. In our fast-paced clinics today with pressure on high throughputs and ensuring all follow ups are necessary follow-ups, we must remember this hope and the holistic role we should play for our patients. More recently, I am happy to say that emphasis is being placed on helping our future doctors empathise with their patients. 9 As my late father and orthopaedic surgeon, Prof Jimmy S Daruwalla, once remarked: In my humble opinion, the aim of education should be to teach us how to think rather than what to think. Compassion and empathy make for better doctors they heal, not just cure. As doctors, we must uphold this humanistic tradition, even in the midst of the forces evolving the healthcare environment today. In the words of Hippocrates, First, do no harm. References 1. Johns Hopkins Medicine. Johns Hopkins medical grand rounds. Available at 2. Sandal S, Iannuzzi MC, Knohl SJ. Can we make grand rounds grand again? J Grad Med Educ 2013; 5(4): Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12(5): Oyler DR, Romanelli F. The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking. Am J Pharm Educ 2014; 78(7): DesRoches, CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care a national survey of physicians. N Engl J Med 2008; 359(1): Integrated Health Information Systems. Ng Teng Fong General Hospital becomes first in Singapore and ASEAN to achieve HIMSS Analytics EMRAM Stage 7 award. Available at ASEAN_to_Achieve_HIMSS_Analytics_Stage_7.aspx. 7. Jha S, Topol EJ. Adapting to artificial intelligence: radiologists and pathologists as information specialists. JAMA 2016; doi: /jama Ruyssers N. A new curriculum based on four pillars. GMS Z Med Ausbild 2010; 27(2):Doc 17. doi: /zma Smith TM. American Medical Association. New textbook is first to teach third pillar of medical education. Available at new-textbook-first-teach-third-pillar-medical-education. JAN 2017 SMA News 17

18 Exec Series Handling Compromising Situations Text by Dr Desmond Wai In private practice, I often find myself and my staff entangled in difficult situations and sometimes, our ethical tolerance may be tested. I wish to share some of these situations and perhaps we could all learn a thing or two. Common compromising situations Re-dating receipts A patient once called my clinic staff asking for a change of date on the receipt, from the 28th of that month to the first day of the following month. He asked for the amendment as his company has a monthly limit for medical claims and he had exceeded the amount for that month. My staff checked with me and I was shocked to hear such a request. According to the Inland Revenue Authority of Singapore (IRAS), receipts are legal tax documents and should not be amended once they have been issued. This is especially so as our company is GST-registered and cancelling a receipt without a valid reason may be viewed by IRAS as tax evasion. Backdating referral letters An old patient called me on the phone, asking me to write a referral letter for her to see another specialist. I thought the request was reasonable, but the problem is that she had already seen the specialist on her own. However, for her to claim the medical expenses from her company s insurer, she must have a referral letter. To her disappointment, I declined her request as I did not feel comfortable backdating things. Issuing multiple receipt copies Some patients call to ask for reprints of receipts from their last visits, claiming that they had lost the originals. This is a legitimate request and we often oblige. 18 JAN 2017 SMA News

19 However, when I discussed this issue with my accountant, I was advised to put a stamp that says DUPLICATE on all reprints. This is because some patients may use the receipts to claim compensation from multiple sources, such as their personal insurance and company insurance companies. It is safer and more proper for all reprints to be indicated as duplicates, as most insurance companies would demand original receipts for claim applications. To my surprise, this new policy upset some patients, who insisted that we reprint original receipts upon their request. Writing up multiple insurance forms Many of my patients have their medical bills paid for by their insurance companies and it is quite common for them to ask their attending doctor to fill out some insurance reports. To my surprise, some patients (mostly foreigners) asked me to fill out four to five different insurance forms for the same hospitalisation period. Initially, as usual, I obliged. However, when I later spoke to some insurance specialists, I was surprised to find that multiple claiming for one hospitalisation is not practised in Singapore. When a patient has both personal and corporate insurance policies, he will not be able to claim compensation from both policies. He can claim from one policy first, and if there are deductibles or a cash outlay, he can claim the rest from a second insurance company. Imagine this: if a patient who spends $1,000 in hospital bills could claim from five different insurance companies, he would end up having an extra $4,000 in cash. Since then, I have only agreed to fill out forms from one insurance company for the same hospitalisation for free, and will impose a charge for subsequent forms. Besides that, I insist on putting the DUPLICATE chop on all reprinted receipts. GST refunds Under the Singapore law, foreign patients can claim a GST refund for unconsumed goods upon departure from Singapore and there are certain rules on the refund. By and large, most of my patients have no problem making the claims at the airport, but sometimes I encounter special requests. Once, a friend or relative of a foreign patient came to purchase medicine on behalf of a patient who was overseas, and requested for the receipt to be put in the name of the foreign patient. From a medical standpoint, while I think it is the legitimate right of foreign patients to claim back the GST, I cannot prescribe medicine to their relative. I can only prescribe medicine to my patient and hence, the receipt can only show the name of the visiting patient. Modifying an invoice This is the most ridiculous request I have encountered. After I saw this patient at my clinic, I prescribed the medicine and issued a receipt upon payment. The patient proceeded to ask if my staff could mark up the amount on the receipt so he could claim more from his insurer. Adding extra medicine This request happened a few times. A patient and his spouse visited me for consultation and after making a diagnosis, I prescribed medicine for the patient. The patient s spouse then asked if I could double the amount of medicine as she, too, had similar complaints. So instead of a four-week supply, they asked me to prescribe eight weeks worth of gastric medicine. Furthermore, they expected me to bill the patient s insurer altogether. While I don t mind giving free consultations to a patient s relatives or friends, I do mind dispensing unreasonably large amounts of medicine. If his insurer asks me to explain why so much medicine is being given, I will have problems justifying my actions. Prescribing an inpatient s drug to his caretakers I had an inpatient with a digestive problem and I put him on gastric medicine. His caretaker had abdominal pain and requested for me to prescribe similar medicines for his use. I was prepared to waive my consultation fees, but I still needed to document history and physical findings, diagnoses, etc. I asked the caretaker to visit my clinic for a formal consultation and to pick up a prescription. However, the caretaker just asked me to prescribe more inpatient gastric medication to the patient so he could consume the medication too. In other words, the cost of the caretaker s medication would have been added to the patient s bill. I felt very uncomfortable and rejected his demand. Changing of medical reports A few years ago, a young girl was admitted under my care for paracetamol overdose. At the emergency department, the resident physician did a gastric lavage and we gave intravenous N-acetylcysteine as an antidote. The patient recovered without sequelae. A few weeks later, her mother called me to express her unhappiness that the hospital gave an itemised bill to her insurer, which included the cost of a gastric lavage. The insurer concluded that the patient must have had a drug overdose and declined the claim. The mother asked if I could remove gastric lavage as a procedure from her hospital notes and hospital bill, but of course, I could not change history. Extending medical certificates I recently received a request from an old patient of mine who asked me to certify him unfit for his Individual Physical Proficiency Test. He was admitted seven months prior for cholangitis and choledocholithiasis, during which I performed an endoscopic retrograde cholangiopancreatography on him and my surgical colleague performed a laparoscopic cholecystectomy at the same admission. JAN 2017 SMA News 19

20 I have always asked such patients to avoid doing strenuous exercises for at least six weeks after surgery, but stretching the unfit for exercise period to seven months is too extreme. Why I don't comply Personally, these requests are improper and some of them are ridiculous. Medical records and clinic receipts are legal documents and once printed, cannot be amended without valid reasons. Of course, if a mistake is made on my part, say in history or physical examination, I could make an amendment and date it accordingly. However, amending such legal documents without good and valid reasons, or in improper ways, is inviting trouble. In addition, marking up the payment so that a patient can claim more from his insurer, or prescribing extra medication for their spouses or caretakers is, to me, fraudulent. Why patients make such requests Some patients are just trying their luck. They know that their requests are improper but they try anyway, as they have nothing to lose. However, some patients are very pushy when their pockets are hurt. When their expectations are not met, they kick up a big fuss at my clinic reception. Many of these patients often say that other clinics accede to their requests and they are disappointed that we turn down their requests. How to handle such situations Firstly, use common sense. Most of these issues are very simple and commonsensical. Legal documents cannot be amended. Activities that happened cannot be deleted from records. Dates cannot be backdated. Medical leave durations have to be reasonable. Giving a patient additional medicine to treat his spouse, at the expense of his insurer, is plainly wrong. Secondly, when in doubt, check with the experts. I often check with experts in various fields, like my clinic accountants, for queries on receipts and GST refunds, and my finance consultants about insurer issues. Their answers are usually very straightforward a yes or a no. Thirdly, when still in doubt with no experts to turn to, turn to our peers. There is always wisdom in a group. Personally, I find the hospital doctor lounge, as well as SMA events, to be the perfect ground to seek opinion from our colleagues. I have learnt that whatever issues I face are also faced by other doctors and that I normally become wiser after discussing my problems with friends and colleagues. In the end, I would explain to my patients why I cannot fulfil their improper wish, and try to convince them that they stand to lose more. For example, to the spouse of my patient who asked me to double my prescription so that he can get medications at the insured patient s account, I would tell him that if their insurer found out the truth, they would lose their whole policy. To the insurance agent who asked me to amend receipt dates so that it would be easier for his client to get claims, I would tell him that he risked losing his job if his company found out. Why these problems exist The problem comes mainly from the fear of displeasing our patients. During our training, we learn to take patients complaints seriously and we often try hard to solve their complaints and problems. We are used to seeing our patients satisfied with our work, but we ought to separate medical problems from non-medical ones. Actually, if we compromise, we may please the patient at that moment, but we put our practice and reputation at risk in the future, and it is just not worth it. Final thoughts I always tell my clinic staff (and myself) that we want to be known for practising good medicine, rather than being nice and compromising. If patients choose to leave us because we are too rigid, so be it. At the end of the day, it is better to practise good medicine and good business ethics for a good night s sleep, than to please the patients and be worried later. Dr Desmond Wai is a gastroenterologist in private practice. Like other medical colleagues, he is struggling to balance family and work. Desmond believes that sharing our thoughts and experience is important in moving our profession forward. 20 JAN 2017 SMA News

21 Do something now that your patients will thank you for later SHARE WITH YOUR PATIENTS ABOUT THE LPA TODAY! Role of a Certificate Issuer Ensure that the Donor understands the purpose of the LPA Ensure that the Donor understands the scope of authority conferred to the Donee Ensure that no fraud or undue pressure is used to induce the Donor to make the LPA and there is nothing else that would prevent the LPA from being created 3 simple steps to becoming an LPA Certificate Issuer - 1 non-core CME point Visit the SMA website ( and click on the banner Register by filling in your particulars and clicking Submit Log in to the online portal and complete the module For enquiries, please contact the SMA secretariat at tel: or OPG_LPA@sma.org.sg. For more information on the LPA, please visit the Office of the Public Guardian s website at

22 SMA Charity Fund Reflection, Appreciation and Motivation A Journey of Doing Good Text by Jennifer Lee, Deputy Manager, SMA Charity Fund Not all of us can do great things. But we can do small things with great love. Mother Theresa Big thanks to our donors! Dr Atasha Binti Asmat Ms Chan, Emily Mdm Chan Lam Choon Nee Mun Swee Heong Dr Chan Wai Ling, Theresa Ms Chen Yu Qing Prof Chee Yam Cheng Mr Chew Zheng Hao Dr Chin Koy Nam Dr Chu Siu Wen Dr Chua Seng Chew Dr Dohadwala Kutbuddin Dr Fong Qi Wei Dr Goh Boon Cher Dr Guan, Richard Dr Hardie Billy Dr K Gunasegaran Mr Koh, Kelson Mr Koh Wei Ping Mr Khoo Yong Kiong Dr Kwong Kum Hoong Dr Lee Lay Tin Dr Lim Hsin Loh Mr Lim Teck Chai, Danny Dr Lim Tian Zhi Dr Lok Ying Fang Mr Low Chien Chong, Peter Mr Mohit Khurana Mr Murugaiyan Rajkumar Dr Nair Rajalekshmi D/O K N Nair Dr Ng Keck Sim Dr Ng Lee Beng Dr Ng Swee Cheng Dr Ong Choo Phaik, Caroline Dr Ong Eng Cheng Dr Ong Eng Kang Dr Ong Seh Hong Mr Ong Yeow Chon Dr Ooi Chun How Dr Phoon Kwon Yun, Ian Dr Raut Pradeep Prakash Dr T. Thirumoorthy Dr Tan Chin Hor Dr Tan Cheng Lim Mr Tan Kok Yeang Mr Tan Suat Lin Ms Tan Wen Yi Dr Tan Wu Meng Mr Tan Yeo Chye Dr Tan Yuen Lan, Diana Dr Woo Chin Yee Dr Yong Chee Fah Alpha Omega Medical Pte Ltd ASICS Asia Pte Ltd Lam Soon Singapore Pte Ltd (Pocari Sweat Run 2016) The Summit of Our Lives Campaign Project Team Other anonymous donor(s) The list above includes donors from 1 January to 15 December 2016 and may not be exhaustive. If we have inadvertently omitted the names of any donors, we apologise for the oversight. It has been four years since the inception of the SMA Charity Fund (SMACF) and three years since we started our charity operations. It has been a great start for us here in SMACF. Slowly but surely, we continue to work towards building a compassionate medical profession to impact the future of healthcare. Birth of the SMA-MSAF Our charitable initiative started in a small way back in Although there were a number of bursaries, financial assistance schemes and loans available that could help pay for students' tuition fees at the National University of Singapore (NUS) Yong Loo Lin School of Medicine (NUS Medicine), those were not likely to cover the basic living expenses of underprivileged students. A medical education, even a highly subsidised one, is expensive to many. A survey conducted by the NUS Medical Society in 2007 found that about 21% (250) of medical students in the NUS undergraduate course had a monthly household income of less than $3,000. The same survey also found that an NUS medical student needed at least $4,410 a year (or $ a month) for day-to-day expenses such as transport, food, books and miscellaneous expenditure. Thus, in partnership with NUS Medicine and with the support of the NUS Development Office, SMA started the SMA Medical Students Assistance 22 JAN 2017 SMA News

23 Fund (SMA-MSAF) bursary programme to help students from underprivileged families pursue their dreams and aspirations of becoming medical doctors, without undue financial burdens. The birth of the SMA-MSAF brought a glimmer of hope to our needy medical students. It has been almost ten years since we started the bursary programme. We have remained firm that our youths from underprivileged families should never be disadvantaged in their pursuit of becoming medical doctors. We have since anchored this core programme, reaching out to more needy medical students from all three medical schools and putting together a more concerted effort towards building a compassionate medical profession to impact healthcare. We will strive to build SMACF on good governance as we continue this journey. SMACF has successfully renewed the Institution of a Public Character (IPC) status, which is effective from 27 December 2016 to 26 December The successful renewal of our IPC status is a testament to the work of SMACF and enables the issuance of tax benefits for all donations received. With the strong support from the medical profession, we are certain that we will achieve what we have set out to do and will seek to do more for the future of healthcare! To all the doctors who believe in us: Thank you for making a difference! I am a medical student from Lee Kong Chian School of Medicine (LKCMedicine). Being accepted into medical school is one of the most privileged opportunities given to me. I come from a single-parent family with an elderly dependent who has medical conditions and there are times when I wished I will live better days. I have lived in a small unit all my life a two-bedroom flat with two of my family members. Though I may not have parents who are corporate high-flyers or senior medical professionals working in big organisations, I have a small family who has always stood by me and supported me in pursuing my aspirations to become a good medical doctor. I have been working par t-time to help us tide through the tight financial situation at home and alleviate the burden that my single parent has to bear. Coupled with my own medical conditions, life has been an arduous ride. Through it all, advancing through this tough environment has strengthened my personality. With the plight of my financial limitations, I was happy to hear that my schoolmates and I are able to apply for external bursary from SMACF from AY 2016/17 onwards, even on top of the financial awards we receive from school. This truly brings a glimmer of hope as I am approaching a new phase of my medical training in school that will significantly affect my ability to generate a flow of income on the sideline. With the sudden spike in hours required for school and a change in studying climate, I was destabilised from my comfort zone. I did not want to compromise my education in the path of being a medical practitioner and eventually the standard of care that I would provide my patients with. I am moved that there are people who do not know me and yet are willing to undertake such a hear t-warming gesture that will greatly aid me in my life. I honestly do not think that I am suffering from a very dire plight especially compared to other less fortunate individuals overseas. However, I do believe that my journey has made me grow to see the importance of support in the society and cultivating the next generation of intelligentsia, especially those who are less wealthy and privileged. Once again, thank you for all your generosity and for believing in us! Yours sincerely, A very grateful medical student LKCMedicine JAN 2017 SMA News 23

24 OPINION Values That Work Text by A/Prof Jason Yap Organisations are made up of people, and people can have very different beliefs, values, personalities, preferences and behaviours. How then do we speak of the values of an organisation? Would this be the sum (or the net) of all the diverse personalities, or does an organisation have a life and ethic of its own, just as it is also in many ways a person under the law? Can we believe the corporate values on display, or must we delve deeper into the organisational soul of the rank and file, or of the professional groupings within? Ultimately, we find that the organisation s ethos lie not in what people say or even think, but in what they do; in this regard, it is the leaders who must show the way. Ethos Organisations espouse communal and shared values proudly displayed on corporate walls and websites that they would like to think is their spirit or ethos. These values are related to their mission and vision, or sometimes to their founder. Healthcare organisations cannot do without Compassion and Excellence. Throughout the years, some phrases have arisen some then fading as must-have values, like Customerfocused, Knowledge-based, and most recently, Innovation. For many, organisational ethics are the ethics or ethos that should be espoused by organisations, and they guide how organisations ought to behave and make decisions. For those in charge, there is the added dimension of how values and ethics can drive their mission and the way it is achieved. Others consider also how individuals ought to behave at work, especially when their own ethics do not align well with those of their corporations. These are important considerations because people, however well-meaning and passionate, have different ideas of what actions are right, both ethically and operationally, and working together can tax even the most amiable and amenable of friendships. In healthcare, one of the most complex workplaces, these alignments can be critical. Values Ultimately, ethics of any sort are based on a set of values, whether formally stated or intuitively grasped. Ethics is about what ought to be done, and that ought-ness rests on a value system, which is held as axiomatically correct and necessary, in effect as virtues. Gus Lee, author of an insightful book entitled Courage, 1 describes three types of core values. First, there are the values that actually happen on the ground: what observers and participants can see and possibly manifest every day at work. These include nasty stuff like interdepartmental strife, mindless bureaucracy and unreasoning competition values that senior management would not happily own up to having, but nonetheless need to acknowledge, because they are in fact real and must be dealt with. Then there are the many values that festoon corporate walls: Teamwork, Customer Focus, Passion, Compassion, and even Professionalism. But as Gus Lee points out in his book, Enron displayed superlative teamwork in paper-shredding, while Arthur Anderson was wonderfully customer-focused in their support, not all good-sounding values are sufficient in and of themselves. At the pinnacle lie just three special values: Integrity, Character, and Gus Lee s focus in his book Courage. These values are different not in intensity or impact but in their very nature. They are otherly-oriented and determine the organisation s mission ( Why do we do this? ), while the others are merely useful in the achievement of the said mission ( How shall we do it together? ). The insight that Gus Lee s illuminating book shows us is that not all values are created equal. There are higher-order values that shape what we do, and there are other values that merely shape how we do what we do. We can, as organisations, do very well what we ought not to be doing. We must also recognise that there may exist values that are real, even if unwanted, and pretending they do not exist will not cause them to disapparate. 2 Professionalism Some readers might have been surprised at the inclusion of Professionalism in the second tier (though I did say even ). Should it not automatically be in the top tier, as the high order value that guides the entire profession? In Lewis Carrolls Alice in Wonderland, Humpty Dumpty said: When I use a word, it means just what I choose it to mean neither more nor less. To which Alice replies: The question is whether you can make words mean so many different things. 24 JAN 2017 SMA News

25 Professionalism is one such much-abused word. It could denote a paid service, a livelihood, quality that meets expectations, or a set of high-prestige occupations (bankers, accountants, lawyers, engineers, doctors), some of which society allows to self-regulate. For the last group, doing their best is not enough; they must also perform to the standards of their peers, or suffer their judgement and consequences. Professionalism falls outside the top tier not because it is in itself not good enough, but in that people often settle for a weakly brewed substitute. Professionalism allows conscientious objectors to abstain from practices they personally consider unacceptable. We respect those who stand by their principles, even on principles we do not agree with, more than others who act against their own consciences. But what we admire here is not Professionalism itself but Integrity, Character and Courage. Praxis There is much divergence when one considers what organisations would do for success. For some, it might simply be enough that one does not break the law; anything not explicitly proscribed is fair game. Others insist that personal ethics nurtured on religious or humanitarian grounds must remain a higher order. We have found out several times in the past decades, from Enron to Lehman, that what organisations do that is not ethical can have far-reaching consequences. Unfortunately, too many people simply might not care. What the organisation that large vague thing that pays our salaries does is beyond us, and we salve our consciences with the thought that so long as we are not the ones with our hands in the blood, our consciences are clear. Then we must return to Integrity, Character and Courage, or the lack thereof. Community To deliberately set out their ethical principles, organisations publish written codes of ethics and standards (much like what the Singapore Medical Council has produced for medical practitioners), provide training in ethical behaviour for their employees, provide advisory services for those in need of guidance, and set up reporting mechanisms for breaches of conduct. Most of us would be able to recognise the parallels within our own places of work. The above are predicated on individual ethics, with a focus on how individuals ought to act. There should also be the sense of communal responsibilities. This goes beyond how, for example, we ought to act towards our colleagues or our clients. Organisations, in their corporate policies, informal practices and cultural milieu, do have a life beyond the individual. Not all unethical practices within organisations originate from individual misdeeds. Public sector organisations can strive for their own organisational glory when they should be supporting other organisations that are better placed to serve the population. HR policies can unjustly treat staff differentially, financial policies can take unfair advantage of vendors, business operations can callously damage the environment, and corporate strategies can selfishly cause hurt to society. These ought-nots are more often than not set up by well-meaning people who did not anticipate the inadvertent side-effects. Leadership Beyond basic compliance with the law, organisations must foster cultures that encourage and reward exemplary behaviour. However, such an integrity-based approach would be fatally wounded if the leaders themselves do not provide appropriate role models. Too many of us can recount times when the leaders demonstrate that they think themselves to be above the conduct they require of others. Whether deliberately or not, it is the role of leaders to ensure that the organisation does what is right, not just for the organisation or their clients but for society as a whole. Ultimately, even though organisations do have a life of their own, it is the responsibility of the leaders firstly to define, develop, and maintain the ethics of the organisation, and more importantly, to demonstrate and model it. The buck stops at their desk. References 1. Lee G, Elliot-Lee D. Courage: The Backbone of Leadership. Jossey-Bass, All seven books and eight movies about the life and adventures of Harry Potter. A/Prof Jason Yap is a public health physician who s been around a bit. He is currently a practice track faculty in the Saw Swee Hock School of Public Health, and the Program Director for the National Preventive Medicine Residency Program. He helps out with various abbreviations like AMS s CPHOP, SMA s CMEP, IFIC s FB, SATA s BoD, SLH s MAC, SPRING s SISC, and PGAHI s AB. JAN 2017 SMA News 25

26 gp matters Using Technology to Enhance Medical Practice Text by Dr Choo Kay Wee Dr Choo Kay Wee graduated in 1984 and obtained his diplomate membership of the College of General Practitioners, Singapore, in He has been in active private general practice since He is currently also an adjunct lecturer at NUS Yong Loo Lin School of Medicine, Singapore. When I read of the phenomenal sales of smartphones, 1,2,3 I was astounded. I could not have imagined owning a smartphone myself, just ten years ago! With such an overwhelming response to the adoption of smartphones, I have no excuse for not using it to enhance my medical practice. Since I decided to become a GP in 1990, my goal has always been to practise good primary care medicine and to improve the standard and recognition of general practice. I have been struggling to find a solution to facilitate and augment the standard and quality of my clinical practice. Eventually, last year, I was able to utilise a mobile app software to put my thoughts into actual practice. I am happy to share what I have done and hope that you will benefit from it, and perhaps gain the knowledge to design your own app to meet your practice s needs. The app that has been created allowed me to share contents such as written articles, web links and videos. It also allowed me to create forms for collecting information, and I could access any information available on the Internet. I could also initiate a phone call with a single tap of the finger. For example, by tapping on the link for an emergency ambulance, it automatically puts the call through without the need for dialling. How has it enhanced my medical practice? Uploading my curriculum vitae in the app. By doing so, I hope that my patients would be able to know more about me: my training, qualifications, continual medical education and contributions in the area of my professional interest. I could also keep my portfolio updated or add on to it without much difficulty. Perhaps all trainees and even medical students could use it as a versatile tool to build their training portfolios. Providing web links to healthcare establishments. This was for my patients ease of access to specific pages, such as queue cameras in A&E departments or polyclinics, which would be useful to them. Creating forms for collection of information before consultation. This allowed me to collect some relevant information such as a patient s chronic illnesses or drug allergies before he/ she enters the consultation room, thus allowing more time for face-to-face communication during the consultation. It also allowed me to be more thorough in history-taking. Sharing useful materials. I was able to put up selected useful health education materials, found in online websites 26 JAN 2017 SMA News

27 or videos for my patients. Special instructions for patients could also be stored in PDF files for their reference and printed out for reading when necessary. Availing easy communication. Patients were able to questions for clarification and book appointments for their subsequent visits. What are the pros and cons? The pros n It allowed me to reach out to my patients in a novel way, by giving them a source of information about their healthcare provider and healthcare issues. n It allowed me to communicate with my patients. For instance, I was able to alert them to any health-related issues, such as the Zika virus outbreak, via instant messaging. Other useful information may be left in the app for regular access. n An ecommerce setup allowed ease of payment for the sale of products and services, doing away with heavy and cumbersome terminals and printers that were previously in use. n It facilitated easy dissemination of information, whether personal, business- or health-related, via PDF files, weblinks and videos. n Feedback, contacts and appointment-making features allowed ease of two-way communication. The cons n The inertia, effort and cost needed to effect change and adopt the new technology can be stressful. n The lack of time, energy and resources did not provide the luxury of being innovative. n A lack of evidence of the benefits and acceptance by peers and patients. n Fear of the unknown. n New challenges such as confidentiality, ethical, copyright and cyber security issues. In the end, it will be the individual doctor s decision whether to adopt or reject this new reality. However, I find it fulfilling enough to just allow me to enhance communication with my patients. The following apps are available for download with the links provided: A Life Clinic apps/details?id=com.create.app. v2.novenamedicalcenter Health Information SG apps/details?id=com.create.app. v2.sghealthinfo References 1. 2 Billion Consumers Worldwide to Get Smart(phones) by Available at: emarketer.com/articles/print.aspx?r= Mosa AS, Yoo I, Sheets L. A Systematic Review of Healthcare Applications for Smartphones. BMC Med Inform Decis Mak 2012; 12: U.S. Smartphone Use in Available at: PI_Smartphones_ pdf. SMA EVENTS FEB APR 2017 CALENDAR DATE EVENT VENUE CME Activities 19 Feb Sun 10 Mar Fri BCLS/ CPR+AED CME POINTS SMA Conference Room 2 Medico-Legal Forum 2017 Supreme Court, Auditorium Max 4 WHO SHOULD ATTEND? Family Medicine and All Specialities Legal and Healthcare Professionals CONTACT Huda or Shirong cpr@sma.org.sg les@sal.org.sg 21 Mar Tue Achieving a Safer and Reliable Practice Grand Copthorne Waterfront Hotel 2 Family Medicine and All Specialities Margaret margaret@sma.org.sg 23 Mar Thu Mastering Professional Interactions Grand Copthorne Waterfront Hotel 2 Family Medicine and All Specialities Margaret margaret@sma.org.sg 25 Mar Sat Mastering Difficult Interactions with Patients Grand Copthorne Waterfront Hotel 2 Family Medicine and All Specialities Margaret margaret@sma.org.sg 28 Mar Tue Mastering Adverse Outcomes Grand Copthorne Waterfront Hotel 2 Family Medicine and All Specialities Margaret margaret@sma.org.sg 19 Apr Wed Mastering Your Risk Grand Copthorne Waterfront Hotel 2 Family Medicine and All Specialities Margaret margaret@sma.org.sg JAN 2017 SMA News 27

28 From the Heart Text by Dr Foo Gen Lin Everest! The very name evokes a sense of adventure, courage and real mettle. The highest peak on earth was summited by the duo, Sir Edmund Hillary and Tenzing Norgay in 1953 and has since attracted numerous daredevils and adventure seekers. Dr Foo Gen Lin is a senior resident under the National Health Group s orthopaedic surgery residency programme. He is actively involved in sports and adventure. Being a running enthusiast, Dr Foo has participated in many major running events as a competitive runner. Legend 1. "We made it!" The team at Everest Base Camp 2. High jumps on the top of the world Our journey began three years ago with an idea to build camaraderie within our hospital departments. We settled on the Everest Base Camp (EBC) as one of our team members, Kumaran, had ample experience and knowledge in travelling and trekking in Nepal. Our trip came to a standstill after the Nepal earthquake in April 2015, but we realised then that it was more pertinent than ever to embark on the expedition. We wanted to share with our friends that it is safe to travel to Nepal, and also to witness the country s current state to figure out how we can contribute to further recovery. We also felt that the expedition could contribute to our medical community here, and what better way than to start with the SMA Charity Fund. The fund provides bursaries to medical students facing financial difficulties to help them achieve their goals of being doctors. Through our trek to EBC, we hope to inspire these students to continue chasing their dreams and to challenge our community to remember and help the less fortunate. Onward bound In anticipation of the tough climbs and journey ahead, our motley crew of ten got together several times a month to train our muscles. We are most grateful to our departments for endorsing our expedition, approving our leave and providing the awesome banner that we carried all the way to EBC! With our bags packed (some done hastily the night before with last minute shopping at Decathlon!), we departed Changi Airport on 23 October Surreal as it seemed at the start, the reality of the punishing ascents and long daily treks kicked in. Motivation came in the form of the breathtaking (no pun intended) snow-capped mountains and the friendships that blossomed over the two weeks that we spent together. Amazing hospitality Nepal is blessed not just with amazing natural beauty but also inspiring inhabitants. Our guides and the locals whom we met during our trip were always cheerful and friendly despite the harsh environments they lived in and the losses from the earthquake. Being typical Singaporeans, food was always at the top of our minds and we were pleasantly surprised that the tea-houses served many alternatives to the local staple dal bhat (local vegetarian curry). Their 28 JAN 2017 SMA News

29 1 cuisine is heavily influenced by Chinese cuisine, with a variety of dishes like fried noodles, fried rice and dumplings (affectionately termed momos ). Our daily schedule consisted of a hearty breakfast followed by nearly a whole day of trekking, with a lunch break in-between. Fortunately, food was always prepared fresh, so we had almost an hour each day during lunch time for us to rest our legs. Dinner was usually followed by stories of our daily treks, card games and rounds of Mafia. Our fellow team member, Mr Cheng, would occasionally serenade us and liven up the dining room with his guitar (that he carried all the way to EBC!), and we would usually be tucked in by 10 pm on most days, all tired out and in need of sleep to prepare for the next day s journey. Reaching the goal Each day got tougher as fatigue built up and the air thinned out as we went higher. It also got colder and facilities became more basic as we got closer to our target the Everest Base Camp. I have great respect for my teammates who pushed through these physical and mental challenges to finally arrive at EBC on the ninth day of our trip. For the brief half an hour that we spent there, the bitter cold and lethargy melted away, replaced by the joy and sense of achievement in reaching this summit of our lives. The journey does not end at the base of Everest but continues to live on in our memories. Our lives have been greatly enriched by the experiences from this trip and some of us are already eagerly making plans to return to this beautiful country in the not so distant future! SMA and the SMA Charity Fund support volunteerism among our profession. SMA News provides charitable organisations with complimentary space to publicise their causes. To find out more, news@sma.org.sg or visit the SMA Cares webpage at 2 JAN 2017 SMA News 29

30 INDULGE This Cold Text by Dr Tan Su-Ming Photos by Zoe Davies, Martin Dallimer and Dr Tan Su-Ming We were preparing to head out with the Inuit hunters. I can remember how the still morning air was filled with the eerie sound of 40-odd huskies baying like wolves all around, and the sight of them tugging at their chains excitedly as if to say: Me first, pick me!, as their mushers unchained them one by one to put on their harnesses and ready them to pull the sleds. I felt immobile and clumsy, like Mrs Michelin, suited in six layers, including the outermost survival suit, while the boiled wool mittens made my hands quite useless. Soon we were off six adventurers, one guide, four hunters and four sleds, each powered by 12 dogs. We packed what we would need to survive in the arctic wilderness for the next five days. I had gone camping before sort of but my tent was always pitched for me and there had always been porters to handle my luggage. No such thing this time. Would a city slicker like myself, deathly afraid of the cold and not being able to bathe, survive the next five days? But my mind soon forgot those fears. I was once told that when we see something we ve never seen before in our life and cannot put a name to or explain it, our minds momentarily suspend judgement or commentary and we are truly in the moment. That was what it was like for me as we traversed old dogsled routes, crossed glaciated islands and travelled down frozen fjords to visit some of the remotest areas on earth. Time slowed down. I had to pinch myself to realise that I was being pulled by 12 dogs across a frozen sea in -15 C weather. On that sunny day, the cloudless sky was a brilliant blue, and the white of the snow-covered frozen sea and mountain ranges was blinding. Turquoise-blue icebergs, some the size of a car, some the size of a Tyrannosaurus Rex, rose from the ice to meet us. There was only the sound of the sled moving over the frozen ice, the panting of the huskies, the rhythmic patter of their large paws, and the musher/hunter calling out Yooot or Hreee to the dogs, which I think meant right and left, respectively. Every now and then, I would detect a sulphur-like smell in the wind, as the huskies were farting and defecating as they ran. I felt a vague sense of pride when my travel mate and I managed to pitch our two-man tent under the supervision of our guide, who made sure it was sturdy enough to not get blown away by strong winds. That first night camping, I remember groaning when 30 JAN 2017 SMA News

31 I had to wake up to answer nature s call, dreading having to leave the warm cocoon of my sleeping bag to trudge out in the -25 C cold to the makeshift toilet (which was essentially just a wall of ice to give privacy). I woke my travel mate to accompany me, as I was afraid of encountering a polar bear. As we left the tent and stepped outside, we again experienced one of those moments where the mind suspends commentary. In the sky all around us was a silent, surreal and ghostly display of lights; the Aurora Borealis what the Inuits believed were the spirits of the dead playing ball in the sky. Neither of us spoke. We had no words. Finally we broke the silence and said, It s too cold. Shall we go back in? We were very lucky indeed. We were treated to the Northern lights three nights in a row, thanks to the calm weather. Once the weather got stormy, there were no more sightings. Any notions of trying my hand at driving a dog sled were quickly dispelled as I soon realised it was not easy. Unlike Canadian huskies that pull the sleds in pairs, these Inuit huskies are tied to the sled in a fan formation. The mushers have to be skilled enough not only to disentangle the dogs when their traces get entangled or snagged, but also in controlling the huskies, whose disobedience could lead to life-or -death situations. The Inuit huskies, though of a medium built, are very hardworking creatures with amazing endurance. The Inuits treat them not as pets but as working animals that spend their entire lives outdoors. I remember our British guide telling me that when the hunters learnt how dogs in other countries are allowed into the house and even onto the sofa, they were incredulous. The dogs aren t fed every day when they aren t working, so that they will still pull when hunting has been poor and food is unavailable. Also, it keeps them from becoming overweight. I wished I spoke Danish or Greenlandic because there was so much I wanted to ask the hunters. There was a day when we were ice fishing, and the bounty was six halibut and 22 stingrays. The hunters kept the halibut but threw the rays into a pile for the ravens. Why don t you keep them? I asked, Is it because they are ugly? Is it because you don t know how to cook rays? Is it because they don t taste good to you? The hunters would only reply, We don t eat it. Maybe if they had sambal, I thought to myself. We returned to the village of Kulusuk two days earlier than planned because weather forecasts predicted a big storm approaching. The village has a population of about 380 people with 700 huskies two dogs for every inhabitant. My Singaporean friend and I had survived the cold and not bathing, and had more than subsisted on boiled fish, polar bear meat and freeze-dried food. I felt grateful towards our guide for taking care of us, and for the expertise of the hunters who led us safely through the demanding terrain. And I would never forget the stoic, uncomplaining dogs that had pulled me across the many, many miles of that cold heaven. Dr Tan Su-Ming graduated from the National University of Singapore in She is married with a daughter and runs her own general practice. JAN 2017 SMA News 31

32 AIC SAYS

33 SALE/RENTAL/TAKEOVER Serviced clinic for rent at Mount Elizabeth Novena Hospital. Fully equipped and staffed with IT support. Immediate occupancy. Choice of sessional and long term lease. Suitable for all specialties. Please call or Gleneagles Medical Centre room for rent. Newly renovated. Please call No agents please. Gleneagles Medical Centre clinic for rent. 400 sq ft. Waiting area, reception counter and consultation room. Immediate. SMS Buy/Sell clinics/premises: Takeovers: (1) D14, industrial/hdb area; (2) D21, high net-worth patients; (3) D14, established practice; (4) D19, Heartland central. Rental: (a) D21, share with specialist, near MRT. (b) Novena Medical Centre, 452 sq ft, fitted clinic. Hp: Medical unit for rent. SBF Mediplex. SBF Centre, 160 Robinson Road, Singapore. Next to Tanjong Pagar MRT station. 645 sq ft. Dual entrance. Direct access via escalator from street level. Asking $8k. Please call Landa at Clinic at Telok Blangah Street 32 Block 78B for rent. Existing clinic. No renovation needed. Can take over furniture, office equipment and medicine free. Rent $5,000 per month. Contact Dr Cheng at POSITION AVAILABLE/PARTNERSHIP Drs. Bain and Partners welcomes dedicated medical doctors to join our established and growing city practice. We offer a competitive remuneration package with comprehensive benefits for successful doctors. A post graduate qualification in occupational medicine would be an advantage. Good prospect of profit sharing/ partnership for committed doctors with a long term outlook. Interested applicant, please send your CV to drsamuel@drsbain.com.sg or call Manager/regular locum +/- partner treasured. Geylang clinic. Able to do some nights. Please enquire at or daytime. Confidentiality ensured. TLC lifestyle has positions for visiting ophthalmologists to co-manage protrusion blepharochalasis [eyebags] for our patients. We welcome your interest via hr@tlclifestyle.com. MEDICAL SUITES & COMMERCIAL UNITS FOR SALE BY DEVELOPER THE FLOW Price Reduced, Save Up To*$2,100,000! MEDICAL SUITES 1582sf Last Unit!! Was $6,150,870 ($3888psf) Now $4,047,000 ($2558psf) Ready For Occupation Soon RETAIL SHOPS 775sf Was $3,069,000 ($3960psf) NOW $1,947,000 ($2512psf) Freehold Prime Katong East Coast Next to Hotels/Upcoming Marine Parade MRT Foreigners Eligible. No ABSD/SSD 66 East Coast Rd *Prices are subject to changes without prior notice. ** ROYAL SQUARE@NOVENA. Integrated Hotel+Shop+ Restaurant For Sale. Deferred Payment/Lease First & Purchase Later Scheme Medical Suites $2.04M Special 5% Discount For Doctors Only! ** TRIO@SAM LEONG Behind Mustafa Farrer Pk MRT. Freehold Shop/Restaurant from $1.26M. Level Purchase@$1900psf Only! YVONNE KWOK Senior Marketing Director yvonnekwok@live.com (CEA R016747B) Estate Agents Licence No: L K We are looking for doctors who wish to pursue family medicine as a career to join our growing organisation. Local and overseas graduates from recognised universities may apply. We provide fulfilling work environment where you can work, learn and deliver care to your patients with our team of nurses, healthcare managers, specialists and family physicians. As an approved Learning Institution, we provide opportunities for you to learn, grow and develop your career as a family physician, physician leader or as a healthcare manager. Remuneration is attractive and competitive and being a key member of the Raffles team, you will participate in the employee share option scheme of Raffles Medical Group. Exciting career opportunities are available in the following positions: 1) Family Physicians / General Practitioners 2) Health Screening Physicians 3) Medical Officers with A&E experience Both full and conditionally registered doctors may apply, full time or part time. Please send your full CV to: Dr Michael Lee lee_michael@rafflesmedical.com Dr Wilson Wong wwong@rafflesmedical.com Tel:

34 We are looking for an enthusiastic aesthetic doctor to join our practice part or full time. Extensive and continuous training will be provided. Registered doctor with Certificate of Competence for lasers and injections is preferred. Please send your resume to Tel: Fax: Aesthetic Doctor Requirements: 1. A medical degree from a recognised university 2. Must be fully licensed by SMC to practise privately in Singapore 3. At least 1 year of experience in the medical aesthetics field with experience in handling lasers 4. Able to work as a team with the Group's management team to develop the medical division at rapid pace 5. Self-driven individual for success 6. Strong interpersonal communication skills 7. Well-groomed with a pleasant personality Benefits: 1. Training in Japan will be provided 2. Training centre is recognised and certified by Japan Society of Plastic & Reconstructive Surgery Parkway Pantai Limited (PPL) is the largest private healthcare provider and operates Mount Elizabeth Novena Hospital, Mount Elizabeth Hospital, Gleneagles Hospital and Parkway East Hospital - all accredited by Joint Commission International (JCI). Our Accident and Emergency department / 24 hour clinics provide first-line treatment for a full range of medical conditions, including management of critical and life-threatening emergencies, to the treatment of walk-in patients 24 hours a day. All our medical and surgical specialists are well-trained and ever ready to support the handling of emergencies effectively and efficiently. By adopting a team approach towards the management of emergencies, we ensure the smooth and expedient management of all patients. We invite dedicated individuals who are passionate and driven to join us as: Resident Physician (A&E/ 24 hours Walk-In Clinic) Based in Gleneagles Hospital, you will be part of a team of dedicated doctors and paramedical staff providing comprehensive care to our patients. You will also play a key role in the maintenance of clinical standards and the delivery of a Parkway service experience to our patients. At Parkway, we provide sponsored postgraduate training opportunities in addition to a comprehensive suite of benefits. Join us for a challenging career and opportunities for personal development. Requirements: Basic medical qualification registrable with Singapore Medical Council Possess a valid practising certificate from the Singapore Medical Council At least 3 years of clinical experience post-housemanship. Postgraduate medical qualifications and relevant experience are advantages Good oral and written communication skills Good interpersonal skills Good team player Kindly steve.tan@parkwaypantai.com or call for a friendly discussion.

35 The Hospital Authority is a statutory body established and financed by the Hong Kong Government to operate and provide an efficient hospital system of the highest standards within resources available. Resident Trainees and Specialist Doctors with Full Registration The Hospital Authority invites both Non-specialist and Specialist Doctors who are eligible for full registration with the Medical Council of Hong Kong (MCHK) to consider joining the Hospital Authority to pursue specialist training and/or serving the community of Hong Kong. For Resident Trainee positions (Ref: HO ): Please visit (choose English language, click Careers Medical Resident Trainees [Various Clusters]) for details. Application should be submitted online via the above Hospital Authority website on or before 15 February 2017 (Hong Kong Time). For Specialist positions: Recruitment of specialist doctors is conducted throughout the year (no application deadline). Specialist doctors who would like to obtain further information are welcome to send to hohrcrt@ha.org.hk. Enquiries Please contact Ms M L Fong, Hospital Authority Head Office at (852) or send to hohrcrt@ha.org.hk. Homegrown and headquartered in Singapore, the Spa Esprit Group is one of the world s most unique beauty, lifestyle and F&B brands. Tasked with the mission of responding to the lifestyle needs of the modern consumer, each of the Group s 18 brands addresses the specialised needs of its target market by being an unabashed trendsetter. We are looking for driven individuals with a passion for beauty to join our growing team. DOCTOR (AESTHETIC TREATMENTS) Requirements: Basic medical qualification registrable with Singapore Medical Council Relevant experience in aesthetics treatment is advantageous Excellent interpersonal and communication skills A good team player with positive mind-set Well-groomed with pleasant personality Interested applicants, please send in your resume to melissa.chee@spa-esprit.com. by We are a newly created medical GP clinic group looking for doctors who would join us as pioneers. They would have a hand in shaping the clinical practices and SOP as pioneers. The offer is for full time and regular locums who can work day or night. Responsibilities: 1. Work with Management to establish and maintain clinic practices 2. Provide basic medical care services at our newly established clinics Requirements: 1. Possess basic medical qualifications recognised by Singapore Medical Council 2. Obtained valid practise licence awarded by Singapore Medical Council 3. Relevant post-grad qualifications will be welcomed Benefits: 1. Competitive remuneration package 2. Good career prospects as clinician or progress to Management 3. Training opportunities provided Please send your detailed resume to hrsgresumedeposit@gmail.com, Tel No:

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