Tuesday, April 26, 2005

Letting go

I wonder how many mothers out there are really prepared for their child's first romance...

My first born is taking another step towards adulthood. I just found out that he is the "apple" of someone's eyes in school, and has been the recipient of "sweet" messages from this certain someone.

I have to say that I did not expect the wrench of my heartstrings when I discovered this new development. It hit my gut like a punch. I am not ready to let go of my "baby", and for him to be the object of someone's puppy love. I admit that I am jealously guarding him (probably in futility) from female advances of the romantic kind.

At the same time, I don't want to hinder his emotional and social growth so that he would become one of those men who are unable to hold a decent conversation with a girl without breaking into a sweat or stuttering.

This motherhood thing is gut-wrenching!!!

Sunday, April 24, 2005

Check your Breasts!!!

Had my yearly mammogram done yesterday - this is the 2nd one I've done. It's scary, when the radiographer says that she has to do 2 additional views. Paranoid thoughts race thru your mind, wondering "Did the radiologist pick something up?" This is made worse when you are 'invited' to the ultrasound room for a supplementary scan to be done.

Just as scary is when you are waiting to pick up the results. After what seems like an eternity, the clerk calls your name and hands you the big envelope. With racing heart and shaky hands, you open it and search almost frantically for the report. You breathe a sigh of great relief as you read the Conclusion: No evidence of malignancy. Spirits lift again, as a great burden seems to come off your chest (no pun intended).

I wonder if it's just as scary or even more so for non-medical people.

Ladies, check your breasts monthly, and if you're over 40, do routine mammos yearly scary though they may be...it could save your life.

Tuesday, April 19, 2005

Grow up!

I wonder when Singapore will grow up. I hear the arguments put forth by anti-casino groups and to me, it all sounds very self-righteous.

It's time to treat our fellow Singaporeans as adults who should have free choice on whether or not they want to step foot in the casinos. Don't impose your own morals and religious values on others. Stop asking the government to make the decisions for us. It's time to grow up and make our own decisions whether it involves watching a movie uncensored or engaging in occasional gambling for recreation.

Evidence-based Medicine or Medicine-based Evidence?


The term “evidence-based medicine” has been much bandied about for the last decade or so. It has been used globally as the “in” way of practicing medicine.

As far as the scientific process is concerned, EBM seems to make the most sense in terms of giving the patients the best available treatment to treat their respective medical problems. In layperson’s language, we doctors are using proven methods of treatment.

However, Medicine is not purely a science – many would agree with me that it is also an art. One hopes that with the use of EBM, physicians will not lose that extra touch of compassion that should come with healing the sick. Patients are not just subjects of scientific studies. They are human beings first, who happen to be sick.

Speaking from experience as a physician, a patient and now a pencil pusher, I notice that the art of communication between doctor and patient has been lost. I hear of many complaints arising from either a lack of communication, miscommunication, or insensitivity in communication between the doctor and his/her patients. Have we become so evidence-based that we now lack the human touch when it comes to dealing with our fellow Man? Is the process of keeping the patient and his family involved in managing their own health so difficult, or has it just become a low priority in the busy doctors’ schedules?

Perhaps the “touchy-feely” aspects of medicine is not emphasized enough in medical school. Communication, compassion, and empathy are all important parts of the doctor-patient relationship. Oftentimes, harried doctors, jaded by their experience with upset patients & family members neglect to develop these “softer” skills of being a healer. Hard as it may be, it is time to take a step back and consider practicing “medicine-based evidence” (to coin a phrase that I recently picked up while attending a very enlightening seminar) in concurrence with evidence-based medicine.

Instead of referring to a patient as a bed number (“Bed 12 needs a urine culture done.”) or a diagnosis (“The Ca Liver needs a LFT done today”), we should refer to them by their names and remember that they are first and foremost, someone’s mother/father/daughter/son. We should also remember that doctors are first and foremost, human beings. Somewhere along the way to attaining a medical degree and becoming a doctor, perhaps because we have focused so much on the evidence-based Science of Medicine, many of us have forgotten or lost the Art of the Practice of Medicine.

I hope that the Faculty members in NUS will consider including an extra module in the medical curriculum to “teach” and show budding doctors the importance of the softer and more human side of Medicine.

Friday, April 15, 2005


Working in the civil service the last 6 months has been an eye-opener for me, not just in terms of learning about the workings of local politics, but also of realising how utopian my own view of - "the way things should be" - is.

It amuses me that looking out from the inside, people are actually very fearful of the government (although it shouldn't surprise me <>). Literally. You say jump & they jump.

Another thing that I've realised (and here , I admit that I have been rather naive) is how powerful "The Government" is. Example: I attended a meeting today where there was discussion over how to manage a potential national problem. The meeting was attended by consultants, heads of department, very respectable & knowledgeable people in their fields. And yet, they raised the issue that without support & "recommendations" from the government, their suggestions on how to handle this problem would be moot as the administrators would rather look at the bottom line! Amazing.

My view of medicine is : if it's right, do it. However, when you are within the political system, this view has to change to: if it's right, do it in a politically correct way, although it may mean do it differently. Confounding to me, but I guess I have to live with the system & lower my ideals.

Saturday, April 09, 2005

It's About Time, People

In today's newspaper, a reader wrote in to add his view to the recent discussion about withdrawing treatment or life support in extremely ill patients. He wrote that doctors should not think themselves as God in making this decision. Another reader, an ICU specialist, wrote in, coming from the other side of the coin, explaining that doctors have to communicate with their patients and their families, giving complete and clear information to them in order for them, ESPECIALLY the patient, to make their own decision. He also emphasised the importance of the Advanced Medical Directive as many times, patients who are critically ill & have not signed this directive, are unable to voice their wishes, resulting in much distress to their families & themselves, as well as a huge financial burden.

In response to the first reader's view that doctors think themselves as God, I feel that he has erred in his thinking. Doctors don't think themselves as God; patients think of doctors as Gods and allow them to make the decisions for them. Majority of patients don't question the medical management given to them - they just accept it as "if you say so, it must be OK." It is time that patients empower themselves with the knowledge that is so readily available now, especially with the powerful Internet search engines. They should start researching for information about their own health. It's time to stop being lazy and to stop accepting your doctor's word as the Bible (a good doctor wouldn't mind - in fact, it would help that you understand in some detail what is actually going on).

The second reader is absolutely right about the importance of communication with the patient and his family with regards not only the withdrawal of life support, but also any kind of information that relates to the patient's condition and treatment. Sad to say, the skill of communication is lacking and not addressed in medical school. I say it's time to review the curriculum, and add on a module on "How to Communicate" in medical school - maybe use some of that 200 million dollars that was just donated to the medical faculty to start such a program.

In addition to communication, trained counsellors or psychologists would also be helpful adjuncts to dealing with families whose loved one is terminally/critically ill. Often, the families are trying to deal with their grief and their loss, and one reaction is to try to find someone to blame for "causing" their beloved to die.

Unfortunately, I see many such cases in my line of work, where a combination of poor communication, and the loss of a relative leads to much unhappiness with the medical care given (despite this care having been appropriate).

It's about time for a paradigm shift in the way we practice medicine and in the way we "receive" medicine.

Wednesday, April 06, 2005

The Suspense is killing me

Man, I hate not knowing...are we moving? Are we staying?

I like to plan ahead. I don't like last minute surprises - stresses me out.


Sunday, April 03, 2005

This Painfully Wonderful & Perilous Journey Called Motherhood

My son fell and bumped his shin & scraped his knees yesterday. I saw it happening but was too far away to stop it from happening. It was a hard fall and I know it must have hurt tremendously, especially on the shin judging from the large hematoma that formed very quickly, but my 11-year-old "I am not a baby" son was too brave to cry though I could see that he was trying very hard to hold the tears in.

I could feel a tugging in my heart as this event occurred and even after it had occurred - almost as if I was the one who had been injured. I wouldn't call it a physical pain, but it was definitely not a comfortable feeling. I think all mothers feel this "pain" when they see their children physically or psychologically hurt. It comes with the territory of being a parent. Whoever said "This hurts me more that it does you" while punishing his child was right. This bond between parent (I think it is more pronounced for moms!) and child is a strong one and will never break whether the child is still a child or has become an adult with his/her own famiily.

Saturday, April 02, 2005

Bali…Island of the Gods

My family visited Bali for the 3rd time last week. It is truly a great place to go to chill out and basically do nothing if you are so inclined. Alternatively, there are a variety of sights (eg.Gunung Batur, Tanah Lot), cultural activities (Indonesian dance & musical performances like gamelan) and artsy areas (i.e. Ubud - overrated & overly commercialised, in my opinion...need to find a local to look for more reasonable prices) to visit. Shopping, for Singaporeans of course, is a no-brainer.

We stayed on Nusa Dua - a nice beach but rather touristy with numerous beach touts selling their wares and assorted water sport related services. The sea was not terribly clean (plastic bags floating around) but had an abundance of sea life which made exploring the rock pools at low tide a great adventure. My younger son and I spent a wonderful time doing just that, discovering live coral, starfish, crabs, seashells and the occasional dead fish (paranoid kid that he is, he said, "A tsunami is coming!") It was one of those snapshot moments which hopefully in the years to come, will be something he will look back on fondly as quality time spent with Mom.

I still remember the vacations I used to spend with my family as a kid in a beachfront bungalow in Port Dickson, Malaysia, with a number of cousins, aunties, uncles and grandparents. We frolicked (<-- ha! Always wanted to use this word!) in the sand, played water games, explored the tiny "caves" which were exposed at low tide, looked for fish (only found mudskippers) in the rock pools and literally spent every waking hour in our swim suits. Of course, we all got terribly sunburnt (those were the days before sunscreen) but that never deterred us kids. Indeed, those memories are one of the precious ones which I will never let go.