Tan Yia Swam
Singapore
“Finally, as a follow-up to my Committee of Supply (COS) cut, asking you to help us to help you, do remember not to be prescriptive in the implementation but to guide healthcare workers with kindness and patience as HCSA rolls out in the coming months. The above notwithstanding, I support the Bill.”
“Chairman, I thank Dr Janil for the detailed replies. I have some clarifications. Regarding wellness and beauty salons claiming to offer treatments for slimming and detox, such as fat loss pills and lymphatic treatments to reduce cancer risk: firstly, are these medical treatments? Secondly, how do we recognise misleading claims?”
“I thank both Ministers for the very detailed updates. And honestly, sometimes knowing too much or too little makes people feel helpless over things they cannot control and trigger a lot of anxiety. I have seen a lot of anxious people in the past three years as a clinical doctor.”
“Thank you for the opportunity. Mr Deputy Speaker and the House, I would like to thank Minister Ong for acknowledging the contributions of healthcare workers, especially in the past two years. Three big points. One is that my own term here as a Nominated Member of Parliament is limited and will come to an end pretty much soon.”
“I am so sorry. About the KPIs, one big thing is that, as MOH and various committees talk about KPIs, please remember to involve doctors in the conversation and not be chasing economics – which is more economically viable. Let doctors advise you on what we think are feasible, medical and clinical KPIs.”
“Establishing a good doctor-patient relationship and having mutual trust in each other gives much better patient outcomes and satisfaction. The rise of badly-written Search Engine Optimisation articles is severely detrimental to the doctor-patient relationship. So many articles share half-truths and myths, even fear mongering.”
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“Yes, I would like to respond because I am a doctor and I think I know a bit about healthcare. I think firstly, regarding bills, to the hon Member, it would be useful to ask your affected residents to approach the hospital's business office that they were in to seek clarification on the bill breakdown. There are very clear explanations and breakdowns on the tiers of subsidies available and different drugs, whether it is branded or generic, have very, very clear costings. So, I would like to know more details of the case rather than make a blanket statement that the costings are unfair. In relation to the second question for the Government to procure all medicines, I understand that right now, there is a procurement for all medications for chronic conditions, for public medical institutions. In the private sector, though, may I respectfully state that all doctors in the private sector have our own business models and different ways of generating income. So, not all doctors may want to be part of the Government effort. I thank the Member for his suggestion. We can take it back to the professional bodies and further get our members' feedback.”
“It is helping the patient to overcome all these other emotional and mental barriers to seek health and to eventually be on the road to recovery – that is the challenge for which I call for a global change and a whole-of-Government support. I thank everyone who has taken part in the debate and I emphasise. First, walk the ground, get real feedback and acknowledge problems in healthcare. Second, continue education at all levels of engagement. Third, cross-collaborate across Ministries, across industries, across the public-private divide. Humans have short memories. Let us learn from the mistakes of the past so that we do not repeat it. People care only when things affect them. Help me and make everyone care. Finally, breaking formal protocol, I want to thank Shahirah, Samad, Lian Pin, Mark, Janet, Joshua, Hian Teck and Hsing Yao. Thank you all for your friendship. It has been an eventful and fun NMP journey. To all MPs from both sides of the House, I am glad for the chance to get to know you all as people and real humans, not just as public figures on your posters. This is my last speech in this Chamber. The next time we meet again, it may be when I complain to you at Meet-the-People sessions. [Laughter.] I thank you all – both sides of the House – for your service to Singapore. If I may, I will pray for wisdom and kindness for you as you all continue to debate meaningfully on issues to guide Singapore safely through future challenges. [Applause.]”
“But are we building up on useful knowledge or frittering our time away on social media in mindless entertainment? I see patients and the medical treatment algorithms are actually quite simple. There is a breast lump. It needs to be checked. But frequently, emotional stress gets in the way. This manifests as hesitation, fear, worry and even anger at me – "Why is there a lump?" I understand but it is not easy to process the onslaught of negative emotions. Healthcare workers, teachers, drivers – all frontline service workers, in fact – have received the brunt of a lot of negative outpouring of emotions. This is our society now. A pressure cooker. People being unhappy in their daily lives without even realising it, feeling irritable, snappy, overly critical, worried about everything and feeling unable to cope. I repeat a point from my previous speech. Recognise mental health issues in yourself or your loved ones. If you suffer from anxiety or anger management, do not take it out on your healthcare worker. Do not take it out on others. Get help from a mental health professional. Even though I am a breast surgeon, I cannot just operate on the cancer. I have to consider the patient in her whole entirety. Her overall health – does she have other medical conditions that impact her surgery and recovery? Her preferred language – does she fully understand what I am saying? Is she making a true informed decision? How is her personality like? Her social network? Is she going to be well supported at home and at the workplace or will she forgo care because she perceives that others' needs come before her? The surgery itself is simple in expert hands.”
“Blindly supporting or opposing any political party or mocking NMPs for being mouthpieces or puppets or blaming the Government for everything – I ask you, is it logical? Does it serve anyone? Before reacting and speaking, consider three points: one, is it true? Two, is it necessary? Three, is it kind? If the answer is no to any of the above, maybe it is better not to say. I am sure that many of you have friends who are in healthcare. Do speak to them and understand the problems we face. Create your own small little informal think tanks and brainstorm on how to solve larger healthcare issues. For all the people listening in, whether you are working in Ministries, whether you are an ordinary citizen like myself, I hope that you will also think of ways to ensure that healthcare gets the support it needs and prioritise your own healthcare needs. We now live in a rapidly changing and volatile world. Look at how COVID-19 brought the world to a standstill for three lost years. Look at the Ukraine war, the US bank collapses. Overnight, the world changes. Nothing is new. History repeats itself – maybe in a much faster cycle than before. The modern person has to be able to adapt to a world where answers may be less obvious, where there is no rulebook or 10-year-series to refer to. There may be no single right answer and choices will have trade-offs. Should war ever come to Singapore, should there be an apocalypse, we will need warriors, we will need leaders. But I tell you, we will need people who know how to look after others, people who know how to stop bleeding, prevent infections, deliver babies, how to grow food, how to get clean water – any kind of knowledge to ensure that we survive.”
“In my closing, I come full circle, back to "Why". Why do we stand up to advocate for a cause? To leave behind a better world than the one we were born in. Recent news regarding the next round of NMP applications has again raised some criticism. I believe the NMP role has given an ordinary citizen like myself the chance to voice opinions at a national platform. Ordinary, because I am a struggling working mother in the sandwiched generation. Ordinary, because I also fear and worry about my children's future. What kind of Singapore will my children grow up in? Fellow MPs will appreciate how hard it is to prepare for a speech. It is not just simply coming up to the microphone and saying some fancy words. There is background research, sticking to the timing before getting scolded by the Speaker or Deputy Speakers; and speaking the truth – in a palatable way and driving home a point. I commented before – we are all talking a lot, but who is listening? Is the public listening? The livestreaming only has 400 plus viewers, usually. A few people will deliberately make funny clips of our mistakes or slip-ups. And yes. Once I get over the embarrassment of my own, I have to say, it is actually very funny, so, thanks for making us laugh! But the people I am really speaking to are fellow citizens who share my interest in the larger good of Singapore, the citizens listening in and considering policy. Maybe some of you are civil servants. Singapore has 150,000 public officers who report to the Government, not to any one political party. I rephrase for emphasis. Civil servants are individuals who would have their own different political beliefs and alignments. They serve the people of Singapore.”
“I also need to seek clarification from Mr Leong on his comment that, I quote, "drug prices should not be marked up unreasonably for non-subsidised patients to cross-subsidise subsidised patients." Firstly, is there have evidence of this happening? Secondly, what is the definition of an "unreasonable" mark-up? If I can use another food analogy other than chicken rice, a can of soda can be sixty cents at a budget grocery mart, $1.30 at a super mart, $1.60 at a coffee shop, $3 in a restaurant and $5 in a hotel. How much is a reasonable mark-up for medications? Patients who are not subsidised will be patients who opt in for A or B1 class, or foreigners. I, as a doctor, would think that allowing market forces to determine costings are fair. Would Mr Leong also want taxpayers to pay for everyone? I also thank the political office holders from different Ministries for your assurance and commitment to support healthcare. I thank Senior Parliamentary Secretary Eric Chua in advocating for sports across different Government agencies and active community engagement. Parkour aunties like myself rejoice. No more Police chasing us off. Minister of State Gan Siow Huang has also given an overview of how teaching on exercise and healthy eating is integrated at all levels of education. I thank Senior Minister of State Janil Puthucheary and Minister Ong Ye Kung for their detailed and candid replies in recognising complex problems of manpower, IT and financing. The professional bodies will continue to work closely with MOH in resolving issues within healthcare, especially those that pertain to training and working hours. Honestly, only clinicians truly understand the delicate balance needed. I am glad that we are all aligned in this – that healthcare has to be a whole-of-Government effort.”
“Thank you, Sir. First, I thank Minister Ong. Okay, maybe not so angry anymore, after all your kind words. If you are going to stay 10 years like Mr Gan, then I will continue to advise and help for 10 years. Sir, I am very heartened by the strong support for the Motion. First of all, I thank all my fellow NMPs in attendance who have each shared their insights into how healthcare can be supported in their various sectors. This is the kind of fresh ideas that we need to have a synergistic whole. Next, I thank all Members for their various speeches covering a wide range of topics in relation to support for healthcare, namely: (a) recruit, reskill and retain healthcare workers; (b) fair pay, reasonable working hours; (c) financing and business needs; (d) better IT systems; (e) taking a firm stand against bullying and harassment; (f) emphasis on prevention and primary care; (g) legal protection and support; and (h) looking after vulnerable groups, in particular, children, the elderly, migrant workers and the differently-abled. However, I must address some of the points that the Member Mr Leong brought up yesterday. I appreciate his points about reviewing MediSave but I urge him to have in-depth discussions with MOH to better understand the current funding and to help in future reviews if necessary. MediSave and MediShield Life have been extensively and rigorously reviewed to ensure that the majority of Singaporeans and Permanent Residents can afford medical care when they opt for subsidised wards in restructured hospitals. If any of you know residents in financial distress, please direct them to an experienced medical social worker who will be able to further advise on additional available subsidies.”
“Ideally, I want to look after patients who become sick despite their best efforts, not those who have neglected themselves through the lack of knowledge, a lack of resources or lack of self-care. Let us work together to bring down the number of preventable illnesses. That is the real cost savings. It is our individual responsibility to keep as fit and healthy as we can. Be educated and keep up to date. As a society, to be kind and civic-minded. For those who hoarded medical supplies and tried to profiteer during COVID-19, shame on you! As a doctor, I look after all patients equally. But when intensive care unit beds are full, who deserves it? The pandemic has made everyone acutely aware of limited resources – masks, antigen rapid test kits, oxygen. That is the real fact of life. There are limited resources and who will be the gatekeeper as to who needs it most? Healthcare workers need the Government to help shape these policies. We need everyone to prioritise health. Do not force us to have to have to triage and decide who to save. I look forward to a robust debate. [Applause.] [(proc text) Question proposed. (proc text)]”
“I am still deeply bothered by the businesses of medical concierges who collect fees from healthcare providers in exchange for bringing in foreigners for healthcare. Will MTI help MOH to attract Singaporeans to take up essential jobs in healthcare? Look into the development of healthcare workers to recruit, train and retain experienced workers. Human resource management will be essential, not to manage people as commodities, but to truly build a good working relationship for them, so that they feel appreciated and will stay for the long haul. Complex medical conditions are managed by a multidisciplinary care team. I apply a similar concept to our healthcare system problem. Cross-collaborate; engage with healthcare providers; step outside of your comfort zones across the different Ministries and industries. Appropriate remuneration for consultancy work may be something to consider and, in time, build up a network. I am very mindful of costs and ideally, if we can call upon volunteers, that would be great, but I also realise that runs the risk of the same few big-hearted people being called upon again and again. Set up a think tank whom all the Ministries can have access to and call up on for brief consultations on global issues, not ad hoc requests to organisations. As I end, let me recap. I have explained why healthcare should be a whole-of-Government concern and not just MOH. I have listed chronic problems in healthcare. I emphasised the need for education at multiple levels of engagement and I asked for everyone to cross-collaborate. My old friend told me, "Don't pretend you want people to be healthy. You doctors want more patients, right? Got business!" No!”
“I think that people still buy a lot of bubble tea even when graded "C" or "D"! What is commendable is the rise of urban farming, supported by state agencies such as the Singapore Land Authority, Urban Redevelopment Authority (URA), Agri-Food and Veterinary Authority, SFA and Animal and Veterinary Service and Housing and Development Board (HDB). I hope I did not miss anyone out. This has benefits such as a start towards food security and the health benefits of working with nature, learning to grow and eat our own organic foods will be lasting. Information technology (IT) continues to be a huge challenge in so many aspects. I said in a previous speech; electronic health records are sometimes nothing better than Microsoft Word documents or PDF documents scanned and stored online. Systems are unwieldy and not instinctive. Vital signs are still keyed in manually. My patient tried to find her operation histology from HealthHub, Healthy 365 and Health Buddy; we could not find it. I do not know how this can be achieved, but can MCI, GovTech, Integrated Health Information Systems (iHIS) and other IT Statutory Boards please coordinate and get a good national system up? I envision using Singpass and Healthhub, with trigger questions to remind the individual of major health checkpoints: height and weight; health screening; vaccinations; appointments. Medical tourism is a complex international issue. Will the Ministry of Trade and Industry (MTI) look into how this could contribute to increasing healthcare costs locally but still help Singapore maintain a leading-edge reputation as one of the best places to get good quality care?”
“Ministries such as the Ministry of Culture, Community and Youth, MSF and Ministry of Communications and Information (MCI) might be ideal to be the facilitators of cross-collaborations between the different Ministries. Good ideas, content and projects can be supported by all, rather than every Ministry trying to come up with their own independent project. I give one example. If you Google "Singapore how to lose weight", see what comes up. Articles on HealthXchange, HealthHub, Health Promotion Board (HPB) get buried amidst advertorials from aesthetics clinics, spas and gyms. One good quality article with a good video might be shared across different Ministries and across all the various social media platforms for wider reach. Repeat the same essential health messages in each of your various networks: eat right, exercise every day, protect your mental health, whichever division you are in, for social support, for youth or for sports. I thank the Ministry of National Development for the new SkatePark at Lakeside Garden. I hope you continue to integrate sports into the community. Are you aware that Singapore's cityscape is acknowledged as a parkour paradise internationally? But practitioners frequently get chased away by residents who think they are vandalising and that the Police are called to chase them away. I hope for stronger support for the parkour community in Singapore. The Ministry of Sustainability and the Environment (MSE)'s mission to supply water and safe food may also extend to more affordable fresh produce, as eating whole foods has more health benefits than processed foods. Food safety labels are regulated by the Singapore Food Agency (SFA), under MSE, but nutrition labelling is by HPB, under MOH. I found the 64-page handbook online.”
“Teach older teenagers and tertiary students about the parenthood journey, its many joys but also hardships so that in time, young couples can make an informed decision about marriage and the pros and cons of having children or not, and when to have children; in their 20s, 30s or 40s? Once we enter the workforce, we often neglect our own health to pursue a career. In work with long hours or shifts, we develop unhealthy eating habits and irregular sleeping hours, and do not know how to make time to exercise. How many adults notice weight gain and lethargy over five or 10 years of working life? The weight creeps up on you. Singaporean men have their yearly individual physical proficiency test to clear but women might not have a fitness benchmark. There is a phenomenon of being "skinny fat", where the person has a healthy weight range but has low muscle and bone mass. I think this is where all the different Ministries can contribute to health, by continuing education on diet and exercise, screening and vaccinations as well as empowering adults. For the Ministry of Manpower (MOM), look into how to develop healthy routines at the workplace; ask the fitness industry; make affordable healthy foods easily accessible; encourage 10 to 20 minutes of simple office or chair-based exercises; get the bosses to implement such health practices; teach workers screen time limits and the value of mental breaks; look into flexi-hours so that they may prioritise time for themselves, family and medical appointments; consider incentives for good health; work with MOH, Consumer Association of Singapore, Monetary Authority of Singapore to look into alleged complaints of poorly paying corporate insurances and panel limitations imposed by TPAs; help workers to access good quality care.”
“I believe that when people with similar goals and ideas discuss casually, the mind-mapping and synergy may create something way better. Starting from young, the Early Childhood Development Agency and MOE can work closely with MOH to identify key basic health messages for young Singaporeans to learn. And the challenge is not in rote learning but how to get updates on information, because some scientific breakthroughs develop rapidly. The food pyramid that I learnt in primary school is now outdated, replaced by the healthy plate model and current nutrition and fitness research is leaning towards low-carb diet with resistance training. Who knows what will future research show? Teach children how to eat right and cultivate the habit of regular exercise to maintain a healthy weight. A lot has been done for mental health education and safe, appropriate use of social media in primary schools. These can also be adopted for adults who did not grow up in the Internet age, so that they are also taught about online etiquette and safety. Introduce and strengthen the idea of the family doctor and the importance of good primary care. Teach how to navigate the healthcare system, how to get into subsidised care and the role of different types of insurance. MSF, in your mission to build strong families, could also collaborate with MOE and MOH to shape sex education, guide families on how to hold the tough conversations on morality, religious beliefs and identity. Ask the coaching industry, especially those who specialise in sexuality counselling.”
“Do people from different Ministries talk to one another, or is there a very strict protocol of how new ideas may be raised? I ask because previously when working within the confines of a restructured hospital as an employee, I know that there are clear hierarchical processes. And even now, I only have experience talking to certain folks within MOH. I know there are incredibly smart and devoted people in the Civil Service at all levels of seniority. I know passionate and caring people who are active volunteers in various groups, charities and social enterprises. There is a flourishing ecosystem, but I wonder if perhaps there are too many small-to-medium groups. Can we pool these resources? Every one of us may be a domain expert, but we do not know what we do not know. From my participation in MHIC, I had the privilege of networking across different industries, to be acquainted with insurers, financial advisors, actuaries and to discuss healthcare problems from their point of view. It was humbling to realise how little of healthcare financing I knew before, as a clinician. I am yet again bringing up the story of blind men examining the elephant and everyone only touching the part they can touch and arguing about what the elephant looks like. Because it is true – we do not know what we do not know. I now challenge you to think beyond your usual area and how you can apply your knowledge to better support healthcare, wherever you are in. You have heard the problems I brought up as a doctor, as a healthcare leader. Are you able to help me? I respectfully share some of my ideas of how to align future policies, with the compass oriented towards healthcare. Formal workgroups seem very structured.”
“People rely on word-of-mouth recommendations, some use Google reviews and some people do not know that these can be bought or faked, or that there are malicious marketing agencies who deliberately downvote rival companies. Whose role is it then to teach people how to use Google and Artificial Intelligence (AI) as a tool? It does not feel like it should be the Government's job. It is up to individuals then. Motivational speaker Jim Rohn said that, "You are the average of the five people you spend the most time with". I use this to take stock of my personal and professional growth periodically. Whenever I feel stagnant, time to review and change a bit, step out of the comfort zone, learn something new. Do not settle in too comfortably and be trapped in an echo chamber. Lifelong learning is a challenge. How do we then cultivate this mindset in people? This leads me to my next point: cross-collaboration. I think the COVID-19 Multi-Ministry Task Force was a good platform for leadership to discuss and share timely information on a rapidly evolving situation and align policy direction. Of course, there were problems as it filtered down, because humans being humans, we have a wide range of responses. We had people ranging from lawful good to chaotic evil, to use a Dungeons and Dragons reference. Some followed the exact letter of the law, some followed the spirit of what is intended. Some profiteered off other's desperations and some wilfully, selfishly lived by their own rules and not respect the society they are living in. The Government of Singapore is complex: organised into 16 Ministries, further divided into departments, divisions and more than 50 Statutory Boards.”
“I am alarmed at how often I notice infants being spoon-fed while they are looking at an iPad. Studies have shown that screen time adversely affects brain development. Babies are not able to read faces as well and develop social skills, leading to later problems in executive and higher order functioning, such as the ability to focus, impulse control and emotional regulation. I have seen increasing numbers of young adult patients in their 20s with such problems and I am deeply concerned for the future generations. Teaching the appropriate use of technology is not just for the young, but for the adults as well. News abound of increasingly elaborate financial scams. In relation to health, there are trends of miracle cures to fight cancer or guarantee weight loss. I have seen patients trying the black garlic diet, aloe vera, alkaline water, negative ion clothing. The list is endless. I call this pseudoscience because there is a hint of truth in it. There is one experiment to show that the item has one property that has killed a few cancer cells in a petri dish. To me, this is like an observation that, "Hey, the ant can use a leaf to float on water! Therefore, if I use a big leaf, I can use it to sail across the ocean!" I cannot professionally extrapolate such studies to claim that it can cure cancer, which is what some salespeople do and vulnerable patients will try it and sometimes even forgo proven treatments. During the pandemic, vaccine hesitancy and big pharma conspiracies had direct negative impacts on public health. Internet connectivity has brought people closer together but has also allowed misinformation to flourish.”
“Fear, anger, worry, joy are all emotional responses that are normal but we must learn to regulate them. Too often, I see my patients so paralysed by anxiety that it interferes with the treatment process. Some diseases are well-studied and the progression is clearly understood, for example, Hepatitis B leads to liver cancer and Hepatitis B vaccination is effective. Some others are multifactorial, such as most cancers and cardiovascular diseases. So, just because I smoke, it does not mean I will get lung cancer for sure. Likewise, just because I do not smoke, it does not mean that I will never get lung cancer. It is not so simple; there is no magic bullet or "免死金牌". Obesity, strokes, heart attacks – we call these "lifestyle diseases" because every day, we make small decisions on food and activity level that will build up to or prevent these. Some illnesses are insidious. Do we recognise mental health issues or is it unseen until there is a sentinel event with self-harm? Preventable trauma is another huge area we can improve on. Awareness on child safety seats, road safety awareness by all users including pedestrians and cyclists, stricter regulations for driving licenses, giving way to emergency vehicles, workplace safety. There is so much to teach, so much to learn. Education cannot be assigned to just the Ministry of Education (MOE), just as health should not be the domain of the MOH only. I firmly believe that education starting from as young as infancy and carrying on throughout our schooling and working adult years will be the key to good sustainable health. I am glad that Minister Ong stated last month that MOH will partner MOE and the Ministry of Social and Family Development (MSF) to lay a strong foundation of health for our young.”
“This is what I talked about in March, for insurers to build closer working relationships with healthcare providers so that patients have more assurance of affordability. People need to learn how to navigate our healthcare system. Some years ago, I started a blog specifically on how to enter the healthcare system, the different paths available and the pros and cons of each. But I could not maintain it. Other commitments took priority. Since then, I have seen several well-written articles. There is no need to keep re-inventing the wheel. Collect these, have a good library of such articles in the central repository and let it be the main reference for all Singaporeans. People do not actively care until it happens to them. Look at global warming, does the average person worry about global warming, even when faced with evidence of changing microclimates? Does a person worry about fertility and starting a family young, until they are actually trying and come across difficulties? I know most of my patients never worried about breast cancer until they have a symptom or heard that a friend or colleague is recently diagnosed with breast cancer. Then, it triggers fear and worry. People care, only when things affect them. I want my children to grow up and take responsibility for themselves. Likewise, I believe that everyone of us can take responsibility for our own health, but we need to be empowered on how to do this. Humans are emotional creatures, but we have the capacity to think. Learning how to regulate emotions and using our brains to think is an invaluable skill that can be taught from childhood. I know some adults who still struggle with this. I cannot underestimate the importance of having a scientific and logical framework in approach to all problems.”
“For most people though, the first major illness is the first time ever that we have to seek medical care in the hospital. That is not a good time to find out how expensive healthcare is. One is already worried about their cancer diagnosis and the impact on survival, side effects and potential complications of treatment, responsibilities of work versus family. Not many people know the cost of treatments in Singapore and many are stunned when they first see the numbers. I know I was when I had to handle the bills for an open heart surgery. Healthcare financing is very complex and there are actually many safety nets for Singaporeans – public sector versus private sector. Who pays? Taxpayers' monies, insurance pooling. Various combinations of co-payments and tiers of subsidies exist. The problem is most healthy people do not bother to check these until they encounter health issues. If it is an elective surgery, there is time for financial counselling, pre-authorisation and so on. But in an emergency, the team would deliver the necessary life-threatening treatments first. The patient and their family may be saddled with a big debt. Or the hospital writes off bad debt – not often, I believe, but I know that this happens when we have a foreign worker with no health insurance, just an accident policy and there is no or inadequate cover. Same for locals who are not familiar with the product they bought, whether it is a plan for hospitalisation, critical illness or early cancer plan. Maybe they did not know about exclusion terms or coverage limits. I picked up this lingo and knowledge only in these recent three years and I hate that I have to know it. It distracts from my real work in caring for patients. But it is necessary.”
“There is consultant lead practice and there is a specialist in charge of your medical journey. When you meet a young doctor with a heart, I hope you help the doctor to train and grow. Some of you will choose to go private if you can afford it because you get personal service, it is generally faster, there is more privacy because it is a much smaller team attending to you. But then I ask for your understanding that every doctor runs a business and there are various models that are used with various business costs. If you find a doctor that you trust and there is clear communication and transparency, I hope you will also give him the support he needs. I have listed a string of perennial problems, which are complex and systemic, and that I do not expect any one person to solve. Stay with me as I share my views on education and cross-collaboration. There are many ways how people learn. I think the commonest method is by frequent exposure and repetition. We eat frequently, right? Three times a day, maybe five times or even more. Singaporeans are passionate about our food. So, if I ask about chicken rice, there will be a very hot-blooded robust debate on which store is the best, comparing roast chicken versus steamed chicken, the ginger, the chilli. Enthusiasts will even know the exact cost breakdown from different stores: how much you charge for extra chilli, extra rice, an upgrade to thigh meat. But how many of us need major surgery or admission for a major illness? There are some patients with complex medical issues who have been in and out of hospitals. The healthcare team ends up knowing the patients and families very well over time. Such families will likely also be very aware of how treatment costs are like.”
“Many feel unease and unhappiness at "the system", but there is no one whose job is to really evaluate and improve the system. Instead, experts from other service industries are imported to provide opinions, get paid consultancy fees – and they leave, while we care so hard and so badly, that it hurts. Even with all my lobbying for the private sector, for reviews into Shield plans, corporate insurance, concierge services, third-party administrators (TPAs), many have heard but might not be listening. Sadly, even my own doctors do not pay close attention to my advocacy efforts and keep repeating the same old grouses. Some are aware but do not dare to take action. They might be afraid of losing their livelihoods if they do not play by the rules of TPAs who have come between doctors and patients. I have frequently said to my peers that it is common sense that a business should be profitable, but we should never profiteer here from people's suffering. Healthcare providers are in a no-win situation – getting complaints for long waiting times in Government hospitals, getting accused of overcharging in private. Patients have very high expectations now. We all want perfection – cheap, fast and good. I have repeatedly vouched for our restructured hospitals. We have all trained and worked there at some point and they provide good quality care. Sometimes, the communications may not be as clear or personable, simply because it is a very large team-based practice. I think restructured hospitals are cheap and good, and it is hard to be fast. I ask the public to be understanding. Restructured hospitals are teaching hospitals. We all start somewhere. We all learn through mentorship, by examining small lumps, do our first operations. Patients are never used as an experiment.”
“In the private sector, business costs are increasing due to rental, manpower costs and pressure from business entities; perpetual problems with poor IT systems; a brain drain of experienced nurses, allied health and even doctors. I have previously spoken on wellness and alternative health services, which are not regulated and which sometimes do more harm than good. Poor use of Google leading to badly written search engine optimisation articles that further increases the disconnect between doctors and patients. Some family physicians have expressed their perceived difficulties to onboard Healthier SG. Many doctors are concerned over the capitation model, about the impact of the drug whitelist and actual payments to general practitioners (GPs), which may not cover their running costs. I am not saying it is bad. I am saying doctors are worried about these changes. We have lived through changes with adverse outcomes and we feel really helpless when others dictate how we should practise medicine. We should learn from the mistakes of the past so that we do not repeat it, but humans have short memories and few people have the time or commitment to dig into history. Political office bearers come and go, but for most doctors and nurses, we are here for a lifetime. The longest serving Minister for Health is Mr Gan Kim Yong for 10 years and for that, I thank him for the warm and supportive relationship he had with our profession, which Mr Ong Ye Kung has kindly continued – hopefully, for the future, after my speech. There is no one who is giving the healthcare system his full attention and thought. Doctors do clinical work. Clinician scientists do research. Nurses care for patients' daily needs.”
“There were patients fit for discharge but the common social request was to keep the patient until the weekend because the children cannot take leave to bring him home or the need to wait until the helper arrives in Singapore. So, instead of operating, I was there doing bed management and being scolded by family members for being heartless. Then, when I go down to finally attend to the new patients waiting, I get scolded for making them wait very long. A call starts at 8.00 am and ends at 8.00 am the next day, followed by a full day's work until 6.00 pm the following day. We did six to eight calls a month. Eighty to 100 work hour weeks are not unusual. Doctors, nurses, lab technicians, couriers, healthcare attendants – everyone in the healthcare system is trying our best to meet demands; and sometimes, we cannot deliver. How many of us have just gone to cry and hide in the toilet for a while? How many have walked away? We have seen the ups and downs of problems in the past decades. The removal of the guideline of fees, coupled with as-charged plans, leading to escalating costs, due to multiple factors that we are still trying to address now in the Multilateral Healthcare Insurance Committee (MHIC). Changes to residency training, leading to the loss of mentorship, loss of a sense of belonging by the trainees. Shorter training periods with consequences in some specialties. The privatisation and commercialisation of healthcare is a "necessary evil". Someone has to ensure there is money to run a sustainable business. But when healthcare workers are treated as a commodity by administrators, it is yet another bad influence on the doctor-patient relationship. Currently, we face new concerns.”
“I will now share three broad strategies on how this can be done: one, identify and acknowledge problems; two, education at all levels; and three, cross-collaboration. Let me tell a funny story. More than a decade ago, as a junior doctor, I remember there was one day when there was a mini commotion in the operating theatre. We were told to recall our chits so that the queue of patients waiting for surgery is cleared up. I demanded to know why and I was told, "Minister is visiting." I remember being indignant and told the sister-in-charge, "Let him see. Let him see how swamped we are." Of course, I was chased away while the welcoming party walked him around. I was an angry young doctor, but I resolved to learn to be a better advocate for change. Leaders need to walk the ground and healthcare workers need to learn to speak up better for ourselves. Maybe it is not in our nature to ever admit defeat or ask for help, because it implies weakness and we are determined to stay strong for our patients. Maybe that is why so many of us work until breaking point. In the past two years, mainstream news and social media gave much attention to bed shortages, long working hours of junior doctors and nurses, bullying and harassment, but I tell you this is nothing new to us. Corridor beds, lodgers in tentage, conversion of day surgery beds to acute care beds. Another story – once, when I was on call, I was called by my head of department in the middle of the night to urgently identify patients who may be fit for discharged in the morning, because there were 50-over patients waiting for a bed in the Emergency Department (ED).”
“We need to be ready for the next pandemic, for the silver tsunami, for the mental health crisis. Healthcare must be a global, national whole-of-Government effort and not only a Ministry of Health (MOH) effort. I urge for all of you to adopt a mindset change. I urge every Ministry, every Government official, every public servant – in fact, anyone listening right now – to think in terms of how to better teach our people to look after their health and prevent illness. Next, support for healthcare workers – what does it mean? It cannot be just a one-time snapshot, a once-off wellness event, a "thank you" campaign, a medal. Regular salary revisions to match inflation and the rising cost of living are essential. But beyond that, support for healthcare workers should be a deeply rooted respect and acknowledgement of the nature of our work. Many of us see our work as a calling. We commit to looking after patients. It is more than just a job. Much like those in our armed forces who protect our nation, healthcare workers protect the health and well-being of our people. It is not just business transactions selling remedies. What kind of support do healthcare workers want then? Back to my analogy about the parent-child relationship. I hope the doctor-patient relationship will be mutually loving and respectful. We cannot be just using that one day of Father's or Mother's Day to love our parents, right? It should be an ongoing process. Take into account what we say, listen and involve us in decision-making. I have explained why we need to support healthcare beyond the pandemic and why we need a whole-of-Government effort.”
“As a doctor, I want to focus on my patient's medical conditions, her needs and wants. But life is more complicated than that. So many other factors influence this relationship – different kinds of health-seeking behaviours, different health beliefs, financing models, expectations of outcomes, customer service, social media marketing, business entities seeking to profit in the healthcare sector. Why am I pushing for a whole-of-Government effort? Healthcare spending is the second highest in the national budget. The emphasis on building more hospitals, polyclinics, Healthier SG and recruiting staff – this cannot go on indefinitely. While the current hot news is about the Cancer Drug List, I share a list of sobering health statistics: yearly, 26% of deaths are due to cancer; yearly, 20% of deaths are due to pneumonia; every day, 20 people die from heart attacks or strokes; every day, four people undergo leg amputations due to diabetes; Singapore ranks first in the world for diabetes-induced kidney failure; one in 10 people over 60 years old have dementia; one in 10 people have a mental illness; one-third of post-menopausal women have osteoporosis – and if they ever have a hip fracture, one in five will die within the year. These are some well-known facts in our medical community. Health news magazines frequently report these, but people do not care until it happens to them. Most people have a healthcare encounter only when they are sick and that is too late. Humans have short memories. That is why the institution has to remember and pass on the teaching. It feels like the whole country, even the whole world, has moved on after COVID-19. But if you look back at the history of pandemics, the next one will be here – maybe in 10 years, maybe in five.”
“Madam, I beg to move*, "That this House commits to supporting healthcare beyond the COVID-19 pandemic and the whole-of-Government efforts for consistent and sustainable support". [(proc text) *The Motion also stood in the name of Mr Abdul Samad and Dr Shahira Abdullah. (proc text)] I declare my interest as a breast surgeon in private practice and my various medical leadership roles as an appointed member of the Singapore Medical Council and the Vice President of the Singapore Medical Association. More importantly, I speak as a daughter to elderly parents and parents-in-law and as a mother to children with medical conditions. Allow me to say a few words in Mandarin. (In Mandarin): [Please refer to Vernacular Speech.] As the saying goes "Doctors have the heart of a parent". Doctors should be caring and concerned towards their patients, just like parents to their children. Doctors should have this mentality throughout their life. However, patients are not necessarily willing to be treated like a child all their lives. When a child is young, he is ignorant and will obey the instructions of his parents. As he grows up, he will start to rebel against the instructions of his parents. Thirty years ago, patients would generally listen to the doctor's words. But now, due to advanced technology and easy access to information, more and more patients will question doctors' diagnoses or instructions, or even challenge them. (In English): Why does anyone stand up to advocate for certain causes? We want to leave behind a better world than what we were born in. I advocate for the doctor-patient relationship. As a patient, I want my doctor to look after my best interests and not be worried about being complained or sued unfairly.”
“Finally, as a follow-up to my Committee of Supply (COS) cut, asking you to help us to help you, do remember not to be prescriptive in the implementation but to guide healthcare workers with kindness and patience as HCSA rolls out in the coming months. The above notwithstanding, I support the Bill.”
“Mr Speaker, Sir, in the past months, there were multiple engagement sessions and email requests to doctors, and I assume all healthcare workers, asking for feedback on the Healthcare Services Act (HCSA). I was involved via the Singapore Medical Association (SMA) as well as the Singapore Medical Council (SMC). However, I would like to know how many doctors actually responded. It is a challenge for my profession to self-govern and self-regulate sometimes, as most doctors are too busy with providing clinical work, teaching, research, maintaining competencies, and do not forget, doctors are humans too, and have our own personal lives. Perhaps medical school curriculum needs to further expand their law and ethics segment, to emphasise these administrative components. In addition, the role of SMC versus SMA should be ingrained into medical students, so that as doctors progress in their careers, they value how a professional body can effectively do group representations with MOH in policy engagements. I welcome the expanded scope of HCSA to include complementary and alternative medicine. But I still ask for consideration to include beauty and wellness services as well, I remain concerned over misleading claims. I give one classic example, in my work as a breast surgeon, I have been dismayed by a few women who had discovered breast lumps while breastfeeding. They consulted their masseuse or confinement "auntie", who try to massage the lump away, telling them repeatedly: "it is just a blocked duct". While that may be true for most women, a few actually have a breast cancer and they delayed seeing a doctor until months later. People become patients when they see a doctor, but the first health encounter may be well before that.”
“So, the three questions I had were: are these considered medical treatment; how do we recognise misleading claims; and who do we report to?”
“Chairman, I thank Dr Janil for the detailed replies. I have some clarifications. Regarding wellness and beauty salons claiming to offer treatments for slimming and detox, such as fat loss pills and lymphatic treatments to reduce cancer risk: firstly, are these medical treatments? Secondly, how do we recognise misleading claims? Thirdly, whom may the public lodge a complaint with?”
“The wellness industry is booming, with many providers in various forms, such as fitness, mindfulness and life coaches, and many more complementary health services. Psychologists and counsellors come from a diverse background and are currently not registered under the Allied Health Professions Act. While I believe that the majority of these providers are doing good work, I would like to advise MOH to monitor for any reports of a missed diagnosis, for example, someone with a psychiatric disorder not getting the correct diagnosis or treatment, with adverse outcomes. Finally, I am perpetually bemused why poorly written search engine optimisation (SEO) articles are always more widely read than those written by real doctors, or those published on Government websites, such as HealthHub and hospital sites. I think we write too responsibly and factually, which is boring, without any sensationalism. Should we, and are we, able to regulate these SEO articles? If not, can MOH work with other Ministries to educate the public on how to choose the right reading materials? Recall the confusion during COVID-19. We must learn from it and prepare for future health crises. An educated population is the best defence we can have. Reviewing Gestational Limit for Abortion”
“Mr Chairman, I declare my interest as a breast surgeon in private practice. Sir, part of the burnout and stresses on the healthcare system are misinformation and complications arising from complementary health and wellness services. I work closely with allied health professionals, such as physiotherapists, diagnostic radiographers, radiation therapists and TCM practitioners, whom I know and acknowledge as fellow health professionals. I am alarmed by anecdotal reports – some from my patients, some from newspapers – of patients who have suffered unusual complications from some forms of treatment. I state a few examples. One, free filler injections into the breast, which interferes with screening mammograms for breast cancers permanently. Some present years later with pain and infection, requiring surgery. These complications cause significant scarring and cosmetic defects in appearance. Two, international news reported a few deaths after chiropractor manipulations. In a 2018 Channel News Asia (CNA) article, Dr Yap – then-President of the Chiropractic Association – himself asked for regulation, so that patients can make a safer choice. Three, people who have received Botox or other invasive beauty treatments in Housing and Developemnt Board (HDB) flats – a few victims have reported to the Health Sciences Authority (HSA) or MOH, with the culprits being charged and reported in local newspapers. These are not new issues and have been brought up before. I strongly urge MOH to look into these. It is better to prevent problems than having to stress an already over-burdened healthcare system. Educate the public and encourage victims to lodge Police reports of battery and assault.”
“I hope MOH can use existing bill sizes and conduct a large-scale study of the out-of-pocket payments for cancer treatment for IP policyholders under the new terms for CDL versus non-CDL drugs, should they opt for private healthcare. I pose several issues for thought: (a) the insurance industry is heavily regulated and I respect their work; yet, I am mindful that they are business entities who need to be profitable, yet keep premiums affordable; (b) public expectations of what our IPs can cover have to be managed; (c) out-of-pocket payments by patients need to stay affordable; and (d) limited public healthcare resources have to be managed prudently. These are difficult issues and we need to think carefully about them. How many patients on private insurance will still not be able to pay for drugs and have to go to the restructured hospitals for care; and how many may never be able to afford the so-called "better medications"? How will this affect long-term cancer survival rates? This will be a hard lesson for all of us to learn and to accept the practical limits of what we, collectively and individually, can afford. Dental Subsidies in Government Hospitals”
“Using the latest available SingStats Survey on household expenditure ending 2018, I extrapolate: monthly expenditure all in was around $5,800. In the report, the monthly housing rental is around $1,000; in current times, monthly rental may range from $2,000 to $3,000. So, the surplus may be about $2,000 to $4,000. In this family, if someone has cancer and needs treatment, the financial implications are sobering – potential loss of job and loss of income. Even with a Shield Plan, if the out-of-pocket payment exceeds, say, $3,000 a month, not just for drugs but for all services, such as consultation fees, investigations and non-cancer drugs to treat side effects of therapy, then perhaps this patient may opt for subsidised care in a restructured hospital, even though he or she has private insurance. In itself, this is fine, and I have often vouched for the high-quality care in restructured hospitals. But it begs the question as to whether the policy intent of IP is met, which is, that insurance will make private services affordable to more people through risk-pooling. Should there be a big shift of patients to the public sector, it will lead to a further strain on the system, with longer waiting times for appointments and treatments. Also, do not forget that the subsidies are, ultimately, paid for by taxpayers through the MOH budget. Singaporeans should be strongly advised that having an IP does not mean that private healthcare will necessarily be affordable when it comes to cancer care. It is a tragic and stressful situation to have a double whammy of receiving a cancer diagnosis, and then finding out that they actually cannot afford cancer care in private because the IP coverage is inadequate.”
“I propose three solutions: (a) insurers can approach a professional body to provide training to their administrators to better process clinical claims; (b) maybe there should be an on-call agent, much like how hospitals have an on-call doctor to attend to any emergency, and this agent will help the clients to navigate the paperwork statim; and (c) perhaps there needs to be a new speciality – a clinical insurer – a medical doctor who changes track mid-career and brings a wealth of clinical knowledge into how insurers should work. Finally, I want to put on record my personal appreciation to the MOH Deputy Secretaries and staff leading the MHIC, who have been instrumental in bringing together various stakeholders to a common table and working for the greater good. Financial Planning for Cancer Care As our population grows older, more people will be diagnosed with cancers. As medical technology advances, there will be newer and better drugs for cancer care, which are costly. The MOH CDL dictates which drugs will qualify for subsidies and MediSave Coverage. IPs providers have also updated their coverage and claim limit terms. 2.15 pm As a breast surgeon in private practice, most of my patients with breast cancers will be referred to medical oncologists for systemic treatments. These include chemo-, targeted- and immunotherapy. Sixty-five percent of Singaporeans have IPs, and we bought them with the expectation that when a catastrophic disease like cancer strikes us, we can proceed with treatment in the private sector where we get to choose the doctors that we are comfortable with, have faster access to treatments and be able to afford it. Let me run through some numbers. The 2022 median monthly household income was around $10,000.”
“I was a doctor on the patient's insurance panel and completed the pre-authorisation process. However, the problem came later on, when even the lab could not make a clear diagnosis and needed to send to another even more specialised lab for a second opinion and additional complex immunohistochemistry (IHC) tests. The lab needed payment prior to doing the tests and the patient should pay first and reimburse later, but he declined to do so as he had a limited cash flow and was worried that the insurer will not reimburse him, despite written reassurance that he would be. In the end, I had to circumvent the issue and asked Mr J, one of the senior managers I know in that insurance company, to help with this. On the backend, he personally attended to the case and helped the patient to have cashless payment and got the tests done. A few months later, I was asked by the insurance administrator to explain and justify why the second opinion was needed. I checked in with Mr J. He noted the duplicate request and had it withdrawn. This is a long story, I know. But now you know why doctors complain so much about paperwork and insurance. Thankfully, this case had a happy ending. This was possible only because of mutual trust. Mr B trusted his oncologist to recommend the appropriate surgeon for a necessary surgery. Mr J trusted me – that my medical judgement was sound and my explanations were adequate. However, how many patients or doctors enjoy such a relationship with their insurer?”
“The Monetary Authority of Singapore (MAS) is the final arbiter for matters pertaining to the financial viability of insurance companies in Singapore, including IP providers. But regrettably, they do not deal with clinical matters. Currently, there is a Clinical Claims Resolution Process (CCRP), which was one of the solutions presented by the Multilateral Healthcare Insurance Committee (MHIC), of which I am an appointed member. It is a platform with great potential, in which patients, IP providers and healthcare providers – both doctors and hospitals – can take part in when disputes arise due to clinical issues. But the CCRP is a voluntary process and it falls apart when any one party does not wish to participate. In other words, it has no teeth and it is not a final arbiter. Will MOH consider annual updates on the number of CCRP cases that have been filed and, in addition, state how many cases could not proceed because one or more of these parties refused to take part, and who the refusing parties were? So, who should be the final arbiter for clinical matters in IP policies and claims? Could there be a law to directly compel IP providers to cover and reimburse healthcare services, in line with acceptable clinical practices or even best practices? Let me tell you about patient, Mr B. He had colon cancer, which was operated on several years ago. On a follow-up, his oncologist found an abnormal lymph node near the armpit, which he thought was a relapse of the first cancer. A core needle biopsy was done to sample the lump and the result was normal. However, six months later, that lump grew larger and looked worrying for a different kind of cancer – lymphoma. Mr B was then referred to me for surgical biopsy. This is a surgery to remove the lump for complete testing.”
“Help us re-establish respect for all healthcare professionals – patient service associates, audiologists, dieticians, medical social workers, lab technicians, podiatrists, couriers – to name but just a few. Help us with IT challenges. Help us reduce unnecessary paperwork. Protect us from undue influences by market forces and business entities. Recognise and call out abusers. Recognise mental health problems in yourself. If you suffer from anxiety or anger management, do not take it out on your healthcare worker; get real help from a mental health professional. I ask each and every one of you to be understanding, to be kind and help us to help you. Developing Clinical Capabilities of Insurers During my surgical training years in Singapore General Hospital (SGH), I had this highly principled and no-nonsense trainer called Dr Koh Poh Koon – now the Senior Minister of State for Manpower. I regard him as a man of wisdom and insight, and a mentor to me professionally. On 29 November 2022, he rejected a proposal by the General Insurance Association (GIA). He said, "GIA's suggestion of using only existing prolonged medical leave insurance or group personal accident insurance in place of WICA would relegate this to a private insurance policy whose terms and conditions are dictated by the insurer without a clear mechanism to adjudicate disputes... I do not think we should be leaving it to insurers to be the final arbiter of any disputes to work injury claims," citing possible conflicts of interest. Once again, I learnt something valuable from him, as I often had in the past as a surgical trainee – the concept of "final arbiter". There is no final arbiter in Integrated Shield Plans (IPs) when clinical matters are involved.”
“Some have self-diagnosed and demand a treatment which they have googled online because they perceive that 20 minutes of Googling is more significant than 20 years of your experience. Doctors adopt defensive medicine. You have all heard about these concerns in October 2020 in the Second Reading of the Medical Registration (Amendment) Bill. The more senior I get, the more artificial barriers I find between me and real patient care: third party administrators, insurance restrictions; the Cancer Drug List (CDL); reimbursement limits for various schemes. I have spoken on these before and will elaborate on some of these in my later cuts. It is this deep sense of unease that is poisoning our entire healthcare ecosystem. My gut feel is that we complain about tangible things – asking for more pay, more leave – because we cannot quite express just how sick we feel. Well, I have just tried, and unless we treat the illness and not just the symptoms, no amount of pay will ever give us back the joy we once had. Finally, how can you all help? Rather than more legislation, I am asking for understanding. I ask for kindness. Help us to help you. The next time a healthcare worker complains about the system, listen. Truly listen, with your heart. The next time a healthcare worker quits and walks away, take the exit interview seriously. In the next round of engagements, listen, past the naysayers, to the core issues which are bothering us. Help us with public education: how to navigate the local healthcare system, how to best utilise your health insurance plan. I intend to lead the SMA in collaboration with Consumers Association of Singapore (CASE) to jump start this.”
“Do you know the doctor-nurse couple struggling with infertility because they were too busy, too stressed to try for a family during their training years when they worked shifts and 100-hour work weeks? Do you know the solo-practice doctor struggling to maintain a viable business, because of increasing manpower and rental costs and falling prey to unfair corporate insurance contracts? I know there are some really bad doctors out there. Of course, I do. The newspapers, social media are full of these reports. But for the rest of us, we have no outlet to share our woes, our struggles. Secondly, the practice of medicine has changed, not just the medical aspect, but the social and legal aspects. We face stressors and problems which the general public is not aware of: Changes in specialist training systems, electronic records which are no better than paper documents placed online. The use of multiple and, sometimes, duplicate checklists in the name of patient safety. Increasingly strangulating regulations while complementary health services flourish with no checks or balances – which I will speak more on in my later cut. Imposition of key performance indicators (KPIs) which drown out what I feel is the most essential – to be a good clinician. We, as a society, have also changed. We lost the ability to listen, to empathise. We have short attention spans, are quick to take offence, are quick to judge. I blame social media, allowing baseless accusations and falsehoods to be amplified by anonymous keyboard warriors. When healthcare is managed as a business, healthcare workers become mere service providers, with a fee for service. Patients become customers, expecting customer service.”
“Mr Chairman, I declare my interest as a breast surgeon in private practice and my role as the elected president of the Singapore Medical Association (SMA). Today, I want to talk about the heart and soul of healthcare. I am gratified to see many Members of Parliament speaking up for healthcare workers over these recent years and I hope that you will continue to do so, because who heals the healer? After three years of fighting COVID-19, healthcare workers are burnt out. Many feel overworked, underappreciated, even trapped, with no way out. Let me share from my personal and professional experiences on three key areas for Parliamentarians to consider: (a) why we chose to enter healthcare; (b) how circumstances are interfering with the delivery of care; and (c) how can you help? Many of us entered healthcare because we wanted to help people. Many were inspired by healthcare workers who attended to our loved ones in their time of need, and we also want to do the same. A handful, perhaps, are street smart and see that being a healthcare worker provides a comfortable and steady income. But I believe most of us had the calling to serve. However, along the way, many of us got jaded. Some of my doctor and nursing friends have said, they will never allow their children to follow in their footsteps. It is too hard – "I don't want them to suffer like I did." People see the glamour of being a doctor. Maybe they see the top 1%, who are earning very well. Even here in this House, the perception of the overcharging doctor is prevalent. Yet, do you know the junior doctor who is the sole income earner looking after his elderly sick parents, a disabled sibling and starts off his career with a large student loan?”
“I thank both Ministers for the very detailed updates. And honestly, sometimes knowing too much or too little makes people feel helpless over things they cannot control and trigger a lot of anxiety. I have seen a lot of anxious people in the past three years as a clinical doctor. May I just simply summarise and clarify that this is the main take-home message for each and every one of us – to stay alert, do not panic, maintain personal responsibility, which includes: one, wear masks when appropriate, and wash hands; two, avoid crowded places; three, get boosters when it is time; and four, only read reliable sources. [Applause.]”
“I am deeply aware of how divisive discussing LGBTs rights is and how society may become fragmented. We are one Singapore, one united people. I urge everyone to stay calm and be kind. The above notwithstanding, I support both amendments.”
“How many have suppressed their feelings and stayed single or went on to have a heterosexual relationship just to fit in? How many are deeply unhappy? For those who have advocated actively for LGBTQ rights, I applaud their steadfast commitment and bravery. I am glad that one key change will be achieved – the decriminalisation of the homosexual male. I look to an environment where each person can grow and explore safely. As I have said in most of my other speeches, education is key – education by the family, by formal schooling and by the various faiths. For those people facing conflicts and stress, there must be safe havens for them to seek fair and balanced counselling without undue influence. Perhaps the healthcare profession needs to step up and lead this with paediatricians, psychiatrists, psychologists who are trained and experienced – professional providers who do not impose their personal views. In schools, I urge MOE to review the sex education component to ensure that it is based on science and facts, while controversial opinions and trends are clearly stated as such. This will be a guide for parents to use in our own conversations at home with our growing children. To fellow parents, if you, like me, grew up without any knowledge of LGBT terms, let us educate ourselves. What is hetero, homo, pan or asexual? What is trans or cis gender? What is sexual orientation versus sexual identity? Only then we are equipped to guide our children as they grow and explore. This is when we can meaningfully share our personal beliefs, our religious convictions and allow the child to find his or her own way, with love and support. We fear what we do not know. We react with anger when we are hurt. We are all talking a lot. But are we listening?”
“Mr Speaker, in my view, the proposed amendments are nothing more than stating the current social norms. I am not a lawyer. Let the lawyers discuss the legal aspects of the implications of such a change. I am not a religious leader. I look to them to lead the future discussions of what their faith finds permissible. I speak to you now, as a doctor and as a mother of boys. As a doctor, I will treat all patients who come before me equally, regardless of race, language or religion, and – I add – sexual preferences or gender identity. I ask about these only to advise on any impact on their medical care. As a mother of boys, I want for them a world where they can grow safely in. What does that mean? Think back to your growing years. It was a time to find oneself – your identity and who you are – and I dare say that there are some adults who are still searching or may never find the answer their whole lives. We form our identity through multiple factors – our character at birth, be it extro- or introverted, then shaped by family, school and peers. Teenagers explore their sexuality and their gender identity. In my time, tomboyish girls and effeminate boys were given mocking and even derogatory names. For those of us who were lucky to never be confused as to whether you liked a boy or girl, it was already not easy. We still worried and fussed over whether your crush liked you back, collected red saga seeds, folded hearts from bus tickets and listened to heartbreak songs. For those who felt an attraction to someone of the same gender, I can only imagine the fear and anxiety – fear that there’s something wrong with you, that your parents will disown you, that your friends will call you a freak.”
“I am so sorry. About the KPIs, one big thing is that, as MOH and various committees talk about KPIs, please remember to involve doctors in the conversation and not be chasing economics – which is more economically viable. Let doctors advise you on what we think are feasible, medical and clinical KPIs.”
“Thank you for the opportunity. Mr Deputy Speaker and the House, I would like to thank Minister Ong for acknowledging the contributions of healthcare workers, especially in the past two years. Three big points. One is that my own term here as a Nominated Member of Parliament is limited and will come to an end pretty much soon. I hope that all of you will continue to engage with healthcare workers on the ground, not just doctors to reflect our view. Doctors have always felt that we cannot be a union and sometimes, we are marginalised. As it is, there are 15,000 doctors in Singapore. There are even more nurses around and someone needs to help represent healthcare workers as we forge forward for Healthier SG. Final point. Oh no. I am so nervous that I have lost my train of thought. I will email Minister Ong separately about my final point.”
“Establishing a good doctor-patient relationship and having mutual trust in each other gives much better patient outcomes and satisfaction. The rise of badly-written Search Engine Optimisation articles is severely detrimental to the doctor-patient relationship. So many articles share half-truths and myths, even fear mongering. As a council doctor of the SMA, I will continue to advocate for this public education and allowing doctors to do our work well, with adequate support. Each and every one of us here has to play our part well, in taking responsibility for our own health. In the launch of Healthier SG, I look forward to the shift of care to a community-based care and truly embody "prevention is better than cure".”
“After the hurrah of healthcare heroes during COVID-19, we now struggle with a backload of "business as usual" cases, long waiting times and general unhappiness. Perhaps, the average layperson does not quite understand how complex the healthcare system is. In having team-based care, with nurses and allied health taking on so much of the healthcare needs, it should be recognised, by having the patients know that these are all professionals, who are trained to deliver specific interventions and health outcomes. As an example, I perceive that sometimes, patients do not understand the importance of physiotherapy after surgery and neglect to keep the range of movements, resulting in a frozen limb, and then, wrongly blaming the doctor for bad surgery. For patients who come to the hospital for the first time ever with end-stage organ failure; I am deeply saddened. Why the years of neglect? Was it a lack of awareness or lack of resources? How about the role and responsibility of the immediate family in reminding the elderly loved one to go for regular check-ups, advise compliance with medications and to take active steps to modify this. On the one hand, we see some patients who have chosen not to know anything about their own bodies. On the other hand, we also see some people who Google non-stop and take bits of information with inadequate context, even to the extent of arguing with healthcare professionals about what is correct medical care. I wonder, do people argue with lawyers or bankers this much in legal or financial matters? What is the right balance? I always believe that education is key: good basic health education and understanding of how our body system works, how the body gets ill – is essential towards keeping oneself healthy.”