The SMA hosted our inaugural National Medical Students' Convention at Marina Bay Sands Convention Centre on 26 August 2017, as part of the Singapore Medical Week, in a bid to encourage our medical student members to participate in SMA activities. We were honoured that Director of Medical Services A/Prof Benjamin Ong was able to grace the occasion and give his opening address to the gathering of students from all three local medical schools.
Medicine used to be small community. Ten years ago in 2007, there were a total of 7,400 doctors registered to practise medicine in Singapore. Today, we have approximately 13,000 registered doctors in Singapore, and our third medical school, Lee Kong Chian School of Medicine, was officially opened recently by Deputy Prime Minister Teo Chee Hean on 28 August 2017. The three medical schools will be producing some 500 doctors a year.
During my time, there was only one medical school at the National University of Singapore (NUS), with 160 medical students in my cohort. Being in the same school meant that each batch of students would have contact with their seniors four years ahead and their juniors four years after them – which works out to be about 1,300 medical students gearing to be future doctors.
There was a good chance that these graduates from NUS Medicine would know many of their medical colleagues when they eventually obtained their qualifications. This was important when it came to being part of a small network of medical professionals after graduation. The medical officers and seniors were likely to be familiar faces – doctors whom freshly minted house officers could relate to in the stressful and sometimes harsh hospital environment.
Now that we have three medical schools and many more doctors per graduating cohort, it is no longer possible for students to get to know everyone within the medical community, and it is likely that they will someday be working with colleagues hailing from different schools, each with unique cultures.
In my address to the audience of students at the medical students' convention, I talked about the importance of forming good relationships within the medical profession early – to learn to regard each other as professional brothers and sisters.
Collegiality
Collegiality within the medical profession is about treating one another with professional courtesy and respect, being able to learn from one another, and having an eagerness to help and serve one another in a common purpose.
The Singapore Medical Council's Physician's Pledge is a compulsory vow that all physicians must take before they can become fully registered medical practitioners. One of the items that physicians declare is the pledge to "Uphold the honour and noble traditions of the medical profession; and to respect my colleagues as my professional brothers and sisters".
Respecting our fellow colleagues is an important part of professionalism. The practice of medicine is a collaborative endeavour now more than ever, with doctors being required to work in teams. If the common purpose is to do the best for our patients and to ensure the best possible outcomes, then collegiality promotes harmony within the team, and encourages open communication and consensus, and the sharing of skills and experience.
Respecting each other means that we intrinsically believe that all members of the team have something to contribute to the care of the patient. Junior doctors should value and respect the experience and clinical intuition of their senior colleagues, while senior doctors should possess the humility to accept constructive suggestions, be willing to pass on their knowledge to others in the team, and act as positive role models. I think that respecting each other is one facet of professional courtesy, and also the basis of the timeless but unwritten tradition in the medical profession – that doctors do not charge one another for professional services.
Collegiality is also about communication. When faced with a challenging problem in our clinics or ward rounds, this collegial relationship allows us to pick up a phone to call, or nowadays we can text a colleague, and consult one another to benefit our patients. In fact, the sharing of such medical information with colleagues in order to benefit the care of the patient can be regarded as an ethical obligation.
In recent times, the mutual respect among doctors seems to be eroding, with disputes and conflicts becoming more visible through social media. But of particular concern, and perhaps even more commonly experienced, are the incidences of disparaging and negative remarks made by doctors about their colleagues, especially to patients.
Some examples are:
"It is very fortunate that you came to the hospital, your GP should have referred you earlier!"
"You should not undergo this treatment; those doctors practicing in private are out of touch with the latest advances."
"These extra tests done by that doctor are useless and unnecessary."
Doctors are urged to refrain from making such remarks especially when they do not know the context of the case. These "casual remarks" are extremely erosive to a patient's trust in the doctors being blamed, and it also reflects badly on the entire profession. Needless to say, trust is a critical component in maintaining the public's confidence in the medical profession.
Patients often consult us to obtain our professional opinion about the appropriateness of treatment plans recommended by colleagues. During such second opinions, we may find that we do not agree with the suggested course of management previously recommended. When this happens, it is important to take extra care with how we communicate this to the patient. We can acknowledge the patient's concerns, inform them that we do not have the full facts of the prior consultation and encourage the patient to speak to the previous doctor to clarify.
Collegial behaviour needs to be inculcated early and it is best to start in medical school. Our medical students are rigorously selected from the top of their cohorts and are inevitably products of a highly competitive educational environment. We need to "rewire" them and mould them from highly competitive individuals to cooperative team-based doctors. One example of SMA's efforts to encourage team-based values is the SMA-Lee Foundation Outstanding Teamsmanship prize that was jointly established in 2009 by SMA and Lee Foundation for graduating Duke-NUS students, to mark SMA's 50th anniversary. The award serves to honour five students who have demonstrated exemplary team values.
The importance of networking among students from all three medical schools is absolutely essential, and gatherings like the recent medical students' convention should be the platform to stress the importance of teamwork, better communication and mutual collaboration, and encourage the exchange of ideas.