Life's simple things.....

Monday, March 30, 2009

Casuarina lunch with Doctor Lee=)

Met up with Dr Lee at Casuarina for some brunch/lunch. It was very different seeing him in polo-T, jeans and sneakers. In fact, his sneakers were more hip than mine! (ignoring the fact that mine have been spoilt for a few months now) In any case, it was nice meeting up and catching up with everyone....and hearing Dr Lee's little stories before we fly off to our separate electives.

Some photos taken with the sigma. Have been trying out different settings to this wonderful lens.

Sigh. Despite pre-setting the settings, this was the outcome of the photo when taken by a passerby---who moved around to "fit" us into the photo. But it's the only shot of all of us. Dear people, next time when you take a photo....please say "1,2,3", then click.

In any case, I have finally finished editing all the photos from the previous wedding. Was invited to go for another wedding shoot today, but didn't have time. Plus I was thinking that the time needed to edit the photos would heavily eat into my electives. Not to mention, I'll definitely be taking tons of photos in Edinburgh=)

4 days left and counting....=)

3/30/2009 02:43:00 AM

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Ice Cream @ Udders=)

Met up with mirri, li, rachel, hl and marcus for some ice cream at udders. They have some really good ice cream there=) I recommend the durian, chempedak (is tt the correct spelling?), honey vanilla mars bars, the premium flavours...etc etc=) Good stuff.

Facial nerve palsy---inspired by my swollen post-wisdom-teeth-extraction face=P

3/30/2009 01:12:00 AM

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Friday, March 27, 2009

Coldplay blew my brains....to bits....

When Coldplay comes down to Singapore next time, I am definitely going to buy front row seats.

The concert was really awesome! Seriously mind-blowingly good. It's just so inexplicably good that you have to be there to understand....=)

Happy Birthday Diyanah!=)

Staying true to their tradition of reaching out to the "poorer audience", the band walked to the back of the stadium and performed a few pieces right in the middle of the crowd, on a make-shift stage in the middle of the audience.=)

3/27/2009 11:41:00 AM

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Sunday, March 22, 2009

Signs

3/22/2009 03:02:00 AM

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Friday, March 20, 2009

Some wedding photos.

Congratulations to the lovely couple, Sabrin and Margoob=)

A cute and lovable couple!

Need to get down to editing the photos. Have to finish the batch before I fly off in less than 2 weeks time!=P

Oh, and when I went to collect my camera bag from Cathay photo, which was supposed to be repaired, they told me that they decided to replace it with a new one altogether because they happened to find one last piece.=) So, now I have a new camera bag for free!=) Don't be lazy people! Go and make full use of your warranties, even if it's for minor stuff.

3/20/2009 09:41:00 AM

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Wednesday, March 18, 2009

Happy Birthday Mummy!=)

Happy Birthday Mummy=) Have a happy, healthy and blessed year ahead....=)

Celebrating my mum's birthday at The Chinese Restaurant.

Playing with Stephen=)

Our "traditional" cake cutting photo at home=P

Happy Birthday!

Anyway, the IT fair just ended over the weekend. My first visit was on Saturday night, where I managed to get a canon digital camera for my family. The price wasn't spectacularly cheap for an IT fair, as I could have gotten the same camera for slightly cheaper, but with all the freebies and extras bundled in, it was actually a pretty good deal=)

I decided to walk around the place to see what other deals there were and (of course) visited the Nikon Booth. As expected, the "deals" there were as good as not having any. I guess it's cheaper than the advertised prices of places like Best Denki, Harvey Norman etc, but they were still more expensive than places like Alanphoto, Cathay etc, esp if you are their regular. Anyway, I still went round to look see look see=)

Interestingly enough, something caught my interest---A tripod (including the head)!

While I was talking to the "boss" of the booth and discussing a bit about the recent increase in lens prices, I happened to mention about how it was still cheaper to get the cameras from places like Alan Photo, Cathay and Edison from Sim Lim. Turns out the boss was actually from Edison (=P) and he quietly agreed. In fact, he also told me that there were only a few really good deals at the fair. One of which was the flash and the other was the tripod+ballhead. However, he said the tripod+ballhead could only be bought if I got the D90. And not just any D90, but the more expensive kit 2.

So I decided to go home and do some research and come back the next day to try my luck.

After some research, I found out that the tripod and head costs around $300+ outside (cheapest is around $290-300 according to clubsnap). But, if I were to buy them ALONE at the fair, it would cost $199. HOWEVER, if I were to buy the D90 kit 2, I could get them for only $119.

So there I was camping out at the cashier waiting in hope for someone to buy the D90 kit 2. (Luckily, the cheaper kit 1 had already sold out by then.) And through the sharp eyes of Li, who managed to see this guy count $2000, we found someone who got the D90 kit 2! And I got my tripod for super cheap!=)

Actually, I feel kind of bad for these people? The fact is they can get it cheaper outside. Not only that, but they do not recognise when the sellers are actually "sweetening" the deal for them. The D90 kit 2 was obviously not worth it (although having a better kit lens) than the much cheaper D90 kit 1. But the Nikon people decided to throw in the tripod deal thinking the people might go "wow!" at the made in Italy Manfrotto tripod+ballhead. Sadly, few people were educated about tripods to know that they were missing out on a good deal. Most of them were just plain unwilling to fork out the extra cash. (Which was also the reason why the Nikon people decided to just sell off the extra tripods at $199.)

But I guess that's business.

Anyway, here is my new tripod---A Manfrotto 190XPROB, which costs $180+ outside.

And the Ball-head--A Manfrotto 486RC2, which costs $110+ outside.

Just need to find a strap to carry this thing around.

Somehow, patience always pays off. =)

3/18/2009 08:45:00 AM

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Friday, March 13, 2009

So, why did you join the SAF?

A question that many relatives, friends, medical students and doctors have asked me.

Most of the time, I would just give a small chuckle and divert the question with a non-answer. It is not that I do not have an answer.

The main reason why I do not answer directly is because, sometimes there is no point in answering. The questioner already has his preconceived notions of what a doctor does in the SAF; He already has his belief of what the "SAF" entails; He is happy with living in his stereotype of what the SAF is. Any answer I give would be futile in convincing nor explaining.

Besides, I have noticed that questions by sincere and earnest people go somewhere along the lines of, "So what are you going to do in the SAF?" or "What does a medical officer do in the SAF?". And often, this would develop into an extended discussion of our futures and how each of us intend to plan and work out our lives.

Indeed, I have sat down and discussed at lengths about the future of my job and, more importantly, the future of the SAF Medical Corps with friends, senior doctors and also with my manpower officer. In fact, I must admit that I have played both witness and advocate, supporter and pusher to many new changes to the scheme and scholarship. There are indeed a lot of changes that have happened in the past few years. More noticeably after my batch entered medical school.

I remember smiling to myself when I saw the Local Medical Scholarship being listed in the Scholarship Newspapers a few months back under the SAF scholarships' segment--with 2 main things clearly written.

The bond has been cut to 6 years with suspension upon specialty training. And
Applicant's are only eligible for the scholarship upon their own entrance into NUS Medical School. The rest of the information were, of course, about monetary benefits and perks offered by the scholarship.

So what is my answer for signing on?

The truth of why I chose to join the SAF lies somewhere in an unknown "in-between"---the uncertainty of both hope and bleakness. I promise I will answer this question right at the end of this (edited) reflection of mine.

It is very difficult to discuss about such a personal decision on a blog which I said to myself that I will keep as neutral and as "frivolous" as possible. My guiding principle of when I choose to write something on this blog is if I have some value to add or share that might hopefully shed light or benefit a larger group of people. Secondly, to try and explain 18 years of my life experiences leading to that decision of choosing to serve in the SAF would be impossible. Yes, it is indeed true that there are numerous answers to that question, some of which include the common derogatory comment by the ever-critical "gods" saying that, "It is impossible for an 18 year-old to be able to decide what future he wants and it is definitely too premature for an institution to bind someone as young as 18 years old for 18 years."

To that I say, yes it is true. 18 years old is indeed very young and if you can't see a future in the SAF, if you want a future that you can envision clearly, or if you want a future that is free for you to choose, then the SAF is definitely not something you should consider. Secondly, monetary benefits should never factor into your decision. So likewise, I always only just nod my head in silence when I hear people say, "It's actually pretty good right? They pay your tuition fees, plus you get yearly allowance, book, computer and hostel allowances etc etc."

So why did I smile when I read about the scholarship listing in the newspaper?

When my friends and I signed on to the SAF 4-5 years ago, we did not sign on to a scholarship. We signed on to a Local Study Award. It was a simple award, with a 12 year bond, no properly explained route of advancement that was made clear to us, basic monetary benefits, no "standardised" selection process, a lot of "rumours" surrounding this obscure award of minimal prestige.

I remembered how I came to my decision, it was pretty simple actually. Because I saw hope and I saw a continuity in the way things were being done/changed. Being handpicked by the then CMC, Doctor Wong and a room full of Krebs, I remembered how they interacted with us during the interview and, later on, in the office. We came into close contact with him, other senior doctors and more importantly, our immediate senior batch. I clearly remembered the times when our direct seniors were present during our vocation attachment and how they showed us the "ropes"---they brought us around, took care of us and showed us the "human" side to an otherwise "paper" bond. They showed us continuity. Through that short vocation training and school orientation, I knew that my direct seniors were great people who I could work with. Not only that but I also knew I will be able to go through thick and thin with my own batchmates. In fact, most of my batch mates were friends who were either my classmates in JC or course-mates in OCS. And slowly, I found out that the current leaders and leaders-to-be had a vision, which they shared with us once in awhile. My second most important reason of why I chose to sign on was that there was a need for something to be done in the SAF Medical Corps, and that improvements needed to be made.

Just as how the healthcare scene in Singapore is constantly changing, the SAF medical corps also needs to change to remain RELEVANT to Singapore. For example, it will be pointless to place all of our operational emphasis on "preparing" for a war that we hope does not come. If we were in Israel, Korea or in the US...Sure...that would be a necessary operational focus. Over there, doctors are indeed needed on the field, in hospitals and in transport vehicles operating on the wounded, planning resources, tending to the sick and dying, treating civilians etc etc. In Singapore, our closest to a war scenario are the occasional peacekeeping missions and humanitarian aid missions.

So how does one ensure that the SAF Medical Corps changes and remains relevant? First and foremost, attract the brightest of individuals and leaders into the Medical Corps. Make the scholarship a proper one, attract the best, groom the individuals and ensure that there is continuity in leadership that will change the Medical Corps.

To do so, there can only be one way that the best of the best can be attracted into the SAF. The first step is to ensure that the scholarship must be beyond reproach, ie the selection process must be transparent and must be meritocratic at all costs. The interesting thing is, it has always been meritocratic for as long as I have known. Rumours of "desperate" situations whereby the SAF "helped" their awardees into the Medical school were unfounded. But that was not important, for a successful branding, our feedback to the manpower department was to revamp the system. And the focus of the selection process must be two stepped.

The first step is choose the best from all who apply. No two ways about that. Set a basic cut off standard and ensure that there is a clear and meritocratic selection process.

The second step is to attract as many suitable candidates to apply for the scholarship. Because if we only achieve the first step, we will only be able to choose the best of those who apply. But if we attract a large pool of applicants, then we will have a higher probability of choosing the best of the best.

And honeslty, all these changes are happening, despite countless seniors having told our batch that our plight is hopeless, that they have given the same feedback after feedback, year after year, to no avail. But from an ancient award described above, the newly named scheme is now of scholarship status, with increased monetary benefits comparable to other similar scholarships (including the PSC), clear route of advancements, utilizing larger resource pools such as MINDEF, clear eligibility requirements and now having a concerted effort to attract younger generations of scholars. I must admit that the reason for the success in changing was a combination of factors. It was as though the stars were aligned. We had a fantastic manpower officer and department, whom my batch were really close to, a retiring CMC who felt strongly about the cause and put in effort to this seemingly parting legacy of his, an incoming CMC who was still "fresh" (as some would put it). And the icing on the cake was the emergence of the PSC scholarship that proved to be the catalyst for change. The PSC medical scholarship showed how our award was glaringly in need of review and that our resistance to change and stubbornness in choosing to live in denial that everything is all fine and dandy, will only lead to our demise. As always, even though the "stars were aligned", nothing would have happened if nobody acted. For that, I am grateful to everyone who played a part in seizing the opportunity and eliciting such a change. And looking back, all these changes are already a few years old.

However, the second step is the more difficult step--which is to attract a large pool of individuals to apply.

For that, there is no real solution. There are, however, a few factors that will affect a person's interest in choosing this different lifestyle.

There must be a clear vision among the Medical Corps' leaders and this vision must be communicated to future generations. The future and relevance of the Medical Corps must always change to serve the SAF, the country, the doctors and her patients. The Medical Corps must always seek to serve a greater purpose other than to simply excel at being status quo.
There must be a well defined route of advancement. In other words, there must be a role for your scholars. If you want to attract the best, make sure there is a suitable and challenging path for them to pursue in this other "world".
Know the people inside the system. Know your peers, your seniors, your juniors and your leaders. Such that even if all else fails and the system is far from perfect, you can count on the fact that you have leaders and seniors you can count on, who will continue fighting the good fight for future generations. In short, make sure you have people who will journey with you.

In any case, talking about vision and purpose, I would like to share a few snippets from some random discussions with random people both inside and outside of the SAF. As said earlier, the SAF must serve a greater purpose other than excelling with status quo. To put it simply, one should consider buying a car instead of trying to make a push cart go faster. What I mean is that we must be open to importing lessons/models from other countries and tweaking them help serve our purpose. Instead of always holding on to our age-old traditions, maybe it is time to improve/expand our portfolio and roles. Yes, in the past, the Medical Corps may have been born (not too long ago) out of necessity to serve the various vocations, to treat the soldiers and to manage the wounded and the sick. Coupled with rudimentary resources, the best then would have been a "push-cart". But with expanding resources and changing needs, it is time to seriously relook into the system. Even though the push cart can serve the present needs well, it might actually be more prudent to buy a car that can carry more, function better, play a larger role and serve more. Instead of trying to mask our inadequacies by placing 'Goodyear' tires and a suspension system on a self-drawn cart.

So what possibilities are there for the SAF Medical Corps? Some refreshingly interesting and seriously possible futures that I have come across in some discussions are as follows. (By the way, these are just discussions through personal encounters and definitely is in no way, reflective of what the SAF is thinking. I don't even know if such topics even arise in their conversations)

Have a DUAL track route of advancement. Instead of the single track of advancement whereby Medical Officers have to play both "doctor" and "administrator" in the current local system, emulate countries like the United States etc, where Medical officers are groomed with equal chances of developing their clinical experience and also their organisational management skills. They can then later split along parallel paths and be promoted based on their skill sets in either one--for example a doctor can be a colonel due to his expertise in trauma surgery or in his ability to manage a humanitarian crisis. The thing is both skill sets are necessary to the SAF IF ever a crisis does occur, but sadly the development of both are somewhat exclusive to each other due to time limitations. The important thing about such a route is that it acknowledges the varying interests of the doctors in the SAF and also the dual role of doctors in the SAF.
Consider starting a "Military" Hospital that is open to the public. It is no secret that Singapore medical officers are not the kind that remove bullets from soldiers, that reattach severed limbs, or regularly do stuff that one hears of in other countries. However, it is important that a proper environment is set aside to groom such doctors and that their clinical experience is not neglected. Secondly, serve a greater purpose. The SAF Medical Corps definitely has the resources and the capabilities to establish a Military Hospital. The Military Hospital can then pull together their segregated departments of Hyperbaric Medicine, Aviation Medicine, Diving Medicine, Burns Unit etc etc into one housing, instead of all across the island. The Military Hospital can also be of a central location and can specialize in certain specialties. Of course, the hospital should be run mostly like other public hospitals, including employing doctors from MOH(H) and also serving the general public (other than NS men and regulars). But just imagine the possibilities of crisis management, organisational plannings, military operational readiness, developing MOs clinical experience, ease of implementing contingency plans, conducting of SAF's own medical research. etc etc. Of course, the Military hospital can also serve other purposes such as offering subsidized rates for regulars and their families, which is what other countries are also doing.
Work even closer with MOH. The thing about the Medical Corps is it is neither exclusively with the SAF nor with MOH. The Medical Officers are also neither true blue soldiers nor full fledged doctors. So it would be best to strengthen ties with both MOH and the SAF. Not just through papers or discussions, but through actual operations. Such as a military hospital (instead of building numerous other public hospitals), national plannings, crisis management, national research etc. For example, in a mere one week of research with the SAF, I have realized how easy it to carry out a study on half the population of Singapore. Just involve all NS men during their health check up. Period. The only "sad" thing is that the impact of these studies are usually limited because there is no "reason" for studies to include the other female half due to funding issues. So instead of going that extra step of answering research questions that can impact the whole nation, researchers are limited to just answering SAF related questions while hoping that in the future, other organisations like public hospitals or MOH will develop on this study and carry out a larger scaled national research.

So why did I sign on to the SAF Medical Corps? I definitely didn't have the above thoughts when I was 18 years old.

But for that moment, I believed.

Maybe it was in the potential of the SAF Medical Corps and her people. Or maybe I believed that there was hope and a future to shape in the SAF medical Corps. And Maybe I believed in my potential being fufilled in the SAF.

Yes, maybe I won't be able to be a damn good neurosurgeon, but just as how the new scholarship is only benefiting future batches, maybe there will be a young medical student who will look forward to becoming a General neurosurgeon when he graduates.

And all I pray is that the current LSA/LMS scholars continue to keep pushing for a vision and that the present leaders never stop tearing down the truckloads of bureaucratic red tapes that stand in the way of improvement. But to only attack and bring down the authority is a clear sign of one's failure to recognise that you yourself are part and well on your way to become that authority. In other words, if you serve your duty, there will come a time when you are in a position to answer those demands for change.

But as always, consider such a service only if you are willing to serve. In a perfect situation, there would be no need for a bond if there is an abundance of people who are willing to serve. If you are more concerned about yourself and not sure of how to best develop your potential (which I feel is important too, so that we can get talented doctors and surgeons), then stay free from any bonds.

Whatever happened to Doctor Allen is unfortunate and it is honestly retarded to speculate about the causes of his actions and having mainstream newspapers attributing his death to hard-core gaming, relationship problems, depression, drugs, running afoul with the law etc etc (Seriously??). And in response to that, having random bloggers/online tabloids resorting to publishing his letter on the world wide web and slamming newspapers, the "gahmen" and the SAF.

Somehow citizen journalism is still very sensationalist-driven. They somehow find it hard to accept that situations like this are usually multi-factorial and what is more important is that we look forward and move on.

3/13/2009 11:22:00 PM

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Nicest Thing

~Kate Nash

3/13/2009 02:13:00 PM

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Steamboat at Huilin's House

More good food=)

My last meal before I pluck out my wisdom tooth!

3/13/2009 04:21:00 AM

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Thursday, March 12, 2009

Don't Worry, Be Happy

~Bobby McFerrin---From the album "Simple Pleasures"...=)

3/12/2009 11:15:00 PM

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The endless field shot=P

I got a few questions on how to take that shot, so here is a simple explanation. You need to find a slope and position yourself on the downside of the slope such that when you prone down, the gradient of the slope will block out the nonsense on the other side=)

I'm not sure where the other photographers picked their spot to shoot, but in my case the red cross below was what worked for me=)

Hope that was useful and everyone can go and have some fun with their own jumping photos=)

But you need to be REALLY patient! We had to take quite a few shots and wait for random people/heads to move out of the picture so that we can get the photos below.

Either that or photoshop.

I suggest you go down at around 5 pm also, especially if you are using the red-cross spot, because the sun will be shining from the photographer's back (ie from the left when you are looking at the above hand-drawn image), so the subject will be nicely illuminated, as opposed to downward shadows when you take during noon or overexposed background/dark subjects when you take in the mornings. But I guess one could always move around to take the shots.=) Have fun!

3/12/2009 05:10:00 PM

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Some set-up shots=)

Here are some shots I took at the Marina barrage, with a bit of set-up and time.

Times like this I wish I had a reflector....Maybe I should invest in one. It would have been so much easier to use a reflector than to take out and adjust my flash (which I was too lazy to do=P).

And the story about a girl's feet.=)

3/12/2009 04:18:00 PM

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Marina Barrage=)

Finally managed to meet up with everyone after such a long while. Really nice to see everyone=)
Here we are having a picnic at the Marina Barrage=)

Had a really enjoyable time, with all the good food, good weather, good scenery, good photo opportunities and, most importantly, good company=). Everything was just nice. Was actually quite worried that it might rain, especially since it was raining quite heavily the day before (Saturday). Thankfully, the weather held out. In fact, it was scorching hot! Luckily, we got a nice spot under the shade to set up our picnic=)

Here are some of the photos. If you would like to see the rest of the photos and/or to download original sized photos, please go to my flickr account.

cute little kids running around=)

Our shaded picnic.

Dancing robots=)

The soon-to-be-trademark shot of marina barrage. One of the FEW places that can actually offer the illusion of endless fields that stretch into the horizon. It is almost impossible in Singapore to achieve such a photo=) So after showing the pic to everyone, everyone decided to have a shot too=) New facebook pic! haha.

YAY!

And the gymnasts work their magic..=P

I like this pic a lot=)

REALLY REALLY LIKE THIS! super funny!

The sunset from the marina barrage....The sky kept changing every few minutes, so in between snapping pictures of everyone, I would walk to the edge and catch a few photos of the city silhouette .

Group shot! It was almost impossible to get everyone to jump together..

We jumped until the moon came out=P

Gorgeous sunset=)

And this is how we took the photos of the jumping shot....=) we literally had to prone onto the ground, with our cameras just a few inches off the ground.

Wanted to take a picture of the sky, but sadly, I didn't have a wide angle lens that could capture the whole sky.

We may not have any scenery, but we sure do have an impressive city skyline.

Night city skyline. This is the best I could do without a tripod---as I had to find a balance between the ISO noise and the instability from being hand-held. The best would have been to walk all the way back to my car to get the tripod. haha.

More photos coming up soon.=)

3/12/2009 01:36:00 PM

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Sunday, March 08, 2009

February Electives=)

One month has passed and I must say that my electives at NNI was an enjoyable one. I definitely learned more about medicine (more than just about neurology or academics) and I think everyone would agree, that we definitely thought a LOT about our future during these 4 weeks. =P

Here are some random photos taken during the course of the electives=)
(Photos taken with the samsung wb500)

3/08/2009 11:58:00 PM

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Haircut day=)

Li's bold new haircut=) Which initially made her panic cuz the hairdresser just chopped off the whole chunk at one shot instead of slowly snipping off inch by inch..

I think it is really really nice=) So it deserves special mention....haha.

Cute mother and daughter having some fun outside vivocity next to the fountains..

A really nice (and expensive) coat at desigual.

New hair=)

Some changing room mirror fun=)

3/08/2009 10:50:00 PM

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Some of my favourites...

Some of the keepers from the event=)

3/08/2009 01:40:00 PM

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Sixes Tournament (Part 2)

Here are some more photos from the Hockey Sixes Tournament last week. Have finally managed to edit them properly=)

For more photos or to download the original-sized photos, just go to my flickr account here. Just give me a buzz if any of u would like to use them for any publication or commercial uses=)

They had a cute little pool in the middle of the tents so that people could soak in it to cool down from the blistering heat.

Another way to cool down=)

"So close!"

"My hair is on fire!"

Good looking kids

Happy Hockey People=)

Really really really gorgeous girl! I was standing beside her taking photo after photo until she noticed me. After which she turned to stare at me and shyly buried her face into her mum's side..=P

Pretty kids=) They were walking beside me, and so I asked them "Hello there! Would you like to have your photo taken?=)" The little girl replied "okay!" and then they posed...=)

Bright and cheerful team! They were really friendly!

Supporting their daddies.

As you can see, the clouds started coming in...threatening to pour anytime.

and it starts pouring..

Liyana=)

Officials catching some well deserved rest during the downpour.

Guest of Honor table.

For more photos of the prize presentation, please go to my flickr account.

I guess the next Hockey event would be the Hockey World Cup (Under 21) coming in June.=) Hopefully I'll get to photograph that event.

3/08/2009 12:29:00 PM

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Wednesday, March 04, 2009

International Hockey Sixes Tournament (Part 1)

Organized by the Singapore Cricket Club and held at the Singapore Padang, the sixes tournament was a pretty nice event (to shoot=)...). The whole place was filled with people from all over the world. And the atmosphere was a very cheerful and lively one, with people dancing, drinking beer and sweating it out in the hot sun. Not to mention, there were quite a few cute little kids running around the place too!

Got invited to be an official photographer for the event, courtesy of Jonk, and managed to get some good shots. Will upload all my photos here for everyone to download and use.

Haven't managed to edit all my shots given the lack of time, so here are the first 50 shots that I've managed to edit so far. Will upload more soon.

Cheers=)

3/04/2009 11:42:00 PM

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Sunday, March 01, 2009

What is Medicine?

Heard some news that got me thinking.

Our healthcare scene is changing a lot. It's almost staggering and shocking as to how fast, much and uncertain these changes are being pushed for.

All I hope is that our leaders and each of us never forget what being a doctor is about and to always remember that medicine does not equal to healthcare.

To put it simply, medicine is the relationship of trust and healing between an individual patient and his doctor.

Healthcare, on the other hand, is the management and provision of resources to a population----and that requires/includes financial planning, evidence-based medicine, population statistics, cold-hard profits, sustainability and the public's perception of supply and demand.

It does not matter if we have an engineer, a lawyer, or a businessperson running hospitals. If you ask me, the best team should include financial analysts, mathematicians, a group of Harvard business graduates, hoteliers and, to top it off, a marketing team for publicity and damage control.

The tricky part about healthcare, especially in a highly ambitious setting, is that there are 3 main factors to deal with:

Population demands and requirements
Financial sustainability/profitability
Reputation and regional/global recognition

Of course, it is great to build a healthcare system that caters to all 3 factors.

But if we go all out to change the system, so that we can "create" a "Medical Hub of the Future" that is heavily shrouded in self-acclaimed glory and self-praised reputation; with the aim of turning our healthcare system into a viable source of revenue for our little island; coupled with the sudden interest in boosting research and translational medicine; on top of meeting demands from her country's population for accessible and world-class medicine; all packaged in the political correctness of providing "affordable" healthcare to the masses.......we are just going to shoot ourselves in our feet. I won't say it is not possible, but it is no easy task and, personally, that is something that a doctor is not trained to do.

But in our rush to achieve all this, we now see random complaints from individual patients against respected doctors who we, students, look up to and who are usually held in high regard by a large number of individual patients. Complaints of how cold, distanced, short and calculated medicine is being practiced.

And that is because the healthcare system has compromised medicine.

The limited time available, the high turnovers needed, the "necessity" to create reputation and to live up to our self-proclaimed standards, the "need" to ensure profitability on top of sustainability, the believe that research is "the way to go"....etc etc.....all this has heavily interfered the way a relationship between a doctor and his patient is supposed to be. Other than the limitations imposed, another intangible effect is how the emphasis of all these "priorities" has changed the way this altruistic profession is supposed to be carried out---where new generations of doctors are immune to such realities and are only acquainted with this form of "medicine"

And what is happening now is a domino effect. In an ideal domino scenario, which is for a perfect sequence of dominoes to fall, it would require a lot of meticulous planning and careful laying of pieces. Not only that, but it would be best to check and recheck the pieces to ensure that everything is in place. Then and only then, when we tip that first piece, the chances for a failed connection or an incomplete picture would be low.

But all too often, we try to rush, and skip some steps. The biggest mistake comes in choosing to tip that first piece even BEFORE we have finished laying the pieces. So now, we are faced with the time element of having to lay the next piece at the same rate of the falling dominoes. And that means that time becomes the first consideration---above planning, careful laying of pieces and checking. Everything is reduced to just one primal goal of ensuring that there is one domino placed at a spot to receive the falling piece. Just keep everything moving, and hopefully, we will still be able to make a picture eventually.

I still remember sitting in the NHG scientific congress last year. There was this invited professor from overseas commending our healthcare system and how we have managed to grow so fast. He droned on for quite a long while and I found myself zoning out once in awhile. At times, I thought he was either going off tangent or being cryptic. But on hindsight, I realised that he was offering poignant advice in a politically correct manner.

One thing that stuck with me was how he mentioned an obscure anology of our healthcare system by comparing our way of cooking fried rice to their method of stewing. He was very politically correct in his delivery and mentioned bits and pieces of how our healthcare system is likened to a delicious plate of fried rice, resulting from quickly chopped individual ingredients stir fried together. He then quickly mentioned how sometimes a stew is better because it is given time for the ingredients to mix and for the flavours to mix.

He seemed to toy around with the analogy for awhile, but did not elaborate it much further in front of an audience including some of Singapore's top healthcare administrators.

On a final note, developing our healthcare system in line with "national interests" is fantastic and it definitely has my utmost respect. Just as long as basic medicine is preserved. (Personally, I would gladly overlook everything else.)

And......protect not just the patients, but also the (future) doctors.

(Maybe it is time for a collective voice from the doctors/medical students.)

3/01/2009 02:51:00 AM

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