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An Occassional Word From Your Honorary Secretary-
"The Tasks at Hand Part 2: External Issues"

This is a continuation of Part 1: Internal Issues which is published in the last issue (July) of SMA News.

Last month, I had talked about the internal issues that SMA faced. This month, let us go into the external milieu and discuss what challenges lay in store for us:

a) Casemix

Casemix is coming. For many in the restructured hospitals, it has already come. For some of us not involved in hospital medicine, we may think it is irrelevant. This may not be so. Casemix will undoubtedly change the way medicine is practised in Singapore. It will not just change hospital inpatient care, but seen in the continuum of the patient traversing the breadth of the healthcare inpatient and outpatient system, Casemix will also affect outpatient care down to the primary healthcare level.

How do we respond to Casemix, as doctors? As the great Yoda said in ‘Phantom Menace’, "Fear leads to anger, anger leads to hatred, and hatred leads to suffering". To avoid unnecessary suffering, the profession must first replace fear of the unknown with informed opinion. An informed opinion of Casemix by the profession, one that serves to protect patients’ rights and safeguard doctors’ freedom to practice is perhaps the most important strategic ability that SMA has to develop as soon as possible.

Casemix is like a knife: it can help us cut out the unwanted and unhealthy fat in the system or it can mangle and mash up everything, including the bacon that we have to bring home. Casemix is a neutral tool that can be applied or abused either way. I do not think the profession should suffer out of ignorance or fear and should take part in discussing and influencing how Casemix is applied. The Ministry has invited SMA to send a representative to its Casemix Private Practice Committee. We hope that more of such participation by us is in the pipeline.

SMA will devote much attention and resources to Casemix in the coming year. Members will be informed and encouraged to take part in SMA’s Casemix activities.


b) Primary Health and Elderly Care

This may appear to be a flaccid and flogged-to-death issue. The same old tired vocal cords strain against the roaring tides of glamorous high-tech medicine without finding any resonance in the right hearts. The same old vacant echoes of developing primary health care without backing up with deeds and deployment of resources. As long as family medicine remains a high-volume, low-price 4-minute transaction, and geriatrics pays less than procedural medicine, these two are going nowhere.

This is actually not a bad business proposition for us doctors, as that means with poorer primary health care and later, more serious presentation of diseases, more and more medical work will end up with procedures and costly inpatient stays in the end ie. more money for us.

But frankly, SMA has a conscience and a social responsibility. Years have passed and opportunities lost, not for want for trying by SMA at least in the last few years. SMA will continue to be a lone voice in the wilderness until the tide turns and the medicine that we know now stops trying to rise with hot air and gets back on its two feet and stand on solid ground again.


c) Over-commercialisation of Medicine

Companies come and companies go, but doctors must still practise decent medicine at the end of the day. SMA’s stance against the over-commercialisation of medicine is like a public health physician’s constant surveillance against a communicable disease outbreak: we are always alert to its potential threat and possible emergence. First it was profit guarantees, now we have American-brand one-upsmanship medicine in the heart of town. Just the other day, SMA was asked to assist in compiling a list of ‘best doctors’. SMA was not very helpful in that matter, to say the least. And of course, there are still the innocent, ignorant and well-meaning folks who revel in promoting this over-commercialisation of medicine, because they probably think this can do wonders for our grand leap into the Information Age and being an Knowledge Economy, and of course their next promotion. All these we must guard against.


d) The Young and the Restless

Young doctors remain a major concern of SMA. SMA has made major strides in making itself relevant to young doctors. But new issues crop up all the time. We may not have to deal with low or no call allowance anymore, neither do, as I understand, housemen have to give repeat I/Vs and do hypocounts most of the time (to this, I must say we doctors should give our thanks to our nursing colleagues), but this does not mean that the problems of the young doctors can be dismissed as insignificant.

Some of us ‘older’ folks cannot assume that because giving I/Vs and doing 120 second hypocounts were the biggest problems of our lives as Housemen and that getting zero or 40 dollars for our calls was the gravest injustice known to mankind (and now that all these have been solved) that today’s housemen and medical officers have no problems.

Just as 5 of us ‘young Turks’ got together 4 to 5 years ago to solve what we saw were our biggest problems, SMA will still have to devote much effort to solving today’s problems among the young doctors, hopefully with the input of today’s housemen and medical officers.

We have the talent

Each of the above 6 issues I have discussed in this month and the last require not just SMA Council and Committee members to deliberate and decide. It requires the active participation of many different rank and file members with the requisite expertise and experience. Just as DPM BG Lee recently commented that a lot of the nation’s talent resides in the medical and legal professions, I am sure that if our profession could harness just a fraction of this immense pool of talent, SMA and doctors should do well enough to more than cope with these 6 issues and more, and not let others decide our professional well-being and destiny.