Letters to the Editor
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Presidents Forum -
"What does SMA Stand for?"
What does SMA stand for? This is a question that members in the SMA Council need to ask time and again. As the new President, I would like to share with the SMA members what I feel it should stand for. SMA should stand for the medical profession, its members, the patients whom we care for, their significant others, and our national interests.
The Medical Profession
The SMA, to be effective, needs to be recognised as a guiding light for the profession. The contributions of the past Councils certainly have made a mark. We are asked for our opinions by our colleagues, sister medical associations, our Ministry of Health, other Government Ministries as well as many patients who wish to know if their doctors are doing things right.
Modern day practice is complex. Donald Irvine writing as the President of the General Medical Council in the BMJ in 1997 observed the United Kingdom setting, "Many doctors are unhappy at the impact of these developments on their ability to practise in their own way. Yet the public expects doctors to help make the system work well"(1). His observations are equally applicable to Singapore and for that matter worldwide.
He went on to say, "To retain our independence, and reasonable control over our affairs, our professionalism must be capable of adapting to change ... . Medical professionalism rests on three pillars which together constitute the basis of our independence or autonomy: expertise, ethics and service. Expertise derives from a body of knowledge and skills whose utility is constantly invigorated by the results of research. Ethical behaviour flows from a unique combination of values and standards. Service embodies a vocational commitment to put patients first."
In working towards the first pillar of professional autonomy, expertise, the Academy of Medicine, the College of Family Physicians, the University and the Graduate School of Medical Studies must identify and fulfill the needs of doctors in a changing world. The Singapore Medical Journal aspires to be a forum where doctors from different disciplines can share with one another, recent advances and reviews, broadcast the results of local research, and provide every doctor something for his or her continuing medical education. A new column in the Journal is being planned to meet the educational needs of younger practitioners by getting more knowledgeable and professionally seasoned peers to write on "how to do it" and "how I will approach it" on problems seen in everyday practice.
For the second pillar of professional autonomy ethics, there is a need for us to accept professional self-regulation. The ability to be reasonably free to do things is conditional to accepting and actively performing this regulation. Herein lies the pivotal question on the role of the SMA Ethics Committee. Is it to set standards, to mediate, to chastise or to advise?
Perhaps all of these. In the name of self-regulation.
The complaint letters received by the SMA Ethics Committee tell us in SMA many things about patients and doctors. They range from unreasonable patients to unreasonable doctors. There are also doctors who need to learn the art of professionalism. And the substance of professionalism should be taught at all levels of medical education as part of the professionís response to changing societal expectations(2). Towards this end, the SMA will be setting up a Centre of Ethics and Professionalism collaboratively with the University. It is hoped that it will be a forum where doctors can learn to empower themselves to practise will confidence and commitment.
For the third pillar service, there is a need for the commitment to put patients first. There is a need for constant self-reminders. In a world of commercialism, the alluring icon of a successful doctor gauged by the dollars he earns needs to be examined, as a national objective. Commercialism and commitment to your personal commitment be to put patients first?
There is always a need to do more for SMA members. To do better in this area we need to do some assessment of doctorsí needs. Perhaps, members could suggest ways in which the Association can help them professionally. Having focus groups is one way of assessing such needs. Getting members to write is another. I look forward to receive your letters.
Patients and significant others
It is difficult to be a doctor. It is probably more difficult to be a patient. Indeed, it has often been remarked that it is better to die than to be sick in the modern world. There is a need therefore for us to perceive the patients whom we care for as constituents in need of our help and support. Education of patients on the choice of treatment, the natural course of disease and illness, and the proper use of the different levels of care is a social task SMA needs to undertake. We need to do more.
As doctors and health care providers we do have important views that relate to wellness, illness, disease and social aspects of Medicine from the national viewpoint. As a profession we must be able to give expert advice and opinion to our politicians, our people and our Government. It is important to remind our entrepreneurs 3 important points time and again: (1) Healthcare is an investment to the nation and not a consumption item; (2) The practice of medicine is not a trade but a profession made trustworthy to the user by self-regulation; (3) Entrepreneurs as good corporate citizens, need to follow a common code of ethics and have good corporate governance.
Do the right thing at the right time
What Hippocrates has said in BC 600 with regards to the individual doctor is relevant to the leadership of the Association too. Let us try to do the right thing at the right time together.
"Life is short, art is long, experiences fleeting ... the physician must do the right thing at the right time."
1. Irvine D. The performance of doctors. I: Professionalism and self regulation in a changing world. BMJ 1997:1540 (24 May).
2. Cruess SR and Cruess RL. Professionalism must be taught. BMJ 1997; 315:1674-7 (20 December).
A/PROF GOH LEE GAN