Healthcare: Tale of two nations

last SG · 2006-04-12T21:15:58+00:00

Originally posted by oxford mushroom 12 April 2006 04.20AM I wonder where Atobe isCongratulations for some good responses to your thread, and surely you c...

fymk SG

The statistics are all on MOH's website . I just quoted where the bulk of money goes to.

Anyways, nurses who want to be doctors can be doctors - same for the pharmacist. Doesn't matter if you are clinical nurse specialist.

In Australia.
If the nurse has the bachelors, Grade point average must be at least 3.5 for everything with double weightage given to the third year.
Then the nurse takes the GAMSAT which is worse than the MCAT - score about 60% percentile to ensure an interview into a recognised university. If they pass the interview which is not too easy- it will be 4 years minimum for the medical degree.

But then again snow leopard makes it sound so easy.

First of all you have to get NUS or NTU to agree on a 2.5 shortcut medical degree. Then you have to get people to pick and choose out of the syllables to give the nurse /pharmacists a qualified recognition.
- 1. Everything is evidenced based now - you have to ensure half the degree is made out of how to scrutinise evidence based research.
-2. You need to retrain them on pathophysiology , anatomy which takes at least 3 years from theory to application .

So snow leopard - you have ideas - so how would you implement it?

snow leopard SG

Originally posted by fymk:

Anyways, nurses who want to be doctors can be doctors - same for the pharmacist. Doesn't matter if you are clinical nurse specialist.

In Australia.
If the nurse has the bachelors, Grade point average must be at least 3.5 for everything with double weightage given to the third year.
Then the nurse takes the GAMSAT which is worse than the MCAT - score about 60% percentile to ensure an interview into a recognised university. If they pass the interview which is not too easy- it will be 4 years minimum for the medical degree.

you have gotten me all wrong. maybe i didn't explain myself clear enough. i am not converting these nurses into full fledged doctors, for that would be counter productive. i'm not asking people to spend 3 years getting a nursing degree followed by 4 years to get a medical degree. you spend a total of 7 years to become a doctor when all you need is 5 years.

what i'm saying is we convert the nurses into a new profession with a new title, maybe clinical practitioner or something like that. this new profession will have all the competence that the doctor has in and only in a clinic environment, which is really not too much to ask of them considering it is just common day to day mild illnesses.

But then again snow leopard makes it sound so easy.

First of all you have to get NUS or NTU to agree on a 2.5 shortcut medical degree. Then you have to get people to pick and choose out of the syllables to give the nurse /pharmacists a qualified recognition.
- 1. Everything is evidenced based now - you have to ensure half the degree is made out of how to scrutinise evidence based research.
-2. You need to retrain them on pathophysiology , anatomy which takes at least 3 years from theory to application .

So snow leopard - you have ideas - so how would you implement it?

what you have listed can be done as they have been done in many other faculties. on top of that as i say again, in case you read me incorrectly again, i am not asking for these nurses to be converted into full fledged doctors, only doctors certified for private clinics. surely they do not need three years to cover those parts of the anatomy that a doctor in a clinic setting is required to know?

furthermore, given their experiences, they probably already know. the important thing is that these nurses are already experienced and competent enough to handle patients in a clinic setting. the conversion course is just a formality to cement their status. we can even do away with that and stick to exams and interviews. as long as these folks pass stringent exams and interviews specifically meant to test doctors in a clinic setting, there is no reason to doubt their capabilities.

oxford mushroom SG

Snow Leopard's idea of training a doctor in 2 years is just not feasible. He thinks that because MBBS stands for bachelor of medicine and bachelor of surgery, you can cut the course in half by not teaching surgery. This is an oversimplification.

About 3 years of the medical course are devoted to so-called basic medical sciences such as anatomy, physiology, biochemistry, microbiology, pathology and pharmacology. The remaining 2 years are for the clinical disciplines such as general and orthopaedic surgery, internal medicine, paediatrics, obstetrics and gynaecology, community medicine, anaesthesia, ENT, ophthalmology, geriatrics, radiology and psychiatry. And this does not even include the 'minor' subjects such as molecular medicine, medical ethics, biostatistics etc...

Snow Leopard will probably insist that it can be done so there's no point debating this issue further. But as someone who has taught medical students for the past 10 years, I'd say this not be a feasible option.

snow leopard SG

Hey Mr Oxford, it's perfectly fine for us to agwee to disagwee but we should at least be precise in our understanding of the viewpoint from the other side.

I say yet again, i am not proposing to train full fledged doctors out of nurses, merely endorsing already experienced, already competent nurses to hold a responsibility that they already have no problems holding. Of the myriad basic medical knowledge they are required to know, they probably already know. but as with any appointment in any discipline, there needs to be some form of endorsement, which could be a short conversion course or simply a series of tests and interviews. in any case as i say again, the idea is to certify beyond doubt the nurse in question has attained a level competent enough to see patients in a clinic setting for everyday common illnesses, nothing more. this, i believe they can deliver with ease and in turn free up many more doctors who would be better utilised at higher levels of application for the benefit of the entire nation.

oxford mushroom SG

But you want to give them the power to isse MC and to prescribe controlled drugs as well....those are heavy responsibilities that will require a doctor to shoulder. It is one thing prescribing simple medication to treat symptoms of self-limiting conditions like coughs and cold.

To certify someone as unfit for work or attend court and prescribe addictive controlled drugs will require someone with full medical training and qualifications.

In any case, it will not wortk because as I said, most Singaporeans will insist on seeing a doctor when they go to the polyclinic, not a nurse.

snow leopard SG

with all due respect, selection criteria can be made stringent so that only well experienced, competent and thoroughly tested nurses would be given the responsibility to take on the role of clinic practitioner.

the doctor didn't take 5 min to come to a decision to prescribe the controlled cough mixture to me. the amount of knowledge that was relied upon in making that decision is but a tiny fraction of what one learns in the full medical course and which can easily be articulated in a few sentences. it is therefore quite unacceptable to say that just because someone did not take the full 5 year course, he or she cannot learn that tiny fraction that can be articulated in a few simple sentences, especially someone who is constantly exposed to such matters on a daily basis, year in year out.

miongisback SG

Let me put this straight to you -

our modern hospital, high tech and all, was planned
not solely to care for heartlanders. These hospitals
were built to make money from foreigner patients!

There was no due consideration whether Singaporeans
can afford such expensive hospital facilities
and 'specialist' doctors.

That's why, today, we are all facing huge hospital bills.
And there is nothing Government can do now to reverse
the situation.

Atobe SG

Snow Leopard,

Your perseverance is simply admirable to continue with your effort to convince someone who is a specialist - inside-out - and will battle you in his special turf on micro-issues, but will hardly be able to argue on macro issues.

As was mentioned, in all the FORTY-FIVE YEARS of Singapore's history, there has yet to be anyone from any specialist discipline leading any Ministry of the same discipline.

It took a team of System Engineers to map out the Education System, and came out with the present Production Line - Education System, from Primary to Tertiary (including Medicine) - System Engineers mapping out the Medicine Course but not the curriculum, which is left to Educationist with their wishy-washy ideas.

Similarly, there has yet to be a Medical Specialist to head the Ministry of Health, and can the reason be any clearer ?

I am presently still 'on the move' and have been following the issues posted, but with limited time to give a full response to some of the points raised by Oxford Mushroom.

fymk SG

Ah atobe , you forgot - some of our ministers are economists like GCT or lawyers . Economists set a value at everything including life while lawyers make the rules that govern our society.

Oh Ya Benjamin Henry Sheares, one of our former presidents was an obstestrician at kendang Kerbau.

Oh wait....Mr Vivian Balakrisnan is an opthamalogist....only problem not a minister of health but of community. Dr Ng Eng Han is also another surgeon who is not a minister of health but of manpower.

Do you know why most doctors do not become Minister of health? It is a conflict of interest with their profession . It is not because they are not capable - there are already 2 medical specialists who are ministers . It is to prevent people from saying that they favour another specialty or even profession over others in the healthcare arena.

fymk SG

Not really. I think it is just targetted at those who can afford to pay and pay they shall.

fymk SG

Doctors sometimes have patients with straightforward illnesses and some with complex problems. You cannot keep judging on coughs and colds.

I remembered a nurse who told me that she had a long time experience with people like me who she assumed was making a huge fuss of a minor cold. She had about 10 years of emergency nursing and I knew her because she and I worked in the same hospital. Well she was wrong , in 5 minutes, I nearly went into respiratory arrest while waiting for a doctor to see me. Not fun to be pushed into the resuscitation bay and see the ett tube standing by with the laryngeal scope. I found out later that I had bronchopneumonia due to influenza and legionella co-infection. It mimicked a cold until I got short of breath on that night.

Sometimes things are easy , sometimes things are hard....just like the cases of the patients. You cannot always assume it will always be a straightforward cough and cold in a person or that the next patient walking in will just have a haemorrhoid problem .

snow leopard SG

agwee somewhat. the way i see it is hospitals like raffles medical have sprung up to serve the rich indonesians. they take doctors away from govt hospitals and we have shortage.

there is a somewhat unorthodox way of filling in the shortfall, upgrading competent, experienced and tested nurses to a clinic practitioner level.

snow leopard SG

Gee, thanks Atobe, must chiar you lim kopi liao.

what you're saying is interesting ... perhaps you can share more when you've 'settled down' ...

all the best ...

snow leopard SG

Originally posted by fymk:

Ah atobe , you forgot - some of our ministers are economists like GCT or lawyers . Economists set a value at everything including life while lawyers make the rules that govern our society.

like the swiss standard of living?

Oh Ya Benjamin Henry Sheares, one of our former presidents was an obstestrician at kendang Kerbau.

he is definitely a well respected man but at the end of the day, he was, like his counterpart is today, just a figure head ...

snow leopard SG

you seem to always forget, you are special remember? if 15 other doctors couldn't diagnose what you had, i would not be too hard on that one nurse who couldn't as well ...

BillyBong SG

I find it somewhat strange that a DOCTOR is not leading the MOH. Yet you are claiming a conflict of interest?

What kind of conflict could possibly adhere to a professional in the same profession as his fellow colleagues? Wouldn't he/she (politically correct) be in the best position to dictate policy in the medical industry?

Isn't THE DOCTOR in the best possible position to understand the complexities and obstacles faced and in doing so able to address their needs appropriately?

And incidently, why should people claim government bias on what profession is favoured? Isn't it worse for the medical community to have a non-medical professional helming them?

Should a medical doctor lead the MAS instead? Or will an economist be better off leading the SAF?

fymk SG

I would assume it would be a conflict of interest if they choose to continue to practice. I cannot practice as a nurse in certain areas because it conflicts with my work according to the protocol of where I work.

So don't ask me about it . Go ask the Singaporean government (coz I ain't working for them so I don't know) . Some countries allow it some countries don't depending on their protocol.

fymk SG

So are you saying that I should deserve to suffer ?

I don't present normally because of my condition , so is it my fault?

Yes there are plenty of experienced nurses around. I have been trained as one - I worked in the acute sector and yes sometimes intern have to consult the senior nurse specialist on how to handle problems. However a nurse only specialises in one area , that doesn't mean she sees other clinical problems, unlike the houseman/intern they rotate around for about 2-3 years to gain a wider experience of other clinical areas before deciding on a specialty .

They don't rotate nurses around for long periods of time . Nurses stick to their ward and the designated specialty. yes you have community health nurses but some of them are long out of touch with independent diagnosis of acute problems.

I know of specialist nurses in cardiology but they cannot deal with intensive care area while the stoma nurse only knows how to assess a stoma, how to teach a patient how to deal with his/her stoma, whether the stoma is working but give her an 12 lead ECG and a arterial blood gas reading - she is lost . Sure we have competent nurses, no doubt about that - just in the area they always practise in that they are very competent. Put a cardiology specialist nurse to deal in the infectious disease area or work in an orthopaedic area- you get a literal fish out of the water. Community health nursing education in Singapore is not too advanced . They focus more on primary prevention , primary health care delivery , health assessment and community education. Even a nurse like me can do community nursing in Singapore.

You want nurse practitioners?Sure
Think of all your potential problems

Firstly which singaporean wants to see a nurse practitioner. In singaporean culture, don't forget about the kiasu and the kia see people.

Secondly , if the pay is crap at the end of their program , do you think nurses will be retained ? Plus added responsibilities, make a mistake and the nurse lose her registration which means end of a career. Most nurses will think like that - it is like a loss of livelihood. It is just like a lawyer getting debarred - loss of a livelihood - it means that the lawyer cannot practice anywhere
I remembered a hospital in Singapore wanted to teach nurses to cannulate so that they can free up time for the houseman to get around his business. Do you want to know what my ex colleagues and schoolmates said to me? They said why should they get the responsibility and the blame if something goes wrong through no fault of theirs especially when there is no money involved .
I am all for nurses getting more responsibilities - however more responsibilities must come with more income earnt and indemnity protection . How much MORE do you want to pay senior nurses? I am well aware that some senior nurses earn as much as a houseman does .

The reason why nurse practitioners are good in rural areas of australia is because they are like the doctors there - rely on the basics of health assessment and basic equipment. In addition they know the people around well enough, their habits , the town gossip etc plus people in small towns will know almost everyone around. However regional and rural health is still below par compared to big metropolitan areas because of the lack of manpower, advanced equipment and lack of specialists. I won't do rural nursing because it is too basic in equipment and all you pray is that the medical helicopter comes fast while you try to stabilise the patient using BASIC methods. I have plenty of respect for rural nurse practitioners . I came from the major metropolitan hospital and I seen the patients who the rural general practitioner and rural nurse practitioner stabilised long enough to ensure their survival with just PLAIN BASICS. I spoken to a few nurses who worked in the rural areas and they are good as any doctor in health assessment because they see the whole community - they actually go to the homes to see sick kids and adults. If they cannot deal with it - they have to call up the rural GP and if he cannot deal with it - he calls the bigger regional or metropolitan hospitals. If it is just one nurse practitioner - she can radio a doctor to discuss the problem and it will decided if the patient goes to the better equiped hospital . That is EXTREMELY different from Singapore.

Even in Singapore, the polyclinics are better equiped than the rural outback hospitals.

BillyBong SG

An article about a former CEO labasting one of his close surbordinates appeared in the TODAY paper yesterday or the day before.

In it, it depicted the sad reality of boardroom meetings where everyone simply nodded their heads in unison, none offering so much as a disagreement with company policies. The CEO blasted his surbordinate because he never disagreed with him and always served as a YES-MAN. Without deviating from the norm or challenging the validity of certain policies, the company would almost fall into the model of a pseudo-dictatorship.

Perhaps we shouldn't always stay apathetic; if it affects you, shouldn't you ask why the policy is so?

If we all adopted your policy of "Go ask the Singaporean government", then i guess the singaporean government is truly a first world team leading a bunch a 'YES-MEN'.

fymk SG

LOL . If I was a yes man , I would be in Singapore now working my head off for pittance and worrying about foreign talents coming after my job.

I said ASK the government why. Why isn't a doctor be a health minister since they have 2 on the ministerial cabinet . I MOST CERTAINLY DID NOT SAY agree with them. I did HOWEVER say I don't know since I don't work for them.

I ask when in doubt and your analogy is all wrong. i don't keep silent or nod when I disagree with something . I tend to ask before I get the basis to disagree.
Ask and you shall be answered
Seek (change) and you shall find (change)

By asking , it indicates that you might have a problem with why it is implemented , it rarely means you agree with the policy.

I may disagree strongly with policies of the government but sometimes there might be good reasons for why things are not the way they are.

Like me (bearing in mind I work overseas now) , I cannot work as a nurse in the hospitals anymore because it presents a conflict of interest in my present work. That could be the reason. Who knows?

Go read my statement you quoted again.

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