In commemoration of SMA News' 60th anniversary, we peer into the past to showcase some of our older articles and their contributors. Among the many who have given the newsletter their love and passion over the years, the late Dr Chan Kah Poon (1943–2005), also known by his pseudonym Garfield, stands out as one of our most prolific and iconic contributors. Dr Chan served on the SMA News Editorial Board from 1987 to 2005 and shared many tongue-in-cheek essays and reflective poetry about what he saw of life as a doctor and a citizen. The following article by Garfield was first published in the March 2001 issue of SMA News.
DEAR PRESIDENT OF THE SMA,
I am writing to you about my GP. This is not a complaint against him. But as President of the SMA of which I assume my GP is a member, I thought that you or some of your committee members may like to have a word with him, regarding his recent attitude and practice, which I as his patient, have found different from before and rather disturbing.
To start with, I shall acquaint you with some background information. I have been his patient for more than 10 years. My wife and child are also his patients. I have to see him quite often because I suffer from migraine. Our relationship in the past had always been cordial. There were no problems between us.
However things have not been the same in the past few months. I detected a certain change in the manner in which he treats me, which may have affected his other patients as well. It isn't easy for me to describe this change. Perhaps I'll relate to you what happened during my last visit to him. I can still remember the occasion clearly.
"Good morning doctor and Happy New Year," I greeted him. "You are Mr. Amos Lim, I presume," he replied, "I wouldn't know how good this morning is until lunch and how happy the New Year is until next January." The doctor is technically right of course but is this a nice way to answer a patient? And what is this "Amos Lim, I presume," business? I have been his patient for donkey years. "Don't you recognise me?" I asked him. He said he thought so but he must make sure because nothing can be taken for granted. Doctors cannot make mistakes, he added.
I told him that he must be kidding, as doctors are also human and all human beings make mistakes. I am a social worker and I know a thing or two about human failings. Human beings are not perfect, only God is. He had to agree and said somewhat contemptuously that soldiers, economists, politicians and bishops all make mistakes that have resulted in the exile, killing, starving to death and burning at the stakes of innocent people. The difference with doctors, he said, is that the public is unforgiving. They expect doctors to be infallible and if anything goes wrong, the fault finding begins. Maybe doctors are easy prey, he opined.
I said that it is not true and that those people he mentioned will ultimately be judged by history. "Bah!" he said, "after they are gone or have disappeared." Doctors, I suppose, sometimes get up from the wrong side of their beds too and can be cranky and irrational. Just to please him, Mr. President, I promised to ponder over what he said.
Since he was in such a touchy mood I thought I had better leave. I said, "Doctor, please prescribe my usual cafergot, stementil and propanolol and I'll be on my way. You have other patients waiting. Also, can I have more of these medicines, my attacks are getting worse and occur with greater frequency recently." He looked at me and said "Mr. Lim, I can't do that." "Why not?" I asked him, "and I prefer to be called Amos or Almost, the nickname you gave me." "I can't do that either, Mr. Lim. My old ways are the wrong ways. Our relationship is a formal one and I must address you correctly, otherwise I can be accused of impropriety," he said.
He really must have had a screwed-up weekend. "Call me whatever you like – Boss, Patient, Customer, Your Excellency, Your Majesty, just prescribe the medicines and I'll be gone," I told him. "Mr. Lim, as I have mentioned just now, I can't," he replied. "Are you angry or upset with me for reasons that I am not aware of?" I asked him. "Would I dare to be angry or be upset with you or with any other patients? The courts take a very serious view of improper behaviour nowadays, especially those relating to rage," he replied. "Why are you making life difficult for me then?" I asked him. "Mr. Lim," he said, "I am sorry if you feel this way. Let me explain. Didn't you say just now that your headache is becoming more severe and frequent? In which case there is a change in its characteristics and I have to reassess your case and not just simply repeat your medication."
I told him not to worry and that I was just going through a period when the headaches were more pronounced. He said he wasn't taking any chances and that a reassessment was mandatory, otherwise he would be blamed for being negligent. I assured him that I wouldn't blame him but he said I couldn't speak for my wife, my son, my relatives, my insurers, my lawyers, my friends and other doctors and that if I did not agree to be reassessed, he wouldn't accept me as his patient anymore. He looked as if he meant it. I capitulated.
The next fifteen minutes or so he spent asking me all sorts of questions, including some on my libido, which I found totally irrelevant and if not for the fact that I was having a headache, might have found amusing. Then he started knocking, poking and scratching me with his instruments, tortured me by shining a powerful light into my eyes, made me wrestle with him, perform acrobatics, walk with my eyes shut and stand on one leg, all this while my headache and nausea were getting worse. When he had finally finished, I asked him what did he find? He asked me not to be impatient as he had to record his findings first.
From what I saw written, we had certainly wasted time. There was a long list of "Nothing abnormal detected". I was about to tell him that when I saw him write "PR down going". I had been very patient but I lost my cool when I saw that. "Hey," I said, "what do you mean by my public relationship is going down. I am a social worker you know." He said PR is plantar reflex. I told him I am a human, not a plant. He then had to explain to me the test and more time was wasted.
After waiting many more minutes for him to complete his notes, I asked, "Are you satisfied now?" "Not quite," he replied. "Are you serious?" I asked him. "Don't I look serious," (in fact he looked dead serious) he said, "Mr. Lim, a medical consultation can have two parts, clinical and laboratory. I have only completed the former. You need some more tests. The most important is the MRI." "What is that?" I enquired. "It's currently the mother of all X-rays. A high-tech procedure to find out whether there is anything inside your head that shouldn't be there. When it is done, both of us will sleep better."
That was the last straw. "I am not having that done, even if it's free," I told him, "Give me my medicines and I'm off." He looked at me for a while and said, "OK, if that is your wish but please sign here to confirm your decision, I need to keep a record." He then added, "Mr. Lim, you are a very understanding patient and I really appreciate it. However, not every patient is like you. I have to protect myself. Believe me, it is not funny, in fact it is a nightmare to be involved in a legal dispute with a patient. You even end up as a news item in a bulletin board on the Internet."
Mr. President, Sir, I would appreciate it very much if you can find out what is happening to my GP. He used to be a cheerful and optimistic doctor but now he has become morose and pessimistic. Personally I don't like his new style and I have a feeling that he doesn't like it too. I want a confident doctor, not one who is timid and defensive and also one who treats the patient and not the disease alone. Wayward doctors are a different matter.
One other thing, his charges for my consultation have more than doubled. I asked his nurses the reason for the increase. They told me that it is for "upgraded services". I wonder.
Best regards,
Yours sincerely,
Amos Lim
c.c. to the GP
