No more dr Oz bloke, just me

aka Dr Charlotte Charlatan

Sunday, April 08, 2007


I remeber watching a feedback session on TV between Melissa Hiak and David Lim (former MP and ex-President Scholar, later turned NOL CEO then left and dunno go where now) in 2001.

The topic was the increase in Ministers' salaries and scholars who break bonds.

I tried to call in to ask a question but could not get through.

David Lim was the one who said "If you pay peanuts, you get monkeys as ministers"

He also added that the Ministers put potential candidates through an extremely careful and thorough process to decide if the candidate is sincere in his desire to serve Singapore and hence the question of people entering politics for the sake of money is near impossible.

In the same session in response to scholars breaking bonds he said something about how scholars must learn to have a sense of loyalty and duty to give serve the nation and that it cannot just be about the best offer on the table for them.

He also added that PSC had a very rigorous process of selecting their candidates to choose the right candidates who would return to serve Singapore, but despite that scholars are still breaking their bonds.

I wanted to call in to say the following :

"Good evening Mr Lim. I have noted your comments regarding the two topics. Although the two topics are being discussed seperately I see a link and association between the two.

Regarding the Ministers' salaries, what you are saying is that the Ministers want to be paid what they think they are worth. And that in today's world it is only realistic to expect that you must pay the right amount to get the right people for the job. That I can understand.

So the leaders of Singapore speak this. And this message filters across our nation to every person in Singapore including the young student we have applying for scholarships. These students also take the same view. They take up scholarship, get to the very top in their Ivy League universities, are then head hunted by foreign MNCs and the offer to them is way in excess of what they would get when they return to Singapore. They remember the words of Singapore's leaders. Nobody wants to feel like a monkey when they could be paid huge sums of money. Hence they decide to allow the MNCs to break their bonds for them and take the high paying jobs.

The bond breakers are smart. They are merely following the principle set by our Ministers. Seek to be paid what you think you are worth and accept nothing less regardless of any reason.

I would also like to ask Mr Lim this : The Ministers are so sure that their method of choosing the right candidates for MPs weeds out the money-grabbers totally. But then the PSC's method seems to have been proven to fail. Why not apply the Ministers' methods of choosing candidates for office to the PSC selection process for scholars? Or could it also be possible that the "fail-proof" method of the Ministers can indeed have flaws as well?"

Anyway 7 years ago I realised there was something wrong with this whole way of thinking. And to be proven right, David Lim left office subsequently to join the private sector (NOL) where he would earn much more than what he was getting as a Minister of State. I have a very good friend whose father is a grassroots leader who works closely in David Lim's old ward. It was interesting to listen to how David Lim operated in his old ward.

7 years later, we are seeing the same debate. Ministers' salaries to go up by a million a year. Philip Yeo says Singaporeans are bond breakers and not hungry. Why not give the scholarships to foreigners who are hungrier and have the right values.

Don't they realise that leadership begins with me?

Wednesday, April 04, 2007

OMACOR revisited

Cedric asked me a question

"Hi,Ive just seen your comment about omacor on Angry doc's blog. You say that it costs 8 times the price for the same dose at a common health food store. Could you give me more info on that ? I mean : what is the cost of omacor, and what cheaper product are you refering to ?thanks!ceric"

I would like to direct Cedric to my post regarding OMACOR here

Cedric might want to read the comments section in that post for more info as well.

Basically OMACOR is just EPA/DHA in a 36%/24% fish oil capsule. That's your omega 3 fatty acids. Most common 1000mg fish oil capsule contain EPA/DHA in 18%/12% concentration.

The price of a common 1000mg of fish oil sold in Watsons is abotu $0.10-$0.15 per capsule.

Most of our propietary (non generic) lipid lowering drugs are about $1-$2 a pop. You can work out the maths.

Tuesday, April 03, 2007

SMA withdraws guidelines on fees

Angry doc has blogged about this.

Dr Huang has blogged about this.

And so SMA has withdrawn its guidelines on fees for clinics because the guidelines go against competition laws.

For the uninitiated, the guideline on fees was published by SMA at the request of MOH several years ago in response to complaints from the public that they were overcharged.

MOH tasked SMA to come up with a guideline on fees so that the public can be aware of what the upper limits of charges should be. Do note that I wrote upper limits.

As for doctors who were charging way below the guidelines, no action was taken against them. (There are quite a number of people out there who keep saying that doctors are a cartel and we set our own fees and decide how much to charge and how much we earn. But in most cartels that I know, there is no such thing as a cartel member undercutting the rest and getting away with it)

I also wonder how many people out there actually are aware that such a guideline exists? Do people know that public display of the guidelines at all clinics used to be a requirement under the Private Hospitals and Medical Clinics Act and Regulations? How many patients bothered to look at it?

In all of the cases where I actually used the guidelines on display, it involved explaining to patients that my $10 consultation fee was far below the recommended $20-$30 by SMA. To which they would exclaim "Wah you doctors want to rob people ar? $20-$30 just to talk to you?!!!"

I blogged about this before in 2006 to show that consultation fees for GPs had been dropping since 1998, especially if you count inflation. And this was if GPs had been following the guidelines on fees from SMA in 1998 and then following the increases in the next revision in 2006! (Hey even the Admin service had their last revision of salaries in 2000! So that's a 6 year interval whereas for SMA's guidelines on fees we waited 8 years to revise it!!!!)

I dare say that the majority of GP clinics were not charging according to the guidelines on fees. And despite the revision in 2006, few clinics actually increased their consultation fees after the revision was released.

For those who are interested you can read my analysis on the guidelines on fees here.

It might also serve as a free online old copy of the 2006 guideline on fees for you to refer to lest you think your doctor may be overcharging you.

Singapore is leaking talent

DDU asked "I thought Singapore imports workers from third world countries to do the menial jobs "

Don't know if DDU has read this

Singapore is leaking talent: SM Goh

TEHRAN: As he sat speaking to reporters about his meetings with Iranian leaders, Singapore Senior Minister Goh Chok Tong's thoughts were still focused on home.

Singapore, he said, is leaking talent. Not just ordinary talent, but its best and finest.

The concern bubbled over when he was asked if Singaporeans could ever be as proud as the Iranians.

"If we can last 1,000 years, I think we will be just as proud as the Iranians, probably even more," he said.

But the question bothering him was whether Singapore could continue to do as well over the next 50 years as it had done in the past.

"The issue which we are most concerned with is the loss of our own people at the very top," said Mr Goh. "These are bright young people, children of very well educated Singaporeans."

Some may study overseas, and the best ones were harvested straight away by companies there. And this often starts a spiral that ends up with Singapore losing these talents.

"They do not want to come back to Singapore. They want the experience of working in foreign universities, banks and companies," said the Senior Minister.

And often, two or three years down the road, these talented Singaporeans marry overseas and settle down there.

Even if they were to think of moving back to Singapore later, some find houses here too expensive. Others are put off by Singapore's shortage of space. Still others prefer the lifestyle in America, Europe or Australia.

"They don't come back; we lose them," he said. "This is a very big problem for us because if we lose the top 0.5 per cent from the next generation, Singapore will have a much lower 'peak'. The world is now competing on human resources and talent."

That was why Singapore, too, has had to turn to talented people from other countries, get them to work here and eventually turn them into Singaporeans. That was the only way to ensure that Singapore's population "peak" would remain at a high level, said Mr Goh.

The battle for talent has not just been between various countries. Closer to home, the Government stands to lose civil servants to the private sector.

Mr Goh said that it had been mentioned in Parliament that salaries in the civil service will be reviewed. Ministers' salaries are now pegged to those of civil servants.

"I personally support such a review because I know from my chairmanship of the Monetary Authority of Singapore that there has been a high turnover of staff over the past one or two years," said Mr Goh.

And since the finance industry as a whole expected wages to go up significantly this year, the MAS has a lot of catching up to do, he said.

In fact, the Public Service Division had touched on a similar point earlier.

It had said that 42 per cent of accountants who left Government jobs over the past year had cited better pay and prospects in the private sector.

About 46 per cent of legal service officers who resigned over the same period also expected higher salaries outside.

In Tehran, Mr Goh said: "I understand the need for civil service as a whole to revise the pay for civil servants. Of course that means that ministers' pay will also be revised, but by how much, I do not know. No decision has yet been taken." - TODAY

Thursday, March 29, 2007

Singapore in 30 years time?

It's been a while since my last post. I guess there wasn't much I wanted to blog which was really original.

But this morning I was thinking about what's been happening recently in Singapore and I had a vision of what Singapore would be like in 50 years time.

Currently, the authorities have liberalised just about everything to do with foreign imports, foreign workers, and foreign talents. The only 3 fields that seem to be sacred cows that can only be filled by Singaporeans are Cabinet Ministers, top civil servants and SAF Generals. Everything else.....well if we can find a foreigner who is cheaper, let's do it.

In 50 years time, it is certain that there will be more foreigners living and working in Singapore than we have today. That's a no brainer.

But I personally think that the majority of the population who are citizens in Singapore would be low income earners. All the middle and high income paying jobs will be taken up by foreigners. This is in line with the current policies the government has set up. In fact the policies are strictly discriminatory against Singaporeans by virtue that Singaporeans will always be more expensive to hire and the males have NS liabilities to boot.

The high income earners would be well traveled and few would actually reside in Singapore. This is already happening judging from recent comments from SM Goh when he was interviewed in the Middle East.

As for the middle income earners, they will be driven out of Singapore slowly but systematically with the current policies. They would have to move to other countries by virtue that it is cheaper to live in other countries and also that they might not be able to find middle income paying jobs in Singapore.

That leaves the low income wage earning Singaporeans who are left in Singapore.

It would be interesting to see though how the world views Singapore in 50 years time.

A nation where more than half of its population are foreigners (includes PRs) and less than half are citizens of the country. Native Singaporeans are largely low income earners working menial jobs. The leaders of the nation are the children of the political leaders from 50 years ago, more in line with the system of monarchy type succession.

The richest people in Singapore are all foreigners (includes PRs), all the top level positions in the private sector are filled by foreigners (includes PRs).

Uniquely Singapore.

Note: after thinking about this for the afternoon I realise that this situation will NOT happen. Because Singapore will soon allow dual citizenship. This would result in a jump of foreigners taking up full Singapore citizenship (they don't have to renounce their homeland) and thus on paper the number of Singapore citizens would be much more respectable.

The day of dual citizenship is very very near I reckon.

Sunday, January 21, 2007

Look what you've done

From CNA

Thai ITV agrees to pay 2.21 bln baht fine

BANGKOK, Jan 22 (Reuters) - Thailand's ITV PCL said on Monday it had agreed to pay 2.21 billion baht of the nearly 100 billion baht ($2.84 billion) fine the government has imposed for breach of contract.

The broadcaster, owned indirectly by Singapore state investment firm Temasek Holdings [TEM.UL], said in a statement it was still negotiating the final size of the fine with the government.

But ITV, which runs Thailand's third most popular television channel, said after a board meeting it was considering several options to raise funds to pay an additional sum.

ITV risks losing the right to operate if it failed to agree a final fine and payment timetable with the Prime Minister's Office, the department which owns the concession licensed to the broadcaster.

"If ITV and PMO could not negotiate on the issue and ITV was unable to pay the PMO within a specified time, the government agency has the right to terminate the contract," the statement said.

The company had planned to seek loans and raise money in a rights issue, but was unable to do so because of the uncertainty about the amount of the fine, ITV said.

In December, ITV lost its final appeal in the licence fee dispute with the PMO, which imposed a 97.7 billion baht fines for breach of its licence fee agreement.

ITV had appealed after a lower court ruled in May 2006 in favour of the PMO, which had sued the broadcaster to overrule an arbitration ruling which cut the company's fee payments to 6.5 percent of revenues from 44 percent in the original contract.

ITV is 53 percent owned by Shin Corp , for which Temasek paid $3.8 billion a year ago after buying the controlling stake of the family of ousted Prime Minister Thaksin Shinawatra.

ITV shares, valued at $39 million on the Thai bourse, were down nearly one percent at 1.10 baht at the midday break, when the overall Thai stock market was down 0.24 percent. ($1=35.16 Baht)

I was listening to this song and realised it was rather appropriate to dedicate it to Temasek and gang....

Wednesday, January 03, 2007

Funny comics?

Me : After reading Geoff John's Green Lantern: Rebirth miniseries I now understand why Green Lantern's ring has a weakness to yellow

Wife : Why is it superheroes are always attracted to the things that they have a weakness against?

Me : Huh?

Wife : I mean he's going out with Canary right?

Me after thinking for a while : That's Green Arrow! I'm talking about Green Lantern!

Wife : Oh oops sorry.

Me : And it's BLACK Canary who is going out with Green Arrow. She isn't the Yellow Canary! LOL!

Anyway if you don't understand the above, don't bother. Hee hee!

Monday, December 25, 2006

The customer is always right!

What do they teach you in the service sector?

The customer is always right! I totally agree to be frank.

This letter to the ST forum illustrates this very well.

And this reply from KKH reinforces my view.

I'll summarize the case in question. Customer goes to see the doctor and expects to have an ultrasound scan for her problem. The doctor says she doesn't need one. The customer insists she wants one. So the doctor reluctantly performs the scan and tells her beforehand that it would be normal anyway. But it turns out it is NOT normal. the customer is admitted to hospital and has an emergency operation that very night! Sounds scary eh?

Put it this way, an ultrasound scan is totally harmless. It has no side effects whatsoever. The customer wanted it. So why not serve the customer?

Ok so some doctors out there would say, most likely the scan would be normal. Well 9 times out of 10 you would be right, but then you can't be 100% correct all the time either. So why not just accede to the request, please the customer and make sure everything is alright? Or in this case, pick up something much less common but still nonetheless a dangerous pitfall?

The communication could have been indeed better. The customer SHOULD GET what they request for. But of course you are welcome as a professional to give an opinion of what the test is likely to show or not show. But nonetheless, why deny the patient?

I can only think of ONE reason. MONEY.

People don't realise that at the government hospital A&E's you pay a flat rate for all consults, test and medications given at that visit. Hence you don't earn more for ordering that scan or an extra test of any kind.

In the private sector, the customer is king. Whatever you want, we'll do it especially so if the procedure is totally harmless with no side effects! I am sure the guys at Mt E or Mt A or Gleneagles must be laughing when they read this letter!

In today's day and age....the customer is KING and IS always right. I pity the doctors working in the government sector though. They are schizophrenic.

One moment they are told that they have to keep costs low for the customers. Save on health care costs for the country. But at the same time, keep service standards world class. That's like saying you make sure customers don't buy those Bang & Oloufsen TVs but instead go for the Akira, Nachus or Prima brands? What kind of business is that? I can't imagine a professional TV expert telling his customer "You don't need a Bang & Oloufsen!"

Of course in this case it is a bit different. But then we are all taught in medical school the ICE of consults. The customer's Ideas, their Concerns, and their Expectations.

This can be applied to any service transaction don't you think?

When a customer wants something just give it to them.

On the other hand, customers should also be aware that SOMEONE has to PAY for what you want at the end of the day. It is better if it's you but if not then someone has to do it for you.