Journals 
Present Issue 
Past Issues 
 

SMA Editorial Board 

Letters to the Editor 

 

E.T. DON’T GO HOME. 

Last night I had a talk with my friend E.T. (not Extra-terrestrial). E.T. is a GP trainee. Somehow our conversation drifted into the dark void of private practice and I was actively telling her the many ways of making money as a GP and the economic issues associated with the starting up and running of a GP practice. These issues included how to negotiate rent, goodwill "coffee money" for the taking over of a rental lease and the goodwill money for taking over a practice from another GP. Onto all these were added the finer points of looking for employment, negotiating employment terms with either senior GPs or GP groups, and the pros and cons of joining some of the big GP groups versus solo practices. I was obviously in a didactic mood. Or quirky and chirpy. Whatever. 

"I don't know. I don't think I want to start a practice. I don't want to get money involved in my medicine. As a doctor, I don't want to think about money matters or how to make more money when I practice. I'll probably join somebody and take a salary." E.T. said seriously. 

"You what?!?! Don't want to think about MONEY?" I was utterly flabbergasted, floored and flustered. Unfathomable. What's there to think about besides money? True, there is always upgrading. Upgrading of medical skills and knowledge, I mean. 

"You don't want to think about money?!?!". I repeated to her and to myself. Women are so wonderful. They just keep me wondering all the time. I cursed GLG under my breath. Some of these GP trainees are just indoctrinated too well by that boy scout and Samaritan excuse of a doctor...sigh. 

To all my other soul mates out there well versed in the discipline of money medicine i.e. M Med (Money Med). I must confess, this is not the first time, and it will not be the last time that we encounter such fossilized relics of voodoo medicine., i.e. medicine without money. Why, these are probably the same doctors that don't prescribe antivirals for chicken pox and withhold antibiotics for flu. 

Unfortunately, it is perhaps time for these good souls to realise that there is always money in medicine in the 20th century. Either doctors take control of the situation and make a fair and equitable amount of money for their services rendered, or someone else will extract the money out of the whole healing process. Someone else include big business, administrators and co-operatives or other less scrupulous doctors, which incidentally, are definitely more 
 

Perhaps medical school has taught us too well in the art and science of medicine, but it has been grossly inadequate in the economics and politics of medicine i.e. the ways of today's world. Certainly, our training has been successful in producing many such idealistic and selfless doctors who wish to stay above the rat race and rampant materialism of our times. But have we overdone it? There are those who are so uncomfortable with money in medicine that they actively shun the idea and avoid learning about the subject. Is this healthy? I think not. We need precisely more such as  uncompromising doctors E.T. to be at the helm of the economics of medicine to ensure that the system continues to work for all, especially the patients. The demon of "money-theism" can thus be kept bound in the realm of medicine. It is all too tragic that by actively avoiding these issues, the ground is left to be filled by the money people, who will make a dime out of their grandmothers, let alone the mere sick. 

The vicious cycle is thus complete. Good doctors shun the idea of money in their practices. The void is filled by not-so-good people. The result is that medicine is more and more infiltrated by big business and the overriding cause of making a profit. Uncompromising and ethical doctors thus have less and less space to practice their brand of innocent medicine. They can run, but eventually they can't hide. 

I am sorry, E.T., but if you don't confront the money issues, come to grips with them and try to make a difference by taking charge and stemming this tide of "big bucks" medicine on a scale larger than your personal practice, you may truly well have to go home then. 

Like my dear friend PY once told me, "You can either make a stand and try to change the world by doing your bit, or you can be like one of those frustrated Chinese poets in ancient China, who gave up the fight and retired to the countryside to write sad poetry and get drunk everyday". Unfortunately, we will not have that luxury as we do not even have a countryside. (although I know some doctors who drink and write poetry, hic!) 

The age of innocence is over. The good thing is, the end of innocence does not equate to corruption and the desecration of the ideals and nobility of medicine. Provided the good guys do not run away and hide but stay to fight and make a difference. There is still hope. I really believe so. 
                                           ;                     The Katana