How Long Should We Wait?

I was waiting to see my Lokun the other day (yes, Dr Og IS ah pek and need to see dr also lah) and I had to wait one hour! The lady in front of me cow peh cow boo for being seen 15 minutes late, "Aiyoh, like that hor I tell you I might as well come late. Also get seen at the same time WHAT!!"


But then when it was her turn, she stayed in the consult room long long, refuse to leave and thereby contributed to my long waiting time!

Dr Og usually don't complain when I have to wait because my medical colleagues always waive professional charges for me la. Even at A and E, I also don't cut queue and most of the time I don't declare I am a doctor because I paiseh...

I know its quite a hassle to see a lokun because of the long wait. Its like tennis, you wait for the player to wayang abit, bounce the ball, swing the bat and suddenly everything is over in a split second! Still ok if its a sweet young thing tennis player but otherwise what a boring sport.

Waiting for doctor is the same thing. You wait and wait and when you enter the consult room its like kennah hypnotise, cannot remember what you wanted to ask and then the consult over liao!

But how long should we wait?

I'm not talking about how long patients should wait but instead how long should doctors wait for their patients? I can safely say that at least 75% of my patients don't come on time. The range of lateness can be from 5 minutes to anything like a few hours. But because the clinic staff don't want to offend the patients and always got something against doctors, the late patients still get registered and have to be seen.

If I had my way, I will not see any patients that is late. If you are five minutes late, its 50% of a ten minutes consult. Its neither fair to you as a patient to be seen in a rush nor to the doctor who needs to decide on your management.

Patients have many reasons for being late:

1) "Loctor, hospital boh parking one". This one quite true. They build hospital never build car park space one. Expect patients to take helicopter isit?

2) "Raining leh, din bring umbrellllllla". Singapore weather suka suka rain and Dr Og also don't like to take umbrella out, so can understand!

3) "I forgot got appointment until last minute than I rush out!". Aiyah, forgot then forgot all the way can or not?

4) "I was looking for my appointment card..." Alamak, the last time and the last last time already tell you no appointment card also can register...

5) "I come early also must wait!" Ok, you continue waiting.

6) "I was abducted by aliens on my way here!" Boh jiat yok!

7) "Loctor, I have to finish watching 爱 first."Courtesy of anon@1123AM

Sometimes, patients may be late because we cock up on our side too. For eg, they give patients a cardio appointment before the respi appointment and the cardio appointment got delayed.

And sometimes, doctors can be late themselves causing delays in the consult.

But in all honesty, patients being late is the number one cause of why you are not seen on time! The appointment time just keep getting shifted backwards and the ones who are slotted towards the end just gets seen later and later.

So I will like to make an appeal for all those who read this (you must be really bored) to go for your appointments with your doctors early. Simply because the reason why you are not seen on time is because you are late yourself. Have pity on doctors, they are humans and need to have their lunch. They also got family to go back to after work.

And surely you don't want to be the one waiting for one hour behind some kpkb woman.

Green Creatures

As a young kid, I was often fascinated with mythical creatures such as the Yeti and Loch Nest Monster. It was even more fascinating when I visited Scotland that I did not see any monsters (unless you include those ang moh char bor who are double my size with more facial hair than my pelvic region)  but instead found out that a whole tourist industry can be generated from these creatures of unknown origin.

But actually hor, there is also such a mythical monster that has been frequently sighted in our hospitals. In Singapore, we are unable conjure names like The Abdominal Abominable Snowman as its too hard to spell and cannot pronounce in Singlish. So we call this creature, AnAssF (pronounced N-S-F).

The AnAssF is green in colour (mostly)  and was first sighted in the eighties. The sightings have become more frequent as our little island become more urbanized and congested (it will however be wrong to assume causality as con founders such as over pampering mothers need to be ruled out).

Possible areas for sightings include the A and E particularly in the middle of the night. He will appear out of nowhere with the chief complaint of "Can have MC for today boh?" If he manages to get a MC for today, he will routinely try his luck and ask for MC for the entire week. When asked what physical ailment he actually suffers from, he may have anything from anal itch / headache / eye pain / earache / sore throat / chest pain / armpit pain /  leg pain / faint when exposed to sun. Over the years he has learnt not to complain of abdominal pain and/or diarrhoea as that will automatically earn him a PR which is generally unpleasant unless you meet one that enjoys prostatic massages.

Physical examination will invariably yield NAD ("No Abnormalities Detected" /  or sometimes "Not Actually Done") but the kind doctors will always give him the benefit of the doubt. However, the real diagnosis will be revealed when you see the re-entry chop to Zouk on his wrist and it is Thursday wee hours.

Sometimes, the AnAssF may get admitted by some sotong amateur A and E locum, especially if the doting mother (another legendary mythical creature) is accompanying. In the ward, the AnAssF continues to have strange and unexplainable symptoms but no actual signs (except for the washout Zouk re-entry chop) can be detected.

It will not take long for junior doctors to know that the cure all for these green creatures is Atten-C (MC lah).

PS: That said, many NSFs have genuine symptoms. Some are also genuinely very stressed up since their maids are not there to help them do everything. Boy boy needs time to adjust lah!

4ever Young

When I was a Houseman, I often see the fear in the eyes of the patients I treated.

The nice patient would say: Lokun you look so young... (then shiver)
The nasty one would say: Lokun you real one or not, now they let teenagers into med school meh???

Ok, the truth is I DO look young but I feel that looking young is better than being mistakened for your balding Professor. Tio boh?

A word of advice for patients, don't make your doctor kan cheong la. Wait he aim buay zhun, who suffer you tell me?

It has been ten years down the road and with the receding hairline, the complaints have been less. But recently I got one from a female patient.

Pt: Dr Og, you had a hair cut. You look much younger than the previous times I saw you...
Dr Og: Real or not?
Pt: Seems like you are younger than me right, I thought you are older...
Dr Og: Isit? Lemme see your ic number starts with what. yah... I abit younger la.
Pt: Like that I cannot see you anymore!

I can understand if someone goes to a nightclub and insist on someone younger. But I'm your doctor can? You think matchmake isit????

And I don't get tips ok!

Solid song from a forgotten era!

The Seventh Month

Someone asked me why I have not been blogging.


Simple truth is that sometimes when I blog, I feel like I'm writing to myself, or worse, to ghosts.... since there is hardly any response from whoever is reading (if any).....


But since its the hungry ghost month, its highly appropriate for me to at least make an entry for the ghosts out there supporting this blog. (My mother will surely scream choy! and hit me in the head if she saw this)

Source: http://asiaparanormal.blogspot.com/

For the Chinese at least, the seventh month can be a rather scary time. We were brought up to believe that the hungry ghosts will do us harm and going out late at night and activities such as swimming were frowned upon during this month. The seventh month this year has been somewhat unsual in that we celebrated NDP in a big way in Marina and will be having the presidential election soon! The pompous fireworks and wong hei (王气) will surely send all the ghosts into hiding!


But that is not true for our hospitals! There remain many scary and unnatural things that we have to look out for! 


The Ghost Whisperer


Technically not scary but suspected to be a spirit medium / tang-ki (乩童) of sorts who serves to bridge the living to the dead. He is usually a junior doctor who appears to be very busy and would disappear for a long time but not get anything done at all. When confronted he would insist that he has done a lot of work although not witnessed by any living patients. It is likely that he has an inert ability to see things that other normal house officers and medical officers cannot and was busy helping those poor souls still lingering the corridors of our wards. His disappearance can be explained by the fact that he transists between earth and the netherworld without really knowing. In actual fact, his colleagues all hope that he will go to hell too!

The real Ghost Whisperer looks nothing like this la!

The Lift

Frightful stuff inside!

Otherwise known as The Elevator. Super slow and often contains scary objects! The Lift in the hospital has a mind of its own having been possessed by the spirit of a nasty ward nursing manager who met an untimely death when the ECG leads, stationeries and paper she was hoarding fell onto her one day. True to her (mean) spirit, you will wait long long if you needed a ride to go to the upper levels. Worse, if you are really down on your luck, The Lift will  bring you down to Level -18 instead where you WILL bump into your CEO!!


The Zombies


Another breed of doctors. Unlike the Ghost Whisperer, the Zombies are doctors who specialises in KLKK (Kia Lai Kia Kee) and have no specific directions (be it in life or in their medical career). They are seen wandering and bumping into one another, often getting in the way of those doing real work. Occasionally, by brownian, these Undead Walkers will wander into the canteen and start having a nice cup of coffee while their fellow doctors continue to slough to their deaths in the ward. The Zombies can be identified by their lack of expression and of eye contact. (Compare this again to the Ghost Whisperer who is often anxious and frightened having seen things they shouldn't...) The Zombies come to work in crumpled clothes having have no motivation whatsoever! 

Blood stains from yesterday's surgery

The Gwai Lo (鬼佬)


Literally "ghost man" in Cantonese, these ghosts are often foreign and used to be mostly pale white when spotted in the past. Recently, black coloured ones have also appeared and have become so prevalent that you are more likely to bump into one of these than an actual Singaporean human! It is also pertinent to note that one must avoid them at all costs this seventh month as it is also Jay-See-I (pronounced J-C-I) haunting month. They may well be one of the auditors from Gwai Lo Land and it will be a straight road to hell if you kennah caught by them!

Bird Park II 之鸟中鸟

R RATED, Read on if you are 18 and above.

Dr: Yes young man, how can I help you?
鸟人: Loctor ar, I cannot piak piak...

Dr: Pee-ark Pee-ark? What is that?
鸟人: Aiyah, piak piak loh you know... (moves his right middle finger in and out of his left fisted hand)

Dr: Oh... You mean to have sexual intercourse?  
鸟人: Yah la, sex la. How loctor??? Can help boh? Got medicine?

Dr: So you have problems when you have sex with your girlfriend?
鸟人: No. I no girlfriend.

Dr: Prostitutes?
鸟人: No, my mother say cannot go find chicken.

Dr: Boyfriend??
鸟人: Loctor, you say I homo?? I hoot you understand???

Dr, puzzled: Then??
鸟人: I kaki lai! My left hand! (hand still fisted)

Dr, sighs: so whats the problem?
鸟人: I think I don't last long enough.... Can I have 伟哥??

Dr: But who are you having sex with??
鸟人 (grins): Don't have but I want to be stronger mah!

A Corn Job?

Suddenly, in Dr Og's FB, alot of status say going Fire Drill. Seems like in recent weeks, there have been a spike in the number of drills performed all across the hospitals of our little island! If only I can bring my dog to work, he would be very excited!

Well, there are no dogs in hospitals but there are DOCS. The everyday challenges of life and death are seriously insufficient to occupy the great minds of doctors. In between saving lives, docs are also expected to be involved in operational and administrative duties.

Jay in his corn field

The holy grail for the admin is of course Jay-See-I (pronounced as JCI). Jay is a Bee Kok Kia (from US) and every few years, he will come visit us in the hospital and See (actually more like scrutinize) how I am doing. He will issue you with a certificate if he thinks you are doing things right.

But I think Jay is a con corn man, peer jiat one! Does he know anything other than corn to tell us what to do? No, no, no... In true Americano Bee Kok style, he gets you to produce books and books of standards, protocols and policies and then audit you based on the standards you created. Like that very sinang mah, Jay just make you do the work and collect his million dollars fee after he tells you how terok you are!

Actually like that also is very simple for us, as long as we make the policies easy for ourselves! But how can right? We kiasu, kiasi! We need to SM ourselves with the highest standards. If Jay tells us to jump 5 metres, we die die jump 10 metres!

In the ward...

Medical Officer: Why I cannot use blue pen???
Sister: Bee-coz hor, Jay won't like it.
Medical Officer: But other wards can what!
Sister: You see you see, I photocopy blue ink not clear! Wait sure fail Jay-See-I! And you also cannot use fountain pen bee coz will fade. And you cannot use gel pen because will smudge. And...

Somewhere else...

Staff Nurse (SN): Doooctooor, harder! Yes, deeper! 
Senior Consultant (SC): I cannot tahan liao! (panting) How many more thrust???
SN: Oh Dooctooor, almost there! almost there!

The SC is of course performing chest compression on a mannequin at the Basic Cardio Life Support (BCLS) Course with the trainer who is the SN. Never mind that he is all 70 years old and might collapse anytime himself. Also never mind that he has 40 years of experience in Anaesthesia and the number of resuscitations he has done are too many to be counted. Even more never mind that his trainer has never resus anyone other than a plastic mannequin (and if the SC collapse the SN would fail in resuscitating him).

Why liddat? Because Jay-See-I...

Again, this is all very solid if we can maintain high standards we saboed ourselves with. But oh no... being Singaporeans, we only mug when the exam is round the corner, right? So in the half year prior to Jay's arrival, we suddenly gotta chop our names, write the date and time, use black ink (but no fountain pen), get accreditated for BCLS and of course, there's always the fake fire to learn how to run away from.

Interesting Fact: Fire was a discotheque popular in the 70s. The patrons were all bengs and lians chanting "Fire fire in the sky..."

Tags: Fun, JCI, Medical, Quality

The meaning of (my) life

One day, my patient asked me this question as we were coming to a close of the clinic consult. This was a patient coming for her last review. She was going to be discharged from any further follow-ups as she has recovered fully.

Dr : "Well, before I discharge you, can I ask if you have any other questions?"

Pt: "Dr Flat, can you tell me what is the meaning of life?"

(Reflection is a great tool)

Dr: "Well, what do you think is the meaning of life?"

Pt: "..."

Dr: "..."

===

Life is what we make it out to be.

Al' Cheapo

Claim kopi with envelope??? You think I so cheapskate???





Yes, I am :)

Only Human

"The many docs who recognize themselves as regular humans are the ones who seem to empathize best. My doctor is a real person, I hope I am too."

From Twitter @DrOttematic

Spinal Reflex

Once upon a time, in a country not too far away, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore full-faced motorcycle helmets while committing the heinous acts of crime. No one could see who they were. The authorities decided to ban all full-faced motorcycle helmets in the country.

In the next few months, the number of bank robberies reduced. Even though the number of motorcyclists who sustained severe head injuries and the number of fatalities from road traffic accidents increased, the authorities were happy since there were less bank robberies.

Within the next few months, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore ladies' stockings over their heads while committing the heinous acts of crime. No one could see what they looked like. The authorities decided to ban all sale of ladies' stockings in the country.

In the next few months, the number of bank robberies reduced. The sales of razor blades in the country increased rather significantly and the number of shops that do waxing sprung up all over. The authorities were happy since there were less bank robberies.

Within the next few months, there were a series of bank robberies. Based on the CCTV recordings, the robbers wore toy masks over their heads while committing the heinous acts of crime. No one could see what they looked like. The authorities decided to ban all sale of toy masks in the country.

The children cried.

===

In many places, knee jerk reaction is the norm. The reason it is called a spinal reflex is because the reaction does not use the brain.

Changing Times

Dr Tan Cheng Bock appears in the latest SMA News. Inside you can also see a picture of him with Dr Ang Yong Guan (of the jin jia cham, sibei cham fame) and Mr Tan Jee Say.

Times have changed!

Read the article here.

Tags: Singapore, Politics

The Nocturnist

Dr Og read on ST today that Bee Kok hospitals have a new subspecialty called The Nocturnist!

It's been discovered that Docs at night very sleepy (ah bud den??!) and we need to train a new breed of nocturnal drs.

Vampires would have made the ideal NOCTURNIST, except that at the time of this blog, I still have not friend (FB or otherwise) a real one (though blood suckers are aplenty in any HR dept).

I think it's very impt for Singapore to quickly adopt this concept and start a residency programme to train vampire doctors! Trust me, Jay-See-I (pronounced as J-C-I) will soon audit you for the number of bats noctunal specialists you have working the witching hour!

And Dr Og volunteer to be the master vampire training director! In fact, I already have the training schedule in place. For the first year of residency, our dear residents just need to hang around. As precious residents, we cannot expect them to do any work before they are nortunalised can we?

In the second year, they will learn to take blood like true vampires; needles and syringes optional. The number of blood they can take shall be limited to ONE. (If you work them too hard, they will quit and the programme will fail! How can residency fail tio boh?)

The third and final year will be the critical year! This will be the toughest year where they will be required to stay from 11pm to 6am...... in a discotheque. Please understand that the Nocturnist will be permanently nocturnal. As such where else can he go relax and unwind on off days? As far as Dr Og is concerned, we should only have female residents since budget is limited and girls can get into discos free on ladies nights! We need work life balance for the pos Gen Z mah!!!

So you might ask, Where got training like that!!?? Come on, we must be fair and treat our residents as slack as the other specialty.

To bring the concept further, we should also have nocturnal multidisciplinary team with nocturnal nurses, OTs, PTs and MSWs... (and not just uniform night in the discos). What the heck, why don't we set up our third medical school as a Nocturnally Imperial College or Imperially Nocturnal College ( whose name come first is very important and needs to be deliberated carefully).

Sounds stupid to you??!! Yeah, it probably is...

PS: Love Song For A Vampire :)

RETRO SIAH!!!

Tags: Fun, Nocturnist, Medical, Vampire

Bird Park

Via http://funny-pictures-blog.com/

In an outpatient clinic far far away, a tutorial was taking place...

Senior Doctor: This elderly gentleman said that he cannot stand. Uncle, can stand in the morning?

Ah Pek: Morning also cannot la.

Senior Doctor to Blur F**k Medical Student (BMFS): Please proceed with the examination.

BFMS starts examining Ah Pek's legs much to his displeasure.

Senior Doctor to BMFS: What are you doing???

BFMS panics: Er.... I can't find anything wrong with his legs, the strength and reflexes are intact... and he walked in just now.....

Senior Doctor: This is a urologist clinic you bodoh!

Tags: Fun, Urology, Medical Student

Dr Og's My Plate

Something made Dr Og sibei buay song recently. I had not long ago taken much effort to teach and help my daughter memorize this:

Then the Bee Kok president, Obama's wife, Michelle intro a new version!

Wah lau, you all can decide or not! Wait I get scolded by my bao bei daughter leh... ask her learn wrong things!

Also hor, Asians alot cannot lim guni la! Dairy products eat liao lao sai... I as a prooo-fessssioner suggest this one better:

1. Wine is now officially part of Asian cuisine with the mainland Chinese buying all the La-fite and La-tour! Now the ang mohs cannot afford their wine liao so of course you don't see it included in the western version! Wine is also good for health loh and one glass a day decreases your cardiac risk.

2. If you don't like La-tour and prefer to La-Kopi, drink kopi orh kosong! Unlike dairy, it has zero calories. Don't drink kopi how to survive the rest of the day??? Especially hang over from last night's wine!

3. Honestly, I don't really know what is Grain in the original version la. Dr Og only knows that here in Singapore, we eat RICE. Ok la, roti prata also can.

4. Bak You is also an essential part of our healthy diet. If no Lard, you will have no Bak Chor Mee, Char Kway Teow and every other (tasty) dish you can think of! Those who claim that Bak You is Bad For You, show me the evidence! Show me a single evidence based literature that Bak You is bad!

5. Starch and MSG is essential for making those thick thick broth that we all like so much. Especially shark's fin soup! Don't believe the Ang Moh when they tell you sharks are endangered la. The last I check, they are still attacking humans in Bondi Beach Australia leh.

AND since people so gian to know what is on My Plate in the hospital, this is it loh:

We have lots of peanuts. Quite good la, a whole plate of it! You are also provided free water cooler H2O for lubrication while they shove it down your throat. If not enough, can find KY jelly anywhere in the wards!

Tags: Fun, My Plate, Diet

10 reasons why your Dr so BCC (Bin Chow Chow)

Ever kennah black face by your doctor? Well, being a loctor is a very very pek chek job. Ten reasons why your doc so buay song during a consult....

1) He hasn't had lunch becoz patients like you tend to oversleep and all come just before lunch time.

2) He hasn't had lunch and becoz u decided to have your hair done first ( since you were late anyway) he is not gonna make it home to watch 爱 on Channel 8.

3) You were already late for your appointment but when you were called you went to toilet pang sai.

4) Even though you were in the midst of kegg sai (bowel output), you got your maid to enter the consult room so that the lokun cannot see the next patient.

5) You remarked that he looked too young (thereby insinuating he is not experienced enough) and caused serious ego injury.
Or you remarked that he looked very old (thereby insinuating that his self injected botox treatment failed) and caused serious existential anxiety.

6) You ask for MC but did not even bother to read wiki to at least get some symptoms correct.

7) You asked for sleeping pills, cough syrup, pain killers (when you have no insomnia, cough or pain) becoz your source in Geylang in hiding.

But of course it's not always YOUR fault!

8) His wife found out about the drug rep / clinic assistant / nurse.

9) His new Porsche kennah drowned in the flash flood.

10) He is just born that way with a buay song facies... Dun be so sensitive la!

When the Fat Lady Sings

Recently (ex) MM and (ex) SM stepped down. This triggered me into thinking about retirement. Many patients I have seen do not seem to understand that retirement needs to be planned and we need to learn how to slow down and relac lah.

Doc: Uncle you got any hobbies?
Ah Pek: Simi Orhbeee???
Doc: no, no uncle, not guiness stout. What you do when you are free?
Ah Pek: Feee? I work work work then go home jiat bah, koon la.
Doc: Er, what do you like to do when you are not working huh? Things you like.
Ah Pek: Don't haff.
Doc: You listen to music?
Ah Pek: No
Doc: Watch TV
Ah Pek: No, I work so hard everyday to support children, family. Where got time?

I used to think that these Ah Peks were just having me on. I imagined that they were having lots of fun in Desker Road on weekends distributing their CPF payouts. But having spoken to many over the course of years (plus they never asked me for viagra), I realised that the generations born prior to 1960s had it ingrained in them that the only route to success was hard work. They sloughed their life away for their family and did nothing for themselves.

The problem being when they retire, they suddenly find themselves with no work to do, no hobbies and having absolutely no idea how to pass the day. The children are busy with work and their spouses may find them to be a nuisance at home since they are not used to having them around. They find themselves irrelevant and becoming a relic more than anything else. The loss of role can lead to much stress and many psychological woes.

So what should Dr Og do when he retires from blogging (medicine being only a delusion of mine)? I was thinking of politics but gave up the thought as I don't fancy sweating in a blue shirt shouting to a crowd of 30,000 in a stadium. And honestly, you will never see me in a red shirt coz the only time I'll wear one, if I ever do, is during Chinese New Year.

Indeed sibei cham if you cannot find something sane to do!

Next up, Dr Og's (patented) Preparation for Retirement Programme ... Akan Datang

Tags: Retirement, Medicine, Singapore

Singapore M.D.: A Lifetime to Master

Singapore M.D.: A Lifetime to Master

Residency, Ageism and Me (Yes it's always about me)

So the first batch of Duke medical students will be graduating this weekend. Congrats wor.

Totally unrelated, I was ignored when I asked for free tickets (offered on Twitter) to Zouk this Saturday. Dr Og just asked for fun la (my principle, anything free just ki chew first) and really given my age, lack of vitality and that I will be cheonging at Shanghai Dolly ( sorry I cheena one) on Friday, it is unlikely I will be able to survive Zouk on a Sat night.

While I did suffer some narcissistic injury when the fellow twitter did not offer me the free tix ( and worse ar never follow me on twitter), I also knew that my time in Zouk is (long) over. This has nothing to do with ageism. Do you see ah peks running hundred metre sprint?

Its not just the young ones who get to enjoy everything! There are also other stuff whereby being older works in your favour. The older folks have seats choped for them in MRTs and buses, can scold you if you take their seats and Stomp you until you apologize! They can also get senior citizen prices for movie tix. No wonder all the ah peks gather at Yangtze.

What Dr Og is saying is that whatever your age is there is a right place for you... I used to cheong Zouk but now I reminisce and spent Saturday resting. One day it will be my turn to be hanging around Yangtze getting cheap tix to 肉脯团19 but until then I stick to bit torrent.

So what do you do when you have people who are older than Consultants (hopefully not Senior Cons) graduate and needing to do housemanship meant for young Drs? They invented the Residency.

Ok, not exactly invent coz this one is basically copy cat the US of A. As these graduates are older, they cannot be put through the same vigorous training that Drs since the time of modern medical training started in Singapore have been put through. They will die! Like if I go Zouk on Saturday. They need to rest. So, less patients for them in clinics and even if they do night calls they cannot see more patients than the no. of fingers they can count on one hand. (Hopefully dun get one so old cannot even count fingers la).

This is all very good coz they can now continue to study very hard for their postgrad, publish sibei cheem and solid papers in renowned journals (as depicted in the newspaper article) and do all the things that Dr Og and the doctors of his time were not able to do coz we sloughing away seeing patients. I was told I may soon need to vacate my clinic slot to make way for the residents. I will also need to supervise them even though I am not appointed as a faculty member and will not be getting any head count for the work. Plus I will need to see the cases which traditionally can be managed by junior Drs since now we must protect their workload. The patients will have to pay to see a consultant even if they do not need that level of care.

When the residents become specialist themselves they will discover that they never received an essential training which we oldies have mastered to survive public healthcare, the art of seeing many many patients at one setting...But it's really all ok, since they who have invented the residency have a ready backup in the form of FTs where the supply of Drs is seemingly endless.

Tags: Residency, Medicine, Singapore

Lan Fang Republic, Malacca and Their Relevance to Singapore

Alert: Contains seriously heavy reading and historical stuff! Do not read on if you only use one side of your brain!!!

I was surprised when Lan Fang Republic was mentioned by MG Ki Chew. Dr Og is politically apathetic but I was one of the top history student for my year and I would have become a historian (really!) if I din become a dog doc.


Lan Fang Republic - Huh?
And honestly, what the *#@# is Lan Fang? I have not in my most comprehensive (means chow mug la) study of Southeast Asian history ever come across this name. There can only be two reasons:
1) The historians are so f%$% up they forgot to mention Lan Fang (except in some minor articles)... OR
2) LF Republic was so insignificant no one cared.

I leave you to your own conclusion and unless you have an IQ of 10, the conclusion would be 2) anyway. The only reason why LF Republic is recieving any attention at all is because our MG decided to Ki Chew (literally).

The Malacca Sultanate
Now, let us look at Malacca. (Of course not Malacca of today lah, bodoh!) The Malacca Sultanate was founded no later than 1400 by a Malay prince, Parameswara and was invaded by the Portuguese in 1511 (lasted at least a good five years more than LF Republic!) In its time, the Malacca Sultanate achieved the following:
1) Conversion to Islam in 1409. To date, Islam remains the main religon of the Malay Peninsula.
2) Prevented Thai influence in the Malay Peninsula by successfully repelling their attacks.
3) Encouraged bilateral trade and inter-racial marriages with Chinese when the Sultan married a Ming princess. This was the beginning of the Peranakan culture (or not you where got Little Nonya!!).

The Fall of the Malacca Sultanate
Some may say that the fall of the Malacca Sultanate was inevitable as the Portuguese were too much of a force to deal with. But seriously, our red hair (and hence ang moh) dudes have travelled half the world in ships (not even economy class can??!!!). Some internal factors hastened Malacca's demise!

1) Weak ruling government
The golden age of Malacca, with its wealth and prestige, very much depended on one leader Tun Perak who is the Prime Minister equivalent. After his death however, there was no successor capable of running the state. The Sultan, Mahmud, paid no heed to the administration of the government. He allowed his officers to act as they pleased and this encouraged much bribery and corruption among them.

2) Dependence on Foreigners
Many of the foreign merchants were not loyal to the government of Malacca and some jumped ship (again literally!) and backed the Portuguese during the attack on Malacca. A Chinese merchant, for instance, provided on loan, 5 huge barges to the Portuguese while a Tamil merchant supplied information on Malacca’s defense system. Lagi worse, the Sultanate hired Javanese mercenary soldiers who were not willing to die for a country which wasn’t their own and they chow liao liao when Malacca came under siege.

In short: Weak government and foreign talents were in part to blame for the fall of Malacca.
 
I think as Singaporeans, there is a need to understand the lessons learned from Malacca Sultanate. Who will Stand Up For Singapore (fave national day song!). External and alien funds can flow out as easily as they flow in. When crisis strikes, only the loyal locals will stay and fight. Time and again this has been shown in history.
 
And what is the relevance of LF Republic? Beats me....

Tags: Lan Fang Republic, History, Singapore

You really want to be a doctor???

I hate to say this, but I am getting more senior aka lao liao :( And throughout the years of my practice I have been called upon by some relatives, friends, aunties or uncles to advise their relatives, friends, sons, daughters, nieces and nephews who aspire to be a doctor.

So I am writing this such that next time anyone ask me for an opinion, I will Ctrl C and Ctrl V this. Before I become demented...

You think being a doc is cool like in House MD, can any old how scold patients or like in Grey's Anatomy all pretty girl and handsome docs sleep here sleep there? Better wake up your ideas!

Ok, lets be objective and list down the pros and cons.

Pros

1. Job stability. And I am saying rock stable! How many drs have gotten sacked from a public hospital? This is like what durian sellers say "Bao Jiat!" Only that in our case, it is real.
2. Not Bad Pay. Mah hiam buay pai. You can well afford a 2 litre car, place your little one in a Montessori and bring your family for a holiday once a year.
3. Job stability. I still see those koyak Drs walking around after donkey years! You can't lose your job!
   No such thing as retrenchment :)
4. Good leave entitlement. Lots of leave, 24 days or more of annual leave, additional conference leave, blah blah.
5. You get to be called Dr. And can hao lian.

Cons

1. School Fees. Would have set you back by ??100,000k before you even start practising and that does not include your bond!
2. Pay Not Bad? Ai hiam kennah sai! Trust me, you will be frustrated as your Sec, JC classmates out earns you. As a successful Dr, you will be earning what your friend the successful banker pays for income tax, unless of course you are into the business of overcharging royalties of some banana republic. But heh! that banker dude was an asshole from your class who could not string two english sentences together. Can't take that? Well, he is getting all the girls too! Be consoled, the bankers will always tell you that you have Job stability (see Pros 1.... and Pros 3 also lah).
3. Long hours. Longest I have clocked was 36hrs, without food and just some sip of water. I have been told that things have since gotten better for junior Drs. But the work still has to be done right? Who does it? Yes, me! And you the junior Dr when you become senior. Doh!
4. No time to take leave. Not uncommon to see Senior Drs burn their leave coz there is just no time to take. Even if you do claim or your leave, you will die clearing your work before and after.
5. Transport claim still at 60cents/km.
6. Most likely, you will be unhappy. Ever seen a happy Dr? If you do, you better double check you bill
7. You think you can hao lian??? You will hate being addressed as a Dr. Insurance agents, sales people, real estate agents will assume you are very rich and you will not ever get any special discounts! When someone shouts for "Dr Dr", its to get you to do work or to attend to some emergencies...  

In short, don't be a doctor unless you are into the business of healing or helping people and you are overwhelmed with altruism and self sacrifice, or you are so narcissitic that you are deluded into thinking the above.

Just my take, don't flame but you can add to the pros and cons if you like!

Tags: Education, Medicine, Singapore

Jiak Por! (吃补)

Traditional health supplements are becoming a boom market given that it is becoming quite a fad in the west.

Locally, you can see all the Chinese medicinal hall mushrooming in general hospitals and you can even find one in our local mental institution!

Jiak por is on everyone's mind and despite the lack of evidence in these quasi medicinal products, they remain extremenly popular. So much so that I've heard of medical professionals spending tens of thousands of dollars buying TCMs on trips to China!! Whether they kennah cheated only they know lah!

What is really disconcerting is that as a doctor, we often get asked about traditional medicines as part of our consults with patients, though honestly I know as much about TCM or Tongkat Ali as my mother who has a Pri 6 education. But you see, patients expect their Drs to know everything...

If a Patient ask: Lokun, can tell me this ginseng good or not ar??? Jiak liao can por naw, make me smarter??

The Junior Dr will reply: I don't know. Do I look like a Chinese Sinseh???

The Senior Dr will reply: There is no good evidence when it comes to traditional medicines but if you have tried it and find it useful, its ok to continue taking.

The Private Dr will reply: Aiyah this brand no good la! You buy from me this special ginseng essence from Chang Bai Shang! See got my face on the box somemore!

All the Drs are thinking: You want smarter, get a brain transplant...

Lately, I had a patient's family member asked me whether eating placenta is good for the patient's condition. He further instructed me to read up about it when I told him that I have no clue about placentas since I last did an Obgyn posting many years ago. So being ever the conscientious doctor that I am, I googled the subject "eat placenta" and found a wiki on Placentophagy. The pictures made me lose my appetite immediately... much less Jiak Por.....

Tags: Fun, Alternative Medicine, Homeopathy