One of my former boss’s favorite anecdotes was that of Prof Seah Cheng Siang making a Singapore President, the titular head of state, wait while he was attending to a patient in the C-class wards. In the course of researching my book on the Singapore health system, I came across a speech by our late President Wee Kim Wee. A relevant excerpt caught my eye:
“I was at his clinic at the Singapore General Hospital when he was summoned from the ward, where one of his patients needed immediate attention. He returned after 20 to 25 minutes and apologized profusely. I was then President. The patient he was summoned to see in the ward was someone in the C-class ward. My regards and respect for Prof Seah edged up several tiers. VIP and the non-VIP got the same attention and the same treatment from him.” (Emphasis added)
Contrast this with a grumbling I heard recently from an internist colleague who asked a senior surgeon whether he could refer his (the internist) father to him, and was shocked at the reply “Only if he is a private patient”.
In Parliament, it is sadly almost routine for Members to ask what safeguards there are in public hospitals to protect subsidized patients and ensure they receive adequate care. Current Speaker Mdm Halimah Yacob has raised concerns previously about foreign patients being prioritized over local patients while in this year’s Committee of Supply debates, Workers’ Party leader Mr Low Thia Khiang remarked, “I am of the view that the current remuneration scheme incentivizes specialists to treat private patients over subsidized patients”.
Two issues stand out from all these vignettes. One, why does our system make it difficult for doctors in public institutions to do the right thing and treat all patients equally? This is not a rabid criticism as public hospitals have to mobilize the resources to attract and retain top medical talent and fees from private patients undoubtedly help. But there must be a better way. Thankfully, Health Minister Gan has announced that a review of the public hospital physician remuneration scheme is underway and hopefully, the changes will align the clinical interests of subsidized patients better with the financial interests of doctors.
The second observation is that Prof Seah passed away in 1990. Our still using anecdotes from more than a decade ago suggests a dearth of role models today. When I speak to medical students about memorable tutors, some names like ‘Low Cheng Hock’, ‘Lee Kim En, ‘Thirumoorthy” and ‘Phua Ghee Chee’ pop up with impressive regularity but the list is modest. As a 3rd medical school opens its doors this year, it would be wonderful if we can re-ignite the noble traditions of virtually all doctors providing care for all patients without regard for finance or favor. System design to neutralize the advantages of patient wealth or paying status would be very helpful but the role of values is still paramount. Society drives the value of the ‘values’ and it is here we can all play a part in developing an ethos where “regard and respect” from policy makers, peers and the public go up several tiers when doctors do the right thing.
The Singapore Medical Council introduced the Physician’s Pledge in 1995 and it is worthwhile to re-examine the Pledge.
The SMC Physician’s Pledge
I solemnly pledge to:
dedicate my life to the service of humanity;
give due respect and gratitude to my teachers;
practise my profession with conscience and dignity;
make the health of my patient my first consideration;
respect the secrets which are confided in me;
uphold the honor and noble traditions of the medical profession;
respect my colleagues as my professional brothers and sisters;
not allow the considerations of race, religion, nationality or social
standing to intervene between my duty and my patient;
maintain due respect for human life;
use my medical knowledge in accordance with the laws of humanity;
comply with the provisions of the Ethical Code; and
constantly strive to add to my knowledge and skill.
I make these promises solemnly, freely and upon my honor. (Emphasis added)