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......

Happy Birthday (I think)

You know you are getting older when:

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

Beautiful again

Well, it looks like the recent publicity over the regulation of aesthetic medicine (or rather, the lack thereof) has stirred up quite a hornets' nest. After the initial article which seemed to imply that MOH was going to clamp down on doctors performing scientifically unproven aesthetic procedures & prescribing what was referred to as 'snake oil', MOH has just put out a press release that seeks to clarify its position on this issue (implying that there was incorrect reporting before! I, for one, would have liked to know exactly what a certain reporter's interview notes contained when she obtained the information from MOH).

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

Beautiful no more

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

Mile High SOS

So, the excitement of the day for me was being called to render medical assistance to a passenger on the flight from Singapore back to Beijing.

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

No Money No Talk

And what does this say about our society in Singapore?

You tell me.


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 .

Impressions from Singapore - Dubious Imports

I was quite alarmed to read this in today's Straits Times. I wonder if the hiring managers or whoever makes these decisions in SMRT & SBS Transit have ever traveled on the streets of China before. I certainly hope so. Nightmare, is all I can say.

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.