How I chill out- When I don't take myself too seriously...

Dear friends,

I love this life.

I can choose to take Singapore seriously and try to dissect government policies or ( rarely) propose new ones or ... just chill out and do what I love best.

Also- I am pretty jaded about following the state of " he said/ she said" type of petty politics.

Too much negativity all round ( not just from VB and his people).

When I let loose, besides spending previous time with friends and loved ones ( not enough of both groups), I also do things by myself.

In this inner sanctum, that even my beloved is forbidden, I read books... and read happenings in my hobby groups ( and just wish...):

Books i just read:

1. Haruki Murakami : 1Q84 

I still love Norwegian Woods but I have to move on...

2. Chinua Achebe: Things Fall Apart 

How the west love to colonize all of us and make us white like them...

3. Stieg Larsson: The Girl with the Dragon Tattoo

 Sadly Larsson and Achebe have both died! And Larsson's trilogy are the only books that have been published!!

Hobby groups I linger with ( but they don't know I am lurking behind in the dark)

1. Urban Sketchers Singapore ( very talented Sg artists)

2. Fountain Pen Lovers Group ( a new obsession that I will be speaking to my psychiatrist friends soon- before I spend all my children's inheritance)

Any comments, my friends?

 Cheers

Dr Huang Shoou Chyuan

Need for Guideline on Medical Fees : Aftermath of Dr Susan Lim case

Dear Friends
The letter below was published in the Straits Times Forum page (4th July 2013).

Revisit need for Fee Guideline

THE verdict of the Court of Three Judges, in dismissing an appeal by Dr Susan Lim against her professional misconduct conviction by the Singapore Medical Council (SMC), brings about a welcome closure to a contentious issue that had split the medical fraternity into two opposing factions (“Surgeon Susan Lim loses appeal”; Tuesday). Click here for background.

(Until the verdict was finally made known, no one had any inkling on which side of the fence the ruling would fall. Anyone who said “ I told you so” either had inside information or is a liar.)

 The “free market” proponents have no qualms about charging what they think is the “market rate” as, to them, medicine is just another means of making a living, and as patients come to them of their own volition.

“Caveat emptor” (let the buyer beware) being a dictum that is repeated ad nauseum, they think it must be permissible to charge what the market can bear. After all, in materialistic Singapore, is not wealth the main measure of a doctor’s true worth?

 The opposing faction is made up of the “traditionalists” whose most conservative members frown upon all forms of advertising. To them, medicine is a noble calling that is different from other professions, and it is crass to even promote one’s practice.

 Patients will find them by word of mouth, hence advertising is superfluous at best and a tool for false representation at worst.

 The appellate court has decided that “a doctor cannot rely solely on the morals of the marketplace” and that there is “an objective ethical limit” on medical fees, in both private and public health care, that operates outside of contractual and market forces.

 Doctors, especially in private practice, now face a very real problem. What is this proverbial “ethical limit” that has been bandied about? What may seem like a reasonable fee to one might appear to be “fleecing” to another, thereby leading to unnecessary complaints to the SMC.

There used to be a fee guideline published by the Singapore Medical Association (SMA), but this was scrapped in 2007 as it was deemed anti-competitive by the Competition Commission of Singapore.

(The GOF was mooted in the early 1980s when the Ministry of Health, the SMA and the Association of Private Medical Practitioners of Singapore felt a need to publish a fee schedule to provide greater transparency for patients. )

 It is surely timely to revisit the need for such a guideline.

 The Academy of Medicine, SMA and the Health Ministry should also come together to provide answers to the perplexing question of what the “ethical limit” is.

Huang Shoou Chyuan (Dr)

PS: Edited out parts in (brackets)
I had blogged on this issue several times and had some letters published in both Straits Times and Today
1.Click here
and
2. Here

How to shorten long A & E queues? - Patients referred from GP/Polyclinic should get 50% discount

 Dear Friends,

This is a suggestion to shorten the never-ending queues at the public hospital’s Accident and Emergency Departments that may be worth considering. Sometimes the queues can be longer than 4-5 hours ( not exactly a first world standard?).

I want to emphasise that obvious serious emergencies such as symptoms of heart attacks and major trauma ( eg broken bones)- of course should go straight to the A & E and I trust that the staff who do the triaging ( filtering) at the reception will get the doctors to treat these immediately. It is the rest ie not obvious emergencies- eg giddiness, fevers, pain here or there etc that I think may consider seeing the GP or Polyclinic. If the doctors at the GP/Polyclinic then direct them to A&E as they are deemed emergencies needing urgent and early intervention, then these should get a 50% ( or whatever sum) discount. Hence the total sum of someone who sees a GP + A&E ( referred) should be less than the flat fee of A & E ( direct self-referral). Eg Flat fee of A & E now ( approx $95), new amended sum ( if accepted) should be ( $43 + $25-30 ( GP’s fees)).

I did not add, that referred patients should join a fast-track queue also…

Addendum (19.1.13- same day)
Another non-emergency source of A & E attendance are the patients who go there to get referral to specialist clinics at the public hospitals.  Referrals to specialist clinics from A & E and polyclinics are considered subsidised and enjoy discounts whereas patients referred by GP's are automatically considered as non-subsidised and pay ( often substantial) full rates even if the patients are obviously poor. Those who are referred by GP's , and who then try to appeal to be downgraded to subsidised rates have to go through a sometimes demeaning process where they are interviewed by Medical Social Workers who pry into household incomes etc to see if there are any rich members in the family etc and hence do not deserve subsidies ie the Means test. This is the subject of another letter to the press...
 

Click here for the published letter ( which was edited slightly). Here

Below is my original letter.

Cheers,

Dr Huang Shoou Chyuan

Unabridged Letter

Dear Editor,

I wish to lend my support to 2 recent letters writers (Lower A&E fees for referred patients: Ms Soh Ah Yuen ) and (Why non-emergency cases throng A&E departments:Ms Wong Jee Kiat ) who suggested that patients referred to the Accident and Emergency Departments ( A&E) of public hospitals ( by GP’s and polyclinics respectively) should get a discount from the flat fee charged to patients who “referred” themselves there directly.

This is a sound proposition as one of the major reasons why patients (even emergency cases) need to wait for several hours before being seen by attending doctors is that despite best efforts at triaging patients at the reception area to identify patients who have life or organ-threatening conditions (eg heart attacks; airway obstruction) , many others with less dire emergencies but still require timely intervention nonetheless ( eg semi-acute bleeding from internal organs) are left to wait in the queue together with many who obviously do not have urgent conditions (eg patients whose companies do not recognize GP’s Medical Certificates (MC); mild diarrhoeas).

 

To incentivize patients to see GP’s and Polyclinics first , patients who have been screened by doctors at family clinics and polyclinics and deemed as emergencies that require urgent intervention at public hospitals through admissions at A & E, should get substantial discount from the said flat fee. This sum must be significant enough or else the thought of paying at the GP’s followed by paying almost the same A & E flat fee again if referred to A&E will not be any incentive. I suggest 50% discount so that together with fee from the GP or polyclinic ( if referred back) – will still be lower than the original flat fee.

 

The advantage in this system is that :

1.     Many who would have otherwise joined the throng at the A & E , would have been treated and followed up at the GP’s / polyclinics with no untoward effects to themselves

2.     Less non-urgent cases in the A & E queue would allow more accurate triaging ( which is still needed) and more expeditious treatment of whole range of dire to semi-urgent emergencies.

3.     This also has added advantage of increasing the work load at the GP’s ( which is good and may dissuade some from embarking on non-conventional branches of medicines e.g. Aesthetics)

 Other measures that MOH/MOM can consider include not allowing companies to only recognize MC's from A & E and not those from GP’s as the latter are bona fide SMC-qualified doctors.

A further disincentive ( but may not be politically-palatable) may be to surcharge those who ( even by any stretch of imagination) can consider themselves as having an emergency ( eg mild rashes with no associated organ symptoms etc) .

 

Unfortunately, there will be an increase in attendence at polyclinics who may need to beef up their staff numbers but their consolation would be that they have contributed to emergency cases being better treated at the A & E’s!

 

Dr Huang Shoou Chyuan