Part of a Larger Whole

Tan Yia Swam

The SMA Council has decided to cancel, not just postpone, the SMA Annual Dinner this year, in view of the uncertainties of COVID-19. It's the first time in living memory that this has happened.

The SMA Annual Dinner has always served as a way for SMA to pay tribute to the long-serving volunteers and prominent leaders in our profession, honouring them for the contributions and sacrifices they have made for their colleagues and the public. It's also been a tradition for Council members to treat their families and friends to a grand dinner. I have always enjoyed letting my friends get a glimpse of what I do in SMA and the camaraderie that I enjoy. Those who stay to the end of the Dinner are always treated to a heart-warming performance that speaks well of brotherhood, loyalty and friendship.

However, not having a physical event for our award winners does not mean that we treasure them any less. Our team is working out a safe way to personally deliver the awards. In this issue we also feature the citations for this year's Honorary Membership recipients, Prof Chee Yam Cheng and Prof Phua Kong Boo. The SMA Honorary Membership is the highest honour the Association confers on individuals who have made tremendous contributions to our profession.

I first met Prof Chee when I joined the SMA News Editorial Board as a medical officer (MO). Through the years, he kept track of how many kids I've had, which specialty I entered, and of course, the progress of my SMA involvement. He is a mentor to many of us, in both medical leadership and advocacy. In his current appointment as the Singapore Medical Council (SMC) President, we look forward to continuing engagements with him and the SMC Council to strengthen our internal governance.

Prof Phua is well known to many of us who have passed through KK Women's and Children's Hospital's paediatrics department for our postings. His dedication to patients and to teaching is beyond question. I feel that what especially distinguishes him is his kindness. He may not remember this, but I recall my miserable performance for the paediatrics short case examinations. I was completely flabbergasted and tongue-tied when the first child burst into tears upon seeing me… I was also ready to burst into tears. Yet Prof Phua remained warm and friendly as he spoke to the mother and calmed the child down. That also calmed me down enough to complete all the stations. He exemplifies the soul of a caring healer, and we would all do well to learn this human touch from him.

Beyond clinical practice

The practice of medicine is not limited to the clinical aspects alone. We learn about teamwork and human fallibility. Mastering clinical practice and maintaining competency is the foundation for most of us. Some delve into research or education, some become administrators or businessmen, a few become leaders. It is remarkable how rich and diverse our local doctors are. My membership and active participation in the SMA and the Academy of Medicine, Singapore have enriched my medical career greatly.

In the past months as SMA President, my fellow executive committee members and I have been actively reaching out to larger segments of the profession: students from the three local medical schools and overseas universities, young doctors (via the Doctors-in-Training committee), and the private sector (via the Private Practice committee). We have also reached out to senior leaders of the profession. Hopefully, we have managed to touch base with a few hundred colleagues more personally. Telegram has given us a great platform for informal engagements, and any complaint is just a tap away! I am constantly encouraging current Members to be even more active-speak up, donate your time and your expertise or network to help better the profession. Members can help the SMA advocate as well, and bring in more members, so that our collective voice can be even stronger.

We will do our best to show the general membership the activism we have constantly been doing. It is always with much sadness when I hear doctors saying "SMA is doing nothing". Only the Council and active volunteers know how much time and effort we put into SMA and its work.

Healthcare economics

A huge aspect of SMA's work is in educating and advocating for our profession. There's this huge, terrible monster called healthcare economics, which I think most clinicians know very little about. During my time in the public sector, I wondered how best to grade trainees on the "cost-effectiveness" component of the six-month evaluation. As doctors take over the portfolios of heads of departments or division heads (ie, senior leadership positions), they have to learn about costs. For those of us who venture into private practice, we must learn – this is why we have titled the SMA Private Practice seminar "Taking the Plunge". It's often either sink or swim.

I have been hearing about the ongoing problems with third-party administrators, insurances (Integrated Shield Plans, corporate plans), panels, co-payment, etc, since I first joined the Council as a relatively naive MO. For the colleagues who first learnt about this when they joined private practice in the past one to two years, it came as a shock, and perhaps with dismay, at how much healthcare economics affect health-seeking behaviours.

Many have complained to me and offered what they saw as instant solutions. I understand the anger and outrage, and I will tell you that we are looking into solutions for this immensely complex problem. If quick fixes could work, these problems wouldn't be present now!

Working together for a solution

Let's all be part of the solution. Read up past issues of SMA News to understand the breadth and depth of the problem. Talk to other doctors, non-doctor friends, administrators, accountants, lawyers, business people, and friends in positions of power and influence. Educate your patients, the public and yourself on health insurance products.

Understand how our local healthcare system works – its infrastructure and limitations. Read Myth or Magic by Dr Jeremy Lim. Read the Medical Registration Act and keep abreast of the proposed changes. Read the SMC Ethical Code and Ethical Guidelines. Sign up for SMA Centre for Medical Ethics and Professionalism courses. Be part or a professional body, whichever best represents your needs. (If I may do a sales pitch here, the SMA membership is the lowest priced and probably the most flexible.) I envision great things that the SMA can achieve – I hope, if I ever come to you for help with the SMA's work, you would not say no.

Once again, thank you to the dozens of new (and old) friends who have reached out and willingly volunteered for the various committees. This infusion of new blood and energy is what is needed for growth. My thanks to the various doctors with second careers who have given your time and expertise to help this simple surgeon better understand the other forces at play, so that we can lead a change for the better.

Tan Yia Swam is a mother to three kids, wife to a surgeon; a daughter and a daughter-inlaw. She trained as a general surgeon, and entered private practice just over a year ago, focusing on breast surgery. She treasures her friends and wishes to have more time for her diverse interests: cooking, eating, music, drawing, writing, photography and comedy.