Internationalising Singapore Healthcare

SMA Lecture 2017 4 November, Saturday, 1 pm to 5 pm Grand Copthorne Waterfront Hotel Singapore Riverfront Ballroom, Level 2 Max 2 CME points

Dr Loo Choon Yong Executive Chairman and Co-Founder, Raffles Medical Group

Dr Loo Choon Yong is the Executive Chairman of Raffles Medical Group. He co-founded the Group in 1976 and was appointed to his current position in 1997 when the Group was listed on the Singapore Stock Exchange. He is also the Chairman of the Asian Medical Foundation Ltd and Raffles Health Insurance Pte Ltd. In the area of public service, Dr Loo was appointed by the President of Singapore in 2015 as the Non-Resident Ambassador to the Republic of Poland. Prior to this, he was Non-Resident Ambassador to the Italian Republic between 2006 and 2015. He was also appointed Chairman of JTC Corporation from January 2013. He was previously the Chairman of Sentosa Development Corporation and Sentosa Golf Club.

Please return this slip for SMA Lecture 2017 to Jasmine Soo, Singapore Medical Association, 2 College Road, Level 2, Alumni Medical Centre, Singapore 169850. Tel: 6223 1264, fax: 6224 7827 or email: [email protected]. A confirmation email will be issued to all applicants. Name: Handphone no.: Email: Profession/Specialty: MCR no.: SMA Member: YES / NO (please circle accordingly)

By registering for this event, you consent to the collection, usage and disclosure of personal Registration (inclusive of GST) data provided for the purpose of this event, as well as having your photographs and/or videos Complimentary for all healthcare professionals taken by SMA and its appointed agents for the purpose of publicity and reporting of the event. news CONTENTS Vol. 49 No. 6 2017 Editorial Insight EDITORIAL 04 The Editor's Musings 20 A Glimpse into the Past – BOARD Dr Tan Yia Swam Medicine in Singapore (Part 10) Editor A/Prof Cuthbert Teo Dr Tan Yia Swam Deputy Editors Annual Dinner Dr Tina Tan 05 SMA Annual Dinner 2017 Reflections Dr Tan Tze Lee Jo-Ann Teo 23 A Walk Down Changi Museum Editorial Advisors Dr Chie Zhi Ying A/Prof Daniel Fung A/Prof Cuthbert Teo Dr Toh Han Chong Event Members Dr Chie Zhi Ying 25 SMA Seminar: Tax Obligations on Dr Jayant V Iyer Medical Practice Dr Leong Choon Kit Jasmine Soo Dr Jipson Quah Dr Jonathan Tan Dr Jimmy Teo SMA CMEP - Professionalism EX-OFFICIOS 26 Resilience Dr Wong Tien Hua Dr Habeebul Rahman Dr Lim Kheng Choon

EDITORIAL OFFICE GP Matters Senior Manager 28 The Smoking Issue Sarah Lim Dr Seow Weibin Senior Executive Sylvia Thay Editorial Executive AIC Says Jo-Ann Teo 10 President’s Welcome Address 30 Power Up Your Clinic Agency for Integrated Care ADVERTISING AND Dr Wong Tien Hua PARTNERSHIP Li Li Loy Tel: (65) 6223 1264 12 Citations for Honorary Members Prof Tan Cheng Lim and A/Prof Cheong Pak Yean From the Heart Email: [email protected] 32 Fighting the Good Fight: PUBLISHER Paediatric Brain Tumour Singapore Medical Association Council News Awareness Day 2017 2 College Road Level 2, Vanessa Lim and Tan Si Qi Alumni Medical Centre 16 Highlights from the Honorary Secretary Singapore 169850 Dr Lim Kheng Choon Tel: (65) 6223 1264 Fax: (65) 6224 7827 Indulge Email: [email protected] 17 17th MASEAN Mid-Term Meeting URL: https://www.sma.org.sg Denise Tan 34 Family Time: Making Every UEN No.: S61SS0168E Moment Count 18 SMA’s Letter to MOH on Patient Privacy Dr Jipson Quah, Dr Daniel Fung and DESIGN AGENCY Dr Tan Yia Swam Oxygen Studio Designs Pte Ltd and Confidentiality under NEHR

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Welcome to the June issue! For those of Mid-Term Meeting in Kuala Lumpur, Dr Tan Yia Swam is a consultant you who took leave to go on overseas and a tax seminar to help private at the Breast Department of KK trips with your kids, I trust that you had practitioners better know their rights Women’s and Children’s Hospital. a good time with them (and meanwhile, and obligations. SMA Centre for Medical She continues to juggle the counting down the days before they Ethics and Professionalism shares commitments of being a doctor, a go back to school!). For those of us who with us techniques on how to build mother, a wife and the increased stayed in Singapore, at least we enjoyed resilience; these tools should help us to duties of SMA News Editor. She also the eased traffic and reduced crowds at resist burnout, in both our professional tries to keep time aside for herself the malls. and personal lives. and friends, both old and new. In this issue, we carry a full report Vanessa Lim and Tan Si Qi were part on this year’s SMA Annual Dinner, of the annual Paediatric Brain Tumour where Minister for Health Mr Gan Awareness Day, which was held on Kim Yong graced the occasion as the 19 February 2017 at KK Women’s and Guest of Honour. Dr Chan Sing Kit and Children’s Hospital. It was a fun-filled A/Prof Goh Lee Gan were conferred event that brought much joy to the Yia SwamEditor the SMA Honorary Membership for brave children and their families. their years of patient care, education and contribution to the profession. In continuing awareness on national Incidentally, A/Prof Goh Lee Gan programmes to promote healthy served as the SMA News Editor from lifestyles, we have Dr Seow Weibin 1985 to 1998, leaving big shoes to fill! writing about the Health Promotion Board’s “I Quit” programme. He At the dinner, SMA President Dr Wong provides a comprehensive overview of Tien Hua highlighted the problem of the impact of smoking, the difficulties escalating healthcare costs and the in quitting the addiction, and the various contributing factors. One of details of how the programme helps the solutions he mentioned was the smokers kick this habit. reintroduction of fee guidelines, which would help both doctors and patients We continue down memory lane know what constitutes reasonable with A/Prof Cuthbert Teo’s historical pricing. Those of you who have been articles, this time taking us through following should know the full history of a harrowing period of our nation’s why SMA had to remove the guidelines history – the Japanese Occupation. (https://goo.gl/esLW2M). Tien Hua Multi-talented Dr Chie Zhi Ying ties in suggested that the Ministry of Health with a poem inspired by her visit to should take the lead in reinstating the the Changi Museum and the tales of guidelines on fees. suffering endured by the prisoners of Other recent SMA events include war during that period. our participation in the 17th Medical Enjoy this read, and whatever jam- Association of South East Asian Nations free traffic there is for the rest of June!

04 JUN 2017 SMA News SMA

2017 ANNUAL DINNER Text by Jo-Ann Teo, Editorial Executive

It was a splendid night at Regent Hotel’sA Royal Pavilionnnual Ballroom on 6 Dinner 1 May 2017, as doctors and friends of SMA convened for this year’s SMA Annual Dinner. Gracing the event as our Guest of Honour was Minister for Health, Mr Gan Kim Yong, who was greeted with a warm round of applause upon his arrival. Other distinguished guests in attendance were Senior Minister of State for health, Dr Lam Pin Min; Permanent Secretary for health, Mr Chan Heng Kee; Member of Parliament, Dr Chia Shi-Lu; and Director of Medical Services, A/Prof Benjamin Ong. The evening’s programme officially commenced as SMA President Dr Wong Tien Hua took to the stage to deliver his welcome address, where he shared key developments and challenges in Singapore’s healthcare landscape. He also thanked all for their presence and support, and introduced 2 the 58th SMA Council.

Conferment of the SMA Honorary Membership The SMA Honorary Membership is the highest possible honour that SMA can present to individuals who are distinguished in public life or who have rendered meritorious service to the medical profession or to the Association. This year, Dr Chan Sing Kit and A/Prof Goh Lee Gan were conferred the Honorary Membership and received the awards from Minister Gan. Throughout her career, Dr Chan has been a mentor and role model to paediatricians here. Before going into private practice in 1977, she was a clinical teacher and examiner for the MBBS (NUS) and MMed (Paediatrics) examinations, MOH and other professional bodies, SMA Merit Awards and head of Paediatric (East) at Singapore including SMA where he was President The SMA Merit Awards were presented General Hospital. Till today, Dr Chan from 1999 to 2001. continues to see patients at her clinic at to four recipients who have contributed Glenagles Medical Centre. A/Prof Goh has Prof Tan Cheng Lim and A/Prof Cheong significantly to SMA, the medical dedicated much of his time and effort Pak Yean delivered the citations for profession, or to social service in the to the profession. For the past 30 years, Dr Chan and A/Prof Goh, respectively community. SMA would like to thank and he served in multiple committees within (see pages 12 to 14). recognise them for their good work.

JUN 2017 SMA News 05 A/Prof Chew Suok Kai has helped 3 in the advancement of public health in Singapore through his leadership roles in the protection of public health, delivery of healthcare services, and regulation of professional and healthcare services. He has received National Day Public Administration Medals (Silver) in 2003 and 2016 for his efforts in overcoming SARS and his leadership contributions, respectively. The next SMA Merit Award recipient is Prof Ho Lai Yun, who has contributed to the advancement of paediatric care in Singapore. In 2010, he received the National Outstanding Clinician Mentor Award from MOH, as well as the Public Service Star National Day Award. A/Prof Toh Han Chong is the third recipient of the award. He is recognised for his work in the field of cancer immunotherapy, immunology 4 and inflammation, and was a recipient of the National Clinician Scientist Award for his pioneering work in cell therapy for cancer. The final Merit Award recipient is Dr Wee Teck Young. Dr Wee has been involved in humanitarian and social enterprise work in Afghanistan for the past 12 years, and volunteers as a mentor to young Afghans with the Afghan Peace Volunteers. For his contributions, he was awarded the International Pfeffer Peace Prize in 2012. Dr Wee could not be present to accept the award in person.

SMA Long Service Awards The SMA Long Service Awards were presented to ten individuals, in recognition of their constant support and service to the Association. 5 10 years of service Dr Liau Kui Hin: Singapore Medical Journal (SMJ) Editorial Board since 2006. A/Prof Lim Swee Han: CPR Training Committee since 2005. A/Prof Poh Kian Keong: SMJ Editorial Board since 2006; SMJ Editor-in-Chief since 2014. Dr N Venketasubramanian Ramani: SMJ Editorial Board since 2006. Dr Tan Yia Swam: SMA Council since 2006; SMA News Editorial Board since 2008; SMA News Editor since 2014. Prof Teo Eng Kiong: SMJ Editorial Board since 2004. Dr Woon Yng Yng Bertha: SMA Council since 2007, Vice-Chair of the SMA Professional Indemnity Committee since

06 JUN 2017 SMA News 2011; Board Member of the SMA Centre oral colonisation in geriatric patients: 6 for Medical Ethics and Professionalism a randomised controlled trial”, which since 2011. was published in the May 2016 issue of Staff SMJ. Dr Chong Mei Chan and Sharifah Shafinaz Binti Sharif-Abdullah received Ms Lin Shirong: five years of service in the award on behalf of their team. the SMA Secretariat. Ms Li Li Loy: ten years of service in the Conclusion SMA Secretariat. It was a delight to see members of the Ms Angeline Teoh Siok Hwa: 20 years of profession – practitioners, pioneers and service in the SMA Secretariat. mentors, friends and partners – gathered 7 to catch up, reminisce and share their SMJ Best Research Paper experiences. Medical students also Awards 2016 had the opportunity to interact with The winners of this year’s SMJ Best Minister Gan Kim Yong, Dr Lam Pin Min Research Paper Awards were selected and other distinguished members of from 74 original papers published in SMJ the medical profession. The evening from January to December 2016. This concluded on a high note and we hope award seeks to encourage the publication to see all of you again next year! of high-quality research papers in the SMA thanks our lucky draw prize journal, and to recognise local and sponsors: 3M Singapore Pte Ltd, Crystal Time regional researchers for their effort and (S) Pte Ltd and novita Singapore, and booth achievements. The winning teams each 8 received a commemorative trophy and sponsor: Summit Planners Pte Ltd for their a certificate, presented by SMJ Editor-in- support. The 58th SMA Council would like to Chief, A/Prof Poh Kian Keong. thank all guests for joining us and for making the evening a special and memorable one. The first prize was awarded to the paper “Can venous base excess replace arterial base excess as a marker of early Lucky draw winners shock and a predictor of survival in trauma?” which was published in the Ms Irene Chen: 3M Littmann February 2016 issue of SMJ. Adj Assistant Electronic Stethoscope (E3200) worth $575.30 sponsored by 3M Prof Ramesh Wijaya received the prize Singapore Pte Ltd on behalf of his team. 9 Ms Yanley Beh: Edox Grand Ocean Dr Lee Le Ye received the second prize Ultra Slim Calibre Watch worth for her team’s paper “Limited benefit of $2,124 sponsored by Crystal Time hepatitis B immunoglobulin prophylaxis (S) Pte Ltd in children of hepatitis B e antigen- negative mothers”, which was published Mr How Ti Hwei: novita AirCare in the October 2016 issue of SMJ. Pro Air/Surface Sterilizer NAS12000 worth $1,899 Placing third was the paper “The sponsored by novita Singapore effect of chlorhexidine in reducing

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Legend 20 1. Minister Gan Kim Yong, our Guest of Honor 2. Dr Lam Pin Min and A/Prof Benjamin Ong catching up with distinguished guests before the Dinner 3. A/Prof Chew Suok Kai, Merit Award recipient 4. Prof Ho Lai Yun, Merit Award recipient 5. A/Prof Toh Han Chong, Merit Award recipient 6. Dr Liau Kui Hin, Long Service Award recipient 7. A/Prof Poh Kian Keong, Long Service Award recipient 8. Dr N Venketasubramanian Ramani, Long Service Award recipient 9. Dr Tan Yia Swam, Long Service Award recipient 10. Dr Bertha Woon, Long Service Award recipient 21 11. Remembering the joyous evening with a "wefie" 12. SMJ Best Research Paper Award recipients with SMJ Editor-in-Chief, A/Prof Poh Kian Keong 13. Sharing a light-hearted moment 14. Medical students posing for a group photo with Minister Gan and Dr Wong Tien Hua 15. Mrs Benjamin Ong and Dr Jeanette Chen 16. Prof Chew Chin Hin and Dr Lee Suan Yew 17. Raising their cups for a toast 18. Dr Tan Tze Lee (far right), emcee for the Dinner, with Prof Lionel Lee and Dr Euan Murugasa 19. Distinguished guests having a photo taken to commemorate the evening 20. Invited guests from Medical Association of 22 South East Asian Nations 21. Mr Chan Heng Kee and Dr Tan Yia Swam engaging in conversation 22. Minister Gan sharing a light moment with Drs Wong Tien Hua, Aline Wong and Chia Shi-Lu

JUN 2017 SMA News 09 ANNUAL DINNER President's Currently, Integrated Shield Plans allow the purchase of riders, which provide 100 per cent cover for private hospital treatments from the first dollar. When policyholders who have purchased such Text by Dr Wong Tien Hua riders are insulated from the cost of their Welcome Address medical bills, they no longer have an The rising cost of healthcare continues look at the problem of rising insurance interest in looking for the best value in to be a prominent issue in our quest to premiums for Integrated Shield Plans medical treatment. This will eventually deliver a world-class healthcare system that currently cover two-thirds of translate to higher insurance claims. for Singaporeans. Singapore residents. As you are aware, Insurance companies that engage Singapore’s current healthcare Integrated Shield Plans supplement third party administrators to manage system can be described as good, MediShield Life by offering policyholders their medical schemes may also fast and cheap. We are able to higher coverage for stays in Class B1 and introduce an additional layer of cost. provide good quality and accessible above wards in public hospitals, and The HITF report states that hospital healthcare, achieving the highest medical treatment at private hospitals. bill sizes have been increasing. It rankings in healthcare indices such The HITF report essentially noted shows a “significant contrast” between as life expectancy, while spending that over a ten-year period from 2005 private and public hospital treatment only a low percentage of our gross to 2015, the healthcare component of inflation. The HITF report also noted domestic product. In fact, improving the the Consumer Price Index (CPI), which that “over-charging and inappropriate accessibility, quality and affordability includes the cost of medical treatment treatment by healthcare providers not of healthcare for Singaporeans is the and health insurance, outstripped only contribute to increases in medical key element of the Ministry of Health’s general inflation. If the CPI for healthcare treatment frequency and charges, but (MOH) Healthcare 2020 Masterplan. continues at this trajectory, healthcare also threaten the patient’s well-being”. The challenge that we face now is costs will soon become unsustainable. This is something of concern to SMA. whether we can continue to maintain Many factors are at play. At the Firstly, on the issue of overcharging, this happy state of affairs in the years population level, the inevitable ageing of SMA is no longer able to comment on to come; that is, can our system our population will lead to an increased overcharging, since our Guideline of remain sustainable? demand for healthcare services. Fees was nullified a decade ago in 2007 SMA was one of the members of On the insurance side, the way an to comply with anti-competition laws. the Health Insurance Task Force (HITF), insurance product is designed affects It is very difficult to determine what which was set up in February 2016 to the way healthcare services are utilised. constitutes overcharging. Singapore

Back row (from left): Dr Wong Chiang Yin, Dr Ng Chee Kwan, Dr Bertha Woon, Dr Lee Yik Voon, Dr Toh Choon Lai, Dr Tan Yia Swam, Dr Tammy Chan Teng Mui, Dr Chong Yeh Woei, Dr Noorul Fatha As’art, Dr Anantham Devanand, A/Prof Chin Jing Jih, Dr Daniel Lee Hsien Chieh Front row (from left): Dr Benny Loo Kai Guo, Adj Prof Tan Sze Wee, Dr Chan Sing Kit, Dr Chia Shi-Lu, Mr Chan Heng Kee, Dr Wong Tien Hua, Mr Gan Kim Yong, Dr Lam Pin Min, A/Prof Benjamin Ong, A/Prof Goh Lee Gan, Dr Tan Tze Lee, Dr Lim Kheng Choon

10 JUN 2017 SMA News Medical Council (SMC) guidance on this SMA has always advocated for interest, the privilege of self-regulation is that the doctor’s fees must be “fair fee guidelines as a means to address that we hold so dearly may eventually be and reasonable”, commensurate with overcharging. We feel that this initiative taken away. the work done, and cannot be so high as is best led by MOH, with input from Business practices that put the to bring the profession into disrepute. various practitioners in their fields of doctor at risk need to be highlighted as So far, the most prominent case of expertise to come up with a range of well. One example is the use of “profit overcharging brought before SMC was fees based on complexity. SMA will be guarantees” when medical clinics are the case of the doctor who charged $24 happy to provide our input as well. bought over by business entities. SMA million in 2012. The second point made by the has previously made a resolution in Many people, including certain HITF report – that of “inappropriate 1998, stating that profit guarantees journalists, use public hospitals’ charges treatment” – is more worrying. SMA place the doctor at risk of unethical as a benchmark against that of private believes that the majority of doctors behaviour. The financial obligation will hospitals. One journalist quoted the HITF in Singapore practise with the highest pressure the doctor to overcharge or report that private hospital bills were ethical standards and provide our provide inappropriate treatments. The about twice that of public hospitals for patients with the best of care based 2016 SMC Handbook on Medical Ethics inpatient treatments, three times more on empathy, professionalism and a specifically mentions profit guarantees for outpatient treatments, and four times relationship of trust. Unfortunately, under the section “Financial conflicts more for day surgeries. there remain black sheep within our of interest”, yet such business practices continue to operate. The problem with comparing profession who place profits before public hospitals’ charges against ethics, personal benefit over patient All stakeholders have a part to play private hospitals’ charges is that it safety, and short-term gains above in managing healthcare costs, and it is is not comparing apples to apples. long-term investments in the doctor- in everyone’s interest to ensure that our Private sector specialists operate in a patient relationship. Being a part of healthcare system does not become competitive market, and their charges the HITF, I have seen examples of unsustainable. As doctors, we have a have to include factors such as rental inappropriate treatment, and personally special duty to ensure that we abide and property costs, staff salaries, and feel saddened that some of our own by the highest ethical and professional the costs of ever-increasing malpractice colleagues resort to such behaviour. standards, so that we can continue to insurance. Obstetricians now pay about SMA will not be averse to bring enjoy the trust that society bestows on us. $25,000 a year in malpractice premiums. such cases of unethical practice to On that note, I would like to thank Private sector specialists also need to the attention of SMC, especially when you for your support of our Association factor in the cost of taking annual leave. patient safety may be compromised. and I wish you an enjoyable evening. Many of our private sector colleagues Bringing such behaviours to light is not constantly worry about whether they are just the responsibility of SMA; each and pricing themselves out of the market, every one of us has a part to play as well. especially with more and more doctors We must not hide behind a wall taking the leap from the public to private of silence, or be party to collective sector. Private sector healthcare is a ignorance or passive disengagement. brutally competitive environment, where This is not considered whistle-blowing profits are not guaranteed and the risk or betrayal of a fellow colleague. of failure is ever present. We have even Instead, let me appeal to your personal heard of some specialists going back to interest because it is ultimately about the public sector after a stint in the so- professional self-regulation. If we protect called “greener pastures”. ourselves at the expense of public

Dr Wong Tien Hua delivering his welcome address

JUN 2017 SMA News 11 ANNUAL DINNER Dr Chan Sing Kit Citation forText by Prof Tan Cheng Lim

When the President of SMA asked me to Boon and Dr Tan Kwang Hoh in Paediatric the state is the only employer and deliver this citation for Dr Chan Sing Kit in East and West, SGH. All their special everyone is an employee). She visited honour of her receiving the SMA Honorary talents must have rubbed onto her. centres in Tashkent; Yereven, Armenia; Membership, I was most happy to do so. Sing Kit graduated from the University and Moscow. This eventually led to It was my good fortune to have had of Malaya (Singapore) with MBBS in 1956 the setting up of childcare centres in her as my mentor for paediatrics in the and served a Government scholarship to Singapore in 1964. late sixties, when I was a medical officer the UK to attend courses, and sat for the Sing Kit continued as senior (MO) and she was the Head of Paediatric membership exams and obtained her consultant and head of Paediatric (East), (East), Singapore General Hospital (SGH). DCH (Lon) and MRCP (Glas, Edin & Lon) SGH till 1977 when she went into private between 1961 and 1963. Sing Kit had a kind and warm practice as a paediatric specialist in personality with a strong commitment She was also awarded a Gleneagles Medical Centre till today. I to patient care and had a way of putting Commonwealth Fellowship to study am not sure where she gets her energy everyone at ease, be it doctors, nurses or neonatology under the late Prof Peter from, but she is still going strong after 40 ancillary staff. Tizard at the Hammersmith Hospital, years in private practice. London, from 1968 to 1969. She was As a MO, she had worked under the subsequently awarded the FRACP in She has also been a visiting late Prof Benjamin Sheares in Obstetrics 1971, FRCP (Glasgow) in 1972 and FRCP consultant to Saint Andrew’s Mission and Gynaecology in Kandang Kerbau (Edinburgh) in 1973. Hospital for children since 1969. Hospital; Prof Gordon Arthur Ransome in I thus continue to marvel at the Medical Unit I, SGH; Prof Yeoh Ghim Seng She was a clinical teacher and commitment, dedication and energy that in Surgery A, SGH; and Dr Elaine Field, examiner for the MBBS (NUS) and Dr Chan has had all these years, serving Dr Quah Quee Guan, Prof Wong Hock MMed (Paediatrics) examinations. She also spent one month on a United as a role model for all paediatricians. Nations Children's Fund grant to study May I present Dr Chan Sing Kit to us all childcare set up in the Soviet Union as someone truly worthy to be conferred (then a Communist country where the SMA Honorary Membership.

Prof Tan Cheng Lim

Dr Chan Sing Kit receiving the SMA Honorary Membership from Minister Gan Kim Yong

12 JUN 2017 SMA News A/Prof Goh Lee Gan Citation forText by A/Prof Cheong Pak Yean

Introduction I am very happy to give this citation for A/Prof Goh Lee Gan on his conferment of the SMA Honorary Membership. I am reminded of how Lee Gan would often begin his speeches by quoting his father’s admonition to make only three points, because any more than that, the audience would forget. So in this citation, I would narrate the three roles he played in the medical profession: first as a servant-leader, second as an academic-teacher and the third as a physician-healer.

Servant-leader Lee Gan was born to lead by serving. He was born in Kuala Lumpur in 1946 to a Chinese school teacher and a housewife. He was the eldest in a large family with A/Prof Goh Lee Gan listening attentively during the delivery of his citation by A/Prof Cheong Pak Yean ten children; his youngest brother being 21 years his junior. From a young age, Lee Lee Gan also laboured relentlessly in A/Prof Cheong Pak Yean Gan learnt to lead and serve. numerous committees in the Ministry of Health (MOH) for the past 30 years. For I first met Lee Gan 55 years ago in his role as Chairman of AIDs Task Force, Anglo-Chinese School when I joined the he was awarded the Public Service Star stage crew of the Drama Society. This (BBM) in the National Day Awards of team that Lee Gan led was the unseen and unsung hands that set the stage for 2005. He also served the community the actors basking in the limelight. This outside healthcare; for example, as a was the servant-leader role that Lee Gan member of the Public Guardian Board played time and again. of the Ministry of Social & Family Development, Singapore. It was therefore not surprising that Lee Gan chose to study medicine, Outside Singapore, Lee Gan was graduating with MBBS from the the Regional President of the World University of Singapore in 1971 with a Organisation of Family Doctors in Asia- distinction in Social Medicine and Public Pacific (WONCA) for six years, from 2001 Health. He then underwent training in to 2007. His professional achievements internal medicine (IM), culminating in were recognised by fellowships conferred the Master of Medicine (IM) in 1977. by many institutions: The Academy of Medicine and College of Family We all know Lee Gan’s immense Physicians in Singapore, Academies of contribution to the medical profession Family Medicine (FM) in Malaysia and the as a servant-leader. He served in various Philippines, and the Royal Colleges of capacities in many professional bodies; General Practitioners in UK and Australia. notably as President of SMA from 1999 to 2001, and as President of the College He also championed training projects of Family Physicians Singapore (College) in Singapore and overseas. He is presently from 2007 to 2011. the deputy team leader of a Singapore

JUN 2017 SMA News 13 tending to the suffering of the chronic sick. He is presently the medical director of Bethany Methodist Nursing Home and also the liaison physician for the Agency for Integrated Care HOME programme in NUH. To him, healing transcends the body. When one colleague became severely depressed and lost his will to live, I saw how Lee Gan carried him by spending an inordinate amount of time being with him. His unconditional positive regard carried the day. He attributed his energies to answering “God’s assignments”, which Ms Chan Swee Swan, the woman behind the successful man he never flinched from.

International Foundation (SIF) project to “No, I am just the midwife.” Midwife Back to family enhance healthcare services for the elderly indeed! In February this year, NUS Lee Gan is happily married to Chan in Yunnan, China, and was SIF’s expert in celebrated thirty years of Academic Swee Swan. Their son, Terence Goh, a FM to Indonesia for ten years from 1995. Family Medicine. consultant plastic surgeon in Singapore Lee Gan is an accomplished General Hospital, happily married Academic-teacher academic. His 60 publications cited Marilyn Liew last year. They are a happy In 1987, Lee Gan left private practice to in the PubMed literature spanned family. I do not want to ask Swee Swan answer the call to start academic FM in the panoply of FM and public health whether she was happy to share Lee the National University of Singapore (NUS). (PH). His present research interests are Gan with us for the past four decades related to FM training,1 assessing mental He was Divisional Head, Department of but certainly, in honouring Lee Gan capacity2 and translational research on Community, Occupational and Family tonight, we are also honouring Swee dementia prevention. Medicine, from 1987 to 2008. When FM Swan for her sacrifice. joined the National University Hospital However, Lee Gan would be As a close friend of Lee Gan, I tried (NUH) in 2008, he took on the role of remembered best by generations of to convince him to say “No” to some of the Head of the Division of FM in the doctors as a compassionate teacher. the onerous demands on his time. But if Department of Medicine for the next He taught FM as a holistic discipline of he had taken my advice, he would not three years. breadth, often reminding his students have lived his life so fully. Many doctors not to be daunted, as we can “eat the FM would be contented to be recognised Lee Gan led many sentinel College elephant in parts”. and MOH committees that laid the as leaders, academics or physicians, but tonight we have the rare occasion to foundation of FM training in Singapore. Physician-healer As Deputy Chairman, FM Committee, honour one of our own as a composite servant-leader, academic-teacher and School of Postgraduate Medical Studies, Lee Gan is a three-in-one generalist physician straddling the world of FM, physician-healer. from 1993 to 2011, he directed its PH and IM. development. Lee Gan was, and still is, SMA President Tien Hua, the stalwart of various FM academic He worked in the joint FM and PH distinguished guests and colleagues, programmes in Singapore. Department in NUS, consulting and I present A/Prof Goh Lee Gan as most publishing papers in both disciplines worthy of being conferred the SMA Presently, Lee Gan is an associate for two decades since 1987. Trained as Honorary Membership. programme director of the National an IM specialist, he continues to run an University Hospital System FM residency IM clinic in NUH. This clinical work, he programme. His teaching tasks range from tells me, provides contemporary and References supervising FM residents in clinical work contextual clinical experience to teach 1. Goh LG, Ong CP. Education and training to helping them develop competency in in various FM settings – ambulatory in family medicine: progress and a proposed research and scholarly activities. care clinics, nursing homes and national vision for 2030. Singapore Med J 2014; 55(3):117-23. For what he has done for FM in community hospitals. Singapore, the FM fraternity rightly 2. Lim HM, Goh LG, Thirumoorthy T. Legal More than just a physician, Lee medicine: assessing mental capacity and considered him the “Father of FM” in Gan epitomised what it takes to be writing medical reports for deputy applications. Singapore, but Lee Gan will always reply: a healer. He is still preoccupied with Singapore Med J 2017; 58(1):18-23.

14 JUN 2017 SMA News LIMITED SLOTS LEFT Date: A ANNU 5 July 2017, Wednesday M A S L time: 12 pm (shotgun will start at 1.30 pm) Venue: Seletar Country Club (SCC) Registration Fees: SMA Member + SCC Member: $40 2017 SMA Member + Non-SCC Member: $140 Non-SMA Member + SCC Member: $100 Non-SMA Member + Non-SCC Member: $220 Early Bird Gift FREE* Sanya Tour Package (4D3N or 5D4N) for ALL PARTICIPANTS! Inclusive of: • Chartered Flight to Sanya, China • A Pair (2) of Return Economy Class Air Tickets by Jetstar • Accommodation, Meals and Sightseeing *Terms & conditions apply

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Report by Dr Lim Kheng Choon

Dr Lim Kheng SMA: Profit guarantees prohibited (IDI, or Indonesian Medical Association) Choon (MD under medical ethics guidelines representatives – Chairman Prof Ilham [Singapore], SMA responded to a Business Times Oetama Marsis and Dr Ihsan Oetama MMed media query and highlighted a SMA – to renew the Memorandum of [Diagnostic resolution published in 1998, stating Understanding (MoU) first signed in Radiology], FRCR 2014. Members of our IDI-SMA Joint [UK]) is Honorary that the financial imperative imposed by Secretary of profit guarantees is incompatible with the Committee also hosted a lunch with the the 58th SMA Singapore Medical Council (SMC) Physician IDI representatives. Council. He Pledge and other ethical principles. Highlights from the MoU include: is currently a senior resident Section H3.1 of the 2016 SMC 1. Members of our Associations should at Singapore Handbook on Medical Ethics also abide by the publicity guidelines of Health Services. mentions that doctors should be careful the other country when advertising not to allow any financial arrangement their healthcare services there. that commits doctors to give a revenue or profit guarantee to a third party, 2. Members of our Associations should as this may potentially influence how not make unsubstantiated laudatory doctors manage their patients. claims or insensitive remarks which undermine the professionalism of The article was published in the doctors in the other country. Business Times on 25 April 2017. 3. Before members of our Associations Access fee for SMJ online organise or participate in talks, CME programme workshops or other activities for the purpose of promoting or advertising Starting from the July 2017 issue their healthcare services in the other of Singapore Medical Journal (SMJ), an access fee will be charged for country, they should use their best participation in the SMJ online endeavours to request for a formal continuing medical education (CME) invitation from the national medical programme. SMA Members will be association, medical specialty bodies granted complimentary access as part of or hospitals. their membership benefits. Please log in with your email and CME and membership activities SMA password to access the SMJ CME on SMA website programme. If you have not logged into Details of SMA's various CME and your SMA Membership portal before, membership activities are available please email [email protected] online at https://goo.gl/Im1HX2. to activate your account and obtain Alternatively, visit https://www.sma.org. your login details. For enquiries about sg, and select “SMA Courses”, followed the SMJ CME programme, please email by “Search Courses for Doctors”. [email protected]. Legend 2017 draft AGM minutes Renewal of IDI-SMA MoU 1. Group photo of the SMA The draft minutes of the 2017 SMA and IDI representatives On 14 March 2017, SMA representatives Annual General Meeting (AGM) was with the MoU met with Ikatan Dokter Indonesia circulated via email to members on 3 May 2017, in accordance with Part 4 of 1 Article XI of our SMA Constitution. If you did not receive the email, or have queries relating to the 2017 AGM, please contact our SMA secretariat by email: [email protected] or fax: 6224 7827. We would also like to take this opportunity to thank members who took time off to attend the AGM on 9 April 2017.

16 JUN 2017 SMA News easily accessible online, along with the COUNCIL NEWS th growing usage of digital and social media platforms, the needs of our patients have changed accordingly. MASEAN Discussed during the meeting were some common challenges that may MID-TERM MEETING arise as the healthcare industry moves into the digital age, such as data protection and infrastructure capability Text by Denise Tan, Assistant Manager, Event and Committee Support in the less advanced countries. Through the presentations and discussions, The 17th Medical Association of 2016, the MASEAN Group of Journals the national medical associations had South East Asian Nations (MASEAN) held its first interim meeting on 25 April the opportunity to learn from the Mid-Term Meeting was held from 2017. Representatives from Indonesia, experience of other countries and 25 to 27 April 2017 at PARKROYAL Malaysia, Myanmar, Thailand, Singapore hopefully to apply what they have Kuala Lumpur, Malaysia. This year’s and Vietnam attended. The mission of learnt back home in their country. meeting was hosted by the Malaysian the MASEAN Group of Journals is to Medical Association and attended by build capability and quality within the MASEAN dinner delegates of the seven ASEAN medical Group through the training, collaboration associations: Indonesia, Malaysia, and development of its members. The 17th MASEAN Mid-Term Meeting Myanmar, the Philippines, Singapore, Collaborative efforts include providing ended with a gala dinner on 26 April. Thailand and Vietnam. The SMA open access to journals and sharing of Malaysia’s Minister of Health, Datuk Seri delegation comprised Dr Wong Tien selected journal articles and abstracts Dr Subramaniam S/O KV Sathasivam, Hua, Dr Lee Yik Voon (Secretary General, on the MASEAN website. Through this graced the event as the Guest of Honour. He expressed his delight in what MASEAN MASEAN), Dr Tammy Chan (Treasurer, collaboration, we envision to be among is doing and encouraged the national MASEAN), A/Prof Mahesh Choolani the top international medical journals. We medical associations to keep up with the (Interim Secretary General, MASEAN look forward to more collaborative efforts collaborative efforts. Group of Journals), and the secretariat from the MASEAN Group of Journals. team (secretarial support for MASEAN Next MASEAN meeting and MASEAN Group of Journals). Scientific Symposium We would like to thank the Malaysian The theme for this year’s Scientific Medical Association for hosting this Pre-conference meeting: Symposium was “eHealth – The way event and we look forward to the next MASEAN Group of Journals forward”. Through the advancement meeting – the 18th MASEAN Conference Following the discussion on “How to Boost of technology, the working processes – to be held in Vietnam in 2018. the Collaboration of our Medical Journals” have changed over the years to allow held at the 17th MASEAN Conference and better productivity and effectiveness, Legend the Asia Pacific Association of Medical and this is the same for the healthcare 1. Delegates at the 17th MASEAN Mid- Journal Editors (APAME) meeting in industry. With information being Term Meeting

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JUN 2017 SMA News 17 council news 18 JUN 2017 JUN 4. 6. 5. Dear DrTong, Singapore 169854 College ofMedicineBuilding 16 CollegeRoad MINISTRY OFHEALTH Regulatory PolicyandLegislationDivision Director Dr PhilomenaTong 2 March2017 the receipt ofSMA’s letter viaemail. deliberated andautonomy, ontheissueofpatient privacy andsent thefollowing letter. MOHhasacknowledged proposed amendments to thePrivate Act. Subsequently, Clinics(PHMC) HospitalsandMedical theSMA Council ofHealth(MOH)officialsmetwith SMA Memberson18 Council November 2016Ministry todiscussMOH’s confidentiality unerNEHR on p SMA's Letter to MOH 2. 1. 3. Privacy Feedback Opting

SMA News This meansthatthepatientmedicalrecordremainsinNEHR butaccessisdeniedtohealthcareprofessionals. information inconfidence. includes theobligationofproviderwhohaveaccessto patientrecordsorcommunicationtoholdthat is privilegedcommunicationbetweentwopartiesaspartof thepatient-healthcareproviderrelationshipand cannot besharedwiththirdpartieswithouttheexpressedconsent ofthepatient.Inotherwords,confidentiality For theavoidanceofdoubt,confidentialityreferstopersonal information divulgedwithhealthcareprovidersthat interchangeably orconflated,especiallywhenweintroducethe NEHRtoallpatientsinSingapore,localorforeign. rights andtoaddressthetwoseparately.Theterms“privacy” and“confidentiality”shouldnotbeused The SMAfeelsstronglythattheNEHRneedstodrawdistinction betweenapatient’sprivacyandconfidentiality Electronic HealthRecord(NEHR). We wishtohighlightSMA’sfeedbackrelatingproposedchangestheActwithrespectNational the PHMCAct,includingmeetingwithSMACouncilon18Nov2016. The SingaporeMedicalAssociation(SMA)thankstheMinistryofHealthforengagingSMAonreview healthcare professionalseventhoughyourhealthrecordintheNEHRwillstillbeupdated.” MOH FAQmentionsthat SMA notesthatapatientcan“optout”oftheNationalElectronicHealthRecord(NEHR).However, Out “Once optedoutoftheNEHR,yourhealthrecordwouldnotbeaccessiblebyanyauthorisedcliniciansand versus on atient priv review Confidentiality of Private Hospitals and

acy and Medical Clinics (PHMC) Act i

7. Privacy is more fundamental than confidentiality. It is the right of the individual patient to be left alone and to make decisions about how personal information is shared. The Singapore Medical Council reiterates this point with the SMC Ethical Code and Ethical Guidelines 2016 stating: “You must always respect patients’ right to privacy and dignity” ii

8. As such, while SMA does not object to the proposed PHMC Act amendment that a clinic or hospital’s participation in the NEHR is a licensing requirement, due consideration must be given to the rights and best interest of the patient.

Patient Autonomy 9. The proposed policy that the patient’s records will be continually updated in the NEHR even when the patient has opted out, by assuring that doctor-access will be blocked, does NOT address the patient’s rights to privacy. It only addresses the patient’s confidentiality rights, and even so, in a rather blunt manner.

10. When a patient opts out of the NEHR, he should be given the choice to forbid his information from being updated in the NEHR. There will be certain negative and indeed permanent consequences of such a decision (as compared to unblocking or blocking access to this information in the NEHR), and the patient should be duly advised of these serious consequences, but he should still be given the option to make such a decision based on his rights to privacy.

11. Once his privacy rights has been addressed, the patient’s confidentiality rights can be accommodated by giving the patient the option on whether his information can be accessed by healthcare providers (i.e. whether to “block” or “unblock” his records).

12. At present, we understand that once a patient gives consent to his data, all doctors with proper clearance can access the patient’s records. There has already been cases reported in the press of unauthorized access of patient data by healthcare providers. Even though a doctor or healthcare professional can be punished for accessing a patient’s records without valid justification, such measures are punitive and retrospective in nature, after the transgression and damage has already been done.

13. In an era of increasing patient awareness, sophistication and empowerment as well as rapid technological advancement, SMA advocates that patients be allowed to decide for themselves what information they wish to reveal to which healthcare provider and that control be imposed prospectively. In such a manner, a patient’s confidentiality rights and needs can be addressed with more finesse and measured control.

Conclusion 14. In conclusion, while the NEHR is in-principle the right way forward, the fundamentals of privacy and confidentiality rights need to be addressed to take into account the different needs of individual patients. By addressing these issues transparently and effectively, we believe that Singapore’s position as a regional medical hub will be strengthened.

Yours sincerely

Dr Wong Tien Hua President Singapore Medical Association

i. https://crms.moh.gov.sg/FAQ.aspx [Under NEHR - “Can I choose to opt out of the NEHR? What will happen if I do so?” ii. SMC Ethical Code 2016, C1(2)

JUN 2017 SMA News 19 INSIGHT

A Glimpse

intoMedicine the in Singapore (PartPast 10) February 1942 to September 1945: The Japanese Occupation Years This is the tenth instalment of a series on the history of medicine in Singapore Text by A/Prof Cuthbert Teo, Editorial Advisor

A/Prof Cuthbert Teo is trained Death of 11 medical and day earlier, the Malayan Broadcasting as a forensic dental students Station had been destroyed. The civilian population (around one million at that pathologist. The An incident that occurred on 14 views expressed in time) was experiencing artillery fire February 1942 – the day before the above article and air attacks, and water was running the British formally surrendered are his personal short. Governor and Lady Thomas had opinions, and do Singapore to the Japanese – has been not represent those memorialised in a bronze plaque. evacuated from Government House of his employer. (the Istana) to the Singapore Club The situation in Singapore around that (in Fullerton Building). The General time is vividly described by then medical Hospital (GH) area was generally safe student Abdul Wahab, a Penang Kapitan compared to Tan Tock Seng Hospital 1 Kling Mosque Scholar. His account is (TTSH), where shell fragments were paraphrased below. flying everywhere – no bombs had By 13 February 1942, the Japanese dropped around the GH except at were only miles from the city centre. A around 4.15 am on 8 December

20 JUN 2017 SMA News 1941, when a few bombs fell near the was held to bury the killed students, given priority and was operated on Federated Malay States (FMS) hostel with prayers said by a Catholic priest, a (Author’s note: by Mr JK Monro, the and the tennis court. At the College Buddhist monk and a Malay imam. Professor of Surgery) at about lunch, of Medicine Building (COMB), several A very moving personal description of despite hundreds of casualty cases and hundreds of people (doctors, College the event was written by Dr Frank Dourado the corridors were all chock-full of beds. staff, blood transfusion service workers, in a 1993 issue of the SMA newsletter: The splinters had entered his liver and friends, relatives, medical auxiliary despite being removed he died shortly workers and students from Raffles “Three days before the fall of after the operation. … [W]e brought the College in Bukit Timah, where there Singapore, we the medical students of corpse back to the Medical College. … was very fierce fighting going on) were King Edward VII College of Medicine We took the corpse on a trolley up to sheltering from shelling, mainly on the were ousted from our quarters in the Professor Young’s house above the hill ground floor. Although the COMB was TTSH, a three-storey student building. prior to burying him in the cool of the spared damage, many of the buildings … We were all dumped in Professor GA evening. At about 3 pm, Kuldip Singh, in the area had collapsed from the Ransome’s Neurological Ward which Hu Chee Tong and myself obtained bombing and shelling, many dead was built on the highest terrain of changkols and proceeded to the top remained amid the debris, and there Tan Tock Seng Medical Wards. … The of the Golf Links near the road under was looting and disorder. The Japanese Japanese guns were within earshot the trees and started digging a grave. of TTSH which was scheduled to be were concentrating their attack on Pasir The terrain was very firm and solid their next target as we found out to Panjang Ridge because of its strategic and despite digging for more than an our cost. … At about 5.30 am in the importance – access to the Alexandra hour, the three of us could make no morning, a shell burst through our area where the British ammunition headway and managed only to dig roof and exploded just above our steel depots were. Some students were at the less than a foot deep. Fortunately for bed. The deafening noise woke me medical college and some were at TTSH. us, we thought then, the rank and file up and I noticed Yoong Tatt Sin on Indian soldiers decided to leave their On 14 February 1942, at about 5.30 my left groaning with pain as he had encampment in front of the College am, a shell exploded in the student splinters into his abdomen, and Emile and went towards Kampong Bahru. dormitories at TTSH, injuring (and Baptist to my right had a huge cut on As they had ready-made trenches later killing) a clinical student from his forehead from a splinter and was we decided to use the first trench to Malacca named Yoong Tatt Sin, who bleeding profusely. … I gave a hand bury Yoong Tatt Sin. The corpse in a was honorary secretary general of the and Mr Young, Professor Ransome’s make-shift wooden coffin covered with Medical College Union (MCU). On 15 Chinese attendant who was in charge a Union Jack Flag was brought to the February, while a group of about 50 of the ward … came to help and side of the trench. I decided to wheel medical and dental students, who were then only bandaged Emile Baptist’s the steel trolley back to the Hospital members of the MCU, gathered to bury forehead which he refused to attend where it was badly needed. Halfway Yoong in an air-raid trench behind to until Yoong Tatt Sin’s abdominal en route, Poon Wai Leng joined me to COMB, there was intense shelling, and wound was bandaged. Strange as it push it. Near the fence surrounding the a group of ten students were killed. The may sound, all the medical students tennis courts we hear the whistle of a students were Hera Singh Bul (pre- under the bed did not come to give a shell coming close. Both of us jumped clinical student from Selangor and MCU helping hand as they must have been instantaneously into the big drain at cricket captain), Chan Kok Loon (pre- frightened out of their wits by the the side of the road and I could hear clinical student from Penang), Abdul blast. Professor Eric McKie who was in the fragments of the shell whisking Hamid Bin Mohd Yusoff (dental student charge then came up to the damaged off the foliage on the side of the road. from Telok Anson, Penang, and MCU ward and shouted to the students to If we had been there we would have hockey captain), Emile Baptist (clinical help. … We carried Yoong Tatt Sin to the shrapnel into our bodies. This shell student from Penang), Teoh Tiaw Teong the main dressing station down the hit the top of the Biology building (pre-clinical student from Penang), road and he was sent to GH Sepoy and a couple of minutes later, when Mabel Luther (pre-clinical student Lines. … In Tan Tock Seng mortuary we were in the Hospital the next from Johor), Henry E Oorjithan (dental … I notice[d] two mortuary attendants shell exploded on the area where the student from Penang), Chen Kok Kuang quarrelling about a purse recovered students were burying Yoong Tatt (pre-clinical student from Singapore), from a corpse. Up comes the medical Sin’s body, killing 11 [10] of them and NP Sarathee (pre-clinical student officer – the pathologist – who solved injuring several others. (According to from Kedah) and Ling Ding Ee (clinical the problem by the simple expedient an account by medical student Abdul student from Perak). On the morning of taking away the purse. … Being a Wahab, one of the shells exploded on of 16 February 1942, a brief ceremony medical student, Yoong Tatt Sin was Yoong’s coffin, partially dislodging

JUN 2017 SMA News 21 in Biology. He was succeeded by Prof Harrower on 19 April 1922, who in turn carried on until his death in 1935 (and was then succeeded by Prof WA Fell). Prof Harrower was said to have been an excellent research worker. More than being an excellent research worker, Prof Harrower was said to have been a very inspiring teacher, who identified himself with students and a student’s life to a marked degree. In recognition of this, the Student’s Lounge or Student’s Club House in the Medical College was named as Harrower Hall. It is not known exactly when the Club House was built, but is thought to have been around 1931, by the conversion of an L-shaped portion of the GH used for isolation cases. the lid, and caused post mortem entrance of Harrower Hall in October Its converted use was for dining and wounds to the chest of the corpse). I 1948. The plaque reads: “In memory recreation, and for a kitchen. Part of remembered Chee Phui Heng coming of the students of King Edward VII the reason for the conversion was because Beaconsfield House, part of to the Hospital. I examined and found School of Medicine who died on 14 the nearby FMS Hostel containing he had a splinter in his gluteal area and February 1942”, followed by their student’s dining and recreation rooms, he was sent to have it removed. … At names, followed by the following four and janitor’s rooms, went into disrepair. about dusk I went back to the College lines “They shall not grow old / As we There was a covered walkway between and straightaway looked for my friend that are left grow old / Age shall not the Club House and the Hostel. FMS Emile Baptist whom I had given strict weary them / Nor the years condemn”. Hostel was the predecessor of King instructions not to join the funeral After deducting the cost of the plaque, Edward VII Hall at that site, and was party because of his injuries. Imagine a balance of $3,374.10 was invested built in 1916 at the expense of the what I felt when I was told that he was to make annual awards for the best Governor Sir Arthur Henderson Young out there in the trenches. Despite it performances at oratorical and literary (Governor, 2 September 1911 to 17 being pitch dark, I was heading for the contests, but with the founding of the February 1920). It was an imposing trenches with a torchlight as I wanted University of Malaya, the balance of the four-storey building overlooking the to be sure he was dead. I was held Memorial Fund was transferred to the GH. It housed 72 male students and back physically by Cheah Chong Ching King Edward VII Medical Society. At the before the Club House was built, its and his uncle Cheah Chong Sin, a unveiling of the plaque, the address only social life was said to have been police officer who was evacuated from was delivered by Dr Gwee Ah Leng, as a billiards table. A second hostel, SS Mandalay hostel, which could house Singapore and deterred from doing so chairman of the first Memorial Sub- 100 students, was built a few years as the army had occupied the area and committee. This plaque was moved to later, again at the expense of the I might have been shot. In the morning the King Edward VII Hall in September Governor. The playing field behind when I turned his corpse over in the 1957 and subsequently to the COMB in the FMS hostel was opened on 14 trench, his wallet which I had given August 1987, where it now sits next to December 1932 by Sir Cecil Clementi him the day before which was loaded the central doorway. (Governor, 5 February 1930 to 9 with money was missing. … With a Professor J Gordon Harrower, MB, ChB, November 1934). A pre-cast sports heavy heart I went back to the safety of DSc, ChM, FRCS, FRSR, was the Professor pavilion was erected on the field in the Medical College building. The next of Anatomy for 14 years at the College. 1934 (it is not clear what happened to day Singapore surrendered.” The teaching of anatomy was essentially this pavilion). A Memorial Fund was started by the a part-time function of government MCU, in memory of the 11 students. medical officers until the creation of a References A total of $4,551.10 was collected. A Chair in 1922. Professor Colonel J Holt 1. Wahab A. Medical students during the Japanese bronze memorial plaque measuring was the first incumbent of the Chair invasion of Singapore, 1941-1942. At the Dawn of the Millennium: 75 Years of Our Alumni. Alumni 66 cm by 114 cm was erected at the in Anatomy and he was also Lecturer Association/Singapore University Press, 2000:36-45.

22 JUN 2017 SMA News Dr Chie Zhi Ying is a family physician A Walk Down working in the National Healthcare Group

Polyclinics. She enjoys Reflections freelance writing and singing. She writes for Lianhe Zaobao, Shin Min Daily News and Health No.1. She can be contacted at Changi [email protected].

MuseumText by Dr Chie Zhi Ying

I had the chance to visit the Changi Museum as part of my secondary school Social Studies curriculum and the trip left a lasting impression. I remember vividly the intricate and inspiring murals drawn by the prisoners of war (POWs) during the Japanese Occupation in World War II (WWII). The many worn-out black and white photographs and torn yellowed letters tell the heart-rending stories of Changi Prison and its occupants, many of whom did not live to enjoy the days of peace. More than a decade has gone by and I recently decided to revisit the site with my family. The serenity and tranquillity of the Changi chapel – a source of strength for the POWs in the dark days – is a stark contrast to the dreary Changi cell which held its occupants in a dark crowded space with little sustenance and poor sanitation. For those interested in delving into the history of Singapore and WWII, the Changi Museum is a must-go. Let’s not forget the sufferings of war and take for granted the peace and prosperity that we are enjoying now.

As the dreary dawn quietly breaks In the little chapel they silently pray POWs shuffled painfully in shackled legs Trying to regain their trust and faith Things swirling around them dark and vague Waiting despondently for that fateful day Minds pondering how long it would take Where fear and desperation can be kept at bay For a divine being to come to their aid Reading letters from loved ones made their day And to leave behind all the suffering and aches Yearning to go home come what may

Under the sweltering hot sun they toiled Whoever doesn’t want peace and harmony? Their clothes all fully soiled Too painful to recall the days of agony Enemies humiliating them so much till blood boiled Now we stand together in unity Hoping all their hideous plans get foiled Proud to forge a common identity Why in the world should they get embroiled? Let’s not forget the past atrocities Their bright futures bleak and destroyed And strive bravely for the betterment of humanity

Living quarters swarming with flies Labouring day in and out like little mice Stricken with diseases, they had no choice This was certainly not blessing in disguise Waking up to constant horrific cries Life had sadly become a game of dice

JUN 2017 SMA News 23 BasicIn collaboration with Health Singapore General Hospital Law (SGH) Postgraduate Course Medical Institute

Programme Speaker Venue: Academia (L1-S3) Adj A/Prof Lee See Muah Time: 1 pm to 5 pm Senior Consultant, Occupational Medicine, CME Points: Max 2 CME 2 September Ng Teng Fong General Hospital Points/Session Introduction to Ms Kuah Boon Theng Health Law and Legal Director, Legal Clinic LLC This course will cover the basic Responsibilities of concepts of health law. Medical Practitioners Adj A/Prof Seow Wan Tew Senior Consultant, Neurosurgical Service, It is relevant to all practising KK Women’s and Children’s Hospital doctors and of greater value to new and/or foreign-trained Dr T Thirumoorthy doctors, especially those Immediate Past Executive Director, SMA Centre for Medical Ethics and Professionalism who have had no previous 9 September education in this area. Mr Edmund Kronenburg Understanding the The faculty will consist of both Managing Partner, Braddell Brothers LLP lawyers and doctors. Elements of Medical Negligence Prof Kumaralingam Amirthalingam Professor, Faculty of Law Chair, NUS Teaching Academy, National University of Singapore 16 September Dr Peter Loke Regional Medical Advisor, Syngenta Asia Pacific Pte Ltd Professional Accountability Mr Christopher Chong and Misconduct Senior Partner, Dentons Rodyk

Please return this slip for SMA Basic Health Law Course to Jasmine Soo, Singapore Medical Association, 2 College Road, Level 2, Alumni Medical Centre, Singapore 169850. Tel: 6223 1264, fax: 6224 7827 or email: [email protected]. A confirmation email will be issued to all applicants. Name: MCR no.: Specialty: Contact no.: Email: Mailing address:

Registration fees (inclusive of GST) 1 Session Full (3 Sessions) SMA members and SGH employees $40 $100 Non-members $100 $250 Please select the following A. SMA member: Yes No B. SGH employee: Yes No C. I would like to register for: 2 Sep 9 Sep 16 Sep Full (3 Sessions)

Mode of payment Credit card Visa/MasterCard no.: - - - Expiry date: / CVV2/CVC2 no.: Cheque (payable to Singapore Medical Association) Bank: Cheque no.: Signature: Date:

By registering for this event, you consent to the collection, usage and disclosure of personal data provided for the purpose of this event, as well as having your photographs and/or videos taken by SMA and its appointed agents for the purpose of publicity and reporting of the event. SMA Event Seminar: Tax Obligations on Medical Practice Text by Jasmine Soo, Executive, Event and Committee Support

On Saturday, 8 April 2017, the Tax relevant matters, including obligations Obligations on Medical Practice seminar as a self-employed person, tax filing was held at One Farrer Hotel & Spa with obligations of companies, goods over 80 participants in attendance. This and service tax (GST) obligations, the year’s seminar covered the following importance of keeping proper records, Mr Stephen Chew, Principal topics: CorpPass, Tax Obligations of a filing income tax returns, and avoiding Consultant, Summit Planners Pte common errors for income tax and Medical Practitioner, Productivity and Ltd, shared on the overview budget GST. Mr Shahajan also shared that the Innovation Credit (PIC) Scheme, Budget 2016 and how it supports doctors that objective of the enhancement and 2017 and its relevance to medical are venturing into innovation and extensions of the corporate income practitioners, and Tax Planning. exploring foreign markets by affording tax rebate is to help companies cope We were honoured to invite easier access to Government grants with economic uncertainty and to Ms Elita Lawalata, Manager, and support. He also mentioned that continue restructuring. Product Management, Government the 2017 budget is all about moving Technology Agency, who updated Mr Lo Yeow Fong, Senior Tax forward together, having a strategy us on the changes in CorpPass. Officer, Inland Revenue Authority of rather than a plan, and enacting policies CorpPass is a corporate digital identity Singapore, spoke on the PIC Scheme, which can help, especially with external for businesses and other entities which included an overview of the environment changes. (such as non-profit organisations scheme, tax benefits, how to claim PIC, and the qualifying activities. Changes SMA would like to take this and associations) to transact with opportunity to thank all speakers and Government agencies online in the PIC Scheme took effect from 1 August 2016, where there was a participants for allocating time in their conveniently and securely. More busy schedule to speak and attend than 200 Government digital services reduction of the cash payout rate for qualifying expenditure incurred on or Tax Obligations on Medical Practice managed by about 60 Government and also all booth sponsors, namely agencies will require CorpPass as a after 1 August 2016 from 60% to 40% (the cash payout rate is not determined DBS Bank Ltd, Plato Medical Pte Ltd login method by December 2017. by the date of submission of the cash and Summit Planners Pte Ltd, for their Mr HS Shajahan, Principal Tax payout application) and compulsory generous support. Auditor, Inland Revenue Authority of e-filing of cash payout applications. Singapore, spoke on tax obligations of Hard copy applications are no longer Legend a medical practitioner. He elaborated on accepted from 1 August 2016 onwards. 1. Participants during the panel discussion

1

JUN 2017 SMA News 25 SMA CMEP – PROFESSIONALISM Resilience Text by Dr Habeebul Rahman, Teaching Faculty, SMA Centre for Medical Ethics and Professionalism

Resilience is a term which has to bounce back from adversity. But that entered the current conscious in a would be akin to describing a bicycle big way over the last decade. In the ride to someone who has not ridden field of medicine, there is increasing one before. recognition that doctoring is hard To truly capture the essence work, and that it takes a toll on the of resilience, one must understand practitioner in ways that we have not three concepts: imagined before. Left unchecked, the syndrome of burnout takes over, 1. Adversity is a part of normal where the individual experiences experience as we go through life. symptoms of emotional exhaustion, 2. How we cope with adversity depersonalisation (experiencing events determines our resilience. as unreal), or being unable to have a 3. The repeated cycle of overcoming sense of personal achievement from adversity and being able to the good work that they do. However, withstand greater adversity endows burnout is often insidious, and until us with increasing resilience. a significant event occurs, such as a preventable mistake or a serious health We often work towards reducing scare, it largely goes undetected. Long- stress in our lives, because we have term sequelae include impairment of been told that stress is a bad thing. So professional function and development shouldn’t avoiding stress be the simple of psychiatric disorders. answer to avoiding burnout? Evidence is to the contrary: there are various In data from local research, burnout forms of stress and just like cholesterol, is present in more than half the doctors some are good and some are not. surveyed, ranging from junior doctors Healthy engagement with, rather than to consultants.1 Significantly, there were running away from, the source of the low rates of personal accomplishment. stress, is what predicts future success Among the most vulnerable were junior and happiness. doctors who have spent less than two years working in the local system, or How then do we go about improving who were socially unsupported. our resilience so that we are not overwhelmed? We all have resilience However, while there has been much factors that we have used and perfected interest in burnout and its impact on along the way. Foremost of which are the medical profession, with resilience relationships, which in a strange way, touted as a means of overcoming while being a great source of stress burnout, definitions of resilience are still in themselves, do hold the key to us poorly understood. managing stress in general and building our resilience. Healthy relationships Defining resilience with family members, friends and One simple way of appreciating colleagues are great places to start to resilience is to see it as a person’s ability build resilience.

26 JUN 2017 SMA News The things we do can also make a to practise effectively contributes to Dr Habeebul is a difference. They could be in the form of our sense of “agency” or to being able senior consultant spirituality, religion, exercise, or limited to make a meaningful change from our psychiatrist at Tan doses of “retail therapy” and activities own efforts. The most important thing Tock Seng Hospital that engage our natural endorphins and is to recognise that something needs (TTSH), Department increase our sense of contentment. to be done because the stress of which, of Psychological if left unnoticed, will snowball into Medicine. Prior to A change in outlook is another something much harder to deal with attaining specialist good way of improving resilience. The accreditation, he further down the road. Change needs American Psychological Association has completed a thesis to happen right away – in the same way published ten ways which will help to on resilience within that vaccination against a potential doctors, and serves make a difference. They are: pathogen is only useful before actual as chairperson of 1. Make connections exposure has occurred. TTSH’s peer support programme. 2. Avoid seeing crises as Resilience is not a concept unknown insurmountable problems to doctors: primary healthcare is 3. Accept that change is part of living about developing physical resilience, and once illness sets in, we work to 4. Move towards your goals encourage resilience through the 5. Take decisive actions course of treatment. It is time we turn this useful tool to ourselves. To take 6. Look for opportunities for the idea one step further, are we able self-discovery to not just bounce back from adversity, 7. Nurture a positive view of yourself but to emerge even stronger in the 8. Keep things in perspective phenomenon dubbed “antifragility”? 9. Maintain a hopeful outlook The answer starts with being resilient – rather than resistant – to change. 10. Take care of yourself

Developing resilience Reference At this point, it is important to note 1. Teoh L, Rahman H, Chew NWM. Burn-out in Hospital Registrars. Ann Acad Med Singapore that everyone is different, and so are 2011; 40 suppl 11:S280. our preferred resilience factors. If Further readings picking up a sport does not appeal to you, perhaps some meditation or 1. Zwack J, Schweitzer J. If every fifth physician is reflective writing would do just as well. affected by burnout, what about the other four? Resilience strategies of experienced physicians. Resilience strategies can also differ Acad Med 2013; 88(3):382-9. between various medical subspecialties 2. Jensen PM, Trollope-Kumar K, Waters H, – research suggests that while GPs Everson J. Building physician resilience. Can Fam obtain gratification from the doctor- Physician 2008; 54(5):722-9. patient relationship, interventionists 3. Graham J, Albery IP, Ramirez AJ, Richards MA. may obtain greater gratification from How hospital consultants cope with stress at their medical efficacy. While at work, work: implications for their mental health. Stress it is important to build professional and Health 2001; 17(2):85-9. relationships and have a clinical 4. Taleb NN. Antifragile: Things That Gain From variety. Ensuring that we have time Disorder. Random House, 2012. away from work actually contributes to 5. American Psychological Association. The maintaining a passion for work. Being Road to Resilience. Available at: http://www. able to prioritise and manage time and apa.org/helpcenter/road-resilience.aspx.

JUN 2017 SMA News 27 gp mattersgp

It is no secret that smoking has profound public health implications across the globe. According to the World Health Organization, there are over one billion smokers in the world, with tobacco use being responsible for the deaths of around six million people a year. It is the only known product that can potentially cause up to half of its users to die prematurely, by an average of 15 years.1 To put an end to this infliction, many countries have put in place measures Text by Dr Seow Weibin to control tobacco, such as taxation, advertising bans, public education and cessation programmes, and sales control. In Singapore, this is no different. Singapore recently announced that the minimum legal age for smoking will be raised from 18 to 21. Countries such as the US, Malaysia and most recently, Thailand, have also made similar moves to raise their minimum legal age. With statistics showing that 95 per cent of smokers in Singapore had their first cigarette before the age of 21,2 increasing the legal age was done with the aim of reducing youths’ exposure to tobacco products at a juncture in their lives when they are more susceptible to peer pressure and nicotine dependency. While policy measures are useful in deterring one from picking up his/her first cigarette, focus also needs to be placed on helping those looking to quit the habit.

Supporting attempts to quit In Singapore, the Health Promotion Board’s (HPB) I Quit programme has been offering smokers a support network to help them quit smoking. By rallying a community of supporters, a boost of confidence is given to smokers to take the first step to quitting – taking a pledge to go smoke-free. The focus on building a support network is a shift from the scare tactics used in previous anti-smoking campaigns.

28 JUN 2017 SMA News The first few weeks are generally GPs are often seen as a reliable successfully quit smoking, with many the most difficult part of a smoker’s and knowledgeable source of health smokers citing a lack of motivation or quit journey. During this time, there is information. We should leverage on our self-confidence as reasons why they a constant struggle against the urge doctor-patient relationship to positively gave up their quit attempts.3 to slip back for another cigarette. The influence and educate our patients on HealthQuay Medical, a holistic I Quit 28-Day Countdown programme the benefits of a smoke-free lifestyle. medical clinic, leverages on the I Quit helps to break down the process into An example would be to incorporate programme to guide and support daily actionable steps. This community- smoking cessation advice as part of our smokers who want to quit. Patients who based but personalised approach has consultation with patients. are looking to start their quit journey reaped success. According to HPB, more I have met many smokers who are encouraged to sign up for the I than 16,000 smokers signed up for the I want to quit but are often daunted Quit 28-Day Countdown by calling the Quit 28-Day Countdown programme in by the process. I find it useful to get QuitLine at 1800 438 2000. 2016. One in five smokers successfully a thorough understanding of the The decision to stop smoking is a stayed smoke-free over the 28-day smoker’s profile and the motivation personal and difficult one. Smokers period, which is a ten per cent increase behind his/her reason for wanting to will need strong support from their from 2013. quit. This allows me to customise my loved ones and medical professionals, smoking cessation advice and tips The 28-day programme uses tools as well as public education programmes according to the challenges they face. such as a countdown calendar that such as I Quit, to increase their chances provides daily tips and encouragement, I recall a story of a 35-year-old of quitting. as well as a supporters’ guide to assist patient who had tears in his eyes as he recounted how he found out the smokers in their quit journey. References Several of my patients have successfully that he had a large tongue ulcer two weeks prior. He consulted an ear, nose 1. World Health Organization. WHO report gotten through the first few weeks on the global tobacco epidemic, 2008: the with these aids, which include daily and throat specialist and had to do a MPOWER package. biopsy as the ulcer was suspected to be motivational exercises, such as getting 2. National Health Surveillance Survey 2013. cancerous. He decided to stop smoking them to write down their reasons for 3. R West, J Stapleton. Clinical and public health wanting to quit and having family because of the incident. However, he significance of treatments to aid smoking members organise activities together to kept the incident from his wife as he cessation. Eur Respir Rev 2008; 17(110):199-204. distract them. did not want her to worry and because of this, he felt isolated and frustrated It also helps that I Quit offers several in the early days of his quit journey. I Dr Seow Weibin is other support services. With the currently working at felt both encouraged and worried for HealthQuay, a holistic QuitLine service, daily SMS reminders him at the same time. I was encouraged private practice, providing tips and motivation, and a because of his strong desire to quit, together with a Facebook community club for smokers but worried that he might find it too team of dietitian and physiotherapist. and ex-smokers to share advice and difficult and give up. I drew up a quit He enjoys spending success stories, the quit journey can plan with him, taking into account time with people. be made less daunting. HPB has also his motivation and social support. By He understands the worked with the healthcare community assuring him that mood changes were struggle of keeping a healthy lifestyle and to offer free advice at over 280 locations common and that pharmacological tries his best to lead across Singapore so that smokers can agents are available to relieve his by example. access such support easily. withdrawal symptoms, he felt more at ease and had a renewed determination The role of GPs to continue on his quit journey. I Quit is evidence that public education Quitting can be a great challenge efforts can go a long way in reducing for those who have been smoking smoking rates in our nation. As GPs, we for a long time. Studies have shown have an opportunity to play an active that it takes a smoker an average of role to complement this effort. six to seven attempts before they can

JUN 2017 SMA News 29 30 JUN 2017 SMA News

From the Heart Fighting the Good Fight:

Paediatric Brain Tumour Awareness Day 2017 Text by Vanessa Lim and Tan Si Qi

“I am brave because…?” In Singapore, brain tumour is the He paused for a long time, marker in second most common childhood one hand, balloon animal in the other. tumour, with over 40 young patients Our young patient was asked to share undergoing treatment in public hospitals something that he was proud of for our every year. Moreover, paediatric brain “Hey Little Fighter!” photo montage. tumours are different from adult brain “Come on, tell them that you returned to tumours because childhood cancer prepared script midway and spoke from school and recently passed your Primary tissues grow more rapidly, together his heart instead. It was heartening School Leaving Examination (PSLE)!” His with the fast-growing tissues of the to see our audience taking photos of mother beamed at him, radiating a warm child. In addition, brain tumours and its the informative presentation slides sense of pride. treatments are associated with long- prepared by the doctors, as well as the term effects of growth and neurological This child, along with 38 other brave waves of emotions that were displayed development. Some children also face paediatric brain tumour survivors, throughout these talks – an important side effects, such as scars or hair loss, was part of a special group of children reminder to us that science, medicine that they carry with them on their who took part in the third annual and humanity all go hand-in-hand. journey. It is thus essential to increase Paediatric Brain Tumour Awareness public awareness on the severity and (PBTA) Day, held on 19 February 2017 Performances for children prevalence of paediatric brain tumours. at KK Women’s and Children’s Hospital Running concurrently with the talks (KKH). Launched in 2014, PBTA Day is were the music performances for an annual event organised by a team Community education programme children, which included “Let It Go” of Duke-NUS Medical School (Duke- from Frozen, pop songs by Duke-NUS NUS) students, to provide support for This year, we expanded our pre-event Jam Band, pieces by the East Coast the affected patients and families, and publicity efforts through social media Choir and last but not least, the Mascot also to raise public awareness about campaigns, paediatric brain tumour trivia Dance, all in an enclosed, balloon-filled paediatric brain tumours. games, and educational talks for our auditorium. It was heart-warming to volunteers and performers. We hoped see the children singing along to the that with a better understanding of the performances, and the mascot dance 1 kids that they would be interacting with finale saw many children going up in the event, stronger rapport and longer- on stage, with many more within the lasting bonds will be made. audience, dancing enthusiastically.

Educational Speaker Series Interactive booths and mascots PBTA Day 2017 started off with a series Laughter filled the air as children raced of educational talks on paediatric their toy boats in the inflatable pool, brain tumours. While these talks have challenged themselves to memory Photo: Denise Lee previously been geared towards parents card games, attempted puzzles and of paediatric patients, the Educational questions, and knocked down bowling Speaker Series was open to the pins. In addition, they claimed their public this year. The various speakers free ice cream from Stickhouse’s ice offered insights from different areas of cream station, tried their hands at the expertise, ranging from neurosurgery interactive booth set up by Science and oncology to psychology. Nashrul Centre Singapore, and requested for Rasman, a 20-year-old paediatric various balloon swords, flowers and brain tumour survivor, also shared his animals from our friendly balloon personal story, where he discarded the sculptors. To create cute mementos of the event, children adorned themselves Abdul Lateef, gave a meaningful speech with accessories and took photos sharing her belief in the strength of our 3 with their families at the photo booth. little fighters. All eyes were on the thirty Buzz Lightyear, Woody and Jessie Porsche cars as the air horn sounded joined in the fun as well! The children brightly for the flag-off. subsequently visited the arts-and-crafts The event ended on a gleeful note station to decorate their photos in pretty as the cars zoomed off with the excited customisable frames to take home. Over children passengers. It was indeed a fun- the span of the day, the children also filled day of laughter and love. filled their booklets with stamps, which BryanPhoto: Chen Xiangdian could be used to claim exciting prizes. He peeked at us with a shy smile. This is a special boy who has been through more SMA and the SMA Charity Fund than anything his peers have experienced. “Hey Little Fighter” support volunteerism among our Returning back to school, and passing his photo montage profession. SMA News provides PSLE exams. Standing tall, fit and happy We wanted to empower the voices charitable organisations with may seem trivial to others, but are incredible and self-confidence of our little heroes complimentary space to publicise milestones for little fighters like him. by creating a “Hey Little Fighter” their causes. To find out more, photo montage, allowing them to fill He wrote, with some slight hesitation: “I email [email protected] or visit in the blanks “I am brave because…” am brave because... I put in effort”. the SMA Cares webpage at https://www.sma.org.sg/smacares. Throughout the course of their illness, Once again, these kids continue to many children lose confidence in their inspire us. Through love and support for abilities. Yet, we wish to see them each other, let us continue this spirit of Legend acknowledge their struggles and realise PBTA Day 2017, celebrate the strength of 1. 20-year-old Nashrul Rasman, a paediatric their strengths. It was a celebration of our little fighters and make each day more brain tumour survivor, shares his inspiring hope as each of them held their markers meaningful than the last. journey at the Educational Speaker Series deep in thought. 2. A participant posing with Toy Story Mascots Our thanks from Duke-NUS Medical School Porsche joy car ride We would like to thank our mentor, 3. Porsche cars line up outside KKH for the joy ride with children with paediatric brain tumours At 1 pm, shiny Porsche cars made a Dr David Low, and our various partners grand appearance as they filled up and sponsors from Duke-NUS, KKH, the entire driveway of KKH’s Women’s SMA Charity Fund, VIVA Foundation, Tower, much to the excitement of the Brain Tumour Society (Singapore), Vanessa Lim crowd. One could not help but notice Science Centre Singapore, Porsche Club and Tan Si Qi are second year the heart-warming interactions between Singapore, The Cocoa Trees, Exquisite the drivers and their assigned child medical students Technique Singapore and Stickhouse passengers as they mingled at the (Duke-NUS for making PBTA Day 2017 possible. Class of 2019) booths, taking pictures and exchanging and the head of conversation. One driver-child pair even You can find out more about PBTA programmes and planned to head over to McDonalds after Day at our website, http://pedsbta. head of publicity the event! The Guest of Honour, Member wix.com/pbta, or our Facebook page, for PBTA Day of Parliament, A/Prof Fatimah binte https://www.facebook.com/pedsbta. 2017, respectively.

2

JUN 2017 SMA News 33 Photo: BryanPhoto: Chen Xiangdian INDULGE Family Time: Making Every Moment Count Text and photos by Dr Jipson Quah, Dr Daniel Fung and Dr Tan Yia Swam

Working hours for medical professionals are often long and demanding, leaving little time and energy for oneself and their families. SMA News approached three of our Editorial Board Members to find out how they spend quality bonding time together with their families. 1

Dr Jipson Quah playgrounds at Marina Square and Suntec City, respectively. As my peers and I approach our thirties, we face an impressive myriad of Another enjoyable activity would responsibilities. Many of my peers are be weekend meetups with friends grappling with issues like managing their and colleagues over tea, but with an finances, getting married, purchasing a evolutionary twist. By that, I meant tea house, and getting through residency parties with the daughters. The parents and postgraduate examinations, will sit around and sip our imaginary among others. Here, I give another tea, while the children bake their make- snapshot of my life as a junior doctor – believe cakes and delicacies with the aid juggling a young family on top of work of their toy tea sets and Lego pieces. responsibilities. As all parents will have After dinners on most days, I try to realised by now, everything revolves do my fair share of teaching by reading around your children. to them both in English (mostly) and In between histopathology Chinese (as best as I can). Occasionally, reporting work and studying, I try we would do some spelling and play mathematics games to keep the learning to spend whatever precious time I 2 have with my wife and daughters. fun. Bahasa Indonesia is beyond me, so Most recently, we brought our eldest I leave the teaching of the language to my in-laws. It is quite surprising to see daughter to Sydney where I was how much the little ones pick up just by attending the Pathology Update Legend listening and observing. 2017 conference, and we did some 1. Dr Quah’s wife sightseeing and shopping. We even When time and energy permit, we and daughters visited a number of zoos and parks will also play music and sing together. 2. Dr Quah’s daughters where my daughter had a great They enjoy watching my wife and I play enjoying themselves at amount of adventure. Keeping her the piano (they do join us to tinkle at the the Pororo-themed meaningfully occupied is very often keyboard) and they sing and dance along indoor playground our foremost preoccupation during at times. My wife and I do not watch 3. Celebrating my eldest our holidays. much TV on our own these days. Instead daughter, Grace's 21st I accompany the girls while they watch birthday three years ago One of my children’s favourite children’s TV programmes like Ben and 4. Family holiday to pastimes is visiting the indoor Holly’s Little Kingdom, Team Umizoomi and celebrate Joyce's 50th playgrounds. Yes, Daddy has brought PAW Patrol. Not only does it help me relive birthday at Luang Prabang them to quite a number of such my childhood days, but it also serves as 5. CL captaining a boat playgrounds, especially during the an excellent family bonding activity and at my friend's son's public holidays and weekends. These creates more relatable conversational birthday party places are relatively safe and fun, topics between all of us. 6. CJ wearing a different often with some enrichment activities After all that is done, it is time to hit kind of mask from the one I or children's shows. They love to run usually wear around in the colourful play zones and the books (or bed)! navigate through the mazes. While we let them explore to their hearts’ delight, Dr Jipson Quah is currently a resident in the we also ensure that they do not run into Department of Histopathology at Singapore General Hospital. He enjoys music-making, fitness- other children. I particularly like the related activities and editorial work in his free time. Pororo- and Polliwogs-themed indoor

34 JUN 2017 SMA News Dr Daniel Fung we hope to make this an annual event. In fact, a friend of ours has It is hard after years of raising small and an inheritance from an aunt who adorable children (both at work and at dictated that the money can only home) to have to face tall adolescents and young adults who are no longer be spent on family holidays, which as cute as they used to be. My wife, is a great idea in my opinion. Finally, Joyce, and I discovered our empty great family time can occur when a member is performing (Joyce nest recently as we realised that our 3 regular time for family get-togethers and her choir) or having an event 4 (ie, meals and visits on weekends important to them (Grace getting to family gatherings and outings) her membership confirmation in became increasingly small in terms of church). The key to spending time attendance. These days, we have to with the family is learning to evolve specifically make time for family get- the practices and innovate on new togethers. Fortunately, we still have the opportunities. After that, I guess we regular birthday celebrations and in our will be waiting for our grandchildren family, that’s at least seven times a year, to bring us full circle. not including the grandparents, aunts and uncles, nieces and nephews. Dr Daniel Fung used to be a part-time professional and a full-time father of five A regular family holiday also helps. children. He realises that he is now a full-time The draw for our kids is the free trip and child psychiatrist and a grandfather wannabe.

Dr Tan Yia Swam rarely went out as a family except maybe Weekends: we bring them out to to bring CJ down to our condominium’s East Coast Park and Bishan Park, or When we had our first son, CJ, both my pool or playground, or to the nearby just around the neighbourhood to husband and I were still in general surgery shopping mall. swim, scoot or cycle. I would check out advanced specialist training at Tan Tock mummy blogs to read up on family- Seng Hospital. Some thought that we By the time our second son, CL, friendly restaurants or shopping malls, got to spend a lot of time together, but came along; we were both associate and organise playdates with CJ’s friends. the truth is that we always made sure we consultants, with a bit more control over Sunday is laundry day, which is no joke were in different subspeciality teams and our time. when it comes to four people’s clothes, hardly ever did calls together to keep Our daily routine had a small underwear, towels and bedsheets. If work and personal life separate. Thus, improvement: there’s a special occasion, like the recent we probably spent more time with our Star Wars Day at Gardens by the Bay, we teammates than with each other! 7.10 am: drop CJ and CL off at childcare (with CL kicking and screaming) would try our best to go for it! We did our respective outrotations (I Ultimately, we realised that it is not went to National University Hospital and 7.35 am: ward round and work how much time we have, but how he went to Singapore General Hospital), 6 pm: pick CJ and CL up (grandparents we make the most of it. It takes a bit took our exit examinations at different rarely needed unless the husband has of juggling and planning, and lots of times, and each of us stepped up to be the a long case in the OT or I have a work support and understanding from friends, more involved parent while the other was meeting). Dinner is tingkat (Malay for colleagues and family. busy. Somehow, we made it through. tiffin carriers) delivery

Our routine then was quite standard: 9 pm: bedtime routine for CJ and CL (with Dr Tan Yia Swam is a consultant at the Breast 7 am: drop CJ off at childcare CL kicking and screaming), household Department of KK Women’s and Children’s chores, sleep and it begins again Hospital. She continues to juggle the 7.30 am: ward round and work commitments of being a doctor, a mother, a wife and the increased duties of SMA News Editor. 7 pm: one of us had better pick up She also tries to keep time aside for herself and CJ on time (or risk a $10 fine for every friends, both old and new. five minutes past 7 pm), or get the grandparents to help. Tabao (Chinese for takeaway) dinner from the kopitiam 6 9 pm: bedtime routine for CJ, household chores, sleep and it begins again Weekends: as registrars, we could usually arrange one day off each, so one would stay home to look after CJ, while the other one rounded and cleared whatever emergency there was. We 5

JUN 2017 SMA News 35 SALE/RENTAL/TAKEOVER POSITION AVAILABLE/PARTNERSHIP Serviced clinic for rent at Mount Elizabeth Novena ONLY Clinic: Here's your chance to build your career/ Hospital. Fully equipped and staffed with IT support. medical credentials with Singapore’s largest medical Immediate occupancy. Choice of sessional and long term aesthetic group & yet be rewarded with attractive lease. Suitable for all specialties. Please call 8668 6818 remuneration package! If you’re an experienced or email [email protected]. aesthetic doctor who’s passionate about helping people to transform, apply now: [email protected]. Gleneagles Medical Centre clinic for rent. 400 sq ft. Waiting area, reception counter and consultation room. Minmed Clinics invite doctors to grow with us. Good Immediate. SMS 9680 2200. remuneration with profit-share options. Excellent clinic locations in shopping malls. Please call or text 9009 2899 Buy/Sell clinics/premises: Takeovers: (1) D14 Ubi; (2) D10 for a catch-up! Bt Timah; (3) D14 good crowd; (4) D19 Heartland central. Rental: (a) D21 share with specialist, MRT (b) D05 HDB clinic Full Time Physician $15,000 to $23,000. Mon-Fri: space (c) D10 near Holland Village (d) Novena Medical 9am-6pm; Sat: 9am-1pm & on call at home 1 trip/ Centre. Hp: 9671 9602. day; Mon-Sat: 6.30pm-11pm; Sun & PH: 9am-6pm. Gleneagles Medical Centre clinic for rent/sale. 670 sq Email: [email protected] or SMS 9734 3087. ft. $11,000/month or $10,000 psf. Negotiable. Available immediately. Please SMS/call 8354 4530. Expanding GP group looking for motivated doctors to join. Long term view with significant Clinic in CBD for takeover. Arcade 11 Collyer Quay. Next profit-sharing and partnership in mind. to Raffles Place MRT. 1367 sq ft. Suitable for medical/ Please contact us at 9765 1525 or email us at dental practice. Available from July 2017. Please call [email protected]. Amara at 9336 5788. Established medical aesthetic group in CBD area Medical clinic for rent at $6,500/month. Newly renovated looking for motivated doctors for expansion. Full or shop house facing main road and with good wide part time considered. JV partnerships are welcomed as frontage. 2-min walking distance to Farrer Park MRT. well. Applicants must have COCs. Experience in medical Please sms 9137 7787. aesthetics preferred. Please email detailed resume to: [email protected]. RP Medical Specialists | Clinic space with well-equipped Established clinic looking for resident doctor. Clinic in consultation rooms, registration and dispensing counters Choa Chu Kang, near MRT. Good remuneration with profit available for rent at Malacca Street. Immediate occupancy. sharing. Please call/text Dr Lee at 9151 9154. Please call 6391 0271 or email to [email protected]. Looking for female doctor as partner, salaried employee Specialist clinic at Woodlands for rent, 1,000 sq ft, own or locum for small group practice. Hours and renumeration or shared entrance. Town centre, MRT, Lab. Immediate negotiable. Interested, please call 9237 4141 or occupancy. Call Prunella at 9626 7607. email [email protected]. Royal Square at Novena. Medical unit for rent. TOP expected in June/July 2017. Situated right at Novena MRT. 690 sq ft. Suitable for medical or dental practice. $6,800/month. SMA JOBS PORTAL Contact 9829 1109 Cheng or [email protected]. Position/ Application Date Posted Organisation Job No Clinic in Toa Payoh for takeover. Facing hawker center Job Title Deadline with good traffic. Newly renovated. Low rental. Ready to Associate Hospital 01/06/2017 Consultant 21/07/2017 J00172 start operation. Message to 9450 5839 for discussion. Authority positions

Service Shop space available next to dental clinic at Serangoon Hospital 01/06/2017 Resident 21/07/2017 J00173 Authority Ave 3 HDB estate near NEX. Ideal for any specialities, positions para-medical practice, hearing, counselling, etc. Contact Kerry Medical Dr Tan at 9637 9976 / 6288 9508. 30/05/2017 GP Doctor Group Holdings 31/07/2017 J00170 Pte Ltd Mount Elizabeth Medical Centre clinic for rent. 1,087 Family Healthway 26/05/2017 31/08/2017 J00169 sq ft. Fitted unit. Available now. For interested medical Physicians Medical Group specialists, please call 9191 3766. Clinic for takeover. Doctors retiring. Location Upper Paya For more job postings, visit Lebar. Flexible arrangements. If interested, please contact https://www.sma.org.sg/membership/jobsportal.aspx (whatsapp/sms/call) Catherine 8118 6712 or Gary 9105 4595. now! Kerry Medical

We are a newly established medical GP clinic group looking for AN EXCITING CAREER AWAITS YOU! medical doctors, who wish to join a dynamic and fast expanding setup. We would like to invite pioneers who would like to helm Healthway Medical is one of Singapore's largest private outpatient medical our clinics as anchor doctors. service providers. It offers quality healthcare services across the medical value chain in family medicine, dentistry, paediatrics, orthopaedics, aesthetic medicine and healthcare benefits management. Responsibilities: The Group operates 11 medical practice groups, comprising more than 1. Provide primary healthcare services at our newly established clinics 100 clinics. Each medical practice group has an established brand presence and has its own medical specialisation, market positioning and service 2. Work with management to establish and maintain clinic practices proposition. They include Healthway Medical, Singapore Family Clinic, Silver Cross, Peace, Aaron, Universal, Singapore Baby & Child Clinic, Paediatric Requirements: Centre, Island Orthopaedic and NeuGlow. 1. Possess basic medical qualifications recognised by Singapore Medial Council Medical Positions Benefits 2. Obtained valid practising licence awarded by Singapore Medical Council • Family Physicians / • Attractive compensation package 3. Relevant post graduate qualifications welcomed; especially GDFM General Practitioners and/or GDOM • Good career prospects and • Health Screening Physicians rewarding experience Benefits: • Medical Aesthetics Doctor • Profit sharing option for committed doctors 1. Competitive remuneration package • Paediatricians • Excellent clinic locations 2. Good career prospects as clinician or progress to management • Obstetrician & Gynaecologist 3. Training opportunities provided

Please send your full CV to: Mr Kelvin Chen | Email: [email protected] | Mobile: 9858 6295 Please send your detailed resume to [email protected]. Dr John Cheng | Email: [email protected] Tel No: 9770 9355.

Yona 月华 Senior Director MBA (Financial Services) Associate Financial Consultant Certificate in Law (Estate Planning) Private Client Advisory Court of the Table, Top of the Table Representing Manulife Financial Advisers, part of Manulife (Singapore) Pte. Ltd. Based in Singapore, you will be part of a team of dedicated doctors and medical staff rendering specialist medical care and health screening of infants, children and Please call 97271702 adolescents. You will also play a key role in the maintenance of clinic standards and or email: [email protected] the delivery of a service experience for our young patients.

Dear Medical Specialists (Full time / Part time) Successful Individuals Like You Deserve Only the Best! OBSTETRICIAN & GYNAECOLOGIST pAEDIATRICIAN Our Universal Life Medical doctor The answer to your legacy (in US Dollars and Singapore Dollars) and retirement planning needs. Requirements 1. Basic medical qualification registrable with Singapore Medical Council (SMC) 2. For specialist positions, completion of “training and post-graduate • With years of experience and expertise, I am well-positioned qualifications which are recognised by the Specialists Accreditation Board to provide you with sound advice to help you achieve your financial goals. (SAB), Singapore and must either be registered with SMC or have a letter of • You will have access to a wide range of solutions from Manulife as well approval by SMC to work in an institution or clinic in Singapore” as other trusted partners. 3. Documentary evidence to show “specialist training and specialist registration in the country of origin and from the relevant licensing body/ • You have worked hard to get to where you are today. Would organisation in the country where the specialty training was done” you like to know more about your preservation of your assets and 4. A Certificate of Good Standing distribution to your loved ones? Let me help you meet your unique 5. Good oral & written communication skills financial needs. 6. Good interpersonal skills 7. Good team player Disclaimer: Buying a life insurance policy is a long-term commitment. An early termination of the policy usually involves high costs and the surrender value payable (if any) may be less than the total premiums paid. This promotional Additional Information material is not a contract of insurance and is not intendedd as an offer or recommendation to the purchase If you would like to take advantage of this exciting opportunity, we would love to of the plan. The specific details applicable to this insurance plan are set out in the policy contract. This promotional material is for general information only and does not have regard to your specific investment meet you. Please e-mail your detailed resume with a recent photograph, stating objectives, financial situation and any of your particular needs. You may wish to seek advice from a financial your availability, current and expected salaries to [email protected]. adviser before making a commitment to purchase the plan. In the event that you choose not to seek advice from a financial adviser, you should consider carefully whether this plan is suitable for you."

This plan is protected under the Policy Owners' Protection Scheme which is administered by the Singapore Deposit For more information about MindChamps Medical, please visit Insurance Corporation (SDIC). Coverage for the plan is automatic and no further action is required from you. For http://mindchamps-medical.com more information on the types of benefits that are covered under the scheme as well as the limits of coverage, where applicable, please contact us or visit the LIA or SDIC websites (www.lia.org.sg or www.sdic.org.sg). We regret that only shortlisted candidates will be notified. Parkway Pantai Limited (PPL) is the largest private healthcare provider and operates Mount Elizabeth Novena Hospital, Mount Elizabeth Hospital, Gleneagles Hospital and Parkway East Hospital – all accredited by Joint Commission International (JCI). Our Accident and Emergency department / 24 hour clinics provide first-line treatment for a full range of medical conditions, including management of critical and life-threatening emergencies, to the treatment of walk-in patients 24 hours a day. All our medical and surgical specialists are well-trained and ever-ready to support the handling of emergencies effectively and efficiently. By adopting a team approach towards the management of emergencies, we ensure the smooth and expedient management of all patients. We invite dedicated individuals who are passionate and driven to join us as:

Resident Physician (A&E/ 24 hours Walk-In Clinic) Based in Gleneagles Hospital, you will be part of a team of dedicated doctors and paramedical staff providing comprehensive care to our patients. You will also play a key role in the maintenance of clinical standards and the delivery of a Parkway service experience to our patients. At Parkway, we provide sponsored postgraduate training opportunities in addition to a comprehensive suite of benefits. Join us for a challenging career and opportunities for personal development.

Requirements: • Basic medical qualification registrable with Singapore Medical Council • Possess a valid practising certificate from the Singapore Medical Council • At least 3 years of clinical experience post-housemanship • Postgraduate medical qualifications and relevant experience are advantages • Good oral and written communication skills • Good interpersonal skills • Good team player Kindly email: [email protected] or call 9670 0472 for a friendly discussion. www.parkwayshenton.com

The Hospital Authority (HA) is a statutory body established and financed by the Hong Kong Government to operate and provide an efficient hospital system of the highest standards within the resources available.

1. Associate Consultant (AC) Positions for Experienced Doctors without Full Registration (Anatomical Pathology) (Ref: HO1705028)

2. Service Resident (SR) Positions for Experienced Doctors without Full Registration (Anaesthesia / Anatomical Pathology / Cardiothoracic Surgery / Emergency Medicine / Family Medicine / Internal Medicine / Neurosurgery / Obstetrics & Gynaecology / Orthopaedics & Traumatology) (Ref: HO1705024)

The Hospital Authority invites applications from experienced doctors who are not fully registered with the Medical Council of Hong Kong (MCHK) and yet have acquired relevant postgraduate qualifications set out in the Requirements to serve the community of Hong Kong. For details, please visit http://www.ha.org.hk (choose English language, click Careers → Medical).

Application Enquiries Application should be submitted on or before Please contact Ms. Melanie TAM, 21 July 2017 (Hong Kong Time) Hospital Authority Head Office at + 852 2300 6542 via the HA website http://www.ha.org.hk or send email to [email protected]