I once took my blog down after being stalked by a clinically-diagnosed Schizophrenic I'd never met. I'd dealt with the mentally ill before, mostly in medical school. I understood her condition well (Psychiatry was, strangely, one of the things I really found interesting in med school) and that she couldn't help herself. It didn't help in the least bit to lessen the slowly mounting sense of alarm when the phone was ringing for the xth time, or when the gifts started showing up at the gym I went to. It didn't help when I picked up the phone, and conversations took oddly predictable yet incomprehensible slants, and somewhere in there I felt sorry for, and concerned for - someone else's patient.
I hope she's doing better now.
I tried to restart the blog some time later when things had simmered down. It had been hijacked by a porn site. Laugh.
These days I just can't find the time or will to write, and there's just so much happening in real life...
I ask prospective bright-eyed bushy-tailed hatchlings why they want to study medicine when they could be doing so, so much else.
The answer is always the same - I want to make a difference, I want to help people (or some permutation thereof). Always so rehearsed, and so unconvincing.
I can almost understand why the NUS interviewers asked me what they did : So why do you want to do medicine, aside from all that being nice and saving people shit?
Almost, but not quite. I would never ask that. There's the off chance that this person is actually for real - it happens - and not just in it for the "prestege" or "money". And right now, right here, he/she believes it with his/her heart. So just pause, and wait for the rest of the story. And then I tell them, I'm glad, because this will stay with you.
And if they haven't got a story, they just... want to help people, because.... well... it's good.
Then I inhale, and start telling them about how they'll feel one day in the distant future, watching their friends grow up around them while they languish in career infancy, drowning day to day in multitudes of thankless calls, succumbing slowly to Real Life after the glow fades.
I'm still glad to do what I do. I tell people it's because I like cutting off legs, and in truth part of me does (well, I like doing things well, and I think I do that pretty well... heh). But I much prefer saving legs. I say it's because I like the nature of the operations, and I really, really do. But, well : there's many other things I like too, and I really, really would like to be retired with all the time in the world to write, lounge around, and relax too :)
I've been asked what the point is, since these people will just go back to smoking anyway, and you'll see them again soon, and they'll be dead even sooner.
I guess I just have a story.
Friday, March 18, 2011
Tuesday, March 15, 2011
Much ado about Nothing
In the aftermath of events still unfolding in Japan it seems almost wrong for everyday, humdrum life to go on. It feels as if we shouldn't... be going about our daily chores, making inane chatter at work, screwing over colleagues for personal gain, stabbing each other in the backs... it just seems so wrong, somehow. And then the weirdos pitch in and start spreading hoax nuclear rain SMSs and make light of a tragedy of monumental proportions, and then self-centered morons write into the straits times complaining about how personally inconvenienced they were by the disaster (SIA where were you etc)... word. People are fucked up. Bigtime.
The Susan Lim scandal has lost momentum; knocked for six it will plod on now-unnoticed to a public that has cast judgement and moved on. Few people are left to care as the smoke clears.
I can't help but wonder what precipitated this bizarre show-and-tell by the Singapore Medical Council. The layman may not be able to discern the trees from the woods, but to an insider... it's even more bewildering. Wood? There's just matchsticks here.
I don't imagine that the court case is going to be cheap. Who will pay for it? Why we will of course - us doctors who pay our annual subscription, wonder what happens to it for a moment, and then stop caring... (ah suddenly the clouds are parting. This is the true destiny of our subscription monies!)
The butterfly effect had started... public mutterings of discontent, of rich and poor, of greed on an unusual scale so at odds with the "noble" field of medicine" were already rippling outwards and building to a crescendo just before the hammer of Mother Nature fell upon Japan and turned the mountain into a molehill.
Like the layman I'm burning for answers too - but to different questions.
I don't care how or why Susan Lim could have asked such outrageous prices. It's easy to understand how someone like Susan Lim could have asked the going prices that she did. Just put yourself in her shoes for an instant.
In her head she was "up there" with the best in the world. The much-touted Medical Hub of singapore had arrived in her mind, and she was the epicenter.
Her corporate website proclaims that common knowledge splattered all over wikipedia, and the web, thanks to unifem and the australian high commission - that she is the first surgeon to perform a successful liver transplant in asia.
Trawl back through time and reality emerges. The first liver transplants in Asia - living donor related (1989) and cadaveric (1964) - were done by the Japanese.
Susan Lim performed the first liver transplant in Singapore - not Asia. And she did it when she was young - in her mid thirties, as a young consultant.
Look still deeper and you will see the names of the three surgeons who were members in the team she "led". All of them Professors, all old enough to be her father (kind of), "assisting" her through one of the most difficult operations known to medicine. And suddenly the picture becomes much, much clearer.
Conjecture? A favourite amongst favourites, public recognition, going private.
Sounds a bit like a Taiwanese medical drama...
I don't know Dr Lim personally, and I don't think I'd care to after reading her reproduction of erroneous claims to regional fame.
She strikes me as someone driven to market herself at all costs. Someone selfish and self-centered.
This is what the public resentment really centered about - doctors aren't meant to be selfish or money-faced! They swore the Hippocratic oath! They're all meant to be paupers and Saints who toil without rest, and live hand to mouth until they die from it!!
Well fuck you. Doctors are people too, same as you are. And if you had the means to make big bucks - and if you ran a big business involving marketing yourself - you'd probably go the same way Susan Lim did. Don't kid yourself.
Granted, a larger proportion of medics don't than average, and not through want of talent. Medicine does weed out the oddballs that prioritize the needs of others over their own, and are willing to try to help alleviate suffering by forgoing some of their own pleasures of the flesh. That's what the "rigorous selection" is for, innit? But no system is perfect... and bear in mind that it's still just a job. In the same way that not all politicians are noble, not all models brainless, and not all lawyers incorrigible - not all doctors are blathering goody two-shoes who buy breakfast for their impoverished C-class patients every day and serve it on a silver platter, balanced precariously on bended knee.
Having said that, Dr Lim achieved her aim - she got to where she was through hard work and aggressive marketing and one (or two?) misleading claims - but this doesn't detract from the act that she got There. People came to her - rich people, like the Bruneian Sultanate. That alone shouts volumes about her regional reputation.
And frankly, if she was on the level - world best, patronized by royalty - then she had every damn right to charge the way she did. The UK surgeon who charged five hundred thousand pounds for two days consultation with this same patient -- two days -- why isn't anyone wondering about that? Why - because the white man must have been a world expert of course. His time was valuable.
So too, was Susan Lim's. She is an expert - in her patients' eyes - as much a world expert as Woffles Wu. So she charged tens of millions of dollars - so what? This was a very demanding patient that treated her more as a personal retainer than a consultant surgeon. The patient-doctor relationship was skewed towards client-consumer from the start. Respect appeared to be a one-way street. The patient demanded, the patient received.
Dr Lim claims she made her fees clear to her patient beforehand. The patient spent years prior to her death paying exorbitant fees apparently without complaint. This appears to corroborate those claims.
And everyone knows that when you do favours for asian royalty you get kickbacks. Perhaps Dr Lim doesn't have a thing for camels, Maserati's or expensive wine and just likes cold hard cash - we'll never know. This sort of stuff doesn't come out in court.
At the end of the day, this was a mutual agreement between doctor and patient. You treat me like a servant, take me away from work, and endanger my eyes - well sod you, I'll charge you like the royalty you are. (Just doing a House.)
Dr Lim did what all of us wish we could when dealing with our own patients from hell. And I kind-of applaud her, while hating her for it at the same time. I can empathize with her, even though I don't agree and certainly wouldn't have done it myself.
Was what she did so wrong? Step away from your pre (mis) conceptions of saints and doctors, and Hippocratic oaths (which just says we shall do no harm... and well. Taking money from a willing, very, very rich donor isn't exactly doing harm... Oh but wait, but the patient died! Surely that's evidence of harm! Think again. The woman had cancer. She was dying from the get-go. A recurrence? Was there curative surgery that... failed? Bollocks. You get cancer, you get cured, it comes back - them's the breaks. That's just bad luck and statistics, not a failure of the physician.) and look at it anew with unbiased eyes, from the view of a healthcare professional.
Does Susan deserve to be "disciplined" for entering into a mutual agreement with a willing patient? Did she deceive the patient in any way? Is it even overcharging when your patient is pre-warned about exorbitant costs and wants to go ahead? Would anyone bat an eye if Dr Lim had been a lawyer, or a businesswoman? Or a minister?
How much do the doctors-turned-ministers earn before they "fall from grace" and accept their paycuts to don the white short-sleeved shirt and long pants again? How do you think they were earning such big bucks before signing up for their one true calling? By seeing thousands of patients a day -- or charging big bucks to a privileged few?
And why, why on earth would the SMC build a case against it's own public image?
That's what bugs me the most. Why in the blue blazers would the one organization that was created with the sole purpose of protecting the profession seek to encite the public against itself? What could it have taken to bring this about?
One more thing.
1) Susan Lim sends bill to Royal family
2) Royal family complains to Ministry of Health
3) Ministry of Health assigns Singapore Medical Council to mediate
4) SMC raises disciplinary hearing
5) Hearing dissolved - allegations of prejudice
6) Susan Lim brings SMC to court to prevent hearing being raised again
7) Press involved
Hmm. Which one doesn't quite fit in there, one wonders? Which ones are closed-door events, and which open to the public?
Let's take a look at the key players.
Salma Khalik and Prof Satku aren't strangers to each other. Let's see what Prof Satku had to say about her reporting style, even if it was oblique. Not... exactly the best of friends, eh.
I've seen it said on forums that poor Prof Satku is a victim himself, removed from his position of power as Registrar to the SMC (hmm. once director medical services. Registrar must be a step up?) because the Men in White are staging some kind of cover up. The poor deluded fools.
Perhaps what Susan Lim herself has to say about Prof Satku can shed some light on his abrupt reassignment of duties, and why a new position - non-constitutional - was created and legalized expressly for this trial.
Does anybody smell a warm, fuzzy, long-tailed mammal?
The Susan Lim scandal has lost momentum; knocked for six it will plod on now-unnoticed to a public that has cast judgement and moved on. Few people are left to care as the smoke clears.
I can't help but wonder what precipitated this bizarre show-and-tell by the Singapore Medical Council. The layman may not be able to discern the trees from the woods, but to an insider... it's even more bewildering. Wood? There's just matchsticks here.
I don't imagine that the court case is going to be cheap. Who will pay for it? Why we will of course - us doctors who pay our annual subscription, wonder what happens to it for a moment, and then stop caring... (ah suddenly the clouds are parting. This is the true destiny of our subscription monies!)
The butterfly effect had started... public mutterings of discontent, of rich and poor, of greed on an unusual scale so at odds with the "noble" field of medicine" were already rippling outwards and building to a crescendo just before the hammer of Mother Nature fell upon Japan and turned the mountain into a molehill.
Like the layman I'm burning for answers too - but to different questions.
I don't care how or why Susan Lim could have asked such outrageous prices. It's easy to understand how someone like Susan Lim could have asked the going prices that she did. Just put yourself in her shoes for an instant.
In her head she was "up there" with the best in the world. The much-touted Medical Hub of singapore had arrived in her mind, and she was the epicenter.
Her corporate website proclaims that common knowledge splattered all over wikipedia, and the web, thanks to unifem and the australian high commission - that she is the first surgeon to perform a successful liver transplant in asia.
Trawl back through time and reality emerges. The first liver transplants in Asia - living donor related (1989) and cadaveric (1964) - were done by the Japanese.
Susan Lim performed the first liver transplant in Singapore - not Asia. And she did it when she was young - in her mid thirties, as a young consultant.
Look still deeper and you will see the names of the three surgeons who were members in the team she "led". All of them Professors, all old enough to be her father (kind of), "assisting" her through one of the most difficult operations known to medicine. And suddenly the picture becomes much, much clearer.
Conjecture? A favourite amongst favourites, public recognition, going private.
Sounds a bit like a Taiwanese medical drama...
I don't know Dr Lim personally, and I don't think I'd care to after reading her reproduction of erroneous claims to regional fame.
She strikes me as someone driven to market herself at all costs. Someone selfish and self-centered.
This is what the public resentment really centered about - doctors aren't meant to be selfish or money-faced! They swore the Hippocratic oath! They're all meant to be paupers and Saints who toil without rest, and live hand to mouth until they die from it!!
Well fuck you. Doctors are people too, same as you are. And if you had the means to make big bucks - and if you ran a big business involving marketing yourself - you'd probably go the same way Susan Lim did. Don't kid yourself.
Granted, a larger proportion of medics don't than average, and not through want of talent. Medicine does weed out the oddballs that prioritize the needs of others over their own, and are willing to try to help alleviate suffering by forgoing some of their own pleasures of the flesh. That's what the "rigorous selection" is for, innit? But no system is perfect... and bear in mind that it's still just a job. In the same way that not all politicians are noble, not all models brainless, and not all lawyers incorrigible - not all doctors are blathering goody two-shoes who buy breakfast for their impoverished C-class patients every day and serve it on a silver platter, balanced precariously on bended knee.
Having said that, Dr Lim achieved her aim - she got to where she was through hard work and aggressive marketing and one (or two?) misleading claims - but this doesn't detract from the act that she got There. People came to her - rich people, like the Bruneian Sultanate. That alone shouts volumes about her regional reputation.
And frankly, if she was on the level - world best, patronized by royalty - then she had every damn right to charge the way she did. The UK surgeon who charged five hundred thousand pounds for two days consultation with this same patient -- two days -- why isn't anyone wondering about that? Why - because the white man must have been a world expert of course. His time was valuable.
So too, was Susan Lim's. She is an expert - in her patients' eyes - as much a world expert as Woffles Wu. So she charged tens of millions of dollars - so what? This was a very demanding patient that treated her more as a personal retainer than a consultant surgeon. The patient-doctor relationship was skewed towards client-consumer from the start. Respect appeared to be a one-way street. The patient demanded, the patient received.
Dr Lim claims she made her fees clear to her patient beforehand. The patient spent years prior to her death paying exorbitant fees apparently without complaint. This appears to corroborate those claims.
And everyone knows that when you do favours for asian royalty you get kickbacks. Perhaps Dr Lim doesn't have a thing for camels, Maserati's or expensive wine and just likes cold hard cash - we'll never know. This sort of stuff doesn't come out in court.
At the end of the day, this was a mutual agreement between doctor and patient. You treat me like a servant, take me away from work, and endanger my eyes - well sod you, I'll charge you like the royalty you are. (Just doing a House.)
Dr Lim did what all of us wish we could when dealing with our own patients from hell. And I kind-of applaud her, while hating her for it at the same time. I can empathize with her, even though I don't agree and certainly wouldn't have done it myself.
Was what she did so wrong? Step away from your pre (mis) conceptions of saints and doctors, and Hippocratic oaths (which just says we shall do no harm... and well. Taking money from a willing, very, very rich donor isn't exactly doing harm... Oh but wait, but the patient died! Surely that's evidence of harm! Think again. The woman had cancer. She was dying from the get-go. A recurrence? Was there curative surgery that... failed? Bollocks. You get cancer, you get cured, it comes back - them's the breaks. That's just bad luck and statistics, not a failure of the physician.) and look at it anew with unbiased eyes, from the view of a healthcare professional.
Does Susan deserve to be "disciplined" for entering into a mutual agreement with a willing patient? Did she deceive the patient in any way? Is it even overcharging when your patient is pre-warned about exorbitant costs and wants to go ahead? Would anyone bat an eye if Dr Lim had been a lawyer, or a businesswoman? Or a minister?
How much do the doctors-turned-ministers earn before they "fall from grace" and accept their paycuts to don the white short-sleeved shirt and long pants again? How do you think they were earning such big bucks before signing up for their one true calling? By seeing thousands of patients a day -- or charging big bucks to a privileged few?
And why, why on earth would the SMC build a case against it's own public image?
That's what bugs me the most. Why in the blue blazers would the one organization that was created with the sole purpose of protecting the profession seek to encite the public against itself? What could it have taken to bring this about?
One more thing.
1) Susan Lim sends bill to Royal family
2) Royal family complains to Ministry of Health
3) Ministry of Health assigns Singapore Medical Council to mediate
4) SMC raises disciplinary hearing
5) Hearing dissolved - allegations of prejudice
6) Susan Lim brings SMC to court to prevent hearing being raised again
7) Press involved
Hmm. Which one doesn't quite fit in there, one wonders? Which ones are closed-door events, and which open to the public?
Let's take a look at the key players.
Salma Khalik and Prof Satku aren't strangers to each other. Let's see what Prof Satku had to say about her reporting style, even if it was oblique. Not... exactly the best of friends, eh.
I've seen it said on forums that poor Prof Satku is a victim himself, removed from his position of power as Registrar to the SMC (hmm. once director medical services. Registrar must be a step up?) because the Men in White are staging some kind of cover up. The poor deluded fools.
Perhaps what Susan Lim herself has to say about Prof Satku can shed some light on his abrupt reassignment of duties, and why a new position - non-constitutional - was created and legalized expressly for this trial.
Does anybody smell a warm, fuzzy, long-tailed mammal?
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