No more dr Oz bloke, just me

Recollections

2007-04-08T19:51:00.000-07:00

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?

OMACOR revisited

2007-04-04T02:40:00.000-07:00

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.

SMA withdraws guidelines on fees

2007-04-03T04:51:00.000-07:00

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

2007-04-03T03:04:00.000-07:00

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

Singapore in 30 years time?

2007-03-29T23:33:00.000-07:00

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.

Look what you've done

2007-01-21T22:47:00.000-08:00

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....

Funny comics?

2007-01-03T23:47:00.000-08:00

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!

The customer is always right!

2006-12-25T18:50:00.000-08:00

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.

Doctor fined $2500? (Only?)

2006-12-20T21:23:00.000-08:00

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!

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

2006-12-14T17:53:00.000-08:00

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.

Appropriate use of my money? I think not!

2006-12-07T19:07:00.000-08:00

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!

2006-12-07T18:50:00.000-08:00

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?

2006-12-07T17:33:00.000-08:00

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!

Cost vs Value?

2006-12-07T17:03:00.000-08:00

I was listening to Derrick Paulo on NewsRadio 93.8FM today. He mentioned something about Singaporeans examining the cost of their citizenship against the value of citizenship.

Well we all know what the big "cost" is to most Singaporean males. National Service. Just those two words remain a huge sticking point in the locals vs foreign=talent debate.

Of course the government has now responded to our good citizens.

All this while we the citizens kept asking, what is the value of our citizenship? (we all know the costs already) We ask, "Isn't the value of our citizenship the same as that of a Singapore PR?"

And what does our good government do? They think about it for a long time and then decide that to appease us citizens, they will raise the cost of being a foreigner.

I mean they could have increased the value of our citizenship. But no, they choose to raise the cost of being a foreigner.

No wonder the foreigners are angry now. Well here's what I would like to say to the foreigners : "Welcome to Singapore! Now you know how it feels to be a true Singaporean!"

Don't you know that this is how our country works? Everything is about increasing costs. ( One wonders where all that increased revenue collected goes)

You are not happy because you feel you should be getting more than the other guy? Ok we'll make you happy by making the other guy pay even more than you ok? But no way in hell will we ever make it cheaper for you!

Cost vs value. Dear government, how about increasing the value of the citizenship for a change? Take the carrot approach. Make the foreigners feel they can gain MORE VALUE than they have now as foreigners rather than INCREASE COSTS for them.

Perhaps the Ministers still don't get it. Well here's how I think they will definitely understand.

Instead of raising Minister's salaries every now and then, why not we ask the leaders of other countries to be paid less! Or instead of saying we need to peg our salaries to the top 6 earners hence the need to raise Minister's salaries, how about we lower the pay of the top 6 earners every now and then? Get it now? If you still don't get it....sigh.......

Do you really want to know?

2006-12-06T19:22:00.000-08:00

Those of you who know me in real life will know that I have a Fellowship in Clinical Nutrition from the USA.

Nutritional therapy is gaining recognition these days. In fact the USFDA approved omega 3 fatty acids as a drug in 2004. Reliant pharmaceuticals has come up with a drug called OMACOR. No prizes for guessing why they chose to name it OMACOR. Zocor, Lipitor, Crestor anyone?

But I'm beginning to realise it is useless having this knowledge in Singapore.

Singaporeans would always question you when you advise them on lifestyle modifications, diet modifications, nutritional modifications either via natural foods or supplements. They would question how it works, why it works etc. But most of these people have no real interest in the answers. Or for the matter, most of them have so little background knowledge that they simply will not be able to understand the biochemical pathways to how these nutritional therapies work. So why ask? But if they ask I have to answer right?

And of course you will have the objections.

"Fish oil is for kids. Not for adults!" (good for kids = bad for adults?)

"My doctor said I have high cholesterol levels and taking fish oil will raise it further!" (could your doctor be out of date?)

"Take so much fish oil? The salesgirl in the health food shop says take 1 capsule a day enough already!" (so the salesgirl knows more about health right?)

"Yuck I hate the taste and smell of fish oil!" (gee I guess medicines taste really good eh?)

But if you told them to take a medicine, the majority would never question how it works. Even if you tried to give them some information, they would say "Sorry I am not a doctor, I won't understand all this"

So I'm quite glad that OMACOR might be making its way to Singapore. Now I don't have to feel like a cheap salesman anymore. I can be a simple salesman.

"This is a medicine that you need. Take 3 a day. Have a nice day."

Simple and sweet.

Singapura the music video!

2006-12-05T20:49:00.000-08:00

Hossan Leong wrote and performed this song at the TalkingCock parliament some time back.

Now the music video is out!

Enjoy!

I say we SHOULD give foreign talents equal dues!

2006-12-05T19:23:00.000-08:00

Reading this letter to the Today paper reminds me once again of all the reasons why we Singaporeans are unhappy with foreigners.

For this blog entry I'll be doing it differently by putting in comments in between paragraphs. I think it has better effect.

Give foreign talent equal dues
Why treat overseas employees differently?

Letter from Robyn M Speed

Robyn Speed chooses to title this letter "Give foreign TALENT equal dues". Why not just foreigners and drop the word talent? Or is the writer suggesting that we only give the "elite" foreigners equal dues but not the "peasant" foreigners? Minefield there. But it goes to show like attracts like.

I refer to the report, "Permanent Residents debate price of citizenship", (Dec 5).

One might argue that Singapore citizens in other countries should not be entitled to the same benefits as the citizens of those countries. It is only fair that they pay full health costs and pay more for education.

If they want the same treatment as citizens, they should take up citizenship in that country.

It should not matter if Singaporeans have been living in Australia, New Zealand, or the United States for a decade or more — they should not get the same rights as the citizens. They should expect to pay more.

It is only fair. Right?

Actually Robyn Speed has a point. I totally agree with him/her. But the whole idea rests upon this principle : Equal benefits and privelleges for equal contributions and sacrifices. I shall address this a bit more later to show something that Robyn failed to point out in this letter.

I bet you would say no; that if you do the work, you should get fair and equal treatment. Yet, that is what Singapore wants to do to foreigners here.

Now I take issue with that statement that Robyn makes. Do you do the work? And I mean all the work! What about National Service? Do foreign talents here as PRs do National Service? They don't. Now let's not sidetrack into the point Robyn makes below about making Singapore an attractive place. But perhaps Robyn should put himself/herself in our shoes as Singaporean males.

We serve National Service for 2.5 years (now 2 years). We get called up for In Camp Training every year that disrupts our working and social lives. We have to go for IPPT and RT. This is all part of the "work" that we do as Singapore citizens. Do the foreigners do it? They don't. So can you really say foreigners "do the work"? Yes or no? If no, then can you still say "you should get fair and equal treatment"?

This is why we Singaporeans are so angry. Try to understand that before you write such letters to the press to fuel our anger further. It is not as if Singapore citizens get much benefits anyway.

You want the top professionals in the world to come and work here, to build Singapore as the top research place in the world, the top education hub. Yet you want to hold them distant, to treat them as second to the locals.

I don't like Robyn's tone here. Perhaps Robyn speaks the truth. Singaporeans are pathetic and we need people like him/her to come and help us. Or else we would die.

But I suspect Robyn has not lived in Singapore for very long. Because if he/she did, he/she would have come to realise that Singapore citizens get very little if not close to nothing in terms of benefits and privelleges by being citizens compared to being PRs.

(Sorry to bring up the NS issue again, but one forumer asked if we could pay more for healthcare like the PRs and not have to serve NS. I think most of us would gladly take it!)

What exactly are those "benefits" that the writer cannot get that makes him/her feel so second rate anyway?

Surely these foreigners are working for Singapore and her citizens, to build your country and economy, to add to your markets and prestige.

Some come here, with their families, for career opportunities. They pay rent at the market rate for a condo apartment, their children attend an international school (because they want a sense of continuity for their children's education). Add up these costs and they are paying a lot of money, while supporting Singapore's economy.

Why do these foreign employees come here? Because the employer decided that they were the best person for the job.

That last sentence "Because the employer decided that they were the best person for the job." makes me wonder something. If these foreign talents are the best people for the job, won't it mean they are also paid the best rates? Shouldn't their healthcare benefits be the best as well? If not then why work for such companies if you are indeed the best? Don't shortchange yourself. You are not a Singaporean!

Most TRUE foreign talents that I know and read about (eg our Ministers talk about them) are paid big bucks and have comprehensive healthcare insurance plans and if not even hefty expat allowances. They are usually well taken care of.

So it seems strange that Robyn Speed chooses to write this letter after the Singapore government announces that healthcare would cost more for foreigners (mind you at the subsidized government healthcare centres). The timing seems strange to me.

Can you thus fault me for suspecting that the writer is unhappy because he/she has to now pay more for his/her healthcare needs? What happened to the employer taking the best care of "the best person for the job". Whose fault is that really?

Singapore is a small country and it is difficult for anyone to have the same experience as a worker who has travelled the world, worked in massive markets and learnt from the top people in their fields.

More condescending statements from the writer to fuel the anger once again. We all hear these truths from our leaders everyday already. Is there a need to rub it in?

I am an expat. We all have a bond with our homeland and to turn one's back on it is considered to be almost despicable by many. Our homeland is our home in the world — you cannot lightly ask a person to give that up.

Excellent point Robyn. I would love to ask you what you think of Singapore as a nation, her government and how her people are treated compared to your lovely homeland. How would you feel if you were a Singaporean? That would be something the government would not like you to write about I am sure. So have some pity for us. That much we ask you.

Singapore wants to be an international hub of research, education, tourism and so on. And yet, this latest move smacks of: "You are welcome to come, but … ".

Foreigners are either welcome or they are not.

And beware, for there are always other markets for these people to go to.

Good point. Once again reiterates how "vulnerable" Singapore is.

Just a last point. This letter seems to spark a lot of debate and fans the underlying flames of discontent in the foreigners vs locals issue. Would we consider that as disrupting the harmony of our society? Seditious?

But it's printed in the papers so I would think this is not a OB topic.

Time for MOH to go Naked

2006-12-05T18:40:00.000-08:00

Just 3 days back I posted an entry about how polyclinic bills should go naked.

Today a letter written to the Straits Times Forum basically validates that my assessment of sentiment on the ground is correct!

Hmm....maybe the government should hire me as an MOH advisor. No need to spend more money with all those REACH programs to listen to the ground. Just hire me!

Anyway here's what Mrs Tan has to say :

Polyclinics should review flat-rate pricing policy for drugs

I refer to the reply "Polyclinics' flat rate for drugs benefits chronic patients" (ST, Dec 2) by Ms Chan Soo Chung, general manager of National Healthcare Group Pharmacy.

Ms Chan stated that with the $1.40 flat rate pricing policy for essential drugs at polyclinics, "the majority of chronic patients who need to take more expensive drugs on a long-term basis will benefit from the flat rate".

I do not think this statement is accurate. The flat rate price applies only to "essential" or generic drugs which on average cost only a few cents per tablet. It does not apply to the "more expensive" patented medicines.

To demonstrate this, Ms Chan cited the example that a common diabetic medication that requires the patient to take six tablets a day over ten weeks would have cost $21 without the flat rate policy. This works out to five cents per tablet. I do not think any "expensive" patented drug will be close to this price.

The flat rate pricing policy inadvertently allows the polyclinics to "profit" from the sale of cheap "essential" drugs. For example, a week's supply of an "essential" drug that costs three cents a tablet and taken once daily should cost 21 cents, but with this policy, the same quantity of drugs costs $1.40 instead, which translates into a "profit" of $1.19 for the polyclinics.

And given that polyclinics dispense largely such essential drugs, I wonder how much money they make each year from such drugs.

The polyclinics' $1.40 flat price policy has been questioned in the Forum page every year since 2001. While the polyclinics may argue that the excess money from "essential" drugs is used to subsidise other services at the polyclinics, I do not think this is right.

The two healthcare clusters receive government funding and if the funds are insufficient, they should resolve the matter with the Ministry of Health. The patients should not be penalised as a result of their inefficiencies or inability to manage their budgets.

Cheap "essential" drugs, if priced at their actual per tablet prices, can mean savings for polyclinic patients, especially the elderly. I urge the two clusters to relook at this flat rate pricing policy at the polyclinics.

Mrs Tan Qui Boon

To summarize the main points:

1) "The flat rate pricing policy inadvertently allows the polyclinics to "profit" from the sale of cheap "essential" drugs."

You see, Singaporeans do not like this. Nobody wants to pay for healthcare DIRECTLY. While keeping the bill transparent but with strategic areas covered is one way to hoodwink the largely blind Singaporean, it is still too obvious. Raising taxes to get hte people to pay and fatten the coffers and then using that money to "subsidize" (it's still their own money anyway) the drug costs would be a far better option.

2) "I wonder how much money they make each year from such drugs."

See? Most Singaporeans think the government healthcare sector should be a "no-profit" organization. MOH, you better tell people the truth. Are the Polyclinics making money?

3) "While the polyclinics may argue that the excess money from "essential" drugs is used to subsidise other services at the polyclinics, I do not think this is right."

Once again. The spirit of giving is simply not here in Singapore. And I guess we are just learning from the best in the business. The best way is still to make people pay up first then use the money help them later. That way it is so convoluted it doesn't make a difference if you were naked or transparent!

How come it's always MORE money and not less?

2006-12-03T23:40:00.000-08:00

Whenever the government announces anything you can be sure it involves making the government MORE money, never less!

I read this article and laughed myself off to bits again!

Foreigners to pay more as Singapore says citizens the priority

Foreigners in Singapore will pay more for education and health care as the government puts a priority on its own citizens, Prime Minister Lee Hsien Loong has said.

Lee also defended a planned increase in the consumption tax, saying the extra revenues would go mainly towards helping lower-income families in one of Asia's wealthiest economies.

"We have to treat visitors well, too, but citizens have to be treated better," Lee was quoted as saying in The Straits Times.

"Citizens come first in our priorities, in our thinking," said Lee, speaking at the ruling People's Action Party (PAP) convention on Sunday.

Official statistics say Singapore had a population of 4.4 million last year, but 18 percent of those were foreign workers who filled a wide range of jobs, from white collar to construction work.

The Straits Times gave no specifics on the increased education and health costs but said overseas students already paid 10 percent more for university and polytechnical studies.

For health care, permanent residents would pay more, and foreign workers would pay the full cost. Their employers would need to protect them with medical insurance, the report said.

While costs were going up for foreigners, Lee said Singapore's lower-income citizens would receive "far more" in terms of social programs and assistance from the government than what they paid, as a result of a planned increase in the goods and services tax (GST).

The main points :

1) "We have to treat visitors well, too, but citizens have to be treated better,"

2) "For health care, permanent residents would pay more, and foreign workers would pay the full cost"

Well that's what the government says. We Singapore citizens have been saying how about making the cost of healthcare LOWER for us since the PRs pay the same. After all we think as Singaporeans we should pay less than them right? Nobody was really asking for PRs to pay MORE. But rather for us Singaporeans to pay less!

And what does the government do? They RAISE the amount PRs have to pay, yet again fattening the coffers.

I think instead of saying "We have to treat visitors well, too, but citizens have to be treated better,", in reality it's a case of "we treat our citizens well, but we have to treat our visitors a bit less well now to keep the citizens satisfied"

You're just not transparent enough!

2006-12-03T21:56:00.000-08:00

Picture this : A magazine cover reads "Zoe Tay in a transparent outfit!" You flip the magazine and you see Zoe Tay in a transparent gown except the important areas are NOT transparent.

Well after reading this letter in the Straits Times Forum, I can understand why people are calling for more transparency. And Ms Chan has got the wrong parts that they want transparent.

Polyclinics' flat rate for drugs benefits chronic patients

I THANK Mr Chua Koon Ngee for his letter, 'Why medicines cost more at polyclinics' (ST, Nov 28).

At all polyclinics, essential drugs are priced at $1.40 per week's supply per drug. This flat rate applies regardless of the actual drug cost or the number of doses taken per week.

While this means that some patients may end up paying more than the actual cost of their medications, the majority of chronic patients who need to take more expensive drugs on a long-term basis will benefit from the flat rate.

For example, a common diabetic medication that requires the patient to take six tablets a day over a period of 10 weeks would have cost $21 before subsidy. However, because of the $1.40 per week standard fee at the polyclinics, it would cost the patient only $14.

Similarly, the most expensive anti-Parkinson drug, given over 10 weeks, would cost $136.50 before subsidy but it would cost the patient only $14 at the polyclinics.

One should not just look at specific drug pricing which varies from institution to institution but rather overall affordability for the patient, and take into account doctors' consultation fee and other service charges.

Though the per-unit cost of drugs at the Specialist Outpatient Clinics (SOCs) may be lower than at polyclinics, the overall bill size of a patient seen at polyclinics is still lower and affordable, than if one is treated at an SOC or in a hospital.

With regard to Mr Chua's feedback on the need for transparency of charges presented on the invoice, patients can request a breakdown of their bill.

However, most of our patients do not require a breakdown as most of the drugs are charged using the standard flat fee.

To better serve the needs of our patients, we are in the process of enhancing our invoice presentation.

We thank Mr Chua for his valuable feedback.

Chan Soo Chung (Ms)
General Manager
National Healthcare Group Pharmacy

Just to recap the important points:

1) "some patients may end up paying more than the actual cost of their medications"

You see Ms Chan, this is really where people are not happy about. Nobody complains when they pay less than the actual cost of their medications. For the matter, do the MAJORITY of patients pay less than the actual cost of their medications? You have to understand, most Singaporeans are not interested in how much they are paying for the next guy buying those expensive medications. They only want to know how much they are paying for their medicines and how much the medicines COST to the Polyclinic!

2) "patients can request a breakdown of their bill"

3) "However, most of our patients do not require a breakdown as most of the drugs are charged using the standard flat fee"

Which leads us to points 2 and 3. There is little point in providing a breakdown of the bill if it does not provide the most important information that we want to see. What is the cost of each medicine given per tablet/per week whatever to the Polyclinic and how much am I paying? Do the bill breakdowns say these? They don't. So nobody bothers. It's like Zoe Tay wearing the "transparent outfit" but with the vital areas covered up.

Everyone suspects and will continue to suspect (and they might be right after all) that the Polyclinics STILL make PROFITS despite all this talk about "Similarly, the most expensive anti-Parkinson drug, given over 10 weeks, would cost $136.50 before subsidy but it would cost the patient only $14 at the polyclinics."

Why? Because the number of people paying MORE than the cost of medicines at Polyclinics are MORE than the people paying less and the amount collected from te majority is still MORE than the subsidies they give to the few patients who need the expensive medicines.

Admit it MOH, you run the Polyclinics, hospitals etc as businesses. All this talk about subsidy.....why not be COMPLETELY transparent?

There is a term for this. It's called being NAKED.

"Zoe Tay NAKED" Now that's what the people really want. Forget being transparent.

Is that transparent enough for you?

Did the government use the reserves during this time?

2006-12-01T16:45:00.000-08:00

I was listening to the radio this morning. They had one of those "this time in history" sort of segments.

And they mentioned SARS. "Singapore was hit by a mystery virus which plunged the country into a crisis....."

All those memories came flooding back to me. It was one of those periods where we did not know whether to rejoice (because suddenly the work load at the govt hospitals dropped to all time lows. I'm still thinking where did those people go and why was it there was no rise in death rates despite people staying away from the hospitals?) or to be terrified that we could be the next victim? (I was admitted for suspected SARS myself and my colleagues did die after being infected, but that is another story)

Somehow the phrase "plunged Singapore into a crisis..." struck a cord with me. All this talk about raising GST, to raise the money to help the poor and how we "must not ever touch the reserves unless there is a crisis...."

Well did the Singapore government touch the reserves during the SARS CRISIS? As I recall businesses were hard hit. Many lost their jobs. But I don't recall talk about using the reserves.

In fact, they had ANOTHER one of those donating charity drives. And people donated. As a matter of fact, they donated so much there was a surplus! And we still don't know what happened to that surplus money!

The point I'm trying to make is this. If the Singapore government didn't touch the reserves even when the country was indeed in a crisis from SARS, then when will they ever touch the reserves? So dream on guys. I'm beginning to wonder whether the reserves are really "national reserves" at all? Do they exist? Or is it another one of those "terminology", "definition" games that politicians play?

Go figure.

The REAL reason why we won't exempt basic goods from GST!

2006-12-01T04:33:00.000-08:00

I read this report in TODAY on a recent forum between Minister Tharman and certain Singaporeans.

One statement made by Tharman made me fall out of my chair literally!

It goes like this : "He added that if necessities were exempted from GST, the benefit would go to the well-off, who spend more on basic goods, than to the poor."

On first look I must say I fell off my chair. But on closer look, you can see many layers to this.

Most among the online community are cryin foul. They are saying that such basic illogic would qualify them to be Finance Ministers instead of Tharman Shanmugaratnam.

Illogical? Well yes and no. The catch is in the definitions of the terms used.

What would consitute as "basic goods"? Let's take a look.

1) Staple foods eg rice, eggs, chicken, fruits, vegetables

2) Clothes

3) Utilities eg Water

4) Utilities eg Electricity

Most people have harped on basic goods being staple foods. While that is one way to look at it, there IS a point that the well off stand to benefit more because they do tend to eat more. There is a possibility that the Finance Ministry has done some research showing that well to do people tend to be bulimic and thus eat ten times the amount of food and then vomit 90% of it out.

Next we come to clothes. Now you're probably getting the idea. Do you draw a line between "luxury clothes, not-so-luxury-clothes, staple-clothes"? Minefield there.

Water and Electricity is the next stop. Well we all know that the rich live in bigger houses and have more lights and sleep in airconditioned homes etc. So usage would be much higher than the poor.

I think the REAL reason why the government does not want to exempt "basic goods" from GST is because of the LOST income in taxes from the rich rather than because it would help the poor.

That seems the more likely answer, but of course it is politically not a wise statement to make.

It must be VERY difficult to find a parking lot in the UK!

2006-11-28T21:54:00.000-08:00

Wow people must be damn desperate to get a parking lot in UK!

TCM physicians have problems with Singaporean patients too!

2006-11-28T18:47:00.000-08:00

I had always thought that TCM physicians had it good with their patients. Patients would see them and ask few questions. Turns out that is partly true, but they do have problems with some Singaporeans.

One of my lecturers is a TCM physician who works very near to where I used to work and saw all sort of nasty people. In fact I call that area the worst slum district in the whole of Singapore. And my lecturer agrees!

Anyway here are some of the stories he told us :

Story 1.

Patient : eh sinsei! My 5 year old son has fever. I want to buy fever medicine for him.

TCM Physician : Err I need to see your son. See what type of syndrome he has. Heat, cold, excess Yang, deficient Yin etc. Different condition needs different TCM fever concoctions

Patient : Aiyah, he got fever, just give fever medicine lah! So simple why you so complicated?

TCM Physician : Then why not you go to the 7-Eleven store next door and buy some Panadol syrup?

Patient : Har? You ask me go buy Panadol? What kind of sinsei are you? Aiyah you lok quite young must be dunno anything one lar!

Story 2.

Patient : I got back pain. I want acupuncture.

TCM Physician start to take a history and asks whether she was injured, hurt herself, symptoms of numbness, and other questions pertaining to her general health and other systems...

Patient : Aiyah! Why you ask so many questions?!!! I got back pain. Just acupuncture the back lah! Talk so much for what. I very pain now you know?

TCM Physician Sighs : Ok. Anyway before I start I have to tell you the risks of Acupuncture....

Patient interrupts : Aiyah! I know already lah. Dun have to tell me. Waste time only. Hurry up and poke me lah!

TCM Physician : I don't care whether you know or not already, but it is my duty to tell you anyway.

Patient: Ok lah ok lah you damn cheong hei. I know already lah. Ok lah tell me again lah.
.....

Patient jumps : HAR! ACUPUNCTURE CAN CAUSE BLEEDING????!!!!!!! YOU SURE OR NOT?!!! WU YA BOH?!

TCM Physician : I thought you said you know the risks?!!!

No wonder diabetic patients are so scared of insulin injections!

2006-11-27T18:08:00.000-08:00

We all know that Mediacorp Drama programs act as important modes of information delivery to the people. I mean the government uses it to explain Trade Union, Tripartite Wage Adjustment issues etc. So why not protray medical issues properly? "The Ties that Bind" was one such drama serial that talked about the wage adjustments after SARS. But from the way they dramatized a particular scene makes me wonder why MOH doesn't take offence and issue advisories to Mediacorp not to perpetuate

I was watching the repeat telecast of "The ties that bind" , a Mediacorp drama serial starring Chen Liping, Huang Wenyong, Cynthia Koh, Joanne Peh and others.

Yesterday's episode revealed how Cynthia Koh's character was diagnosed to have gestational diabetes (diabetes when pregnant). The gynaecologist told her that she would have to take insulin injections. Cynthia's character was very sad after hearing this and called her husband to cry about it. And the husband told her "if you don't dare to give yourself the injections, then I'll do it for you. But I'm very busy tonight. Hopefully I can finish soon and come back early"

The next scene showed Cynthia's character feeling dizzy. And she went on to use the Glucometer to check her blood glucose level. Except the way she did the test was WRONG. She was using the Roche ADVANTAGE system and you usually put the meter strip into the machine FIRST then apply the blood on the strip! She put the blood on the strip then inserted it into the machine! Anyway this error was not as scary as the misconception the next scene protrayed!

(Point to note : usually if you are diabetic and feeling dizzy, it is likely due to LOW blood glucose levels rather than high)

The next scene showed a teary Cynthia taking out her insulin, putting it into a 5ml syringe with a long and big needle and trying to inject it into her ARM VEIN!!!!!!!!!!

Basically it looked like this :

Yes. It looked like she was a drug addict trying to inject insulin into her vein! For dramatic effect they showed the huge needle, her popping vein and her expressions of excruciating mental anguish! Just like a drug addict!

No wonder diabetics are so fearful of being told they need insulin injections! They picture putting huge needles into their veins like drug addicts!!! Mediacorp is doing MOH and the population no favours with such blatant misrepresentations! We should sue them!

To set the record straight, diabetics inject SMALL amounts (ranging from 0.1 to 0.2ml)of insulin using small 1ml syringes and very very fine needles into the SKIN (not veins) around the abdomen or thigh area.

It is rather less terrifying and less painful than how the drug addicts do it!

Here are the pics to illustrate my points.

This picture shows the different sizes of syringes and the needles. The smallest one is what diabetics use for their insulin jabs.

The needle and syringe that Cynthia Koh's character used looked like this:

In reality the one we used looks like this :

And the procedure can be done by little kids!

I think Mediacorp has a responsibility to at least get overall medical facts right. I can understand the small stuff, but misrepresenting how insulin injections are given and scaring patients away is irresponsible of them!

Another patient complains!

2006-11-26T18:56:00.000-08:00

Read this comment by "anonymous at November 26, 2006 11:37 PM" over at angrydoc's blog.

"Anonymous said...

I had an experience about a doctor prescribing cough and running nose medicine to my son even if the child was not showing the symptoms. The clinic's name is: Lifelink Clinic & Surgery 446 Pasir Ris Drive 6 #01-120 Singapore 510446.
I asked the doctor why did he do it and he was stunned why I asked. He said later that he had given the two medicines just in case the child would be sick with cough and running nose.
Total bill is $50. And the medicine we are expecting was the antibiotic as my kid was having fever, and was vomitting. But there was no antibiotic.
This experience, as was my experience with the doctors here in Singapore, shows how clinics are mere cashcows, and not a place to be healed. It seems to me that doctors have forgotten about their Hippocratic oath and their service to humanity. Their minds are more bent on how to earn more money to pay the increasing rentals and other expenses related to their clinics. "

This is really quite typical of Singaporean patients (for you overseas, non-Singaporean people reading this). Antibiotics is an "expected" medicine when it comes to all forms of colds and flus. If you ever see a Singaporean patient in your clinic (wherever you are) you better giver him/her antibiotics!

As for the cashcow bit. Well I can't speak for the GP in question. It is true that some GPs might really be milking you for all that it is worth, but I find it strange that if this GP was really like that, why not milk you the cashcow a LOT more by giving you some original patented antibiotic and make the bill $85 instead?

Sometimes we do get requests from patients asking for these medicines as their children DO INDEED develop runny nose, and cough a couple of days later. I doubt any GP out there in Singapore would dare to say "No Sorry! Your kid get runny nose and cough then I give you the medicine. Now cannot give!"

Of course the real issue here is that there was something lost in the communication chain between the patient and the doctor. The patient has a right to refuse medicine! Isn't "anonymous" aware of it? Or too intimidated by some old looking grey haired doctor to speak up? And this GP forgot to enquire what ideas, concerns and expectations (mnemonic ICE) you might have. If he had, then I doubt you would have this problem. It takes two hands to clap I guess.

What's with the complaint of a bill of $50 inclusive of consult and medicines? Hey that's real cheap compared to other FIRST WORLD COUNTRIES (don't go comparing with third world ok? You're not the government :)) I wonder if anyone reading this is a doctor from Oz or Uk or Canada or US. Please write here how much a visit to your office would cost?

As for the use of antibiotics. I have previously written a long post on this in February 2006. Go read it. Get educated. Cold or flu, antibiotics don't work for you!

I never knew Singapore was such a dangerous place!

2006-11-26T18:37:00.000-08:00

I realise now that Singapore is such a a dangerous place after reading this letter to the ST forum.

Bear with a little inconvenience when VIP visitors arrive

I REFER to the letter by Mr Yeong Chan Kong asking why United States President George W. Bush did not consider taking a helicopter during his recent visit to Singapore (ST, Nov 23).

I think the simple reason is safety. When a flying object is hit, it has to come down and if it does, it will crashland. Considering the density of buildings on the ground here, this will be disastrous not only for Mr Bush's survival, but also for those on the ground.

Moreover, security staff on the ground will be helpless to do anything, whereas Mr Bush's motorcade is reputed to be able to withstand a direct missile hit and still rush him to safety.

All said, let us welcome any head of state to Singapore with open arms and bear with a little inconvenience.

Also, the Land Transport Authority could be a little magnanimous to bear with some losses in Electronic Road Pricing collection by waiving charges if traffic has to be diverted.

Thomas Lee Zhi Zhi

I did not realise that there are people with rocket launchers walking around in Singapore. Hey, if it's such a hassle to protect the President of the United States of America, what chance does the PM Lee have? Just kidding.

Anyway I agree a small country like Singapore which is so dependent on "good relations" with bigger countries (read every other country) has to bend over its back sometimes.

Mr Lee's letter would have be good except that he disguised his request to have ERP waived as a "feel-good-praise-government-letter" in order for it to be published. Very smart this Mr Lee. LOL!

Here's the question I'm BURNING to have answered. Did George Bush's entourage pay ERP? *snicker* I suppose everyone already knows the answer to that one so save your crappy answers LTA! LOL!

Insurance agents have code of ethics too!

2006-11-26T18:29:00.000-08:00

I discovered that insurance agents are also bound by a code of ethics after reading this letter in the ST Forums.

Insurance professionals sell policies on basis of client's needs

We refer to the articles "Many Singaporeans don't have the right insurance cover" (ST, Nov 11) and "More turning to term insurance plans" (Sunday Times, Nov 12).

The statements in the articles - "there is a high chance that whatever product is sold depends on the commissions derived" and "agents did not push such (term insurance) plans aggressively given the lower commissions" implied that all insurance advisors sell products that give the highest commissions and not based on the customer's needs.

The Insurance and Financial Practitioners Association of Singapore (IFPAS) feels that such an implication is highly unfair to the many professionals in the insurance industry who sell products based on clients' needs.

Each type of coverage, be it participating whole life and endowment, investment-linked plans or term insurance, has its own product attributes that cater to specific needs.

For example, the cash values accumulated in participating whole life plans can be used to pay premiums should the policy owner run into financial hardship and cannot afford to make premium payments. On the other hand, the cover for term insurance will cease once premium payment is not made.

Though one can argue about the merits of "buy term and invest the rest", the purpose of this letter is to rebut the highly biased statements in the articles.

IFPAS represents over 4,500 insurance and financial practitioners in the industry and we are proud that our members have to adhere to its Code of Ethics, which IFPAS enforces strictly to ensure a high standard of professionalism and to protect the public's interests.

The Code of Ethics is appended below:

An IFPAS member shall:

- Always place the best interest of his clients before his own.

- Hold in the strictest confidence, and consider as privileged, all business and personal information pertaining to the client's affair.

- Make full and adequate disclosure of all facts necessary to enable the client to make a intelligent decision.

- Not conduct his profession to cause the public to lose confidence in the Association or the insurance and financial services industry.

- Not indulge in unethical practices which may be detrimental to the client or the insurance and financial services industry.

- Abide by and conform to all rules and regulations of the Association.

The mark of the IFPAS membership signifies professionalism and ethical practices. Consumers can rest assured that our members will sell products based on client's needs.

Ting Chee Kheong
Council Member (Chairman, PR Committee)
2006/2007 Executive Council
Insurance and Financial Practitioners Association of Singapore

It is good to hear that there is a code of ethics that agents have to abide by. Very similar to what doctors have.

However when was the last time you heard of insurance agents found guilty of unethical practices? Eg advising clients on policies based on what the agent's interests are vs the client's?

It is one thing to have the code of ethics and all. It is another to actually enforce it and catch the offenders.

Frankly, I am sad to say I do not have the confidence that the IFPAS has acted and will act on agents. For the matter it is unlikely anyone ever goes out to catch any such offeding agents.

Real life machine to terminate yourself!

2006-11-24T00:21:00.000-08:00

Anyone want to try using this machine?

Map Wars : The Empire Strikes Back!

2006-11-23T19:03:00.000-08:00

Looks like Virtual Map is in trouble

The roadmap to the courts
SLA sues creators of streetdirectory.com

Leong Wee Keat
weekeat@mediacorp.com.sg

THE Singapore Land Authority (SLA) has filed a civil suit against Virtual Map — the company behind streetdirectory.com — for copyright infringement.

The copyright material in question: Singapore's map data and street information, which the SLA had licensed to Virtual Map, but whose licence the authority terminated in July 2004.

The statutory board claimed that after the termination, Virtual Map continued to sell and distribute its maps. It also created new maps, which the SLA alleges are reproductions of the authority's works.

The SLA is seeking damages and an injunction to restrain Virtual Map from further infringement of the data.

It also wants Virtual Map to disclose the names and addresses of all persons or companies that it has distributed the maps to. Additionally, the SLA is also seeking an order to destroy all documents, materials or images in which copyright breaches have occurred.

The suit, filed in October last year, was confirmed yesterday by an SLA spokesperson.

It goes to show you don't screw with the government. Or the government will screw with you. Also, contrary to what they keep denying, NTUC is the "government" in every sense of the word.

All those legal suits by Virtual Map settled out of court.....well the government is going to take it all back and more!

I have never seen a private entity go up against the government and win in the courts. And I don't envision why it will be any different with this case.

Virtual Map would be wise to settle out of court and try to broker a deal to work WITH the SLA rather than compete.

Good luck Virtual Map!

Husband is angry....

2006-11-22T21:17:00.000-08:00

Read this letter in the Straits Times forum :

Op scare but patient discharged 2 days later

ON AUG 21, my wife had keyhole surgery at Tan Tock Seng Hospital (TTSH) to have her gall bladder removed. Shortly after the operation, she developed complications, with her blood pressure dropping to 50/30.

The doctors (excluding the main surgeon) that operated on my wife were alerted. They immediately ordered intravenous drips, a blood test and an X-ray machine, apparently to arrest the problem and also to check for the cause. When I enquired, I was told that it was due to the after-effects of surgery.

Two days later, we were astonished to hear the surgeon tell my wife that she could go home. This was because she was still in pain and her stomach felt bloated.

On Aug 31, my fears came true when my wife complained of extreme pain in the abdomen. I immediately drove her to TTSH's A&E.

A CT scan confirmed internal bleeding, which the doctors suspected could involve the womb and they might need to have it removed. However, after the operation, the surgeon - a different one from the first - told me that the actual site was the fats area around the abdomen and not the womb.

I have several questions:

1)During my wife's follow-up appointment on Sept 11, the first surgeon said that the keyhole surgery was the likely cause of the internal bleeding. I was rather unhappy when he told us that this was the first time he had encountered such a case and they were still investigating the cause.

What upset me further was that upon hearing that my wife had undergone ligation, he said that as both types - ligation and gall-bladder removal - of keyhole surgery used the navel as the entry point, the possibility of internal bleeding was increased.

Should not the medical staff to be extra careful in treating such patients as my wife did tell them about her ligation before the surgery?

2) Was the surgeon aware of my wife's complications after surgery and did he study her blood-test and X-ray results before certifying her fit to go home?

3) Last but not least, was it not the duty of the doctors to be more precise in their diagnosis, rather than to speculate on the site of the internal bleeding, resulting in such a long laceration?

Allenn Tay Boon Leng

You can read TTSH's reply to Mr Tay here.

Dr Chia's approach to replying to the letter is to give the facts of Mrs Tay's medical history ( I am not sure if that is really a nice thing to do, but I guess if you write to the open press then it sort of means you waive the right to privacy), but he does not really answer Mr Tay's questions.

He may have sort of answered his 2nd question but he certainly does not answer questions 1 and 3.

Question 1 is really Mr Tay suggesting that the surgeon might have been negligient because he was not more careful when operating having "failed to remember" that she had previous key hole surgery for ligation. Well here's the thing. The umbilical route is still the safest port of entry for the key hole surgery. However having had surgery before makes the risk of bleeding higher. But is it higher than going by another route? I am not certain. Well Dr Chia certainly chose not to answer this question. I wonder why?

As for question 3. Perhaps Dr Chia doesn't realise it. But Mr Tay is very upset that his wife now has a huge operation scar (most likely midline from pubis to rib cage). It is well known that such scars do affect sexual and marital relationships. However in emergency setting, scar conditions and not the priority. Save the patient first. An operation to remove the scar can always be performed later. Mr Tay's wife's life is obviously more important than her appearance during those few hours when she was bleeding internally.

Finally, all surgery carries a risk. What happened to Mrs Tay was unfortunate. But she is NOT the first and last person who will have such similar complications.

Which is why we get patients to sign a consent form. However, the consent forms in Singapore are pretty pathetic. They are no where like the contracts that lawyers draw up for people when they sign to buy a house or a car or get a loan. As a matter of fact I think as doctors we should have 16 page consent contracts for patients to sign before they go for the operation. You might say "But how will I read 16 pages and will I understand it?" Well then ask yourself when was the last time you understood all that stuff written in the contracts you sign to buy that HDB flat? It's the same. It's all there to cover your ass. Except as doctors we don't cover our asses very well.

Free maps of Singapore online!

2006-11-22T17:36:00.000-08:00

From the TODAY

"Twist to online street map row
SLA sets up website that allows users to download maps free, gives information on State-owned lots

Leong Wee Keat
weekeat@mediacorp.com.sg

CAN you really use that online map without being slapped with a lawsuit? Singaporeans, who are familiar with such cases, now have one more resource to turn to.

Launched yesterday by the Singapore Land Authority (SLA), StreetMap@Singapore allows users to download street maps for personal and non-commercial use free. Users, for example, can utilise these maps to make personal invitation cards.

The SLA has also launched LandQuery, a map-based system that will provide information as well as ownership and contact details about land in Singapore, particularly State-owned lots.

Senior Minister of State for Law and Home Affairs Associate Professor Ho Peng Kee, who launched the services yesterday, denied that StreetMap@Singapore was the result of a series of lawsuits filed — and letters of demand sent — by an online map company against a slew of users for copyright infringement last year.

Since 2004, Virtual Map — the company that owes streetdirectory.com — has sent letters to hundreds of small and medium enterprises demanding payment for reproducing maps from its website. If they did not pay, these companies faced being sued.

So far, Virtual Map has filed five civil suits — against the likes of NTUC Income and Suncool — for copyright infringement. The suits have all been settled out of court.

Yesterday, Virtual Map managing director Firdhaus Akber refuted suggestions that legal action was a part of his company's business model. He pointed to an increase in online traffic — from 300,000 users in 2004 to about 600,000 users now — and an increase in revenue, from $2 million in 2004 to $5 million now, as proof. "If our objective is to sue, no one would want to do business with us," Mr Firdhaus told Today.

While SLA said its new service is not to compete with existing ones, StreetMap@Singapore's web interface is similar to streetdirectory.com's. On both sites, users can retrieve street maps by keying in an address, building or development name, postal code or the nearest MRT or LRT station. Interface options on both sites are also similar.

Virtual Map's Mr Firdhaus said his website "had the lead" in this face-off. Alluding to the map quality on StreetMap@Singapore, he said: "I think the public doesn't have to get too excited with their service."

He added that new landmarks such as VivoCity and Tanglin Village could not be found on the new website. "This clearly shows how much work they need to do to get up to speed," he said. "For us, not only do we update daily, we even provide information like 'formerly known as'. SLA's mapping application seems to be more focused on selling services related to land — such as land title and land information."

While its plan is to update street maps on its site every quarter, SLA's director of strategic planning and policy Ng Siau Yong said the maps would be updated more frequently if feedback was received from the public. The two services launched yesterday cost the SLA a total of $500,000. A further $200,000 will be spent each year to maintain the services.

Along with these new services, Prof Ho said the aim was to build SLA's Integrated Land Information Service into a one-stop portal for land information.

SLA sets up website that allows users to download maps free, gives information on State-owned lots"

This is interesting news. I wonder why would the government want to compete with Virtual Map for this small segment of business unless, Virtual Map was indeed causing a lot of problems for the government in the first place.

The interface for SLA service is indeed uncannily similar.

And to top it all, SLA is allowing people to use the maps for FREE! Granted the website is a bit slow right now, but I'm sure it will improve over the next few weeks.

I think this would be great for businesses as they can now post a map of where they are located on their websites or print them out etc. Good move SLA! Credit where credit is due.

As for Virtual Map's Mr Firdhaus' comment in reference to the quality of StreetMaps@Singapore's online maps, "I think the public doesn't have to get too excited with their service." I think Mr Firdhaus has missed the point totally. The public and businesses are going to be excited because the service is FREE. Yes the word FREE brings out the biggest smile and generates the most excitement in the land of Singapore.

I'm sure Virtual Map's revenue is bound to drop a bit now that they have a competitor that gives free map usage and possible might get more advertising contracts on their site.

Good luck Virtual Map!

The TRUTH! Can you handle the TRUTH?

2006-11-16T17:47:00.000-08:00

You know after reading the forums and blogs and internet for 3 years. Having had my revelation about the true nature of Singapore 6 years ago. I've come to realise one very very sad thing.

For all the complaining and talk that we have, the truth is that for many Singaporeans all they are running down and condemning are people like themselves/ourselves/myself.

Put it this way. It's not as if 90% of the nation goes out of its way to help the poor, are involved in charity work, involved in community work etc. If they did, you think the government would be so bold as to marginalize the lower income groups?

All the talk about actually helping the poor is it reflective of what the majority of Singaporeans think? Or is the unwillingness to help due to a national philosophy and not just the government's initiative?

Some would argue that Singaporeans have become like that because of the government (ie blame the government again). Well the government has to take some responsibility for that as they are our leaders. The old guard were against welfare for reasons, and they succeeded in transforming Singapore economically. Hence an entire generation were brought up thinking welfare is a dirty word. But the people made their choice too. So the people are also accountable for this mindset. When we go to the polls we vote for various issues. As Mr Wang (of Bakes Good Karma fame) mentioned before, although the PAP won 66.66% of votes it does not mean that all 66.66% support ALL of PAP's initiatives and philosophies. They might like the economic policies but what about the rest? It's a matter of priority. And frankly helping the poor is not a priority in the majority of voter's minds.

I once remember someone telling me that the easiest and laziest way to help the poor is to give money. What is far more valuable and what few people would donate is their TIME.

Personally I must admit that I'm not someone who would actively go out and spend time helping the poor outside of my current work interaction with some of the poor. Granted I do my part to help them medically and financially while at work, but I spend far more time working for a fee than volunteering. Somehow I feel that in Singapore, volunteerism is just not the way we live life. We're supposed to work as hard as we can to better ourselves and OUR lives. Not other's lives. If we do well, it's our effort. If we do badly it's our fault. Someone tell me this is not what Singapore's society preaches?

Having said that, I am free to make a choice and help. But I don't. I could choose to go against the majority trend and be a minority. But I don't. So I am also just as guilty. I make no excuses for myself.

Hence if you read my first post. I'm not criticizing the government because they are not helping the poor. But what I don't like is people PRETENDING that they are helping the poor when their true intentions lie elsewhere. ( The GST rise is PRIMARILY because of the need to lower income/corporate taxes, the "help the poor" bit is incidental due to current hot topics)

The government can only do so much. Even with welfare (ie money) there's only so much it would achieve. What we need is for the nation and the people to get involved. And frankly I don't see that happening. And it's both the government's and the people's fault. Singapore and Singaporeans choose the pursuit of personal and individual glory and wealth over all else. It's a very Asian mindset and that's no surprise bearing in mind where we are and where we came from. (Much of the complaints about GST increase are complaints by individuals because it would increase their living costs, the impact on the poor is just a veiled attempt at increasing emotional and sympathy support for a protest)

If we want to help the poor and be a truly inclusive society (incidentally everyone is happy to say yes to an inclusive society except that the "people" included should not be in THEIR OWN lives), what we need is a cultural and mindset change. An overhaul of the way we think and grow as a nation. Perhaps this is where the leadership failed despite its economic successes.

Catch ball liao!

2006-11-13T19:27:00.000-08:00

After giving it some thought and revisiting my previous thoughts on Singapore (for a while I stopped thinking of Singapore)

This whole GST increase and lowering of tax rates is meant to promote Singapore's economy. This is of course very very important. And I have no qualms about doing it. Hong Kong and China and India are all big competitors globally. We have to keep up. If Singapore's economy fails, we WILL be in big trouble. Hence most of Singapore's policies are always geared towards that. Ensuring the NATION'S SURVIVAL FIRST. The people's survival comes in at second place.

What I don't like is the fact that they don't want to say it as it is.

All this rejection of the "minimum wage" and "welfare". The reasons for doing so are political. Not economical. In fact they would help the lower income groups, but it would go against what the government puts as first place on its priority list.

What I would prefer to see PM Lee say is that Singapore is in a bad situation. Let's work together to ensure Singapore's survival. Hence the need for GST increases etc.

On the other hand the government SHOULD come up with concrete measures to help the lower income group. If it is welfare. So be it. Work out how to decide who needs what and help them accordingly. So far we have not heard anything of that sort. All we hear is plans to help businesses grow in Singapore. How to attract more rich people here by letting them pay lower taxes (how does that help the lower income group? Perhaps it does but indirectly?)

Nevertheless, this is the way companies and businesses are run. It's all about the bottom line. That's understandably so because businesses do not have "natural resources like gold, precious stones, oil etc". Singapore by nature is also a company and not a country.

This is a fact I accepted a long time ago. Which was why I decided that even if you handed it to me, I would pretty much do the same as the PAP. Singapore is a small country with no resources (albeit a fat bank account). In the long run where can it go in terms of expansion?

The answer therefore is that if you can, get yourself more options. Go overseas. Work. Diversify.

Remember we are more employees of this company than citizens.

Remember that no company ever thinks of how they can help their lower earning workers because they can't survive. If you are not worth your weight in salary, then off you go! Sounds familiar right?

Singapore is so small we have to be run like a company. Bo bian.

Hard to comprehend Govt's plan

2006-11-13T17:41:00.000-08:00

I was listening to PM Lee's parliamentary speech on TV last night. After listening to what the government has plans to do, I find it hard to understand what it is they are trying to achieve!

Let's look at what the government is concerned about currently:

1) Widening income gap

2) Helping the lower income groups

3) Maintaining foreign investor interest in Singapore (ie lower tax rates)

Now let's look at what PM Lee has suggested and analyze the implications :

1) Welfare is a dirty word. I can understand that giving freebies to people may encourage people to continue where they are without putting in any extra effort. That is indeed not ideal for our economy. But sometimes, people need some help to get started in the first place. It's all about a balance. Some welfare can't be all that dirty frankly.

2) Say no to minimum wage. Apparently foreign investors will leave in droves if we had a minimum wage. Nobody bothers to talk about how much the minimum wage would be exactly. I mean if I set the minimum wage at $100 per month per worker I doubt it would do anything to scare investors away! However it makes no sense to have a minimum wage that you cannot survive on! I suspect the real issue about not having a minimum wage is because the government is fully aware that there are people who earn so little in this "free market" that they simply cannot survive on one job alone. In some ways you can infer that the government has stamped its approval on foreign companies coming here to exploit cheap labour. It's a political move not to have a minimum wage. Not an economic one. The government could set the minimum wage at a low level that would please investors and keep them here, but then it would anger the people and hurt the PAP politically. The government has thus chosen to sidestep the tricky question of what constitutes the minimum amount a person should earn to survive in Singapore.

3)Increase the GST from 5% to 7%. When I heard PM Lee's speech last night, he announced this in the context that Singapore was competing (economically for investments) globally and had to adapt to global trends. He had mentioned that corporate tax rates would have to drop a few points to make Singapore competitive and attractive to investors again. Every 1% drop in corporate tax rates would cost the nation SGD$700 million annually (if I recall correctly). Hence we had to increase GST to make up for this fall. I'm not really sure whether these investors coming to Singapore hiring workers and paying them salaries with no minimum wage restrictions is going to really help lower income workers or not.

Now what is more interesting is that in Today's paper this was written :

"What are we going to do then, when the people are stuck with a higher cost of living?" he (Mr Low Thia Kiang) said. In response, Mr Lee rebutted the WP for its lack of a clear concept and its constant refrain for a welfare system, and told Mr Low to "wait for the Budget". Details for the "offset package" would be revealed at next year's Budget speech in February, he said, adding that it was "not the time for a long, supplementary debate".

"The higher income should end up paying more. That is part of being one society. I think that is fair and Singaporeans will support it," Mr Lee said.

I don't understand this part totally.

An increase in GST is an increase in the cost of living across the board for all in Singapore. The 2% increase applies to both the rich and the poor. It's not as if the 2% increase is for certain luxury items only , while necessities like water and electricity will be GST-exempt (unless this will be mentioned in the budget). So what happens here? Cost of living goes up for the poor. The poor suffer. What do they get in return? More chance of finding a job that will not pay a minimum level wage that can help them survive in Singapore? How does this help the poor?

As for the above comment by PM Lee that the higher income should end up paying more, it goes against his reason for increasing the GST in the first place! Everyone knows that the low tax rates benefit the business and the rich. It's pro-business. PM Lee did say last night "Have to lower corporate tax rates to be competitive" (ie attract rich people to do business here) "So no choice but to increase GST".

But then he tells Low TK that the rich will pay more? Huh? Did I lose something in translation? Doesn't a lowering of tax rates mean the rich paying less? Which is the point to attract them here right? And now he says they will pay more?

I really don't get it.

To end off, PM Lee said "We have done this before" referring to the past increase of GST from 3% to 5%, and the assistant package they came up with to help the lower income groups. And he implied that they did it well and it caused little problems to the lower income group during that increase.

From what I know, and from what the MPs are debating about, isn't it a fact that the lower income group are SUFFERING badly right now? Since the last GST increase, the lower income groups have lagged further behind! This despite the package they boast about. Hasn't the income gap widened? It is somewhat strange that the government would refer us back to the past increase in GST and their programs as a show of "evidence" that the new increase will be good for the lower income groups.

Having said that. The Singapore government will do what they want, when they want and how they want. As a Singapore citizen, all I can do is read, watch, work as hard as I am expected to, and hope for the best.

Support The Gaming Net!

2006-10-31T21:56:00.000-08:00

I say doctors are NOT evil! Too bad if you disagree!

2006-09-24T20:20:00.000-07:00

My last post got some people angry. But then that's what I was hearing day in day out from awfully nasty patients for more than a year! The area where I worked was filled with such people.

My father told me that I should not trivialise what I do. Although what I do at work may seem simple and trivial to me. They are things that only a doctor is authorized to do. So we should still be paid for the services we render even if it seems simple.

It's the same for lawyers. Many of the checks they run are performed by clerks but the lawyer signs off and charges a lawyer fee. But he takes responsibility.

So for those people who say doctors are evil and should be as poor as the man next door, sorry for you.

I will continue to do my best for my patients and not let such comments bother me so much.

As it is the places where I am working now have MUCH MUCH nicer people. The group I work with also has very good packages for patients that represent excellent value for money!

I have little to complain about :)

Doctors are evil

2006-08-29T05:18:00.000-07:00

"Doctors are evil". "Doctors are like whores". "Doctors make too much money". "Doctors profit from the suffering of others"

In Singapore that's probably what the majority of Singaporeans think to themselves everytime they think of doctors. It's just the way it is. Or at least how I've come to feel in my 2 years working in the HDB heartland in the south.

And they do have a point. Because these people are not rich. You see beggards sitting along the walkways asking for money. You see people passing urine in public.

And a good number of patients will always bargain for that discount and expect to get it.

Everytime I tell a diabetes or hypertensive patient that they need to increase their meds or that they have to do a HBA1c or Lipid profile and they say they have no money....well I lose my moral ground. And they start to ask for free this and free that cos we doctors make so much money. To them making $3k to $4k a month is a lot of money already! It is way beyond their wildest dreams!

So how do I practise medicine like that? I can't.

I think where I am going....in the central region...it's going to be very much the same.

It might be time to look at things again and see if it is worthwhile staying in this STUPID profession. I'm quite sick of feeling this way.

A patient told me this. You guys are just like those City Harvest Church pastors. Con people. Pretend say want to help etc, but really you guys are all just interested in making money.

So making money is not bad if you are say a businessman or banker. But as a doctor, or a pastor, you should not be making money.

Ah!!!! Your boss is my good friend!!!!

2006-08-29T01:38:00.000-07:00

Me : Good afternoon sir, how can I help you?

Patient : No I came to see Dr S. He's my good friend. I've known him for over 20 years! I also go to see Dr H for my diabetes.

Me : So how can I help you medically?

P: I want to get my diabetic medicines. I actually came to see Dr S, but since he's not here so I see you. Can you help me check my glucose level?

Me : Sure!

P: I also want to get my pink colour and yellow colour diabetes medicine. I usually get from Dr H opposite but now I found out Dr S my good friend is here so I come here

Me : Do you know the names of the medicines? I'm not familiar with the colours of the medicines

P : Usually I just say pink and yellow medicines and Dr H clinic will know. I know Dr S for 20 over years that's why I come here, but he is not around so I see you.

Me : I'm sorry sir I am not familiar with colours of medicines..

P taking out a box of his medicines showing me the pink one, but he has run out of the yellow one.

Me : The pink one looks like Avandia. Is it 4mg or 8mg?

P : If I know I will be doctor already lah!

Me : but the dosage is important.(Me takes a closer look at the Avandia tablet and sees an 8 on the pill so it's 8mg)

P : I used to take 2. Now I take one. I think it is the 8mg one. So can you give me the yellow one also?

Me asking the clinic assistants if they know of any yellow diabetic medicines. And the answer is no.

P : Usually I say yellow and pink can already! Dr S is my good friend for 20 years that's why I came to see him

Me : I'm sorry sir but I am not Dr S and I do not know you for 20 years. I need to know the name of the medicine to give you the same one as different companies manufacture their drugs in different colours especially generic versions

P : Aiyoh if I know the name I will be doctor already lah!

Me : I'll give you Avandia but for the other one I'm afraid I can't help you. How about I call Dr H to ask her.

P: No lah. Dr S is my good friend. I get from him lah.

Me : then maybe you can come back another time when he's around. Maybe he knows the yellow colour medicine.

P : I think he will know lah

Outside...

Clinic assistant : So the bill is $XXX.XX

P : Wah so expensive! I come here because I know Dr S for more than 20 years. Last time his clinic was just below my block.....

Sir William Osler also had bad days

2006-08-22T03:14:00.000-07:00

According to a friend the following was written by the great Sir William Osler.Makes you wonder whether the world is still the same as it was in the 19th century.

"At times and in degrees differing with our temperaments, there come upon us bouts of depression when we feel that the battle has been lost, and that to fight longer is not worth the effort, periods when, amid the weariness, the fever and the fret of daily practice, things have gone against us, we have been misunderstood by patients, our motives have been wrongly interpreted and smitten perhaps in the house of our friends, the worries of heart to which we doctors are so subject makes us feel bitterly the uncertainties of medicine as a profession, and at times make us despair of its future."

MSMH!

2006-08-22T02:16:00.000-07:00

Just here to promote the Mee Sian Mai Hum movement.

This one must try man. Mee Siam with Hum.

Things just get worse....

2006-08-10T23:57:00.000-07:00

I was hoping and trying to wait for the right time to post something happy for a change.

But unfortunately things just seem to get worse and worse.

I dunno where all this will end eventually.

Reality check 102

2006-07-27T18:29:00.000-07:00

The past 2 weeks have been interesting now that I think about it. But it didn't seem so at the start of that period.

But I've learned something in this time. When a person starts to settle for less and tell himself that it's ok to be content with reduction he is handed with, that's really the start of a bad end for him.

Whether a person is happy or not, depends on how he looks at things. That's very true. But frankly I don't think it should include telling yourself to be happy with what you have when you KNOW you can do better.

That's what I had been doing for the past few months.

I should have left my current position last year around this time. I had stagnated on the job quite simply. Working in the shadow of my employer.

Of course the Australian opportunity came along and that gave me something to think about as well as some hope. But when the unexpected spanner got thrown in. I fell back to my comfort zone and habitually forced myself to accept it and be contented with it even though I wasn't happy about it.

It's a bad mistake.

In life we should always live with hope. If you don't, then you essentially live a life of despair.

And despair is never good.

Hope however does not equate to success. And success does not equate to happiness. Happiness is an internal state of mind. You can essentially psycho yourself to be a little bit happy or not unhappy.

Which would you rather say to yourself?

I live a life of despair with no hope and am happy with it?

or

I live a life filled with hope and am happy with it?

I think I'll take the latter.

No more stagnations for me. As I learned in TCM. When Qi and blood stagnates, it is a harbinger of certain doom.

Reality check 101

2006-07-23T19:42:00.000-07:00

It's one thing to be contented in life and be happy with what you have. That's what most people say when talking to others who seem to be unhappy with their lives because they cannot "see" how lucky they are.

Well I think it goes further than that.

What happens when the things that you are so contented with, and "lucky" to have get taken away from you? Then you just have to be contented with less and less. But till what level?

There is a saying that the key to happiness is good health and a very bad memory.

I tend to agree.

I realise that some of the happiest people are those who live day by day. They never plan for the future. They never worry about the future. They just live for today.

Two quotations come to mind :

1) Today is the tomorrow you worried about yesterday.

2) When you can think of yesterday without regret, and tomorrow without fear, you are near contentment.

I find it difficult not to think of tomorrow without fear. But I do think of yesterday without regrets. At least I'm half way there.

3.5 year old Evan plays the Xbox!

2006-07-21T04:25:00.000-07:00

My 3.5 year old son playing Kung Fu Chaos on the Xbox!

He's playing the pink ninja with rabbit ears!

Radioactive poisoning tests?

2006-07-19T21:49:00.000-07:00

Patient : Doctor I suspect that the blower at my factory is blowing radioactive substances at me for the past few months. Is there a test that I can do to prove that I have radioactive poisoning?

Doctor : I don't think so. Do you wear any radioactive shielding at work?

Patient : None at all!

To myself : Either this guy is nuts, or he is going to be the whistle blower in the biggest radioactive pollution scandal in Singapore's history!!!!

"But he doesn't want to eat anything....."

2006-07-14T21:59:00.000-07:00

Parent : So doctor, can my son take the medicine on an empty stomach?

Doctor : It shouldn't be a problem but it is better if he could have some food before taking it

Parent : But my son doesn't want to eat any food.

Doctor : Well that's because he is having a fever and is feeling unwell. If you let him take his medicine, and his fever comes down, his appetite will return.

Parent : But my son doesn't want to eat any food.

Doctor : Then give him the medicine and sponge him.

Parent : But my son doesn't want to eat any food.

Doctor : ............

Issues churning at NUS Business School

2006-07-12T19:27:00.000-07:00

The Today paper reported about issues churning at NUS Business School that involve mainly its Dean.

Reading the article I get the impression that Prof Earley thinks that he can spend the school's funds as he sees fit and then justify it later.

This is consistent with the modus operandi of many other "foreign talents" that we have hired in Singapore.

Was the TV commercial for the NUS Business School well received? Nope it was not.

I wonder whether all this money spending achieves anything besides putting a smile of satisfaction on the "foreign talent" who spends it?

It is sad that in Singapore we value these non-performing foreign talents who have reputations that flatter their true worth to our country.

Molly's suggestion

2006-07-11T20:32:00.000-07:00

I like this suggestion from Molly.

check out the last part, what we can do to enure that mainstream media posts only articles that are non-partisan

http://mollymeek.livejournal.com/#114761

quote from Molly's (solly molly!!)

"OK, someone once complained that more than 85% of Internet postings are anti-PAP and so there is a need to have some “balance” by managing the Internet. Now, allow Molly to suggest that since probably more than 90% of mainstream media articles are pro-PAP BUT the PAP wants the mainstream media to be non-partisan, we might have to do our parts as citizens to remind the mainstream media to be non-partisan.

So, every time we spot a partisan article (pro-PAP or pro-opposition) in the ST or in Today or any other local paper, we might want to politely write to them and tell them to be non-partisan. We need to work together with the government to ensure that the mainstream media is non-partisan.

Template for Letter:

Dear _______,

I refer to the article “_________________,” in the paper ____________________. This article is dangerously partisan and I hope you will make amendments to the article and perhaps suspend the journalist who wrote the article.

As Ms. K Bhavani once wrote to the press, “[i]t is not the role of journalists or newspapers in Singapore to champion issues, or campaign for or against the Government.”

Kindly issue a public apology for publishing partisan articles.
Thank you very much.

Yours truly,
_____________

" unquote

do your part citizens!!

GIC returns impressive? I beg to differ

2006-07-11T18:46:00.000-07:00

And so the GIC has released information on the performance of its investments.

According to the reports " .....GIC has significantly enhanced the value of Singapore's savings.......Over 25 years, GIC has grown to an outfit that invests in over 40 countries through nine asset classes, handling over a hundred billion dollars.

And its track record has been good.

Over a period of 25 years to March 2006, the annual rate of return on the foreign reserves managed by GIC averaged 9.5 percent in US dollar terms, and 8.2 percent in Singapore dollar terms.

The average rate of return over global inflation was 5.3 percent per annum."

The report makes it look like the returns are good. But really they are not.

I would have done better simply parking my money with the US S&P 500 index.

The Standard and Poor's website writes " From January 1926 through March 2006 the annualized total return for the S&P 500 was 10.46% per year up from the annualized 10.44% rate in December 2005. The dividend component consists of 40.97% of the return, down from the 41.16% value at December 2005."

10.46% vs 9.5%. I think a Primary 5 student will be able to tell you which is better. I wonder why we pay so much to these GIC people to give us returns that underperform against the S&P 500 which is just an index of stocks and not actively managed! We are wasting our money!

And the Chairman gives us further insight into their strategic thinking : "GIC invests the government's reserves abroad in assets which carry higher risks like equities, bonds, real estate.

Therefore these are expected to earn higher returns on average over the long term."

That sounds totally ABSURD to me! From what I understand high risk investments positions are usually taken to maximize returns over the SHORT TERM and not the long term! As it is for all the "good" high risk investment options that GIC took up, they achieved poorer returns compared to the S&P average! I would consider that a massive failure!

Even more shocking is the next statement by the Chairman : "The CPF invests members' savings only in absolutely risk-free Singapore government bonds. CPF members are paid market-related interest rates based on the 12-month fixed deposit rates and the savings account interest rates of the major Singapore banks, subject to a floor, he said.
CPF members who are willing to accept higher risks for higher returns have many channels to do so on their own through the CPFIS scheme," he added."

If the GIC is so good at achieving long term higher returns in high risk investment positions, then it makes no sense why CPF should only invest in absolutely risk-free Singapore government bonds!

I am no financial wizard but I am not naive either. It is safe that CPF invests members' savings in very low risk (there is no such thing as risk free) bonds. It is the people's money.

But please don't play with figures to proclaim that GIC is doing well when it is clearly the contrary! We are not fools.

Courage in the face of adversity

2006-07-10T18:52:00.000-07:00

MOH gave an award to the team who investigated the recent fungal infection outbreak among contact lens users!

Well done team! Great work.

Mr Khaw's comments however throws up some questions for me.

Health Minister Khaw Boon Wan said: "Certainly when you decide to do something like this, you're taking on a very big multi-national corporation and as I said, they're armed with teams of (scientists and) lawyers. And if the advisory was pre-mature or without basis, or could not be proven, I'm quite sure there'll be a legal suit on our table.

"But more than legal suits, it's also our own reputation. In this instance, the reputation of SNEC and of course Ministry of Health and Singapore. So I'm quite glad. More importantly it ended up well."

Why should that be mentioned? You mean to say that if the MNC or "organization" is big or important enough, then the advisory would not be published?

In any case, if there were an instance where it was the reputation of MOH vs say Temasek Holdings, whose reputation would be more worthwhile protecting?

I suppose things are never as simple as they seem.

I feel Mr Khaw would have been wiser not to have made such statements at all. All it does is highlight that such considerations were made by MOH and that the possibility of overlooking the issue for the sake of reputations is real.

Not good.

"Liak Boh Kiew"? "Catch No Ball?"

2006-07-08T18:53:00.000-07:00

Today's Sunday Times carried an article about Singapore doctors being unable to speak the dialects. Especially the younger doctors.

Well the question is whether young doctor are expected to know how to speak 3 or more dialects, Mandarin and Malay? Why is it so surprising that young doctors can't speak those languages?

Let's see. In the 80s the government decided that all Chinese TV drama serials from Hong Kong would be dubbed in Mandarin. There was a speak Mandarin and not dialect campaign as I recall. Children studied English and their Mother Tongue ie Mandarin, Malay or Tamil. So it's obvious that young doctors should NOT be expected to speak dialects and 2 "Mother Tongues"!

But the way the article was written makes it sound like it's the fault of the doctors that they are not multi-lingual! That's a tad bit unfair I feel.

The problem is really with the older uneducated elderly majority. (I have previously written that this group of Singaporeans needs special medical care and communicators)

These patients also are one kind. The young doctor may be trying his best to speak whatever broken, half past six dialect to them but these old folks would show unhappiness or disgust and even lecture the young doctor for not being able to speak his dialect! No appreciation for the young doctor's effort are shown most of the time.

Is Singapore truly and English speaking country? Well perhaps for a certain majority of the pre-1965 generation, they are still stuck in that era.

Is this for REAL?

2006-07-07T03:46:00.000-07:00

The latest Health Facts statistics for Singapore are out.

At the MOH website they have listed that the total government health expenditure as % of GDP was 1.2% for 2003 and it dropped to 0.9% for 2004. Figures for 2005 were unavailable.

Government Health Expenditure

I was just curious to know how Singapore ranks among other countries going by this statistic.

I found this site which displayed data from WHO in a 2002 survey : International government expenditure on health care as % of GDP

The results were rather surprising to me!

There's not much surprise that USA is at the top with 14.6%. Australia and Canada spent about 9.5% of their GDP on health care. The UK was ranked #48 and spent 7.7% of their GDP on health care.

So where was Singapore?

Singapore ranked an impressive #149 out of 186 countries! But WHO listed Singapore's GDP expenditure as 4.3% and NOT 0.9% or 1.2%!

Well these were 2002 figures from WHO.

Iraq's expenditure on health care was ranked the lowest at 1.5%. I suppose you don't spend very much on health care when all you are doing is killing most of the people!

But something has to be wrong here. Singapore's spending of 0.9% would make it the lowest spending country in the entire world! Is this for real?

I have always wondered how Singapore can spend so little on health care and yet have a relatively efficient, competent health care system. My suspicion is that the statistics are fake, or that the health care workers are actually severely underpaid for the good work that they are doing.

Poor Mr Brown. All he did was follow Daddy's instructions!

2006-07-06T19:12:00.000-07:00

Poor Mr Brown. Our big brother has been caned like the older brothers before him. And all he did was to follow instructions from Daddy.

These were Daddy's instructions and comments that we got in the past :

"feel free to express diverse views, pursue unconventional ideas or simply be different."

"You can get anything you want in this family. You can travel, you can bring it in. You can - you can organize what you want. You can say anything you want, and all sorts of things are said and debated in this family" - Aug 2005

"We encourage the children to express their views and to have a view. Our problem in this family is that many children don't really have a view." - 30 June 2003

"We don't mind if you have different views, but you must have some views. If you have no views, I have a problem. If you have different views, we can talk about it and let's do something about it together."

"Whether the children fully agree with Daddy's point of view is less critical than whether the children are following the issues at all." - July 2001
-----------------------------------------------------------------------------------------------

This is how Singapore has developed over the years. It's a bit like the old traditional families.

Daddy always makes the decisions. He works to feed the family, to earn the money for the household. He decides what home to buy/rent, he decides what the colours of the walls are, he decides what Mom should cook for meals.

Initially the young children don't feel any wrong with this. Because they are helpless, know nothing of the world and trust Daddy wholeheartedly.

But as the years go by......the children become teenagers, and then young adults. They are educated. They have studied history, science, and read about social family structures and systems around the world.

Soon the older children start to make noise. They don't like the colour of their room walls. They want it blue and not white. They want to eat different types of food and not the constant rice and soup Dad always wants.

Dad realises he has a problem at home. He talks to the older children. They make it known they want to have a say in the home, in the family. So Dad says, ok I will listen to your feedback. Let us sit down and discuss things.

So they have regular meetings at the dinner table. The older children trash ideas. They give suggestions. Dad doesn't say very much. He just nods and write notes and at the end says he will consider all the suggestions seriously.

And at each subsequent meeting, Dad explains to the children why the walls have to remain white and not blue. Why it is more healthy to eat rice and soup rather than hamburgers. He justifies all his previous decisions. He also tells them that they are young and the world is good for them such that they can afford to be concerned about the walls being white and not blue when in the past, Daddy had to fight to get food on the table. It was his efforts that have brought the family to where it is today. Hence he knows best and all the children know nothing!

Increasingly, the older children realise that it is a waste of time talking to Dad. He is merely listening to the suggestions but doesn't intend to act on them at all. All it gives him is more information so that he can justify and rebut the requests of the older children. Everything is to be EXACTLY THE WAY HE WANTS IT TO BE.

After a while, the older children get disgruntled and decide that if they really want to have things how they like it, they have to leave the family. Set up their own. Or join some other family where the Daddy is not like their Dad and is more open to suggestions for improvements.

The dinner table meetings continue. The younger children attend because Daddy says they must continue to have it. But it is a silent affair. Daddy just keeps saying "How anybody got any feedback today? We are here to listen to feedback. That is what you all want right? A channel for feedback"

And all the younger children just keep quiet. And Daddy asks "How come you all so quiet? I don't mind if you have different views, but you must have some views. If you have no views, I have a problem. If you have different views, we can talk about it and let's do something about it together"

And the younger children think in their mind "Yeah Daddy talk talk only. I remember how last time when big brother and big sister got different views, how he beat them up with the cane. Better don't have different views lah"

And Daddy adds finally to the silent family " Aiyah, if you all not happy, I always tell you all that Mom can go find another Daddy for you all what! But I also warn you that all of the other men out there are simply not up to mark!"

My comment on the recent ban of smoking in hawker centres in Singapore

2006-07-04T19:09:00.000-07:00

Well everyone has their rights. Smokers have a right to be able to choose to smoke. Non-smokers have a right to breathe air that is not polluted by exhaled smoke from smokers.

So who has the bigger right? That seems to be the argument on today's talkback show on 93.8FM.

To put things in perspective, smoking doesn't do any good to the smoker nor the non-smoker. In fact it is very harmful.

As such I support the recent ban on smoking in public areas like coffee shops and hawker centres. It is a law designed to safeguard the health of people.

So to smokers out there, if you can't smoke, because you simply can't find a place to smoke, it's actually good for you. Remember that.

On the other hand, to ask non-smokers to breathe in 2nd hand smoke that is detrimental to health is simply not advised.

As for the debate about whether Singapore should ban smoking across the island, I too feel that is a bit too drastic. However having said that, Singapore is a very small country, and you don' t have vast open spaces where there are few people around. So inevitably, when a smoker lights up, some non-smoker around him will breathe 2nd hand smoke. That's not good.

Just something for all to think about......if you have smoking sections in a restaurant or enclosed space, isn't that akin to having a peeing section in swimming pools?

Think about it.

Managed Health Care.......

2006-07-03T20:40:00.000-07:00

There is this managed health care company that reimburses clinics in this manner

For acute cases : a flat rate of SGD$15+ (inclusive of medicines)
For chronic cases : a flat rate of SGD$21+ (inclusive of 1 month's supply of medication)

And there are several GP clinics that subscribe to such plans.

I suppose this is very much polyclinic rates already isn't it?

Why doesn't the government simply do the same for all private GP clinics then?

Offer SGD$15 for every patient? As it is there will be many GPs who will take up the plan.

Also I think those disgusting managed health care companies should close down as they do nothing but siphon money away from the actual health care for patients. Why have a middleman at all? I wonder how much the companies pay the MHC to let the MHC pay the clinics SGD$15 for every patient? How much do these MHCs make? Perhaps they make >SGD$15?

For the matter, the cost of medicines is not cheap. Even if you go for generic drugs the number of medicines and amount of medicines has to be low in order not to LOSE money. So patients walk away with a small quantity of cheap medicines.

SMA's guidelines on consultation fees should be thrown to the dogs! SGD$15 isn't even half of the SGD$30 they recommend GPs charge. It's a mockery!

I think the health care system in Singapore has gone down the drain.

I'm losing it here. I spent an hour talking to a patient who has hypertension, diabetes, weighs 106kg and is 42 kg overweight with a BMI of 38, his father passed away in his 40s due to complications arising from diabetes and hypertension. And after that the fella argued saying he did not want to pay SGD$10.50 for the consultation fees. SGD$10.50!!!! Under the SMA guidelines, the first 20 minutes would be SGD$30-SGD$55, and for every 10 minute block above 20min, SGD$20-SGD$25. So in reality I should be charging SGD$70-SGD$105 for a 1 hour consultation! And yet people argue and shout at me for $10.50!!!

What's the point in being a good doctor these days? Nobody wants to pay for advice. I much rather just talk little or better still don't talk, give some cheap medicines and collect my SGD$15. And some patients ask why doctors don't talk or say much. Well that's because you bloody people don't want to pay for it! DAMN IT!

TO HELL WITH IT! THIS IS SINGAPORE. IT IS TIME I ACCEPTED IT AND BE LIKE EVERY OTHER DOCTOR IN SINGAPORE.

Say little, give more medicine = value for money for the patient, no arguments. They don't know anything anyway.

TO HELL WITH IT!

Singapore's overburdened primary health care system

2006-06-28T21:35:00.000-07:00

I read this over at channelnewsasia

Why those long polyclinic lines pose a health threat

Think queuing up for a copy of this newspaper is a drag? Try joining a similar queue when you're sick — outside a polyclinic.

The wait could stretch for hours, and might go some way towards explaining exactly why the frazzled staff at Clementi Polyclinic ended up giving the wrong dosage of heart medicine to an 88-year-old woman, who eventually died.

While recording an open verdict on the case, the State Coroner on Tuesday heard testimonies from pharmacy staff who spoke of the daily crush they faced.

Even when a doctor changed a prescription, they could not afford to wait for the amended slip to reach them. Instead, they issued the medicine first — the amended slip could take up to two hours to reach them.

"Of course we'd prefer to wait," said Mr Ja'al Maaruf. "But we can't force the doctor (to hurry up) and we serve hundreds of patients."

Even though the possibility of a mistake in such situations cannot be ruled out, the staff have no choice as patients clamour to be served. The culprit, it appears, is the sheer load the polyclinics face.

Officially, they open at 8am.

"The queue starts before the clinic opens for registration," a former polyclinic doctor told Today. "It's like queueing for National Day Parade tickets at some polyclinics — people leave their slippers or belongings to 'chope' (reserve) the spot, go for the coffee, get a newspaper and then return nearer to opening time.

"It's not just in the morning. When we close for lunch, we see people queueing for the afternoon session."

Patients who arrive later are often subjected to long queues and the wait can be as long as four hours.

Official figures from SingHealth Polyclinics show that bigger polyclinics see about 930 patients a day with 15 doctors serving them; this works out to 62 patients per doctor a day. At smaller SingHealth polyclinics, it's about 56 patients per doctor a day. At the National Healthcare Group (NHG), this number is 60.

The numbers are higher than the average of 40 a day at a busy private GP practice.

During peak seasons, some doctors said they could see up to 100 patients a day — all within seven-and-a-half hours.

The pharmacy staff were equally hard-pressed. Serving more than 900 patients each day at the bigger SingHealth polyclinics are 10 to 12 pharmacy employees.

They are supposed to be the second line of defence in checking a doctor's prescription. But sometimes, sheer numbers can overwhelm them. Communication lines can get crossed.

In the case of Madam Koh Ah Tow whose case was heard by the coroner, the doctor said she had changed the dosage after a call from the pharmacy. However, two pharmacy technicians who packed and issued the medicine denied receiving the instruction. Madam Koh died 10 weeks later.

At SingHealth Polyclinics, some two to three amendments are made per day at each polyclinic. At the NHG, there are two to four a day at each polyclinic.

In an email reply to Today, SingHealth said that alterations are documented in the prescription and endorsed by the doctor. They are also recorded in the patient's case notes.

Over at NHG, doctors now need to make amendments in black and white and not just over the phone. But as patients refuse to wait for the amendments to arrive in writing, it is possible for the wrong dosage of medicine to be dispensed.

"We are humans and there is a limit to how much you can do with just one hand, one mouth and one pair of hands," said the former Polyclinic doctor.

"But you just can't turn patients away if they are there to see you."

62 patients a day per doctor in 7.5 hours. That works out to about 7.5 minutes per patient.

Well for any doctor out there, this sort of news is not new. We've been seeing that number of patients for years. In fact things have gotten better in recent years. It used to be much worse in the past.

Interestingly I knew of some Army camp Medical Officers who had to see 100 patients in 5 hours from Mondays to Fridays!

Frankly speaking there is a problem in the way MOH utilizes our medical manpower resources.

There is a relative shortage of doctors in the polyclinics if you consider the sheer number of patients they have to see a day. They are overworked quite simply put. Patients also are not satisfied with the level of care from the overworked doctor. The doctors of course don't like being overworked. So they leave. What MOH has done to overcome this exodus of doctors to the private sector as well as overseas is to bring in foreign doctors from the Philipines, Nepal, Pakistan and India.

Singaporean doctors prefer not to work in the polyclinics because it is clearly not safe being asked to see that many patients everyday. Most GPs who leave the polyclinics for the private GP market are not leaving for more money. In fact most would probably make about the same if not slightly more but have much better working conditions.

It just makes things more sensible. Having enough time to see patients, talk to them, counsel them etc. It takes even more time if the doctor cannot speak the same language as the patient (as in the case of Dr Diana Santos and a 88 year old dialect speaking chinese lady). Frankly which doctor wants to work like that?

Lately many private GP clinics have been experiencing hard times. Patients are not willing to see them because the price of seeing a doctor is too expensive for them. But is it really that expensive? I know many clinics charge $10 for consultation. Total bill usually comes to about $20-$30 with generic drugs.

I wonder what the cost of seeing a patient at the polyclinic is to MOH? I would suspect that it would not be much further from $20-$30.

MOH offers susbidies for patients visitng the polyclinic. Patients pay $4 for consultation vs $10 in the private GP clinics. There are also subsidies for medicines partly because the health groups bulk buy.

Perhaps what MOH can do is the following :

1) Work out and be transparent what the subsidy is like per patient with common conditions visiting the polyclinics. Eg Colds, Diarrhea, Sprains etc.

2) Offer the same subsidies for patients with these common conditions visiting private GP clinics. While there will be clinics that charge differently, the patients can "claim" back the subsidy from MOH (or get the clinics to claim from MOH). This can be offset from the clinic bill and the patient pays the balance (if any)

What this would do is allow patients the option of going to the private GP clinics and enjoying the subsidies from MOH. After all the subsidies are meant for sick citizens. Why should it be restricted only to the polyclinics? This would better utilize doctors who are in the private sector and lessen the load at the polyclinics.

In Australia, a similar system is in place. There are clinics which are called "bulk billing" clinics where patients see the doctor and essentially don't have to pay anything, because the clinic would bill the government. There are other clinics where the patients have to pay and extra seperate private charge while the clinic still bills the government the standard fee.

Right now in Singapore we are seeing polyclinics filled beyond their capacity, foreign doctors being roped in to work under insane conditions, medical errors being committed as a result , patients dying as a result of the medical errors, a distinct sense of unhappiness among the people, patients and medical community.

All this for what? To save money?

Perhaps MOH's philosophy is to make the polyclinics as inconvenient and as uncomfortable as possible such that only the very needy and desperate will go there for the subsidized treatment.

Is that the way to go?

Kids of young mums more likely to reach 100

2006-06-25T21:11:00.000-07:00

On today's Straits Times front page, there was this headline "Kids of young mums more likely to reach 100"

According to research, the chances of living to the ripe old age of 100 - and beyond - nearly double for a child born to a woman before her 25th birthday.

Why this is so requires further study.

Interestingly, in TCM we learn that the Essence or Jing is inherited from the parents. The older you get, the more you lose your Essence.

Old people are usually advised to try and replenish their essence if they want to live longer.

Children born to older parents tend to have more medical problems because they might have a lower amount of Essence.

Coincidence?

The Singapore way

2006-06-19T19:03:00.000-07:00

I got some nasty comments again from a certain reader of my blog.

Anyway I would admit that I have made a turnaround from my previous stance on "free speech".

I have asked for respectful comments and for reader to avoid personal attacks for no apparent reason.

I have had to activate my option to moderate comments.

I think having accepted that I'll have to live in Singapore, my mindset has changed now. Free speech? Only if you do it respectfully and within certain specified boundaries specified by the owners of the forum or the blog.

If not then please be prepared to get censored.

This is after all Singapore. If you like free speech so much, then go to bloody Australia!

You can't have your cake and eat it.

RTM channels jammed!

2006-06-08T20:29:00.000-07:00

Starhub has purposely scrambled the signal for RTM channels.

For so many years my TV could receive RTM channels via the HDB cable for free.

Then just a few days ago the feed is scrambled.

And there is a message at the bottom of the screen : Do not adjust you TV set. Poor picture quality is inherent from the signal Starhub receives. Sorry for the incovenience"

Time to get out the trusty old antennaes!

Did you know that registered TCM practitioners are not allowed to.....

2006-05-23T19:49:00.000-07:00

They are not allowed to give any western medicine. Not even the Panadol that you can buy off the shelf at 7-eleven! If they are caught doing so they can be censured.

That also means that TCM practitioners cannot give any injections also.

I used to wonder why TCM practitioners sent their patients to western doctors to get blood tests done, eg Blood cholesterol levels etc. Why didn't they just do it themselves?

Well I guess for one TCM practitioners are not trained in phlebotomy and are probably not allowed to do such "western medical" procedures and investigations either.

But it is necessary to monitor the results of treatments and confirm that there is improvement for the patient.

My outlook of this has now changed ever since I started attending lectures at Singapore TCM College. I think western doctors and TCM practitioners should communicate more. But before we can have meaningful communication we must be able to understand the language we both speak.

TCM practitioners do study western medical school subjects eg pharmacology, physiology etc. So they can understand quite a bit of what we talk about.

On the other hand, I think 99% of western doctors have no proper understanding of Yin and Yang, Qi, Blood, Body Fluid, 5 Elements, Meridians, Wind, Cold, Heat, Dampness, Dryness, Fire etc.

In many ways, whether each school of healing decides to learn about other schools of healing begins with acknowledgement and recognition. And that step is highly political.

We can see that it has happened in Germany. Prince Charles wants to do it in UK, but is having lots of protests from the allopathic western doctors.

Will it happen in Singapore? It remains to be seen. But at the moment the TCM practitioners have taken the first proactive step by opening a course for us Western doctors to learn their craft. And I think we owe them a debt of gratitude.

I put a picture of your loved one on the floor to let everyone step on.....

2006-05-23T18:42:00.000-07:00

From http://www.todayonline.com/articles/120191.asp

Movie posters a step on the wrong side of faith

Letter from Richard Koh

I FIND offensive the way in which the publicity for the movie, The Da Vinci Code, is being done.

A copy of the Last Supper painting with the image of The Christ and the apostles is used in the movie poster together with the lead actors' photos. Two of these large posters have been placed on the floor of Orchard MRT station (picture), which sees a high volume of human traffic.

Although there seems to be some kind of barricade around the face of Jesus to prevent people from stepping over it, it is still disrespectful for such an image to be placed on the floor. The relevant authorities should remove such floor posters.

This just goes to show how much blatant disregard Sony is showing to Christians in Singapore. I'm surprised the Singapore government with all their bold proclamations of racial and religious harmony and sensitivity are allowing such things to go on.

I doubt such a similar situation involving a certain other race and religion in Singapore would even be allowed to ever be thought of much less implemented!

I suppose terrorism has achieved its objectives.

The Da Vinci Code Controversy

2006-05-20T18:53:00.000-07:00

I watched the movie recently.

The movie clearly challenges certain aspects of the Catholic Church, although I do not see how it challenges Christianity itself.

Dan Brown's work is controversial mainly for the following claims:

1) Jesus Christ was married to Mary Magdalene.

2) The four gospels (Mark, Luke, Matthew and John) were chosen from among several (namely 80) that existed in the 4th century because the four gospels presented a divine Jesus whereas the excluded books depicted a human Jesus.

3) The divinity of Jesus became orthodoxy by a close vote at the council of Nicea in AD 325.

The key to the novel’s plot is that many in the Catholic church knew that Jesus was married. Somehow Dan Brown book implies that this "marriage" makes it impossible for Jesus to be divine. In The Da Vinci Code, the Catholic Church takes steps to protect Jesus's late emerging divinity status they "conspired", and not let it be known. Even to the point of committing murder.

As the whole premise of The Da Vinci Code falls on the claim that Jesus married Mary Magdalene and sired a child, I will comment only on this claim in this blog entry. The other 2 claims are mostly historical ambiguities that of course hold the possibility of error in judgement. However, if the first claim doesn't change Jesus's divinity nor the Christian faith, why the need to cover up at all? (Also to make this entry not so long! :))

So let's look at problem number 1
1)Was Jesus Married? The evidence for this claim comes from two extra biblical gospels, the Gospel of Mary Magdalene 17:10–18:21 and The Gospel of Philip 63:33-36. Both contain remarks that Jesus had a special relationship to Mary or that he loved her more than any of the twelve disciples. One text uses the term “companion” to describe her. This was a line in the movie as well. In addition, there is an appeal in the Phillip text where Jesus is said to kiss Mary on the lips. So the inference is that if he kissed her in public then he must have been her husband.

Now here are the facts. First, almost all scholars question whether these extra biblical gospels contain anything of value in terms of the historical Jesus. However, even if they did, the texts noted do not actually affirm that Jesus was married. In fact, the famous kiss on the lips text actually has a blank in the original manuscript right at the point where it describes where Mary was kissed. So it could be the lips or the cheek, which would simply refer to a kiss of fellowship. The term companion is debated as to its force. Most interpret the term as pointing to a spiritual relationship Jesus had with Mary because of the mystic character of the gospel in which it appears. So it does not allude to actual marriage at all, but to a fellowship that Jesus and Mary shared as believers.

More than this, we have volumes and volumes of texts about Jesus from the first five centuries. They are mostly all small print, single space, double columned texts of several hundred pages each. They include traditional orthodox texts and those that were rejected as heretical. In all of these materials not a single text describes Jesus as married and most assume he was not, as that was a basis for some arguing that priests should be single.

In 1 Corinthians 9, the argument appears that the spouse of those married should be supported. Had Jesus been married Paul could have clinched his argument by noting this fact. All of this leads to the conclusion that Jesus was indeed single.

Now some reply that 1 Corinthians 7 mentions believers being single and yet does not mention Jesus. However, here Paul only advises being single. Had he mentioned Jesus’ example that might have said more than Paul intended, by giving an impression this is what to do. So this is the likely reason Jesus being single was not mentioned.

One important final point on this though is that Dan Brown's book claims that a married Jesus would need to be covered up by the church because it would expose the fact that Jesus was not divine. Why? So what if Jesus was indeed married? Would that change his divinity status? Would that make him any less of "The son of God made man"?

The Catholic Church has always confessed the full humanity of Jesus. Jesus was a full blooded man who died on the cross. How would Jesus being married change any of this? In fact, the status of marriage would fit in nicely with such a claim. Thus, even the premise of the theological problem the novel sees for a married Jesus is false.

A lot of the movie depends very much on Leonardo Da Vinci's painting "The Last Supper". A lot is made about John looking like a woman. During Leonardo Da Vinci's time, men were simply drawn in that manner. They looked like women in many paintings and sketches.

Go to this website and take a look at Leonardo Da Vinci's sketches of men and see what you think.

As a sample, look at the picture below. That is a sketch by Leonardo himself of St. Philip for the Last Supper painting. It kind of looks like a woman to me too! So maybe we should look more carefully at Philip in The Last Supper instead?

Personally after watching the movie, I can understand why the Catholic Church wanted this movie to be banned. It does contain many damning protrayals of Catholics. Two ladies who were sitting behind me were talking throughout the movie and they kept going "Ohh! So like that har? I must tell my Catholic friends they are so stupid!"

Well this movie is a work of fiction. It insults the Catholic Church. It makes false claims and presents the claims in a misleading manner such that Jesus looks like a common man and not God. Hence you can see why the Catholic Church was so angry. As a Catholic I feel somewhat offended. However I view this more as a challenge on my faith than anything else.

I keep seeing articles in the Catholic News condemning The Da Vinci Code. I guess that's one way to do it. However why such a violent reaction? I think that by reacting so strongly, the Catholic Church may be playing into the hands of Dan Brown. After all, such strong responses fall in line with what the Catholic Church in Dan Brown's book would have reacted. If it indeed is a work of fiction and total lies, then why worry? Do we not have faith in our Lord to guide us through all this? Do we not have enough faith in the faith of our fellow Christians to rise up to these lies rather than accepting them?

I have learned that without doubt, there is no faith. "Doubting Thomas" will tell you that. In the gospels, the Apostle Thomas doubted when the other apostles told him that they had seen Jesus. Thomas replied that unless he put his fingers through the holes in Jesus's hands, he would not believe. And Jesus granted him his wish. It goes hand in hand. Doubt and faith. You cannot have one without the other. Just like winners and losers. There must be a competition, and then you must have both or else the "winners" somehow lose significance. But I would note that you can have all believers and no unbelievers. The two are not partners. For it is in the Lord God that we believe and have faith in, and it is every person's choice to believe or not believe.

Let us respect people's beliefs. We can argue, we can debate, But at the end of the day, faith is something that cannot be proven or forced. It is of your own free will to believe or not believe.

Anyway to put the Catholic Church's strong response in perspective, I wonder what would happen if there had been a similar movie called "The Rembrandt Code", which presented claims that challenged the Islamic Faith in the same vile manner as "The Da Vinci Code"? How would the Islamic world respond? Bombs? Terrorist acts of violence? Jihad?

I would bet my life that the movie would be banned in Singapore much less NC-16!

Sometimes life just isn't fair.

Lastly, I would recommend you watch the movie as it is an entertaining movie. 3.5 stars out of 5 for me. But remember that it is a work of fiction. In fact it reminds me quite a bit of the movie "National Treasure" which starred Nicholas Cage and talked about the Freemasons and the Knights Templar.

Popcorn anyone?

Win an Xbox360 by playing Fantasy World Cup Soccer Game!

2006-05-19T03:38:00.000-07:00

Want to win an Xbox360 (SG version premium edition) worth $660?

Play SGPSP's World Cup Fantasy League 2006!!!! http://forums.sgpsp.com/viewtopic.php?t=7541

Top Prize is the Xbox360!

Foreigners speak out!

2006-05-17T18:17:00.000-07:00

I was listening to 93.8FM this morning. The topic for talk back was "how do you feel about the redevelopment plans for seletar airbase?"

Just some background for those of you who have never been to seletar airbase. It used to be the seletar airbase run by the SAF. There are also numerous single storey houses which are occupied by foreigners. A very nice tranquil estate to live in if you like nature and all. But I would say 90% of the residents in that area are foreigners. Driving around the estate, the homes have their own swimming pools, have big dogs which are of rare breeds etc....

Well anyway during this talk back session on the radio, for the first time since I started listening to the programme, the majority of callers were foreigners! Expats with thick non-Singaporean accents.

Well they were are pretty unhappy with how the government had decided to go ahead and redevelop the rustic natural surroundings where they live for the purpose of attracting aerospace companies, building retail outlets etc. Basically turning it into more or less of a "concrete garden" at best. At worst a "concrete jungle"!

One caller commented that there is a long waiting list to "get into seletar airbase". I take it she meant her fellow expats who are on the waiting list.

I must say the callers were very eloquent. They said their piece and also suggested ideas on how the government should consult the residents in the area before making such plans. One pilot also said that seletar airbase should be preserved as part of Singapore's heritage given that it is over 100 years old. All points were nicely put across by the very outspoken and well spoken expats.

The last caller in the programme, however was a local and he said that looking at more bread and butter issues, this re-development was for improving Singapore's economy, and creating more jobs for Singaporeans. He also ended his call by stating that the majority of the callers today were foreigners.

I do know seletar airbase. From my days in serving my NS as well as frequent trips around the area for leisure as well as work when I start my medical evacuation sorties from Seletar Airport.

To be frank I like the place and wished I could live there. Unfortunately the truth is that the place is mainly for foreign expats. There is a long waiting list if you want to rent a place there. For Singaporeans, it is virtually an impossibility to live there. I can understand why the expats like the place. In a concrete jungle like Singapore, Seletar Airbase is the closest you can get to living in suburbs in places like Australia for instance. And the best thing is that this "natural reserve" is but a 10 minutes drive away from the bustle and hustle of the city! So you get really the best of both worlds.

I wonder how many residents live there? What are the numbers? And what is the percentage of foreigners among these numbers?

Here are a few comments I have personally :

1) Seletar Airbase is more of a colonial vestige for foreigners living the "special" life in Singapore. It serves its purpose for Singapore as part of the package we sell to the foreign talent we so covet. Most Singaporeans don't live there. Most Singaporeans don't even go there.

2) Should the residents there have been consulted before the re-development projects had been decided? Yes of course they should have. But since when has the Singapore government consulted Singaporean residents on anything before deciding what they want to do? And for the matter even if they do "consult" it is merely at face value as the plans continue anyway, but they get to explain away the objections. So to the expats in Singapore, welcome to "Uniquely Singapore". Learn to live with it. You cannot have your cake and eat it.

3) Expats may say that their arguments are helpful to Singapore. Shouldn't Singaporeans support them in seeing this last vestige of rural peaceful living preserved? Well thank you very much. But somehow I don't buy that. I don't hear expats calling the talk back programme when we are talking about other Singapore issues. Where are they? Usually people who are unhappy tend to be the ones who call in to express their disappointment and lodge their complaints. And it was no different today. Interestingly you can look back and realise that expats probably have it real good in Singapore. They have little to be unhappy about and little to complain about. If they did, you can bet they would make their views known, just as we saw today. It's no open secret that Singapore is designed to please the foreigners more than the locals.

4) I am all for re-developing the seletar airbase area. Singapore is a land scarce small country. We cannot afford such "vestiges" for small residential purposes. It's just the realities that we Singaporeans have to face up to. Why should it be any different for foreigners? If you do not like living in a busy hectic concrete jungle like Singapore, then think twice before you come. It is the same for locals. Some Singaporeans do not like living in Singapore and prefer the lush greens and open spaces in other countries. For that, some would migrate to those countries. It would be ironic that they could actually have lived in similar surroundings in their very own country in Singapore only to have those homes taken up by foreigners from countries with large amounts of open spaces.

5) I wonder what happened to our racial quotas to maintain a nice spread of races living in harmony? There is clearly a strong concentration of expats in this nice place to live called Seletar Hills. Isn't that a time bomb waiting to explode also? Oh sorry I forgot, it's not a HDB estate. Expats don't deserve to live in HDB flats, only Singaporeans deserve that fate.

6) Lastly, I would not be surprised however if the Singapore government backs down and decides to leave Seletar Airbase as it is. I can almost picture some CEO of some big MNC calling our PM and say that if his Regional Manager is unhappy because his home is now next to a warehouse, he will pull his multi-billion dollar business out of Singapore and go to cheaper Malaysia! I wonder if Singapore would stand firm to such threats?

Did your wages increase by 3.5% last year?

2006-05-17T03:21:00.000-07:00

Did you get a pay rise of 3.6% in 2003-2004? And another pay rise of 3.5% for 2004-2005? Apparently the authorities think we all did!

Today's news reported that the price hike for transport fares will be capped at 1.7%.

Apparently this 1.7% is calculated by a year-old adjustment formula expressed mathematically as
0.5 (CPI) + 0.5(WI) - 0.3 = fare hike in %

where CPI is the change in Consumer Price Index (in simpler terms inflation), WI is the change in average wages and the third element is the productivity gain of transport companies, fixed at 0.3% until the next review in 2008.

Hence this year's 1.7% cap is dervied thus :
0.5(0.5) + 0.5(3.5) - 0.3 = 1.7%
The CPI for 2004-2005 was 0.5%
Wage Change was 3.5%

Last year's 2.4% rise in transport fare was derived as
0.5(1.7) + 0.5(3.6) - 0.3 = 2.4%
CPI for 2003-2004 was 1.7%
Wage Change was 3.6%

Now I'm just thinking, how many people have had a WAGE INCREASE of 3.6% for 2003-2004 and an increase of 3.5% for 2004-2005? How many?

Man that's a WAGE INCREASE of 7.1% over 2 years! I certainly didn't get such a pay rise. Did you? Last I heard the problem was getting people jobs much less WAGE INCREASES!!!

How do they come up with such figures? It doesn't seem to reflect reality if you ask me!

I find George Yeo funny

2006-05-14T21:34:00.000-07:00

I laughed out loud when I watched George Yeo try to speak in mandarin during a TV interview he gave on one of his walkabouts during the GE campaigning. He can't speak mandarin for nuts.

During the campaign he said that parliament was like a well run Swiss Watch. Why do you want to put in new parts to screw it up? Well that was his point then.

And then today in the papers he says that having the PAP win all 84 seats would be "unhealthy".

I guess politicians are like that. Whether they are PAP or not, Singapore or not, they are all the same.

Flash and Circle

2006-05-10T00:55:00.000-07:00

While I was searching for logos and pictures of The Flash (the superhero) I stumbled upon this : flash and circle .

I thought it was interesting that the PAP's logo was modified from the logo of the British Union of Fascists (BUF)!

In the Wikipedia entry it is stated the Lee Kuan Yew was an acquaintance of Sir Oswald Mosley. I wonder how true this is.

I wonder why Lee Kuan Yew decided to use the logo of the BUF as inspiration for his own party logo? Any possibility that it was because he agreed with fascism?

I didn't dare post this during the elections period because it could potentially be misinterpreted as an attempt to influence voters or something.

Anyone know more about this logo and its history?

Is Medicine an art or a science?

2006-05-08T19:42:00.000-07:00

We heard that phrase quite often in Medical School. But most of the time we didn't take it too seriously. The "art" side of Medicine seemed to be in the history taking, interpretation of symtpoms etc.

Well after attending lessons in Basic Theory of Traditional Chinese Medicine as part of our coursework for the Graduate Diploma in Acupuncture and reading the textbooks, I can say that the "art" side of healing is very much well and alive even today.

TCM is founded very much in philosophy and "art" rather than in science the way we popularly understand.

The way TCM explains the body, disease syndromes etc is based on the Yin-Yang theory as well as other theories like elements eg Wood, Fire, Earth, Metal, Water. These are generally more philosophical in basis. Eg the laws of nature would explain that Wood would feed Fire, Fire would nourish the Earth, the Earth is where we find Metal, and Metals enrich Waters.

Diseases as well as bodily functions are explained using these philosophies. And these philosophies were written >2000 years ago.

Now there is no denying that TCM is an art. If you asked a TCM physician why he thinks you have a particular problem and the basis on which he prescribes certain herbs to you as treatment, you would get an explanation that is philosophical in nature. Eg you have excessive Earth Qi which has transmitted to the Metal Qi and thus you have a problem and so he has given you herbs to drain the Metal Qi as well as stimulate the Fire Qi to "dominate and control" the excess Metal Qi. Hardly sound "scientific" right?

Now the interesting thing is that for some diseases, the treatment eg choice of herbs and the organs associated with the elements affected in TCM principles are very closely correlated with the findings from scientific research in modern westerm medicine. It is amazing to think that the TCM treatment based on philosophies written >2000 years ago are actually scientifically correct!

Personally I look at it as the philosophy on Traditional Chinese Medicine being logical and sound and science being a means of "proving" these philosophies.

So the art of healing came a long time ago, because scientific techniques were archaic. But the healing arts were by no means wrong. Scientists merely help us better understand the arts in another way and therefore lend weight to the theories. The art and the science may still be wrong in some cases.

Many patients who do not feel well but do not present with typical symptoms or any palpable symptoms at all might be termed "Normal" by western doctors in the past. Today we have an emerging new category of diseases termed "subclinical" diseases or "functional disorders". These problems are hardly explained in scientific terms, but we do know that there is a problem.

This is where the true art of healing should be applied. If one understands the philosophies and basics of TCM, you can deduce and explain a disorder or symptom or syndrome using those concepts. And in so doing, you can then deduce the appropriate best treatment.

I'm glad I signed up for the course. I had always suspected that there were many inadequacies in my western medicine training. The TCM philosophies complete my education in the healing arts. Similarly I would have felt inadequate had I completed TCM training but not training in western medicine.

I look foward to completing my course and helping my patients better in the near future.

How will the results be?

2006-05-05T03:40:00.000-07:00

OR

OR

Possible fallout after the elections

2006-05-02T19:19:00.000-07:00

Teacher: Nicole, you didn't hand up your project assignment.

Nicole : But I did. I thought I did my project assignment and passed it up to you in class yesterday.

Teacher : No you didn't. I can't find it among the ones handed in by the rest of the class.

Nicole : But I thought I did! Teacher it's very important you know. If you don't mark my homework then I will lose marks for the final exam because this is counted as part of the final assessment. Do you know the implications of it?

Teacher : Ok I will go and check again.

The next day........

Teacher : Nicole come here!

Nicole : Yes teacher?

Teacher : The classroom CCTV which MOE installed after the 2006 Elections has captured footage of you doing your project assignment in class but you then put the work into your bag and did not hand it up!

Nicole checks her bag ....: Oh yeah hor! It's really in my bag all this while. I'm very sorry teacher!

Teacher : Anyway the project is no longer counted in the final assessment so it doesn't matter whether you handed it up or not. But Nicole you are a liar and a dishonest person and will never make it in any respectable field of work.

Nicole : I'm very sorry teacher. Please accept my sincere apologies if my mistake has caused distress and inconvenience to you Mrs Ong.

Teacher : I have discussed with the school's principal and we have decided to expel you from school because we both agree that you are a liar!

Nicole : But I am not a liar!

Teacher: Then you are implying that the school principal, Mr Li and I are liars? That is a defamatory remark Nicole. You are implying that Mr Li and I are unfit to be teachers in this school! We'll see you in court.

Nicole's family is sued for several hundred thousand dollars and become bankrupt.

Transparency

2006-05-01T19:56:00.000-07:00

There's a lot of talk in the papers right now about transparency, hidden agendas, people with things to hide etc.

One thing I am sure many people in Singapore would want to know is how much does it cost to build a HDB flat in Singapore?

No, I do not want to hear that it is based on market price of land, contractors, building materials and be told to work it out myself. I just want the figures.

Please tell me how much it costs the HDB to build a HDB flat. Is it that complicated?
I mean we are told that there are tremendous amounts of subsidies given to us when we buy a HDB flat too. In fact reports have said that because of these subsidies the HDB loses millions of dollars a year. I can't imagine how much my flat actually costs then considering HDB charged me $367,000 for the flat AFTER subsidies!

Come on HDB. It's a simple question. "How much does it cost to build a HDB flat?" The answer should be eg $X or X dollars. It's that simple.

This is something that HDB knows that we do not. Instead of asking others whether they know something that we do not, please HDB, come out and tell us the facts that we do not know but we know that you definitely know but for some reason do not want to tell us.

Please live up to the claim of being a transparent government.

More logos I keep seeing on the streets!

2006-04-27T22:18:00.000-07:00

Star Trek Logo

Audi logo
Mjolnir, Thor's weapon

Interesting Logos that I keep seeing

2006-04-27T22:08:00.000-07:00

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

2006-04-26T01:14:00.000-07:00

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!

2006-04-26T00:52:00.000-07:00

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

2006-04-25T05:20:00.000-07:00

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!

2006-04-17T21:35:00.000-07:00

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

2006-04-17T21:25:00.000-07:00

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

2006-04-17T19:30:00.000-07:00

Found this trailer of the sequel to the Titanic!

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

I've changed......

2006-04-17T19:10:00.000-07:00

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?

2006-04-16T21:06:00.000-07:00

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?

2006-04-16T20:59:00.000-07:00

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!

2006-04-10T22:49:00.000-07:00

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?

2006-04-10T18:40:00.000-07:00

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

2006-04-10T18:18:00.000-07:00

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.