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VO L . 5 2 N O . 5 | M AY 2 0 2 0 | M C I ( P ) 0 6 6 / 1 2 / 2 0 1 9
BEYOND DOCTORING
Hospital Denizen
to Corporate Citizen
Braving
a New World
news
CON T E N T S
Vol. 52 No. 5 2020
EDITORIAL Editorial
BOARD
04 The Editors' Musings
Editor Dr Tina Tan and Dr Chie Zhi Ying
Dr Tina Tan
Deputy Editor
Dr Chie Zhi Ying Feature
Editorial Advisors 05 From Hospital Denizen
A/Prof Daniel Fung to Corporate Citizen
A/Prof Cuthbert Teo
Dr Toh Han Chong – A Personal Journey
Dr Andrew Green
Members
Dr Ganesh Kudva
Dr Jipson Quah
Dr Tan Tze Lee President's Forum 24 Standing Together in
Dr Jimmy Teo 08 A Time of Change in
Dr Alex Wong the Face of COVID-19
the World and SMA Dr Victoria Leung, Dr Ian Mathews,
EX-OFFICIOS Dr Tan Yia Swam Dr Valerie Tay and Dr Yeoh Chuen Jye
Dr Tan Yia Swam
Dr Ng Chew Lip
Council News 26 Defending Defensive Medicine
EDITORIAL Dr Chuang Wei Ping
10 Highlights from the
OFFICE
Honorary Secretary
Senior Manager
Sarah Lim
Dr Ng Chew Lip Indulge
Assistant Manager
30 Nanjing: A Witness to the
Sylvia Thay
11 2020 SMA Annual Centuries of Change
General Meeting Dr Jimmy Teo
Editorial Executive
Lee Sze Yong
Daryl Lai
ADVERTISING AND 12 Support and Appreciation AIC Says
PARTNERSHIP for our HCWs 32 Supporting the Primary Care
Li Li Loy
Tel: (65) 6540 9174 Sector’s Response to COVID-19
Allan Kuek Agency for Integrated Care
Tel: (65) 6540 9175
Email: adv@sma.org.sg
PUBLISHER
Singapore Medical Association
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Opinion
18 Braving a New World
Opinions expressed in SMA News reflect the Dr Yau Teng Yan, Dr Lee Guo Rui,
views of the individual authors, and do not Dr Zubin J Daruwalla and Ethan Seow
necessarily represent those of the editorial
board of SMA News or the Singapore Medical
Association (SMA), unless this is clearly 22 Psychological Fallout –
specified. SMA does not, and cannot, accept
any responsibility for the veracity, accuracy
Doctors in the COVID-19 Pandemic
or completeness of any statement, opinion or Dr Tina Tan
advice contained in the text or advertisements
published in SMA News. Advertisements of
products and services that appear in SMA News
do not imply endorsement for the products
and services by SMA. All material appearing
in SMA News may not be reproduced on any
platform including electronic or in print, or
transmitted by any means, in whole or in part,
without the prior written permission of the
Editor of SMA News. Requests for reproduction
should be directed to the SMA News editorial
office. Written permission must also be
obtained before any part of SMA News is stored
in any retrieval system of any nature.
editorial
Dr Tina Tan newly elected Council, for their question. Rather, we showcase what
support as I take on the role of Editor. some of our colleagues have done
Editor There is little point in wishing that in place of the usual “doctoring”, and
these transitions had occurred in their motivations in doing so. We are
Dr Tan is a consultant at the Institute more peaceful times, though I remain grateful for their honest perspectives.
of Mental Health and has a special hopeful that by the time this issue is Last but not least, I’d like to
interest in geriatic psychiatry. She is published, the dust of the pandemic thank Dr Jonathan Tan for his years
also an alumnus of Duke-NUS Medical will have settled a little. Instead, of contribution to SMA News, as he
School. Between work and family what I desire is for the newsletter steps down due to work and family
life, she squeezes time out for her to remain relevant, dynamic, and commitments. We wish him all
favourite pastimes – reading a good continue to advocate for all of us as the best.
(fiction) book and writing. healthcare professionals, and I will
strive to do that with my colleagues. With that, thank you all for your
dedication and hard work. Stay
In the midst of the organised safe, everyone.
I’d like to welcome Dr Chie Zhi Ying chaos wreaked by COVID-19, there
as Deputy Editor to SMA News, and is a certain sense of loss that could
thank Dr Tan Tze Lee for his previous cause some of us to reconsider our
contributions as Deputy Editor. Next, choice of medicine as a career. We
I wish to extend my appreciation might ask ourselves – is this where
to the SMA News team, my fellow I’m meant to be? This issue isn’t
Editorial Board members, and the meant to answer that very personal
As I’m penning this editorial for President, as well as to all newly
the first time as Deputy Editor, I am elected SMA Council members.
thankful for the support, guidance It now gives me great pleasure
and help that I have received from to introduce the theme of this issue,
the SMA News team and fellow “A New World: Beyond Doctoring”.
Editorial Board members. I would also We are privileged to have Dr Andrew
like to thank our readers for giving
me the opportunity to share my
Green from Takeda Vaccines to
shed light on his works in the Dr Chie Zhi Ying
thoughts and learn from you all over pharmaceutical industry and to see
the years. how “pharmers” contribute behind Deputy Editor
Congratulations to Dr Tina Tan the scenes to the better health of all.
on taking over SMA News as Editor This issue also features doctors Dr Chie is a family physician working
and the team looks forward to and medical students who have taken in the National Healthcare Group
bringing fresh perspectives and the leap of faith to venture into fields Polyclinics. She enjoys freelance
issues close to heart to our readers. beyond doctoring, such as starting writing and singing. She writes for
healthcare technology companies. Lianhe Zaobao, Shin Min Daily News
Congratulations also to and Health No.1. She can be contacted
Dr Tan Yia Swam, our ex-Editor, With that, enjoy the issue, at chiezhiying@gmail.com.
on being elected as our new SMA stay safe and stay healthy.
04 MAY 2020 SMA News
FEATURE
From Hospital Denizen
to Corporate Citizen
A Personal Journey
Text by Dr Andrew Green
The unorthodox physician in a negotiators, teachers, innovators While the training starts off with basic
public health world and so much more – all of which are clinical rotations like other residencies,
The medical curriculum at large has traits highly sought after in virtually the curriculum quickly sets itself apart
always focused on skills to produce any industry. Yet, a doctor outside of after two years to concentrate on public
physicians who can deliver care that clinical practice remains to be rare as health. Public health does not work
reflects disease knowledge, evidence- hens’ teeth. by treating one patient at a time but
based treatment and professional accepts the population in its entirety
I happen to be a hen’s tooth, which
patient communication. However, to in the “consult room” as its patient. For
is why I was invited to write this article.
believe that these doctor skills are this, preventive medicine residents are
non-applicable outside of clinical My journey in medicine has been formally equipped with epidemiology,
practice is a grave insult to the current unorthodox, to say the least. Having biostatistics, ethics, economics,
medical education system that is completed my medical degree, I was health policy and management to
based on principles advocated by accepted into the Preventive Medicine complement the application of their
Flexner and Osler. Physicians are not Residency Programme, a national clinical knowledge into solving the
mere healers; they have been trained residency programme offered by the population’s most pressing health
to be distinguished leaders, analysts, National University Health Systems. concerns. This is not to say that doctors
MAY 2020 SMA News 05
in other specialties are not equipped drug that revolutionises medicine. the dark. To launch a new drug into
with such skills, nor is it to say that they Take the Hepatitis C virus (HCV), for the market, data on the drug’s efficacy,
do not dabble in public health matters. example. Prior to 2014, HCV treatment safety and manufacturing quality must
They are, and they do. However, their centred around the use of an be present. Similarly, to convince payors
exposure to public health usually interferon-based regimen which had that a drug is worth covering, data on
happens at a much later stage as poor tolerability and low cure rates. its value must be generated. Having
training to become a clinical specialist The treatment landscape changed said that, not all data can be translated
demands years of undivided attention dramatically with the introduction of a into good business or clinical insights,
and dedication to complete. new group of oral medications called let alone positively impact public
Contrary to popular belief, public direct-acting antivirals. They were health. To do so, the data in question
health is not a domain that is exclusive highly efficacious, well-tolerated and must be produced in high quality and
to governments. Public health is short in the duration of treatment. The disseminated in a systematic manner.
achieved through the collective efforts cure rates were so encouraging that in This is medical affair’s cue to enter.
of organisations in the society, be it 2017, the World Health Organization
governmental or private, large or small, set a target to eliminate chronic HCV Medical affairs,
commercial or non-profit, clinical or infection by the year 2030. my drug of choice
otherwise. Humour me please: “If a Like it or not, innovative medicines I joined a leading pharmaceutical
private company can deal with public are inextricably linked to the company last year and landed a
health problems” and “a physician pharmaceutical industry. In fact, almost position in medical affairs. For all
can play a central role in solving all the innovative medicines launched intents and purposes, the medical
public health problems,” then through to the market in the last decade were affairs team functions as custodians of
simple Socratic deduction, one can produced by the top pharmaceutical the company’s scientific and clinical
safely conclude that “there is room for companies. This is no coincidence; the data. The job description came to be as
physicians in private companies.” industry makes it a point to commit the need to separate R&D (the creator
The next logical question is, of a large proportion of its revenues on of data) from commercial functions
research and development (R&D). To arose to reduce the commercial
course, which company?
put things into perspective, the global influence on R&D efforts. In the
I knew medically trained colleagues annual pharmaceutical R&D spending pharmaceutical industry, scientific
who have bravely left medicine for is expected to reach over USD 200 truth must always prevail, and no
careers completely unrelated, such as billion (SGD 283 billion) within the next misleading claims, especially for
banking or finance. But for me, I knew five years. The fruits of this capital- marketing purposes, should ever be
I was not ready to completely part intensive labour are visible in terms of derived from it. Unfortunately, data
ways with medicine. Truth be told, I an increasing number of novel drugs produced by R&D often come in a
had to be convinced that whichever that have become available in the format that is difficult to interpret:
new occupation I took up in the last decade. Making such life-saving statistics. Coupled with the rate
private sector would still allow my drugs available is just one part of the in which data quickly becomes
medical knowledge to be applied and industry’s commitment to public health. outdated and obsolete, it comes as
remain up to date. More importantly, A natural extension of this mission is no surprise that misinterpretation
however, I had to be certain that public the industry’s participation in myriad (whether intentional or not) frequently
health would always be an integral public-health initiatives around the occurs. With in-depth knowledge
component of my work. I found both in world to make essential and innovative in clinical trials methodology and
the pharmaceutical industry. drugs widely accessible and affordable. disease understanding, members of
The pharmaceutical industry genuinely the medical affairs team are adept
Pharmaceutical public health believes that such a vision is attainable in translating complex statistics into
Having been posted to Singapore’s – one data set at a time. medically-accurate implementable
Health Sciences Authority during It is a common misconception to strategies for the commercial team and
my senior residency, I had been think that the pharmaceutical industry’s the rest of the organisation.
acquainted with the world of strengths lie only in its ability to The stewardship of data flow to
pharmaceutical medicine, produce pills, tablets, or ointments. The external stakeholders is also under
understanding the great impact industry is, first and foremost, in the medical affairs’ oversight. From the
pharmaceuticals have on people. business of producing data, for without point of view of the data lifecycle,
Every now and then comes a new data, every decision made is a stab in the aim is to enrich and mature a
06 MAY 2020 SMA News
product’s data through information As a career, medical affairs also the clinical trials aspect of it, while
exchange with healthcare workers, promises continuous learning, personal others in healthcare policy or access
policymakers, patients and even growth and thought leadership. With to medicine.
caregivers. Throughout the sophisticated novel molecules (eg, If you have a passion for medicine
interactions, a rapport is built, which gene therapy), new data sources and bringing life-saving drugs to
culminates in an understanding of (eg, real-world evidence and big the right patient at the right time
the clinical needs in the field. This, in data), tighter market barriers (eg, while charging a fair price, then
turn, allows the medical affairs team Health Technology Assessment), and medical affairs may just be the job
to improve current data or create new emerging information channels (eg, for you. All you need is a medical
ones to address these needs. In the virtual conferences) coming up at degree and a willingness to learn. A
process, medical affairs often partners unprecedented rates, learning is a word of advice: not liking the work
with physicians by supporting their continuous undertaking. It is to be in clinical medicine is not a good
research and evidence generation understood that pharmaceuticals is a enough reason to join Big Pharma;
efforts. Subsequently, as the data for-profit industry, and medical affairs you may not like it here either. The
mature, medical affairs will also pharmaceutical industry is an entirely
is not exempt from that. Hence, as
be able to stake a bold claim for different milieu with its own set of
a medically-trained person, a steep
upgrading the physician and patient challenges and pain points. However,
learning curve is expected in order to
decision-making process. Towards a career in medical affairs may offer
catch up with critical business skills fulfillment to many healthcare
policymakers, medical affairs must be such as strategic planning, finance,
capable of clearly articulating clinical professionals by enabling them to
regulatory affairs and even legal respond to public health challenges
and economic value to accelerate matters. In this industry, excellent with the ultimate goal of improving
access to treatment in support of bedside manners are not sought patient care and outcomes – one
universal healthcare coverage. As you after but expected. One must be data set at a time.
can see, medical affairs physicians,
sure that his/her business etiquette,
backed with data as their weapons, act
communication, cultural savviness, The author would like to express
as agents of change towards a world
conflict resolution and problem-solving his heartfelt gratitude to Dr Goh
with better drug armamentarium.
skills are in top form. Fortunately, large Choo Beng for his invaluable inputs
The spread of data to the outer pharmaceutical companies make it a to the writing of this article.
world is an enormous undertaking point to ensure that formal training
and can be prone to misuse. Medical resources for both hard and soft skills
affairs activities are thus bound by are available for their employees.
Dr Green is the Regional
law, as well as industry codes. In
(APAC) Medical Affairs
Singapore, medical affairs activities How does one get a job in Manager of Takeda Vaccines.
are governed by the Health Products medical affairs? He graduated from Duke-NUS
Act, and to a lesser degree, by a set Medical School in 2012 and
of industry guidelines established The role of the medical affairs completed his residency in
by the Singapore Association of physicians is constantly evolving well Preventive Medicine in 2018,
beyond the usual support to internal while also pursuing his MBA.
Pharmaceutical Industries. Similar He has worked as an associate
to clinical practice, the codes that regulatory and commercial functions. consultant at Duke-NUS’ Centre
apply to medical affairs also stem In the future, collaboration with key of Regulatory Excellence (CoRE)
from the four pillars of medicine opinion leaders will extend beyond and was involved in various
communicating medical evidence to pharmaceutical-policy projects.
(patient autonomy, beneficence,
also include generating evidence and He is currently busy with the
non-maleficence and justice) with launch-preparedness activities
the addition of guidance for the leading medical education. Increasing of Takeda’s dengue vaccine.
proper conduct in the marketing and responsibilities in the various facets
promotion of medicines. A breach of the industry, such as public health
in the code of conduct may result initiatives and empowering patient
in monetary and reputational loss. associations, make the field of medical
Therefore, a physician in medical affairs a vibrant one. Of course, one is
affairs will need to have a thorough not expected to master all domains
knowledge of the laws in place and in medical affairs. As in clinical
to maintain this through professional medicine, medical affairs physicians
development as updates arise. also specialise. Some specialise in
MAY 2020 SMA News 07
PRESIDENT'S FORUM
Illustration: Dr Justinian Zai
A TIME OF
CHANGE Text by Dr Tan Yia Swam
in the
World and SMA
This column in the May 2020 edition media: fake news, keyboard warriors I have made many new friends in these
marks the first time I write for SMA News and armchair experts are everywhere. groups, and we have shared anecdotes,
as President of SMA. I am the first woman Some countries have increased incidents complained together and reassured
president of SMA, and I am acutely aware of racism. The COVID-19 pandemic is a each other. I was especially touched by
of the responsibilities, expectations threat to us all: to life and personal safety, the individuals who reached out to me
and challenges. I am positive about the to livelihoods in all walks of life. privately to offer personal assistance, and
great potential I see, everywhere. Being But, not all is lost. to volunteer for the various small projects
elected to be SMA President is a privilege I wanted to start. Funnily enough, I realise
There is much greater connectivity that we have never met in person, nor
and an honour. I will do my utmost for
today. Colleagues reach out across even video-chatted yet. If the profile
doctors and for patients.
continents to share scientific information photo is a childhood photo, or covered
and updates, to better enable each other in personal protective equipment (PPE),
COVID-19: a time of change to heal their patients. Friends continue to or of a pet, I don’t even have a face that
This marks the fourth month that catch up remotely. In Singapore, we see I can visualise. In fact, if your name is a
COVID-19 is present in Singapore. people setting up groups to help those nickname or initials, I’m sorry, you’ll always
COVID-19 has impacted the world and in need. We have so many volunteer be “FluffyBunny92” in my mind. (This is
brought unprecedented changes to our groups springing up everywhere. a fictional example. Any coincidence to
lives. International travel came to a halt; In our own profession, Facebook, anyone alive/dead is sheer coincidence!)
there’s confusion, worry, and fear over WhatsApp and Telegram chat groups Thank you all, for your friendship. I am
falling sick and dying. Struggles over have allowed doctors (especially very glad to know you. I look forward to
resources threaten healthcare in every those in private practice) to keep in meeting you in person one day, soon.
country – personal protective devices, touch. Hardworking moderators have
ventilators and healthcare workers. The managed the groups – to allow for
World Food Project warns of famine in fruitful discussion, sharing of good
SMA now: current changes
some countries. Economies move into information, some humour to de-stress There are changes within SMA. The
recession. Harder times are coming. and the occasional venting. This level of Council has been planning to take SMA
We see a surge in the abuse of social support is amazing. up yet another notch, to keep abreast
08 MAY 2020 SMA News
with changes in the way we practise Giving thanks (ahem, you know who you are) still call
medicine. Broadly, I see three key areas: me “xiao mei mei” (translate: little girl), I
I want to register my thanks to Dr Noorul
1. Changes in medical advances Fatha As’art; immediate past President, have now crossed over to an age where
How can any doctor know the whole Dr Lee Yik Voon; and past Presidents some other xiao mei mei will say, “you
breadth and depth of all the different Dr Chong Yeh Woei and A/Prof Chin were my tutor when I was in M3”. And of
Jing Jih for their years of service and course, she’s not a little girl either, she is
specialties? As training programmes
leadership on the SMA Council. Special a consultant!
change, and residency has a shorter
training time compared to the old thanks and gratitude to Mr Martin Ho, The age divide is real. Young
basic specialty training/advanced Chief Administrator of the SMA people think that the old are slow
specialty training system, how Secretariat for the past ten years. He and unchanging. The old think that
do we better prepare our young has brought structure and improved the young are hasty and fickle. The
doctors? How do we better utilise the workflow of the organisation – and “strawberries” are pampered. The
telemedicine? How do we integrate this provides a solid foundation for the “boomers” are over the hill.
artificial intelligence into our future changes I hope to bring about.
We should not and must not
practice safely and meaningfully? I want to thank the many friends subscribe to the same biases.
The SMA Doctors-in-Training and colleagues who have shared your
I respect and honour the seniors
Committee and Telemedicine struggles with me. I hear you; I feel for
who have taught me so much, and
Workgroup serve to provide some you. Wherever you are.
done so much for our profession. I will
guidance on these matters. Solo GPs trying to keep your practice heed your words.
2. Changing medico-legal landscape going...
As for the doctors younger than me
Medical practice is getting more Locum doctors wondering about PPE and the medical students whom I have
complex. Treatment options are more support, locum slots... interacted with, thank you for trusting
varied. Patients have more access me, and sharing your passionate hopes
Sandwich generation having to look
to information, whether or not the and dreams.
after young and old...
information is accurate or appropriate.
Junior doctors in restructured hospitals So what lies ahead?
A lot more communication is needed
to address a patient’s concerns and following rosters and leave restrictions... The SMA serves as a rallying point
deliver satisfactory care. Doing the Senior doctors being burdened by for all doctors, and maybe even all
right thing may not be enough tough decisions… healthcare workers. With these many
anymore. We have to do the right ongoing changes, there are great
I know how frustrating it is. I opportunities for growth. I ask for your
thing, the right way. The SMA Centre feel your resentment. I feel the
for Medical Ethics and Professionalism support. Join the SMA, and join me in
hopelessness. And yet – performing more works of service.
is further developing new modules
to augment the programmes that Whatever we do, whether in word
or deed, let us do it for the right “I alone cannot change the world,
individual residency programmes
reason and give thanks. but I can cast a stone across the
provide. Some of these will be waters to create many ripples.”
suitable, even essential, for doctors We were called to this profession. – Unknown
who are many years past graduation It is hard, it has always been hard. The
to be up-to-date with changes in personal sacrifices we had to make,
medical law, in applications of the and will continue to be asked to make. Dr Tan is a mother to three
You are not alone. Far from it. These kids, wife to a surgeon; a
Singapore Medical Council Ethical
are difficult and challenging times for daughter and a daughter-in-
Code and Ethical Guidelines. law. She trained as a general
everyone. Let’s keep our eyes and heart surgeon, and entered private
3. Changes in people focused on WHY we are doing this. practice a year ago, focusing
We have four Council doctors who on breast surgery. She treasures
have stepped down, and four new
SMA future: being female, her friends and wishes to have
doctors who have come forth to more time for her diverse
being “young” (relatively) interests: cooking, eating,
serve on the SMA Council. The
current Chief Administrator who I’ve been fascinated by research music, drawing, writing,
articles on the strengths and photography and comedy.
has been with us for a decade, has
decided to change his area of work. weaknesses of female leadership.
The SMA Secretariat has had many People’s perception of my relative
more people joining to better serve youth is a double-edged sword.
our Members. I am actively looking I used to always think of myself as a
out for more doctor volunteers to young doctor. I joined Council at age 26.
join our various committees. I’m not 26 anymore. While some doctors
MAY 2020 SMA News 09
council news
Report by Dr Ng Chew Lip
Dr Ng Chew Lip is an ENT consultant in public COVID-19 support measures
service. After a day of doctoring and cajoling
his two princesses at home to finish their
food, his idea of relaxation is watching SMA has initiated a series of support measures for
a Netflix serial with his lovely wife and our Members and extended them to ALL healthcare
occasionally throwing some paint on a canvas. workers (HCWs).
The Psychological Wellness Support Programme
entails a list of psychologists and GPs who have
Closure of SMA secretariat office
stepped forward to provide pro bono or reduced fees
counselling for HCWs during this challenging period.
The SMA office has been closed with effect from 7 April 2020, in A list of helpful expert advice on managing stress and
line with the circuit breaker measures during the COVID-19
anxiety has also been uploaded on our website.
pandemic. Due to the fluid situation, we will inform our Members
on the date the office will be allowed to reopen. Do check our We have also partnered with the National Gallery,
website for the latest updates regarding our opening date. If you Singapore Arts Museum, Nanyang Academy of Fine
require assistance, please contact us at https://www.sma.org.sg/ Arts, Singapore Prison Service and others in the
general/contactus.aspx or at our main line 6223 1264. creative community for the #SGArtforHCW campaign
to collect artworks to support HCWs. We have received
For indemnity matters: 400 submissions to date and are currently working
MPS: 800 616 7055 (toll-free) / mps@sma.org.sg on displaying the artworks. Reports on our campaign
Income MMI: 6223 1264 / sma@sma.org.sg have appeared on Channel 8 News & Current Affairs, the
Straits Times and Time Out. Please refer to our Instagram
JLT Medefend Scheme: 6411 9002 / page to view the artworks:
website: https://www.medefend.com.sg https://bit.ly/SGArtforHCW.
For membership matters: For reference, SMA’s resource page on COVID-19 can
General: membership@sma.org.sg be found at the following link:
https://www.sma.org.sg/COVID19.
New sign ups, renewals and Medik Awas: 6540 9193
We would like to take this opportunity to thank our
Clinic assistant, update of personal info and Members and the greater healthcare community for
other general queries: 6540 9194
stepping up during this difficult period. Stay safe.
For SMJ matters:
All enquiries: smj@sma.org.sg “Bring Your Own Bottle”
For SMA News matters: hand sanitiser distribution exercise
All enquiries: 6540 9181 / news@sma.org.sg
SMA, in collaboration with our partners College of
Family Physicians Singapore (CFPS) and Singapore
Dental Association (SDA), as well as venue support by
Supporting junior doctors in the fight
the Singapore Manufacturing Federation, conducted
against COVID-19
the “Bring Your Own Bottle” hand sanitiser distribution
The SMA Doctors-in-Training Committee has partnered exercise for registered medical/dental clinics and
with MOH Holdings (MOHH) and local food and beverage CFPS/SDA/SMA members. This took place from 16
companies to support junior doctors. We hope that these March to 20 March 2020 and we received good
promotions will help to boost the energy and morale of responses from clinics and members who came to
junior doctors in the nation’s fight against COVID-19. We collect the complimentary hand sanitiser (5 l per
would also like to thank MOHH and the following partners for registered medical/dental clinic, or 500 ml per CFPS/
SDA/SMA member).
their generosity – Mr Bean, Polar Puffs & Cakes, Royal
T Group, 4Fingers Crispy Chicken and Strumm’s Holding. This event was made possible with the generous
Please refer to https://bit.ly/2XOtjLC or visit our Members’ support of the Temasek Foundation. We hope that
Facebook group at https://bit.ly/SMAFacebookGrp for more members who benefitted from this distribution found
information on these promotions. it useful.
10 MAY 2020 SMA Newscouncil news
2020 SMA Annual General Meeting
Text by Lee Sze Yong, Manager, Council Support
Dr Tan Yia Swam was elected as SMA the teleconferencing AGM, and referred Members present affirmed the SMA
President during the SMA Annual members to the SMA Annual Report Council’s proposal to elect Prof Chee
General Meeting (AGM) held on 2019/2020, themed “Go the Distance”. Yam Cheng and Prof Phua Kong Boo as
19 April 2020. SMA Honorary Members. The Honorary
Next, Honorary Treasurer Dr Ng Chee
President of the 60th SMA Membership will be conferred during the
Kwan presented the 2019 accounts for SMA,
SMA Annual Dinner, tentatively set on
Council, Dr Lee Yik Voon, started the of which he highlighted an operating deficit
5 September 2020.
proceedings by thanking Members for of $58K.
attending the AGM via teleconference. Elections for the 61st SMA Council
The accounts for SMA Pte Ltd (SMAPL) were then conducted. Three new council
He highlighted the following during the
President’s message: was presented by Adj Prof Tan Sze Wee, members, Dr Chie Zhi Ying, Dr Ivan
Chairperson of SMAPL. SMAPL’s profit Low Jinrong and Dr Tan Zhenwen Tina
• SMA will continue to be a strong and loss statement largely depends made introductions to the members
advocate and an active voice for the on the performance of its investments, in attendance. The remaining council
profession and our patients. managed by UBS. For 2019, SMAPL vacancy was filled by Dr Low Tchern
• SMA’s participation in the Ministry of achieved an unrealised fair value profit Kuang Lambert. Following which,
Health (MOH) Workgroup to Review of about $600K; however, this has been election for the executive committee
the Taking of Informed Consent and superseded by events related to was conducted.
SMC Disciplinary Process – sensible COVID-19 in 2020. Incoming SMA President Dr Tan Yia
resolutions can be achieved, with
Dr Chong Yeh Woei, Chairperson Swam made an address to Members
the interests of patients upheld, and
of the SMA Charity Fund (SMACF), then present, thanking the secretariat and
challenges faced by doctors taken
presented a report on SMACF, SMA’s the four outgoing council members and
into consideration.
independent charity arm. SMACF raised highlighted plans for SMA going forward.
• COVID-19 – the medical profession has $2.1 million and awarded 309 bursaries The role of SMA now, during this time of
taken great efforts to prepare for the in 2019. Members present were change, is more important than ever.
next pandemic, and SMA has provided encouraged to donate to SMACF. With that, the AGM was concluded.
practical support, such as securing
N95 and surgical masks from MOH for
sale to doctors in the private sector. 61st SMA Council 2020–2021
President Assistant Honorary Secretary Dr Ivan Low Jinrong
Dr Lee ended by thanking all SMA Dr Tan Yia Swam Dr Benny Loo Kai Guo Dr Low Tchern Kuang Lambert
volunteers and expressed how it A/Prof Nigel Tan Choon Kiat
1st Vice President Honorary Treasurer
Adj Prof Tan Sze Wee
has been a privilege to serve as SMA Dr Ng Chee Kwan Dr Lim Kheng Choon
Dr Tan Tze Lee
President. He also urged all Members to 2nd Vice President Assistant Honorary Treasurer Dr Tan Zhenwen Tina
strive forward as one, with a common Dr Tammy Chan Teng Mui Dr Chie Zhi Ying Dr Toh Choon Lai
goal to serve each other and to care for Council Members Dr Wong Chiang Yin
Honorary Secretary
Dr Wong Tien Hua
patients to the best of their ability. Dr Ng Chew Lip Dr Anantham Devanand
Dr Daniel Lee Hsien Chieh Dr Bertha Woon Yng Yng
Honorary Secretary Dr Lim Kheng Dr Lee Pheng Soon
Choon highlighted the ground rules forcouncil news
Support and FOR OUR HCWs
SMA played its part in the growing COVID-19
crisis in its own way! To help front line healthcare
workers, SMA procured N95 and surgical masks
for sale to Members to ensure they are sufficiently
equipped to handle any potential cases. A few
weeks later, in collaboration with the Temasek
Foundation, SMA was mobilised again to assist
with dispensing hand sanitiser for registered
medical/dental clinics as well as SMA Members.
The large crowd of HCWs purchasing masks
The hand sanitiser distribution setup at the outdoor parapet
near the SMF carpark entrance
The queue extended all the way
outside the SMA secretariat office!
Topping up hand sanitiser for dispensing
Prepping and mixing the hand sanitiser
12 MAY 2020 SMA NewsAppreciation
In collaboration with the National Gallery Singapore, SMA invited members of the public to show
support for front line healthcare workers (HCWs). Words of encouragement or artwork could
be submitted under the hashtag #SGArtforHCW on Instagram. We’ve collected some of these
heartwarming pieces below for our readers.
agnestan2004 chinnienemo
breastfriendsurgery
Life is all about balance. Be there for others, This was inspired after I had a training session
but never leave yourself behind. You can’t pour at work to learn how to don the Powered Air
from an empty cup. Remember to take care Purifying Respirator. Drew this as encouragement
of yourself When I think of heroes, the Marvel Avengers to frontline colleagues and friends. Everyone has
come to mind. I did a series of how these heroes a part to play in the fight against COVID-19.
actually won't be effective in COVID-19, as tribute
to our real-life frontline healthcare heroes.
clarekal_creates
tifaaani
nagomiluv
The COVID-19 virus mainly infects the lungs and
impairs respiratory function.This artwork is Moved by the endless toils of our healthcare
dedicated to all healthcare workers who nurse workers. If only everyone saw it this way. To
patients' lungs back to health, just like a gardener Dandelions are known for healing properties, and
share and band together to help rather than
nurtures his flora with tender loving care. ladybugs rid gardens of pests. Like the ladybug
to hoard and hate.
clinging to the dandelion, I pray healthcare workers
would cling on to hope in the storm, and infected
patients to cling on to healing and not let go.
MAY 2020 SMA News 13DOCTORS IN TRAINING
RE T URNI NG FR O M A BR O AD
AS A JUNIOR
+ +
Dr Chong is a medical officer
currently working in Singapore
As students, the one thing many Medical knowledge
with an undergraduate degree of us struggled with was determining
In the process of rotating through
in Anatomy and Biomedical the “best time” to return home as an
different hospitals, I had the privilege
Sciences, and postgraduate overseas doctor. During my time in
Doctor of Medicine. She enjoys
of meeting numerous house and
university, I found that I did not have
medical missions, baking, and medical officers, most of whom had
the answer to this question. Before
being around nature. She hopes graduated from local universities.
to hone her skills as a doctor in graduation, I actively asked different They were all brilliant and extremely
order to ultimately serve the people already in the profession, all capable, rattling off solutions to
less privileged and to improve of whom had (of course!) different difficult cases from the deep fount
global health standards. things to say. Some advised me to of knowledge at their fingertips. It
work overseas for a few years before was easy to compare myself to the
coming home, given that working local graduates and feel that I did
overseas would give me a better not possess the same capabilities.
work-life balance – fewer working This was an anxiety shared by most
hours per week, more hand-holding of us overseas graduates, regardless
from senior doctors and fewer hours of whether we were from the UK,
spent on call. However, other seniors Ireland or Australia. We did not know
encouraged me to take a leap of if our syllabus was as rigorous as the
faith and come home as soon as I one that was taught in Singapore. It
graduated, as this would allow me to was easy to think that, perhaps, we
adapt more easily to the Singapore were not as accomplished or that our
medical system. This was valuable examinations were more lenient.
experience that I had already missed
Thankfully, I discovered over
Text and photos by out on from studying overseas.
Dr Glenda Chong Sze Ling time that this was a common cause
After long hours spent agonising for concern for all junior doctors,
over this decision, I finally made the regardless of which university they
I moved to Perth, Western Australia decision to return upon graduation. had graduated from. Having a vast
at the age of 17 to study medicine. Ultimately, I knew I wanted to amount of knowledge did not ensure
Eight years later, I was finally done complete my specialisation in the that you magically transformed into
with my university education; country that was closest to my heart, the best house officer overnight. I
having completed Year 12, an and where my family resided. I also learnt that it was more important
undergraduate degree in Anatomy knew that the longer I am away from to be able to manage your primary
and Biomedical Sciences and a my home, the harder it would be to team’s patients efficiently, speak to
postgraduate degree in Doctor of call it home when I returned. seniors if medical emergencies arise
Medicine. This marked the start of my That being said, returning home, and work effectively with other allied
return to Singapore and an entirely especially as a house officer, was health workers to ensure smooth
new life as a junior doctor. easier said than done. recovery and patient discharge. Any
14 MAY 2020 SMA NewsNow, I am glad to say that my Singapore was ranked second in the
mindset has been unequivocally world, just behind Hong Kong. Being
changed over the course of this year. one of the most efficient healthcare
Many other house officers are trained systems in the world, the pace of
in different countries, such as Australia, healthcare is definitely much faster
the UK, Ireland, etc, and through compared to certain other countries,
opportunities that allowed me to and most of the international
spend time with them, I realised that graduates returning from these
most differences are minute. Often countries often feel the difference.
times, the principle of treatment is However, as I saw my colleagues,
largely the same, and this did not seniors and other allied healthcare
affect my ability to practise medicine workers working hard and setting
l Hospital Vascular here at home.
Singapore Genera a flawless example for me by not
complaining, it made it easier for me
Asking for help to formulate my own strategies on
gaps there may have been in my With the increasing complexity of how I could better improve my speed
knowledge were always quickly and medical cases and the specialisation and quality of work.
gently met by more senior colleagues, of care, it is very rare to be treated by So, after everything – if given the
who were always kind enough to take just one doctor. As a junior, you will be same choice – would I still choose to
time to discuss the difficult cases with inserted into many different teams as come home? The answer is definitely
me to ensure that my understanding part of your career. Another concern of
was on a similar level. It was a resounding yes! In retrospect,
mine was that I would not be able to
imperative to learn from my mistakes all the things I lost sleep over may
get help when I needed it – the pace
and to ask for help when needed. have been unfounded and silly.
of healthcare in Singapore seemed
Perhaps the healthcare system here
fast and daunting and I felt that I did
at home was not exactly the same
Differences in guidelines not have many seniors I could rely on.
as the one I studied under. But at
I worried that my colleagues would
Before I moved home, I had the the end of the day, it did not matter
think less of me if I said that I was not
misguided notion that the guidelines able to accomplish certain tasks alone. as long as I was willing to embrace
for patient management were very the differences that arose and learn
disparate in different countries. Despite my misgivings, I was again from my mistakes. Working here is no
proven wrong. Help was never far easy task, but I have been so blessed
Guidelines are important, especially
away when I needed it, no matter to meet and learn from so many
when evidence-based medicine is
how busy or tired the people around wonderful individuals. Had I chosen
the best form of treatment we can
me were. This often arose through to stay in Australia, I would not have
give to our patients. For example,
the kindness of my peers or seniors had this amazing opportunity to
in patients suffering from acute from different specialties, and nurses
stroke, the dosages of atorvastatin grow as a doctor.
and colleagues from allied health
used to stabilise the thrombus departments. With the new mentor
differs in the Asian versus Western and buddy system that various
population. In particular, a higher hospitals have embraced, the
dosage of atorvastatin is often used anxiety that people face in
in Singapore as our population is not asking for more support has also
as susceptible to transaminitis been minimised. I was never
as compared to the Western placed in a sink or swim situation.
population. In cardiovascular I learnt that there will be times
medicine, ticagrelor is widely used when you need help from others,
as a dual anti-platelet medication but there will also be times when
in Australia; however, in Singapore, you are best placed to offer help
we use clopidogrel as there are to others, and by doing so
some controversies regarding the willingly, you are paying it
efficacy and safety of ticagrelor in forward to the people around you.
Asian patients. These were just a few
items on the long list of differences, The pace of healthcare
and I felt that I would have to learn in Singapore
new protocols suitable to the In the most recent Bloomberg
Singaporean healthcare system. Health Care Efficiency Index, Friendships fo
rged during
my National Un
Hospital Intern iversity
al Medicine ro
tationOPINION
A NEW WORLD
Doctoring is a calling, but there can be times when medical personnel feel called to another mission or direction amid their
journey. What happens then? Here, SMA News features four authors who have generously shared their journeys as well as advice
for others who may be facing such a dilemma in life.
Text by Dr Yau Teng Yan
to be able to positively impact more pitches. It was (and still is) a steep
Dr Yau is a digital health advocate and
people, and was frustrated that I was learning curve and there are constantly
self-professed techie. He is also the
chief medical officer of Holmusk. He not able to scale my time up to do so. new things to learn which keeps me
believes that one day, technology will My impact was limited to the number excited and growing.
finally fulfil its promise of making our of patients I could see (or number of
lives as medical practitioners easier, The skills and experiences I picked
CT scans I could read) a day.
so that we can spend more of our time up from medical training have helped
on what matters most – our patients. This led me to go on a year-long me immensely in this career detour.
break from clinical medicine, which Medical training provided me with
has since extended to almost six years. various mental models to use when
Together with my partner Nawal, approaching difficult problems – to be
we started a healthcare technology systematic and analytical. Ambiguous
company five years ago where we are business problems can be approached
building the world’s largest real-world in the same way as we doctors
evidence platform for neuroscience and approach a diagnostic problem of a
chronic diseases – to accelerate research patient with fever of unknown origin
and development in new therapeutics or abdominal pain – do a good history
for various disease areas, including and examination, conduct relevant
I have always had a deep interest in depression, schizophrenia and diabetes. investigations (gather data), come up
healthcare. Looking back, I was highly I did not realise it at that time, but with a list of differential diagnoses
inspired by my father, a doctor who is I was driven by a personal vision. A (probability analysis), treat, and consider
still practising. I remember vividly when vision to use my skills and expertise other diagnoses if the patient does not
I first told him that I was going to apply in a unique way to bring different respond (adaptability).
for medical school. He asked if I was people together to solve complex Another important thing I have taken
absolutely sure about it and whether healthcare problems. My current away from medical training is the ability
I would rather consider other career work is very cross-functional. I still to work and perform in highly stressful
options, and shared that medicine was use my clinical knowledge to guide situations. As doctors, we have all had
a very challenging path. As a teenager I our teams – to ensure that the work to go through years of working long
was stubborn of course and stuck to my we do and products we create are irregular hours, rigorous training and
decision. I have no regrets that I did. grounded in medical science and are multiple code blues on a bad night call.
After housemanship, I spent a good relevant to the various stakeholders, This builds in us an inner resilience,
part of my six years working in the field especially clinicians. But a larger part a perseverance which I greatly
of diagnostic radiology. Radiology was of my work now involves skills that I appreciate. It lends us confidence to
intellectually stimulating investigative was not taught specifically in medical handle difficult situations outside of
work and it was nice to be at the cutting school – building and managing teams the hospital. Few things can be more
edge of technology to support clinical of people, operational management, stressful than a patient collapsing on you
diagnoses. But there came a point strategic thinking and planning, and unexpectedly, and everything else seems
where I felt I wanted more. I wanted making business presentations and relatively minor compared to that!
18 MAY 2020 SMA NewsText by Dr Lee Guo Rui
who come through my clinic as well as designing a viable business model to
Dr Lee is the medical director at
managing the day-to-day operations. fulfil my duties to the company.
Kai Suites Pte Ltd. He constantly
pursues challenges and seeks to I am now thankful I chose the latter.
offer solutions that help plug the Over the span of 18 months, a close- Embracing change
gaps in the medical landscape.
knit team of doctors and founders grew The journey from conceptualisation
the group from three clinics to a chain to the execution of my “hybrid clinics”
of 12, allowing me to hone my skills in and “nurses on wheels” model was
business management. It was at that fraught with unexpected turns and
point I was offered a chance to take a dive surprises. Through this, I understood the
into the fast-paced world of telemedicine regulatory processes better and made a
and set up a practice of my own. vast network of like-minded individuals
from all walks of life. I even had the
Telemedicine and last-mile solutions
opportunity to integrate a telemedicine-
for health screening were novel ideas in
In my free time, I occasionally sit back enabled chronic disease management
2017. These new operational concepts programme into a life insurance plan
to reminisce the journey that I have enabled GPs to consult patients via
embarked upon when I entered medical offered by a leading insurance brand.
a telemedicine application, enabling
school 17 years ago. What first started the dispensation of electronic medical Once again, I have embarked on yet
as a passion for the art of medical certificates and delivery of medications another exciting new path, introducing
practice evolved over the years into a to the patients. Mobile phlebotomists a novel holistic step-down care model
love for the ever-advancing frontiers of could be scheduled to perform home- for pre- and postnatal ladies. Carefully
medical technology. extracting the essence of seasoned
and office-based health screenings at
specialists in the fields of medicine,
the convenience of patients. Follow-
Venturing beyond my nursing, dietetics, hospitality and
ups could then be made via video
comfort zone gastronomy, my team has set out to
consultation. This allowed clinic owners
blend age-old traditions of confinement
Three years into my residency training to open longer hours, tapping on a pool with outcome-driven practice, offering
with the department of radiology, I was of doctors to cover them remotely and peace of mind to parents and
presented an opportunity at managing also extend their reach to patients across grandparents alike so they can truly
general practice clinics in the capacity the island! savour the joy of welcoming a new life
of a medical director. Having nestled While I was eager to spring into into their family.
comfortably for over seven years in action, I was also filled with nervousness My training from medical school and
the restructured hospitals, it was a from challenges that faced my team. radiology has definitely given me an
tough choice between the pursuit of Introducing these modules into edge in managing my projects, allowing
cutting-edge diagnostic technology unchartered waters and applying for my core offering to always revolve
and the chance to run my own business, the regulatory sandbox was daunting around the provision of excellent and
attending to the concerns of patients enough, let alone the responsibility of holistic patient care.
Text by Dr Zubin J Daruwalla
Which stage of your medical journey I have a creative and innovative mindset,
Dr Daruwalla is the Health Industries
were you at when you made the with many of my friends and colleagues
Leader for PwC Singapore and PwC
South East Asia Consulting and leads decision to depart from medicine? referring to me as a healthcare futurist.
the healthcare consulting team What changed your mind? What I soon realised however, was that
in the region, while remaining a this was often frowned upon by many
practising clinician with an interest
I left my full-time job in the Department
of Orthopaedic Surgery at the National (at the time) who did not believe in
in orthopaedics, and an advisor to what I did – that we needed to rethink
a number of start-ups in the digital University Hospital almost four years
health and medical education spaces. ago in July 2016. At the time that I left, the future of healthcare and health
A healthcare thought leader and strong I was going into my final Accreditation industries. We needed to work towards
believer in collaboration, he hopes to Council for Graduate Medical Education allowing technology to complement
bridge the gap between the clinical accredited year of the NUH Orthopaedic rather than replace our clinical practices.
and corporate sides of healthcare. In the private sector however, locally
Residency programme and had
already been awarded the degrees as well as globally, things had already
of MCh (Orthopaedics) and MMed started to evolve.
(Orthopaedics) by the Royal College of
Surgeons in Ireland and the National Why did you decide to enter your
University of Singapore, respectively. current vocation/field?
Several reasons existed for my During my residency, I became a
decision to leave. First and foremost, Clinical Ambassador to Singapore’s first
MAY 2020 SMA News 19digital health platform, MyDoc, which What advice would you offer to 3. Do not expect to parachute into a
subsequently triggered my passion in someone considering a non-medical senior position just because you are a
digital health. Over time, learning more path for themselves? doctor. The extent of the advantages
about healthcare technology and how They say hindsight is twenty-twenty. of being a doctor is dependent on
it was transforming patient care for the Switching careers is daunting, especially the organisation and role, as well as
better only got me more excited. This as practising clinicians. Advice I would whether your clinical insights and
give all my doctor friends and colleagues experience actually add value.
pull factor, in combination with the
push factor of several policy changes considering a switch in their careers to a 4. Decide if you want to give up
continually shifting the goalposts of non-medical one would be: clinical practice completely. This
residency programmes in Singapore, 1. Think long and hard on the career is very important because many
made me actively explore alternative switch you are considering. The grass organisations and roles may or may
career options that would provide me is not always greener on the other side not be able to cater to this.
opportunities to make a difference and all that glitters is definitely not 5. Look for a boss, not a job. This is
while maintaining some form of gold. Why are you looking to leave? something I would say applies to all
clinical practice. During the year-long What are the push and pull factors? Be jobs and industries. Find a coach, a
objective and think things through. mentor. A good one.
exploration, I saw examples of the bigger
differences I could make outside the 2. Spend time exploring the options. 6. Dream big and do not let anything
system, at a population level. This really Do your homework and understand anyone says or does hold you down.
sealed the deal for me. what the jobs actually entail and In the words of William Arthur Ward,
whether you have the right skillset(s) “If you can imagine it, you can
Ultimately, I accepted an offer where for them. Speak to people in similar achieve it. If you can dream it, you
I had the opportunity to build and grow organisations and roles that you are can become it.”
PwC’s Health Industries practice in considering to get a better grasp and
Singapore and Southeast Asia. understanding of things.
Text by Ethan Seow
guide them through their toughest times workplace and found us focusing on the
Ethan is a TEDx and CreativeMornings
and I wanted to do that in psychiatry. fundamentals of the problems – culture.
speaker, author, entrepreneur and
ex-medical student from the National However, returning to medical That was how I found myself starting a new
University of Singapore. His love for school reminded me of the gruelling project to help people with office politics.
mental health and developing people has hours, inability to connect with patients One of the biggest gifts from
led him to help companies design their
because of the rigours of the career, and medical school was the ability to think
cultures. He is now on a quest to help
good employees rise above office politics conversations I had with doctors who algorithmically about challenges and
through his company Undelusional. burnt out along the way because reality problems. The diagnostic methodologies
and expectations did not match. I saw that I gained from my days in medical
myself in the burnt-out doctors and school helped me tremendously in being
realised I did not want to be one of them. laser-focused on finding problems in the
company culture.
Of course, it would have been nice to
say that I persevered, but the five years Today, I empower people to rise
in medical school already took a toll on above office politics through my platform
me and drove me to depression. When I The Office Matters, while consulting for
Which stage of your medical journey realised that I did not have the capacity companies to develop cultures of trust,
were you at when you made the to maintain that passion in me, I left. initiative and collaboration.
decision to depart from medicine? It has since led me to who I am today,
What changed your mind? which I would honestly say I’m proud of. What advice would you offer to
someone considering a non-medical
I spent five years in medical school
Why did you decide to enter your path for themselves?
followed by two years on a leave of
absence, when I ran my own business current vocation/field? Here is my advice that doesn’t look
and worked part-time as a musician. I My current work is an extension of like advice (just like what a therapist
was prepared to return to school, but as my love for mental health. Since I left should do).
I was about to go in for an extra month medical school, I focused on building The most important question I
before school started, I realised I could educational and people-centric asked myself was “who do you want to
not do it anymore. businesses that better mental and be when you’re 30?” To leave medical
I entered medical school because of emotional wellness. Whether it was school is tremendously difficult because
psychiatry; I had fallen in love with it as a through music, education, technology of the social, emotional and financial
teenager. I was passionate about mental or business, my goal was to improve the sacrifice it would take. But if you look at
health, psychology and psychiatry because lives I’ve touched. who you want to be in five to six years’
of my affinity with people with various I founded my company two years ago time, you would know what the right
mental illnesses. I would often support and to target psychosocial problems in the choice is – whether medical or not.
20 MAY 2020 SMA NewsYou can also read
