Sunday, December 28, 2008
A lot, apparently, according to the book, The Best Practice - How The New Quality Movement Is Transforming Medicine, by Charles Kenney.
The author relates the history of the Quality Movement in health care in the USA, in a story-telling narrative style that turns a book on a potentially dry topic, into a page turner. Mr Kenney uses real-life stories to reveal how the health care industry in the USA has slowly realized that quality improvement processes that have traditionally been used by the manufacturing & aviation industries can be applied to health care systems as well, to minimize "defects" (or "adverse events" in the medical world).
I think this book with the mouthful of a title is a must-read for medical professionals to serve as an eye-opener. Quality in Medicine certainly was something of a revelation for me when I worked for that brief period in health administration.
As medical students & then as clinicians, we were never exposed to the "outside world" as far as systems & processes were concerned. We were taught the way our predecessors were taught: mainly by the mentor-apprentice method, the student imitating the teacher, & oftentimes, picking up on bad habits, and operating within an environment of "blame & shame" so that errors remain hidden & buried under a culture of fear, and hence, hindering any possibility of correction.
This book tells of how a handful of people with radical ideas & persistence dared to challenge, & subsequently, changed & improved the quality of health care, starting with their own work environment.
I am inspired by their stories.
There is Hope yet.
Friday, December 26, 2008
Wednesday, December 24, 2008
Friday, December 19, 2008
Thursday, December 18, 2008
Bittersweet, really, as my older boy will be heading off to college in less than 2 years, & this will be the 2nd last Christmas we will have together as a family before he ventures out into the great, wide world. More than likely, we will be living on different continents, at least for a couple of years - hard to predict in a semi-nomadic family like ours.
From my experience, it doesn't really matter where you are in the world....if your loved ones are with you, the warmth of the holiday season does not diminish as long as we are together.
Wishing all a safe, happy holiday season (despite the dismal economic outlook).
Tuesday, December 16, 2008
"Terrorists bomb Mumbai hotel!"
"Blue chip company slashes xxx jobs!"
"Dismal economical outlook in near future!"
"xxx Bank to lay off xxx jobs!"
It's quite depressing reading the news headlines these days. Right, left & center, we are inundated by bad news...it's enough to make one just want to crawl under a rock & hibernate until things start looking better.
Even the health care industry hasn't been spared. I would imagine that the pay cuts & layoffs would affect just the senior management, since the actual doctors, nurses & paramedical staff are not that highly paid in the first place? At least, not compared to the kazillions of dollars that CEO's & senior folks get paid in salary & bonuses. Besides, there always seems to be a shortage of clinical staff in the primary care sector anyway, so cutting their salaries would seem rather short sighted.
So I hope that's not going to happen.
But then I'm not an Economist, I'm just a doctor, so what do I know :).
Just speaking from the heart.
Thursday, December 04, 2008
I think it will bring focus on the growing population of Third Culture Kids in the world that we live in. With all the conflict that is going on these days, perhaps the future lies in the hands of these young people who have grown up appreciating that there is more to the world than just what lies within their own little community or country.
Monday, November 17, 2008
That seems like many lifetimes ago for me. Never in my wildest dreams would I have imagined the life experiences I have had, nor the places I've seen or the countries I've lived in. Then, our main concern was to get through the next night call, crossing our fingers that we wouldn't have too many admissions or get too many pages (I have since discovered that the pager service in Singapore has been discontinued....man, do I feel old & decrepit).
It was great fun getting together with my ex-classmates. I think about half our class showed up - more than expected. I couldn't recognize some of them & it was awkard being said "Hello" to by a familiar face whose name I could not recall! There were a few whom I had to ask close friends to help me identify! Memory is getting terrible. But for the most part I could still remember their names, with a bit of nudging at the ol' brain cells. Most had more gray hair, some with a lot less hair on their heads, some extra pounds (including moi) & a few more wrinkles. Many are senior physicians, with impressive reputations in their own fields. Many are GPs with their own practices or medical groups. But being together again that night, we left our "other lives" outside the door & for a couple of hours, we were med school classmates again.
We had such a great time that there is talk of organizing another get together - not 10 years from now, but 5 years maybe.
I am looking forward to the next one....
Wednesday, November 05, 2008
Today, it was elation I saw, as Barack Obama was elected as the 44th President of the United States, the first black president of this country. He won by a landslide & from the footage shown of the multitudes celebrating, I shared in the joy & hope felt by the American people. Obama represents a new age in American politics, where hopefully, diplomacy wins over brute force, & open-mindedness triumphs over insularity.
I hope, with all my heart, that he will live up to the expectations of those who voted for him today.
Thursday, October 30, 2008
20 years since we walked up on stage to receive that much-worked for piece of paper that made it official that we were finally doctors.
20 years since the first time I heard myself being addressed as Dr So-and-So; it felt strange & awkward, a bit like a new pair of shoes that needed some time to be worn in & gotten used to.
20 years since the first call, & feeling petrified/exhausted/exhilarated/hungry/thirsty/sticky (no shower for me that day - no time).
I am heading back for our reunion this coming week.
It will be interesting.
Friday, October 24, 2008
It's hard to know what to blog about these days. I started this blog partly as a creative outlet for my right brain, & partly as a vent for my woes as a physician. Now that I am not practicing clinical medicine, I find myself busy & enjoying my busy-ness volunteering in school, helping to organize events, updating websites, creating poster & flyers & endless other tasks. What a difference it is to be busy & not feel miserable about it like in my previous life!
People ask me occasionally whether I miss it (my practice, that is) - & more often than not, the answer is no. Admittedly, I sometimes feel a slight pull to start working again. But then this lasts for perhaps, a nanosecond before I brush it off & immerse myself back into the role of parent volunteer again.
On a different note, I think Chinese drivers are the worst in the world. Yesterday, I was stuck in a gridlock when the Airport Expressway was closed for the arrival of dignitaries into Beijing for the Asia-Europe summit to discuss the horrendous world economic situation.
Drivers here do not understand the concept of giving way. Neither do they pay any attention to the concept of a two-way street. Long line of cars? Never mind, they think, just go onto the opposite lane to create a nearly impossible situation of cars going every which way, that takes an expert in the game of Rush Hour to solve.
The US elections are on the minds of many these days, & not just the Americans. My husband asked my opinion last week on who he should vote for, as it was & is a tough decision. If I could vote, I think I would go for Barack. McCain looks like a good guy, but the thought that if he dies (he IS in his 70's after all) & Sarah Palin taking over doesn't really sit well with me!
I finally watched Mamma Mia last week (on bootleg DVD of course, where else) & throughly enjoyed reliving the music of ABBA. I was rather put off by Pierce Brosnan's singing though & was cringing through the bits when he had to whine his way through duets with Meryl Streep, who had a very pleasant voice. I also caught "The Rocker", a "School of Rock" copycat which held its own with Rainn Wilson being hilariously funny as a has been rocker/drummer from the 80's trying to regain his fame with a teenage rock band. Next up on my list of DVDs To Watch include "Wall-E", "The Adventures of Zohan" (which probably contains mostly juvenile slapstick humor - but in these days of economic doom & gloom, I need the laughs), & season 4 of Gray's Anatomy.
Wednesday, October 08, 2008
It's a UNESCO World Heritage Site; this is not surprising, having seen for myself the magnificent vistas & extraordinary colors of the rivers & lakes in the region. We were in Sichuan last week visiting Chengdu, Huanglong & Jiuzhaigou. Visitor numbers are down this year because of the earthquake. This made our visit more pleasant as we didn't have to fight with crowds for photo opps, although there were still certain areas which were pretty jammed with people, by Singapore standards!
Huanglong, another UNESCO World Heritage Site, which is located at an altitude of 3,500 m is known for it's unusual colored multitiered pools which look like craters. With powdery blue colored water, they almost seem as if they are man made. But it is the mineral deposits in the pools that cause the reflection to be that color. Many of us were hit by altitude sickness to varying degrees. Some were merely breathless, while others had headaches & nausea. A few took the Chinese herb Hong Jing Tian (I think the English name for this is Rhodiola Rosea) which is a TCM remedy for altitude sickness. Say what you will about TCM, but those who took this herb seemed to do very well up there!
Jiuzhaigou, the highlight of our trip, lived up to its name. The unusual high mineral content of the area contributes to the colors of the lake & the distinct lack of marine life in the waters there. In fact, if we humans drink that water straight from the rivers, it would probably have the same effect as drinking this.
Pictures do much better than words to describe the beauty of the region. So here are some...(I swear, I did not Photoshop any of the pictures...the colors are all real!)
Multi-tiered pools that is characteristic in Huanglong. Lovely blue color; some have streaks of golden-brown (right side of picture).
Very good feng shui - mountains & lakes!
The pride of Jiuzhaigou - Sparkle Lake - supposed to contain 5 colors - blue, green, yellow, purple, red.
Lone mallard swimming on Mirror Lake - named such for obvious reasons.
I want to offer a common-sense approach to the colon question from the toilet viewpoint. Don't laugh.
I suspect the busy lifestyle of Singaporeans has resulted in little to no time for proper toilet visits, as well as higher levels of stress, leading to more cases of constipation. These may be the contributing factors to the high incidence of colon cancer in Singapore.
We commonly eat three meals a day. Our first meal, processed by the digestive system, would arrive in our colon roughly 16 hours later. If we defecate only once a day, that first meal stays in the colon, and possibly gets added to by the processed remains from the other two meals about 12 hours later. This means the excreta from the meals stay in our colon and may contaminate it as it tries to re-absorb the toxic material in our waste.
My tai-chi teacher taught me that even if we defecate twice a day, we are still mildly constipated, because logically, we need to release the processed remains of earlier meals.
I advise all readers to do the "big one" three times a day and stay healthy. Even if you do not think this is a scientific approach, there is common sense to it and there is no harm to your body when you do so.
After it becomes a habit, I assure you that you'll enjoy the routine and become a happier person.
In return for my free advice, may I also request you demand for clean toilets because that is another reason you could be holding back your urge and that is so unfair to your colon.
Founder, Restroom Association of Singapore, World Toilet Organisation, World Toilet College
Wednesday, September 17, 2008
We watched the Paralympians compete: the amputees, the visually-impaired, the ones with CP, the vertically challenged (I don't know of a politically correct way of saying "short" people :)...sorry), & some whom, for the life of me, I couldn't tell that they had any kind of disability, they were running so fast!
Seeing the Olympic torch in person was pretty awe-inspiring. I can't imagine what it must have been like at both Opening ceremonies when the torch was so dramatically lit.
London has a REALLY tough act to follow...
Once again, China is embroiled in another food tainting scandal, again, affecting babies mostly. Milk is the most fundamental nutritional necessity for young children, & yet, China's wonderfully ethical people are willing to risk these young lives for the sake of the almighty Yuan. Sorry if I am generalizing but this has me fuming.
No matter how wonderful the Beijing Olympics may have been at face value, underneath it all, these detestable acts are still going on. One of the affected brands, Yili, is even a Beijing Olympic sponsor & bears this logo
on its packaging, which means that this product was produced in an environmentally friendly way. Yeah, right. Save the environment; kill the babies.
Sorry if I sound so skeptical. But I am in a crummy mood.
Tuesday, September 09, 2008
The Velodrome is situated in the south-western part of Beijing - it took us over an hour & a half to get there! The heavy traffic didn't make it any easier - so much for the odd-even number arrangement (which is still in place till at least Sept 20). In any case, the first sight of the Velodrome was an awesome one. It resembles a UFO. Inside, it's spanking new, but the seats are not for the acrophobic as there are no banisters to help you climb up the steps in the spectator seats, & nothing to prevent you from falling down to the lower levels of the seats!
HAD any disability!
Video of part of the LC3 event (this cyclist only had one arm & one leg...but look at him go!!!)
Next up - the Bird's Nest athletics event next week! Stay tuned!
Saturday, September 06, 2008
Two trips to opposite sides of the world - visiting colleges, visiting family, sightseeing; moving house (note to self - it doesn't matter if you move halfway across the world or just around the corner, packing/unpacking/sorting stuff out involves pretty much the same amount of work) ; a health scare within the family which has turned out well in the end, thank God, & last week, a busy busy week welcoming new families to school (I volunteer in the PTA).
I can finally breathe, & I now need a vacation (planning one now...hopefully will work out & we will get to see one of the natural wonders of the world: Jiuzhaigou in October)
Saturday, August 30, 2008
Some people just have this tendency to produce lots of ear wax which eventually just clog up the whole ear canal & create discomfort, itching, & hear loss. Sometimes giving them olive oil or Waxsol helps to soften & dislodge it, but occasionally (too often for comfort - mine, that is) even that doesn't help & they would subsequently come to see me to get it syringed out. Yuck.
I tell you, the sight of pieces of ear wax floating in the waste water that gets flushed out ain't pleasant at all. And I swear to God, some of those pieces are as large as one of my distal phalanges! Eew.
Saturday, August 16, 2008
However, I don't think that the lip-synching was the issue; it was the reason given (the real singer was not "cute enough???!!!) & the fact that this was not revealed in the first place.
By trying to put on a "perfect" face for the world to see, China has lost face, & shown herself to be dishonest & shallow. Yes, appearance is important, but not the most important thing in the world. When China realizes this, they will, then, truly be respected.
Having lived in China for the last 1 & a half years, I have come to the realization that much of what they do, & the attitudes of the common people is based on "saving face" & showing the appearance of perfection. But underneath that perfection, one sees that inside, things are far from perfect, & the Chinese still have a long way to go before they become something that not only looks good, but also feels good.
Wednesday, August 13, 2008
Cranes (the mechanical kind) are fast becoming the National Bird of Singapore, as they inundate the landscape.
I've also noticed an increased number of foreign workers, not just the manual labourers, but also in the service industry. Not that this is bad, but honestly, it's often quite hard to understand what they are saying especially if they are speaking "English" (quotation marks deliberate).
Hmm, there may be a market for English language schools here in the near future, catering to teaching Proper Spoken English (which would also be useful for many Singaporeans :)).
Thursday, August 07, 2008
Who wants to bet that money is the underlying root of his complaint here?
When doctors go public to criticise their compatriots, who have donated their time in helping the less fortunate, it leaves a bad taste in one's mouth. He could very well have used his time & energy to work WITH the Singapore doctors/custodians of the funds to see how arrangments can be made to help Ganga.
Maybe it's just me, but this sounds like plain whinging to me. Not at all professional.
Bad form, Dr Pant.
Friday, August 01, 2008
After a rather eventful, busy & tiring month June/July, I have just wanted to chill & do NOTHING in Singapore. What with
1) Pre-packing for our move;
2) an almost 3 week vacation in the US during which we walked what seemed like hundreds of miles doing college visits;
3) returning to Beijing & moving house;
4) unpacking & sorting through our stuff at the new house;
I guess my lethargy is understandable. And the humidity & heat (both in Beijing & here in Singapore) don't help either.
Many are surprised that we are here in Singapore away from all the Olympic excitement in Beijing. But it really has been rather inconvenient for Beijing residents. Especially if you don't live in an area that is easily accessible via public transport. And despite all the measures, it looks like air pollution remains a problem - too little, too late some say.
So here we are, catching up with family & friends (& food!), enjoying movies (in theatres, not on pirated DVDs!), enjoying unfettered Internet access, & being just plain lazy.
Sunday, July 20, 2008
Today - July 20, 2008.
Beijing starts its odd-day-even-day car plate traffic restrictions. You can only drive your car on even days if your license plate ends with an even number & vice versa for odd days.
No more major construction in the city. Which means no work for construction workers.
No more trucks bringing in goods into the city.
It also looks like our satellite TV channels (probably not so legal) has been cut off. Which means no more Star World. AXN, Second Avenue (which has current TV programming from the US) etc.
This is supposed to go on for the next 2 months. Just as well that we will be away for one of those months.
Thursday, July 17, 2008
I love musicals, & always have, whether on the big screen or live on stage.
It was with eager anticipation that I went to the Broadway musical Jersey Boys, which is based on Frankie Valli & his career with the Four Seasons.
I loved it.
Even my husband & two boys, who are usually averse to watching musicals were enthralled almost from start to finish, so much so that once the curtains closed, the first thing my 14-year-old said was, "Let's watch it again." We even bought the CD recording of the music & now, included in their iTunes playlist are Four Seasons classics like Walk Like A Man, Sherry, Big Girls Don't Cry etc!
Listening to the CD which had John Lloyd Young playing the role of Frankie Valli, I think I much prefer Young's voice to Michael Longoria's, whose falsetto, honestly speaking, sounded rather chipmunk-ish at times.
Christian Hoff (who played Tommy DeVito) was brilliant. I could see why he won the Tony for this role in 2006. Peter Gregus , who played the "happy" (*ahem*) manager Bob Crewe was also very enjoyable.
For anyone hoping to catch a Broadway show while in New York, this is HIGHLY recommended!
Here's a snippet taken from the David Letterman show, featuring the original cast doing a medley from the show, with a very enthusiastic review from Paul Schaeffer...
We recently moved to another house in the same compound due to issues with the old house. This is the umpteenth time we've moved. And moving just one street over doesn't make the process any easier. All that packing, then unpacking then sorting out & putting stuff away...it makes you realize just how much stuff one accumulates (let alone FOUR people) in a lifetime.
Moving into a new house is kinda like getting to know a new acquaintance. We have to figure out how things work & where things belong & all those idiosyncrasies that go with the new place. An added challenge now, that comes with age, is putting things away & being able to remember at a lated date, where these things are! Ah, the joys of aging.
Tuesday, July 08, 2008
Mr Wang, Dr Huang, and Angrydoc have all blogged about it too.
This letter in today's ST Forum, together with several others, tells it from the viewpoint of the patient.
It's a tough call to make. As doctors, we tend to look at the world through rose-tinted glasses, where altruism is the best way to get things done (well, maybe not so much anymore in today's society). But till we can walk in the shoes of someone who is actually suffering through organ failure, are we equipped to moralize & lecture on what is right or wrong about $$$ being involved in organ transplants?
As I've said before, this needs to be looked at from different perspectives...
Monday, July 07, 2008
I thought that with all that extra space, getting out of baggage claim wouldn't be such a crush compared to crummy old terminal 1. But the same old bottleneck happened. It seemed like everyone arriving there was exiting through the same door surrounded by throngs of people holding signs with names of the guests they were waiting for.
Some things never change.
Yup, we're back in China.
Wednesday, June 25, 2008
My personal favorite is Princeton. With a smaller campus than Columbia, it had a more homey feel to it, with the added plus of being surrounded by quaint neighborhoods & nice restaurants :). If I had to do it all over again, this would be my first choice (assuming that I could get in!!!)
Tuesday, June 24, 2008
And watched SIX movies in that time. Told ya we were movie buffs.
The Incredible Hulk - I preferred this version to the Ang Lee one. I still prefer Spidey, the FF & the X-Men though, among the Marvel movies.
Wanted - I'm not a huge fan of graphic violence but was outvoted (perils of being the minority in a testosterone-laden family). James McAvoy was great in it, but I really didn't have to watch bullets piercing heads, knives slashing flesh etc etc in slow-mo. I know it sounds strange coming from a doctor, but I hate watching gore. Performing surgery, I can deal with. Watching traumatic injuries on the big screen...ugh.
Hancock - disappointing despite all the hype. The storyline just didn't cut it for me, although Will Smith & Jason Bateman did the best they could with the material.
We would have watched Wall-E, the Love Guru & The Happening if we had more time, but we didn't so I guess we'll just have to make do with the DVD versions.
We look forward to more movie-watching in Singapore. More specifically, The Mummy - Tomb of the Dragon Emperor (yay, Brendan Fraser!), The Dark Knight (in the trailers, it looks like the late Heath Ledger did a tremendous acting job in this) , Mamma Mia (yay! I watched this 3 times in 3 different countries & thoroughly enjoyed myself each & everytime. It's such a fun musical, that makes you just want to sing & dance along. I guess for those of us who grew up in the 70's & 80's when ABBA was HUGE, it's more meaningful), Journey to the Center of the Earth (Brendan Fraser again :)), The X-Files (I watched every single episode of the TV series). A couple of quirky looking films also look promising when we saw the trailers : Burn After Reading, a Coen Brothers film starring George Clooney & John Malkovich; and Step Brothers, starring Will Farrell & John C. Reilly
Saturday, June 21, 2008
We visited the Googleplex in Mountain View (part of the Silicon Valley corridor), an astounding complex of about 30 buildings in Mountain View.
It's been two years since we came back to the USA.
It is so nice to be able to cross the streets at pedestrian crossings where cars actually stop for you.
I appreciate the simple pleasure of browsing through the seemingly endless aisles of Borders, where the books are arranged in logical order.
We love Target, a store where you can literally find everything under one roof at reasonable prices. From pajama bottoms, to chewing gum, to facial wash, to the latest romance novels, I was reluctant to leave the store!
It felt good to shop at Old Navy for reasonably priced, trendy CLOTHES THAT FIT ME. It is great for my self esteem to find sizes which are too big for me in the "Regular" section of the store.
We've missed shopping at supermarkets with wide aisles & huge variety of food that cost a fraction of the prices in China. We had to restrain ourselves from grabbing boxes of cereal, cartons of chocolate milk, & Jello off the shelves, in view of the limited luggage space we will have after taking into account the amount of shopping we will do by the end of our trip (see paragraph about Target & Old Navy above).
Sunday, June 15, 2008
Friday, June 13, 2008
Thursday, June 12, 2008
Anyway, Dr Wong gives a very detailed overview of what kinds of obstacles & risks GP's face when they take on Managed Care contracts. This article reinforces the disillusionment that I was starting to face when I first contemplated stepping away from clinical practice a few years ago. It makes me wonder how my GP colleagues can "tahan" the day to day slog of having to deal with all this c**p, & at the same time try to make a decent living. And I can see why the lure of aesthetic medicine is all the more appealing.
In another article in the May issue of the SMA News (which I had to read online, otherwise I would have to wait till July to get the hard copy), Dr Wong talks about the pain that is being felt by the Medical profession in Singapore. He writes optimistically that, with the SMA, we will be able to work through & learn from the pain.
Me? I think I am more skeptical than him in this respect. The SMA alone cannot do it. They have to get buy-in from The Powers That Be. Otherwise, they will fight a losing battle.
Monday, June 09, 2008
Friday, June 06, 2008
My younger son recently wrote a song for his friends who are leaving his school for good. A soulful melody with heartwrenching lyrics, it makes me want to cry when I listen to it, especially since I will also be saying farewell to a few good friends this week. I will try to post it on this site once he has done a recording of it. Get your tissues ready.
Wednesday, June 04, 2008
Shark's fins menu: Why the double standards?
WHAT Resort World Sentosa has done to promote goodwill and highlight its commitment to the environment is very heartening, 'No shark's fin served here' (May 30).
I am a nature lover. I have attended seminars on the environment and learnt how sharks have been thrown back into the sea after having their fins cut. Why must there be such cruelty to sharks?
However, I was disappointed to read that shark's fins will be served to high-end rollers at the resort. Why the contradiction?
Ace Kindred Cheong
I am surprised at Mr Cheong's naivete. Hasn't he learnt by now that in Singapore, soon to become the capitalists' capital of the world, money talks the loudest? From all-business class flights to an all-A-class wards hospital, it has been proven time & again that those with money are pandered to, high moral standards be damned.
Dr Huang has blogged about the plight of the FDW & how the government still refuses to impose a mandatory day-off policy - another example of how things are done in Singapore. No high road here.
Until the day comes when the government itself realizes that doing the right thing applies to everyone, & not to just certain people, things will not change.
*from "Animal Farm" by George Orwell
Thursday, May 29, 2008
With the end of school, comes the summer holidays & our plans are finally confirmed. We will be visiting both West & East coast of the US, including some campus visits of colleges to give our older boy an idea of what college life is like there. I know that the next two years will fly by, & soon, he will go off to college & the start of a new life for him - not something I look forward to, but have to come to terms with as part of the cycle of life.
While in New York, we will watch Jersey Boys (highly recommended by spacefan!) It was exhilarating to be able to buy tickets for this immensely popular show which is usually sold out, or left with pathetic seats. But luck was with me today as I surfed through the Telecharge website & found 4 relatively good Orchestra seats. However, at the same time, it was painful parting with more than USD 100 per tickets!!!
In a flash, the Olympics will come & go, & the next school year will start. And I will be the parent of not one, but TWO high-schoolers.
And life goes on.
Tuesday, May 20, 2008
Agonized faces of people crying for their lost loved ones.
A small hand in a death grip clutching a pen amidst a pile of rubble.
These pictures we have been inundated with in the last week. It is fortunate that many have rallied to provide help to the survivors unlike in another country where people are dying because of politics.
Yesterday, for three minutes in the afternoon, one week after the Sichuan earthquake struck, China came to a standstill as a sign of mourning for those lost. Traffic stopped, horns blared & sirens sounded as everyone bowed their heads in silence. It is amazing (& heartwarming) that amidst this push-and-shove (literally) society, such empathy and sensitivity can still be seen.
Local TV, however, has taken openness & transparency to an extreme level. It almost seems like propaganda to me when for almost 24 hours a day, pictures of rescue workers are shown on almost every local TV channel, & TV cameras & reporters enter medical tents to show patients being treated. What's happened to privacy for the patients?
Monday, May 12, 2008
It was quite disconcerting, that feeling of imbalance & instability.
I later found out that the tremors were due to aftershocks from an earthquake (7.7 on the Richter scale) in Sichuan. I hope there aren't too many casualties :(
Thursday, May 01, 2008
"So, what was that thing that Tony Stark had on his chest for?"
"Well, remember initially he had a car battery that was attached to his chest? Well, the thing on his chest was an arc reactor which basically generates energy, like the car battery, to create an electromagnetic field that prevents the shrapnel in his chest from piercing his atrial septum hence killing him. Although in reality, in this day & age, he could probably have open heart surgery to get the shrapnel removed."
"Oh. How does it work?"
"Well, theoretically, it would require some kind of fusion reaction to happen in order to create the energy. There would be these two electrodes that sit within plasma, & the arcs of light that shoot between the electrodes would be the energy that is created."
"Are we movie geeks or what?"
A, W & Z (in unison):
This was a rare occasion that we had the opportunity to enjoy a movie in an actual movie theatre in Beijing even BEFORE it is released in the USA.
Movies have always been an outlet of escape from the real world for me, together with TV & books. And I needed something today...and "Iron Man" didn't fail to deliver. Robert Downey Jr. shone in his quirky portrayal of Tony Stark aka Iron Man. He brought humor & sexiness to the role - something which I have never associated with the comic book version of Iron Man. (Admittedly, I have never been an Iron Man fan, & don't "know" him very well, having preferred Spiderman & the Fantastic Four; nonetheless, I had always thought him to be a very serious, straight-laced, "by-the-book" kind of character.)
Action-packed, & jam-packed with special effects, I was riveted to the storyline, as were my boys, who were also thrilled by the heavy rock music that was used for much of the accompanying background scores, including classics by Black Sabbath & ACDC.
One gripe I had , though, was the name of Tony Stark's assistant. Why Pepper Potts (played by Gwyneth Paltrow)??? I would think that the writers could have come up with something less comical! Pepper Potts????!!!!
Comic fans will not be disappointed by this film. I know I wasn't.
Hint: Don't leave before the credits finish rolling, or you'll miss a scene that lays the foundation for a future Marvel movie....
Wednesday, April 23, 2008
It was a bit strange, this concert, not because of James Blunt & his band, but because of the behavior of the security people. There were three of them standing in front of the stage. This venue is set up more like a nightclub than the typical concert-on-a -stage style. The people standing in the front row (standing room only downstairs) could literally reach out & touch James. And he did try to reach out to them too. But the security guards, whom I could tell, were very zealous about keeping Mr Blunt safe from the hands of his audience, raised their arms whenever the audience tried to reach for James (& vice versa). At one point, I thought they were going to slap James' hands away from the audiences'!!!
And so many people were taking pictures during the concert, flashing away rather annoyingly. I even saw the red point of a laser light shining on one of the musician's faces!!! Chinese concert etiquette certainly leaves a lot to be desired. The security people should have made an announcement before the start of the concert letting everyone know that the use of recording devices was not allowed & so on & so forth. Instead, the above mentioned security guards basically just used their hands to block anyone using cameras in the front area of the audience pit. Which meant the ones in the back could do as they please.
So this is the kind of thing that makes me wonder what will happen during the Olympics....hardware ready, but what about the software?
Friday, April 11, 2008
But it looks like these outsiders are not the only ones feeling a bit peeved at the coming Games. I am not sure how the local citizens will feel about the inconveniences that they will have to bear with, some more severe than others...
- the residents living around the Olympics venues will need to have special passes to get into the area to go home
- that whole odd-number-even-number car plate tag team arrangement to try to improve traffic conditions & (maybe) air pollution
- apparently, merchants with stores in a large market near the Olympic venues have been asked, oops, I mean told, to close shop for two months.
Tuesday, April 01, 2008
The one & only time I've ever done mouth-to-mouth resuscitation to a real-life human being was several years ago in my first month of work in a downtown GP clinic. Security had called up to inform us that someone had fainted & they were bringing up the lady. This was at lunchtime when I was one of two doctors on duty, the other one having gone out to lunch, & we were operating on a skeleton crew of clinic assistants.
As soon as I saw the patient's condition, I knew this was not a simple case of syncope, but that she was in cardiopulmonary arrest. She was blue, no pulse, no respiration, & probably had been in this state for at least 15 minutes judging from what the security guard told us.
Adrenaline kicked in immediately as I called for one of the nurses to help me give CPR & look for the crash cart which no one could find as the assistants in charge of "taking care" of the cart had gone out to lunch...so much for being prepared.
Anyhoo, given the urgency of the situation, I had no choice but to give direct mouth-to-mouth resuscitation while the nurse did chest compressions. Fortunately, the patient had a relatively dry mouth (could have been bad - use your imagination). Unfortunately, given that she had probably been down for at least 15 minutes, despite our continued attempts at CPR, there was no response. The ambulance medics continued CPR as they brought her to the nearest hospital.
Alas, this was not a happy ending.
Saturday, March 29, 2008
I am now officially hooked to the soapy family drama hit TV series "Brothers & Sisters". I just went through the entire Season 1 in 5 days.
Before you say how pathetic I am, let me just first counter that this series about a large rather dysfunctional family of 5 siblings in upper middle class America draws you in because we see bits of our own family in the Walkers. Their in-your-face & no-holds-barred interaction with each other strike a chord because they say things to each other (sibling to sibling, parent to child, child to parent, spouse to spouse, partner to partner) that we sometimes wish we can say out loud in our real & oftentimes, repressed lives.
I know this series has been screened in Singapore. I wonder how Mediacorp dealt with the gay issues encountered by one of the siblings (who happens to be homosexual). I would imagine that the scenes of two guys in a passionate embrace probably ended up on the floor of the censors.
And now, on to Season 2......
a) you wake up on your birthday & forget that it's your birthday;
b) you have to think hard to remember how old you are by taking away the year of your birth from the current year to arrive at the answer (your age).
Thursday, March 27, 2008
Dr Huang & angry doc have both commented on this.
It's a good thing, I think, that so much publicity has been generated by this. It serves as a cautionary alert to both patients and doctors:
Patients because, obviously (& hopefully), they would be more discerning & careful about seeking such treatment & (hopefully) do more research into the various options offered to them by their aesthetic physicians....a buyer beware kind of situation, if you like. Which is kind of sad really, when you think about it, because we are talking about that (supposedly) sacred doctor-patient relationship which previously was held at a higher level of esteem than it is now.
Doctors because now, those few black sheep who may previously have been lackadaisical & perhaps, even less than ethical about the kinds of aesthetic treatments & procedures they perform on their patients, have more eyes watching them & what they do. Which will (hopefully) discourage them from continuing with any inethical practices.
To me, (and this may be opening a Pandora's box) this whole debacle seems to highlight the woeful lack of patient advocates in Singapore. And I say this as a doctor: patient advocacy may very well be exactly what the medical profession needs to stay true to its ethical standards & conduct, and what is needed in order for it to "self-regulate" effectively.
Thursday, March 20, 2008
March 20, 2008
Ministry wants doctors to stop 'aesthetic' treatments
It will act against those who persist with unproven beauty treatments
By Salma Khalik
THE Health Ministry has decided to put a stop to doctors offering patients a range of controversial, unproven beauty treatments.
Banning these treatments threatens to wipe out millions of dollars in business for countless doctors engaged in the lucrative 'aesthetic medicine' scene.
Dr Tan Chor Hiang, the ministry's head of regulations, told The Straits Times last night that they will be advised to 'stop these practices immediately'.
'Recalcitrant doctors will be referred to the Singapore Medical Council,' she warned. The profession's watchdog is already investigating the aesthetic medicine practices of six doctors, including a specialist.
The ministry has been concerned about the booming aesthetic medicine market, estimated to be worth $200 million a year.
Over 1,000 general practitioners (GPs) and specialists have taken to offering a wide range of unproven treatments - everything from fat-busting injections and skin treatments to remove flaws or 'whiten' the complexion, to applications of growth hormones or stem cells for a more youthful appearance.
'This is not medicine,' Dr Tan said. 'Such services should never be offered on the pretext that they are medical in nature and are medically beneficial.'
The ministry began cracking down on such practices from September last year, telling about 20 of the bigger operators to stop.
Prominent plastic surgeon Woffles Wu and anaesthetist Christine Cheng were among those targeted. They complied immediately.
Dr Cheng was unhappy to have been singled out, and asked why the ministry did not inform all doctors.
The ministry explained that it did not realise earlier how widespread aesthetic medicine had become.
'Doctors are also advertising these services more aggressively,' Dr Tan said.
An online check showed close to 30 clinics still promoting the treatments, including mesotherapy which involves multiple injections of drugs to dissolve fat. This treatment is not allowed in some countries.
Madam Halimah Yacob, head of the Government Parliamentary Committee for Health, welcomed the ministry's ban, saying people trust doctors to provide approved and safe procedures.
But she wanted more action to regulate such treatments 'or they may end up in unauthorised beauty salons which could be worse'.
Dr Tan said the ministry's main concern is 'doctors performing unsubstantiated procedures, being unethical and subjecting patients to unacceptable health risks'.
'Without having proper scientific evidence, it is not known whether these practices can cause harm in the medium or long term,' she said.
The ministry is in talks with the Academy of Medicine and the College of Family Physicians to draw up proper procedures and the minimum training doctors need before offering them.
'Once these standards are ready, they can be used for regulating the practice of such procedures,' she said.
Copyright © 2007 Singapore Press Holdings.
I can hear the collective flush of money going down the toilet after reading this today. Many a GP will feel utterly depressed, I think, seeing their profit churning procedures "banned".
My question is: What about TCM? It even has its own regulatory branch within MOH. Using the same words as the ministry's head of regulations: 'Without having proper scientific evidence, it is not known whether these practices can cause harm in the medium or long term'.
Why the discrepancy? Why is it OK for this type of non-evidence based "medicine" to be practised & not another?
Don't get me wrong, I wholeheartedly support MOH's efforts to clamp down on unproven procedures being used on patients. But what I don't appreciate is the double standards.
Sunday, March 16, 2008
Fortunately, turned out to be nothing too serious...syncope due to mild dehydration, due to excessive alcohol intake(!!!).
When the flight attendant first approached me to ask for help, my panicked mind was thinking about the case a few weeks ago where a passenger suffered what sounds like a heart attack while on a flight and died. The inner me was saying, "Oh sh*t, don't let it be a heart problem!" while outwardly appearing as cool as ice.
Anyway, all's well that ends well. That's my adrenaline rush for the day.
Tuesday, March 11, 2008
When losing fat gains you a whole load of trouble
Tuesday • March 11, 2008
THEY offer shortcuts to weight loss at cheaper rates. But as more general practitioners (GPs) enter the growing market for liposuction in Singapore, the problems that arise are proving a costly burden for unwary consumers.
Today understands that the number of complications following liposuction procedures — such as patients going into shock from too much blood loss — is on the rise, with at least one near-fatal incident.
Last week, Health Minister Khaw Boon Wan told Parliament that the Ministry of Health had "unconfirmed feedback" of complications from liposuction done in some outpatient clinics. When contacted, the ministry said it could not comment as "there is a case which is currently under Singapore Medical Council investigation".
Echoing the view of most plastic surgeons Today spoke to, Dr Hong Soo Wan said liposuction was "safe if done properly under well-trained hands in a proper manner" but under inexpert hands, the risks increase.
Infection, for example, could set in if the facility is not sterile or well-equipped, or if the surgery is not done properly.
More common are patients who turn to plastic surgeons for revision surgery — on average, five or six cases in the past year, compared to one or two the year before. At the extreme end of the scale, plastic surgeon Dr Woffles Wu saw as many as 30 cases of botched liposuctions performed by GPs within the past year.
Results include irregular contours, scarring or skin rippling from too much fat removal, said fellow professional Dr Ivor Lim. His patients — women from their late-20s to mid-40s, some of whom are foreigners — were too scared to go to their original doctor and required "a lot of hand-holding" when they consulted him for revision surgery.
Said Dr Lim: "This is affecting our national credibility as a medical centre of excellence. Foreigners think because we are so tightly regulated, if a GP says he's trained, he should be qualified."
Prices advertised by GPs are one huge draw. While plastic surgeon Dr Martin Huang charges "well over $10,000" for a patient who wants "a lot of work done," he estimated a GP's fee would be half that.
But as one secretary in her mid-20s discovered, this can prove a costly gamble. She paid a four-digit sum to a GP for a liposuction procedure — then another five-digit fee to correct the results, after discovering uneven contours along her thigh.
"The doctor claimed he was trained in liposuction. When I raised the issue, the clinic kept saying it would go away," she told Today. It did not even after two years.
So, should GPs and other specialists be allowed to undertake plastic surgery? Or should Singapore go the way of France and Malaysia, which have made it illegal for non-plastic surgeons to perform such procedures?
Some say this call by plastic surgeons for more regulation is motivated by a turf war. There are 35 registered plastic surgeons here and more than 1,400 GPs.
"Plastic surgeons seem to think that GPs and other specialists are invading their turf," said a gynaecologist who also performs cosmetic surgery and liposuction.
"We need to move away from the mindset that you need years of training to perform plastic surgery. Doctors go for a weekend course, but also educate themselves at home. Some train overseas under plastic surgeons, some even practice on dead bodies."
Another GP with training in aesthetics said: "Complications can arise from all forms of surgery, sometimes from the doctor's lack of skills, other times from the suitability of the procedure for the patient."
He has "heard and seen first-hand" the problems arising at the hands of GPs and plastic surgeons.
He added that with newer drugs for local anaesthesia and newer techniques, certain liposuction procedures can be performed in the outpatient setting — with backup plans to evacuate to the nearest hospital if needed.
But Dr Wu is adamant — he points out that while specialists may have surgical training, it is not in plastic surgery.
Dr Huang noted that with many GPs now calling themselves aesthetic physicians or cosmetic surgeons, patients could be misled into thinking they are plastic surgeons.
"We are not saying you can't do this work, but get trained and qualified. Become a bona fide plastic surgeon."
Playing it safe
Check the list of registered plastic surgeons at the Singapore Medical Council website.
A qualified one should have a Fellow of the Academy of Medicine, Singapore (FAMS) in plastic surgery.
Get a fully qualified anaesthetist.
Understand what results to expect from the procedure, eg before and after photos of the surgeon's work.
Provide your doctor with a full medical history.
Copyright MediaCorp Press Ltd. All rights reserved.
Is this MOH's way of making their displeasure known? Let the media "expose" the GPs & stir up the masses before putting their foot down on aesthetics practice by GPs? I wouldn't be surprised. It seems to be the path they are taking .
Let's hope these Chinese bus drivers don't bring their horrible driving habits here to Singapore. And I hope SMRT & SBS Transit puts them through intensive training to get rid of these bad driving habits & teach them some road etiquette before letting them loose on the streets of Singapore.
March 11, 2008
China bus drivers hired as few S'poreans keen on job
120 from China hired; low pay, irregular hours are major roadblocks for Singaporeans
By Yeo Ghim Lay & Jamie Ee Wen Wei
BUS operators are turning to China for drivers as more Singaporeans here shun the job, complaining of irregular hours and low pay.
This is the first time SBS Transit and SMRT are looking beyond Singapore and Malaysia in their efforts to hire more drivers.
SMRT's first batch of 34 drivers from China arrived in January. It has hired about 100 to boost its pool of 1,700, 80 per cent of whom are Singaporeans.
Meanwhile, SBS is bringing in 20 such drivers to start work soon on two-year contracts.
SBS Transit spokesman Tammy Tan said that if its first batch of bus captains from China performs well, it might hire more of them and also consider drivers from other countries.
It currently has 5,200 drivers, 75 per cent of whom are Singaporeans or permanent residents.
For both bus operators, Malaysians make up the rest of the drivers.
Both companies said they are turning to China as they find it increasingly difficult to hire Singaporeans.
It is a problem that has surfaced in the past.
In 2005, the basic pay of bus drivers was raised from $936 to about $1,200 to get more Singaporeans to take up the job.
In addition, as part of a job redesign programme - a larger initiative by the labour movement to get Singaporeans to take up jobs they once shunned - drivers were renamed bus captains, to improve their self-esteem.
The measures worked initially, as the number of Singaporeans signing up rose.
But although salaries have risen since then - SBS Transit says its bus captains earn between $1,600 and $3,500 a month now - hiring Singaporeans is getting tougher.
National Transport Workers' Union (NTWU) general secretary Fang Chin Poh said the revised salaries are still not attractive enough for most Singaporeans, especially given the long and irregular hours.
Bus drivers usually work 10 to 12 hours a day, including overtime, said Mr Fang, a bus captain with SBS Transit for 28 years.
Those who are on the morning shift have to start work at 4am or earlier, while drivers on the night shift get back home at about 2am or later, he said.
They also work a six-day week, and their one day off is not fixed. Breaks between bus trips are usually 10 to 15 minutes, added Mr Fang.
'It is a tough job. Not only do you have to drive and keep a look-out for other vehicles, you have to take care of commuters too,' he said.
NTWU president Lau Lye Hock noted that with more jobs being created by the booming economy, Singaporeans have more job choices now.
Driving a taxi is more attractive than driving a bus, for instance, because the hours are flexible, said Mr Lau.
For its part, the union is encouraging older bus captains to continue working if they are able to, instead of retiring.
But Mr Fang acknowledges that as time goes by, it is likely that Singaporeans will see more bus drivers from China.
Besides the lack of interest from Singaporeans, China drivers also come cheaper, he said.
When contacted, SBS Transit said it is still finalising salaries for its China bus captains, while SMRT declined to give figures.
Before they hit the road, the new hires will be given lessons to improve their grasp of English, said the bus operators.
They will also get other training, including service route familiarisation, customer service and how to handle local road conditions.
One major change for the new bus captains from China: They will have to keep to the left-hand side of the road when driving, instead of to the right as they do in China.
On a different note, I wonder if Singaporeans will react by protesting the importation of foreign talent (again). This is another example of Singaporeans not wanting the "tough" jobs.