2011 reasons to be unhappy

I suppose I will ignore all of them and focus instead on the blessings amid what has been a terribly draining year:

1) CG mates

In M3, M4 and M5. After 5 years of being in YLLSOM, I've encountered many people who give me negative vibes, and heard of many horror stories of CG mates quarrelling, politicking and engaging in cold wars with one another. There must be more than one lucky star shining on me because all these years my CG mates have been AWESOME. Not only that, but most of the time people in the neighbouring CGs are great folks, some of whom I've had a great chemistry with.

Central to this bliss are a very pleasant model couple whom I've had the privilege of getting to be friends with.

2) India and Vietnam trips

Cannot belabour the point. While 45 weeks this year have been pretty much dull and laborious, the other 7 were journeys into fantasy worlds where there was no work or responsibility or expectations. In India I learnt how people could live simply but happily, and how to eat with the very same hand I use to wipe my butt. In Vietnam I learnt to conquer a mountain with 3/4 of my luggage stuck in the airport and with only one healthy painless eye.

In Singapore this notion of "heroism" is replaced by how many patients you diagnose correctly, how many questions you can answer during tutorials and your chances of getting into coveted Residency programmes. Nevertheless, I treasure the memories

3) Research mentors

Ok, so it was a long drawn out project. But whatever it was it was a privilege to work with a groups of driven individuals who never failed to be nice no matter how tough the going. Who were genuinely interested in my progress

4) Family

Sister graduated from JC, now moving on to tertiary education. Mother graduated from being a working mum, now moving on to become a teacher by day but fully fledged ah soh by night, what with all the line dancing classes at the community centre. Still the same old pleasant folks that stand tall in this gigantic shit stirrer that is life

My wishes for next year

Personally, I wish to pass the MBBS and find joy in whatever I do again, among other things. As for my wishes for the wider world, here they are:

1) America to clear her rubbish

I consider myself one of those old fashioned people who believe that if you have a problem, you either solve it directly or learn to be happy with it. That does not include sitting down, irritating the hell out of your government, and hoping that something falls from the sky(scrapers of Wall Street). If I ever find myself short of money, I'd either work harder and smarter, or learn to spend less, or both.

Apparently, in this New Age, it is fashionable to whine your way to a solution. And if you can find thousands of like minded people with whom to form a collective public nuisance, why not? Not as if your government, who goes by the ideals of democracy and free speech, can do a Tiananmen and mow the whole lot of you down.

Last I read, nations like America and Singapore weren't built by immigrants who sat down at the beach holding stupid placards.

Is that your name? Hahahaha

2. A vision
The heavens will open, a host of three headed angels will appear singing, and this gigantic guy with a shiny face will read from a golden scroll.... telling us where our healthcare system is headed to.

Why not? First there was just Singhealth and NHG, then suddenly there was NUHS. Now there is the Eastern Health Alliance whose pillar is the gigantic CGH, an enormous tertiary hospital in the east of Singapore that provides an extensive range of healthcare services.

Well to think of it, competition is good. Man Utd needs a Man City to keep them on their toes. YLLSOM needs the Duke-NUS. Gandalf needs Saruman. So, more healthcare alliances to break the monopoly can only be beneficial to patients. Way to go, government!

3. Our country to stop failing further
To build on the above point, I believe SMRT has monopoly over our public transport system. As such, it is indestructible. If another transport alliance group (whatever that will mean) were to compete with them, I'm sure there will be more vigilance.

Although we have not achieved the lofty heights of certain European countries in the art of screw-up, by our high standards bad things have occurred this year. The clean, green, orderly utopia of the 1990s may not appear ever again but hopefully there won't be further deterioration in the standard of public transport, healthcare etc.

An interesting discussion

It all started with a letter written to the Straits Times- this lady was concerned about the lack of staff at night. She was promptly rebuffed by a male reader, L, regarding the possible increase in healthcare cost should more staff be hired:

Dear Mdm Goh, do you mind paying more medical fees for more nurses in night shift?More nurses at night requires more manpower and hospital needs to pay them. In turn hospital will have to charge you higher ward fees. Do you want it?Alternatively to be fair to others who do not need so many nurses at night. You can hire a private nurse at your own cost.

This prompted another retort from my junior in medical school, K:

She merely brought up a point of consideration, on top of acknowledging CGH's merits. I believe that her concern warrants attention even if it seems unreasonable to you. We do lack hospital staff. We should think of ways to improve healthcare for all instead of being dismissive. You, me, anyone else, can land up in the hospital one day and our children will be the ones complaining if there are no nurses to pour us a glass of water at night.

This newspaper and its replies made is way to Facebook and a senior of mine, J, a houseman, congratulated the junior on his spirited reply. I caught hold of the thread and went ahead to post my own comments, both on ST and on Facebook. The following conversation ensued:

Characters in the play:
K: My junior who wants to improve the healthcare system
J: My senior, who's already working as a doctor
L: The dismissive member of public who rebutted the original letter writer
G: A Duke NUS student who provided the epilogue
and me

I'd cut away the frills and thrills of the conversation eg. the emoticons and the adulation and get to the meat of it.

Me (posting on ST): Hi K, is there a concrete way we can increase manpower without increasing healthcare cost?

Me (posting again on FB): http://www.straitstimes.com/STForum/Story/STIStory_744592.html
My reply. As dismissive as L's reply sounds, he brought up a valid point. We can envision the ideal healthcare system as much as we want but we have to understand that these resources do not sprout from the ground, but ultimately come from the pockets of the taxpayer

J: Q: Is there a concrete way we can increase manpower without increasing healthcare cost? Ans: Me, at $7.85/h, it costs each of the 40 patients 0.20/h per extra me on duty.Health care economics is an OXYMORON guys.

K: Hi senior. I honestly do not know. Now you are probably thinking then why am I trying to talk here and acting like I know something. I remember an article which was posted some time back. http://online.wsj.com/article/SB121193074899024387.htmlregarding the risks of night shifts and the lack of hospital staff. Admittedly, the article focuses mainly on doctors and it may not a fair comparison. Also, I also concede that hospitals will never be as fully staffed during nights and weekends as compared to weekdays due to resource constraints. However, I merely wish to make the point in the earlier post that it is a valid point of concern that staff shortages can lead to lethal lapses in patient care. This is an implicit point in Mdm Goh's letter but I am sure you agree with it. This is especially so with nurses who happen to be the first point of contact with the patients. Whether or not there is a way to increase manpower without increasing healthcare cost, or for that matter, whether healthcare cost should be increased at all deserves a separate discussion and I am afraid I do not possess the knowledge and experience to discuss this further. :)

Me: Hi all, I know a lot of drs hate to bring in economics into healthcare, but allow me to point out that healthcare costs can be as much a burden to pts and their families as the disease itself. Some pts (eg. cancer pts) even discontinue therapy because of the cost. So, what's the point of practising healthcare without concern for finances? I don't think healthcare economics is an oxymoron, although its true economics isn't the whole point.Well, if you don't mind me quoting what we've learnt before, health is not the absence of disease or infirmity, it is the complete state of biological, psychological and social wellbeing. If we come to the point where healthcare measures put more financial strain on pts in this harsh economical climate, we may have to rethink.Thanks K for the article and I think it is food for thought :) To combat the current problem of fatigued doctors during nigtcall, institutions like NUHS and NHG have implemented the night float system. Drs are presumably fresher and I believe they aren't paid much extra (pls correct me if I'm wrong) since they didn't work extra hours. I'm not sure about the nurses really. Nevertheless, whatever healthcare measure we implement ultimately should be a balance between the pt's physical wellbeing with financial cost

G: Folks, in the absence of actual data, this discussion is no more than idle chatter. Too bad there's nobody actually tracking patient mortality and morbidity at night vs in the day. Or the price point at which patients drop out of expensive long-term therapy (ie, how elastic is demand exactly?). Even if everything is nicely documented in the case notes (har har) there's no overall analysis of data. Such a shame, considering each cluster has a vast treasure pile of patient information that we could potentially exploit to help improve care delivery. :/

If you, the reader, have made your way to the end of this discussion, I'm sure you are pretty saturated by now. Hence, I won't delve into another essay but will just make some quick points:

1) G, the Duke NUS student, has a point. You can't say anything in Medicine unless it is backed up by clinical evidence. Level A and B evidence preferred. In fact, my previous two sentences aren't backed up by evidence so you can believe it at your own risk.

2) The original ST article has a weak argument. The author has not demonstrated that the lack of night staff can prove fatal or injurious to patients.

3) Healthcare CANNOT be about making huge profits BUT

4) Healthcare CANNOT be a source of financial hemorrhage in our already vulnerable economy because a) We do not wish to bankrupt our patients, this defeats the purpose of healthcare and b) We cannot bankrupt Singapore's economy, simple as that. Drs have a duty to the country's economy too. Are you willing to accept this idea?

5) Whatever it is, I'm just glad everyone had a civilised discussion, unlike the hundreds of disgraceful mudslinging angst filled threads you have in cyberspace.

6) Note to FB stalkers: No you can't find this thread on J's, K's, G's or my own FB page. It is on an unlikely source haha you use your IQ to find out

Questions

That have surfaced in my mind on and off like phantoms but I have found no answer to. Maybe someone could help.

Is there such a thing as knowledge? Or is "knowledge" simply our perception of this world based on the latest research, and more cynically the dominant voice? This is quite important, for in a few cases it may make the difference between a pass and fail in MBBS.

Rat races. Through a combination of hard work, detailed preparation and good luck, we entered medical school. Are you satisfied with simply being a studying machine, simply being a fanciful portfolio, trying to be the shiniest and brightest cog in the whole system?

Are we human beings after all just a bundle of animal instincts, with the will to survive and the will to pleasure?

Am I abusing grace? (Grace is not the name of any living or non living object and although I have friends called Grace this is a side issue)

Crutches

Once upon a time, if you were not too caught up with the burden of academic life, you may have dreamt of the ideal world liberated by science. In that world, there would be no superstition, no conviction, no dogma. Humanity would be free from fear and conflict and would have entered a golden age, an age of progressiveness.

Well not so in real life. There's a reason why we call dreams dreams.

Never did I think that I'd be sharing photos from STOMP but this can hardly be ignored. Apparently, some students in a local university have resorted to praying to a bell curve god (BCG) to help them tide through exams. Of course this isn't really a joke as some have made out. If you spend about $20-$30 buying candles and tidbits for the BCG, if you bother to write a note on your room cursing those who don't follow your practice, then you are getting quite serious there.

So yea, I myself have my spiritual beliefs too. I'm not entirely the "rational man" either. But this article was surprising because I've often thought that Singapore was becoming more and more secular, especially among the younger generation.

In the medical circle, similar superstitions exist. On the day of a night call, no doctor will be caught dead eating a bun (bao), because you'd end up doing everything that night (bao ka liao). Instead, they'll try to eat steamed dumplings (shui jiao), so that they can have a good sleep (shui jiao)

These are not actions carried out by village idiots who've never heard of the 21st century. These are undergraduates and doctors, who have achieved much academically to be where they are.

To cure superstition, is education the cure? Apparently not. Then what is? My first suggestion would be the removal of fear. Not the trivial types like fear of the dark or of insects, but the fear of failure, of oblivion, of poverty. But as you know, that is nearly impossible.

Secondly, it would be the removal of greed and desire. From the desire to have a comfortable night's sleep to the desire to trump the bell curve. But as you know, that is impossible.

Every human being, no matter how intelligent or knowledgeable, has a dark side that cannot come to terms with this frightening entity known as the unknown. Each human being has their own way of filling up this gaping hole in their soul. The notion of human beings becoming truly rational can thus never, never, never take place.