National Healthcare Group's Annual Scientific Congress 2006, Congress Dinner

30 Sep 2006

By Professor K. Satku, Director of Medical Services

Venue: Raffles City Convention Centre

Mr Michael Lim, Chairman, National Healthcare Group;

Dr Lim Suet Wun, CEO National Healthcare Group;

Dr Kenneth Mak and Dr Chong Phui-Nah Chairpersons, Organising Committee, National Healthcare Group Annual Scientific Congress 2006

Distinguished guests, colleagues,

Ladies and gentlemen,

THE CASE FOR SHARED PROFESSIONAL VALUES IN THE HEALTHCARE FAMILY

I am deeply honoured to be asked to deliver the NHG Lecture this evening. Thank you Tong Kiat for those kind words. I am sure all of you have had an exciting day packed with many learning opportunities. I trust that in one way or another, what you learn from here will be for the betterment of our patients. Tonight, I would like to speak about something else that I believe is also for the betterment of our patients. I would like to re-visit the concept of the practice of medicine and professionalism in medicine.

We are indeed fortunate to have one of the best healthcare systems in the world. Our patients trust us and even foreigners, in increasing numbers, seek our care. Medicine, always considered a consumptive service, is now poised to become an economic engine of growth for the nation. Knowing that the opportunity is fast hurtling by, we have made a conscious decision to seize this opportunity. But in so doing we must preserve the same values that have made the practice of medicine what it is today in Singapore. We must not change the fact that the practice of medicine brings relief to people in pain and suffering. We must not change the fact that the practice of medicine is about serving mankind and humanity. That is our passion. That is what we have excelled in. That is our core business and must remain our core business. What we can "change" however, is that Medicine can be more than just healing, more than preventing diseases, it can drive economies.

Until not too long ago, the patient's experience, when confronted with an illness, was almost entirely dependent on the conduct of the doctor. The doctor was guided by a deep sense of duty and commitment to the patient. He placed the patient's interest foremost and delivered the best possible care cognisant of available resources. He kept himself competent, stayed honest with his patients and he maintained the patient's confidentiality. He had the patient's trust. Today the practice of medicine is far more complex than we care to admit. For a patient seeking care at healthcare institutions, his health outcome and overall satisfaction with the care he receives is no longer solely dependent on his relationship with a particular doctor. Many other factors come into play. He will encounter many other healthcare professionals and hospital staff - each one with the potential to build or destroy the patient's trust in our healthcare system. Indeed, when I read a complaint from a patient today, I am no longer certain whether it was the doctor, nurse, an allied health care professional or an administrator who had made things unpleasant for the patient. Their interactions are so enmeshed that it is often difficult to tease them apart.

It is increasingly clear that going ahead, the practice of medicine will need to be built upon not just sound patient-doctor relationships, but also the relationships between the patient and members of the entire healthcare family. In order to continue providing one of the best healthcare services in the world, it will not be good enough for doctors or nurses alone to possess the attributes of care, compassion, competency and the like. There is an urgent need for everyone in the healthcare family, healthcare professionals, policy makers, administrators and others to come together and to articulate what our collective professional values are. We must be entrenched in these values. And we must walk our talk. Our healthcare policies, administrative and care processes must be always centred on our patients, and must reflect these collective values. Not too long ago, The American College of Physicians released their Charter on Medical Professionalism. It had three principles and ten commitments.

The three principles are:

The principle of patient welfare - holding the patients interest uppermost

The principal of patient autonomy - enabling our patients to make an informed decision and

The principal of social justice - to serve regardless of social status and to remove discrimination

The ten commitments are:

Commitment to honesty with patients

to patient confidentiality

to maintaining trust by managing conflicts of interest

to maintaining appropriate relations with patients

to improving quality of care

to improving access to care

to just distribution of finite resources

to professional competence

to scientific knowledge

and to professional responsibilities

These may be values for the medical profession but therein lie the values for our healthcare family as well. We must debate and we must deliberate which values resonate best with us in the health care family - healthcare professionals, administrators and policy makers - and adopt them. At every contact with the sick and vulnerable, all members of the healthcare family must practice these collective values without fail. And we must be taken to task if we are found lacking in these values.

SINGAPOREMEDICINE & PROFESSIONAL VALUES

When practice expands to include SingaporeMedicine, many fear that the practice of medicine will become a commercial business and threaten the core values of medicine. Admittedly, we have committed to grow SingaporeMedicine. However, the fact that we are committed should not change the way we practice medicine. It must remain grounded on sound professional values. That must remain the core. You may be asking - how is it possible to make money when we claim to be a selfless service? How do we avoid treating patients as another economic commodity but treat them instead as unique individuals that we are called to serve. Can we be compassionate in all our dealings with patients while ensuring that medical costs are recovered, processes are lean and profits are made? These are good questions. But if all these were not possible, what do we hope to achieve at the end of the day by engaging in SingaporeMedicine? Indeed, if all these were not possible - we should abandon the idea of transforming medicine into an economic engine. For we would have lost far more as a nation than the profits it would have brought us. Having said that, my belief is that we can do it. We can and must expand Medicine to include SingaporeMedicine. But we must preserve the sanctity of Medicine. We must ensure that the entire healthcare family, doctors, nurses, allied health professionals, administrators, practise the collective professional values that I spoke about.

PROFESSIONAL VALUES - OUR CONTRACT WITH SOCIETY

Though the term client or customer is increasingly being used in healthcare, our patients must never be treated like one. We must remember that our relationship with patients is an extremely unequal one. This inequality doesn't stop at health information asymmetry though many people describe it merely as such. It is far more than that. It is an unequal relationship with human beings who are sick and vulnerable. In this regard there is no profession like Medicine.

If you look up the root word for "patient", it means "suffering", and suffering people do not always have choices. It might seem to be so, but how many sick people really go shopping around for the best prices, the best hospitals, or the best doctors? Most people do not prepare for the eventuality of sickness. We go about our daily lives without worrying about falling sick. We must grant people that sense of freedom and security. And when healthy individuals are afflicted with disease, their emotions and feelings of insecurity are naturally high. As practitioners of the healing profession, we must never take advantage of that insecurity to create unnecessary demand or inflate our profits. We must do everything we can to ensure that our healthcare system operates efficiently, is well financed, and is sustainable. We can inject the appropriate market forces to keep prices affordable. But as far as sick and vulnerable patients are concerned we must provide them the peace of mind that the healthcare system is generally credible and trustworthy. They must feel that the healthcare family, the doctors, nurses and administrators have their best interests at heart. This is how we must practice medicine. This is our contract with society. And precisely because healthcare professionals have largely honoured this contract, Singaporeans have looked up to the healing profession with high regard. The occasional letter criticising the healthcare family is not the tip of the iceberg but the occasional letter; but we must listen if we want to be better. Going ahead, our market may have broadened, but the basis for our product hasn't changed. As we develop SingaporeMedicine, we must export a brand of Medicine that we ourselves can be proud of. Healthcare that is not grounded on sound professional medical values is doomed to fail. The services that we render must be no different whether patients are subsidised or non-subsidised, local or foreign. That must be the basis for our business.

SUSTAINABLE HEALTHCARE GROUNDED ON STRONG PROFESSIONAL VALUES

Again, some of you may ask, how is this possible? Today, I sense that some healthcare institutions are preoccupied with fears that just compensation would not be forthcoming. Some employ debt collectors to recover unpaid medical bills. Some are constantly worried about making ends meet. I can understand why these concerns arise. I can also understand that hospitals need to be solvent. But in ensuring financial sustainability, the means we choose must be appropriate. Our financial strategies and business methods must reflect our status as public healthcare organisations and must resonate well with our collective professional values.

Today we are fortunate to have one of the world's most comprehensive healthcare financing systems. The three "Ms" - Medisave, Medishield and Medifund, as well as the government's subventions for restructured healthcare institutions, ensure that we have an equitable healthcare system, and that no Singaporean would be denied of essential healthcare. While the State has taken the responsibility upon herself to put in place a healthcare financing system that will enable all citizens to pay for  good and affordable healthcare, as a corollary, she has also indirectly reassured all healthcare providers that they will likewise receive a fair compensation. The State will, of course, also take steps to ensure that healthcare providers deliver cost-effective care and put in the public domain bill sizes and the like. But that's another lecture.

STRONG COLLECTIVE PROFESSIONAL VALUES - A REALISTIC PROPOSITION

Some of you here tonight, who are members of the healthcare family, but not doctors or nurses may be asking how you will learn the essence of these professional "medical" values. You may be wondering if it is really possible for non-doctors or non nurses, to embrace and practice these values in their work. From diverse backgrounds and training, and from different walks of life, you have all joined the healthcare family hoping to make our healthcare system better. When I went to medical school, I knew nothing about these values too. Over the years however, seeing my teachers and colleagues, including nurses, practice medicine, I learnt a thing or two about professionalism from them. I picked up along the way. It wasn't until about some 15 years ago that I first started reading about professional values in medical journals - when doctors first sensed the increasing need to reaffirm what these professional values were. But the traditional mode of imparting these values - from master to apprentice - is a luxury we no longer have today. We must articulate what our collective professional values are, and we must deliberately educate and entrench these values firmly within all members of the healthcare family. I believe that although these values are often associated with the medical profession, they are in fact universal values, and deep inside all of us, we have the same capacity for these values. We all want to do good for people especially people who are suffering. All we need to do is to let this quality surface. Let it grow. You may stay on as a member of the healthcare family for one year, or for ten years, but the longer you stay, the stronger these values will become. You should strive to deliver excellence in your own area of expertise, but you must also exemplify these values, and be a role model for others in the health care family. And if you leave the healthcare family in the end, I am sure these values will stand you in good stead in any organization.

CONCLUSION

And so, friends and colleagues - because the practice of medicine deals with people who are sick and vulnerable; and because medicine should be practiced with our patient's best interests at heart; and because that is a basic human need that we cannot deny Singaporeans or anyone else for that matter - the practice of medicine embodies the fullest extent of professionalism. As we exploit Medicine to drive our economy, the need for strong professional values will deepen. To succeed, all members of the healthcare family must be bonded together by mutual trust and a deep collective desire to provide the most appropriate care for our patients - no matter who they are, or where they come from. Likewise, we must create a new generation with the same desire for knowledge, for continual improvement; of the same values and disposition, they will ensure that when we ourselves are gone - the values that have held us together will stay. They will ensure that our profession will grow from strength to strength. We must accept the responsibility and trust given to us as stewards of our healthcare system, and we must work together to build a sustainable system based on strong professional values.

The healthcare family has expanded to include a much larger and diverse group of talents. But we are all humble benefactors of this glorious history of medicine built up by our forefathers. We as members of the new healthcare family must collectively handle this history respectfully and carefully, work hard to build up aspects of it, so that when it is our turn to hand it over to a younger generation, it will be stronger, more resilient, and ever so beautiful and noble.

I wish all of you many more years of success.       

Thank you and have a pleasant evening.