The time may come when a whole new generation of teachers brought up in an environment where doctoring is no longer a calling ...


The study of medicine is not only the study of the human body and its afflictions.  It includes the study of man himself. We need doctors who are able to take care of people’s general health needs, who are able to relate, who are caring, who are knowledgeable and highly skilled, who are able to inspire by example and behaviour to  bring out the best in values in students, and at the same time inculcate confidence and compliance in patients. 

These values  can be epitomised by Ambroise Pare’s oft-quoted observation: “to cure sometimes, to care often but to comfort, always”. It is both a science and an art and it is best learnt by apprenticeship, where the teacher is master and the pupil apprentice. Ideally the master should be the role model whom the apprentice strives to emulate. 

Role models of my time 
“I joined the medical school in 1946 soon after World War II ended. Two of our teachers stood out, the late Professor G A Ransome and the late Professor DEC Mekie. They were particularly outstanding in teaching and in patient care. Like Osler, Ransome was best remembered for his bedside teaching of medicine. Mekie, to my mind, was one of the best lecturers the Singapore Medical College ever had”. 

“Ransome and Mekie could be described as complete doctors in their respective fields. We need such doctors, if not in fact at least in outlook to be teachers of medical students. The ideal clinical teacher should therefore have a broad based training even if he decides later to branch into a narrower field. Medical students are best initiated into medicine by generalists in order to gain the right perspective and to develop the ability to treat a patient as a whole person”. 

Role model characteristics 
What do role models have in common? They share these characteristics: 
(1) They inspire by their example and conduct. 
(2) They have a love of humanity. 
(3) They are highly skilled and knowledgeable. 
(4) They have a broad perspective of life. 
(5) They have an ability to teach effectively. 
(6) They are well versed both in the art and science of medicine. 
(7) They have the patient’s welfare as their foremost priority. 
(8) They have the necessary self respect which enable them to gain respect from others. 

Changes in health care system 
Singapore has undergone tremendous changes since gaining its independence, affecting almost every aspect of its citizens lives. Health care was not spared. Creation of health care as an industry has set up a parallel service to compete with public hospitals. Private hospitals offering specialist care has led to a depletion of doctors, including teaching staff from public hospitals. I believe most doctors still believe health care in whatever form is a calling, dedicated to the service of humanity.  It is of vital importance that this attitude be retained and passed on to our successors. The time may come when a whole new generation of teachers brought up in an environment where doctoring is no longer a calling but a service industry, leave behind them a legacy that commands little respect. To prevent this from happening, steps must be taken to retain good doctors and especially good proven teachers in the service. 

Reasons for staff exodus 
There are many reasons why doctors leave public service. Unsatisfactory working environment, insufficient pay to meet important needs, conflicting work demands, loss of erstwhile fringe benefits and slow recognition of work performance were some of the factors cited. These must be carefully studied by responsible people who have the authority to address the grievances. For comparison let me refer to earlier local role models.  I have excluded Ransome and Mekie who were not employed on local terms. Yahya Cohen, Wong Hock Boon, K Shanmugaratnam, N Balachandran, the late Seah Cheng Siang and many others all remained in Government service till retirement age, and for some even beyond. There were sufficient attractions in the service for them to stay. 

No doubt the private sector could have paid them more, much more perhaps, but their important needs were taken care of by salaries which commensurate with the then cost of living. They had meaningful fringe benefits that gave them added security. In addition, teaching appointments in those days conferred on the incumbents a special status which was highly prized. They were given recognition for their teaching abilities measurable by the quality of doctors they produced. To sum it, there was work satisfaction and a sense of fulfillment. I must agree conditions have changed considerably since then. New strategies must be found to retain role models both existing and potential ones. 

Role model development 
How can we encourage the development of role models? We should create an environment that gives due recognition to good medicine. We should create an environment that gives due recognition to role models for their multiplier effect. We should publicise career paths for outstanding teaching staff in addition to giving special awards. We should ensure those so identified remain in service by giving them: 
(a)    security in service and in retirement. 
(b)   promotions based on performance on primary responsibilities of teaching, patient care and research. 
(c)    protected time for teaching. 
(d)    protected time for research. 

We need to go beyond penalties and pressures. We need to inspire a whole generation of new doctors through their role models. 

Time is not on our side.  Doctors still in service who have inherited the legacy left  by the above role models are dwindling in numbers, through resignations or through attrition because of age. Special effort should be made to identify and retain them.  It is worth the extra expenditure to invest in those so identified. Their multiplier effect is the one effective means of producing more caring, more ethical and more competent doctors. 

I am indeed honoured to give a citation on Dr Wong  Heck Sing  who is the SMA Lecturer for 1997.  I have known Dr Wong  since 1981. 

Dr Wong was born in Singapore in 1923. He started his career as a pharmacist trainee and learnt all that needs to be learnt on the art of compounding tablets and mixtures from the pharmacy assistants in one year.  He decided that this was not going to be an interesting career and joined the Raffles College to study science. The war came and his knowledge of  pharmacy was put to good use. He related to me several accounts of how he helped to treat the war wounds of several civilians with whatever medicines he had. After the war there was a call for talented young  men and women by the then British colonial government to train as doctors. Dr Wong answered the call and started his medical education in 1946. 

Dr Wong is a self-made man. In the period of nine months, he worked as a canteen operator for the Dutch POWs and earned enough money to pay for most of his school fees. He was also appointed part-time demonstrator while he was a medical student to teach his juniors in  biochemistry in 1947-1948 and anatomy in 1948-1949.  For these teaching duties he was paid $50 a month. 

Upon graduation he went into general practice after serving his housemanship in the Government service. His first place of practice was in Bukit Panjang and later in Jalan Jurong Kechil next door to where Dr Cheong Pak Yean is practising today. At that time, his practice was, over large stretches of land, the only one in the Western part of Singapore. 

Dr Wong believed in voluntary work. He was for a period of 4 years from 1956-1960 an honorary doctor of Nantah. He told me he saw students from 6pm to 10 pm in those days.   He was also the voluntary doctor for the Lee Kuo Chuan Home for the Aged from 1964-1970 and Boys’ Town from 1956-1970. He was also the Corps Surgeon, St John’s Ambulance Brigade from 1958-70. He was also Vice-Chairman, Jalan Teck Whye Sec School Advisory Committee from 1968-71. 

Dr Wong is a strong advocate for family medicine. He was the President of the College of Family Physicians for three terms (1973, 1974,  1975-77) and again from 1983-1985.  He worked hard with a group of dedicated Council members to develop the College’s premises and realise its aims and objectives. 

We are proud of what he had set in motion. His thoughts on family medicine are encapsulated in two papers that  he presented. At the Singapore Medical Association’s 7th National Medical Convention , held from 17th to 24th April 1976, he presented a paper titled “Family Medicine in Singapore: Past, Present and Future”. He also gave the First Sreenivasan Oration of the College of Family Physicians on 19 November 1978, titled “The Future Singapore General Practitioner.”  What he said then provided the road map for the development of  family medicine in Singapore. 

Today, we have built on what Dr Wong and his pioneering group started.  Besides CME for family doctors, we have undergraduate teaching in family medicine and in the last ten years also vocational training in Family Medicine. Today, we have 63 doctors with the degrees of  MMed(Family Medicine). 

In the 1970s, Dr Wong was also actively involved with the world body of family doctors, WONCA (which stands for World Organisation of National Colleges and Academies). He was a member of the WONCA Executive  from 1976-78.  The good relationship between the College of Family Physicians, Singapore and the world body that Dr Wong and his colleagues initiated in the 1970s has persisted till the present day. This relationship has been helpful in nurturing the fledging family medicine movement in Singapore. 

Dr Wong has also contributed many years of his time to the Public Service Commission, playing the important role of selecting the leaders for the civil service. He joined the Commission in 1970. From 1973 up to his retirement in 1994, he was the Deputy Chairman of the Public Service Commission. 

For his contributions to our country, Dr Wong was awarded the Public Service Star (BBM) in 1983, the Meritorious Service Medal (PJG) in 1989 by the Singapore Government. 
Ladies and gentlemen, let us welcome Dr Wong Heck Sing to give us his 1997 SMA Lecture.