More logos I keep seeing on the streets!

Star Trek Logo

Audi logo
Mjolnir, Thor's weapon

Interesting Logos that I keep seeing

Lately I've been seeing these logos everywhere I turn.


The Flash's Logo

Wally West aka The Flash - "The Fastest Man Alive"

The Flash
The Family of Flashes : Headshots from left to right - Jay Garrick (Flash from the Golden Age), Barry Allen(Flash of the Silver Age), Wally West (aka Kid Flash and the current Flash)

Some aspects about Hitler

Some aspects that I read about Hitler in the Book Facism by Richard Tames:

"In his book (Mein Kampf), Hitler repeated the same themes on and on:

- Hitler will make this vision happen. Democratic parliaments make quarrels and weakness. Government is about leadership and loyalty, not discussion and compromise. Obedience to an inspired leader heading a disciplined movement of Germany's fittest and finest will bring unity and strength."

--- Fascism by Richard Tames, page 25.

Contact them directly!

I was watching the news last night and heard this opposition candidate say that one of the "services" they would provide to residents is a line for people to call and contact their MP directly on their handphones. And he challenged the incumbent MPs to provide the same level of "committment".

That got me thinking for a while whether that candidate knew what he was getting into. I mean being called anytime of the day? Anywhere? Anyone? Reminds me a bit of the time I was working and being on call 24 hours a day fortnightly, but worse!

But then again after thinking for a while, I realised that these were the same people who said they would quit their jobs and be full time MPs if the people voted them into parliament. Now I do know that the majority of MPs these days have full time jobs in addition to their duties as MPs. Some of these full time jobs are pretty heavy going themselves. Some MPs hold directorships in as much as 10 companies!

And yet the MPs have been reportedly doing great work for their wards. I mean everyone has at most 24 hours a day. You still got to sleep at least 4 hours a day. And the night hours from 12am to 6am are usually not the most conducive to do anything since most other people are asleep. So there is a definite limit to the amount of time one can spend serving people as an MP and holding a full-time day job.

So it got me thinking again what exactly does a full time MP do on a day to day basis during the normal working hours between 8am and 6pm? I mean most MPs would be working their day jobs during those times. Effectively we can call them part-time MPs. (I mean if they were to actually say they were full time MPs but part time manager of XYZ company, or Executive of ABC Accoutning Firm I wonder how the respective organizations would feel about such employees?) So what about those who would be full time MPs? Wha would they be doing during those hours from 8am to 6pm? I think maybe nothing!

I mean if the current MPs can do such a great job without working much during the hours from 8am to 6pm, then those hours are relatively non-essential. MPs do get an allowance anyway. So hey, having a direct line to the full-time MP is not that big a deal for the MP! After all he does about nothing from 8am to 6pm, we might as well give him a call when we have a problem! That's what he's there for isn't it? That's what we pay him for right?

The other way to look at it of course is to ask why don't those "part-time" MPs, full time job holders, forfeit their MP allowance or donate it to charity since they already make a good living from their day time jobs? I'm sure this could be a big political plus point for certain candidates if they said "Vote me and I serve you for free. No allowance! After all I already got my job or business." Otherwise I think if you are an MP and taking the allowance/pay, then you jolly well should take it as a full time occupation.

Downright nasty people

There are some downright nasty people in this world. That's a fact. These people are all around us everywhere as well.

And sometimes they end up as patients in the ER or in the clinic room. That's when my day gets all unpleasant.

Well what can you do? Turn the other cheek and let them whack you senseless? That's one way I suppose.

That's the price we pay as doctors. Worse still they are under some god forsaken HMO that pays pittance for consult and medicine (<$20!!!)

Tomorrow is another day, and it will be a good day......

Our National Library rocks!

I must say we Singaporeans who love to read are a lucky bunch. Our National Library actually rocks big time!

Very good. Very impressive. Very nice.

The selection of books is fantastic. There's something for everyone. You can borrow up to 4 books at a time for 11 days at any branch of the NLB. And you can return the books at any branch as well. The NLB has a website that allows you to search for books, reserve them. You can also download e-books and audio books!

My wife loves this! These days she's always reading from her PDA or listening to an audio book from her MP3 player. Goodbye to Sunny Bookshop!

And recently I realised NLB stocks graphic novels as well. Just borrowed "Fax from Sarajevo" by Joe Kubert, Chris Ware's "Jimmy Corrigan: The smartest kid on earth" and Will Eisner's "The Name of the Game" last night! This is fantastic!

I'm beginning to see all the good things about living in Singapore. Great parks to do inline skating. Great library to borrow your favourite media. It's all there. And best of all, it's all free. (Of course it's from our tax dollars but hey it's money well spent!)

If you want political discussions, this is not the blog for you

Just to remind everyone (or rather the void of nobody) that reads this blog, that this is NOT a political blog.

Some mild comments about Singapore are generally allowed but I do not encourage debates and fights.

It's all safe, harmless fun here ok?

If you want witty discussions about politics and the government, please go to this excellent often mentioned in the newspapers blog titled "Mr Wang Bakes Good Karma". You'll probably find what you are looking for there.

Trailer for Titanic the sequel

Found this trailer of the sequel to the Titanic!

I must say very impressive! (if you get what I mean)

I've changed......

I've changed ever since I started accepting and thinking seriously that I'll be living in Singapore for the rest of my life.

After watching MM Lee speak and all our senior statesmen speak, I tend to agree with them.

Singapore is too small, too young, too fragile to have any form of potential risk to our stability. MM Lee said that if you want to comment, you must comment responsibly. There must also be avenues for reply and action for recourse.

That is why we review things. Censor would be a wrong word. We review comments. And some comments we would have to edit because they harm society, cause disharmony and are simply not acceptable.

So for the good of the people and society and also to protect the commenters themselves, this blog will from now on delete comments that are offensive, abusive, and encourage disharmony.

Remember this is Singapore. You are not in Australia, USA or even the UK. We do what we have to do for the good of our young fragile nation.

Generation gap?

So MM Lee goes on TV and has a forum with journalists who are below 30 years old. And then the media goes berserk running letters and articles all over. Everyone is saying why is there a generation gap. It's no good and all.....

Well is there a generation gap? Maybe we should get the journalists to go to some older HDB estates or old folk's homes and speak to pre-1965ers instead of speaking to MM Lee. MM Lee is a man always ahead of his time. If anything he's ahead of the post 1965 generation and not part of the pre 1965 generation!

And if the journalist start saying that they are thinking in the same way that the pre-1965 generation is thinking I'd be extremely worried. I mean hey it's 2006 now! If the below 30 year olds are still thinking like the pre-1965 generation, it spells disaster for the nation! Don't you think so?

On the other hand I would say that a large number of below 30 year olds, do still think like the pre-1965 generation and thus the government need not worry so much and be" sad" or anything, there is in many cases absolutely NO GENERATION GAP!

We should be careful what we wish for.

Why do eye surgeons continue to wear glasses?

The Sunday Times ran an article asking eye surgeons why they choose to wear glasses and not contact lenses.

The answer given was that there was always a risk of infection with contact lenses. And they didn't want to have that risk.

Well perhaps they should have simply asked the eye surgeons why wear glasses when they are recommending all sort sof alternatives, contact lenses are obviously not one of them, but what about Lasik?

I always find it strange to see all these eye surgeons telling patients to stop wearing glasses, go for Lasik, operate on them all this while wearing traditional frame glasses themselves!

Some parallels with a obese and fat doctor teaching a patient how to lose weight. I would find it strange. Wouldn't you?

I think doctors should practise what they preach!

New Medisave claims for both public and private clinics!

I just finally got my hands on a copy of the Straits Times.

Front page article. 2nd last paragraph:

'The new Medisave claims can be made for visits to both public and private clinics, Mr Khaw told reporters, following an event to declare Woodbridge Hospital a historical site and to launch Buangkok Green Medical Park"

So it looks like my fears were unfounded. Kudos to the Minister for recognizing that private GPs do play a role in our primary health care system.

I look foward to serving my patients being able to tell them they can use their Medisave to pay for tests like HbA1c.

Consultation fees are up! Or are they?

The SMA recently published a revision to the "SMA guidline on Fees"(private practitioners). This is now the 4th edition (2006).

The 3rd edition was published 10 years ago in 1996.

Now let's take a look at how much health care has risen in the past 10 years!

In 1996 the guidline read as follows :

General Practitioner/Family Physician
In-Office Consultation Fees
Short consultation $18 to $26
Long consultation $25 to $55
Extended consultation (per 15 min block) $20 to $25


Out of office consultation Fees
Non-Emergency Consultation $100 to $150
Emergency Consultation $150 to $200
Hospital Inpatient Consultation (per day) $50 to $100

Specialist
In-office consultation fees $45 to $85
Long consultation $70 to $130
Extended consultation (per 15 min block) $40 to $50

Out of office consultation fees $150 to $200
Emergency consultation $200 to $300
Hospital inpatient consultation (per day) $100 to $200

The consultation fees DO NOT INCLUDE costs of medicine, injections, operations, special procedures, laboratory tests and otehr investigations eg X-ray.
Short consultation refers to routine consultation for relatively sinple medical/cases/problems, where the problems allow for quick diagnoses and treatment.
Long consultation refers to cases that are more complex and therefore require more time for diagnoses.

In 2006, the 4th edition reads as follows (percentage increase from 1996 in brackets):

General Practitioner/Family Physician
In-Office Consultation Fees
Short consultation $20 to $30 (up 11-15%)
Long consultation $30 to $55 (up 20% for lowest range)
Extended consultation (per 15 min block) $20 to $25 (no change)


Out of office consultation Fees
Non-Emergency Consultation $120 to $200 (up 20- 33%)
Emergency Consultation $200 to $300 (up 33 - 50%)
Hospital Inpatient Consultation (per day) $50 to $100 (no change)
Death certification $150 to $300 (new addition to guidlines)

Specialist
In-office consultation fees $60 to $100 (up 33%-17%)
Long consultation $90 to $150 (up 28%-15%)
Extended consultation (per 15 min block) $50 to $80 (up 25% - 60%)

Out of office consultation fees $150 to $200 (up 33%-25%)
Emergency consultation $200 to $300 (up 25% - 33%)
Hospital inpatient consultation (per day) $100 to $200 (up 25% for highest range)
Death certification $200 to $400 (new addition to guidelines)

The consultation fees DO NOT INCLUDE costs of medicine, injections, operations, special procedures, laboratory tests and otehr investigations eg X-ray.
Short consultation refers to routine consultation for relatively sinple medical/cases/problems, where the problems allow for quick diagnoses and treatment. Examples : for GPs, uncomplicated cases of influenza or gastroenteritis; for specialists, routine antenatal visits for maternity patients or routine post-operative office visits(added in 4th edition)

Long consultation refers to cases that are more complex and therefore require more time for diagnoses. Examples : for GPs, cases of diabetes or hypertension requiring detailed history, examination and advice; for specialists, complicated cases that require major surgery or complicated cases of cancer requiring detailed examination and discussion. 3 or more minor ailments qualify as "long consultation". Chronic conditions qualify as "long consultation" (added in 4th edition)

First and foremost, let me say that I am a GP. So I will only comment on the fees for GPs.

The price increase for short consultation hasn't gone up by very much in the last 10 years don't you think? Anyway it's a moot point because my clinic used to charge $5 for consult until about 2 years ago and today we charge a grand figure of $10 per short or long consultation (by the definition of the SMA guideline)

Before people start saying that the SMA is a cartel and is always raising prices to starve the people etc......let's consider the facts :

1) This revision is the first in 10(TEN) years! When was the last transport fee hike? Or hike in NUS tuition fees? I think 10 years is a long time and a revision was necessary which goes on to point number 2

2) Have rental rates have gone up in the past 10 years? What about salaries of staff? What about fuel costs? There is something called inflation. And from what I understand inflation rates average about 3% per annum. From the paltry increase of 11-15% for short consults by GPs I would say the consultation rates are growing below the inflation rate! So consultation rates have actually gone down.

3) In reality not many GPs actually charge the recommended fees from the SMA. Not even the lowest range of the fees. Some GPs are up in arms about this. They call it a lack of unity within our ranks. They call it "undercutting" each other. Everybody has their points to argue. But the reality is that the people cannot afford and do not want to pay for health care. The market forces have decided and some GPs are also understanding and compassionate. Hence some of us continue to charge lower than recommended rates. Sadly the public are not aware of this and continue to have misconceptions that GPs are raking in millions of dollars and constantly overcharging. In most cases, such allegations are unfounded.

I found it strange to receive this latest 4th edition of guidlines on fees when my clinic had hardly adhered to the 3rd edition done in 1996! Nevertheless, as doctors, our duty is to our patients. To do the best for them, see them recover, see that their chronic illnesses are well controlled and not run into complications. That is the raison d'etre of doctors. Let us all remember that.

However I do see that if the situation continues, I will have to consider if it makes financial prudence to continue being a GP. Perhaps pursuing aesthetic medicine, mesotherapy, cosmetic work, anti-aging medicine etc would be far more sensible.

As the columnist The Hobbit asked in the latest SMA newsletter, we should do a survey of GPs to find out what percentage of them provide aesthetic services. 50% of each NUS medical school cohort become GPs. If 50% of all GPs provided aesthetic services, that would mean 25% of each NUS medical school cohort would be doing aesthetic medicine work in future. Therefore shouldn't we include aesthetic medicine in the core curiculum for medical students? Otherwise we are not preparing them for the realities of medical practice in Singapore.

MOH to allow use of Medisave to defray costs of chronic illnesses

It's in the news today. MOH is going to allow patients to use their Medisave for the treatment of chronic illnesses. Diseases like hypertension and diabetes would be included in the list of chronic illnesses.

I applaud the move. For many patients, they choose not to do certain tests eg HbA1c because they do not want to pay for it even though we doctors strongly advise them to do so. I am not sure how it is with the polyclinics, but in the private sector GP clinics we do get some of these problems. Also some patients cannot afford our non-bulk purchase subsidized glitazones (eg Avandia) among other things. There have already been many cases of patients telling us they wish to be "transferred" to the polyclinic for further care and ask us to write memos to indicate this (because the polyclinics will not accept them if they do not have a doctor's letter. I find it ridiculous that we GPs have to write such memos when it has nothing to do with our decisions. It's the patient's decision at the end of the day. Who are we to tell the patient 'no you must stick with me!")

In the latest issue of the SMA newsletter, the new Perm Sec of MOH, Ms Yong mentioned that some private GP clinics do not have the patient numbers and feel the GPs are under utilized in the primary health system. She admitted that this was due to the way MOH structures our primary health care.

I applaud this new Medisave usage initiative because it would allow doctors to do their best for the patient with a minimum of obstacles especially financially. This leads to patients with better controlled hypertension and diabetes for instance, leading to reduced complications eg renal failure, retinopathy, heart disease, cerebrovascular disease etc. This reduces costs in the long run and more importantly reduces morbidity for such patients in later years.

However I would hope that the scheme is not confined only to the polyclinics and public hospitals. If it was I foresee that many patients would choose to forgo seeing their private GP who had been managing their chronic illnesses eg hypertension and diabetes. They would choose to go to the polyclinic to make use of their Medisave when they cannot by continuing to see their private GP. This would result in patients switching doctors. Polyclinics would see a large number of new patients with chronic illnesses armed with memos they had requested their GP to write saying they want to go to Polyclinic for follow up from now on so that they can use their Medisave. Is this really the intention of MOH? I hope not. Yes, you can say that one reason I say this is because I worry for my rice bowl. I would not deny that. However in medical terms it is also not a prudent practise to periodically have different doctors manage patients with long term diseases.

While I know some of the old folks I see will continue to come back to me because of familiarity and the relationship we have formed with one another, I feel it is unfair to them that the government would punish them for not going to the polyclinics.

The use of Medisave to defray costs should be extended to private GPs as well. I see no reason why not. The use of Medisave per visit could be capped at a certain amount. And the patient could top up the difference if the bill was higher regardless whether they are in the polyclinic or a private GP clinic. The money in the Medisave account is after all the patient's own money.

However I have a feeling the scheme will only be extended to Polyclinics and Public Hospitals. For this I am preparing myself with ready printed letters of referral to transfer patients to Polyclinics for their long term illnesses so that they can use their Medisave to defray costs.