The third dimension must now be collectively harnessed by ensuring a level playing field, by accountability not only to patients but also to society and by transparency of information and actions. Perceived as such, the excesses which are allowed free rein because of the denial of the role of Commerce can then be curbed."

ONE FRATERNITY (OCTOBER 1996)

"The Ministry’s Mission enshrined in three succinct statements is ‘to promote health and reduce illness; to ensure that Singaporeans have access to good and affordable healthcare that is appropriate to needs; and to pursue medical excellence.’

As a fraternity, we are helping to set the ethical fabric and practice discipline in which doctors can practice good medicine. As individuals, we should each work out our contributions in deeds, not words, not self-aggrandisement nor the bottom-line of our affiliation."

MEDICAL EXCELLENCE DEFINED (JUNE 1998)

"It is the responsibility of those in charge of handling complaints to care for doctors and the healthcare system by vigorously rebutting complaints if proven baseless and malicious. Society must be reminded to care for doctors and allow them to practice medicine in the interest of all patients. The patient is not always right and the doctor whom the patient complained against is not always wrong."

CARING FOR DOCTORS (FEBRUARY 1999)

"In a healthcare system increasingly polarised by structural and funding conflicts, more than professional inputs are needed to minimise tension. Doctors and institutions need to ask themselves, ‘What’s my business? And equally important, ‘What should not be my business?’"

WHAT’S YOUR BUSINESS? (JULY 1997)

"SMA hopes that three concepts are considered, namely broad competency for all, a role for all and involvement of all. We agree with the Permanent Secretary’s caveat that good quality and affordable healthcare is achievable ‘provided we put in place the right regulatory and professional framework".

ACHIEVING GOOD QUALITY AND AFFORDABLE HEALTHCARE TOGETHER (NOVEMBER 1997)

"The Permanent Secretary stressed the need for leadership to come from all sectors of the medical profession.

We believe that leadership is action, not a position. Leadership skills are not innate traits; rather they can be learnt. Doctors must provide leadership in healthcare at all levels. The mission to provide good and affordable healthcare is too important to leave to non-doctor administrators alone."

DOCTORS AS LEADERS (OCTOBER 1998)

"It is important to recognise that case-mix funding is only a tool to implement the funding of in-patient care based on risk-adjustments of standardised care. It may not address issues concerning quality and outcome of care unless they are specifically considered. The SMA has formed a task force on case-mix which will educate doctors and give feedback on the implementation of casemix funding in Singapore."

"We need to strengthen SMA as an institution. SMA should define its role in shaping healthcare policies and in managing issues of relevance to the ethics and practice of medicine. In the market-place of healthcare where the ‘unseen hand’ seems all powerful, SMA has a public duty to ensure that good medical practice is encouraged, training and research are not side-lined and society’s well-being is safe-guarded."

THE TASKS AHEAD (APRIL 1997)

"The percentages of SMA over SMC members have increased from around 56% in 1994 to the present high of 65%. We now have a stronger ship that would not only weather the present storms but sail a chartered direction for the medical profession in Singapore."

A STRONGER SHIP IN TUMULTUOUS WATERS

(MARCH 1998)

"A greater role for SMA, a greater role for the medical profession – that is the common thread that runs through the three official announcements in the past month.

The official roles given by the Ministry of Health to SMA are that SMA will act as a channel of feedback for the medical profession’s view on medical advertisement, as well as interact with non-healthcare bodies; provide a consultancy service in accordance with the Guidelines on medical advertisements; and publish a directory of licensed healthcare establishments for sale to the public.

The SMC President also wrote that ‘SMA has to take a greater responsibility to advise its members on conduct and leave it to SMC to deal with only heinous offences or gross misconduct.’ "

The restructuring to make the system more commercially accountable must now transcend to a new plane. Calling and Career cannot indefinitely subsume the exacting task of sowing when the practice of medicine is besieged by the imperatives of Commerce. As we reap, so must we sow _ if we are to continue to have well-trained doctors tomorrow."

REAPING AND SOWING (SEPTEMBER 1996)

"The spread of CME topics presently resembles a potluck buffet. Providers are tempted to bring to the table what interests or benefits them rather than focussing on the educational needs of the attendees.

Doctors should discriminate between those CME topics that are merely interesting and stimulating versus those that can enable and improve patient care. Over time, if many doctors were willing to support and pay only for good CME activities, then the standard of CME would improve."

WHO SHOULD PAY FOR CME? (OCTOBER 1997)

"The issues of training must therefore be carefully explored, bearing in mind the returns on investments and the differing time-horizons of each of the different stake-holders – the patients, the doctors and the institutions. Society then has the important responsibility of modulating the web of relationships such that future generations of doctors are optimally trained and future generations of patients are provided for and [their interests] protected."

SERVICE AND TRAINING (FEBRUARY 1997)

"The funding of CME in Singapore continues to be laissez faire and dependent on the vested interest of the free market. The Byzantine tax-exempt policies for CME activities have to be looked into. Should we not have a National CME Committee funded from State coffers to co-ordinate and spearhead CME activities?"

FUNDING CME (FEBRUARY 1998)

"SMA supports the Associate Dean scheme and welcomes the opportunity for better supervision and training of our [medical] undergraduate students and postgraduate doctors."

"We hope to empower the healthcare profession to move forward with dignity and integrity. Ethics is not an impediment to the progress of our healthcare system. Ethics is an impediment only to those who want to make money out of providing more and more healthcare and not necessarily more health to our people."

ETHICS IS NOT AN IMPEDIMENT

(ETHICS CONVENTION SPEECH DECEMBER 1997)

"Doctors since time immemorial faced the onerous task of balancing conflicting roles as saint, scientist and shopkeepers. Few of us can be sanctified. But neither would we want to be banal shopkeepers. If we allow a few doctors to besmirch the reputation of the profession by exploiting public trust, then the soul of the doctor in all of us dies."

A PHYSICIAN’S DREAM (MAY 1998)

"Our Prime Minister has urged Singaporeans to go regional. We should be mindful of the sensitivities and pride of doctors in our neighboring countries. The backlash of an overtly commercial approach by some parties can poison the relationships nurtured over many years by others.

For the medical profession, going regional should therefore be driven by the spirit of those doctors who have spent time to train our early generations of specialists."

We argue that treating symptoms in the absence of a definite diagnosis is never in the patient’s best interest. In no case should the patient’s welfare be sacrificed, especially for cost-savings that may actually be no more than mere delusions."

"The medical profession needs to reflect on how these support groups should work with sponsors; the question of scale and logistics; and the doctors’ role in such organisations."

An open letter to SMA in the Straits Times inquired about the training of staff dispensing medicine in clinics. The healthcare assistant training programme is certified by the Institute of Technical Education. It qualifies for special skilled workers status endorsed by the Ministry of Manpower. Healthcare assistants are trained to be multi-tasking to fulfill the roles of receptionist, nurse-aides, dispenser and medical technician at different times of the day, and function at an appropriate level in the healthcare team."