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news
VO L . 5 1 N O . 5 | m ay 2 0 1 9 | M C I ( P ) 0 8 3 / 1 2 / 2 0 1 8
SMA
Years Since 1959
news
CON T E N T S
Vol. 51 No. 5 2019
EDITORIAL
BOARD
Editorial 17 If the SMA is to have Meaning
04 From Students' Council to Prof Arthur Lim Siew Ming
Editor
Dr Tan Yia Swam SMA Council
Dr Tan Yia Swam 18 Well-Wishes from our Members
Deputy Editors
Dr Tina Tan
Dr Tan Tze Lee 05 The SMA – A Fine Vintage and 20 Advocacy
Dr Chong Yeh Woei
Editorial Advisors Good for the Health
A/Prof Daniel Fung Dr Toh Han Chong
A/Prof Cuthbert Teo 22 SMA and Medico-legal Issues –
Dr Toh Han Chong 60 Years On
Members A/Prof Goh Lee Gan
Dr Chie Zhi Ying
Dr Jipson Quah
Dr Jonathan Tan
Dr Jimmy Teo
Dr Alex Wong
EX-OFFICIOS
Dr Lee Yik Voon
Dr Lim Kheng Choon
EDITORIAL
OFFICE
Senior Manager
Sarah Lim
Assistant Manager
Sylvia Thay
Editorial Executive
Jo-Ann Teo
ADVERTISING AND
PARTNERSHIP
Li Li Loy
Tel: (65) 6540 9174 President’s Forum 26 Charting the History of
Janice Soon 06 SMA Through the Years Singapore Medicine – Interview
Tel: (65) 6540 9175 Dr Lee Yik Voon with Prof Chew Chin Hin
Email: adv@sma.org.sg Dr Toh Han Chong
PUBLISHER
60th Anniversary
Singapore Medical Association
2985 Jalan Bukit Merah 08 SMA Milestones (1959–2019) Calendar
#02-2C, SMF Building 29 SMA Events May– Aug 2019
Singapore 159457
Tel: (65) 6223 1264
13 Play and Win: How Well Do You
Fax: (65) 6252 9693 Know Your SMA? AIC Says
Email: news@sma.org.sg 30 Towards Zero Asthma Death
URL: https://www.sma.org.sg 14 The Founder President of the SMA
UEN No.: S61SS0168E
Agency for Integrated Care and Dr Lim Hui Fang
Dr G Baratham
DESIGN AGENCY
Oxygen Studio Designs Pte Ltd
PRINTER
Sun Rise Printing &
Supplies Pte Ltd
Opinions expressed in SMA News reflect the
views of the individual authors, and do not
necessarily represent those of the editorial
board of SMA News or the Singapore Medical
Association (SMA), unless this is clearly
specified. SMA does not, and cannot, accept
any responsibility for the veracity, accuracy
or completeness of any statement, opinion or
advice contained in the text or advertisements
published in SMA News. Advertisements of
products and services that appear in SMA News
do not imply endorsement for the products
and services by SMA. All material appearing
in SMA News may not be reproduced on any
platform including electronic or in print, or
transmitted by any means, in whole or in part,
without the prior written permission of the
Editor of SMA News. Requests for reproduction
should be directed to the SMA News editorial
office. Written permission must also be
obtained before any part of SMA News is stored
in any retrieval system of any nature.
EDITORIAL
FROM Students' Council
Sìà Council
TO
Text by Dr Tan Yia Swam, Editor
This marks my fifth year since taking We hold each other accountable for contests, comics and a wider range of
over as Editor of the SMA News, these attendances. We are volunteers. Indulge articles – while holding on to
just over 12 years since my first article In addition, many of us serve in other the traditional columns from the SMA
(http://bit.ly/2FWUOYN) in SMA News, committees and projects. And this is President, SMA Centre for Medical Ethics
and 12 years of serving on the SMA all on top of our respective medical and Professionalism, and interviews, etc.
Council. What started as a once-off practices. Can you just imagine the time Sometimes, I wonder if anyone still
parody article somehow developed and effort we each put in? reads this. SMA News articles are free, not
into an invitation to join the SMA News What I have gained from my behind a paywall, and yet no one seems
editorial board and the SMA Council. volunteering with SMA though is the to repost. The doctors on the editorial
It has been a very interesting camaraderie and friendship with the board constantly think of new angles to
“extra-curricular activity” since; I had Council Members (past and present) address current issues, and we are open
to juggle my career, my growing and the secretariat staff. Special thanks to suggestions and new ideas. We hope
family and learning what it means to go to big brother, Han Chong, for his that you, the readers, would let us know
be an “Editor”. There have been many encouragement and gentle humour over how else we can make this newsletter
ups and downs over the years, and the years. more meaningful for you. Write to us at
there have been times when I thought The SMA News is the voice of the news@sma.org.sg.
it would be easier to focus on myself Council and the voice of the Members. It has been a good 60 years for the
and stop this “SMA nonsense”. It is not my personal blog. Though, SMA. I hope to live to see the next 60 and
But looking at the service of the the Editor can shape the direction of rejoice in our future contributions!
long-serving Council Members – the publication and engage members
Pheng Soon, Chiang Yin, Choon Lai, in meaningful ways. I am fortunate
Yeh Woei, Tien Hua and Jing Jih – to have a good team in the editorial Dr Tan is thankful to KK
I see their passion and commitment for board, and wonderful capable staff Women's and Children's
public service, and how they truly put providing support. Our writers have
Hospital, Department of
service before self, which motivates me Breast Surgery, especially
been responsive and enthusiastic. her head of department
to emulate and continue to serve. Some others we approached have and the division
The Council meets once a month, declined; I think they are too humble chairman, for the past
often from 9 pm till midnight. During and unnecessarily worried about their five years' experience and
opportunities. Starting May
which, there are active debates self-perceived lack of writing skills. 2019, she will be venturing
and discussions on the dozens of I have tried various ways to expand into private practice.
situations that affect our profession. interaction with readers – photography Meanwhile, she still juggles
the commitments of being
a doctor, a wife, the SMA
News Editor and a mother of
three. She also tries to keep
time aside for herself and
friends, both old and new.
EDITORIAL
The Sìà A Fine Vintage and Good for the Health
Text by Dr Toh Han Chong,
Former Editor
The SMA began 60 years ago as a key in relevant medical matters including Dr Toh is a senior
consultant, clinician-
representative body for local doctors, ethics and professionalism. The scientist and deputy
during the formative years when Association is surely an important director of the
Singapore was still a part of the British independent contributor to the National Cancer Centre
Empire. In those early beginnings, medical wisdom of crowds. The Singapore. He was the
both Scottish and English medicine former Editor of SMA
worrying creep of over-fearful News. In his free time,
had a very profound influence on defensive medicine, the erosion of Dr Toh enjoys eating
the establishment and growth of the healthy doctor-patient dynamic, durians and ice cream,
Singapore medicine, especially in rising healthcare costs and the silver reading, writing, rowing
the training and education of local and watching films.
tsunami will become hot-button Thankfully, the latter
doctors – a legacy that has endured
issues in the near future. four are not fattening.
to present time. We have much to be
proud of in how Singapore medicine As we look back on 60 years of
has evolved from those early SMA and Singapore medicine with
uncertain times to what it has now the conquest of polio and smallpox,
become – a world-class healthcare and effective control of tuberculosis,
system with doctors, nurses and cholera, typhoid and so many other
healthcare personnel who embody diseases, we all surely look forward
and uphold the highest standards of to the next 60 years where the
healthcare delivery, ethics and values. convergence of science, medicine,
Medical bodies worldwide such enlightened regulation and policy will
as the SMA constantly contribute witness an even more remarkable era
to health policy debates, become of modern medicine in 21st-century
sounding boards for doctors’ concerns Singapore. This can only be good for
and act as a lighthouse and capstone the patient.
MAY 2019 SMA News 05
SMA
PRESIDENT'S FORUM
Through
The Straits Medical Association
the Years
Text by Dr Lee Yik Voon
helping the public be aware of their surgical procedures were published by
was born in 1890 and they became personal allergies to penicillin and other MOH in 2018, under the advisory of a
the Malaya Branch of the British drugs. During this period, SMA revised 13-member committee that included
Medical Association (MBBMA) in the SMA Ethical Code. SMA Council Member Dr Toh Choon Lai.
1894. After World War II, two medical Through these collaborations, we have
SMA forged an excellent relationship
associations were set up to replace developed close rapport with MOH,
with the MOH and collaborated on many
the MBBMA – SMA, formed on 15 SMC and the community at large.
issues, one of which was the compulsory
September 1959, and the Malayan labelling of medicine as we saw the In the mid-1980s, to better connect
Medical Association, now known as benefits of transparency in patients with SMA Members, the “President’s
the Malaysian Medical Association, knowing what was prescribed to them. Column” and “Highlights of Council
formed on 24 October 1959. In 1972, ties were forged when SMA Meeting” were started in SMA News and
visited the China Medical Association in are a tradition practised till today. Back
The formative years Beijing. Our delegation received a red then, there was also a “President’s memo”
Throughout the years, SMA has carpet welcome by the Chinese doctors that had a tear-off section for members
dealt with many important issues. and government officials, which we to send feedback.
For instance, SMA’s First National reciprocated several months later at
Medical Convention held in 1968 our Istana. Also during this decade, the In recent decades
sought to address two major themes: Private Hospitals and Medical Clinics In the 1990s, there was a concern with
occupational health and cancer. Bill was passed, and it included the SMA GPs charging low fees and seeing
Around the same time, SMA also met delegation’s suggestions on several issues patients fast – sacrificing quality, not
with a sizable contingent of Ministry such as confidentiality between doctors allowing in-depth consultations and
of Health (MOH) officials and won the and patients, the need to give reasons for health education or advice on disease
dispensing debate. evocation or suspension of practitioners’ prevention. Later, the revision of the
In 1970, we had 14 doctors who licences, and the right of appeal to the Guideline on Fees, and MOH requirement
volunteered to be the first batch of Singapore Medical Council (SMC). for clinics to display charges, helped to
Singapore Armed Forces Medical In 1987, SMA published the Guideline curb the issue of overcharging. In 1991,
Officers, and among them was then on Fees with the main objective of the MOH Review Committee on National
SMA President Dr Arthur Lim. During enabling greater transparency of Health Policies took up many of SMA’s
this time, the SMA Secretariat hosted medical fees and to safeguard patients’ recommendations on improving the
more than ten specialty societies, interests. Though the guidelines were changing local healthcare landscape.
including General Practice, when subsequently withdrawn in 2007 due In 2000, the SMA Centre for Medical
these societies first started out. When to concerns that they may infringe Ethics and Professionalism (SMA CMEP)
these societies were mature enough, the Competition Act, we are happy was set up to provide doctors with a
they were encouraged to move on to to note that our advocacy for greater platform to develop knowledge in the
be independent. In 1970, SMA started fee transparency was heeded when areas of medical ethics, health law and
Medik Awas as a service to the society, fee benchmarks for 222 common medical practice.
06 MAY 2019 SMA News
In the 2010s, pandemics, managed available online in January 1997. This new media and modern IT initiatives,
care organisations and third party online repository houses all the past and towards being a smart nation, it is
administrators, the revision of the SMC issues and is accessible 24/7 by all. important for our medical profession to
Ethical Code and Ethical Guidelines and While SMA is aware that content keep up with the times to provide the
the Private Hospitals and Medical Clinics may be quoted out of context, it is care of the next century.
Act, and the National Electronic Health important that key stakeholders in As we celebrate SMA’s 60th
Record are some of the recent events Singapore healthcare are able to share anniversary, there is much we need to
SMA has been involved in. and understand doctors’ thoughts, views do to catch up with the times so that
and aspirations. Articles that offered we remain relevant and continue to
SMJ explanation and clarification to members lead, integrate, facilitate and empower
The Singapore Medical Journal (SMJ) which the press are unwilling to publish doctors in their mission to serve
published her first issue in March 1960. have often been printed in the SMA News. the healthcare needs of our people,
Throughout the years, the articles towards a better tomorrow.
Some prominent topics that have
have been very varied and depicted been published in the SMA News include
the trends in Singapore medicine and articles on professional conduct, medical References
socio-economic developments. In the ethics, technology, continuing medical
1960s, some of such trends included • Chia JYJ. Straits Medical Association. Singapore
education reports, job listings, and Infopedia. Available at: http://eresources.nlb.gov.
malnutrition, tuberculosis, infections materia non medica, such as travelogues sg/infopedia/articles/SIP_1173_2006-08-30.html.
like gonorrhoea and leprosy, as well as and unique hobbies that doctors indulge • Singapore Medical Journal. Report of events of the
social problems such as opium smoking in. Up till today, the newsletter continues first national medical convention. Singapore Med J
and alcoholism. Rapid industrialisation to carry insightful and thought-provoking 1968; 9(3):227-31.
and development in the 1970s brought articles on current issues and events close • Goh LG. Conversations with Past Presidents.
about concerns of environmental health to the hearts of doctors in Singapore. Singapore Med J 1999; 40(4):212-25.
and social issues, such as family planning,
Both SMJ and SMA News facilitate • Goh LG. The SMA News Through the Years.
abortion, drug abuse, AIDS, and stress
social, cultural and professional activities Singapore Med J 1999; 40(4):206-8.
disorders like anorexia nervosa and
among doctors in Singapore and beyond. • Kua EH, Kua JPH. The social transformation of
work stress. In the 1980s, notable issues In fact, SMJ’s impact factor recently rose to Singapore medicine through 55 years of the SMJ.
discussed included National Service and 1.08, a testament to the hard work put in Singapore Med J 2016; 57(11):587-90.
disasters such as the Hotel New World by the editors and staff. • Kua EH, Kua JPH. Portrait of an Era: A Social
and the Spyros incidents.
History of Medicine in Singapore from 40 Years of
In the 1990s, we had issues Keeping our aims in view SMJ. Singapore Med J 1999; 40(4):193-205.
concerning information technology • Cheong PY. Life After 40. Singapore Med J 1999;
The founding fathers envisioned that
(IT) in healthcare cost containment, SMA is the “LIFE” of the profession and
40(4):191-2.
medical audit and case mix. At the turn that we must: • SMA Constitution. Article II: Objects & Powers.
of the century, we had issues of ageing,
hepatitis vaccination, cancer, obesity, • Take the Lead on healthcare matters;
the advance medical directive, mental • Integrate the contributions from
health, doctors’ stress and international various sectors of the healthcare
traveller health. In 2003, we had the profession; Dr Lee is a GP practising
SARS epidemic that hit Singapore, in Macpherson. He
• Facilitate information exchanges and is also a member of
revealing to us how poorly prepared interactions within the healthcare the current National
we were to face pandemics. The new profession and with society; and General Practitioner
millennium also heralded changes in Advisory Panel. He is a
the health and social landscapes of • Empower the profession to practise pet lover at heart who
Singapore, molecular genetics, positron with the highest ethical and is the proud owner of
emission tomography scan, liver professional standards. a dog, and regularly
feeds neighbourhood
transplantation, gambling addiction and According to the SMA Constitution, community cats. He
robot-assisted surgery. some of our roles include maintaining also enjoys playing
the honour and interests of the medical online war games and
SMA News profession, fostering and preserving the thinks that playing
unity and aim of the medical profession Pokemon Go is a good
SMA News has always played an important form of exercise.
role in the history of the Association. First as a whole, and voicing its opinion and
published in 1966 as the SMA Newsletter, to acquaint the Government and other
it sought to provide a platform to bodies with the policy and attitude of
communicate news and events to doctors the profession.
in a timely fashion. Although print media SMA is constantly looking at how to
is being superseded by new media today, better serve its members and society,
it is good to look back at how far we have and our current slogan – “For Doctors,
come. To get with the times, both For Patients” is a constant reminder of
SMA News and the SMJ were made our goal. As we move into the age of
MAY 2019 SMA News 07
SMA
60th Anniversary
1959–2019 2
4
1
1950s 1960s 3
1959 1960
1 SMA was set up on 15 September 1959, replacing the Malaya Branch of 2 Inaugural issue of the Singapore
the British Medical Association. Dr B R Sreenivasan was appointed its Medical Journal (SMJ) was published
first President in March
1963
3 Institution of the SMA Lecture to
establish an Annual Lecture on
medical ethics and related topics. The
first Lecture, "Advertisement and the
Medical Profession", was delivered by
Dr Gwee Ah Leng
1966
4 The SMA Newsletter, now known as
SMA News, was established to provide
a timely medium for communication
of news and events
1968
5 First National Medical Convention
held at the National Trades Union
2nd SMA Council (1961–1962)
Congress Hall and graced by then
Minister for Health, Mr Yong Nyuk Lin
08 MAY 2019 SMA News
8
10
9
11
5
7
1970s
1970 1975
7 The pioneer batch of 14 SMA 12 SMA hosted the SMA Exhibition
volunteer doctors formed the with the theme “Towards a Better
medical service of the People’s Singapore”
Defence Force
1979
8 S MA hosted the 5th Council Meeting 13 First SMA-Malayan Medical
of the Commonwealth Medical Association Annual Series of Games
Association (CMA) from 7 to 9 was held in Kuala Lumpur on 20
August, where Dr Gwee Ah Leng and and 21 October
Prof AA Sandosham were installed as
joint-Presidents of CMA
9 L aunch of Medik Awas, a medical
alert for the public
1972
10 SMA representatives were invited
for their first China tour from 9 to
First National Medical Convention
23 April
1969 1975
6 Institution of the SMA Honorary 11 SMA became member of the
Membership, with Dr Chen Su Lan and Confederation of Medical
Dr Ernest Steve Monteiro conferred Associations in Asia and Oceania
SMA Exhibition
the first Honorary Memberships (CMAAO)
MAY 2019 SMA News 09
24
18
20
25
21
19
1980s 1990s
1980 1981 1994
14 Establishment of the 15 Formation of the Association of 22 Formation of the SMA Medical
Medical Association Private Medical Practitioners, Officers’ Committee to address
of South East Asian Singapore (APMPS) issues concerning young
Nations (MASEAN), doctors in Singapore
16 E stablishment of the
together with delegates SMA Trust Fund
from Indonesia, Malaysia, 1994/1995
23 Merger of the APMPS with SMA
the Philippines and Thailand 1986
17 The Joint SMA/APMPS Guideline 1996
on Fees for Doctors in Private 24 SMA assumed the position
Practice was printed and of Secretariat of MASEAN
distributed to members 25 Launch of SMA’s website
18 First SMA Computer Conference
1987
19 SMA secretariat moved out of
4A College Road
20 First National Workshop on AIDS
1989
21 SMA Secretariat’s relocation to
Guideline on Fees Questionnaire SMA 5th House Officers' Seminar
2 College Road
10 MAY 2019 SMA News29
25
2000s 32
2000 2003 2008
26 Formation of the SMA Centre for 27 SMA, together with 31 Incorporation of Singapore Medical
Medical Ethics and Professionalism National Healthcare Association Pte Ltd (SMAPL)
(SMA CMEP) Group, SingHealth,
2009
Singapore Nurses'
32 SMA’s 50th year celebration
Association and
and publishing of the SMA 50th
Singapore Press
Anniversary Commemorative Book
Holdings, set up the
Courage Fund
2006
28 SMA becomes member
of the World Medical
Association (WMA)
2007
29 The SMA Medical Students' Assistance
Fund was set up Prime Minister Lee Hsien Loong at SMA's
Bonsai presented at the foundation laying 30 S MA’s withdrawal of the Guideline on 50th Anniversary Annual Dinner, where he
ceremony of the SMA CMEP was conferred SMA Honorary Membership
Fees for Doctors in Private Practice
MAY 2019 SMA News 1141
33
37
34
39
2010s 40
2012 2017 2018
33 Formation of the SMA Doctors 39 Launch of the Singapore 41 SMA secretariat’s relocation
in Training (DIT) Committee Medical Week which included to 2985 Jalan Bukit Merah
provide strong representation the inaugural National Medical
for them during their years Students' Convention 2019
of studies and training 42 60th SMA Council
40 Launch of the SMA eMarket,
34 F irst Members' Appreciation Nite an e-procurement platform for
was held to thank our Members medical supplies
and volunteers for their support
2013
35 Incorporation of SMA Charity Fund,
the independent charity arm of SMA
2013
36 First MedSoc-SMA Dialogue
2015
37 Unveiling of SMA’s new slogan,
“For Doctors, For Patients”
2016
38 SMJ’s involvement in the
formation of the MASEAN Group
of Journals (MASEAN GoJ) 60th SMA Council (2019–2020)
12 MAY 2019 SMA News60th Anniversary
Take our quiz to find out how well you know SMA’s past and current work, and stand a chance to
win a 3M™ LED P1610 Polarizing Task Light (worth $279). Stumped? Fret not! All answers can be
found within pages of this issue of SMA News.
Be sure to fill out your answers at this link before 15 June 2019 to be eligible for the lucky draw:
http://bit.ly/SMAPopQuiz
1. In which year was SMA founded? 5. The first doctors who were conferred the SMA Honorary
Membership were
a) 1945 b) 1949
a) Dr Chen Su Lan and Dr Ernest Steve Monteiro
c) 1959 d) 1960
b) Dr Chen Su Lan and Sir Gordon Arthur Ransome
2. The SMA Lecture was instituted in 1963 to establish an annual
lecture on medical ethics and related topics. What was the topic c) Sir Gordon Arthur Ransome and Dr Benjamin Henry Sheares
of the first SMA Lecture delivered by Dr Gwee Ah Leng?
d) Dr Benjamin Henry Sheares and Dr Ernest Steve Monteiro
a) Advertisement and the Medical Profession
b) Maintaining Standards in Medical Education 6. In which year was SMA Newsletter, now SMA News, established?
a) 1959 b) 1965
c) Ethics of Human Transplant and Experiments
c) 1966 d) 1970
d) Ethical Consequences of Technological Changes
3. The SMA Centre for Medical Ethics and Professionalism
(SMA CMEP), which aims to develop and promote medical
ethics for the betterment of patient care and public health,
was formed in 2000.
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4. Which of the following is SMA’s slogan, launched in 2015?
Sponsored by:
a) "For Physicians, For Patients"
b) “For Doctors, For Patients"
c) “For Doctors, For Singapore”
d) “For Singapore’s Doctors and Patients”
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Photo used is for illustrative purpose only.
MAY 2019 SMA News 1360th Anniversary
equivalent of `O' levels today. This early
exposure to a multiplicity of languages
and cultures may explain the unrelenting
liberalism that characterised his life.
At 15, he sat for his exams and got
nine `excellents', P1's today, which
won him a scholarship to the King
Edward VIIth College of Medicine. This
scholastic flourish did not change the
country bumpkin in him and he told
me how uncomfortable he was in a
tie and jacket being interviewed by
Dr J M McAllister, the Principal of the
College, who is remembered in a road
behind the Medical Faculty Building.
Sreenivasan graduated at 21 and
joined the Colonial Medical Service as
an assistant doctor. This meant that
though he was registered as a doctor by
the General Medical Council in Britain,
he was paid $50 a month and had
THE to take orders from a white superior
Founder
whose knowledge was often less than
his own. He had been brought up in
the hierarchical Hindu caste system
but had an unshakeable belief in parity.
This was given to him by the Christian
brothers, who had imbued in him the
faith that all men are the children of
God and should be treated equally.
He fought for this ideal with little
success. With the powers the Colonial
Medical Service had at its disposal
and the lack of support from local
colleagues who feared the wrath of the
of the SMA
establishment, the cards were heavily
stacked against him. Then something
happened which changed the whole
picture: the Japanese conquered
Text by Dr G Baratham
Singapore. The local, then called "Asiatic",
doctors were called upon to run the
This article was first published in the April 1999 issue of the Singapore Medical Journal. entire medical service and do so under
conditions of extreme deprivation.
I knew the founder president of the SMA well. I should. He was my There was a severe shortage of drugs
father. Baratham Ramaswamy Sreenivasan, known popularly as BR or and equipment, and malnutrition was
Sreeni, was born on 14 June 1909, in Gemas on the border of Johor and common. Even bandages and gauze
Negri Sembilan. His parents, who were Tamil Brahmins, had migrated swabs had to be washed, sterilised
to these parts early in the century and his father was a clerk in a rubber and re-used. It took all the energy and
ingenuity of the "Asiatic" doctors to
estate. When he was five, his father was transferred to Rawang, a
keep the medical service going but
village, an hour's train-ride from Kuala Lumpur. This is how it came to run it they did. At the end of the war
be that aged nine he went to school at Saint John's Institution in KL. it was clear that "Asiatic" doctors had
His mother was illiterate but his father saw to it that he could read and proved they could manage with or
write English and Sanskrit. He also taught him to count. In the Malay school he without the whites and the existence
attended before going to Saint John's he learnt Jawi, the Arabic script, which of two medical services was untenable.
preceded the Romanised Malay that is now used. At home he spoke Tamil, the While this was the general feeling,
mother tongue. At Saint John's he was taught Latin and, in the periods when few were prepared to stick their necks
Catholic boys were at Catechism, a kindly priest taught him French, both out for the cause. Sreenivasan did and
of which he offered as subjects for his Senior Cambridge examinations, the had his head immediately chopped
14 MAY 2019 SMA Newsoff. The exact issue was equal terms for to England. He obtained the London The institution was controlled
doctors within the service irrespective of Membership in five months but could and staffed mainly by 'whites'.
race. One important limb of parity was afford to stay another seven to learn On the medical front was the
the award of scholarships for overseas more than just passing an examination. Alumni Association, which undertook
studies so that locals could obtain On his return, despite his busy social as well as teaching functions. Its
postgraduate degrees and qualify for practice, he found time on Tuesday members had to be graduates of the
consultant positions. As is not unknown, and Thursday mornings to teach King Edward VIIth College of Medicine
those in power reward the cowardly undergraduates at the General or the University of Malaya. Graduates
and the connected. Sreenivasan did Hospital. At one point he was from other institutions though
not fall into any of these categories offering evening classes as well. The licensed to practice in the country,
and was refused a scholarship. cow, indeed, yearned to suckle. could not be members. There was
He resigned from Government The end of the forties was a period also the Malaya Branch of the British
Service at the end of 1947 and set up of political turmoil. In the jungles Medical Association, whose only
practice in down-market Serangoon of Malaya, a war was being fought function was an annual social event.
Road. He was an immediate success, between the British and their erstwhile Its members were mainly expatriates
not I suspect, because of his medical allies, the communists. Sreenivasan and it was a non-starter. Sreenivasan
skills, but because he never relinquished was a determined anti-communist wished for one organisation to
the habit of the country bumpkin with and scorned the term non-communist, represent all doctors on the island and
whom the poor were comfortable. which many adopted. He considered together with a few stalwarts formed
Malaya Clinic was always packed and them fence sitters and whatever else the Singapore Medical Association
Dad worked from early morning till he might do he never hedged his bets. (SMA) in 1959. Membership was
after dark, often seeing as many as 130 Nevertheless, he supported the Malayan however paltry. When I graduated in
patients a day. He did his own laboratory Democratic Union (MDU), which was 1960, Dad decided on a membership
work and, though a physician by nature, a broad front communist organisation drive. An inaugural dinner was to
sutured wounds and opened abscesses. that had among its ranks liberals and be held in a Chinese restaurant
He balked at obstetrics and whenever nationalists. Among his friends were above the old Capitol Cinema. All
a pregnant woman turned up on the John Eber and P V Sharma, who later who attended were to be offered
doorstep, enlisted the help of former fled the country, Eber to Britain and membership at the door. Every
President Benjamin Sheares, who never Sharma to Beijing. Sreenivasan was registered practitioner was to be
failed his friend in need. After dinner, never a politician but he believed that invited. There was a two-week gap
he visited the ill patients he had seen everyone, whether a communist, fascist, between the passing of my exams and
during the day. I accompanied him on or rapist, was entitled to justice and a the beginning of my housemanship. It
these trips to carry his bag, keep him hearing. With the collapse of the MDU was my duty, Dad said, to telephone
company and ask the unending stream he returned to his passion: education. every doctor in town and insist that
of questions I had accumulated during he be present. A brash 24-year-
There were, at that time, two
the day. Dad never tired of these. He old, I did just that, asking those
institutions of higher education:
was obsessed with teaching and often The King Edward VIIth College of who refused why they could not
quoted from the Latin: "More than Medicine and the Raffles College. turn up. Most did turn up and the
the calf wishes to suck does the cow Neither had the status of a university. association was off to a flying start.
yearn to suckle". He encouraged doubt Sreenivasan and his close friend, The PAP was then in power and
and dissent and supported his stand Yong Nyuk Lin, were the two locals Yong Nyuk Lin was Minister for
with the American humorist, James represented on the Council of the Education. Sreenivasan was keen
Thurber's aphorism, "It is better to ask colleges. They fought for the formation to be in charge of shaping the new
some of the questions than to know of a university, which would bring us university. In May 1961, he was made
all of the answers." This attitude which into the international mainstream of principal of the Singapore division
coloured our lives absorbed us on higher education. I remember long of the University of Malaya and in
those long drives in our little Austin evenings when Dad and Nyuk Lin January the following year, became
Eight to visit Albert Chong. Albert lived schemed on the veranda of our rented its first Asian Vice-chancellor. He
in a small flat beside the fire station bungalow as to how this could be was deliriously happy and began
on Aljunied Road. He had tuberculosis accomplished. Their conversation dreaming about integrating the
and was the first patient in these parts was punctuated by the tinkle of ice system of higher education in the
to be treated with the new antibiotic, cubes in glasses of whiskey and soda, whole country. He felt that students
streptomycin. The fire station still stands which was my duty to replenish. from the Mandarin stream were
and, half a century later, I cannot pass Finally a commission was sent from not being given a fair chance to
the spot without remembering those England, under the Chairmanship of acquire an internationally recognised
days. Within a year of being in practice, Sir Alexander Carr-Saunders, and the university education. They had, at
Sreenivasan had earned enough to go University of Malaya was established. the time, the option of attending
MAY 2019 SMA News 15Nanyang University, a privately run to be and enthusiastically talked of
institution with Mandarin as its preventative medicine, which was the
medium of education. Sreenivasan prerogative of the family physician. He
felt that such an education would was more accustomed to the life and
have no international currency. They death struggles of the poor than to be
would have to study in English and concerned with the longevity of the
he began to work out crash courses rich. Nevertheless, he persuaded himself
for these youths so that they would that prevention was the bottom line
be able to join the mainstream. The in medicine. He founded the College
visits he made to the Chinese Middle of General Practitioners in 1974 when
Schools only strengthened his resolve. he was having numerous heart attacks.
He wished to repeat with Mandarin Such an enterprise would not have
youths what the Christian Brothers been possible without the efforts of Dr
had done for an under privileged, Wong Heck Sing, Sreenivasan's friend
Tamil boy from a rubber estate. for Dad so that all of us could have a
and doctor, who is one of the unsung
peaceful night. The downward spiral
There were strikes and riots in heroes of medicine in Singapore.
the town in which Chinese students had begun and there was no moving
Dad was no saint and this no back. He died on 24 May 1977.
were involved. Dad believed that
hagiography. He would not like it to
they were Maoists because they were Dad had in his own way prepared
be otherwise. He had the arrogance
given no option to be otherwise. me for his decline and death, not
to believe that his students would
The government had different with verses from the Bible nor tracts
never betray the principles he had
opinions. They required that students from the Upanishads, but with a
inculcated in them, would never forget
should have a certificate of political quatrain from Omar Khayyam.
what he had taught them. When I told
suitability issued by the Internal
him that they had done just that and "The moving finger writes and having writ
Security Department before they
provided proof of this, he called me Moves on. Nor all your piety nor wit
were admitted to the university.
a liar. We quarrelled frequently. The Will lure it back to cancel half a line
This, to Dad, was a travesty. The Brahmin part of his upbringing had Nor all your tears wash out a word of it."
university was a sacred place: the given him an unshakeable confidence
temple of Saraswati the Hindu and Near the very end, Dad regained
in mathematics and logic. Those a quiet sobriety. He apologised that
Pallas Athenae the Greek, goddesses who saw things differently, even
of wisdom. The pursuit of knowledge he should have at times been so
friends, he considered 'fools or knaves'. unbearable and said that if I could not
should be unfettered by political Rationally, it could not be otherwise.
considerations. To make it otherwise stand to see him suffer I should stay
would be a sacrilege. The politicians Only towards the end did he begin away. He asked me to remember that
offered him evidence of student to have other perceptions. He began when he died, which would be soon,
involvement with the communists. to see that love and charity were a we should not grieve at his passing
Dad refused to even look at these. prerequisite to being human. He was but rejoice at his having been alive.
"I am a Vice-chancellor, not a policeman," then desperately ill. It was at about this We should have a party. We did.
he retorted. He fell out with his time that Yong Nyuk Lin began to see I feel that he would see the
dearest comrade Yong Nyuk Lin and him again. I was present at some of their development of the SMA, its journal
they never spoke for over a decade. early meetings. At first Dad and Nyuk with a literary content, CME sessions
After much acrimony, Dad resigned Lin seemed a little shy of each other and and the audit of medical practice, with
on 4 Nov 1963. It was the worst day in glad of the presence of a third person. typical Brahmin arrogance, as the
his life and the first time I had seen my This soon passed and when Dad died, fruits of the tree he had planted. The
father weep. The next day, the Straits Uncle Nyuk Lin and his wife, Auntie seed had not fallen on stony ground.
Times ran a story, by a reporter called Geok Lan, the sister-in-law of Lee Kuan
Yew, were the first to visit our home. He had an enviable confidence in
Jackie Sam, about the Vice-chancellor the young. He believed that it was
having a communist influence close In his last years, he took to alcohol, our duty to give to them all our own
to him. They gave no names but most initially to still the pangs of angina, lives had taught us so that they would
people took that influence to be but later, out of self-indulgence. He not fail. Fifty years after he taught
me. That, however, is another story became an alcoholic. Life became me the lines, I still remember:
that I will tell in my own memoirs. difficult for all of us, especially for
Heck Sing, who turned up late at "To you from falling hands we throw
Sreenivasan went back into general
night after long sessions at the Public The torch; be yours to hold it high.
practice, not in Serangoon Road, but
Service Commission. His eyes would If you break faith with us who die
in the up-market Specialist Centre in
Orchard Road. He was never happy be drooping, but he would muster We shall not sleep..."
about this though he pretended himself to offer advice and medication May I offer this thought to you.
16 MAY 2019 SMA News60th Anniversary
If the SMA is to have
Text by Prof Arthur Lim Siew Ming,
President of the 9th and 11th SMA Council
Photo by Singapore National Eye Centre
This article was first published in the February-March 1969 issue of the SMA News.
If the Singapore Medical Association only way doctors can have their medicine to keep with the change
is to have meaning then it must views represented collectively is of time: doctors who will generate
identify itself with society and through the Singapore Medical unity amongst the profession
constantly be guided by the principle Association, it follows that if the and lend coolness to judgement
of ensuring that the citizens of Association is weak and lacks and cohesiveness to controversial
our Republic will get the best that organisation, the Government will deliberations: doctors who are
medicine can provide. have to decide on policies affecting prepared to provide leadership
The Singapore Medical Association medical practice unilaterally. even if it means incurring official
was established ten years ago when On the other hand, no Government displeasure, to achieve what they
Dr. B. R. Sreenivasan was elected its or Ministry of Health can afford to consider will ultimately be in the
first President. In the first few years ignore a national medical association best interest to society and in
of its establishment, only part-time which has, by its activities and the practice of the profession.
secretaries were employed and the organisation, shown itself to have In the absence of effective
majority of the secretarial duties were the capacity to give effective organisation, the doctors of
done by our past honorary secretaries
guidance on medical policies in Singapore will not look up to the
and other doctors who dedicated
the best interest of the Republic. Association for leadership and in
their time to the development
of the Association. To them, the It therefore seems clear that there moments of crises, bewilderment
Association owes its gratitude. is a need to further strengthen the may prevail leading to a sense
Singapore Medical Association. of helplessness and apathy.
We have now reached a phase
of development when it is no There is firstly the need to collect Thus in the final analysis if the
more possible for the Association sufficient funds in order to provide Singapore Medical Association
to face up to the many issues and adequate fulltime secretarial help. At is to play its role effectively, the
challenges before it without full-time a later stage, the honorary secretaries first fundamental need is for all
efficient administrative machinery. and honorary editors may need to members of the Association to
be replaced by full-time professional give of their best and be prepared
The important decision for
members is whether doctors who staff. Then there is a host of other to meet the increased cost of
are the experts in the art and the auxiliary staff necessary to run an maintaining an effective secretariat
practice of medicine should have a effective administration. Most of for the strength of the Singapore
say in the type of medical practice all, the Association needs dedicated Medical Association lies not in a
that the citizens of Singapore doctors with the determination to few leaders but in the collective
should be provided with. As the elevate the standard of practice of unity of all its members.
MAY 2019 SMA News 17Well
60th Anniversary
Wishes
m o u r M e m b e r s
fr o
- Adj A/Prof Vishal G Shelat -
Good wishes to SMA and the SMA family. While other organisations/
professional bodies may be seen as adversaries of the medical profession,
the SMA family has an ever increasing role and responsibility to shoulder.
Happy 60th
Stay strong and stay united.
birthday, SMA!
Kudos for all the work
done, very often behind the
scenes, and thank you for
representing the doctors
Happiest 60th birthday and and taking into account that
Keep up all the great work, thank you very much, SMA, we are for doctors and we
SMA, and thanks to all for your great contribution to are for patients!
who have served over the Singapore!
last 60 years!
- Dr Hsu Pon Poh -
- Dr Peter Loke - - Dr Jonathan Pang -
- Dr Lee Suan Yew -
If I am not mistaken, I have been a member of the SMA
since 1961 when I graduated, and was made an SMA Thank you for your support of
Honorary Member in 2007. students and working professionals
throughout the years! Thank you for
I am proud to belong to the SMA because the
sponsoring so many student events,
Association looks after our professional and social
and promoting and engendering
welfare extremely well. All the Presidents and office
student bonding across all three
holders of SMA dedicate their time and services to our
medical schools. We have benefitted
medical fraternity and I wish to take this opportunity to
so much as student participants from
thank them personally.
your various programmes and welfare
May the SMA celebrate its 60th anniversary with pride initiatives. Happy 60th birthday and
for past achievements and look forward to greater may there be many more great years
achievements in the years ahead. to come!
Happy 60th anniversary!
- June Yu -
18 MAY 2019 SMA News- A/Prof Cheong Pak Yean -
When SMA was founded 60 years ago, the Malay phrase
“Jasa Utama” (service before self) was chosen as motto. The Congratulations on turning
slogan “For Doctors, For Patients” was launched in 2015 to the big 60, and I wish SMA
reflect that SMA today stands up for both doctors and patients. all the best in growing its
Doctors can best care for patients only if they are also looked role as a stronghold for
after in a relationship of trust and healing. May SMA flourish advocacy in the medical
in its mission. profession – for doctors and
for patients!
- Dr Ivan Low -
SMA has been the godfather of all doctors in Singapore since its
foundation 60 years ago.
When it first started, SMA was the only medical association to Happy birthday, SMA!
which all doctors here felt affiliated to. In the early days, the Thank you for speaking up
Presidents were literally agongs to us. Over the years, its work for us doctors (across all
and responsibilities have been diluted and shifted. Nevertheless, disciplines) and for organising
it remains a binding force. Its publications are widely read and events to bond our fraternity.
cherished, and its charitable work for less fortunate students and
- Dr Vincent Chan -
others in the community is always deeply appreciated.
- Dr Charles Toh -
- Prof Ho Lai Yun -
Thank you for speaking up for us with
the public and also those in power. In SMA is the first professional body I could not wait to
hard times like now, we need a strong join the moment I passed my final year examination
SMA who is unafraid to speak the from the medical school of the then University
truth. Keep up the good work! of Singapore in 1973. I continued to be a proud
member of SMA and I never failed to pay my annual
- Dr Desmond Wai -
subscription fees on time!
SMA has always been an important voice for the
medical profession while ensuring that the highest
standard of professionalism of our medical practice
is keeping pace and to evolve with the rapid changes
and demands of our society.
60 years have passed and you (SMA) are My best wishes to SMA on its 60th birthday and hope
not older but wiser with each new year. it is ever ready to meet the challenges in the future.
Happy birthday, SMA!
- Dr Simon Wei -
MAY 2019 SMA News 1960th Anniversary
Advocacy
Text by Dr Chong Yeh Woei, President of the 50th, 51st and 52nd SMA Council
A very important role that the Either path that one chooses can be travel to conferences or present
SMA plays is advocating for the argued justifiably; the balancing of papers abroad.
profession. However, advocacy risk versus benefits can be so fine Healthcare is strictly sociopolitical
is by no means confined to that a case may be made for going
in nature, as opposed to dentistry
advocating for the doctor without left or right. However, one road often
where the bulk of the sector is
taking patients’ interests into carries more financial incentive for
privatised. Invariably, there will
consideration. In fact, the starting the doctor, be it due to procedures,
be differences in the views of the
point of advocacy for the profession treatments, imaging, drugs or
national leadership and the medical
is to consider the long-term interest biologics. It is in situations like these
profession. How these differences
of the patient. In this way, we where one’s ethical upbringing is
cannot be misled by the short- should be driven must be for the
tested, where the patient’s decision
term interest of doctors that may greater good of the patient in the
may be swayed, or where the financial
be at odds with the long-term incentives could override the greater longest term. It may sometimes seem
interest of the patients or society. good of the patient. Needless to say, that the profession is fighting for
In a sense, this principle is like the these moral hazards keep most of us itself, but the reality is that what is
lighthouse that guides the path of up at night. good for the goose is often very good
SMA. Without this beam of light, for the gander. Without patients, we
The public sector may also face as doctors will be forsaken and adrift.
we would surely be waylaid by a
certain hazards and there is always
multitude of treacherous obstacles.
the divide between subsidised and
Engaging stakeholders
private patients. Choosing to see
Understanding the concerns private patients over subsidised In my two decades of committee
of the profession patients may be tied to certain work at SMA, I have sometimes found
The bulk of these obstacles would incentives such as remuneration. the Association having different
be moral hazards which we face on Prescribing certain drugs or tacks from the national leadership.
a daily basis. In the private sector, treatments may be tied to incentives We often identify a trend, policy or
we often have patient scenarios such as the opportunity of being decision that is likely to produce a
where there is a fork in the road. invited by pharmaceutical firms to less-than-satisfactory outcome in
20 MAY 2019 SMA Newsthe long run; an alarm goes off in comprehend each other’s positions. meeting with the petition originators.
our collective leadership and we can These meetings are usually held behind The other two recent petitions were
see the problem that will loom in closed doors, and are important to done online yet attracted sizeable
the future. We will then go into an enable points of view to be exchanged response in terms of a majority of
analytical phase where we look at and concerns to be raised. Many a time, registered medical practitioners. We
the issue and the likely outcomes – there is a certain degree of tension certainly do not condone go-slows,
negative or positive – that can arise. in the room. However, I believe that walkouts, strikes or demonstrations
The analysis is very critical with no tension is not a bad thing but instead by members of our profession. That
vested interests, no holds barred and necessary to attain the best outcome. will certainly damage our standing
often draws on institutional memory with society and jeopardise the social
The tension is carefully managed and
and sometimes a phone call to a past contract the profession has with the
calibrated to prevent any outbursts,
SMA President or office bearer. This greater public.
though we have seen our fair share
analytical phase can involve endless I do recall tough situations that
of raised voices, pointed fingers,
rounds of email and text messages, we have collectively lived through
phone calls and research by our accusations and that rare thump on the
table for emphasis. where we had to run the gamut of
secretariat, all culminating in a robust analysis, negotiations and some
session at a council meeting. The aftermath of such meetings is forms of protest. This involved several
The robust session is that both parties leave with a good pandemics, the Night Polyclinic issue
argumentative, with all council idea of what each is trying to say and and the changing of the constitution
members present chipping in and impart. Sometimes, both parties of the Disciplinary Tribunal to be
arguing various points, and with may not be happy during the process chaired by a judge. Despite all this,
different persons playing devil’s but that is the nature of negotiations. SMA has its place in the national
advocate. Our council meeting The most important result is the health ecosystem, championing
starts at 9 pm and often ends past outcome. Very often, we see that the greater good of society and our
midnight. We often end with a outcomes may take a while to patients, preserving the ethics and
unanimous decision, but if there are materialise. The time horizon could be professionalism of our colleagues,
still dissenters, we call for a vote and in matter of months to even years. calling a spade in no uncertain terms,
collectively stand by its outcome. and saying things that need to be said
There are occasions where the without fear or favour. Time will judge
The outcome is usually a decision
to write letters to communicate negotiations cannot produce a whether we have indeed fulfilled
and make a case for our concern. In satisfactory outcome for both what we have set out to do.
preparing our letters to the press, we parties. In such cases, the collective
would involve our media consultant leadership can well take further
to get a layperson’s non-jaundiced action by issuing position papers,
view of the situation. Sometimes, the commissioning a study or conducting
outcome can be to call for a meeting surveys. Very rarely have we asked Dr Chong is in his
with relevant authorities or to make members for direct feedback in forms fifth decade and
trying to decide what
a phone call to a key decision maker of a multitude of letters. It seems
is important going
in the national leadership. On certain today that a very common way of ahead for the last leg.
occasions, we write a position paper expressing protest is to have an Is it leaving a legacy,
to defend and stake out our position online petition. I recall three recent drinking good
in no uncertain terms. petitions, the first regarding the Pinot noir, reading the
good stuff, keeping
Once we have engaged our opposite Kawasaki case. It was started by senior
an active lifestyle,
number, there is often a time for quiet members of the profession and it did or just enjoying the
negotiations to understand, study and end up with a national leadership good company of his
friends? He would like
your honest opinion!
"SMA has its place in the national health ecosystem,
championing the greater good of society and our
patients, preserving the ethics and professionalism
of our colleagues, calling a spade in no uncertain
terms, and saying things that need to be said without
fear or favour."
MAY 2019 SMA News 2160th Anniversary
SMA
SMA AND MEDICO-LEGAL ISSUES SMA Ethics Lectures SMA Centre for
Medical Ethics and
60 Years On
Committee Professionalism
Text by A/Prof Goh Lee Gan, President of the 40th and 41st SMA Council
Introduction Position statements per 1,000 doctors ranged from a low
The SMA has 60 years’ history of
and advisories of 10.6 (in 2009) to a high of 17.2 (in
2014). Table 1 shows the complaint
working with doctors and patients. The SMA website has to date
rates from 1990 to 2007. They ranged
With regard to medico-legal issues, 15 Position Statements and 18
Advisories, mostly from the SMA, from 8.0 (in 1995) to 16.7 (in 1991).5,6
its objective is “to support a higher
standard of medical ethics and with a few from other stakeholders Why do patients complain?
conduct; to enlighten and direct including the Singapore Medical
Council (SMC), Central Narcotics An Editorial in the Medical Journal of
public opinion on problems of Australia,7 written by Paul Nisselle,
Bureau and the Ministry of Health
health in Singapore”. The activities chief executive of the Medical
(MOH).3 The oldest in the list
and events in the local medico- was issued by SMC in 1994, on Indemnity Protection Society,
legal landscape where the SMA has “Issue of Medical Certificates”. Melbourne in 1999, has an important
played a role are briefly presented. evergreen message to share: “Medical
Complaints against doctors treatment is not entirely risk-free. The
SMA Lecture doctor-patient relationship involves
Complaint rates per 1,000 doctors two individuals – both human, and
The SMA Lecture was instituted
Figure 1 shows the rates of complaints therefore fallible. One seeks assistance
in 1963, by a grant from the SMA
lodged with the SMC from 2008 to with a problem and the other has
to the Faculty of Medicine to 2017.4 The number of complaints the skills to deal with the problem.
establish an annual lecture on
medical ethics and related topics.
The list of SMA Lecturers and
the topics of their lectures are Figure 1. Complaints received by SMC (2008 to 2017)
available on the SMA website.1 250 20
Complaints Per 1,000 Medical Practitioners
SMA Ethics Committee 213 18
Total Number of Complaints Received
16.2 16 15.9 15.7
200 15 17.2 16
Since 1966, the SMA Ethics 182
Committee has been a committee 173 172
159 14
of the SMA Council. It started with 152 153
150 141 13.4 12
just an advisory function, but 138
11.9
took on more tasks over the years. 10.6 10.7 10
When its work was reviewed in 100 96
8
1999, the Committee had four key
types of activities: operational, 6
consultative and liaison, policy, 50 4
and education.2 Creation of the
advisory on advertising, and the 2
advisory on breast and chest 0 0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
examination of female patients,
are examples of policy activities. Year
Total No. of Complaints Received Complaints Per 1,000 Medical Practitioners
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