Stronger Together

Ng Chee Kwan

Dear colleagues and friends, I am honoured to be given the opportunity to lead the SMA Council for this coming work year. It has indeed been a privilege to work with my fellow Council members, who are some of the most capable and talented individuals that I have ever met. When I joined the Council nine years ago, I never expected I would end up as its President one day. At the time, new to private practice, I felt that I needed to find out more about what SMA was doing for doctors, and in particular, solo private practitioners such as myself.

Fruits of advocacy

Over the years, I have seen many instances where the advocacy efforts of SMA made things better for doctors and patients. One recent episode that comes to mind was in 2020, when one Integrated Shield Plan (IP) insurer consistently rejected claims for diagnostic endoscopies that were medically necessary. This policy contradicted with IP policy coverage for surgical procedures. If this change in policy was left unchecked, it would have gravely interfered with patient management and set a dangerous precedent where insurers could decide to withhold coverage for all other diagnostic surgical procedures, including biopsies.

SMA, with the support of the Gastroenterological Society of Singapore and the Society of Colorectal Surgeons (Singapore), submitted a letter to the Straits Times Forum to inform the public and also to urge the Ministry of Health (MOH) and the Monetary Authority of Singapore to look into the matter. Within a week, Life Insurance Association Singapore announced that all insurers would provide coverage for diagnostic endoscopies, and further confirmed that the insurer involved had reversed its position and would start approving new claims and settle previous claims that had been rejected.

There was also the DoctorxDentist (DxD) saga, where DxD – essentially a medical concierge – included the names and particulars of more than 1,000 doctors on their website without the doctors' prior permission When the doctors individually approached DxD to request for the removal of their details, they were met with steadfast refusal. SMA met with the representatives of DxD, and also published a letter to the Straits Times Forum in which we called for the particulars of affected doctors to be removed, so that they could regain control over their own advertising, in compliance with the Singapore Medical Council Ethical Code and Ethical Guidelines and MOH regulations. We also published a list of doctors who did not wish to be associated with DxD. Shortly after this, DxD removed the names of all doctors who were affected.

There are numerous other examples of SMA's efforts on behalf of doctors and patients, some of which led to a change or reversal of policy, while others took place behind the scenes, with success measured by minor tweaks in policy. I will be the first to admit that not all our efforts are as successful as the above two examples. I think that our appeal is more likely to be successful when there is a potential for many patients to be adversely affected, or if there is a potential for a clear breach of medical ethics. In such instances, it is more likely that the authorities will be supportive of our stance. If the appeal originates from a professional body such as the SMA, it would also be taken more seriously, compared to a letter written by someone in his/her own personal capacity.

Working hand in hand

I would like to borrow an analogy from the Star Wars series The Mandalorian. According to Wookieepedia (a Wikipedia-equivalent for Star Wars), "the Mandalorians were a clan-based warrior culture composed of members from multiple species and bound by a common creed, language and code".1 However, they were divided and often fought with one another, which is one of the reasons that they lost their "homeworld" to their enemies. In order to reclaim their home planet, two opposing clans put aside their differences and fought side by side against their enemies. In the words of their leader, they were "Stronger Together".

Similarly, doctors are bound by a common creed and code. We may not need to fight in hand-to-hand combat against enemies, but we do need to speak out for the good of our profession, and for our patients. Every year comes with its own set of challenges. This year, some of the issues that will affect doctors are the measures to cap rising medical costs, increasing complexity of medical licensing requirements, and a national shift towards preventive healthcare. With the support of our Members, SMA will be ready to tackle these challenges. I call upon you to encourage more colleagues and friends to sign up for Membership, take part in our various social activities or volunteer in our committees. We will indeed be "Stronger Together".

  1. Wookiepedia. Mandalorian. Available at: Accessed 8 May 2023.

Ng Chee Kwan is a urologist in private practice and current President of the SMA. He has two teenage sons whom he hopes will grow much taller than him. He has probably collected too many watches for his own good.