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news V o l . 5 0 N o . 2 | F E B R U A R Y 2 0 1 8 | M C I (P) 0 5 0/ 0 1 / 2 0 1 8
news
CON T E N T S
Vol. 50 No. 2 2018
Editorial
EDITORIAL 04 The Editor’s Musings
BOARD Dr Tina Tan
Editor
Dr Tan Yia Swam
Deputy Editors Feature
Dr Tina Tan 05 Still At It – 25 Years and Counting
Dr Tan Tze Lee A/Prof Eillyne Seow
Editorial Advisors
A/Prof Daniel Fung 07 At Life's End
A/Prof Cuthbert Teo
Dr Grace Yang
Dr Toh Han Chong
Members Opinion
Dr Chie Zhi Ying
President’s Forum 19 Economics Can Never Replace
Dr Jayant V Iyer Morals and Values
Dr Jipson Quah 08 Longitudinal Primary Care:
Dr Wong Chiang Yin
Dr Jonathan Tan Keeping the Fire Burning
Dr Jimmy Teo Dr Wong Tien Hua
Dr Alex Wong
SMA CMEP – Medical Practice
EX-OFFICIOS 20 Treating Loved Ones and Yourself:
Dr Wong Tien Hua
Dr Lim Kheng Choon When to Step Aside
Dr Neeta Satku
EDITORIAL
OFFICE
Senior Manager Insight
Sarah Lim 22 Fellowship Matters:
Assistant Manager How to Get Into a Good One?
Sylvia Thay Dr Lee Ser Yee, Dr Chai Shu Ming and
Editorial Executive Dr Chan Chung Yip
Jo-Ann Teo
ADVERTISING AND
PARTNERSHIP
Hobbit
Li Li Loy 27 Survival Medicine: The Modified
Tel: (65) 6223 1264 Montgomery Test (Part 2)
Email: adv@sma.org.sg
Council News
PUBLISHER 10 Highlights from the
Singapore Medical Association GP Matters
2 College Road Level 2, Honorary Secretary 30 Why Family Medicine?
Alumni Medical Centre Dr Lim Kheng Choon Dr Ajith Damodaran
Singapore 169850
Tel: (65) 6223 1264
Fax: (65) 6224 7827
Email: news@sma.org.sg
Letter AIC Says
URL: https://www.sma.org.sg 10 NEHR: Will These Changes Make 32 Enhanced Patient Care in the
UEN No.: S61SS0168E a Difference? Community through Primary
Dr Choo Kay Wee
DESIGN AGENCY Care Networks
Oxygen Studio Designs Pte Ltd Agency for Integrated Care
PRINTER Eulogy
Sun Rise Printing & 12 In Memory of Dr Khoo Chong Yew Indulge
Supplies Pte Ltd 34 Where in the World is Okinawa?
(1939-2017): Past President of SMA
Prof Wong Tien Yin Dr Jimmy Teo
Opinions expressed in SMA News reflect the
views of the individual authors, and do not 14 In Memory of Prof Chia Boon Lock
necessarily represent those of the editorial (1939-2017): Doyen of Cardiology
board of SMA News or the Singapore Medical
Association (SMA), unless this is clearly A/Prof James Yip, A/Prof Poh Kian Keong and
specified. SMA does not, and cannot, accept Prof Tan Huay Cheem
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 Calendar
products and services that appear in SMA News
do not imply endorsement for the products 17 SMA Events Mar–Jun 2018
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, Reflections
without the prior written permission of the 18 A Lot to Think About
Editor of SMA News. Requests for reproduction
should be directed to the SMA News editorial Dr Teo Boon See
office. Written permission must also be
obtained before any part of SMA News is stored
in any retrieval system of any nature.
editorial
The
MUSINGS
A few months ago, a doctor in
one of our public hospitals made
the frontlines of our hospitals’ A&E
departments every day without fail. T ina Tan
social media news for allegedly Dr Grace Yang submits a heartfelt
being negligent in the care of a piece sharing her work as a palliative
young child. There was much public medicine consultant and how she Deputy Editor
discourse on the matter. The hospital pushes on despite the nature of her
in question put forward a factual job. As part of our GP column,
Dr Tan is an associate
statement to defend their employee, Dr Ajith Damodaran talks about
consultant at the Institute
another doctor’s social media post the joy he experiences in his work
of Mental Health and has a
went viral for his defence of the first as a family physician, and in our
special interest in geriatric
physician (introducing the hashtag President’s Forum, Dr Wong Tien Hua
psychiatry. She is also an
#targetzeroabuse), and the original writes about burnout among GPs.
alumnus of Duke-NUS
posts with its allegations were This month, we feature Part 2 of Medical School. Between
eventually taken down (though the the Hobbit’s series on the modified work and family life, she
reasons why are unclear). Montgomery test, as well as the first in squeezes time out for
Although the furore has died a series of articles by Dr Lee Ser Yee and her favourite pastimes –
down, this debate caused a stir colleagues on choosing a fellowship reading a good (fiction)
in many of our hearts for various for specialty training. We’ve also book and writing.
reasons. It is a given that healthcare reprinted Dr Wong Chiang Yin’s letter
professionals need to be treated to the Straits Times in support of the
with respect and this was briefly latest decision to reinstate medical fee
highlighted in last month’s issue of guidelines (I believe the new term is
SMA News. “benchmarks”).
In this issue, though, we want Last December, I received a
to take a more positive spin on Christmas greeting from my senior
things. What makes us all tick in colleague and fellow Editorial Board
our everyday work? How do we member, A/Prof Daniel Fung. His
plough on despite the difficulties message spoke of taking joy and
and disappointments we may face? having hope, and in particular, “If we
Where and how do we find our joy are to find joy at work, we must first
when at work? have meaning and purpose. And in
We’ve invited doctors from our work, this has to be the patients
various fields; namely, emergency that we care for.”
medicine, palliative medicine and It was a timely reminder for me
family medicine, to talk about and I hope that this issue serves
#joyatwork. A/Prof Eillyne Seow as a reminder for all to go about
writes about the difficulties faced by our busy, endless days, always
emergency physicians, who battle at remembering to find #joyatwork.
04 FEB 2018 SMA News
FEATURE
Medical professionals deal with a great amount of pressure on a
daily basis, but how one copes with stress and continues to find
joy at work is the key. In this series, A/Prof Eillyne Seow and Dr
Grace Yang, emergency physician and palliative care physician,
respectively, share with us how they derive joy from the work
they do and the motivation for them to persevere on in their
journey of treating those in need. #joyatwork is possible.
Still at it 25 Years and Counting
Text by A/Prof Eillyne Seow
It was an atypical start to a Sunday brought in with a low blood pressure.
A/Prof Seow started
her training in
morning shift. He had been awoken by a severe pain
emergency medicine “Hotel 2, hotel 2…” in his left lower limb. The team got to
in 1987. She worked work – inserting two intravenous lines,
in the Emergency The first standby case was a 78-year- getting an ECG, etc. On examination,
Department, Tan old gentleman with shortness of breath there was radio-femoral (pulse) delay;
Tock Seng Hospital and a low O2 saturation. The patient he had a triple “A” (abdominal aortic
from 1991 to 2015. arrived just after 0830 hours. There were
She was the head aneurysm). Over the next two hours, the
three more calls on standby for critically
of this department team worked hard to resuscitate and
ill cases in the next 40 minutes and as
from 2001 to 2010 stabilise the patient. At 0630 hours, we
and led it during the we were managing our fourth standby
transferred the patient, accompanied
SARS outbreak. She patient, we noticed the paramedics
by a doctor and two nurses, to another
is presently a senior dashing out of their work station, where
institution for definitive management.
consultant in the A&E they had been writing their reports,
Department, Khoo towards the ambulance bay. Sally, the The doctor who accompanied the
Teck Puat Hospital. nursing officer-in-charge for the shift, patient kept in touch with the patient’s
went to investigate. wife and several months later, the
patient and his wife met with this doctor.
It has been more than a quarter The patient had recovered.
of a century since I decided to be an
emergency physician. When I was There have been many times like this,
invited to contribute my thoughts on the though not every day or every week,
“meaning and joy in what I do despite that are enough to remind me that
the difficulties and challenges”, I paused going to work has its meaning despite
and pondered and, typical of most the difficulties and challenges.
emergency physicians, I stepped back to
dissect the statement. Challenges, challenges…
It was 0430 hours on a night shift One of the most difficult challenges in an
when a 57-year-old gentleman was emergency department is a queue – a
FEB 2018 SMA News 05
long one. It was a typical Monday a 20-year-old man who had a dislocated of my kakis (slang for friends) asked over
afternoon shift. The waiting time was left shoulder which was back in its our WhatsApp group chat.
long, the patient care area was chock- socket within a few seconds.
“Debrief what?” another kaki asked.
a-block, the waiting area was crowded, A 35-year-old woman came in
overflowing with edgy patients and antsy “He meant supper,” another
breathless and lethargic; we recognised
relatives; the air was hot (even though the explained.
that she had undiagnosed diabetes and
air-conditioning was working overtime),
was in diabetic ketoacidosis. We started In my younger days, I had considered
and the staff were stretched and frazzled.
treatment and she was discharged after work stress and burnout to be part
Fortunately, there was no one who: a week in the hospital. and parcel of the deal, but in truth,
1. wanted to jump queue; or A 40-year-old man who was rolling in reflecting on those years of managing
2. queried why the displayed expected pain was brought in by the emergency critically ill patients who sometimes have
waiting time was two hours, but they ambulance – typical of patients with unspecified diagnoses, unreasonable
had waited two hours and fifteen renal colic. He was given intravenous relatives, cranky colleagues, an
minutes; or analgesia and his pain was gone. emergency department filled with
Remember Sally, the nursing officer in unattended patients, and corridors full
3. wanted to be attended to “NOW!” or
charged of my atypical Sunday morning of patients waiting for a hospital bed,
he would leave; or
shift? A 60-year-old man with Stage 4 I would not have been able to have
4. was cursing away with four-letter stayed the course without my kakis.
cancer of the lung was in a taxi. He had
words; or
become tachypnoeic ten minutes prior My kakis have laughed and cried with
5. threatened to go to the press, to to reaching the emergency department. me; heard me praise, scold and moan;
complain to the chief executive Sally and I did our best to make him consoled me when I failed; and clapped
officer, or to the Minister. more comfortable. at my successes. Some friends – medical
However, a man did approach a nurse The satisfaction of being pivotal in and non-medical – I would date regularly.
passing by and asked politely when the well-being of my patients gives We meet to catch up over food and new
his father would be attended to, then meaning and joy to what I do and keeps restaurants are of special interest. A few
another asked the same nurse what he me sanguine despite the difficulties and I travel with or visit once or twice a year.
was waiting for, and then another asked challenges on the shop floor. Others share my interest in Chinese tea.
how long more he had to wait as he
would like to go to the toilet. The nurse When in the mood for introspection, I
Staying the course escape into the world I am creating or
was very accommodating and attended
to each request: an unfortunate case for But how have I managed to shrug off read those by other writers.
the patient who had to wait another 20 work stress and avoid burnout is the Did I manage to shrug off work stress?
minutes before she could attend to him. question I have been asked. … not all the time, but my friends have
Another long queue that causes “Who is working afternoon shift kept me sane and they are the reason
great distress all around (from the today? Need a debrief after work?” one why I have yet to experience burnout.
top to the bottom of the hierarchy for
different reasons) is for a hospital bed.
In the (good?) old days, when I had just
started out in emergency medicine, the
priority was to not discharge patients
who were at risk of returning in a worse
state than when they left the emergency
department.
Over the last two decades, our
patients have aged considerably,
medicine has advanced and
expectations have risen; few are averse
to being hospitalised even in the
seventh lunar month (hungry ghost
festival). Due to overwhelming demand,
the emergency fraternity was given
a new role: gate-keepers to hospital
beds. This role is a challenging one for
the fraternity, as critics (both internal
and external) are armed with 20-20
retrospective microscopes.
“Okay, he’s asleep,” I said, after
administering propofol and fentanyl to
06 FEB 2018 SMA News
FEATURE
Text by Dr Grace Yang
A group of seven ward nurses are standing to attend the wedding dinner and came “Teach us to number our days, that
around Mr Tan’s* bed – three on each back to the hospital all smiles, happy we may gain a heart of wisdom.”
side and one at the head. They have just that he was able to fulfil his last wish. (Psalm 90:12)
helped Mr Tan put on a smart-looking He passed away just over a day later, in With my limited and transient life,
long-sleeved shirt and Mr Tan is feeling the early hours of Monday morning. why did I choose to work with the
breathless. He needs to rest for a few That was it – he was referred in on
dying? The dying are, in fact, still living
minutes before the nurses can transfer Thursday and died four days later on
and palliative care is about helping
Monday. At least we managed to fit in
him from his ward bed to a trolley bed. patients to live well until they die.
a tea ceremony and a wedding dinner
His daughter is standing along the It is at this time that they are often
during those brief four days that we
corridor just outside the room, dressed most vulnerable, suffering from pain
were caring for him.
in white and putting on lipstick. She is and other physical discomforts while
getting ready for her tea ceremony which being forced to contemplate the value
Energy to carry on of the lives they have lived as they
is about to take place in the ward’s day
room. I come in to check on how Mr Tan is Days like these remind me of why I face the reality of approaching death.
doing; he looks very apprehensive about studied medicine and became a doctor: Being able to journey with patients at
to make a difference in people’s lives. life’s end, and to ease their suffering
being transferred to the trolley bed. I stand
Days like these keep me going and along the way, is a great privilege.
beside him and say: “Don’t worry Mr Tan, I
give me joy. Yet how do I find joy in This is why I chose to be a palliative
am here. Let’s do this. If you are breathless,
my work, which is widely perceived as medicine doctor. The opportunity to
I will give you some extra medicine.” We utterly depressing? Each of my patients connect with another person and make
then transfer him to the trolley bed, comb has a serious illness – most commonly a difference is what keeps me going.
his hair, put on his tie and wheel him to advanced cancer, sometimes end-stage It makes it all worthwhile.
the day room where he is served tea by his heart failure or respiratory disease. Each
daughter and the groom. *Mr Tan is not his real name and details
of my patients has a limited prognosis
have been altered to protect his identity.
Mr Tan was referred to the palliative – usually months at most, sometimes
medicine division on Thursday, just weeks, sometimes only days. All of my
patients are dying.
one day before the tea ceremony, Dr Yang is
because his advanced cancer was Yet the truth is that all of us are dying. a palliative
rapidly progressing. It was making him Some of us are just more aware than medicine
others. Some of us are forced to face the consultant in
breathless with minimal exertion – even the National
talking made him breathless. He had inevitability of our mortality, while others
Cancer Centre
one last wish: to attend his daughter’s get to live in denial of it. As a palliative Singapore. She is
medicine doctor, my patients constantly married with two
wedding and give a father’s blessing
remind me of my own mortality. It may children aged
to the newlyweds. So, we started five and six.
seem counter-intuitive, but knowing
him on some opioids to control the that my life is only transient makes me
breathlessness and made logistical treasure it even more. It motivates me to
arrangements so that he could focus on what really matters. It reminds
participate in the tea ceremony on me to make the most of every day and
Friday morning and attend the wedding savour each moment. It reminds me to
dinner on Saturday night. With the help live each day well, because after our days
of everyone in the team, he managed are spent comes certain death.
FEB 2018 SMA News 07
PRESIDENT'S FORUM
Keeping the Fire Burning Text by Dr Wong Tien Hua
A review of burnout in primary their lives. However, even with family practitioner has to bear. If this
care physicians by Dr Lawrence the power of the Internet, which is coupled with the long hours spent
Ng was published in the Singapore provides information at the touch confined within the four walls of the
Family Physician (SFP) in 2016.1 of a button, patients who are not consultation room seeing repetitive
It quoted Maslach’s description medically trained may find such cases, then the work may become
of burnout as “... an erosion open access to information to mundane and even meaningless,
of engagement with the job. be overpowering and confusing. leading to physical and mental
What started out as important, Their sense of self-control may be exhaustion.
meaningful, and challenging work threatened, leading to anxiety and There are many interventions
becomes unpleasant, unfulfilling, frustration which they pass on to available to tackle burnout,
and meaningless. Energy turns into the physician. As addressed in the including self-care techniques
exhaustion, involvement turns into paper, difficult patient encounters described in the aforementioned
cynicism, and efficacy turns into are a major predisposing factor to issue of the SFP.
ineffectiveness.” physician burnout.
A burned out physician feels The demands of family practice Staying engaged
depleted of energy, unable to in Singapore means that the If Maslach describes burnout as an
connect to or care about his/her physicians need to spend long hours erosion of engagement, then the
patients, and becomes incompetent in the clinic to ensure accessibility. ability to stay engaged in one’s
and unproductive at work. The Most often, the evening and practice is critical especially over
doctor-patient relationship suffers weekend sessions are the busiest the span of a doctor’s career. I
along with effective care delivery. times for family physicians whose believe that the key to combating
Medicine is an uncertain art and practices are located in residential the feelings of detachment and
this is especially poignant in the neighbourhoods, resulting in less depersonalisation that occur in
primary care setting where patients time spent with one’s own family burnout is to focus on nurturing a
present with undifferentiated and on leisure activities. The ethos strong doctor-patient relationship,
illnesses. Dealing with uncertainty of a “good” doctor is to place the especially among primary care
is a clinical skill that has to be needs of patients above self, and physicians.
mastered, but it is counter-intuitive this renders the doctor prone to
spending excessive time at work to The well-known Stott and Davis
to junior doctors who are trained in
the detriment of family. model for primary care consultation
the hospital setting where the latest
describes four essential tasks for the
diagnostic facilities are available Setting up a family practice in doctor at each encounter.2
and where diseases have evolved the community is indeed a daunting
and become more apparent. This task for doctors who wish to take the • Looking after the acute problem
transition from specialist-based plunge into the private sector. One • Managing any concomitant
training to the community setting, starts off with the task of selecting chronic problem
where one has to rely on clinical the right location with the right
acumen amid limited resources, is a • Modifying health seeking
overheads, then applying for the behaviour
stressful endeavour. clinic licence, stocking up and hiring
Society has also always placed of staff. Once the clinic opens, one • Opportunistic health promotion
high expectations on doctors, with has to worry about maintaining The model recognises that each
patients now more knowledgeable the business and ensuring a good patient encounter is not just about
and connected than ever before. level of service so that patients the acute problem at hand or about
Patients are more demanding and would want to make a return managing the patient’s chronic
intolerant of uncertainty, because visit and recommend it to others. illness, but that each encounter
they are used to the fact that they Needless to say, there are a lot of actually carries far more potential
are in control of many aspects of responsibilities and worries that a with unique opportunities to
08 FEB 2018 SMA News
Dr Wong is
President of the
58th SMA Council.
He is a family
medicine physician
practising in
Sengkang. Dr
Wong has an
interest in primary
care, patient
communication
and medical ethics.
Illustration: Dr Kevin Loy
engage the patient in behavioural on the previous knowledge base who are more open to behavioural
change, and to “nudge” the patient with new insights and information change. The initial few visits are
towards a better quality of life. about the patient. usually business-like as patients
For this to happen, two seek consultation for biomedical
conditions must be present: A change in attitude problems, but at the same time,
A doctor’s approach to his/her these patients also subconsciously
1. The doctor and the patient must
patients will change once he/she observe the doctor to see if they
be committed to a therapeutic
adopts an attitude of long-term are comfortable enough to share
relationship of trust; and
holistic care, with the realisation their intimate medical information.
2. The relationship must take place that he/she is going to bear the Patients who do not “click” with
over an extended period of time. responsibility for his/her patients their GPs will eventually move on to
This means that the element of over decades. What is not addressed other practices and in this way, an
time played out over months and today may come around and strike established practice self-selects its
years is a necessary component of years later. For example, if a smoking patients over time.
effective care delivery for family habit is not addressed, both the
It is with this insight of longitu-
physicians. patient and the doctor may need to
dinal care that the practice of
deal with the consequences of lung
Each encounter is no longer an cancer in the future. family medicine is so engaging and
isolated event beginning with the interesting, because even though
patient entering the consultation I do not think that this attitude patients may seem to present
room and ending with the patient can be instilled or that it is a skill with similar and repetitive medical
leaving the clinic. Instead, the that can be trained; instead, it conditions, each encounter is
patient encounter can be seen as is a perspective that the doctor actually quite unique. Ultimately, the
part of an ongoing conversation that comes to appreciate over time. The
experienced family physician makes
is picked up where the previous one uniqueness of practising family
use of valuable contact time to steer
had ended. The interval between medicine in the community is that
patients towards better health.
each encounter can be months as the practice matures, so too does
or even years, but each individual the doctor-patient relationship.
consultation is part of a continuum The relationship strengthens as
References
and a touch point that makes up the doctor learns more about
the patient and eventually the 1. Ng CLL. Burnout in primary care physicians
the dots that form a continuous and interventions – an evidence-based
line – the longitudinal line of care. patient’s entire family, a nd is able to
review. Singapore Fam Physician 2016;
The doctor is aided by having a appreciate the context behind each 42(1):6-12.
comprehensive medical record of and every encounter.
2. Stott NCH, Davis RH. The exceptional
each consultation, including the An established clinic also tends potential in each primary care consultation.
conversations that occur, building to have a loyal pool of patients J R Coll Gen Pract 1979; 29(201):201-5.
FEB 2018 SMA News 09
council news
Report by Dr Lim Kheng Choon
Dr Lim is the
Honorary SMA feedback on the PHMC We will continue to engage
Secretary of (Publicity) Regulations stakeholders to give constructive
the 58th SMA feedback on behalf of our Members.
Council. He On 8 January 2018, SMA submitted
is currently preliminary comments regarding Re-nomination of SMA’s
an associate proposed amendments to the Private
consultant representative to the WSH
at Singapore
Hospitals and Medical Clinics (PHMC; Council (Healthcare) Committee
General Hospital. Publicity) Regulations. In it, SMA agreed
SMA is happy to re-nominate Dr Wong
with some amendments, but also sought Sin Yew as SMA’s representative for the
clarification on the types of publicity Workplace Safety and Health (WSH)
allowed within clinic/hospital premises; Council (Healthcare) Committee. Dr Wong
the types of Internet advertising allowed; has been SMA’s representative since 2014.
the use of testimonials; participation in The WSH Council will be re-appointing
reward/point promotions; and whether Dr Wong for a two-year term ending 31
certain prohibited terms could be March 2020. We thank Dr Wong for his
acceptable in certain scenarios. volunteer service to SMA.
NEHR:
letter
Will These Changes Make A Difference?
Text by Dr Choo Kay Wee
This reply was submitted I would like to thank Dr Lee Pheng Soon 3. This means that the useful information
in response to a letter for clarifying the ethical rights of the in the NEHR should be carefully
published in the January patient with regard to the National summarised and recorded for the
2018 issue of SMA News Electronic Health Record (NEHR). above purpose.
(https://goo.gl/EC5xxJ). Would the following changes made 4. Another way, perhaps, is to treat
to the present status of the NEHR help the information as if it is in a safe
in any way to eradicate the anxiety and deposit box with both the patient
ambiguity surrounding patients’ rights? and the caregiver holding separate
keys or tokens. They must be used
1. There should never be access to any concurrently to access the summarised
raw data in the NEHR unless for records, unless in an emergency when
forensic examinations or detailed a master key is used.
Dr Choo is a family research studies.
5. The information collected earlier
physician at A Life
2. The information in the NEHR should without the patients’ well-informed
Clinic Pte Ltd.
be treated as confidentially as consent (ie, ALL NEHR records)
our Central Provident Fund (CPF) should not be included unless
accounts or Inland Revenue Authority freshly authorised by the patients,
of Singapore records; ie, the patient but they should be kept for the
would be able to print and submit purpose of forensic examinations or
the information to the caregiver as research studies.
per printing out the CPF relevant 6. Finally, no research should be done
statement when buying a house. without proper consent.
10 FEB 2018 SMA NewsSMA MEMBERSHIP
PRIVILEGES AT A GLANCE
The core of SMA’s work is in the many issues that we have advocated for, in hopes of creating a better
local healthcare landscape - for doctors, for patients
The amount of time and effort that the relevant SMA Committees and Members spend cannot be easily
quantifiable, and the value and impact of our advocacy work may be overlooked at times. Nonetheless,
we are ever thankful to all our members for your strong support and membership over the years so that
the Association can continue to speak up on matters that are close to your hearts.
The more tangible SMA Membership privileges are listed below and on our website at
https://www.sma.org.sg/membership. Log in to your Membership Portal to enjoy the uniquely SMA
privileges as well as sign up for courses and events!
SMA’s Work
Receive complimentary or Utilise resources available for your Gain access to permanent or
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SMA’s Promotional Partners
SMA Membership is based on an auto renewal basis and annual subscription fees would be due at the start of
each calendar year. Any requests regarding your membership status should be sent in writing via mail or to
membership@sma.org.sg, subject to approval from the SMA Council.FEATURE
EULOGY
In Memory of
Dr Khoo Chong Yew (1939-2017)
Past President of SMA
Text by Prof Wong Tien Yin, Medical Director, Singapore National Eye Centre; Provost’s Chair
Professor of Ophthalmology, National University of Singapore; Vice-Dean, Duke-NUS Medical
School; Deputy Chief Executive Officer (Research and Education), SingHealth; President, College of
Ophthalmologists, Academy of Medicine
Division; Chairman, Singapore Eye Panel of the Medical Protection
Bank; Chairman, Ethics Committee; Society. MOH invited Dr Khoo to
and Chairman, Medical Board and several important policy formulation
its Selection Committee. More subcommittees, such as the Health
recently, Dr Khoo chaired the Advisory Council, Committee
SingHealth Centralised Institutional of Specialists Register and the
Review Board (IRB) A and served as Committee for Medisave for Private
IRB chairman at the Singapore Eye Hospitals. He also chaired the Asia-
Research Institute (SERI). Pacific Academy of Ophthalmology
(APAO) Ethics Committee.
Photo: Raffles Hospital
He was also among the first
visiting consultants appointed to International achievements
the Department of Ophthalmology, in contact lens subspecialty
National University Hospital, in 1986,
From 1998 to 2002, Dr Khoo chaired
and was a clinical teacher with the
the International Contact Lens
National University of Singapore.
Council of Ophthalmology. He also
co-authored the book, Contact
Public service – champion of Lenses: Medical Aspects, in 1989. He
Dr Khoo Chong Yew passed away ethical aspects of medicine was a member of the Board of Expert
peacefully on 16 November 2017, in Singapore and the Asia- Advisers for the Asian Foundation
aged 78. Here, I would like to Pacific for the Prevention of Blindness and
acknowledge his vast and profound Dr Khoo’s views and advice on the International Agency for the
contributions to ophthalmology in medical ethics were highly sought Prevention of Blindness.
Singapore and the region. after and respected. He chaired the
National Medical Ethics Committee, Leader
Singapore National Eye Ministry of Health (MOH), from Dr Khoo served two terms as
Centre 2003 to 2005, on top of the ethical President of SMA (1985 and 1986).
During the Singapore National committees of SNEC, SERI and the He was also on the Singapore
Eye Centre’s (SNEC) early years in Parkway Group of Hospitals over Medical Council and the Advisory
the 1990s, Dr Khoo was a visiting various periods. He was also the Subcommittee on Specialist
consultant and advisor, Cornea chairman of the Singapore Advisory Certification, Academy of Medicine.
12 FEB 2018 SMA News1
The SMA Council
expresses our
deepest sympathies
and heartfelt
condolences to the
family of Dr Khoo
Chong Yew on his
passing. Dr Khoo
was Past President
of SMA and was
the SMA Lecturer
in 1992, delivering
the Lecture on “The
Doctor's Role in a
Hi-Tech World”.
Dr Khoo was Secretary-General In recognition of his important
of the XXVI International Congress contributions to SNEC, Dr Khoo was
of Ophthalmology (1990), which awarded the SNEC Gold Medal in
was perhaps the most prestigious 1997. For his work in the Discipline
world ophthalmic event to be held in Committee of the Law Society, Dr
Singapore. Khoo was awarded the National Day
Public Service Medal (PBM) in 2005.
Contributions to the
community Role model
Dr Khoo contributed significantly We are indeed grateful to the
to the community, chairing the late Dr Khoo for his outstanding
National Eye Campaign in 1984, contributions to ophthalmology.
which organised eye screenings in 75 As one of the founding fathers of
community centres. He also provided
ophthalmology in Singapore, the
ophthalmic care to needy patients at
younger generation truly has an
the Home Nursing Foundation and
exemplary role model in Dr Khoo.
served on the Executive Council of
the Singapore Eye Foundation. He
had also led a Rotary Medical Mission
to Cambodia to introduce implant Further readings
surgery to ophthalmologists. 1. Lim KH. Leading lights in the Asia-Pacific:
XXI Congress, Asia-Pacific Academy of
Ophthalmology. Singapore, 2006.
Honours and recognition
2. Lim A. Seri: Singapore's World-Class Research –
Dr Khoo was accorded the APAO Singapore Eye Research Institute. Singapore, 2008.
Distinguished Service Award in
1987. He did Singapore proud Legend
by delivering the Javal Gold 1. The late Dr Khoo (first row, centre) and the
26th SMA Council
Medal Memorial Lecture at the
International Contact Lens Council of
Opthamology in 1994.
FEB 2018 SMA News 13FEATURE
EULOGY
In Memory of
Prof Chia Boon Lock
(1939–2017)
Doyen of Cardiology
Text by A/Prof James Yip, A/Prof Poh Kian Keong and Prof Tan Huay Cheem,
National University Heart Centre, Singapore
Prof Chia Boon Lock, Emeritus Professor University of Singapore medical school the workgroup for the first and second
of Medicine at the Yong Loo Lin School and travelled to Sydney in 1968 on a CPGs on lipids, which spanned more
of Medicine, National University of Colombo Plan scholarship to train as a than a decade, and was the advisor for
Singapore (NUS), Singapore, passed fellow in cardiology. At that time, the the third and most current guidelines.2
away peacefully at home on 27 care of patients with acute myocardial Despite his contributions to
December 2017 at the age of 78 years. infarction was primitive and basically numerous other areas, Prof Chia’s
Prof Chia, an early pioneer in consisted of five weeks of bed rest.1 greatest love and passion was the
cardiology, joined NUS as a senior He was involved in setting up the first field of electrocardiography (ECG).
lecturer in medicine in 1972 and was modern coronary care unit and coronary While his peers collected fine wine
promoted to full professor in 1981. He care ambulance in SGH in 1973, and and rare stamps, Prof Chia collected
was in charge of cardiology in Medical was the first to introduce M-mode electrocardiograms. His book Clinical
Unit II at the Singapore General Hospital echocardiography in 1976. Prof Chia had Electrocardiography (4th edition, 2015),
(SGH) from 1975 to 1985 and was also a sabbatical in 1979 at the Division of
head of the department from 1981 to a labour of love that he revised in
Cardiology, Stanford University Medical his twilight years, is the bible of local
1983. He then went to the National
University Hospital (NUH), becoming Centre, in Stanford, California, USA, cardiologists and medical students
head of the hospital’s Division of where he trained in echocardiography for ECG. As Dr Peter Yan wrote in his
Cardiology, Department of Medicine, and coronary angiography, and he review of his book, it “is a must-read
from 1986 to 1989 and chief of the pioneered the use of two-dimensional that can turn a novice into a competent
Cardiac Department from 1996 to 1999. echocardiography in Singapore two ECG interpreter”.3 Although ECG is an
In 2006, he was conferred the title of years later. Although he had received no old technology that was invented by
Emeritus Professor by NUS. formal training in hypertension and lipid Einthoven back in 1903, its shine has
management, he soon became a giant not been replaced by newer, modern-
Five decades of cardiology in these fields and was a key opinion day technologies. Prof Chia said at the
Prof Chia devoted his five-decade leader in Southeast Asia. In Singapore, 15th Sukaman Memorial Lecture at
career to medicine despite his multiple he was the first to introduce ambulatory the ASEAN Federation of Cardiology
talents, including music and the English blood pressure monitoring in 1986 meeting in 2014: “although there are
language, and was a witness, participant and was involved in various Ministry many pitfalls in the ECG evaluation
and champion of many changes in of Health workgroups for its clinical of ST elevation myocardial infarction
cardiology practice in Singapore. In practice guidelines (CPGs) on lipids and (STEMI), with our current ECG knowledge
1963, Prof Chia graduated from the hypertension. He was the chairman of and expertise coupled with clinical
14 FEB 2018 SMA Newscorrelation as well as the present
1
availability of cardiac biomarkers,
echocardiography, computed
tomography and percutaneous coronary
angiography, accurate diagnosis
today can be achieved in the majority
of cases”.4 This lecture took place a
decade after his highly successful ninth
Antonia Samia lecture on ECG at the
14th Asian Pacific Society of Cardiology
Congress in 2004. Prof Chia was also
an International Editor of the Journal of
Electrocardiology for more than a decade.
His insights into ECG reading have
helped the interventional cardiologists
of today to reduce door-to-balloon
time by predicting the correct coronary
artery to engage first in cases of inferior
STEMI.5 Even just before his death, he
was working on another ECG paper that
would soon be published.
Medical education
Every batch of medical students in NUS
from 1972 to 2016 would remember
being taught by Prof Chia. Before the
era of professional beatboxing, the
Introduction to Cardiac Examination
lecture by Prof Chia was accompanied before their exit examination, which Medicine Singapore (1981–1985) and
by his vocal simulations of every covered the entire span of cardiology. Chairman of the Chapter of Physicians
conceivable cardiac murmur, which Generations of cardiology trainees (1981), and member of the 17th and
received standing ovations from his are indebted to his generous spirit in 18th Council of SMA.
students. His facial simulation of pursing teaching and his help in passing their In the realm of clinical cardiology,
his lips would forever emboss in one’s examinations. Prof Chia was peerless. His patients
mind the image of the fish-mouth ranged from kings to the common
appearance of mitral stenosis. For the Leadership and honours man. He received the following
bedside tutorial, Prof Chia pioneered the Apart from his university and clinical honours for these contributions: Dato
auscultation of cardiac murmurs with responsibilities, Prof Chia was involved Paduka Mahkota Brunei (1984), the
the “octopus” teaching stethoscope, to in many local and regional societies. Lee Foundation-National Healthcare
which multiple students could listen at Together with the late Dr Tan Ngoh Group Lifetime Achievement Award
the same time. As an examiner for the Chuan, he wrote the constitution of (2005), Honorary Membership of the
final Bachelor of Medicine and Bachelor and registered the Singapore Cardiac SMA (2008) and the Singapore Cardiac
of Surgery or cardiology exit interviews, Society in 1973. He was past president Society Lifetime Achievement Award
the presence of Prof Chia at the station of the society four times (1977, 1980, (2014). For his years of service in the
was reassuring, as students were unlikely 1983 and 1989), and was founder public sector, he was often asked if
to fail, unless deservingly so. After Prof and past president of the Singapore he could be considered the father of
Chia stepped down as NUH’s chief of Hypertension Society (2001) and cardiology in Singapore. His humble
cardiology in 1999, it became a rite vice-chairman of the former Singapore reply was that “the honour belongs to
of passage for all cardiology trainees National Heart Association (1982). He Charles Toh, but if you must, I could be
to have his final tutorial a few weeks was council member of the Academy of considered the doyen of cardiology,
FEB 2018 SMA News 15Legend
1. Family photo after the conferring of Emeritus
Professorship
2. The late Prof Chia with his son, Dr John Chia,
and grandson, Peter Chia
The SMA Council expresses our
deepest sympathies and heartfelt
condolences to the family of
Prof Chia Boon Lock on his passing.
2
a respected person who speaks for vision so that he could see his ECGs. and Toronto in the form of videos, to
others”. This expertise was previously not reassure the man who had made a
available in Singapore, but necessity difference in their lives. His message to
Courage in adversity prompted him to master his situation, them ten days before his passing was:
At the age of 43 years, Prof Chia was and Prof Chia became an expert in the “In my lifetime, I have two major aims:
struck with Stage 4 nasopharyngeal field of diplopia correction. To lead an honourable life and to have
carcinoma. Despite knowing the poor an honourable death. The first has been
prognosis of his condition, he sought The final battle achieved, with your kind thoughts and
treatment in Hong Kong with a new Foreshadowing things to come, prayers. I’m confident that the second
high-dose radiotherapy regimen. Prof Chia said in 2006, at the 16th Seah will also be achieved”.
In a reversal of the doctor-patient Cheng Siang Memorial Lecture: “Perhaps, Ten days later, his wish was fulfilled
role, he said: “Once you have found as recommended by some experts, the in the company of his family, whom he
a good doctor, trust him fully and do best strategy for all of us is to strive to loved dearly, with the peace he desired.
everything he says without question”. die young at the latest possible age –
This philosophy of trusting a colleague not just for ourselves, but for the entire
to care for him helped him through population. The best example of this
the darkest days of his life. He suffered achievement is the world renowned References
many long-term complications from his 1. Chia BL. 16th Seah Cheng Siang Memorial
researcher on cigarette smoking,
initial radiation treatment, including Lecture–the changing face of cardiology practice,
Sir Richard Doll, who died in 2005 training and research in Singapore. Ann Acad Med
pan-hypopituitarism, which he said,
following a short illness, at the age of Singapore 2006; 35:729-34.
with tongue in cheek, contributed to
92 years. But alas for many of us, this is 2. Tai ES, Chia BL, Bastian AC, et al. Ministry
his cherubic look. Over the years, he
something that may be difficult to attain.”1 of Health Clinical Practice Guidelines: Lipids.
had multiple health issues, including Singapore Med J 2017; 58:155-66.
poor wound healing, intubation for In November 2017, he had a
3. Yan P. Review: Clinical Electrocardiography 4th
epiglottitis and diplopia from cranial recurrence of secondary cancer of the Edition. Singapore Med J 2016; 57:97.
nerve palsies. Each time, Prof Chia tongue. He had already made up his 4. Chia BL. 15th Sukaman Memorial Lecture: ST
overcame the issue and returned mind that there would be no heroic Segment Elevation: New Electrocardiographic
to teaching in the department. To surgery or measures this time. He said Insights in 2014. ASEAN Heart J 2016; 24:6.
eCollection 2016 Oct.
overcome his diplopia, which stopped that his heart was at peace and he slept
him from driving, Prof Chia taught 5. Chia BL, Yip JW, Tan HC, Lim YT. Usefulness of ST
well at night, unlike 35 years before.
elevation II/III ratio and ST deviation in lead I for
himself to adjust his glasses with a Tributes from friends, past students identifying the culprit artery in inferior wall acute
series of stick-on prisms to correct his and patients arrived from as far as Brazil myocardial infarction. Am J Cardiol 2000; 86:341-3.
16 FEB 2018 SMA NewsCALENDAR
SMA EVENTS
MAR–JUN 2018
CME
DATE EVENT VENUE WHO SHOULD ATTEND? CONTACT
POINTS
CME Activities
18 Mar Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
20 Mar Novotel Singapore on Family Medicine and All Margaret 6223 1264
Mastering Adverse Outcomes 2
Tue Stevens Specialities margaret@sma.org.sg
31 Mar SMA Seminar: Tax Obligations Doctors, Clinic owners and Jasmine 6223 1264
M Hotel Singapore 2
Sat on Medical Practice Clinic assistants jasminesoo@sma.org.sg
7 Apr Achieving Safer and Novotel Singapore Family Medicine and All Margaret 6223 1264
2
Sat Reliable Practice Clarke Quay Specialities margaret@sma.org.sg
7 Apr Health Promotion Doctors and Healthcare Jasmine 6223 1264
Telemedicine Seminar 2
Sat Board, Auditorium Professionals jasminesoo@sma.org.sg
11 Apr Mastering Difficult Interactions Novotel Singapore Family Medicine and All Margaret 6223 1264
2
Wed with Patients Clarke Quay Specialities margaret@sma.org.sg
A Medico-Legal Seminar on
Doctors (GPs, Neurologists,
14 Apr Mental Capacity Assessment Health Promotion Jasmine 6223 1264
4 Paediatricians and
Sat – Caring for Persons Lacking Board, Auditorium jasminesoo@sma.org.sg
Psychiatrists)
Mental Capacity
14 Apr Novotel Singapore Family Medicine and All Margaret 6223 1264
Mastering Your Risk 2
Sat Clarke Quay Specialities margaret@sma.org.sg
22 Apr Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
24 Apr Mastering Difficult Interactions Novotel Singapore Family Medicine and All Margaret 6223 1264
2
Tue with Patients Clarke Quay Specialities margaret@sma.org.sg
28 Apr SMA CMEP Health Law Seminar Doctors and Healthcare Jasmine 6223 1264
Academia 2
Sat (Basic) Professionals jasminesoo@sma.org.sg
3 May Novotel Singapore on Family Medicine and All Margaret 6223 1264
Mastering Adverse Outcomes 2
Thu Stevens Specialities margaret@sma.org.sg
5 May SMA CMEP Health Law Seminar Doctors and Healthcare Jasmine 6223 1264
Academia 2
Sat (Intermediate) Professionals jasminesoo@sma.org.sg
16 May Novotel Singapore on Family Medicine and All Margaret 6223 1264
Mastering Your Risk 2
Wed Stevens Specialities margaret@sma.org.sg
20 May Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
Non-CME Activities
15 Apr 58th SMA Annual Sze Yong 6223 1264
Alumni Auditorium NA SMA Members
Sun General Meeting szeyong@sma.org.sg
12 May Mellissa 6223 1264
SMA Annual Dinner 2018 Regent Hotel NA SMA Members and Guests
Sat mellissa@sma.org.sg
27 Jun SMA Annual Golf Tournament Azliena 6223 1264
Raffles Country Club NA SMA Members and Guests
Wed 2018 liena@sma.org.sg
FEB 2018 SMA News 17REFLECTIONS
PARKING
Text by Dr Teo Boon See
Some time back, I attended a three-day toilet emergency. Evidently he was not, an old man in a wheelchair wanted to
course for doctors organised by SMA. as he settled down at his table instead. disembark. I witnessed the young bus
Most of the doctors at the course were After a few minutes, I approached him driver, who was in his twenties, stop the
young trainee doctors. I, as a senior at his table hoping to get to know him bus, manually unfold a ramp and wheel
family physician, was probably the better. We exchanged pleasantries and the old man off the bus.
oldest doctor there. I found out he was a young registrar
in one of the restructured hospitals, Returning to the bus, the driver then
The course was conducted in a saw an umbrella left behind, where the
and that he was “exiting” soon.
hotel ballroom. Next to this ballroom old man’s wheelchair had been. He left
Throughout this conversation, I did
was a car park. There was a parking lot the bus again, running after the old
not get any sense of awkwardness or
for the disabled right in front of the man to return the umbrella.
embarrassment from him.
entrance to the ballroom. The car park
was too small, but nonetheless, people After I left him, I was deeply The entire time, all our fellow
respected the handicapped logo and perturbed and I prayed for wisdom to passengers waited patiently. When the
avoided the lot – at least for the first handle this matter. In the end, I felt led bus driver finally returned to the bus
two days. to move my car and to offer him my a few minutes later, my friend and I
lot instead. He was now having coffee applauded and cheered him for doing
On the final day of the course, I with a colleague. I interrupted them what I thought was an exceptional
arrived early, and witnessed a luxury car and urged him to move his car to my gesture.
parking into that very lot. Out of the car now-empty lot to vacate the disabled
strode a young man carrying the course And so, within the span of a week, I
lot. He acknowledged my offer without
file – clearly a young medical colleague. witnessed two young men’s behaviour
gratitude. He continued to chat with
towards the disabled. I felt grieved
I asked the young doctor if he his colleague and finally moved his car
that of all the people who could have
knew that the lot was reserved for the after he had finished his coffee.
caused the offence, it came from one of
disabled. He was taken aback and asked If you are wondering which course our own.
me what that meant. I clarified that it this was, it was the SMA Ethics Course!
was a lot reserved for the disabled and This course has been made compulsory Surely, we can do better!
he should not park his car there. He for advanced specialist training (AST)
replied that he did not think anyone and family medicine (FM) trainees as part
else would need it and walked off of their training. What an irony it was.
toward the ballroom. Just a few days prior to the course, I
Dr Teo is a family
physician in
I was upset, but I reserved was in Tokyo with a friend and we took private practice.
judgement in case he was having a a ride on a public bus. At one bus stop,
18 FEB 2018 SMA NewsEconomics Can
OPINION
Never Replace
Morals and Values
Text by Dr Wong Chiang Yin
healthcare establishments, healthcare
professionals, and insurance and managed Dr Wong is a public
This is the original letter that the author
health specialist. He has
submitted to the Straits Times and the care companies, among others. been in the SMA Council
edited version was published on 25 In the last ten years without the SMA for more than 20 years
January 2018 in the Straits Times Forum. and was the President
GOF, things have been “running amok”.
of SMA from 2006 to
This cannot be good for stakeholders 2009. His professional
and Singapore. interests include hospital
I was the President of the SMA in 2007
administration, health
when the Association had to withdraw There are limits to economic theory, policy and regulation.
its Guideline on Fees (GOF) so as not to free market or otherwise, especially when He has been around
contravene the Competition Act. We did so applied to healthcare. Prominent American long enough to know
most reluctantly and amid much anguish. health economist Victor Fuchs eloquently that very bad things can
happen in healthcare as a
Dr Yik Keng Yeong’s letter dated 23 described the limits of applying economic
result of good intentions.
January 2018 to this Forum [the Straits theory to healthcare: “The questions are
Times] questioned why doctors’ fees ultimately ones of value: What value do
should be put under the spotlight of we put on saving a life? On reducing pain?
the Ministry of Health’s Fee Benchmarks On relieving anxiety? … economics is
Advisory Committee, and wondered if the science of the means, not of ends…
this would undermine competitive forces it can tell us the consequences of various
and the free market economy. alternatives, but it cannot make the
The defining characteristics of choices for us. These limitations will be
an honourable profession include: a with us always, for economics can never
group of people who have undergone replace morals or values.”
extensive education and training and A certain set of misguided values and
hence possesses special knowledge beliefs was in play when the SMA GOF was
and skills, and is recognised as such by outlawed in 2007, resulting in the miasma
the public; a profession that adheres of the last ten years. The current initiative
to ethical standards and applies this to have fee guidelines and benchmarks is
knowledge and skills in the interest but a return to the correct trajectory which
of others. The medical profession has
we had enjoyed before.
all these defining characteristics and
therefore, should not live by the bread
of economics alone, lest the profession
becomes a trade.
Competition and the free market
are but means to an end. They are not
ends in themselves. The ultimate end
of any public policy is not adherence to
the dogma of market fundamentalism
but, based on experience and evidence,
the creation of greater societal well-
being over the long-term, such that all
stakeholders can co-exist in a sustainable
way. The stakeholders here being patients,
FEB 2018 SMA News 19Treating Loved Ones
SMA CMEP – medical practice
and Yourself :
When to Step Aside
Text by Dr Neeta Satku
Almost every doctor has a story about What are the risks? and mindful of the ethical and legal
how the course of a loved one’s illness implications of such prescriptions.
Although it is common for doctors to
has influenced the direction of their Perhaps the most obvious problem
treat, and even operate on, those close
career, often in the hope of being able with treating close friends or family
to them,4 this sometimes takes place
to one day change the outcome of their is the loss of professional objectivity,
without a full understanding of the
disease. When we finally find ourselves which may compromise even the most
risks involved.
in a position to use our expertise for the experienced doctor’s clinical acumen.
benefit of those closest to us, we must The first hurdle encountered is A doctor may, understandably, be
consider the possibility that we may not information gathering. The doctor may reluctant to consider an alarming
be the best person for the job. assume that he already knows a friend’s diagnosis in a loved one, or conversely
or family member’s history based on may be so anxious and emotionally
What does SMC advise? their social interactions, or may be invested that he/she over-investigates
uncomfortable asking them sensitive a minor symptom. Doctors may also be
The Singapore Medical Council (SMC) tempted to rely more on intuition than
Ethical Code and Ethical Guidelines questions. Similarly, patients may not be
comfortable disclosing intimate medical evidence when treating those close to
(ECEG) states that doctors may not treat them, and may find it difficult to allocate
people close to them for psychiatric information to a friend or relative, in
particular one who is in frequent contact limited resources impartially.
issues, or when it involves the
prescription of controlled or potentially with the rest of their social circle, such This is a controversial and frustrating
addictive substances. that a breach of confidentiality might issue, because doctors often believe
have disastrous social implications. strongly that they are in the best
The ECEG goes on to say that doctors The physical examination may also position to treat those they care about.
may provide those close to them with be incomplete due to sheer mutual They may feel personally responsible
“routine continued care for stable embarrassment. for the safety of their loved ones,
conditions, minor conditions, or in an particularly because they are acutely
urgent/emergency situation”.1 Doctors Some of these “consultations” take aware of the imperfections of the
are then cautioned that if they choose place informally at social events – which healthcare system. The problem is that
to provide further care, they should may seem convenient, but be warned one is often not aware of the extent to
guard against allowing the nature of that history-taking and examination which one’s judgement is compromised
their relationship with the patient to are unlikely to be complete because of in such situations.
compromise the quality of treatment.1 the lack of time and privacy. There may The relationship between the doctor
Several other medical organisations, such be no documentation of the clinical and a close friend or relative can also
as the American Medical Association and findings, which compromises follow- be coercive. For instance, a child may
the General Medical Council, advise much up care. Doctors should be extremely feel unable to question a physician
more strongly against treating one’s close cautious about suggesting or prescribing parent’s recommendations or to voice
friends or family.2,3 treatment based on these encounters, his/her distress.
20 FEB 2018 SMA NewsYou can also read
