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"Out-going President's Valedictory Address at the SMA Annual Dinner 1999"

Minister for Health, Mr Yeo Cheow Tong, representatives from our sister medical organisations, distinguished guests, ladies and gentlemen and friends,

Tonight, I will be shortly handing over the Chair of Office to A/Prof Goh Lee Gan after the maximum three consecutive years as President of SMA. It has been a challenging three years at the helm. There were events that were difficult to handle but with a good team, we have achieved satisfactory outcomes.

The list of events is long and I would therefore like to allude to only a few of these. The rest can be found in the commemorative issue of the SMJ in the article "Conversation with Past Presidents." 


There are three strategic planning questions that we should ask ourselves periodically. They are equally applicable to the individual or to the organisation.

These three questions are:

  • Where are we now?

  • What have we achieved?

  • Where are we going and how?

Tonight, I’ll try and answer the first two and leave the in-coming President to answer the third question in relation to the SMA.


As we stand on the threshold of a new millennium, the Singapore Medical Association has 40 years of history. The video presentation has highlighted the more important evergreen issues and time-specific issues. The evergreen issues of professional image and the relationship between government and the medical profession as well as that between the doctor and the patient will continue to demand much of the attention of SMA, so will the ethical challenges of the business aspects of medical practice.

Of the time-specific issues in the next 5 to 10 years, I can see the world of health care dominated by the three "C"s of

  • control of healthcare costs,

  • consumerism and

  • confusion

in the face of rapidly changing technology and values.

There is a need for the national medical association to provide the leadership to work with the government, medical profession and the public to find constructive solutions to these challenges.


I note that there have been positive developments on some of the evergreen issues. I can say that the relationship between the Ministry of Health and the SMA has been positive and constructive in the recent years. The SMA has made its stand assertively on several ethical issues.

* Evergreen issues

The "profit guarantee" issue in 1997 is one example where the leadership of the Association had to make a stand. My Council and I were convinced that the "profit guarantee" arrangement will be in conflict with the interests of the patient. We adopted a landmark resolution against it. The Singapore Medical Council and the Ministry of Health subsequently reaffirmed the ethical principles of the resolution.

The practice of medicine today is made difficult by the changing values and perception of the doctor by the patient. More than ever, there is a need to empower our doctors to deal with ethical dilemmas. It is for this reason that we have made plans to set up the SMA Centre for Ethics and Professionalism.

This will be developed as the think-tank and education centre for the whole health care profession. It will be a centre set up to study and understand the dilemmas of medical practice and to empower our doctors to deal with the ethical dilemmas they encounter in their day-to-day professional work.


* Time-specific issues

Of the time-specific issues, several are worth mentioning namely, the study on GP fees, managed care and casemix funding.

A study by the Association on the practice costs of general practitioners in 1996 provided the better understanding why the GP fees had to be around $20 - $25 for a short consultation because of the high cost of rental and other overhead expenses. It also provided the information needed by the Select Government Committee in determining the amount of subsidy for patients seen at the Polyclinics.

The Association has kept an interest in the developments on managed care in the last few years and in February this year, we sent a team headed by Dr Lim Teck Beng to Australia to study the casemix funding system in Australia to understand the concepts and implementation issues.

* Open letter

One of the important policy in my terms of office has been the use of the President’s Forum in the SMA News to communicate with the membership. Since this publication also goes to the government, politicians and the press, it has become an open letter for communicating the views, ideas and concerns between the profession and the outside world.

* Facilitation of our sister organisations

One of the most enjoyable tasks in my terms of office lies in helping our sister medical organisations improve their systems of health care delivery through training. Through the regional medical organisation. MASEAN, with the secretariat hosted by SMA, and through bilateral relations we have mutually benefited from the exchange.

* Continuity

There is a need for the continuity from the work of one President to another. In A/Prof Goh Lee Gan, we have a new man at the helm who has been with the Association since the late 1970s. We have many shared professional values. I am confident that with the team that he has, the Association will scale bigger heights.


Together with my Council we have run a good race. We have tried to do our best to raise the image of the profession, to work constructively with the other stakeholders in health care namely, the government, medical profession and the public.