Like a Parent’s Love

Tan Yia Swam

SMA News has published several issues where medical families were featured – whether they are multi-generational, siblings, or husband and wife. It can sometimes be quite funny when you get to know the doctors in separate settings, and yet it has somehow never crossed your mind that they are related. It is hence surprising when you find out your colleague has a twin. No wonder he/she sometimes does not greet or acknowledge you – that was the twin who does not know you!

Purpose, joy and meaning

It is really heartening to read about such stories, especially when I also hear of friends who regret taking up medicine or friends who hope that their children will not have to walk the same hard path they did.

It is a calling to enter medicine, I suppose. There will be good times and there will be bad. One has to find one's own balance and figure out what is "enough" to persevere on. Whether it is the appreciation from patients and their families, peers and colleagues, or just the quiet satisfaction of a job well done. Appropriate financial remuneration helps for sure! Some of my friends are grumbling about pay cuts, and they feel disgruntled when they read news of pay raises for others. Money is always a sensitive (and sore) topic. I figured that it is better to close one eye and shut the other; if there is enough to get by day-to-day, that is enough of a blessing.

Working for a greater purpose gives me a more sustainable reason than just money. Helping someone who needs it and appreciates it is so much more meaningful than rendering a service for payment and being taken for granted. This seems to hold true for every job. It is the small little human touches that bring our lives joy and meaning.

Often, chit-chatting with the hawker, Grab driver, deliveryman or bus driver can bring a twinkle to their eyes. Each and every person is more than just their job. They have their own personalities, and their own needs and wants as well. It is not about being nice, it is a very simple basic human need and a simple common courtesy. If you have not done so before, give it a try!

Remember how we were taught to take a social history in medical school? I think many of us as students focused on the patients' smoking and alcohol drinking as disease risks. Later, when working, we used their social history to understand their family care structure in order to conduct discharge planning. Then as consultants, we finally have the luxury of time to chit-chat with our patients and take a real social history, and it is amazing what we can learn from our patients in turn. In fact, this can be done by anyone running their own practice and manages to structure the appointments such that there is ample time to build up a relationship.

We pick up the bits and pieces of information on the fields our patients are in, their passion, or their life journeys. We learn about their early childhood education, or how a stay-home mother of five home-schools her kids; we learn intimately about their hobbies, like making homebrewed craft beer or being an avid HDB gardener, and their occupations such as being a veterinary assistant, a competitive surfboarder, etc. We even learn about those who are survivors of spousal abuse and those who are overcoming the untimely loss of a child to illness or to suicide.

At the heart of it all

I ponder on the doctor-patient relationship a lot and on what is special about the relationship. It is not just the professionalism or the mismatch in knowledge, or even the power that doctors hold over patients. This might have been true decades ago, but the pendulum of the power equilibrium has shifted so much.

Doctors (and many other healthcare providers) feel like we have been denigrated to being mere "service providers". For those of you in administration, with your hand on your heart, can you deny this? We are held hostage to the sway of public (and social media) opinions. Our knowledge is constantly challenged by Google. 20 minutes of Google research is used to challenge and poke holes in our 20 years of studies and clinical experience. Hot and trending videos and viral content based on half-myths and quack science cause some patients to mistrust healthcare providers to their own detriment. When the complaint to the Singapore Medical Council (SMC) comes, doctors face the punishment, while the writers of poorly written search-engine optimised articles are rarely held accountable.

Insurance companies lay down various payment guidelines which sometimes hinder the provision of medical services (I do not mean this as an accusation, I state this as an observed fact). I have done what I can to best represent doctors and patients in the Multilateral Healthcare Insurance Committee, in order to bring some fairness to all. I sincerely hope that more doctors and insurers will join in the conversation to better understand the system's gaps and loopholes, and put patients' needs first. As I have always said, we will all be patients someday.

So what is the doctor-patient relationship? It is trust, mutual respect and love – love in an all-encompassing sense.

There is a Chinese phrase, "医者父母心”, which may be loosely translated as the heart of a physician being like those of parents, referring to the way we care for patients: to have no biases, but to love all our children (patients) equally.

If the patient I see in front of me were my own mother, how would I treat her? Would I order her around? Would I lay down all the options and let her decide on her own, without caring if she made a bad decision? Would I hide the truth from her and do what I think was best? Would I do everything possible to keep her alive even if it was likely to be futile? Would I protect her dignity and respect her choice? Would I stand by her through thick and thin?

Even as there seem to be tighter and stricter laws governing the practice of medicine, I tell myself that it is for the greater good. And I will not allow myself to become jaded. Even though there are increasing financial pressures across all sectors, I must not become a pure businessman.

I hold myself to the oath I made.

The SMC Physician's Pledge

I solemnly pledge to: dedicate my life to the service of humanity; give due respect and gratitude to my teachers; practise my profession with conscience and dignity; make the health of my patient my first consideration; respect the secrets which are confided in me; uphold the honour and noble traditions of the medical profession; respect my colleagues as my professional brothers and sisters; not allow the considerations of race, religion, nationality or social standing to intervene between my duty and my patient; maintain due respect for human life; use my medical knowledge in accordance with the laws of humanity; comply with the provisions of the Ethical Code; and constantly strive to add to my knowledge and skill. I make these promises solemnly, freely and upon my honour.

Tan Yia Swam is a mother to three kids, wife to a surgeon; a daughter and a daughter in-law. She trained as a general surgeon, and entered private practice in mid-2019, 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.