I want to give this writer a standing ovation.
Patients and doctors must be loyal to each other
I REFER to the letter, 'Fees aside, pick the right hospital and doctor' by Ms Virginia Goh Min Wen and Dr Victor Teoh (ST, Sept 22).
It is obviously prudent in matters of health, to choose a hospital not based on the cost of treatment but the clinical outcome or effectiveness of therapy.
At the same time, it is not only the skills of the specialist or the quality of the equipment in a hospital that determines good clinical outcome.
Most of all, a patient needs a doctor who will act continually in his best interest.
Patients need doctors who are loyal and place their welfare as their first consideration, even at times at the expense of subjugation of the doctor's personal interest.
Patients, like all humans, have multiple and often varying interests.
Doctors, like all professionals, have multiple interests and commitments.
Some personal interests of doctors which may come into conflict with their professional obligation and thus the patient's welfare and interests include accumulation of wealth, fame, academic position or rank, or even the promotion of scientific innovation.
In today's medical-commercial complex, doctors can inadvertently be drawn to promote the interests of the pharmaceutical industry, companies that produce medical devices and equipment, insurance companies and even hospital bottom lines.
When conflicts of interest arise, there may be, in extreme cases, neglect of professional duties but more often a compromise of the independence of clinical judgment.
In a medical encounter, it is not only the knowledge and skills of the doctor that are important in the clinical outcome but also the independence and quality of the clinical judgment.
The judgment may be tainted so as not to serve the patient's best interest.
The clinical judgment can be compared to the plan and strategy of the diagnosis and therapy.
Thus, even with careful and expert execution, an inappropriate plan and strategy will not lead to a good outcome.
In addition, it is important for patients and the public to know that in the rapidly changing knowledge and technology of modern medicine, medical uncertainties are a common feature of medical practice.
New therapies and technology may not be fully validated.
Protocols of therapy continue to change and many areas of disease and treatment are still unknown.
Every patient brings his own special features to the illness and therapy.
There are large grey areas in medicine where the doctor must exercise clinical judgment.
Independent and good clinical judgment, based on scientific facts, clinical skills and experience and based on the particular patient's context, needs to exercised to serve the best interest of the patient.
To act in the best interest of his patient, the doctor must not only be up to date in his knowledge and skills on the diagnosis and various treatment options, but must also have a good knowledge of his patient and his interests.
Equally important, the doctor must have knowledge of himself and his motivation.
Unfortunately, in the hospital setting when a patient seeks a specialist consultation, the clinical encounter is transient and between strangers.
Many times, patients hardly remember the name of the specialist they consult, let alone the medical information exchanged.
The specialist who sees several patients a day remembers them as diagnostic labels in medical notes.
Specialisation in medicine no doubt increases expertise and more proficient practice.
At the same time, it runs the risk of compartmentalising the patient to organs and waters down the quality of the doctor-patient relationship.
For patients to benefit from a good clinical outcome, optimally utilising medical facilities at affordable cost, a collaborative effort is required between the generalist family physician who knows the patient well and the specialist who has the special skills to carry out the treatment.
It is not always easy for anyone, let alone the patient, to judge whether his doctor is acting in his best interest and welfare.
However, some professional behaviours are surrogate markers to show the doctor is acting in the patient's best interest.
A doctor who spends time and effort giving medical information and options to empower the patient to participate effectively in medical decision making, tells of his concern for the patient's interest.
A doctor who acts in the best interest of his patients not only keeps up to date with his skills and knowledge, but also fills in any gaps by not hesitating to consult his colleagues and getting a second opinion.
One's medical colleagues often have a better insight of their another's clinical competence and patient-centeredness of practice.
Thus the value of a medical referral to a specialist by the family physician.
Unfortunately, in today's society, the climate for and culture of having a regular primary or family physician is not strong.
For patients and their families to run around by themselves seeking the right hospital, right doctor and right specialist for the patient's illness is a common phenomenon locally termed 'hospital (or doctor) hopping'.
Information from books and the Internet leaves many gaps.
Hospital and doctor hopping is nearly always detrimental to the patient's welfare, whether in acute illness or chronic disease care.
It also erodes loyalty and continuity of care.
Nor is it cost-efficient.
The simple formula in choosing the right doctor for the patient, for a good clinical outcome at affordable cost, is for patients and doctors to be loyal to each other and communicate effectively.
The challenge for policymakers and the medical leadership is to build a climate, culture and system which will ensure and promote this loyalty and communication.
Dr T. Thirumoorthy
Tuesday, September 26, 2006
Duh Moments
Duh Moment #1
Patient needs PAP Smear done. I tell her to undress & lie on couch while I prepare the equipment. I return to the examination couch & notices that she still has her underwear on.
Me: "Er...you need to remove your underwear in order for me to do the PAP Smear."
Patient: "Oh, is it? I need to remove my underwear?"
Me: "Er...yeah" (Inner Me: "Duh")
Duh Moment #2
Patient complains of headache. After taking history, I tell her I am going to check her blood pressure.
Patient: "Do you want me to take off my watch?"
Me: "Er...no." (Inner Me:"Duh")
Patient needs PAP Smear done. I tell her to undress & lie on couch while I prepare the equipment. I return to the examination couch & notices that she still has her underwear on.
Me: "Er...you need to remove your underwear in order for me to do the PAP Smear."
Patient: "Oh, is it? I need to remove my underwear?"
Me: "Er...yeah" (Inner Me: "Duh")
Duh Moment #2
Patient complains of headache. After taking history, I tell her I am going to check her blood pressure.
Patient: "Do you want me to take off my watch?"
Me: "Er...no." (Inner Me:"Duh")
Saturday, September 23, 2006
Heroes
I stumbled upon this new series called Heroes starting in the US on NBC Sept 25 while I was perusing my son's latest installment of Civil War (a new Marvel comic series) - OK, OK, I admit it, I still read comics...
Anyway, take a look at the trailer. I think it's going to be a hit & will especially appeal to superhero/comic/scifi/fantasy fans & geeks (like me!). We need a bit of fantasy & optimism especially when we are bombarded daily by news of bombs & terrorists & coups & wars.
Let's hope Mediacorp brings it in.
Anyway, take a look at the trailer. I think it's going to be a hit & will especially appeal to superhero/comic/scifi/fantasy fans & geeks (like me!). We need a bit of fantasy & optimism especially when we are bombarded daily by news of bombs & terrorists & coups & wars.
Let's hope Mediacorp brings it in.
A Xanax Moment
I think I need some Xanax.
Why? Well, we’ve just found out that we will be moving to China.
Oh, don’t get me wrong, I am actually feeling very excited about this new adventure. But I’ve some trepidation about the transition. Been getting tension headaches the last couple of weeks while awaiting final news (which we received this past week) on this.
Things like the kids’ schooling: how they will adapt, whether there will be continuity in what they are studying here & what they will be studying there, the timing of the transfer - should we let them finish off the school year (which ends middle of next year) before moving them over (but then this would involve some logistical acrobatics as A’s new position starts next month) or transfer them in the middle of the school year (i.e. Dec!!!) so that the whole family stays together.
Things like what to do with our home: Sell? Or rent?
Our (very old & large) dog with a few health problems – a heartbreaking decision will have to be made here.
I think I had a mild anxiety attack last night while thinking about all this - slight chest tightness with a sensation that I couldn’t quite inhale completely. It lasted only a few seconds.
A. doesn’t understand why I get all angst-y (that word again!). I guess that’s the “Men are from Mars, Women are from Venus” thing going on. We women tend to think things through to the bone, gnawing over every small detail ESPECIALLY anything involving our children & their well-being. Guys? They just breeze through, with the attitude that they can conquer any obstacles in their way as long as our immediate needs (Food & Shelter) are taken care of.
Breathe, aliendoc, breathe…
Why? Well, we’ve just found out that we will be moving to China.
Oh, don’t get me wrong, I am actually feeling very excited about this new adventure. But I’ve some trepidation about the transition. Been getting tension headaches the last couple of weeks while awaiting final news (which we received this past week) on this.
Things like the kids’ schooling: how they will adapt, whether there will be continuity in what they are studying here & what they will be studying there, the timing of the transfer - should we let them finish off the school year (which ends middle of next year) before moving them over (but then this would involve some logistical acrobatics as A’s new position starts next month) or transfer them in the middle of the school year (i.e. Dec!!!) so that the whole family stays together.
Things like what to do with our home: Sell? Or rent?
Our (very old & large) dog with a few health problems – a heartbreaking decision will have to be made here.
I think I had a mild anxiety attack last night while thinking about all this - slight chest tightness with a sensation that I couldn’t quite inhale completely. It lasted only a few seconds.
A. doesn’t understand why I get all angst-y (that word again!). I guess that’s the “Men are from Mars, Women are from Venus” thing going on. We women tend to think things through to the bone, gnawing over every small detail ESPECIALLY anything involving our children & their well-being. Guys? They just breeze through, with the attitude that they can conquer any obstacles in their way as long as our immediate needs (Food & Shelter) are taken care of.
Breathe, aliendoc, breathe…
Saturday, September 16, 2006
Friday, September 15, 2006
No Survivor?
Hmmm.
This is an interesting development.
Survivor 13 : Cook Islands started today in the US. And I notice Mediacorp hasn't got it on its TV schedule. Somewhat strange seeing that every single season of Survivor has been broadcast on the same day as the US so far.
Could it be the fact that a racial theme has been used to divide up the teams? Is Mediacorp afraid that Singaporeans won't be able to take it? Will our sensibilities be SOOOO affected by this racial divide? Are our values & morals so weak that they are afraid that this multiracial harmony in which we exist will be destroyed by this TV program?
I wait with bated breath to find out...
This is an interesting development.
Survivor 13 : Cook Islands started today in the US. And I notice Mediacorp hasn't got it on its TV schedule. Somewhat strange seeing that every single season of Survivor has been broadcast on the same day as the US so far.
Could it be the fact that a racial theme has been used to divide up the teams? Is Mediacorp afraid that Singaporeans won't be able to take it? Will our sensibilities be SOOOO affected by this racial divide? Are our values & morals so weak that they are afraid that this multiracial harmony in which we exist will be destroyed by this TV program?
I wait with bated breath to find out...
Letters to the Forum
Why do people write letters like this to the newspaper?
"No lunch served on SIA's flight from S'pore to Shanghai
I recently took SQ826 flight to Shanghai, departing Singapore at 8am and arriving at Shanghai at 1.30pm. I was very disappointed that no lunch was served on board. Food was served at about 9am to 10am, which was called brunch. It was breakfast to me.
When I asked about lunch, I was told that only one meal was served on that flight. I pointed out that the flight only landed at 1.30pm, so the one meal in the morning was not sufficient to fill our stomach. I was feeling hungry then, but the stewardess could only offer me cup noodles, peanuts or biscuits.
I was disappointed that not even light snacks were served during lunch time. Other airlines normally provide main meals and light snacks on board. SIA's management should ensure that passengers are served sufficient meals on board.
Tan Saw Bin (Ms)"
This lady could very well have written to SIA directly to voice her complaint and give her suggestions. I find it hard to understand the mentality of such people. It's the same with medical-related complaint letters. Instead of going straight to the hospital or clinic with their issues, patients or their kin write to the newspaper.
And it looks like this letter is going to open another can of worms...
"Don't salvage lives that will weigh on family
THE article, 'Parents of the disabled have a long list of woes'' (ST, Sept 13), serves as a launching pad for me to write to ST Forum on a topic I have felt very strongly about for a long time.
Of the long list of woes, one dominates that of all elderly parents: 'Who will look after my child after I pass on?' Many parents have expressed this concern to me.
In other cases, I have reminded younger parents to cease their globe-trotting in search of a miracle cure and set aside funds to provide for their disabled child while not neglecting their other children.
For those who can afford it, I advise them about setting up a trust fund. But many do not have enough money to provide for their disabled offspring for as long as the patient will live.
I understand the parents' pain and burden because I see it so often. It is one of the reasons I have written to ST Forum more than once about not salvaging lives that will be a burden to their family and society.
My conviction was further strengthened last Tuesday when a patient in his 50s, who I have seen for more than 15 years, came for his annual check-up with his sister.
Surprised, I asked what happened to the father who was the one who brought the patient every time.
'He passed away' was the sister's answer.
'But he looked in good health when I saw him last year.'
'Actually, he jumped and killed himself. He meant to take my brother with him but could not do so.'
I was greatly saddened. The father had asked me for help to find a nursing home for his son two years ago. I gave him a list and he phoned each of them, promising to will everything to the home which would promise to look after his son.
He had a landed property which he lived in, but that too would be willed to the home when he died.
Last year, he told me sadly that all the homes wanted money upfront and turned him down.
As medicine advances, more and more brain-damaged patients will be salvaged. We doctors are playing God all the time though we pretend we should not.
We are trapped between the old days when many of these disabled patients would die because medicine could do no better, and a rational era (which may never come) where doctors and families can come to a rational decision that 'enough is enough'.
As a First World country where millions of dollars are being poured into making us a cultured and vibrant society, could a few million dollars be spared to build nursing homes for disabled patients whose parents are getting too old to look after them any longer?
Dr Lee Wei Ling "
Our esteemed colleague had previously written into the papers with her views on the surgery performed on the Nepalese twins, one of whom apparently is not doing well, requiring full-time care from her family. I suspect this letter will also trigger off a spew of responses.
I can't say that I disagree with her views entirely, especially where it comes to building nursing homes for disabled patients or at least, some kind of daycare or support facilities to help care-givers with what must be an extremely difficult situation. I myself have asked the question "Why?" many times when I did my rotation through Neonatology, resuscitating premies, & taking care of severely ill neonates. Many end up vegetative or with terribly compromising health conditions likely leading to lifelong complications which tax not only the wallets of their parents, but are also emotionally draining. But it was not my call to deny or withhold available treatment. When called to resus, you resus.
Perhaps I am cold-hearted, but personally, if I had a child whom I KNEW was going to go through life with a multitude of health problems if we kept him/her alive with all our modern medical means, I would rather let him/her go peacefully instead of having to suffer through a life of questionable quality.
"No lunch served on SIA's flight from S'pore to Shanghai
I recently took SQ826 flight to Shanghai, departing Singapore at 8am and arriving at Shanghai at 1.30pm. I was very disappointed that no lunch was served on board. Food was served at about 9am to 10am, which was called brunch. It was breakfast to me.
When I asked about lunch, I was told that only one meal was served on that flight. I pointed out that the flight only landed at 1.30pm, so the one meal in the morning was not sufficient to fill our stomach. I was feeling hungry then, but the stewardess could only offer me cup noodles, peanuts or biscuits.
I was disappointed that not even light snacks were served during lunch time. Other airlines normally provide main meals and light snacks on board. SIA's management should ensure that passengers are served sufficient meals on board.
Tan Saw Bin (Ms)"
This lady could very well have written to SIA directly to voice her complaint and give her suggestions. I find it hard to understand the mentality of such people. It's the same with medical-related complaint letters. Instead of going straight to the hospital or clinic with their issues, patients or their kin write to the newspaper.
And it looks like this letter is going to open another can of worms...
"Don't salvage lives that will weigh on family
THE article, 'Parents of the disabled have a long list of woes'' (ST, Sept 13), serves as a launching pad for me to write to ST Forum on a topic I have felt very strongly about for a long time.
Of the long list of woes, one dominates that of all elderly parents: 'Who will look after my child after I pass on?' Many parents have expressed this concern to me.
In other cases, I have reminded younger parents to cease their globe-trotting in search of a miracle cure and set aside funds to provide for their disabled child while not neglecting their other children.
For those who can afford it, I advise them about setting up a trust fund. But many do not have enough money to provide for their disabled offspring for as long as the patient will live.
I understand the parents' pain and burden because I see it so often. It is one of the reasons I have written to ST Forum more than once about not salvaging lives that will be a burden to their family and society.
My conviction was further strengthened last Tuesday when a patient in his 50s, who I have seen for more than 15 years, came for his annual check-up with his sister.
Surprised, I asked what happened to the father who was the one who brought the patient every time.
'He passed away' was the sister's answer.
'But he looked in good health when I saw him last year.'
'Actually, he jumped and killed himself. He meant to take my brother with him but could not do so.'
I was greatly saddened. The father had asked me for help to find a nursing home for his son two years ago. I gave him a list and he phoned each of them, promising to will everything to the home which would promise to look after his son.
He had a landed property which he lived in, but that too would be willed to the home when he died.
Last year, he told me sadly that all the homes wanted money upfront and turned him down.
As medicine advances, more and more brain-damaged patients will be salvaged. We doctors are playing God all the time though we pretend we should not.
We are trapped between the old days when many of these disabled patients would die because medicine could do no better, and a rational era (which may never come) where doctors and families can come to a rational decision that 'enough is enough'.
As a First World country where millions of dollars are being poured into making us a cultured and vibrant society, could a few million dollars be spared to build nursing homes for disabled patients whose parents are getting too old to look after them any longer?
Dr Lee Wei Ling "
Our esteemed colleague had previously written into the papers with her views on the surgery performed on the Nepalese twins, one of whom apparently is not doing well, requiring full-time care from her family. I suspect this letter will also trigger off a spew of responses.
I can't say that I disagree with her views entirely, especially where it comes to building nursing homes for disabled patients or at least, some kind of daycare or support facilities to help care-givers with what must be an extremely difficult situation. I myself have asked the question "Why?" many times when I did my rotation through Neonatology, resuscitating premies, & taking care of severely ill neonates. Many end up vegetative or with terribly compromising health conditions likely leading to lifelong complications which tax not only the wallets of their parents, but are also emotionally draining. But it was not my call to deny or withhold available treatment. When called to resus, you resus.
Perhaps I am cold-hearted, but personally, if I had a child whom I KNEW was going to go through life with a multitude of health problems if we kept him/her alive with all our modern medical means, I would rather let him/her go peacefully instead of having to suffer through a life of questionable quality.
Tuesday, September 12, 2006
Singapore Dreaming & the IMF/World Bank meetings
The latest local movie production, Singapore Dreaming, opened last week. One of its producers is fellow doctor, acclaimed plastic surgeon, Woffles Wu. Together with husband & wife team, Colin Goh & Dr Woo Yen Yen, they do a credible job in creating something that shows the heart & soul of Singapore.
It revolves around the lives of an average Chinese-Singaporean family. Dad, Loh Poh Huat, is the typical wannabe, disdainful of HDB dwellers, & counting the days when he strikes Toto & can afford to move into his dream condo & buy his dream car & join an elite country club. Mum is a housewife, content with her duties of keeping house, cooking & brewing ‘liang teh’ (herbal tea) everyday for the family. Oldest child is Mei, a secretary married to an ex-Army regular, C.K., who now struggles to earn a living by selling life insurance. Mei has always struggled for her parents' love & attention, and being born a girl is a great disadvantage in this struggle. Younger offspring is Seng, the precious son, the ne’er-do-good, sent off to the golden land of America to get a degree from an American university so that he can return after graduating to earn a good living & repay the money spent by his father & his long-suffering fiancée, Irene, to support his studies. Or so it is hoped.
A multitude of local social issues are laid bare: our obsession with the 5C’s, our oftentimes hypocritical attitudes towards domestic maids, urinating in lifts, the preferential treatment shown to sons vs daughters. Swipes are taken at the kiasu-ism of Singaporeans, with a mother shown admonishing her kindergarten-aged son rather violently for scoring 95% in a spelling test instead of 100% like his classmate. Dr Woffles Wu even makes a cameo appearance as a family friend paying his condolences at the wake of the ill-fated Loh (“No need to give so much, OK,” he tells his wife softly, as they approach Mei to give her their condolence money, “They won 2 million dollars, you know.”)
It was a raw experience, watching it. So raw that it was almost painful. Although it sometimes seemed that the storytellers were trying to squeeze too many issues into one movie, it was all very real & familiar to me, as a Singaporean. Seeing it all exposed on the big screen made it almost embarrassing to be a Singaporean, although at the end of the story, everyone gets his/her comeuppance.
And what does Singapore Dreaming have to do with the IMF/World Bank meetings? Nothing direct, really (apart from the fact that the movie opened in local theatres just 4 days prior to the start of the meetings – hmmmmm…coincidence? ☺ ). It just made me think of all the aesthetic remodeling & “cosmetic surgery” (all of which would have done Dr Wu proud ☺) that has been taking place in the preceding few months to pretty up this little island of ours. After watching the movie, it became more obvious that we really needed all the surface touch-ups.
It revolves around the lives of an average Chinese-Singaporean family. Dad, Loh Poh Huat, is the typical wannabe, disdainful of HDB dwellers, & counting the days when he strikes Toto & can afford to move into his dream condo & buy his dream car & join an elite country club. Mum is a housewife, content with her duties of keeping house, cooking & brewing ‘liang teh’ (herbal tea) everyday for the family. Oldest child is Mei, a secretary married to an ex-Army regular, C.K., who now struggles to earn a living by selling life insurance. Mei has always struggled for her parents' love & attention, and being born a girl is a great disadvantage in this struggle. Younger offspring is Seng, the precious son, the ne’er-do-good, sent off to the golden land of America to get a degree from an American university so that he can return after graduating to earn a good living & repay the money spent by his father & his long-suffering fiancée, Irene, to support his studies. Or so it is hoped.
A multitude of local social issues are laid bare: our obsession with the 5C’s, our oftentimes hypocritical attitudes towards domestic maids, urinating in lifts, the preferential treatment shown to sons vs daughters. Swipes are taken at the kiasu-ism of Singaporeans, with a mother shown admonishing her kindergarten-aged son rather violently for scoring 95% in a spelling test instead of 100% like his classmate. Dr Woffles Wu even makes a cameo appearance as a family friend paying his condolences at the wake of the ill-fated Loh (“No need to give so much, OK,” he tells his wife softly, as they approach Mei to give her their condolence money, “They won 2 million dollars, you know.”)
It was a raw experience, watching it. So raw that it was almost painful. Although it sometimes seemed that the storytellers were trying to squeeze too many issues into one movie, it was all very real & familiar to me, as a Singaporean. Seeing it all exposed on the big screen made it almost embarrassing to be a Singaporean, although at the end of the story, everyone gets his/her comeuppance.
And what does Singapore Dreaming have to do with the IMF/World Bank meetings? Nothing direct, really (apart from the fact that the movie opened in local theatres just 4 days prior to the start of the meetings – hmmmmm…coincidence? ☺ ). It just made me think of all the aesthetic remodeling & “cosmetic surgery” (all of which would have done Dr Wu proud ☺) that has been taking place in the preceding few months to pretty up this little island of ours. After watching the movie, it became more obvious that we really needed all the surface touch-ups.
Monday, September 11, 2006
9/11
Five years past,
In disbelief I watched,
Mouth agape,
As planes smashed
One after the other
Into the two towers,
Televised “live” on CNN.
Oh my God, oh my God, oh my God.
This can’t be real,
It can’t be happening,
It must be a trick,
A camera trick,
A scene taken from a movie.
Then they fell
Like a stack of cards,
One after the other
Within seconds,
In a rising cloud of dust
That spread throughout Manhattan.
Another plane
Smashed into the Pentagon,
Another one into a field in Pennsylvania
One after the other.
Was that it? Was that it? Are there more?
Please, no more, no more, please.
Oh my God, oh my God, oh my God.
It felt surreal,
My mind numbed
By the thought of all those lives
Snuffed by unimaginable evil.
Terror transmitted halfway across the globe
Through the wonders of technology.
It was real
And yet unreal.
We lost our innocence
That fateful day,
No more trust
In our fellow man.
We have to find our way again,
Someone help us find our way again
Five years ago, on the night (in Singapore) of Sept 11, I watched CNN broadcast "live" as planes smashed into the two towers of the World Trade Center. It was an almost out-of-body experience, as my brain numbed, & my heart screamed "No!!!" in terror & disbelief, while I watched the buildings crumble down into nothingness.
I called A immediately - he was away on a business trip - he would call his mother as soon as we hung up. He had heard the news but had not seen the terror screened on the tube. She lives less than 15 blocks from where it happened. Fortunately, she slept through it (amazingly) as she is a late riser. He told her to keep her windows shut, & not to venture out into the streets due to the uncertainty of the situation. She had a freezer stocked to the brim with food, thankfully.
After that conversation, it became impossible to contact her as the phone exchanges in that area had been affected by the destruction. For three weeks we remained incommunicado, but was fortunate that A's best friend who lived in Brooklyn was able to contact her & let us know that she was OK despite the area being cordoned off.
Although America has recovered outwardly from this assault, scars remain from that fateful day. Although unspoken, suspicion remains of those who are of a particular faith, or who look & dress a certain way. But can one blame them?
My younger son still worries about his dad's plane crashing when A goes on his frequent business trips despite my reassurances that taking the plane is safer than driving a car. Until recently, he always made sure that whenever possible, A & I were accompanied by either him, or his older brother, whenever we went out, so that they could protect us in case we were "attacked" by terrorists. A sweet but illogical sentiment. But can one blame him? We lost our innocence five years ago.
In disbelief I watched,
Mouth agape,
As planes smashed
One after the other
Into the two towers,
Televised “live” on CNN.
Oh my God, oh my God, oh my God.
This can’t be real,
It can’t be happening,
It must be a trick,
A camera trick,
A scene taken from a movie.
Then they fell
Like a stack of cards,
One after the other
Within seconds,
In a rising cloud of dust
That spread throughout Manhattan.
Another plane
Smashed into the Pentagon,
Another one into a field in Pennsylvania
One after the other.
Was that it? Was that it? Are there more?
Please, no more, no more, please.
Oh my God, oh my God, oh my God.
It felt surreal,
My mind numbed
By the thought of all those lives
Snuffed by unimaginable evil.
Terror transmitted halfway across the globe
Through the wonders of technology.
It was real
And yet unreal.
We lost our innocence
That fateful day,
No more trust
In our fellow man.
We have to find our way again,
Someone help us find our way again
Five years ago, on the night (in Singapore) of Sept 11, I watched CNN broadcast "live" as planes smashed into the two towers of the World Trade Center. It was an almost out-of-body experience, as my brain numbed, & my heart screamed "No!!!" in terror & disbelief, while I watched the buildings crumble down into nothingness.
I called A immediately - he was away on a business trip - he would call his mother as soon as we hung up. He had heard the news but had not seen the terror screened on the tube. She lives less than 15 blocks from where it happened. Fortunately, she slept through it (amazingly) as she is a late riser. He told her to keep her windows shut, & not to venture out into the streets due to the uncertainty of the situation. She had a freezer stocked to the brim with food, thankfully.
After that conversation, it became impossible to contact her as the phone exchanges in that area had been affected by the destruction. For three weeks we remained incommunicado, but was fortunate that A's best friend who lived in Brooklyn was able to contact her & let us know that she was OK despite the area being cordoned off.
Although America has recovered outwardly from this assault, scars remain from that fateful day. Although unspoken, suspicion remains of those who are of a particular faith, or who look & dress a certain way. But can one blame them?
My younger son still worries about his dad's plane crashing when A goes on his frequent business trips despite my reassurances that taking the plane is safer than driving a car. Until recently, he always made sure that whenever possible, A & I were accompanied by either him, or his older brother, whenever we went out, so that they could protect us in case we were "attacked" by terrorists. A sweet but illogical sentiment. But can one blame him? We lost our innocence five years ago.
Friday, September 08, 2006
TV Land
RS: Supernova
Final four are Dilana, Toby, Magni & Lukas.
Storm was ousted last week after repeated being in the bottom 3. I guess Supernova has to listen to the fans. She gave a heart-wrenching performance of Pink Floyd's "Wish You Were Here" which brought even Jason Newsted (Bass Guitarist) to tears; but that was not enough to save her.
Toby's original composition, "Throw It Away" won him the encore (and a brand new Honda!) which he dedicated to fellow Aussie, Crocodile Hunter, the late Steve Irwin. His rousing & energetic performance had everyone singing along. A potential chart-topper, it had excellent guitar riffs, brilliantly performed by the House Band's Rafael Moreira.
My faves to win? Either Dilana or Toby. Dilana has had a rough couple of weeks, & her popularity has dropped after her foot-in-mouth debacle with the media. She still gives impressive performances, although her weakness in songwriting may proof to be detrimental. Toby has the looks, talent & charisma to capture fans for Supernova, especially those of the female persuasion! And in an industry driven by popularity & moolah (more fans=more albums sold=more$$$!), this could give him the edge over Dilana.
Entourage
I loved the most recent episode screened this week! Vince Chase (Adrian Grenier), low on funds after committing himself to buying a multimillion dollar house, decides to do an ad for a Red Bull-like product targeted at the Chinese market. Bai Ling guested as the stunt co-ordinator, to teach him martial arts moves for the ad. She ended up teaching him not only kungfu moves, but also techniques totally unrelated to martial arts (ahem!). The episode ended with the final product - the ad itself, dubbed in Mandarin. Absolutely Brilliant!
Final four are Dilana, Toby, Magni & Lukas.
Storm was ousted last week after repeated being in the bottom 3. I guess Supernova has to listen to the fans. She gave a heart-wrenching performance of Pink Floyd's "Wish You Were Here" which brought even Jason Newsted (Bass Guitarist) to tears; but that was not enough to save her.
Toby's original composition, "Throw It Away" won him the encore (and a brand new Honda!) which he dedicated to fellow Aussie, Crocodile Hunter, the late Steve Irwin. His rousing & energetic performance had everyone singing along. A potential chart-topper, it had excellent guitar riffs, brilliantly performed by the House Band's Rafael Moreira.
My faves to win? Either Dilana or Toby. Dilana has had a rough couple of weeks, & her popularity has dropped after her foot-in-mouth debacle with the media. She still gives impressive performances, although her weakness in songwriting may proof to be detrimental. Toby has the looks, talent & charisma to capture fans for Supernova, especially those of the female persuasion! And in an industry driven by popularity & moolah (more fans=more albums sold=more$$$!), this could give him the edge over Dilana.
Entourage
I loved the most recent episode screened this week! Vince Chase (Adrian Grenier), low on funds after committing himself to buying a multimillion dollar house, decides to do an ad for a Red Bull-like product targeted at the Chinese market. Bai Ling guested as the stunt co-ordinator, to teach him martial arts moves for the ad. She ended up teaching him not only kungfu moves, but also techniques totally unrelated to martial arts (ahem!). The episode ended with the final product - the ad itself, dubbed in Mandarin. Absolutely Brilliant!
aliendoc's top 10 peeves about driving in Singapore
I have been driving for almost 25 years, out of which 18 years were on Singapore roads. I have realised that the only time (OK, almost the only time) I cuss & use four letter words is when I am driving in Singapore. Here goes:
#10
Pedestrians who take there own sweet time crossing the road when there is a long line of cars waiting to pass through at a busy intersection (Think: Junction of Orchard & Paterson Roads just outside Wheelock Place).
#9
Waiting at the red light, then seeing the driver in the vehicle next to you picking his nose/ear, inspecting his finds then flicking it out his window.
(EEEWWW!)
#8
Waiting at the red light, then seeing the driver in the vehicle next to you wind down his window & projecting a loogie which misses your car by 3 inches.
(Double EEEWWW!)
#7
Motorcyclists who treat the lane dividers (or any space between two vehicles) as a designated motorbike lane.
#6
Motorcyclists in #7 who travel at a speed of 60 km/h (or less) on the expressway, making it difficult & dangerous for other vehicles to overtake him.
#5
Tailgaters who follow you like their car was magnetized to yours even though you are traveling at the maximum speed allowable.
#4
While waiting at a side road trying to get on to a busy road, you notice cars which don’t indicate that they intend to turn off into the side road, resulting in you missing a precious chance to turn out onto above said busy road.
(!@#%!!)
#3
When you indicate that you are trying to switch lanes, the oncoming car on the lane you are trying to switch to speeds up to block you off instead of slowing down.
(Double !@#%!!)
#2
Taxis which trawl for fares – they either travel at a snail’s pace; or make sudden swerves & stops to catch the passenger.
And aliendoc’s #1 peeve about driving on Singapore roads:
Drivers who allow their babies/toddlers/children to clamber all over the car- in between the front seats, on to the back ledge behind the back seat- or sit on the front passenger’s lap instead of being restrained in a child’s seat or by a seat belt. Don’t they know that their children would make excellent projectiles if they were involved in a collision???
#10
Pedestrians who take there own sweet time crossing the road when there is a long line of cars waiting to pass through at a busy intersection (Think: Junction of Orchard & Paterson Roads just outside Wheelock Place).
#9
Waiting at the red light, then seeing the driver in the vehicle next to you picking his nose/ear, inspecting his finds then flicking it out his window.
(EEEWWW!)
#8
Waiting at the red light, then seeing the driver in the vehicle next to you wind down his window & projecting a loogie which misses your car by 3 inches.
(Double EEEWWW!)
#7
Motorcyclists who treat the lane dividers (or any space between two vehicles) as a designated motorbike lane.
#6
Motorcyclists in #7 who travel at a speed of 60 km/h (or less) on the expressway, making it difficult & dangerous for other vehicles to overtake him.
#5
Tailgaters who follow you like their car was magnetized to yours even though you are traveling at the maximum speed allowable.
#4
While waiting at a side road trying to get on to a busy road, you notice cars which don’t indicate that they intend to turn off into the side road, resulting in you missing a precious chance to turn out onto above said busy road.
(!@#%!!)
#3
When you indicate that you are trying to switch lanes, the oncoming car on the lane you are trying to switch to speeds up to block you off instead of slowing down.
(Double !@#%!!)
#2
Taxis which trawl for fares – they either travel at a snail’s pace; or make sudden swerves & stops to catch the passenger.
And aliendoc’s #1 peeve about driving on Singapore roads:
Drivers who allow their babies/toddlers/children to clamber all over the car- in between the front seats, on to the back ledge behind the back seat- or sit on the front passenger’s lap instead of being restrained in a child’s seat or by a seat belt. Don’t they know that their children would make excellent projectiles if they were involved in a collision???
Thursday, September 07, 2006
Patient Empowerment
I read a very illuminating, and thought-provoking article, "The informed patient" by Dr David Tovey (Editorial Director of the British Medical Journal) in the September issue of the Singapore Medical Journal. He talks about “information therapy”, a term coined by Don Kemper of Healthwise to describe the prescription of knowledge by doctors to their patients to help them make better decisions about health care.
We doctors are so used to being purveyors of medical knowledge, that I am sure that I am not alone in admitting that when I used to encounter a patient armed with reams of information printed out from the Internet, my heart would clench a little with anxiety, and I subconsciously started to build a wall of resistance to this perceived challenge to my so-called authority!
But I have learnt that most of the time, these patients are only trying to empower themselves with knowledge so that they can understand their medical conditions or treatment. Those who are savvy enough to Google for information about their medical problem are usually able to understand that not everything can be believed and are open to a frank discussion on what information is reliable & what is not.
As human beings, we doctors can’t be expected to be all-knowing (we are not superior God-like beings after all, although some may think so - heehee!) of everything that is available on the Internet. There are thousands of bonafide medical studies & papers out there – as well as a kazillion websites full of quack info. I don’t think anyone in their right minds would expect us to read & memorize it all. What we can hope to do is to guide the patients & help them to separate the wheat from the chaff.
Websites* have been set-up from the UK & USA with information targeted at patients, explaining the condition, its treatment etc in language that non-medical persons can understand. Some even have a doctor/hospital finder.
We cannot ignore the fact that the Internet is a vastly used resource by many. I think we have to be ready to expect our patients to seek information therapy in addition to prescriptions from us!
* These are some examples. Some can only be accessed within its own country.
www.cochrane.org
www.webmd.com
www.healthwise.org
www.nhsdirect.nhs.uk/
www.besttreatments.co.uk/btuk/home.jsp
We doctors are so used to being purveyors of medical knowledge, that I am sure that I am not alone in admitting that when I used to encounter a patient armed with reams of information printed out from the Internet, my heart would clench a little with anxiety, and I subconsciously started to build a wall of resistance to this perceived challenge to my so-called authority!
But I have learnt that most of the time, these patients are only trying to empower themselves with knowledge so that they can understand their medical conditions or treatment. Those who are savvy enough to Google for information about their medical problem are usually able to understand that not everything can be believed and are open to a frank discussion on what information is reliable & what is not.
As human beings, we doctors can’t be expected to be all-knowing (we are not superior God-like beings after all, although some may think so - heehee!) of everything that is available on the Internet. There are thousands of bonafide medical studies & papers out there – as well as a kazillion websites full of quack info. I don’t think anyone in their right minds would expect us to read & memorize it all. What we can hope to do is to guide the patients & help them to separate the wheat from the chaff.
Websites* have been set-up from the UK & USA with information targeted at patients, explaining the condition, its treatment etc in language that non-medical persons can understand. Some even have a doctor/hospital finder.
We cannot ignore the fact that the Internet is a vastly used resource by many. I think we have to be ready to expect our patients to seek information therapy in addition to prescriptions from us!
* These are some examples. Some can only be accessed within its own country.
www.cochrane.org
www.webmd.com
www.healthwise.org
www.nhsdirect.nhs.uk/
www.besttreatments.co.uk/btuk/home.jsp
Wednesday, September 06, 2006
Educating the Whole Person
I share Dr Huang's sentiments & hopes on the recent initiatives announced by the MOE.
Educating our young is something I feel very strongly about. My gripe about the local system is the narrowness of its curriculum & its emphasis on getting good grades in tests & exams.
When we moved back here, my older son went directly into Primary 1. He was in the 1st grade in the US system. What a culture shock it was! So unsurprisingly, my son took about a month of tears & stomach aches before he adapted to the local classroom, crowded with 40 boys & one very harrassed teacher!
Coming from a Pennsylvanian suburb, where tuition classes for preschoolers/kindergarteners are unheard of & where the only enrichment "classes" I'd heard of were Kindermuzik & Gymboree, I was flummoxed to see such classes being advertised in newspapers, community centers, etc etc catering to children as young as 3 or 4 years old! As a matter fact, I refused to have my son take Chinese tuition lessons at the tender age of 7, as I expected his school to be able to teach him what he should know. Alas, 6 months into the school year, I received a call from his Chinese teacher asking if he had any supplementary help from a tutor at home. Upon finding out that he had none, she "gently encouraged" me to find one for him. In my heart, I thought that something was very wrong with a system which requires its students to spend additional time OUTSIDE the classroom with external tutors in order to achieve what they are expected to achieve IN school. Time spent outside of school should be reserved for recreation, leisure or relaxation. Or so I thought.
After 5 years of enduring this (during which my second boy started in Pr 1), my husband & I made the decision to transfer them into an international system, where we hoped that our childrens' potential could be explored more fully. Yes, Math & Science are important but are other areas which are similarly important like the Arts & Music. And the standard of English being taught...don't get me started on that!
We didn't want our kids to become automatons churned out at the end of their primary/secondary education, excelling only in passing exams from rote learning, but not daring to/not knowing how to form their own opinions about the world around them.
What a turnaround it has been over the last 3 years! My kids' minds have been challenged to think deeply & to analyse what they are reading instead of wholesale remembering/regurgitating the contents of a text book. In English, they actually read literature books & learn how the authors have used the language to tell a story & express themselves. My older son actually had some problem "re-aligning" his neurons to think this way in the initial few months, as he was so used to just filling in the blanks & choosing answers for multiple choice questions!
In addition to the quality education they receive, they also get to 'hang out' with children of other races & nationalities, an opportunity they would never have been able to get if they had stayed local. This is especially important in a world that is ever growing smaller with globalisation. Despite what they say about greater integration of races in schools with organised events, together with the media hype focussing on the few who actually DO mix with other races, I still notice that in real situations, like still clique with like.
So yes, there has been some sacrifice on our parts, in order for our children to get the education which my hubby & I feel they should get. The formative years are sooo important to how they will turn out as adults.
My hope is that our current Education Minister's visions will be realised (hopefully sooner than later). The incentives & gratuity payouts to the teachers are commendable indeed; what needs to be fixed next is the way that students are taught, & the system that places emphasis on test/exam results. We have to remember that we are shaping a whole being, & not just that area of the brain reserved for memorising texts & formulae.
As the slogan for the United Negro College Fund goes: "The Mind is a Terrible Thing to Waste"
Educating our young is something I feel very strongly about. My gripe about the local system is the narrowness of its curriculum & its emphasis on getting good grades in tests & exams.
When we moved back here, my older son went directly into Primary 1. He was in the 1st grade in the US system. What a culture shock it was! So unsurprisingly, my son took about a month of tears & stomach aches before he adapted to the local classroom, crowded with 40 boys & one very harrassed teacher!
Coming from a Pennsylvanian suburb, where tuition classes for preschoolers/kindergarteners are unheard of & where the only enrichment "classes" I'd heard of were Kindermuzik & Gymboree, I was flummoxed to see such classes being advertised in newspapers, community centers, etc etc catering to children as young as 3 or 4 years old! As a matter fact, I refused to have my son take Chinese tuition lessons at the tender age of 7, as I expected his school to be able to teach him what he should know. Alas, 6 months into the school year, I received a call from his Chinese teacher asking if he had any supplementary help from a tutor at home. Upon finding out that he had none, she "gently encouraged" me to find one for him. In my heart, I thought that something was very wrong with a system which requires its students to spend additional time OUTSIDE the classroom with external tutors in order to achieve what they are expected to achieve IN school. Time spent outside of school should be reserved for recreation, leisure or relaxation. Or so I thought.
After 5 years of enduring this (during which my second boy started in Pr 1), my husband & I made the decision to transfer them into an international system, where we hoped that our childrens' potential could be explored more fully. Yes, Math & Science are important but are other areas which are similarly important like the Arts & Music. And the standard of English being taught...don't get me started on that!
We didn't want our kids to become automatons churned out at the end of their primary/secondary education, excelling only in passing exams from rote learning, but not daring to/not knowing how to form their own opinions about the world around them.
What a turnaround it has been over the last 3 years! My kids' minds have been challenged to think deeply & to analyse what they are reading instead of wholesale remembering/regurgitating the contents of a text book. In English, they actually read literature books & learn how the authors have used the language to tell a story & express themselves. My older son actually had some problem "re-aligning" his neurons to think this way in the initial few months, as he was so used to just filling in the blanks & choosing answers for multiple choice questions!
In addition to the quality education they receive, they also get to 'hang out' with children of other races & nationalities, an opportunity they would never have been able to get if they had stayed local. This is especially important in a world that is ever growing smaller with globalisation. Despite what they say about greater integration of races in schools with organised events, together with the media hype focussing on the few who actually DO mix with other races, I still notice that in real situations, like still clique with like.
So yes, there has been some sacrifice on our parts, in order for our children to get the education which my hubby & I feel they should get. The formative years are sooo important to how they will turn out as adults.
My hope is that our current Education Minister's visions will be realised (hopefully sooner than later). The incentives & gratuity payouts to the teachers are commendable indeed; what needs to be fixed next is the way that students are taught, & the system that places emphasis on test/exam results. We have to remember that we are shaping a whole being, & not just that area of the brain reserved for memorising texts & formulae.
As the slogan for the United Negro College Fund goes: "The Mind is a Terrible Thing to Waste"
Monday, September 04, 2006
Scoring Docs
I came across this webcast from Medscape, from which I receive regular updates on medical news. It reminded me of angrydoc's bonus bogus story.
Here's the transcript, if you are unable to view it (you have to subscribe):
"What Are Patients Looking for?
Posted 08/18/2006
Steven R. Feldman, MD, PhD
Patients generally can't tell whether doctors are making the right diagnosis or prescribing the right treatment, but patients do make judgments on the quality of care they receive. Their perceptions are affected by their interactions with the practice on the telephone, the ease of finding parking, and their interactions with staff and healthcare providers.
Based on my experiences as a physician, I started an online patient satisfaction survey service, www.DrScore.com,[1] where patients can rate their doctors and look up doctor ratings. We've analyzed the survey results to determine what patients think is important to an excellent medical experience.[2] Quality of diagnosis and treatment plays a role, but more importantly, patients value access and communication with their doctor; a doctor who is supportive, caring, and compassionate; follow-up on test results; quality facilities; and a friendly office staff.
Sometimes we doctors are so caring, so well trained, and so efficient that we can quickly identify a problem and know exactly what to prescribe. When we do that, though, the patient may feel that we were uncaring and that we didn't take the time to do a proper examination or consider the best course of treatment.[3] It's not enough to just be caring and technically expert; the doctor also has to make the effort to communicate that care and empathy to their patient and to provide a uniformly excellent medical experience. When doctors do that, patients are more satisfied. They are also more trusting and adherent to medication -- they actually do better clinically -- not to mention being less likely to sue![4,5] By measuring their patients' satisfaction, doctors gain the information they need to assure patients the best possible medical care experience.
That's my opinion. I'm Dr. Steven Feldman.
References
1. DrScore. Available at: www.DrScore.com Accessed August 10, 2006.
2. Anderson R, Barbara A, Feldman S. Seven traits of outstanding physicians as reported by their patients. 2006. Available at: http://www.drscore.com/press/releases/7traits.pdf Accessed August 10, 2006.
3. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patients' perspectives on ideal physician behaviors. Mayo Clin Proc. 2006;81:338-344. Abstract
4. Renzi C, Tabolli S, Picardi A, Abeni D, Puddu P, Braga M. Effects of patient satisfaction with care on health-related quality of life: a prospective study. J Eur Acad Dermatol Venereol. 2005;19:712-718. Abstract
5. Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118:1126-1133. Abstract"
Who knows, one of these days, we may have a Singapore version of Dr Score...not that bogus after all!
Here's the transcript, if you are unable to view it (you have to subscribe):
"What Are Patients Looking for?
Posted 08/18/2006
Steven R. Feldman, MD, PhD
Patients generally can't tell whether doctors are making the right diagnosis or prescribing the right treatment, but patients do make judgments on the quality of care they receive. Their perceptions are affected by their interactions with the practice on the telephone, the ease of finding parking, and their interactions with staff and healthcare providers.
Based on my experiences as a physician, I started an online patient satisfaction survey service, www.DrScore.com,[1] where patients can rate their doctors and look up doctor ratings. We've analyzed the survey results to determine what patients think is important to an excellent medical experience.[2] Quality of diagnosis and treatment plays a role, but more importantly, patients value access and communication with their doctor; a doctor who is supportive, caring, and compassionate; follow-up on test results; quality facilities; and a friendly office staff.
Sometimes we doctors are so caring, so well trained, and so efficient that we can quickly identify a problem and know exactly what to prescribe. When we do that, though, the patient may feel that we were uncaring and that we didn't take the time to do a proper examination or consider the best course of treatment.[3] It's not enough to just be caring and technically expert; the doctor also has to make the effort to communicate that care and empathy to their patient and to provide a uniformly excellent medical experience. When doctors do that, patients are more satisfied. They are also more trusting and adherent to medication -- they actually do better clinically -- not to mention being less likely to sue![4,5] By measuring their patients' satisfaction, doctors gain the information they need to assure patients the best possible medical care experience.
That's my opinion. I'm Dr. Steven Feldman.
References
1. DrScore. Available at: www.DrScore.com Accessed August 10, 2006.
2. Anderson R, Barbara A, Feldman S. Seven traits of outstanding physicians as reported by their patients. 2006. Available at: http://www.drscore.com/press/releases/7traits.pdf Accessed August 10, 2006.
3. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patients' perspectives on ideal physician behaviors. Mayo Clin Proc. 2006;81:338-344. Abstract
4. Renzi C, Tabolli S, Picardi A, Abeni D, Puddu P, Braga M. Effects of patient satisfaction with care on health-related quality of life: a prospective study. J Eur Acad Dermatol Venereol. 2005;19:712-718. Abstract
5. Stelfox HT, Gandhi TK, Orav EJ, Gustafson ML. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005;118:1126-1133. Abstract"
Who knows, one of these days, we may have a Singapore version of Dr Score...not that bogus after all!
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