Letters to the Editor
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THE FIVE Cs OF MEDICINE
"... we should practise medicine with COMPASSION, with a CONSCIENCE, CREDIBILITY, with a CARING concern for our patients and in a dignified CHARACTER." - Dr Lee Suan Yew
Address by Dr Lee Suan YewTo those who have completed your housemanship, may I congratulate you on obtaining your licence to practise medicine, and for the overseas graduates who have chosen to practise in Singapore, may I wish you a fulfilling career in Singapore.
The next millennium is only nineteen months away. It is conceivable that medical practice will be more challenging and complex albeit a change for the better. New medical knowledge, better investigative tools, better therapeutics and rapid telecommunication will change the mode of medical practice. The future looks bright to the optimists. However, it may evoke mixed feelings in the cynical.
Healthcare costs will inevitably go higher and even beyond the reach of the average wage earner if left unchecked. To compound this there is so much stress on economic success in our highly mercantile society that commercialisation of the medical profession has not only taken root but also influenced our very fabric of good medical practice.
The traditional doctor-patient relationship is no longer a straight-forward trusting mutual relationship. There is now a third-party involvement as in the case of managed healthcare organisations. Unless there is sufficient vigilant monitoring, there is the danger of over-servicing or under-servicing innocent patients whenever profit-making takes top priority.
New alliances between medical specialists and commercial companies have created a new terminology called, "Profit Guarantee". The Singapore Medical Associations President, Dr Cheong Pak Yean warned recently that, "Medical practitioners who are involved directly or indirectly in the provision of the medical services associated with profit guarantees, whether imposed upon or voluntarily undertaken by them, are putting themselves at an increased risk of unethical behaviour, arising from the fact of patients interests may no longer be their first consideration". "The financial imperative imposed by profit guarantees is incompatible with the Singapore Medical Councils Physicians Pledge and other ethical principles".
Public listed companies serve the stakeholders first. We are assured by their executives that there would be no compromises in so far as medical ethics was concerned. The real test will be the assessment by Quality Assurance and Medical Audit Committees. Doctors involved in such practices should ensure that appropriate radical or surgical management must be fundamental and must not be compromised by financial considerations. Doctors, at all times, should avoid allowing any business arrangement to influence his decision-making, in the management of his patients.
The SMC Physicians Pledge forms the basic tennets of medical practice in Singapore. Even though there are only twelve major points in it, nevertheless, they are adequate guidelines for any decent practising physician.
It is not as stringent as some religious orders whereby you give up all your earthly possessions; you lead celebate lives; you eat simple food; you may have to beg once in a lifetime; you have to pray several times a day and you need to help the poor, the sick and the needy without any salary.
All we ask of you is to adhere to these twelve points. We should avoid bringing our noble profession to the level of the tradesmen. Instead, we should practise medicine with COMPASSION, with a CONSCIENCE, CREDIBILITY, with a CARING concern for our patients and in a dignified CHARACTER. These five Cs are quite different from the materialistic five Cs recently mentioned as Singaporeans preoccupation. These ideals and values will maintain the high reputation of our profession.
In conclusion, I would like to read to you an idealistic doctors prayer which I came across in an NUS postgraduate newsletter. I quote, "Enable me to fulfil my medical calling in Love, Wisdom and Integrity. Give me knowledge and diligence in the prevention, diagnosis and treatment of disease. Help me to bring comfort to the anxious and the sorrowing. Free me from selfish ambition. Grant me sincerity in all that I say and do. Strengthen me to persevere in the face of fatigue. Keep me always mindful of the need to maintain a high standard of medical practice at all times".
If this prayer is translated into practice, we can continue to practise medicine in the 21st century with our heads held high with dignity.K