No more dr Oz bloke, just me: December 2006

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.

Wednesday, December 20, 2006

Doctor fined $2500? (Only?)

Read this in the papers today.

A doctor's delinquency

Mismanagement of Subutex prescriptions results in $2,500 fine

A DOCTOR in Woodlands has been found guilty of failing to properly administer Subutex — the first such case since the medicine was listed as a controlled drug in August.

It is believed that several other doctors are under investigation for the same reason by the Singapore Medical Council (SMC).

Dr John Heng Kuo Leng was fined $2,500 by the SMC and given a stern warning for mismanaging 19 of his patients.

Incidentally, this is not the first time the 47-year-old general practitioner from First Medical Clinic and Surgery has been censured.

In 2004, he was suspended by the SMC for 18 months for dispensing addictive cough mixtures and sleeping pills too freely at his clinic in Woodlands Street 11.

This time round, one of the charges levelled at the doctor is that he did not record and provide sufficient patient details and results of the diagnosis.

A council disciplinary inquiry last week found him guilty of mismanaging the 19 patients between December 2002 and February 2004.

It goes to show that the problem was really bad. No doubt about it but those doctors were doing very bad things. And it is no surprise that this doctor was not a 1st time offender. Same pool of patients, same nice market.

What surprises me though is the punishment meted out.

$2500 fine and a few stern words?

I think SMC is sending a signal out to young doctors like myself. Make your millions selling all kinds of sleeping pills, addictive medicines etc then get slapped with a bit of a pocket change fine +/- a short suspension for you to go on holiday and sabbatical then come back with the latest addictive drug and make a few million after 1-2 years and then go on holiday again.

Looks like a wonderful plan to me!

This topic was discussed before.

1 tablet of Subutex earned profit of $20. This doctor had 19 patients taking 1 tablet a day. 19 X $20 = $380. $380 profit a day. $380 x 365 = $138,700 $138,700 x 2 = $277,400. So that's how much he earned over 2 years with just 19 patients. And this is if he had totally been doing everything all well and proper. Who's to say he wasn't prescribing more than 19 tablets a day?

There were an estimated 8,000 Subutex abusers according to MOH. Let's say each of them take 1 tablet a day. That means 8,000 tablets are sold a day. Each tablet gives a profit of $20.

Subutex has been around for 4 years?

So in total the profits over the past 6 years = 8000 x $20 x 365 x 4 = $233,600,000!

$233.6 million over the past 4 years! And if you divide it by the 35 GPs registered to sell Subutex, each GP made $6.67 million over the past 4 years!

That's an incredible amount of money! Maybe I've been doing the wrong sort of work all these years!

Thursday, December 14, 2006

This is why Singapore's service standards are so screwed!

I was pretty shocked after I read Tabitha Wang's latest "Budget Tai Tai" column.

Bad service can drive you Nuts

Some days, it's apathetic service at every turn

Budget Tai Tai • By Tabitha Wang

The other morning, I tried to get something sent overseas at a convenience shop. An international courier company had signed on the shop as one of their drop-off points.

What an innovative idea — or so I thought, until I went to the counter.

"Cannot," the shop assistant said. "We don't do such things."

"But your shop is on the courier company's website," I protested.

"No, don't have. Never heard before."

When I insisted, she gave a theatrical sigh, then said she'd phone her supervisor when she had finished serving all her "legitimate" customers (who wanted nothing more mentally taxing than a can of soft drink or a packet of crisps).

After giving me a few hard stares to will me to leave, she finally called her supervisor, reluctance written all over her. Thirty seconds later, she turned to me and then said: "Ya, got such thing. Give me your parcel."

I wish I could say that this was an isolated incident but I've encountered many sales people just like her.

Their motto: If in doubt, just say no.

Is it possible to get free alteration? No.

Can I have mashed potato instead of fries? No.

It's as if they've been programmed with a set script — greet customer, give product, get money. Heaven forbid if there's a deviation because their brains just shut down.

Now I understand what Creative boss Sim Wong Hoo meant when he said in his book, Chaotic Thoughts from the Old Millennium, that Singaporeans are Nuts. He coined the phrase, No U-Turn Syndrome, to describe how we need someone in authority to tell us what to do before we can proceed. To describe this, he compared local traffic rules to those found overseas.

Here, drivers can't U-turn unless a sign allows them to do so, while in other countries, drivers can U-turn unless a sign forbids them to.

"When there is no rule, we cannot do anything. We become paralysed," he noted.

You see this problem most with service staff here, mainly because they're lowest in the pecking order in any shop or restaurant. They don't dare to deviate from the rule book because they know it might incur the wrath of someone higher up in the organisation.

And in most hierarchical Singapore companies, that's not an exception, it's a given.

If there are no rules specifically allowing them to do something (for example, offer rice instead of baked potato), they will err on the side of caution and say no.

This apathy may serve them well but it sure doesn't serve me, as a customer, at all. While I may sympathise with them, that doesn't stop me from feeling irritated just the same.

Given the Nuts around, it will be impossible to ask them to change by themselves. If we want better service all round, sales managers should be trained to give their underlings more control.

A good example of this was in a restaurant I recently visited. Because they were having an a la carte buffet promotion, the place was packed and the two waitresses there had their hands full trying to get the orders right. Inevitably, orders went missing and tempers were frayed. What I expected to be a quiet half-hour meal turned into a long-drawn two-hour affair.

At the end of the meal, I told a waitress that it was the worst dining experience I'd ever had. I was prepared never to step foot in the place again. But she totally disarmed me by apologising and, without applying to her manager, gave me a $10 voucher.

"Please come again. I promise we'll do better," she encouraged.

I was impressed. By trusting her with the vouchers, her bosses had allowed her to use her initiative, wow customers with good service — and drum up more business.

There's no prizes for guessing which place I'd be going to again. I'm never going into that (in)convenience store again, not even for a pack of crisps.

The shopaholic writer has no qualms dealing with shop assistants, as long as the first word that comes out of their mouth is not "no".

Hello? But will somebody please tell the Budget Tai Tai that this IS exactly why Singapore's service standard are so screwed up!

A restaurant hires 2 waitresses for a busy packed restaurant offering a buffet! Vastly understaffed if you ask me. Service has to be atrocious and Tabitha herself said it was the "worst dining experience I'd ever had"

And all of a sudden it becomes no prizes for guessing which place I'd be going to again?

All because of what? A $10 voucher!

So you see. The restaurants and service staff know what is it that Singaporeans want. It's not good service. It's cheap food and good prices with freebie vouchers to give away. Your service can be the worst in the world, but just give a $10 voucher and you become a place they'd go back to!

Actually I'm not surprised by this fact, because it is true about Singapore and Singaporeans. Tabitha Wang proves she is a typical Singaporean. No problems with that.

However the tone of this article seemed to be an attempt to "fix" Singapore's problem with bad service. Hardly a solution. In fact it's a stab at perpetuating or worsening the problem!

Shocking. Absolutely shocking.

Thursday, December 07, 2006

Appropriate use of my money? I think not!

This was the headline news in the Today paper this morning.

The long arm of ethics
Why holding Shorvon accountable is important to the S'pore Medical Council

Tor Ching Li
chingli@mediacorp.com.sg

WHEN he came to Singapore in 2000 as chief of the National Neuroscience Institute (NNI), Professor Simon Shorvon was acknowledged as one of the world's leading authorities on epilepsy.

Today, his reputation is in tatters, his research is on hold and the 58-year-old is talking of "early retirement" as the Singapore Medical Council (SMC) and its team of lawyers has followed him all the way to Britain to make sure he answers for his actions.

The vigour with which SMC has pursued the Shorvon case — even beyond Singapore's borders — has surprised legal circles, but the council says it had no choice.

What's more, as Singapore becomes a biomedical hub, the SMC says that if any foreign doctor breaches ethics here, he won't get away merely by fleeing Singapore. It will pursue him wherever he goes, taking up the matter through its foreign counterparts.

The Shorvon case shows how determined it is to make this point.

Given a $10-million grant here to conduct research on Parkinson's Disease and other conditions, he used some patients as unwitting guinea pigs. Their medication was changed without their knowledge. In some cases, they were told to ignore the regular prescriptions from their neurologists.

The NNI sacked him in 2003. He was struck off the Singapore medical register and made to pay a $10,000 fine and foot the SMC's $175,000 legal costs. As Prof Shorvon moved back to England, the SMC informed its counterpart, Britain's General Medical Council (GMC), of its findings.

If this was routine, the SMC's resoluteness to hold the former NNI chief accountable became clear after this point.

As GMC prepared for a public inquiry into Prof Shorvon's conduct here, the SMC and its solicitors made two trips to London to assist them.

It discussed options including video-conferencing or sending doctors and patients from Singapore to London for the inquiry.

In September last year, the GMC decided to drop the inquiry as its independent expert, Prof A C Williams, felt that Prof Shorvon's offences here were "of a relatively minor nature".

Far from letting matters rest, the SMC appealed against GMC's move in the British High Courts.

It has hired Queen's Counsel David Pannick to present its case there. And apart from pointing out inaccuracies in Prof Williams' report presented in a two-day hearing this week, Mr Pannick has spelt out the SMC's stand: It feels that Prof Shorvon has a strong case to answer, and he should answer it.

Dr Lau Hong Choon, SMC's executive secretary, told Today that GMC's cancellation called into question the "integrity and independence of the SMC's findings against Prof Shorvon".

SMC president Prof R Nambiar said that Prof Shorvon's ethical lapses were "serious", and the standards to be upheld as "internationally established principles of medical practice and research and must be strictly complied with in all research projects".

Prof Shorvon has said that the SMC has no right to contest the decision of Britain's GMC, and told The Straits Times that his reputation, career and salary progression would be seriously compromised if the GMC continued to inquire into his conduct in Singapore.

Between 1997 and 2003, he received grants worth $21.5 million. He has received no grants since 2003.

But Dr Lau said there was a bigger issue involved.

"The SMC has an interest in upholding Singapore's reputation as a place where foreign doctors can practice medicine and conduct biomedical research, in a framework of internationally well-accepted ethical standards," he said.

"Foreign doctors may practise medicine or conduct medical research in Singapore. However, if medical ethics are breached and patients are harmed, they should expect to face disciplinary proceedings before the SMC.

"If these doctors leave Singapore in a bid to avoid such disciplinary proceedings, the SMC will pursue the matter through its foreign counterparts," he added.

Still, criminal lawyer Bajwa Singh commented that the SMC's move was unusual.

"It is unusual for the SMC, or for any other professional body in Singapore, to pursue a matter outside the jurisdiction of Singapore," said Mr Singh.

"One reason for not pursuing is that our bodies usually have no standing to take action in a foreign jurisdiction — though in this case they do seem to, or they would not have filed for action. On the other hand, the obvious rationale for taking action is for a matter of public interest and duty."

The British High Court will come to a decision before Dec 22. The legal costs will then be decided between the SMC — which is funded by registration fees of doctors in Singapore — and the GMC depending on outcome. Should the SMC fail in this appeal, there are two other tiers of appeal — to the Court of Appeal and subsequently the House of Lords.

Can someone explain to me why the money I pay for my medical registration fees is being used to hire a Queen's Counsel in the UK to prosecute Prof Shovron?

Anyone?

This is what happens when the government tries to go naked!

A few days ago I wrote about asking the government to be more than transparent. That they should go naked.

Well sometimes the government does seem to go naked. But reading such letters from the government makes me wonder if they think Singaporeans are stupid and blind?

I mean I may be stupid. But I can still tell when the babe you are trying to pass off in Playboy is actually a man you know!

HDB consistently incurs losses selling new flats

I REFER to the letter, 'No subsidy in new HDB flats, just a discount' (ST, Nov 25), by Mr Cheong Chee Mun.

Mr Cheong said that HDB acquires land for public housing at 'very low cost'. This is not correct. The land for public housing is purchased from the Singapore Land Authority at market value, based on the Chief Valuer's assessment.

The total cost of developing four- and five-room flats is higher than the example of $200,000 mentioned in the letter. The development cost is even higher in mature HDB estates where the market valuation of the land is higher. Hence, the assumption that HDB enjoys a profit of $150,000 per flat is wrong.

HDB has consistently incurred losses in the development and sale of new flats. It is unable to fully recover the costs of development as it sells new flats at a subsidised price. Together with the other types of housing subsidy, such as the CPF Housing Grant and the Additional CPF Housing Grant for lower-income families, the sale of subsidised new flats results in a tangible and substantive cost to the Government. Specifically, over the last five years, HDB's home-ownership programme incurred an average annual deficit of $390 million.

Kee Lay Cheng (Ms)
Deputy Director
(Marketing & Projects)
For Director (Estate Administration & Property)
Housing & Development Board

You want Dr Patch Adams in Singapore?

Read this letter in the Today newspaper.

Where's the spirit of care?

A hospital should not be a place that patients dread

Letter from Adeline Ang P Y

I refer to the Coffee With interview, "A healer, not a doctor" (Dec 4).

Earlier this week, I visited a child cancer patient in hospital, and got the feeling that the human touch was missing in the healthcare services offered to the patients.

When I was a medical student, I did watch the movie Patch Adams starring Robin Williams. It was quite inspiring, but I doubt any medical student would have thought of doing such a thing.

Singapore is all about being conventional. Being careful. You simply don't try to be funny.

Ironically one of the leading stories in the Today paper this morning illustrates my point nicely.

YouTube, you leave

StarHub fires temp staff for 'misconduct' in office

Loh Chee Kong
cheekong@mediacorp.com.sg

THEY wore company T-shirts. They horsed around in the office and posted clips of themselves on the popular online video sharing website YouTube.

It was after office hours and in their mind, it was harmless fun, but the company did not see the funny side of it. Now one of the two temporary employees engaged by StarHub has been let go while the other is facing possible disciplinary action.

The two clips — posted in October — were two to four minutes long, and showed Mr Terence Tan, 25, and a colleague in a company T-shirt playing around with a small anti-stress ball, while others watched.

About a fortnight ago, Mr Tan said, the management reprimanded him and ordered him to take down the clips, which by then had generated some 460 hits between them.

So any Dr Patch Adams wannabes......you have been warned!

No more dr Oz bloke, just me