Impressions from China - GE*

One of the perils of living in China is the high chance of ingesting tainted food. Today, I woke up with mild abdominal cramps, nausea & have gone to the loo multiple times with watery diarrhoea. My son has also been affected, & I suspect it's from dinner at the restaurant in the clubhouse in our compound. So even eating in a nice establishment does not protect us from getting food poisoning.

I take precautions with food preparation here, as China does not have a particular good reputation as far as food is concerned.

• I try to buy organic or green food when & where I can find it.
• I go marketing at reputable stores.
• As for fruits & vegetables, I have resorted to using vegetable detergent to clean off any remnants of pesticides (according to a neighbour with a degree in Chemistry from Columbia, the detergent helps to wash off any residue of oil-based pesticides), then rinse off three times with filtered water, then soak for at least 10 minutes before draining off. I know, the water soluble vitamins get leached off by doing so, but I'd rather get my vitamins elsewhere than to risk contaminated food.
• We cook with filtered water.
• We avoid eating at roadside stalls with questionable hygiene practices.
• I avoid eating salads in restaurants.

We have also all been immunised against Hep A & typhoid. And I have a bottle of acidophilus, for what it's worth, to improve our GI immunity.

But I know, despite precautions, there will always be a chance of that little bit of contaminated food that will make us puke & purge. Speaking of which, excuse me please...I feel the urge again...

*GE = Gastroenteritis

Rant

So, this is the thing that’s been bugging me for the last few days.

My son & his friend went to a school musical last Friday evening. They came home after school to hang out before heading out for dinner then the show in school. Just before they left for dinner, I heard my son say, “Hang on, I need to get my school ID.” His friend said that he didn’t bring his, to which my son replied,” Oh, but you don’t need to show it. You’re white.” True enough, the guards checked my son's ID but didn't ask for his friend's.

Somehow, it made me sad to hear him say that in such a matter of fact way. Apparently, the security guards in school don’t check ID’s if the kid is Caucasian. I am not sure if they check ID’s of Caucasian adults or not.

I guess I shouldn’t be naïve about the existence of such double standards. But I am very surprised at this colonial attitude being present here in China. After all, historically, China has always been wary of foreigners. However, it seems that now, the reverse is happening & Caucasian foreigners are being placed on pedestals. Not just in this example that I have just quoted, but also in the workplace, where white expats seem to be treated with a bit more reverence than non-whites.

It may seem like a small thing to get upset over, but I want to make the point to my kids that it is NOT okay to discriminate based on skin color, and one shouldn't be complacent about it either.

Impressions from China - The Great Wall

We finally made our way to the Great Wall. Not that we didn't want to do so earlier, but with the cold wintry weather, if you factor in the wind chill factor, we would have frozen our buns off.

So we waited till Spring (i.e. now), when the weather is more favorable & flowers are blooming & birds are singing etc etc before we visited this, one of the Wonders of the World.

We went to the Mutianyu section of the wall which is north-east of Beijing, only about an hour away from where we live. Left at the ungodly hour of 7 am (ungodly for a Saturday morning, anyway) to avoid the heavy traffic that usually clogs up the roads heading to this tourist attraction.

Chinglish on the Great Wall

We took a cable car up to the wall. It was a hair-raising, ball-shrinking (the latter description straight from the mouths of my 3 guys) experience as we were pretty high up & the "cars" were basically just swings with a metal bar across. Our legs literally hung hundreds of feet above ground. Definitely not an experience for the acrophobic. A. had his eyes closed 80% of the time. Men.

View from the cable car (you can see my boys feet at the lower right corner- that's how precarious it was!)

From the wall, we could see miles & miles of mountainous vista, with the wall snaking up, over & through hill & dale. I tried to imagine how it must have been thousands of years ago when the wall was being built without the aid of modern machinery & technology. What a daunting task it must have been. But labor (& life) was cheap then (it still is, here in China), and whatever the Emperor said, went.

The white patches are blooms of white flowers (not sure what they're called)

The construction is still solid though the stones have been slightly worn by the elements. Mutianyu is a particularly well preserved part of the wall, & I believe that it will be one of the tourist attractions being promoted during next year's Olympics in Beijing.

It reaches far beyond the eye can see...

An overcast day...but an awesome view all the same

Definitely a site worth visiting.

Green Day

War.

Terrorism.

AIDS.

Cancer.

Unnatural selection, I call it. Much like Darwin’s theory of natural selection, it seems to be the modern day version of evolution.

Will we one day be a peaceful society, free of AIDS, cancer? Maybe. But new diseases will crop up. Global warming, which seems to be the political in thing now, seems to be slowly & surely creeping up on us. Mankind’s pollution of the Earth & exhaustion of our natural resources will one day prove to be our downfall. These seemingly insurmountable obstacles, which despite efforts of many trying to overcome with education & deeds, are uphill battles to fight.

A vast country like China, with the largest population in the world, wanting to keep up with the Jones’s, has its work cut out for itself when it comes to educating its people about the environment. Many just want to make money, by hook or by crook. Some resort to unethical practices, like the recently discovered melamine poisoning of certain rice protein & wheat gluten products used for making pet food; or the previous debacle involving tainted milk powder. Pollution of the environment by various industries remains a huge problem.

Extinction.

That’s my rather depressing forecast. It will not happen in my lifetime, or even in my children’s lifetime. But I think it will happen one day.

Despite my pessimism, I think we still need to try & beat the odds. So, I’m going to try to stick with Green Food as far as possible. And recycle. Those are my first small steps.

Ai-yai-yai-yai-yai

That was my initial reaction when I first read this article.

Gallbladder removed through the vagina.
Appendix removed through the mouth.

I wonder what's next.

I will reserve judgement on these very new & very experimental procedures until I know more about them & what advantages they may have over conventional laparoscopic procedures (apart from vanity reasons i.e. external scarring).

I'm a Field Spaniel

Take this quiz & find out what kind of dog you are!

Click the "GAME" button on the left side of the screen to start playing!

Another one

I have blogged about this before.

It's happened again, this time in Virginia Tech University.

"White House spokeswoman Dana Perino said while President Bush ``believes that there is a right for people to bear arms,'' all laws must be followed. "

Not a surprising statement, knowing the NRA/Republican stance on the gun control issue. In a perfect world, Ms Perino's words would be appropriate. But this is NOT a perfect world, & there WILL be people out there who WILL NOT follow the law while at the same time, have the right to bear arms.

How right is that?

How Much Is Too Much?

With the recent discussions that have arisen over the withdrawal of the Guideline of Fees for doctors, a couple of questions posed by this writer is certainly a valid one (emphasis mine).

April 16, 2007
How to decide if doc is overcharging?

THE Competition Commission of Singapore's (CCS) response to the recent withdrawal of the Singapore Medical Association's (SMA) guidelines on fees deserves more discussion.

CCS announced that it will work closely with the Consumers Association of Singapore (Case) to handle any complaints of overcharging by doctors.

This is good but it opens up two questions.

The first is will there be a charge levied?

The SMA never levied any charge on members of the public who filed complaints against doctors. But a visit to the Case website reveals that a complainant usually has to join Case as a member. Membership carries an annual subscription of $25 and filing a complaint incurs an administrative charge of $10.

The second question is more fundamental. How will CCS and Case decide on what constitutes overcharging?

The term 'overcharging' carries with it the notion of relativity. Overcharging can exist only if there is an understanding of what is 'normal charging'.

But without benchmarks and guidelines, it is practically impossible to define overcharging. Are CCS and Case going to draw up their own guidelines on what are acceptable and normal prices?

How will CCS and Case decide a doctor is not merely 'expensive' but has transgressed to the point of 'overcharging'?

Do they have the expertise or domain knowledge to know the intricacies and complexities of pricing in the whole spectrum of health care?

And will CCS and Case likewise step up to the plate to handle overcharging complaints when other professional groups withdraw their equivalents of price or fee guidelines?

These are questions that need to be answered clearly and soon.

Christine Chen Siew Mei (Ms)

In response to the first highlighted question, how indeed? What will CASE & CCS use as a benchmark when faced with a complaint from a "consumer" who alleges overcharging? They can't fall back on the now defunct GOF. Will they use results from MOH's planned survey of GPS fees?

More important in my mind is the 2nd question highlighted. Who will provide input to them in deciding whether a doctor has overcharged or not. And HOW would this person (or persons) decide? Can you even put a price on quality of care?

These are tough questions to answer. I am not even sure if doctors themselves would know how to answer them.

I am not even convinced that CCS nor CASE should be the ones handling such complaints in the first place. IMHO, it would "cheapen" healthcare, not literally in terms of dollars & cents, but qualitatively, as I don't think medical care should be considered a consumer product. But sad to say, it certainly looks like it's headed that way.

Addendum (April 17): angrydoc has also commented on this. I guess great minds think alike!

Impressions from China - Springtime

It is SO pleasant to see color after the grayness of the winter months here. With the warming temperatures, Mother Nature has awakened the buds & shoots, & we have started to see the beginnings of life.

Shoots of life

It started with the tiny shoots of leaves struggling to appear on the tree branches. Then the yellow buds of forsythia soon blossomed into a full blown riotous display of yellow, followed by the whites & pinks of the magnolia & peach blossoms. Now I am seeing the red sub-species of the peach blossoms flowering almost overnight after a week of temperatures above 15oC.

Forsythia

It’s amazing how the presence of color brings cheer & makes us feel better. I guess there may be something to be said about color therapy after all.

:)

Pink Peach Blossoms

Red Peach Blossoms

Dollars & Sense & Non-sense

And so it continues in today's ST Forum (April 9, 2007)...

First, a lone voice of reason...

Most GPs charge less than recommended fees

I REFER to the recent announcement that the Singapore Medical Association (SMA) had scrapped the medical fee guidelines and the resultant knee-jerk reactions.

The adverse feedback in the papers and on radio programmes seemed to be directed at the general practitioners (GPs). I think critics are pointing their arrows in the wrong direction.
The public should think about the family doctors who have been servicing them all these years. Think about the charges for simple medical ailments that did not need expensive medicine or investigations. Most of the time, the charges would range between $12 and $24 (inclusive of medicine).

Now look at the recommended charges that were recently scrapped by the SMA. It does not take a mathematics genius to calculate that if the consultation charges recommended were indeed followed, there would be no way that the total charges paid by patients could be within the range we have been accustomed to paying.

The conclusion must be that not many GPs follow the guidelines. They in fact charge much less than what was recommended.

One GP interviewed said that there was competition between the clinics. So it was unlikely that medical charges would increase.

It is not uncommon to see a number of clinics within a few blocks of HDB flats. Market forces would have ensured that none of the clinics would want to price itself out of the market.

Not too long ago, there was a report on the plight of some neighbourhood clinics which faced decreasing takings. Are we so illogical as to assume that these clinics would raise their charges overnight just because the guidelines were removed, when they have been undercharging all this while when the guidelines were around?

One chooses one's family doctor based on a number of factors, such as his medical competence, bedside manners, empathy and trustworthiness. Cost would be a factor, obviously, but if the charges were too high, the GP would not have been our family doctor in the first place.

As we have been told, we should stick with the same family doctor, who would be familiar with our medical conditions. Hence, it was with great surprise when I read that our Health Minister advised the public to vote with their feet when consultation charges are not displayed.

I am sure the issue of exorbitant increase in medical charges would not apply to the majority of clinics here.

Most of our humble family doctors slog hard to open their clinics. Please do not react adversely without first giving the issue a logical think-through.

Gabriel Koh Liat Choon

Not surprising, since I think Gabriel Koh is also a GP.


Then this one...

With no more fee guidelines, will 'bargain' clinics still match polyclinic rates?

I REFER to the editorial 'Beware spike in docs' fees' and the article 'Dropping of SMA's fee guidelines: Other professional groups relooking fee guidelines' (ST, April 5).

In April 2005, 22 clinics that were willing to charge the same $8 fee as polyclinics were told by the Singapore Medical Association (SMA) that they could not list this information on a medical services website, because it infringed the SMA's advertising guidelines ('Does' ads allowed, so why not discount scheme?'; ST, April 13, 2005, and 'Why stop doctors from charging polyclinic rate?'; ST, April 5, 2005). As a result, all 22 clinics stopped offering the $8 fee.

Now the fee guidelines have been withdrawn, will these 22 or more clinics offer the same fee as polyclinics again?

By the way, since polyclinic fees were increased last month to $8.80, it may soon be cheaper to go to a private clinic at $8.

Leong Sze Hian

I wonder if Mr Leong even realises that polyclinics are highly subsidised by the government while private GPs are not? These very pertinent facts seem to be conveniently forgotten. One would think that Singaporeans, in all their great wisdom (sarcasm meant), would take that into account when comparing polyclinic prices with private clinics.

And then there is this one who takes the cake (emphasis mine)...

SMA announcement sure to mean more overcharging

I AM uncomfortable with the latest announcement by the Singapore Medical Association (SMA) to deregulate fees charged by doctors ('Think doc has overcharged you? Turning to Case only recourse now' (ST, April 5).

Already with guidelines, general practitioners (GPs) have overcharged patients. Only recently, letters in the Forum page have reported cases of GPs overcharging patients seeking treatment, especially during the holiday season. Quoted fees of $60 to $100 were commonly seen.

I am sure not many GPs make their fees known to paying patients before they see them. This is unlikely to change now the SMA has withdrawn its guidelines as most GPs also see their profession as a business that needs to stay financially viable.

Many patients will not seek help from the Consumers Association of Singapore (Case) as the amount is not large enough to warrant the hassle of getting back tens of dollars.

Nevertheless, most GPs currently charge between $30 and $40 for general flu and fever cases. Some friends who have seen the same GP for many years say they are charged only $25 per session. Office workers tend to have medical coverage by group medical insurance and may not feel the impact of any fee increase.

More worrying, however, is the retirees group who have no proper income and no medical coverage. Their visits to the GP will also be more regular due to ageing medical issues. My mother was charged $60 last month for a consultation visit to a GP due to some skin problem. She was also not told how much she would be charged before consultation.

I dread to think of the time I was in Australia when each consultation session with the doctor for simple flu and fever was in the region of $150 to $180. No wonder most Australians self-medicate and visit the pharmacist for simple flu and cough.

This may be a viable consideration in Singapore if pharmacists can provide professional advice on common flu and cough illnesses. Nevertheless, as over-the-counter pharmacists cannot issue medical certificates for those who need to rest, the practice of seeing pharmacists may not work here.

Gilbert Goh Keow Wah

What's eating Gilbert Goh? He seems to have brushed off explanations on why consultation charges were higher during the holiday season. Apparently, Mr Goh thinks that doctors should not raise their charges come hell or high water.

He seems to be reasonably well-traveled, & a fairly intelligent fellow when he writes that GPs see their professions as a "business that needs to stay financially viable." I wonder how he thinks GPs are able to stay financially viable if they don't charge enough to cover cost...Oh! I get it now! GPs are supposed to earn just enough to cover cost. No need extra money for kid's education and maid salary (since doctors' spouses will probably need to also work in order to earn money for things like food in the house & utility bills) or car. Forget about luxuries like a TV or a PC at home too, or even the occasional holiday to Desaru.

He even knows that consultation charges in Australia are sky high compared to those in Singapore, and yet, $30 - $40 is still too high for him(although this is only about 20 - 30% of the Aussie charges).

He has the right idea about self-medicating for simple ailments. That's what many do in places like Australia & the USA. The issue about MC's is something that will have to be dealt with by the HR people.

Sigh...I have a feeling that many Singaporeans feel the same way as Mr Goh.

Teach Your Children Well

Teach Your Children by Crosby, Stills & Nash

You, who are on the road must have a code that you can live by.
And so become yourself because the past is just a good bye.
Teach your children well, their father's hell did slowly go by,
And feed them on your dreams, the one they fix, the one you'll know by.
Don't you ever ask them why, if they told you, you would cry,
So just look at them and sigh and know they love you.

And you, of the tender years can't know the fears that your elders grew by,
And so please help them with your youth, they seek the truth before they can die.
Teach your parents well, their children's hell will slowly go by,
And feed them on your dreams, the one they fix,the one you'll know by.
Don't you ever ask them why, if they told you, you would cry,
So just look at them and sigh and know they love you.


I agree with the author of this letter:

April 5, 2007, ST Forum
Wardrobe malfunction? Teach our kids proper values

I REFER to the letter, 'Models exposed too much, by design or otherwise' (ST, April 3), by Ms Wong Kam Fong.
I disagree with the writer's view and her suggestion of regulating fashion shows. If so, we will also have to regulate shows like music concerts, telling the superstar singers and dancers to be discreet with their clothing.

We have to restrict Jolin Tsai from revealing her cleavage, Alex To from taking off his top and Madonna from wearing her undergarments on stage because these shows have also a large number of children watching.

No, I am not suggesting that we should encourage indecency on public shows. I think the key is on education. We should teach our kids to be able to receive information of all kinds, analyse them and learn from it.

We should teach our kids to be able to identify the good and bad information, put them to good use in their life.

Yes, all these can be done through parents teaching their kids proper Values. Shutting out such information from our kids through regulations is not going to help - we are not teaching them how to face the real world, instead, running away from it.

Our kids will grow up not being able to face reality but run away from it. Our kids should be able to look at the exposed breast of the model and say 'Oops! Okay, if I am the designer or the workers backstage in future, I will make sure this blunder does not happen and put the model in such an awkward situation'.

Our Government has so far done a lot in this aspect and constantly reviews its regulations to meet the standards of the ever changing world.

Even with such stringent regulations on our land, we still have problems with our kids. We have a nine-year-old child getting pregnant, teens having multiple sex partners and teens who think there is nothing wrong having pre-marital sex and no qualm filming themselves doing it.

We can stop pornographic materials on our land, we can stop Crazy Horse from advertising but we can't stop the Internet world from having pornographic materials, we can't stop the people on the streets from wearing revealing clothing, we can't stop accidents happening on fashion shows, showing off the wrong things.

Go to the news-stands and you will see that almost every issue of fashion, entertainment, women's and even car magazines have models in bikinis, lingerie or clothing that reveals lots of cleavage or legs on the cover.

Yes, Ms Wong has a valid concern. But I think the way to deal with it is to educate our kids with proper values and face it with the right attitude and not regulating and avoiding it.
Parents and schools play an equally important part in teaching our kids correct values of life and shaping their character to meet the challenges of the world.
Lim Soo Huat

It's hard to shíeld one's children from the "badness" of our world. Technology has made it so easy to access information through the Internet. There is Internet radio, video websites like YouTube, even Internet TV. Attempts at censorship by blocking websites can be bypassed using proxies (personal experience here!).

I know of parents who do not allow their children to watch "Power Rangers" or MTV because of violence in the former & promiscuity in dressing, explicit lyrics in the latter. It's easy to do so when the children are toddlers & preschoolers. But once they reach school-going age, & we let them out into the big, wide, scary world, they will start to pick up things from their friends.

So Mr Lim has it right when he says we need to teach our children well, starting from home. Having strong values & morals will allow our children to see for themselves what is right or wrong, what is inappropriate & what is not. Blocking out what we don't want them to see or hear is not going to work. Eventually, they will have to grow up & decide for themselves what is good or bad. We need to help them start building up a strong moral center, beginning when they are children, and continuing through their teen years so that when the time comes, they can make the right decisions in their own journey through life.

Dollars & Sense

HAHAHAHAHA!
HAHAHAHAHAHAHA!!
HAHAHAHAHAHAHAHAHA!!!

Oh dear..so sorry…*wiping tears of laughter of face*…

That was my response to the question posed to the Minister (highlighted below) taken from this article from channelnewsasia (emphasis mine):

Health Ministry to monitor fees charged by private doctors
By Hasnita A Majid, Channel NewsAsia Posted: 04 April 2007 0011 hrs

SINGAPORE:
Health Minister Khaw Boon Wan says his Ministry will monitor the charges levied by doctors on patients.

And it will gather information from private clinics and publish the data, like what it has done for hospital bill sizes and some clinical procedures.

This is possible as the Ministry is already gathering data from the Chronic Management Programme, where half of all GPs here are on board.

Mr Khaw says doctors should also display their fees as required under the Private Hospitals and Medical Clinics Act and Regulations, so patients know how much they have to pay before they decide to seek treatment.

He was responding to questions on what the Health Ministry will do to ensure doctors do not overcharge their patients, following the withdrawal of the Guideline on Fees by the Singapore Medical Association (SMA).

"Singaporeans are educated consumers, so they should demand all those. If you go to a clinic and find those things are missing, then I think vote with your feet, go to another clinic which does so. Why should you be blindly going to that clinic? So I think providers will react if consumers are demanding and discerning. And I think part of public education is to help them, that they have a right as a consumer to know how much the bill will be and so on." Mr Khaw said. - CNA/yy

Speaking from the POV of a GP, I had to laugh. Why? Because the problem with consultation fees in the GP sector (at least in recent history) is undercharging & not overcharging. And patients do not appreciate that. I have had a patient complain about a $5 co-payment under his company’s medical benefit scheme – Five Freaking Dollars. I don’t believe that patients even look at the GOF tents that are displayed in clinics.

On a more serious note, I see a few possibilities happening with the withdrawal of the GOF:

a) Patients realize that they need to be savvier about their healthcare, and in looking at fees charged by different doctors, learn to question why one doc may charge more than the other, and learn that quality of care is just as important as cost. A good thing, as it encourages transparency, & improved communication between patient & doctor, something that is very lacking at the moment.
b) And because they start to question, they hopefully learn that doctoring is not something as simple as “Say ‘Ah’” & “Take an aspirin and call me in the morning.” Perhaps patients may start to realize that they have “had it good” all this time.
c) With the MOH publishing data about GP bills, healthcare becomes nothing more than a consumer product, with the customers looking only for the most reasonably priced. A price war then starts among the already suffering GP’s, leading to more undercutting & further diminishing morale among them.

In a perfect world, most of us would hope that (a) & (b) become reality. For a skeptic like me, I think in Singapore, (c) is the most probable outcome.

Just take a look at this article from Today Online (again, emphasis mine):

Medical association says it had 'no choice' ; MOH to publish fee schedule online

Sheralyn Taysheralyn@mediacorp.com.sg

DESPITE the weighty ramifications of freeing up private doctors to set their own fees, few expected the Singapore Medical Association (SMA) to take that step so soon.
.
So the suddenness of the decision to withdraw its guideline of fees, taken at Sunday's annual general meeting after a year of bandying the possibility about, caught patients — and even some doctors and health officials — off-guard.
.
Yesterday, Health Minister Khaw Boon Wan expressed surprise that the SMA's fee guide, started 20 years ago to make transparent private medical charges, should be seen by lawyers as contravening the year-old Competition Act. The good news is that his ministry is now planning to publish doctors' fees online to help patients make comparisons.
.
But, as SMA president Wong Chiang Yin emphasised to this newspaper several times yesterday, the move to axe the guideline was made with "great reluctance". The SMA felt it had "no choice" in the matter.
.
It was, in effect, a choice of scrap the guideline now — or cough up $200,000 for a decision from the Competition Commission of Singapore that might simply lead to the same result.
.
Since the Competition Act was enacted last year, the SMA's consultations with its in-house legal counsel had indicated that the guideline was "probably" illegal.
.
But to get a definitive answer from the Competition Commission, the SMA would have had to foot a hefty bill, said Dr Wong.
.
Getting guidance alone from the Competition Commission to file paperwork would have cost $20,000, while getting a decision would have cost the non-profit organisation $30,000. In addition, the SMA would have had to cough up some $150,000 in legal fees.
.
"The penalty (for contravention of the Act) is 10 per cent of turnover for every year of infringement. That's quite a lot," said Dr Wong, who had written to the Competition Commission and requested to meet with them.
.
The commission did not take up the offer, he said, but merely responded to his four-page letter, noting that the SMA had "received legal advice that the guideline of fees may contravene Section 34(2)(a) of the Competition Act".
.
Said Dr Wong: "As the penalties are accrued on a daily basis, we had no choice but to withdraw the guideline of fees."
.
But the move was not taken lightly as it has "huge" ramifications on Singaporeans who typically see a doctor five to six times a year, said Dr Cheong Yeh Woei, first vice-president of the SMA.
.
Ripples will be felt in a wide range of medical services, such as surgical operations, consultations by specialists and doctors, emergency situations and house calls, as well as fees for court attendance and the retrieval of medical reports.
.
Apart from obvious concerns about overcharging, there is even the issue of undercutting, said Dr Cheong. Medical insurance claims may also be affected.
.
Dr Cheong said the association is telling members not to vary fees, keeping in mind that the Goods and Services Tax is also set to rise. Doctors and private medical groups this newspaper spoke to agreed that fees would not rise in the short term.
.
According to Mr Khaw, the Health Ministry intends to publish fee schedules online "before the end of this year", after it collates data on average bill sizes for general practitioners.
.
Patients will have to play their part — such as being aware if they are being "over-serviced" and ensuring that private clinics display their fees as required.
.
"If you go to a clinic and find those things are missing, then vote with your feet. Go to another clinic. Providers will react if consumers are demanding and discerning," he said.
.
One problem, however, is that there is now no clear recourse for victims of overcharging — under the guideline, they could complain to the SMA. The Consumer's Association of Singapore, or Case, might have to "pick up the slack", said Dr Cheong, "but they have not sufficient know-how".
.
Despite the medical community's misgivings, the Competition Commission said it welcomed the SMA's move. "This would permit greater flexibility for fees to be set by the medical practitioners in line with their business costs. Such a move is more in line with today's circumstances," it said.
.
"Consumers would therefore benefit from the greater transparency and competition of prices."
.
But GPs like Dr Clarence Yeo felt a reference was needed. Ultimately, he said, "we mustn't forget that healthcare is a basic necessity. The basic economics of things shouldn't be extrapolated to healthcare".
.
Look at what the rep from The Competition Commission (whose existence I was not aware of till I read the article this morning) says in the article above (highlighted). Greater transparency is great, but I wonder if the patients (note that I use the word patients & not consumers) would bother to find out more about their treatment and why it costs whatever the amount may be? Or would they just go to Dr A because he charges $5 less than Dr B?

After all, consulting a doctor IS different from going to the supermarket to buy groceries. At least, it should be anyway.

(Look at angrydoc, Dr Oz & Dr Huang's blogs for more comments on this issue).

Hip & Happenin'

Apparently, I’m a “hip mom” – this from a friend/fellow doctor’s daughter who knows about the existence of this blog. I guess I am hip for being a blogger, when many others in my generation (man, that sounds so old) are still trying to figure out how to use email.

I’m glad I’m hip. I think it’s important for parents to keep up (or at least try to!) with the latest in technology or top of the chart hits or latest fashion or teen hottie etc. I think if your child sees you showing an interest in what he or she is into, it strengthens the relationship, and also helps parents understand the mysteries of their children’s minds a little bit better. Plus I also think it keeps you young at heart.

And it’s also great if your kid thinks you’re a cool mom.

:)

Pain in the ...

It looks (& feels) like I have a rotator cuff injury. I fell over some packing paper (only a klutz like me would trip over paper) back in December when the movers were packing our stuff. I
a) landed on my left knee,
b) inverted my right ankle, and
c) used my left outstretched arm to catch my fall so that I wouldn't land on my face.

The knee & ankle have since recovered. But I find myself wincing each time I take off my shirt or use my left arm to reach for something overhead - quite classical of rotator cuff injuries. Passive abduction is fine (I used my son to test this :)) but active abduction hurts. Even lying on my left side is not comfortable.

Am going to take Nsaid's for a few days (something I usually try to avoid) as 3 months is a bit long for this to go on. I took Celebrex a couple of times, but not at a stretch. Also tried traditional Chinese massage by a trained Chinese masseur (I'm in China after all!). The pressure he used felt good but the manipulation was not pleasant at all (although after the first session, the pain did lessen for a day), and I am not comfortable with all the joint stretching that he does (ouch!).

I've been using some light weights to try to strengthen the shoulder muscles, & doing some stretching to try to maintain/improve range of motion. I hope I don't need to go for physiotherapy. Being in a foreign country & looking for good healthcare is a bit daunting. On the other hand, I don't want to end up with Frozen Shoulder either.

Impressions from China - Old Beijing Hutongs

Riding through the narrow & uneven streets of old Beijing in a pedicab (or a trishaw), we were given a taste of life in the olden days, when extended families lived in the old courtyard style houses (siheyuan 四合院). Hutongs (胡同) refer to the streets that line these houses. “24 steps” was the width of the “main” streets, 12 steps for smaller streets & 6 steps for hutongs.

A typical hutong

Many of these homes have been demolished to make way for spanking new buildings to accommodate the fast growing population of Beijing. Fortunately, the Beijing government has designated certain areas to be preserved & protected from demolition. These occupants of these homes pay very low rentals (the one we visited pays only 85 yuan a month for living in a space consisting of a living room, bedroom, kitchen & bathroom). Drawback of living in these homes: no toilets! They share a communal toilet outside the home, or use a chamberpot. Ironically, most of these homes have Internet access, & both homes we visited had PC’s in their houses!

Depending on how prosperous the family was in the past, sizes of the homes differed. However, the basic layout of each home is pretty much the same. Entrance to the house is located at the SE corner (the good feng shui to allow luck in). No windows look out into the streets to ensure privacy & quiet. Each sub-building within the courtyard home has windows opening on to the courtyard which is the center of activity. Occupation each of these buildings is hierarchial, with the senior members of the family usually occupying the northernmost building, followed by the eastern building then western. The servants occupy the southernmost part of the home, & the toilets are placed in the SW part (worst feng shui).

Courtyard home, converted into daycare centre

A prosperous family may have more than one courtyard in their home. The first courtyard (closest to the entrance) is used as a “foyer”, a place where visitors wait while the servants announce their arrival to their masters. The second & even third courtyards are common areas for the family to entertain guests or to enjoy the fresh air (when Beijing used to have fresh air!). Wisteria vines crept on lattices built over the courtyards, fish were also commonplace pets, and apparently, it used to be a common past time to sit in the moonlight under the wisteria vines, enjoying the night air over a cup of tea. The rich folks would occasionally even invite an opera troupe to their homes for a private performance.

Aaahh…the simple life.