Wednesday, April 03, 2019

Singapore is more than ready to accept a minority race PM

Dear Friends,
In a recent forum at NTU attended by more than 700 students, Minister Heng Swee Keat tried to convince Singaporeans why we are not ready for a non-Chinese PM. To many observers, this is just another way of enunciating why the popular DPM Tharman Shanmugaratnam was not considered acceptable as a potential PM after PM Lee Hsien Loong steps down.

In reply to a question from Assistant Professor Walid Abdullah Minister Heng explained that based on his own observation,  older Singaporeans would not accept a minority race PM. This acceptance of anecdotal evidence is uncharacteristic for someone trained as an economist.  

This pronouncement is problematic and does not stand to scrutiny in many ways:  

1. During GE 2015 Jurong GRC helmed by DPM Tharman won a thumping 79.28% of the votes. This is the highest vote count and even beats PM Lee's Ang Mo Kio GRC which was a close second at 78.6%.

2. PAP's Murali Pillai, in the Bukit Batok by-election ( May 2016), won by a vote count of 61.21% to SDP leader Chee Soon Juan’s 38.79%.

3.In a 2016 Yahoo poll, 70% of Singaporeans preferred Tharman to be the next PM ; much higher than the next choice who got 25%.

4.Assuming Minister Heng is correct that above 65 year old Singaporeans are not ready for a non-Chinese PM (this is not confirmed), why do we have to pander to the misguided racist views of this minority , who according to Statistics Singapore comprise  about 16% of the population ie 548000 out of 3.47 million Singaporeans  (link here: )?  This is esply as Minister Heng had confirmed for himself that the majority in the NTU audience were more than ready for a minority leader.

I am saddened that instead of showing moral courage , for reasons known only to itself, the government has chosen to repeat unsubstantiated observations to deny Singaporeans the service of an eminently qualified Singaporean in DPM Tharman at the highest level in government.

This seriously undermines our confidence in the leadership and make many skeptical that the part in our National Pledge that says "pledge ourselves as one united people, regardless of race, language or religion" are just words for school children to parrot day after day.

Dr Huang Shoou Chyuan

Monday, April 01, 2019

SMC must act fast to stem the loss of confidence in self-regulation process

MOH must help stem loss of confidence in SMC self-regulatory process
In more than 35 years as a doctor in Singapore, I have never felt more despondent as now and I am certainly not alone in losing confidence in how self-regulation is administered by our Singapore Medical Council (SMC).
Three recent SMC cases have shocked doctors namely :
1. " Kawasaki" case (2017) when pediatrician Dr Chia Foong Lian was suspended for 3 months for missing a difficult diagnosis;
2.  "Steroid" Injection case(2019) when orthopedic surgeon Dr Lim Lian Arn was fined $100,000 for failing to tell his patient the wrist injection could have side-effects such as discolouration of the skin and
3.  " Medical Confidentiality "case ( 2019) when psychiatrist Dr Soo Shuenn Chiang was fined $50000 for writing a memo to the ambulance service/ police to get an alleged "suicidal" patient admitted to Institute of Mental Health. He was found guilty of breaching medical confidentiality.
There was an unprecedented petition drive by a hitherto conservative medical professionals who then signed 3 petitions consisting of 1000, then 6400 and 8400 signatures respectively.
Let me make it clear. The doctors I know who signed the petitions are serious minded people who do not put ink to paper lightly as their professional reputations are at stake!

MOH forms a workgroup in March 2019 to  “review the taking of informed consent and SMC disciplinary process”.
How MOH Workgroup can help Singapore Healthcare
To the workgroup, I quote Stephen Covey and say,
“Let’s start with the end in mind.”
How do I want Medicine to be practised in Singapore?
1. In good faith, I will use all my skills and knowledge to help every patient.  Many diagnoses may initially remain elusive but this is not necessarily negligence.
2. Many treatments/medications have known complications that are often unavoidable. I may not have the time to explain every one of these complications nor do I feel that I have to. Many of these are minor. Eg Cancers

3. Patients are often treated as part of a family unit and I have always shared relevant knowledge with their loved ones for them to make collective decisions. Eg Elderly parents

4. Our courts have reiterated that the Bolam-Bolitho test is relevant as a measure of a doctor’s action during Diagnosis and Treatment ( eg Surgery) . Briefly, this test says that if the doctor's action is supported by a responsible body of medical opinion and is logical, he is not guilty of negligence.

5. I personally feel that the Modified Montgomery Test is the reason for increased healthcare cost and defensive medicine and should be severely curtailed notwithstanding the learned judges’ views. ( NB Court of Appeal says MM Test should be used for “Advising” patients)

I wish to fulfil my dream of being a good doctor.Please help me!

Dr Huang Shoou Chyuan

Saturday, November 24, 2018

Surgical Fee guidelines a good job half done

Hi all,
The letter below was published in the Forum page of the Straits Times (23.11.2018)

Dear Editor, 

The recently published fee guidelines for more than 200 common surgical procedures by private surgeons in Singapore could not have come a day sooner (Opting for private surgeon? See fee guidelines; Nov 14).

Many, even specialists in the private sector, have felt that recent price trends have not been sustainable and that Singapore is beginning to lose its competitive edge in this area to neighbouring countries.

Whether regional patients return to our shores in substantial numbers remains to be seen, but the latest move can only be good if we are serious about Singapore being a centre of medical excellence - a mantra seldom mentioned nowadays.

However, the surgeon's fee is but only a portion of the patient's total hospital bill. How does knowing only this portion allow for realistic financial planning for any patient coming into our private hospitals?

Why leave this task half done? Surely private hospitals have a critical role to play in this journey towards an excellent yet sustainable Singapore healthcare.

To this end, I propose the following:

For the most common surgical procedures - for example, the top 10 procedures of each speciality - the Health Ministry should require all major private hospitals to have all-encompassing fixed-fee packages.

This will introduce real competition and offer real choices for patients and payers (employers and insurers).

With the surgeon's fee kept at reasonable levels by the recent fee benchmarks and the hospitals' fixed-fee packages, patients and their families can be confident of avoiding shocks on the day of discharge, barring unexpected complications or transfers to intensive care units.

Other components of the total fee - for instance, an anaesthetist's fee - are usually predictable as a percentage of the surgical fees.

Only if this is achieved and uncertainty alleviated will Singapore's private healthcare truly be able to enlarge the pie and be ready to compete with our fast-improving regional competitors.

We may just be able to make it, but time is of the essence.

Huang Shoou Chyuan (Dr)