Friday, December 10, 2010

Medicine is not just a career, but a calling (Dr. Lee Wei Ling)

Sent to me by a good friend who is a vet - "Dr. Haiwan" :-)



Thought is was such a good read, it needs to be shared, as it is applies not just to medicine! (p/s what has been highlighted came to me that way)

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Medicine is not just a career, but a calling.

By Dr Lee Wei Ling, Lee Kuan Yew's daughter.
I have always felt keenly the suffering of animals. Since I was a child, I had wanted to be a vet. My parents persuaded me to abandon that idea by using the example of a vet whose university education was funded by the Public Service Commission. When he returned to Singapore, he was posted to serve his bond at the abattoirs. That was enough to persuade me to select my second career choice – a doctor. I have never regretted that decision.

There are still many diseases for which medical science has no cure, and this is especially true of neurological diseases because nerve cells in the brain and spinal cord do not usually regenerate. Hence, a significant percentage of patients seeing neurologists, of which I am one, cannot be cured. But as in all areas of medicine, we still try our best for the patient, ‘to cure, sometimes; to relieve, often; to comfort, always’. 

An example is a 70-year-old woman who sees me for her epilepsy. Her husband has taken a China mistress whom he has brought back to his marital home. He wants my patient to sell her 50 per cent ownership of their HDB flat and move out. Her children side with the husband because he is the one with the money and assets to will to them. 

When this patient comes, I always greet her with a big smile and compliment her on her cheongsam. She will tell me she sewed it herself, and I will praise her for her skill. Then I ask her whether she has had any seizures since the last time she saw me. She sees me at yearly intervals, and usually, she will have had none. 

Next, I ask her how she is coping at home. She would say she just ignores her husband and his mistress. I would give her a thumbs-up in reply, then ask her whether she still goes to watch Chinese operas. She would say yes.
By then, I would have prepared her prescription. I hand it to her, pat her on her back and she would walk out with a smile on her face, back straight and a spring in her step.
It takes me only five minutes to do the above. I can control but not cure her epilepsy. But I have cheered her up for the day.

One very special patient, Jac, has idiopathic severe generalised torsion dystonia. By the age of 11, she was as twisted as a pretzel and barely able to speak intelligibly. She did well in the Primary School Leaving Examination, but was a few points short of the score needed for an external student to be accepted by Methodist Girls’ School (MGS).
I had done fund-raising for MGS prior to this and knew the principal. I phoned her and explained Jac’s disease as well as her determination and diligence.
I told the principal that the nurturing environment of MGS would be good for Jac, and that it would be a good lesson for the other students in MGS to learn to interact with a peer with disability.
At the end of Secondary 2, Jac mailed me a book and a typed letter. The book was a collection of Chinese essays by students in MGS.
There were two essays by Jac. In addition, she had topped the entire Secondary 1 and, subsequently, Secondary 2 in Chinese. She was second in the entire Secondary 2 for Chemistry. She was happy at MGS, and her peers accepted her and helped wheel her around in her wheelchair.
Medication merely gave Jac some degree of pain relief from her dystonia. Being admitted to MGS gave her the opportunity to enjoy school and thrive in it.
I was walking on clouds for the next few hours after I received the book and letter. Jac showed that an indomitable human spirit can triumph over a severe physical disability. As a doctor, I am not just handling a medical problem but the entire patient, including her education and social life.

I have been practising medicine for 30 years now. Over this period, medical science has advanced tremendously, but the values held by the medical community seem to have changed for the worse.

Yearning and working for money is more widely and openly practised; and sometimes this is perceived as acceptable behaviour, though our moral instinct tells us otherwise. 
Most normal humans have a moral instinct that can clearly distinguish between right and wrong. But we are more likely to excuse our own wrongdoing if there are others who are doing the same and getting away with it.

These doctors who profit unfairly from their patients know they are doing wrong. But if A, B and C are doing wrong – and X, Y and Z too – then I need not be ashamed of doing the same. Medical students who see this behaviour being tacitly condoned will tend to lower their own moral standards. Instead of putting patients’ welfare first, they will enrich themselves first.

The most important trait a doctor needs is empathy. If we can feel our patient’s pain and suffering, we would certainly do our best by our patients and their welfare would override everything else.

Medicine is not just a prestigious, profitable career – it is a calling. Being a doctor will guarantee almost anyone a decent standard of living. How much money we need for a decent standard of living varies from individual to individual. My needs are simple and I live a spartan life. I choose to practise in the public sector because I want to serve all patients without needing to consider whether they can pay my fees.

I try not to judge others who demand an expensive lifestyle and treat patients mainly as a source of income. But when the greed is too overwhelming, I cannot help but point out that such behaviour is unethical.

The biggest challenge facing medicine in Singapore today is the struggle between two incentives that drive doctors in opposite directions: the humanitarian, ethical, compassionate drive to do the best by all patients versus the cold, calculating attitude that seeks to profit from as many patients as possible. Hopefully, the first will triumph.
 Doctors do have families to support. Needing and wanting money is not wrong. But doctors must never allow greed to determine their actions.

I think if a fair system of pricing medical fees – such that doctors can earn what they deserve but not profit too much from patients – can be implemented, this problem will be much reduced. The Guideline of Fees, which previously was in effect, was dropped last year. I am trying to revive it as soon as possible.

The writer is director of the National Neuroscience Institute. 

I was born and bred in Singapore.
This is my home, to which I am tied by family and friends.
Yet many Singaporeans find me eccentric, though most are too polite to verbalise it.

 I only realised how eccentric I am when one friend pointed out  to me why I could not use my own yardstick to judge others..
 I dislike intensely the elitist attitude of some in our upper socio-economic class.
 I have been accused of reverse snobbery because I tend to avoid the wealthy who flaunt  their wealth ostentatiously or do not help the less fortunate members of our society.

I treat all people I meet  as equals, be it a truck driver friend or a patient and  friend who belongs to the richest family in Singapore.
I appraise people not by their usefulness to me but by their character. I favour those with integrity, compassion and courage..

 I feel too many among us place inordinate emphasis on academic performance, job status, appearance and presentation.
I am a doctor and director of the smallest  public sector hospital in Singapore, the National Neuroscience Institute (NNI).

I have 300 staff, of whom 100 are doctors. I emphasise to my doctors that they must do  their best for every patient regardless of paying status.
I also appraise my doctors on how well they care for our patients, not by how much money they bring in for NNI.

My doctorsknow I have friends who are likely to come in as subsidised patients. I warn them that if I find them not
treating any subsidised patient well, their appraisal - and hence bonus and annual salary increments - wouldbe negatively affected. My doctors know I will do as I say..

I remind them that the purpose of our existence and the  measure of our success is how well we care for all our patients -
and that this is the morally correct way to  behave and should be the reason why we are doctors.

In NNI, almost all patients are given the best possible treatment regardless of their paying status.

My preference for egalitarianism extends to how I interact with my staff.
I am  director because the organisation needs a reporting structure..
But my staff are encouraged to speak out when they disagree with me.
This tends to be a rarity in several institutions in Singapore.
The fear that one's career  path may be negatively affected is what prevents many people from speaking out.
This reflects poorly on leadership. In many organisations, superiors do not like to be contradicted by those who work under them. Intellectual arrogance is a deplorable attitude. 'Listen to others, even the dull and ignorant; they too have their story,'

the Desiderata tells us.
It is advice we should all heed - especially leaders, especially doctors.
 I speak out when I see something wrong that no one appears to be trying to correct.
 Not infrequently, I try to right the wrong. In doing so,

 I have stepped on the sensitive toes of quite a few members of  the establishment.
As a result, I have been labelled 'anti-establishment'.

Less kind comments include:
I am indifferent to these untrue criticisms; I report to myconscience;and I would not be able to face myself if I knew that there was a wrong that I could have righted but failed to do so. I have no protective godfather.

My father, Minister Mentor Lee Kuan Yew, would not interfere with any disciplinary measures that might be meted out to me.

And I  am not anti-establishment. I am proud of what Singapore has achieved.
But I am not a mouthpiece of the government.

I am capable of independent thought and I can view problems or issues from a perspective that others may have overlooked.

A few months ago, I gave a talk on medical ethics to students  of our Graduate Medical School.
They sent me a thank-you card with a message written by each student.
One wrote:'You are a maverick, yet you are certainly not anti-establishment.
 You obey the moral law.'

 Another wrote: 'Thank you for sharing your perspective with us and being the voice that not many dare to take.'
It would be better for Singapore's medical fraternity if the young can feel this way about all of us in positions of authority.

 After the SARs epidemic in 2003, the Government  began to transform Singapore into a vibrant city with arts and cultural festivals,
and soon, integrated resorts and night F1.
But can we claim to be a civilised first world country if we do not treat all members of our society with  equal care and dignity?

There are other first world countries where the disparity between the different socio- economic classes is much more extreme and social snobbery is even worse than in Singapore.

But that is no excuse for Singaporeans not to try harder to treat each other with  dignity and care.

After all, both the Bible and Confucius tell us not to treat others in a way that we ourselves would not want to be treated.

I wish Singapore could be an exception in this as it has been in many other areas where we have surprised others with our success.

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