RESPONSE TO DR WONG HECK SING’S SMA LECTURE 1997

Where then do our teachers and role models come from? To me, given the size of our country and the finiteness of our resources, they should come from all sectors of the country. In fact, the doctor in private practice who can teach and guide can be a greater source of inspiration because he is speaking from out there in the “real world”, whether in family or specialist practice. Medical education should be a national concern - all capable role models from both the public and private sectors should have a part in moulding those will take their place in the years to come. Similarly, all clinical material in both public and private hospitals and clinics should be made available to enhance the breadth and depth of medical training. 
 

In searching for a role model, students must be taught to realise what are the essential qualities of a profession. I have quoted Justice Louis Brandeis in my convocation speech at NUS in 1994. The judge said in 1933 - “First, a profession is an occupation for which the necessary preliminary training is intellectual in character, involving knowledge and to some extent learning, as distinguished from mere skill. Second, it is an occupation which is pursued largely for others and not merely for one’s self. Third, it is an occupation in which the amount of financial returns is not the only measure of success.”

Remember this you will have your role models.  

Today the profession is in a transitory phase. Most doctors do know what makes a role model. The rules have not changed totally yet. Exceptional skills and knowledge reinforce the qualification for role model-hood. But ultimately, the man behind the doctor is the key to whether I would consider a person to be my role model.

To illustrate, every young doctor says Goh Lee Gan is a role model, but who wants to pay the price and be Goh Lee Gan? Given a choice in today’s world, I would rather be a doctor owning and running a listed company than be Goh Lee Gan. That is the bitter truth. The system must be such that Goh Lee Gans and Low Cheng Hocks are continually produced and not left to the power of market forces. Market Forces do not produce role models. The system must be such that role models are produced without great individual sacrifice to wealth and security. A system that creates great disparity between the earnings and work conditions of the private and public sectors does not nurture role models. A system that does not afford job security, esteem and well-thought out career paths do not create role models. Such a system requires role model aspirants to pay the price of nigh-sainthood to become actual role models. That is why role-models are so far and few in between, and getting lesser as time passes and with each retirement of a role model.

Interestingly, as I look back at my undergraduate days, most of my role models were from humble and usually unglamorous hospitals such as Alexandra and Tan Tock Seng Hospitals. I was not particularly impressed with some people who were more interested in telling me how clever they were as super-specialists and putting down others than telling undergraduates what they should know. I learnt most of my medicine from general internists, surgeons and paediatricians, etc, not some sub and super-specialists with an oedematous hubris and academics in ivory towers.

Everyone says Goh Lee Gan is admirable and worth emulating, but who really is willing to pay the hefty price...? It may not be long when our principles and standards have drifted so far away and our memories so coloured that we may even forget what constitutes a role model. Maybe in the future a role model is one who has the most degrees and earns the most money after resigning from public sector at the soonest opportunity. Certainly today’s medical students are different from my time. These are people who can pay more than $13,000 a year in school fees. Such a self-selecting process already produces a community that may have different ideas and expectations as to what constitute a role model as compared to my time when school fees were $3,900 a year at matriculation (not so long ago). We have less time to salvage the situation than we think we have, I am afraid.

I was choked with emotion as Dr Wong Heck Sing gave his lecture. Because it dawned upon me how far we have fallen and how impotent some of us are in trying to keep the profession going. Dr Wong’s speech bear reading over and over again because it represents the distilled wisdom of a man who in the twilight of his years knows there is much left to do. But unfortunately, there does not seem to be people with more time than him who have the conviction or the influence to do it. His words can either spur us back onto the right track or be a testament to the insufficiency of today’s doctors and leaders.  

It is oft said that experience is the comb that life hands us when we are bald. It is then perhaps one’s great fortune to be handed one by another who has more than enough hair implements to spare. Dr Wong’s lecture spans vast times and topics, introducing us to the barber-surgeon Ambroise Pare who started surgery down its path of success and prestige, to modern legions like William Osler. He then proceeds to present a complete picture of the situation facing the medical profession, present and future. Not only does he describe what he sees as critical shortcomings in the profession, he offers his take on the problem as well as some very real solutions. The entire experience of his lecture is akin to standing on Fort Canning and being offered a pair of magic binoculars that could see both East and West Coasts, and a little of Johore as well.

Unfortunately, such wide views often fall short in fine focusing. Dr Wong raised the issues of changing health care and shifting values in young doctors, the antagonism between public and private sectors, the lack of suitable role models and the importance of having them. He repeatedly stressed the point that holistic patient care is vital not only at the beginning of medical education, but indeed thoughout the entire career of a physician. In short, he raised almost every question that is worth asking and which most of the audience is either familiar with or at least aware of.