SMELL THE ROSES

Patient Safety rounds at Alexandra Hospital by JGH Management

2010-04-27T21:51:00.000+08:00

Head A&E, Head Anesthesia/ Patient Safety Officer, Director Medical Affairs, Chairman Medical Board and Director Nursing chatting with staff at the Eye Clinic at Alexandra Hospital during Management Patient Safety Walkabout

Transition management between the Jurong General Hospital (JGH) and the KTPH team at Alexandra Hospital (AH) has started since 28 March 2010.

The JGH team now runs the Eye Clinic, the Dental Clinics, the Day Surgery Ward, the Dietetics services and other clinical and operations support services such as CSSD, Materials management and security at AH. In the meantime, our doctors and nurses have started to work alongside our colleagues in AH in other wards, clinics and operating theatres. The transition has been smooth and staff are generally in high spirit.

There are 2 key priorities for the JGH team taking over operations at AH - maintain the high level of service that patients have come to expect at AH, and ensure that patients are safe in our care.

To ensure that staff can do their work well, we've started a Management Patient Safety Walkabout, the first of which was conducted on 14 April 2010. The leadership team visited the areas that JGH have assumed management to chat with staff and find out if they have all the necessary resources and support to do their job well and ensure that care to patients is safe. It was very heartening to see and hear that staff are putting in their best and are very open with their feedback and suggestions for improvement. My promise to our staff, we will listen to your suggestions and we will act on them.

Since then, our Patient Safety Officer Dr Ng Huey Ping has been working hard to ensure that good suggestions are quickly implemented and study suggestions that will require more effort to work through.

These official patient safety walkabout will continue monthly. But, if you observe carefully, it is not hard to catch members of the JGH management and clinical leadership making their rounds daily to spot our staff doing the right thing, and be a resource to our ground staff to do a better job.

We have a great bunch from JGH at AH who will put our best foot forward for our patients! Thank you folks!

The "lost" waiting to be found?

2010-03-16T21:57:00.000+08:00

It is the school holidays. The kids are out. They are hanging out, perhaps taking a well deserved break from the routine of school.

My kids are also spending some time away from school routines of homework, assessment books, tuition. There are with my wife at Aranda Country Club, leaving behind this father who is too busy with work to join them. However, I did join my family for dinner last night. We took a short walk from Aranda to the nearby Downtown east to do so.

I was appalled by the behavior of our youths there. While queuing up at the ATM, I noticed that the line was not moving. I realised that 3 youths were taking their time with their transactions. No money came out of the machine for more than 15 minutes and they were giggling away occasionally looking back almost as if to see how frustrated others were as they whiled away time. One of the boys was heavily tattooed from his neck down to his ankle. The other two carried MOE student cards in their wallets. Obviously, there were in bad company and I wondered how would their lives turned out in future? I did not have high hope. They finally moved away from the ATM after about 20 minutes smiling and perhaps happy that they messed up the lives of others even for a while. I stayed in line all this while mainly because I was curious if they would be up to any good. But "good" was not a quality that even came close from these boys.

Soon, my family were at the foodcourt. There were many youths there. I spotted many girls with boys/ boyfriends with hairstyle that would hardly be allowed in schools - or could they be hair extenders that I have come to be aware of? Though young, the public affection that they showed to each other with hands in all the "wrong" places could put many B grade actors to shame.

After dinner, we passed by many youths smoking. Others were using vulgarities loudly. A few others have their noses, lips pierced and one carried a ear loop the size of a 50cents coin! It became quite obvious to me that there were no parents in the midst of this youthful crowd. Are these expressions of pent up behavior from strict parenting or is the result of lack of parental guidance and supervision? Or am I too old fashion and I should just "loosen up" because this is the new generation?

I worry about our youths. In particular, I worry about my kids. I pray that they will not be led astray. I used the experience to tell them that those behavior that we saw was not right and that they should not feel that they have to conform to bad behavior. Most of all, they should know that they are loved deeply, and they should measure their action against the love that they can come to expect.

Views anyone?

It has been a long time since I appreciate a poem...

2010-02-06T18:39:00.000+08:00

Who do you think wrote this poem?

As I came to explore

I began to know more

How our forefathers laboured as they can

With their very own bare hands

So I stepped back to the past

The environment was loud

With chitter-chatter

And the smoke reaches the air

As the coolies shed their sweat

Their load got even worse

Just a pat on the back

Will overcome their fear

As the four sins continue

The secret societies find a venue

To create trouble

Maybe to make it double

Opium smoking becomes a habit

For those not weary

Health may deteriate

But never the will to create

Death houses banned in 1960’s

Then became hospices

The dying slept in coffins

To give space to the sick

The Samsui’s and Ah Ma’s

Work as they must

To take care of construction

And of course the master’s reunion

As the Samsui’s wake up at dawn

They let out a tired yawn

Rice, fish and veggie

Is all their breakfast will be

Due to extreme poverty

They celebrate once a year

With a special steamed chicken dish

They can smile ear to ear

But now times have changed

Technology is improved

Skyscrapers are everywhere

With Singapore in good care

New Kois for the New Year!!

2010-01-23T19:23:00.001+08:00

It has been a tough but challenging week at work. I ended the week with flu but with rest and sleep that my family has so lovingly given me, I am well on my way to recovery!

After tea break today, I brought my family to the Summer Koi farm at Jalan Kayu. My children wanted to get some outdoors and were naturally excited when I told them that we will see some big and lovely kois at the farm.

I ended up buying 2 beautiful kois, one a hiutsuri and the other a red/ black Kumonryu from Japan. These fishes costs me the equivalent of many packets of chicken rice but looking at their beauty and grace bring great calmness to my soul. If that is the case, it is worth every cents (more like dollars).

My daughters named the Kumonryu "Disco" and my 3-year old son named the Hiutsuri "Tango".

Enjoy the photos that I took at the Summer Koi!

Releasing the Kois into my pond

My father watching from the living room

Children can't wait to release the kois!

Packing the Kois

Kois trying to swim away

Almost bought these golden kois but their body shape was in question

Netting in the kois for viewing

My hiutsuro

Mega Koi (Chagoi) about 1m in size!!

My daughter Brittney, shocked by the size of the fish!!

Goodbye 2009, welcome 2010

2009-12-31T17:00:00.000+08:00

Ten years ago, the world was preparing herself for the new millennium with trepidation because of the Y2K bug that never was. It was a non-event, far removed from the gloom and doom that was predicted.

A year later, the world's attention was gripped in horror as many of us watched the terrorist attack of September 11. I remember receiving an sms asking me to tune in to the TV as "war has started in America". The scene on TV was surreal - could it be real that big commercial planes were crashing into the World Trade Centre building at New York? It was. That day changed the way we travelled forever.

Two years later in March 2003, an enemy we could not see again gripped the world and this time Singapore in particular. SARS (Severe Acute Respiratory Syndrome) struck Singapore after it quickly spread from the index case in Hong Kong. Hospitals in Singapore was put on full alert and we geared up rapidly. There was significant fear as the nature of the disease and how it spread was unclear initially. Schools were closed, Singapore companies quickly came up with thermal scanners to help with mass temperature screening, there was shortage of N95 masks and other personal protective equipment. At some point, healthcare workers were discriminated against due to fears of contamination. Visitor limitations were imposed... SARS changed the face of healthcare but we came through stronger and better prepared for future epidemic/ pandemic situations.

One year later, on boxing day, the tsunami of 2004 "crept" onto the shores of many countries and destroyed many coastal homes and families. The devastation was shocking and till today the rebuilding is still taking place. As much as the tsunami destroyed, it also united the world. The outpouring of aids and the direct assistance rendered by many countries and their people were heartwarming. At that time I was in SGH and I recall the number of hospital staff volunteering themselves. Teams were sent, supplies were packed and lives of many who volunteered were changed as they saw how every humble effort of one person could make a difference to another facing calamity.

Thereafter, the world "kind of hum along" with smaller aberrations every once in a while until the "virus of the Pigs" provided yet another scare in April 2008. It started in Mexico but quickly spread to the US and with global travel, the virus found its way to Singapore. Many of us now know of it as the H1N1 virus. Fortunately, mankind is spared of major devastation as the virus turned out to be less virulent than originally thought.

As the world's attention was diverted to the H1N1 virus, the "Mega" financial smeltdown started some time in Sep 2008. I remember thinking to myself at that time that "there is something about the month of September!" AIG bailout, Lehman Brothers collapsed and then the stock market crashed. Companies that were seen to be "too big to fail" fell. It was quite unexpected as the economy was booming just shortly before and oil price saw its peak at US$145/ barrel a few months before that. Fortunately, the economies of the world took concerted measures to shore up the financial markets and today consumer confidence have returned and the market is picking up steam again. The Singapore market has now recovered some 65% from the lows last year.

It is with this brighter horizon that we are preparing to enter 2010 - the beginning of yet another decade.

For me, this past decade has been one where I have experienced growth both personally and professionally. I count my blessings amidst the many things that have happened.

(1) My lovely daughter Melody was born in 2003 and my cheeky son Zachary arrived on 20/07/2007 (auspicious date right?)

(2) We moved into our new home in 2003 albeit shortly after that SARS struck

(3) Had a fulfilling 6-year stint starting from April fools day of 2004 at SGH and SingHealth playing the roles of COO SGH, Group Chief Procurement Officer and later on as Group Chief COO SingHealth

(4) Celebrated my 16th wedding anniversary with my wife - the woman of my life and my source of inspiration!

(5) Living up my dream to lead in the starting up of the new Jurong General Hospital and the opportunity to see it come to fruition in 2014.

2010 looks set to be an exciting year already! Many Singaporeans will be counting down to 2010 tonight. My hope for all of us:

(1) we will have good health so that we can live a life that we desire,

(2) we will truly treasure, love and spend time with our family

(3) we will learn not to live a life as if everything depend on us - rest!

(4) we will experience love, peace and joy even as we work hard for a little more wealth so that we enjoy it with the health that we have

Happy new year everyone!! Talk to you next year :-)

An excellent Singapore product for the elderly

2009-12-28T23:26:00.001+08:00

This Christmas, I picked up a Black iNO CP09 big button phone designed by a Singapore company for my father-in-law.

It is an excellent phone - big button numeric pads that is extremely comfortable both to use and to the eyes, comes with attached touch light, FM radio, and external keylock function. The clincher for me is that one-button "SOS" function in bright orange at the back of the phone. When an elderly person falls at home or is suddenly disabled from illness, all he/ she has to do is to depress the SOS button. Doing so will activate automatic messaging to 4 predetermined mobile phones with the message "This is an emergency. Call me now". Concurrently, the iNO will automatically dial the 4 emergency numbers in quick succession until someone picks up the phone. When that happens, the iNO automatically goes into speaker mode so that the elderly may be able to communicate without the need to hold the phone close to the mouth. At $88 for the phone, I thought it was a great buy and a very useful one too. As Singapore ages, innovation such as this will be in greater demand.

The main problem with this phone is actually not about the phone, but how it is poorly marketed. The instruction manual that comes with the phone was written in poor english with many typos. When the phone was being charged, a message "Charging" appears on the screen. At the end of the charge cycle, the message on the screen was "Charging FULL"!

Singapore companies need to pay attention to details if they want to make it to the global market. It would be such a waste if they have a great product - as the case may be for the iNO CP09, but are confined only to the Singapore market because they have failed to take the product through the last mile!

Life without a domestic helper

2009-12-27T22:54:00.000+08:00

I have been without a domestic helper for the last 2 weeks.

This is the first time that we do not have an overlapping period between change over of domestic helpers - coping without a maid in our busy lifestyle is certainly challenging.

Part of this challenge is due to my expectations. My colleagues would know that I reiterate the maxim of "a place for everything and everything has its place" countless times as we plan transition to Alexandra Hospital and the new JGH. Basically, I am quite neat with my things at home. Little did I find out that my wife, having a led a life with me for more than 15 years has become even more demanding in the area of cleanliness and keeping things neat. So, the rest is history...

There are a few great things that have come about as a result of the unforeseen departure of my maid. First, my children are now even closer to me. I bathe them, change them, bring them to the toilet, play with them, read to them, go shopping with them, bring them to the library and bookstores, write them notes, tuck them into bed, pray for them. Not that I do not do these things with them when my maid was around but the regularity and significant increase in frequency helped solidify our bond further.

Second, I am now better equipped to know where are the various things kept throughout the house. Although the system used to store the stuff may be questionable, the most important quick fix for me is to know where to find things. I am resolved to create a better inventory system when this "crisis" is over.

Third, I have developed better empathy regarding what my wife has to go through daily taking care of kids as a stay home mom. It is really not easy - practically no time-out unless she consciously carve out some time for herself to recharge. Sometimes when I am asked if my wife is working, my reply would be "only one person need to suffer...", and I was really referring to my wife. Taking a job out there could well be "easier" than a stay home mom - at least one can apply for leave, take a lunch break, etc at the office! I really treasure her for taking on this "harder" job.

Despite these, life without a maid is still a "crisis" that my family is trying to manage.

My plans for the rest of the year have been turned upside down. There are many readings and planning for next year that I would have loved to spend more time in my quiet reflection. But, where is that time for "quiet reflection" with kids demanding my attention all the time with their many needs! My maid used to help to manage the kids when I need some time of my own at home. Interruptions are now rampant. I would read the first line on a paper and my 3 year old would yell out "...cannot hold..." and I would hurriedly leave my desk to bring him to toilet. As I settled back, skimmed the next few lines and I would hear a scream - gosh my kids are fighting for the same game again. I would settle the commotion, finished the first page and my daughter would come in and ask if I can read to her. I said I would do so after I am finished with the paper and the next thing I know, my son spilled his food... In quiet contemplative kind of environment, that paper would have taken 15 minutes to read but in my "new life", I would be lucky to finish reading a paper in 3 hours.

The key is to keep the peace at home as our hearts, mind and plans are ruffled. "Sacrifices" will have to be made. I accept it that during this period, not everything will be in its place. Some things may not be done to perfection in order to maintain some sanity. All of us will have to step outside our comfort zone and self-perceived roles and chip in as we should as a family.

I am so glad that my new maid will start work in my home this coming wednesday. There will be a period of "ramping up" for her and during the same period I hope my wife and I can "ramp down" somewhat. I am indeed looking forward to catching some personal time and time with my wife in the near future!

In the meantime, I am just a tad grouchy. I hope that you will find it in your heart to forgive me.

"I prefer to keep them healthy than treat them when they are sick"

2009-12-25T22:25:00.002+08:00

It is strange that I should be doing this on Christmas Day, but I am catching up on my readings. Tasked with the charge to be the healthcare architect for the population in the west with the building of the new Jurong General Hospital, I have been populating and inspiring my mind with ideas others are thinking and implementing.

I picked up an email containing an article from one of the online issue of the NYTimes, "If all doctors had more time to listen". Dr Batlle, a primary care doctor in the US was quoted in the article saying "I prefer to keep them (patients) healthy than treat them when they are sick". I thought to myself, this is indeed what Jurong Health Services - the health system comprising Jurong General Hospital, aspires to do for the population in the west.

The article started with a visit by Dr Batlle to the home of a 93-year old patient. She had 15 types of medications from a range of healthcare providers including a cardiologist, gerontologist, a pulmonologist and upon checking, found that "...some of the medications have expired, some unnecessary and some dangerous if taken together". Dr Batlle was able to cut her medication to 4 and gave the family her personal mobile phone number. According to Dr Batlle, she was able to save the patients from several visits to the accident & emergency and hospital stays because she was able to attend to the needs of the patient in a timely manner.

I asked myself, "Is this a far-fetch example of badly coordinated care, or is this the real world out there where patients may unwittingly be left floundering?" Based on the experiences of my family members, feedback from patients that I have heard over the years, and some recent feedback from colleagues whose loved ones have taken ill (both locally and overseas) - this example represents a real need out there for better care coordination, better access to patient-centred care that will enable patients to manage their medical conditions or to just stay healthy.

Navigating healthcare for our own health can be quite daunting. We lack knowledge of medicine and hence depend heavily on healthcare providers to guide us through the "healthcare maze" of:

- when should I go to the GP,
- when do we need specialist care,
- is this serious enough for us to head straight to the the accident and emergency department,
- is there a particular type of specialist I should see,
- if there are few specialists looking after me is there one overall in-charge who will know everything about my medical condition,
- my doctors who are seeing me for various conditions are giving me different medication - should I take all or discontinue some,
- when I am discharged from the hospital will I be able to take care of myself,
- how will I know if I have fully recovered,
- if I am referred to the community hospital will they know how to continue my care,
- which nursing home should I choose - are they all the same,
- how do I take care of my wound when I am discharged,
- why is the instruction from the discharge nurse different from the doctor - who should I follow,
- if I need help to manage my condition who should I ask,
- this medication makes me dizzy should I stop
...the list goes on.

It has become quite obvious that we need a better way to integrate care for our patients, hopefully even before they become a "patient". The population will benefit when we are able to "stitch together" the various components of our healthcare system and make it easy for the man-in-the-street to be able to better access the right care. In the first instance, we should make it easy for people to stay healthy or at least have the information so that they can be motivated to do so.

My dream is that we will be able to ultimately integrate healthcare in a manner so simple that we can literally "bring health to every home" - much like the simple but powerful Microsoft vision of "putting a PC on every desk running Microsoft".

IT will be a key enabler and work to put in place a national health record for Singapore has already started. Healthcare capacities and capabilities will need to be enhanced, and the plan to build JGH is a testimony to that commitment.

Singaporeans can be proud of our healthcare system. When compared to the healthcare systems of even many of the advanced countries in the world, ours continue to stand out in terms of quality, access and cost. As our population continue to age and with the growing incidence of chronic illnesses, this transformation of our healthcare system that is currently taking place, from the current episodic acute care based approach to one that is integrated, seamless and population based will indeed be the change that we need.

Let's see how we can co-create a healthcare system that will truly put "Health" at the centre and NOT just "illness" care.

Strong when we are weak...

2009-12-20T23:22:00.000+08:00

This week, faith and trust took a beating. It is in my nature to be trusting and believe the best in people as the default mode. Most times, this has been the right approach. I have seen people blossom right before my eyes as I did so, the rewards unimaginable and satisfying!

However, my domestic helper (maid) who has been with my household for the last 3 years betrayed that trust a few days ago. Many of us might say, no problem, move on - she is just a maid. True, she is just a maid but she saw my boy grow up for the last 3 years and actually did her job well. My kids are quite fond of her, my parents have grown to trust her and she is a welcome help to my family.

Last saturday, when we returned from our trip from Hainan (she went on trip with us), I received a call for her from Indonesia. I called her to the phone - she took some time as she was helping to unpack and clean, but after she had spoken for about only 15 secs, she dropped the phone and broke down crying. I asked her what was wrong and amidst her tears, she told me that her husband had died in a bus accident in Indonesia and her son who was traveling with her hubby was in hospital. I called my wife and she comforted my maid and held her hands to give her strength. We told our maid that we would do everything within our means to help her. I went on the Internet, checked out the earliest flight back to Jarkata (turned out to be SQ and not Tiger Airways) and with her agreement booked that SQ flight for her to go back in time to be with her family. My kids were at the airport on Sunday to see her home - there was tears but then she had to be back with her family.

To cut the long story short, all this was all a hoax! The husband did not die and the son is well. In fact, when I called her home in Indonesia and asked her family member "how was her husband?", her husband came mistakenly to the phone and spoke to me. While I was disappointed and felt betrayed, my wife was devastated this has turned up to be one of the biggest hoax. She could have told us that she wanted to go home and we would have still let her. Why did she lie?

Suddenly left without a domestic help and with my wife, parents and kids taken ill, it was really hard for the whole family. Naturally, I chipped in doing the bathing of the kids, preparing their milk, packing the bags before we go out, making the beds, folding the clothes, cleaning up the vomit, etc etc etc. I do not begrudge doing these tasks, in fact I think I do them quite well. But, with everything that went on, the priority was keeping the peace at home.

Faith and trust in people took a beating. I was mentally tired out. At times I thought to myself, I should be less trusting and perhaps even be "nasty" but realises deep down that to do so would be wrong. Even so, I was not able to really rise beyond what I had experienced - the betrayal and lie.

I was on facebook this evening, when I spotted one of my friend Josephine Xu posting a Youtube video of Whitney Houston singing her new song "I look to you". Whitney was my favourite singer until she was lost to drugs. The song was beautiful and brought me to remember again that when we are weak - as I was, we can "look up" and draw strength. I listened to this song 3 times and at the last time, my eldest daughter stepped into my room and I shared the song with lyrics with her. As I listened to the song with her, I know I have the answer to the question that she asked me in the afternoon, "how should I feel towards auntie? I know she did not do a nice thing but she did take care of us..."

I am no longer disappointed, I am no longer angry with my maid. In doing so, I have experienced rest and closure. My faith is back and I can be more trusting again. I Look to You...

Here are the lyrics of the song "I look to you" so that you can enjoy as well

As I lay me down
Heaven hear me now
After giving it my all
I’m lost without a cause
After giving it my all

Winter’s storm has come
And darkened my sun
After all that I’ve been through
Who on earth can I turn to

I look to you
I look to you

After all my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you

About to lose my breathe
There’s no more fighting left
Sinking to rise no more
Searching for that open door
www.musicloversgroup.com
And every road that I’ve taken
Lead my regret
And I don’t know if I’m going to make it
Nothing to do but lift my head

I look to you
I look to you

And when my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you

My levees are broken
My walls have come
Tumbling down on me
The rain is falling
Defeat is calling
I need you to set me free
Take me far away from the battle
I need you
Shine on me

I look to you
I look to you

After all my strength is gone
In you I can be strong

I look to you
I look to you

And when melodies are gone
In you I hear a song
I look to you
I look to you
I look to you

What can we learn from the Tiger Wood?

2009-12-13T23:03:00.000+08:00

The front page of the Straits Times today carried a feature about Tiger Wood taking time off golf to heal his family relationship. I had been away from Singapore for the last 10 days visiting my ancestral home in Hainan Island and have not kept up with news. Before leaving on my trip, I remembered the news about his driving incident and the world was buzzing about why it happened.

I read the news with a tinge of disappointment. I asked myself why would a man with such success come to possible ruin due to such foolish judgement and actions? I remembered too that when the news broke, he vehemently denied any marital problems and extra-marital relationships. But, now he confirmed the problems.

Tiger Wood is a brand name - some may even say an "organisation" unto itself, with "revenues" of over US$100 per year in terms of sports endorsement. Fans, perhaps expected him to be more transparent when the news broke, and through their loyalty, forgive him. Because he denied and later confirmed the problems, his following may take a beating and could take time for him to recover.

On the same day, Salma Khalik wrote an article asking healthcare institutions to be more transparent about their mistakes so that individually and collectively as a system we can improve. I agree. Taking reference from the Tiger Wood "fiasco" (even though direct comparison is incompatible), transparency and sincerity about the mistakes we make would be key to patient (or fan) confidence. Particularly in healthcare where there is information asymmetry, transparency becomes even more important. Patients rely on healthcare professionals to "do the right thing for them" because many times they don't know better. Healthcare institutions should honour that trust by being forthright when things go wrong, apologise with sincerity, and do their best to "make it right" to the patient. The recent chemotherapy incident at KKH provided an excellent example in this regard. Not surprisingly, the patients and families involved in the incident have been forgiving.

To err is human, to forgive divine. For forgiveness to take place when mistakes happen, transparency and sincerity seems to be 2 key ingredients for individuals and organisations to put into action quickly. Doing the right thing will always be the right thing to do.

Take this prescription daily

2009-11-26T20:50:00.000+08:00

All of us need this, so take a healthy dose daily...

Enjoy the meaning of this song "Because you loved me" beautifully sung by Celine Dion

For all those times you stood by me
For all the truth that you made me see
For all the joy you brought to my life
For all the wrong that you made right
For every dream you made come true
For all the love I found in you
I'll be forever thankful baby
You're the one who held me up
Never let me fall
You're the one who saw me through through it all

You were my strength when I was weak
You were my voice when I couldn't speak
You were my eyes when I couldn't see
You saw the best there was in me
Lifted me up when I couldn't reach
You gave me faith 'coz you believed
I'm everything I am
Because you loved me

You gave me wings and made me fly
You touched my hand I could touch the sky
I lost my faith, you gave it back to me
You said no star was out of reach
You stood by me and I stood tall
I had your love I had it all
I'm grateful for each day you gave me
Maybe I don't know that much
But I know this much is true
I was blessed because I was loved by you

You were my strength when I was weak
You were my voice when I couldn't speak
You were my eyes when I couldn't see
You saw the best there was in me
Lifted me up when I couldn't reach
You gave me faith 'coz you believed
I'm everything I am
Because you loved me

You were always there for me
The tender wind that carried me
A light in the dark shining your love into my life
You've been my inspiration
Through the lies you were the truth
My world is a better place because of you

You were my strength when I was weak
You were my voice when I couldn't speak
You were my eyes when I couldn't see
You saw the best there was in me
Lifted me up when I couldn't reach
You gave me faith 'coz you believed
I'm everything I am
Because you loved me

I'm everything I am
Because you loved me

2009-11-18T23:12:00.001+08:00

This is a healthcare joke that got circulated. It sounds ludicrous but true...

A woman brought a very limp duck to a veterinary surgeon.
As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird’s chest.
After a moment or two, the vet shook his head sadly and said, “I’m sorry, your duck, Cuddles, has passed away.”

The distressed woman wailed, “Are you sure?”
“Yes, I am sure. Your duck is dead,” replied the vet.
“How can you be so sure?” she protested.
“I mean you haven’t done any testing on him or anything. He might just be in a coma or something.”

The vet rolled his eyes, turned around, and left the room.
He returned a few minutes later with a black Labrador Retriever.
As the duck’s owner looked on in amazement, the dog stood on his hind legs, put his front
paws on the examination table and sniffed the duck from top to bottom. He then looked up at the vet with sad eyes and shook his head. The vet patted the dog on the head and took it out of the room.

A few minutes later he returned with a cat. The cat jumped on the table and also delicately
sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly, and strolled out of the room.

The vet looked at the woman and said, “I’m sorry, but as I said, this is most definitely, 100%
certifiably, a dead duck.”

The vet turned to his computer terminal, hit a few keys, and produced a bill, which he handed to the woman.
The duck’s owner, still in shock, took the bill. “$150!” she cried, “$150 just to tell me my duck is dead!”
The vet shrugged, “I’m sorry. If you had just taken my word for it, the bill would have been $20, but with the Lab Report and the Cat Scan, it’s now $150.”

Learning from Bumrungrad Hospital

2009-11-18T17:32:00.003+08:00

JGH Chairman Medical Board Prof Cheah WK taking notes of observations

The hospital planning team members asking lots of questions of our host

Unit Dose packing from Inpatient Pharmacy Automation deployment

at Bumrungrad to improve medication safety

The "ring" of medication for each patient

Work for the planning of the new Jurong General Hospital (JGH) has started a few months ago. In order to incorporate some of the best designs to improve patient experience/ safety and operational efficiency, we have set out to learn from the experiences of other hospitals in Singapore and overseas.

One hospital that we visited on Monday this week was Bumrungrad Hospital in Bangkok. They've recently completed a new outpatient building and incorporated flexible modular design at their clinics that would allow the facility to match the growth of clinical services workload - something that JGH was keen to find out.

As we walked around the hospital, one of the things that quickly struck the JGH team was how "calm and peaceful" their outpatient clinic setting was even though they were seeing some 3000 patients every day - more than some of Singapore public hospitals. A conversation with their Group CEO revealed careful planning with an eye for operational efficiency, crowd separation to various floors with deployment of technology to ensure one-stop service (eg. medication orders are routed by system to the pharmacy directly, medication prepared and sent back to the clinic floor by pneumatic tube system within minutes, and pharmacist will dispense to patient after payment), and intelligent queue management as critical success factors. All of these are very helpful in our planning for JGH.

Attention to details is evident throughout the hospital. Rubberised keyboards to facilitate cleaning are used in patient's room. Privacy curtains are neatly tucked behind a wall panel to present an uncluttered and restful space. Semi-automatic sliding doors are used at clinic consultation rooms to ensure minimal effort by nurses while gentle enough so that they do not produce any noise when they are shut tight. Integrated deployment of IT to achieve real-time visibility of a patient's journey and condition and others are just some of the many learning the JGH team brought home with us.

We were also quite amused that Bumrungrad hospital takes a picture of their patient during registration at the clinic. While walking through the clinic, we realised why is it important. Instead of calling patient by name or by their queue number, staff would look out for the patient based on their photo at the waiting area and usher him/ her into the consult room. How interesting?

Overall, we had a fantastic few hours of learning at Bumrungrad Hospital and awed by the hospitality of our hosts. The day trip was indeed worth it - not to mention the delicious Thai food that we managed to savour while waiting for our flight at the airport!

How to mess up without even trying!

2009-10-30T23:28:00.002+08:00

My team recently visited a brand new hospital in the US, reconstructed with many hundred of millions of dollars after an earthquake. Even though there were many things that we could learn from the hospital, I was distracted.

I was distracted because I was disappointed by the lack of ownership and lack of attention to details by staff members throughout the hospital. They carelessly plaster signs on the wall, leave trash along the corridor and left random scratches on the walls as they moved supplies through the corridors.

As a result, even though the hospital is very new, it looks old, worn and shabby. What a waste! I also observed that staff of the hospital did not even try to correct the problems that have become so obvious. Perhaps, they told themselves, "if my colleagues don't care, why should I?"- worst still "if my bosses don't care, why should I?"

My team and I are currently planning the new Jurong General Hospital. What I saw in the US cannot, must not and will not repeat in JGH. I am creating this expectation now.

In the moment that you think you can't, you'll discover that you can... that's the power of the DREAM

2009-10-25T20:10:00.003+08:00

The Power of the Dream was the theme song of the 1996 Olympics at Atlanta.

That year, I was in the US pursuing my MBA, but sadly what I could remember of the Olympics was the bombing that took place. I missed the significance and the magic of this song that was sung at the opening by Celine Dion and at the closing by a 10th grader and hundreds of other students.

Tonight, on Facebook I was introduced to this song again. I listened to it twice and peered into the lyrics and found it so powerful. I especially liked this

"There's so much strength in all of us

Every woman child and man

It's the moment that you think you can't

You'll discover that you can"

There are many moments that we think we can't, people others around us say we can't but where we hold a dream, it's like what the song says "you'll discover that you can!!"

As I am writing this note, my daughter Brittney came into my room and I introduced her to this song using a video clip of celine dion's performance on Youtube. As we followed the lyrics of the song, I told her that if she has a dream of who she wants to be, she'll discover that she can. She looked me in the eye and said "Yes!" ... a moment that money cannot buy!

I am also personally encouraged by this song. The journey to set up Jurong General Hospital (JGH) is both exciting and daunting. Our vision is to create a new future for Singapore healthcare from ground up - new infrastructure, new people, new culture - to care for our Patients. There are many who said (and continue to say) that this is hard, and sometimes we too think that it is hard. BUT, guided by the possibility of co-creating a new future, our team of pioneers keep holding to our DREAM, and we will discover that we CAN!!

For the rest of us, it is my wish that your dream too will come true because you choose to believe in the strength of "I Can!" and the "One thing" that matters!

Enjoy the full lyrics of this song...

Deep within each heart
There lies a magic spark
That lights the fire of our imagination
And since the dawn of man
The strenght of just "I can"
Has brought together people of all nations

There’s nothing ordinary
In the living of each day
There’s a special part
Every one of us will play

Feel the flame forever burn
Teaching lessons we must learn
To bring us closer to the power of the dream
As the world gives us its best
To stand apart from all the rest
It is the power of the dream that brings us here

Your mind will take you far
The rest is just pure heart
You’ll find your fate is all your own creation
Every boy and girl
As they come into this world
They bring the gift of hope and inspiration

Feel the flame forever burn
Teaching lessons we must learn
To bring us closer to the power of the dream
The world unites in hope and peace
We pray that it will always be
It is the power of the dream that brings us here

There’s so much strength in all of us
Every woman child and man
It’s the moment that you think you can’t
You’ll discover that you can

Feel the flame forever burn
Teaching lessons we must learn
To bring us closer to the power of the dream
The world unites in hope and peace
We pray that it will always be
It is the power of the dream that brings us here

Feel the flame forever burn
Teaching lessons we must learn
To bring us closer to the power of the dream
The world unites in hope and peace
We pray that it will always be
It is the power of the dream that brings us

The power of the dream
The faith in things unseen
The courage to embrace your fear
No matter where you are
To reach for your own star
To realize the power of the dream
To realize the power of the dream

Investment Tips or Hypes?

2009-09-20T22:26:00.002+08:00

I was clearing my mounting pile of mails and came across a newsletter from a local bank on investment.

The key message is: Time and NOT timing is key to successful long term investing

The article carried a chart of the MSCI Work Index and the impact on the index by missing the 30 best days each year. Through peaks and troughs, it is clear that missing out on 30 best days can be detrimental to the overall portfolio value.

The ride can be bumpy and sometimes is hard to stay the course, although the logic is clear.

What would be good investment strategy if time and not timing is key?

Reunion with the Principal who gave me a 2nd chance...

2009-09-19T14:43:00.004+08:00

Today, after 25 years, I met up with Mr Rudy Mosbergen, the ex-RJC Principal who gave me a second chance and changed the trajectory of my life.

I am indeed thankful to my ex-colleague from SGH Mumtaj who helped made the connection through a friend of a friend who knew Mr Mosbergen's son Nigel.

It was a simple reunion today at the Delifrance of the Toa Payoh HDB Hub. I ordered a Coke-lite and a tuna puff for Mr Mosbergen and I took a regular coke. I was so happy to see Mr Mosbergen and I could tell he was happy to meet me as well. He showed me a print-out of the tribute to him that I wrote in my Teacher's Day blog in 2008, and he said he underlined the most important things in there. I took a look at the printout and found out that he highlighted in blue the following:

(a) His favourite quotes to students "The mind is a terrible thing to waste"

(b) My name

We shared anecdotes of our lives over the last 25 years. Before we departed, he handed a copy of his book "In the Grip of a Crisis" which he personally autographed. It was at that time that I realised that he is much more than most would know - he is not only an author but also a songwriter, and an ex-national olympian in hockey.

I gave him a little token in crystal of a nurturing bird looking after a younger bird. On it I engraved the words "Specially Dedicated to Mr Rudy Mosbergen, Ex-RJC Principal...Because you gave me a second chance, I could be who I am today...Foo Hee Jug RJC Class of 1984".

Let's give others a second chance, you never know the kind of impact it can mean to them...

Lonely...

2009-09-18T22:12:00.002+08:00

A forgotten banana left perched on top of an office cabinet.

This could be the result of chinese/ asian culture of not taking the last so that others can have it. But when everyone leaves it for another, the result could be a wasted banana like the one in the photo.

Nice pic isn't it?

Other signs from my trip to Shanghai

2009-09-14T22:12:00.003+08:00

Useless and funny signs...

2009-09-14T21:57:00.003+08:00

This is a sign at the lift lobby of a major shopping centre. Notice how useful is this sign. Anyone looking at this sign will know exactly where they are without which we will all be lost! Thank god for such a sign.

This is a sign at a pet shop. Owner must be angry because even when you cooperate by not "trying" to put your hand in, he is only giving you a "singular" "Thank"...perhaps "You" is missing?

Not sure whether this sign says "NO! Hand Touching" or "NO Hand Touching!" or ......

Papaya in bloom

2009-09-07T22:02:00.002+08:00

I only realised recently that Papaya trees are either "male" and "female".

The female tree bears fruits while the male don't. When my father discovered this, he propagated a whole bunch of papaya trees in my garden and some are already beginning to bear fruits. The hard reality is that the male papaya trees are quickly disposed off.

Lessons from the toilet

2009-09-06T22:26:00.003+08:00

There is a popular toilet slogan..."We aim to please, You aim too, please"

One can tell from the level of hygiene is some toilets that aiming need more work. The amount of splatter on the floor shows that while it is easy to assume that people can aim when you tell them to, some people simply need help to focus their aim.

At Singapore's Changi International Airport Terminal 3, the management takes aiming into their own hands. In their urinal is strategically imprinted the shape of a fly (see picture above). All the user has to do is to aim his stream at the "fly" and voilla! the aim is complete! It is almost natural to do so as they have cleverly used the picture of a common enemy (the fly) for the aim. Had they used a picture of a sweet, a flower, etc it would have been less effective.

More developers can take note of this simple innovation. There is a high chance that you will find this implemented in a new hospital.

Symbolism

2009-09-04T22:12:00.002+08:00

This is my first green, perched on my desk at Jurong General Hospital interim office at Alexandra Hospital.

It is a Money Plant. I chose this plant among many for a few symbolic reasons.

1. It has a beautiful form - it symbolises a beautiful hospital set to rise in the west

2. It has many young leaves - it symbolises the youthful nature of the hospital with many energetic staff who are ready to soar and break new grounds

3. It has strong and healthy trunk and leaves - it symbolises an organisation with strong values

4. It has branches and leaves that are spread evenly in all direction - it symbolises an openness that allows us to seek to learn from all even as we improve

Watch the hospital grow...

There is hope!

2009-09-01T20:14:00.003+08:00

This evening, I attended the 2009 MOH Health Sciences Scholarship Ceremony.

37 scholars were selected from an original applicant group of more than 2000. They will soon head to local and overseas university to pursue their course of study in Pharmacy, Podiatry, Physiotherapy, Occupational Therapy, Dietetics and Social Work.

They took the Health Sciences Scholar Pledge and went on to put on a most impressive performance, culminating in a touching segment where every scholar had a statement on their individual goals for the patient set against Michael Jackson's "Heal The World" song.

As I watch each statement flashed across the screen, I am encouraged that each of the scholars has a dream larger than themselves and wants to make a difference to the patient and to the society.

There is hope when our bright and young have such ideals and aspirations.

I wish them well and success in their studies. May they come back and help make the world a better place.

Jurong General Hospital Project Initiation Workshop

2009-08-28T23:47:00.003+08:00

Our Facilitator Roy Barton

Active Participation

Crafting the Charter and Project Values

Intense deliberations on how we word the charter

The JGH Project Charter with ALL our Signatures

Hospital planning for Jurong General Hospital has gone the next level with the conclusion of the Project Initiation Workshop today.

The JGH core team, partner from St Luke's, winning consultants, LTA, URA, MHA and PMlink spent the last 2 days discussing how to work together over the next 5 years to build a integrated patient-centred healthcare facility in Jurong to benefit the community in the west.

The session concluded on a high note with a commitment to the Project Charter that we developed together with all participants putting on their signatures.

Here is where the interesting development work starts and I could tell that everyone is very excited about this creation that we are embarking on.

JGH's plans for Integrated Care

2009-08-28T23:37:00.002+08:00

The Straits Times and Zao Bao carried news about Jurong General Hospital's plans to integrate care for Singaporeans. JGH will partner St Luke's in an integrated development at a 5.5 ha plot at Jurong East Street 21 (in front of IMM).

Do read the articles to find out more...

Straits Times article (Note that the photo in this article is different from the one in print news)

Zao Bao Article

2 Brains better than 1...

2009-08-22T22:28:00.003+08:00

Today, I heard many no-brainers or motherhood statements such as "If you don't know something, it does not mean it does not exist", "AND is better than OR", "you can have the things that you are passionate about", "yes or yes", "you can do it, if others can do it"...

Many of these we know when know, and quite often we don't know what we don't know, until we know. And when we do know, we sometimes ask ourselves since we do know, why does it take reminding for us to practice it?

Here is where 2 brains are better than 1. We need each other to help remind us of the things that are important. The act of "bringing things from the back of our mind (knowledge), to the front of our mind (ie consciousness)" is key to putting into practice what we already know. That's why sometimes, we pay others to tell us the time from our own watch.

It is ok sometimes to marvel at the obvious. Even commonsense can be uncommon sense.

Enjoy the rest of the weekend!

Delivering bad news to patients, it is about bringing comfort not cure

2009-08-20T21:08:00.002+08:00

This is an interesting article from the NY Times.

Delivering bad news to a patient when the prognosis is not good is hard, but needs to be done sensitively and doing it well will go a long way for the patient.

The Summo piggy

2009-08-18T22:10:00.002+08:00

When I was with SGH, I bought a summo piggy bank as part of fun raising for needy patients.

Just 2 Sundays ago, it was filled to its brim with loose change that I've deposited into the summo daily. So, I brought it to the DBS Bank at Serangoon Gardens where there is a coin counting machine to deposit the amount into my children's account. If you have not tried it before, it is actually quite a thrilling experience - digging the coins out from the little summo and hearing the machine counting - almost like a jackpot machine experience, except possibly in reverse.

The picture shows me waiting for my wife with the little summo by my side before we commenced the exercise of depositing the coins with the bank. The Cisco guard who was pacing up and down at the front of the bank could not hold his grin.

Loose change can count for quite a bit, as you can see...

Proud to be a Singaporean!

2009-08-16T22:50:00.002+08:00

I attended my first National Day Rally tonight (Seat H33), and heard first hand PM Lee Hsien Loong's speech.

I am proud of how Singapore has become over the last 50 years, and am extremely excited about how Jurong General Hospital will play a key role in shaping Singapore healthcare to meet the challenges of an aging population. Fast medicine integrating with slow medicine, working together as a system to best meet the healthcare needs of every individuals.

Sometimes we need to slow down to go faster...

2009-08-16T09:51:00.002+08:00

This is a lesson while heading out to breakfast this morning with my wife.

The vehicle in front of us was road hogging. Instead of sounding the horn, flashing our headlights and perhaps stretching our arms and fingers for the morning exercise, my wife decided that she will switch lanes and overtake the road-hogger. As she signaled her intentions, cars started to speed up - does this sound familiar? Her natural instinct was to speed up so that her chance of changing lanes would be higher, but all the same, cars on the other lane refused to give way.

So, I told my wife, "why don't you slow down, let the cars go by and then switch lane?" Guess what? It worked. Soon, we were tucking in on our saturday morning noodles accompanied by our kopi-o.

It is a paradox but true beyond the roads that "sometime we need to slow down in order to speed up."

Does Mickey Mouse has a lesson for improving patient experience?

2009-08-14T20:47:00.002+08:00

The purist will say no. Healthcare is professional business! Mickey mouse...well...is just mickey mouse. Blasphemy! to even suggest that...

There is a book "If Disney Ran your Hospital" by Fred Lee that one of my new colleague from JGH just reminded me today that says just that.

Go ahead, read it and you will find useful lessons. Otherwise read this summary.

An unexpected moment of friendship and inspiration

2009-08-13T22:03:00.002+08:00

Today, for some strange reasons, I turned up at 1pm for a meeting at the Outram Campus that was scheduled for 2pm. Quite unexpectedly, the ex-matron of SNEC also turned up for the same meeting also thinking that the time of the meeting was 1pm. The meeting room was obviously empty except for the 2 of us. Since we have not met for quite a while since I left SGH, we decided to just chat.

The next 1 hour was inspiring. Past retirement age already, she decided to continue to serve. It was clear to me that she wanted to continue to nurture the next generation of nurses with her presence and experience. She spoke about the time when she trained nurses in her younger days. She said, "I did not just train nurses just for eye centre but for Singapore". She went on to talk the need to learn from each other and the need to be generous with knowledge and with each other. She said, "when I have something that you need, I should share it. When you use it, you will improve on it, and later on when I need it, I would have something better in return". How enlightened a person.

I enjoyed the conversation and was energised by the unexpected moment of friendship and inspiration.

There are many great people in Singapore public healthcare system. That's why it feels so good to serve!

Don't Gossip!

2009-08-12T20:52:00.002+08:00

It pays to pay attention. Otherwise don't gossip :-)

A lesson in patience, calmness and thinking out of the box

2009-08-10T22:27:00.002+08:00

On saturday, I brought my daughter Melody to the Kids Farm at Pasir Ris to catch "lokang" fish. The task is quite simple, pay $4.50 for your child, bring along a small net and pail and head to a small shallow meandering pond (see picture) and start catching as many small fishes swimming in the pond with the small net.

The catch is, the task looks simple but is actually quite difficult if we approach it in the most obvious way - eye the fishes, move towards them, lower the net to scoop them up. Wrong! The fishes are extremely agile, swims quickly, switch direction when you do, hide under the bridge, play hide an seek around big stones introduced in the pond and take refuge amidst turbulent water generated by water features.

This is my second attempt at this pond and I must admit it was hard work and a great work-out with very little yield in terms of catch. The more frantic my children and I were in chasing and randomly scooping after the fishes, the more futile our attempts. The more impatient we became to net the fishes the worst our outcome. Often times, we caught the sickly fishes who were too traumatised by the chase and they die soon after - lousy catch.

During this visit, I was determined to calibrate our approach. I thought to myself that there must be a better way to catch the fishes. I did not rushed in to chase after the fishes as I did before. This time I spent time to watch the behavior of the fishes - where do they congregate, what were the group behavior of the school of fishes when others were trying to net them, etc. I realised that the fishes often swim near the surface of the water when they are trying to escape from a catch, and they congregate in big numbers in a sense of safety under the bubbles of the water features in the pond. Hence, the best way to net them is at the water feature with a swift scoup of the net from bottom up.

With calmness, I would position myself at various water feature and with each swift scoup I would land 2-3 fishes in my net. In the process, I caught many fishes for my kids. Melody on her own too, managed a few. It was a harvest and my kids were extremely pleased.

The moral of the story: more haste, less speed. It is useful to be patient, be calm and think out of the box - the results may be better. From the perspective of the fishes - where you think it would be the safest, it can be the most dangerous!

Love Life, Live Life, Enjoy Life and don't be robbed of Life

2009-08-07T14:03:00.003+08:00

This is a random email that I received...Good enough for me to share so that we may enjoy life with our loved ones...

===========================================

A story worth reading and taken as example in life.... dont lose the
moments in life just because of a small quarrel...

This is long but worth reading and is a true story ... you may have
received it... but it is worth to be reminded of it again.

WHAT GRUDGES CAN DO....

This is for all the single, married, divorced, separated, widowed
individuals, who take life for granted. Please I BEG YOU, read this
story until the end, it is such an opener. You will never
know.........................!

Just two years after our marriage, hubby brought up the idea of asking
Mother to move from the rural hometown and spend her remaining years
with us. Hubby's father passed away while he was still very young.

Mother endured much hardship and struggled all on her own to provide
for him, see him through to a university degree. You could say that
she suffered a great deal and did everything you could expect of a
woman to bring hubby to where he is today.

I immediately agreed and started packing the spare room, which has a
balcony facing the South to let her enjoy the sunshine and plant
greenery. Hubby stood in the bright room, and suddenly just picked me
up and started spinning round and round. As I begged him to put me
down, he said: "Lets go fetch mother." Hubby is tall and big sized and
I love to rest on his chest and enjoy the feeling that he could pick
me up at any moment put the tiny me into his pockets.

Whenever we have an argument and both refuses to back down, he would
pick me up and spin me over his head continuously until I surrender
and beg for mercy. I became addicted to this kind of panic-joy
feeling.

Mother brought along her countryside habits and lifestyle with her.

For example; I am so used to buying flowers to decorate the living
room, she could not stand it and would comment: "I do not know how you
young people spend your money, why do you buy flowers for? You also
can't eat flowers!" I smiled and said: "Mum, with flowers in the
house, our mood will also become better." Mother continues to grumble
away, and hubby smiled: "Mum, this is a city-people's habit; slowly
you will get use to it."

Mother stopped saying anything. But every time thereafter, whenever I
came home with flowers, she would ask me how much it costs. I told her
and she would shake her head and express displeasure.

Sometimes, when I come home with lots of shopping bags, she would ask
each and every item how much they cost, I would tell her honestly and
she would get even more upset about it. Hubby playfully pinched my
nose and said: "You little fool, just don't tell her the full price of
everything would solve it."

There begins the friction to our otherwise happy lifestyle.

Mother hates it most when hubby wakes up early to prepare the
breakfast. In your view, how could the man of the house cook for the
wife? At the breakfast table, mother facial expression is always like
the dark clouds before a thunderstorm and I would pretend not to
notice. She would use her chopsticks and make a lot of noise with it
as her silent protest.

As I am a dance teacher in the Children's Palace and am exhausted from
a long day of dancing around, I do not wish to give up the luxury of
that additional few minutes in the comfort of my bed and hence I
turned a deaf ear to all the protest mother makes.

From time to time, mother would help out with some housework, but soon
her help created additional work for me. For example: she would keep
all kinds of plastic bags accumulating them so that she sell them
later on, and resulted in our house being filled with all the trash
bags; she would scrimp on dish washing detergent when helping to wash
the dishes and so as not to hurt her feelings, I would quietly wash
them again.

One day, late at night, mother saw me quietly washing the dishes, and
"Bam" she slams her bedroom door and cried very loudly in her room.
Hubby was placed in a difficult position, and after that, he did not
speak to me for that entire night.

I pretended to be a spoilt child, tried acting cute, but he totally
ignored me.... I got mad and asked him:
"What did I do wrong?" Hubby stared at me and said: "Can't you just
give in to her once? We couldn't possibly die eating from a bowl
however unclean it is, right?" After that incident, for a long period
of time, mother did not speak to me and you can feel that there is a
very awkward feeling hanging in the house. During that period of cold
war, hubby was caught in dilemma as to who to please.

In order to stop her son from having to prepare breakfast, mother took
on the "all important" task of preparing breakfast without any
prompting. At the breakfast table, mother would look at hubby happily
eating his breakfast and cast that reprimanding stare at me for having
failed to perform my duty as a wife. To avoid the embarrassing
breakfast situation, I resorted to buying my own breakfast on my way
to work.

That night, while in bed, hubby was a little upset and asked me: "LD,
is it because you think that mum's cooking is not clean that's why you
chose not to eat at home?" He then turned his back on me and left me
alone in tears as feeling of unfairness overwhelmed me. After some
time, hubby sighed: "LD, just for me, can you have breakfast at home?"
I am left with no choice but to return to the breakfast table.

The next morning, I was having porridge prepared by mother and I felt
a sudden churn in my stomach and everything inside seem to be rushing
up my throat. I tried to suppress the urge to throw up but I could
not. I threw down the bowl, rushed into the washroom, and vomited
everything out.

Just as I was catching my breath, I saw mother crying and grumbling
very loudly in her dialect, hubby was standing at the washroom doorway
staring at me with fire burning in his eyes.. I opened my mouth but no
words came out of it, I really did not mean it.

We had our very first big fight that day; mother took a look at us,
then stood up and slowly made her way out of the house. Hubby gave me
a final stare in the eye and followed mother down the stairs. For
three days, hubby did not return home, not even a phone call.

I was so furious, since mother arrived; I had been trying my best and
putting up with her, what else do you want me to do? For no reason, I
keep having the feeling to throw up and I simply have not appetite for
food, coupled with all the events happening at home, I was at then low
point in my life.

Finally, a colleague said: "LD, you look terrible; you should go and
see a doctor." The doctor confirmed that I am pregnant.
Now it became clear to me why I threw up that fateful morning, a sense
of sadness floated through that otherwise happy news. Why didn't
hubby, and mother who had been through this before, thought of the
possibility of this being the reason that day?

At the hospital entrance, I saw my hubby standing there. It had only
been three days, but he looked haggard. I had wanted to turn and
leave, but one look at him and my heart soften, I couldn't resist and
called out to him. He followed my voice and finally found me but he
pretended that he doesn't know me; he has that disgusted look in his
eyes that cut right through my heart. I told myself not to look at him
anymore, and hail a cab.

At that moment, I have such a strong urge inside me to shout to my
hubby: "Darling, I am having your baby!" and have him lift me up and
spin me around in circles of joy. What I wanted didn't happen and as I
sat in the cab, my tears started rolling down. Why? Why our love
couldn't even withstand the test of one fight?

Back home, I lay on the bed thinking about my hubby, and the disgusted
look in his eyes. I cried and wet the corner of the blanket. That
night, sound of the drawers opening woke me up. I switched on the
lights and I saw hubby with tears rolling down his face. He was
removing the money. I stared at him in silence; he ignored me, took
the bank deposit book and some money and left the house.

Maybe he really intends to leave me for good.. What a rational man, so
clear-cut in love and money matters. I gave a few dried laugh and
tears starting streaming down again. The next day, I did not go to
work. I wanted to clear this out and have a good talk with hubby. I
reached his office and his secretary gave me a weird look and said:
"Mr. Tan's mother had a traffic accident and is now in the hospital."

I stood there in shock. I rushed to the hospital and by the time I
found hubby, mother had already passed away. Hubby did not look at me,
his face was expressionless. I looked at mother's pale white and thin
face and I couldn't control the tears in my eyes. My God, how could
this happen?

Throughout the funeral, hubby did not say a single word to me, with
only the occasional disgusted stare at me. I only managed to find out
brief facts about the accident from other people. That day, after
mother left the house, she walked in dazed toward the bus stop,
apparently intending to go back to her old house back in the
countryside.

As hubby ran after her, she tried to walk faster and as she tried to
cross the street, a public bus came and hit her... I finally
understood how much hubby must hate me, if I had not thrown up that
morning, if we had not quarreled, if....In his heart, I am indirectly
the killer of his mother..

Hubby moved into mother's room and came home every night with a strong
liquor smell on him. And me, I am buried under the guilt and self-pity
and could hardly breathe. I wanted to explain to him, tell him that we
are going to have our baby soon, but each time, I saw the dead look in
his eyes, all the words I have at the brink of my mouth just fell back
in.

I had rather he hit me real hard or give me a big and thorough
scolding though none of these events happening had been my fault at
all. Many days of suffocating silence went by and as the days went by,
hubby came home later and later. The deadlock between us continues, we
were living together like strangers who don't know each other. I am
like the dead knot in his heart.

One day, I passed by a western restaurant, looking into the glass
window, I saw hubby and a girl sitting facing each other and he very
lightly brushed her hair for her, I understood what it meant. After
recovering from that moment of shock, I entered the restaurant, stood
in front of my hubby and stared hard at him, not a tear in my eyes. I
have nothing to say to him, and there is no need to say anything. The
girl looked at me, looks at hubby, stands up and wanted to go, hubby
stretched out his hand and stopped her. He stared back at me,
challenging me. I can only hear my slow heart beat, beating, one by
one as if at the brink of death.

I eventually backed down, if I had stood that any longer, I will
collapse together with the baby inside me.. That night, he did not
come home; he had chosen to use that as a way to indicate to me:
Following mother's death so did our love for each other...

He did not come home anymore after that. Sometimes, when I returned
home from work, I can tell that the cupboard had been touched - he had
returned to take some of his stuff. I no longer wish to call him; the
initial desire to explain everything to him vanished.

I lived alone; I go for my medical checkups alone, my heart breaks
again and again every time I see a guy carefully helping his wife
through the physical examination. My office colleagues hinted to me to
consider aborting the baby, I told them No, I will not.. I insisted on
having to this baby, perhaps it is my way of repaying mother for
causing her death.

One day, I came home and I saw hubby sitting in the living room. The
whole house was filled with cigarette smoke. On the coffee table,
there was this piece of paper. I know what it is all about without
even looking at it. In the two months plus of living alone, I have
gradually learned to find peace within myself. I looked at him,
removed my hat and said: "You wait a while, I will sign." He looked at
me, mixed feelings in his eyes, just like mine.

As I hang up my coat, I keep repeating to myself "You cannot cry, you
cannot cry..." my eyes hurt terribly, but I refused to let tears come
out from there.
After I hung up my coat, hubby's eyes stared fixed at my bulging
tummy. I smiled, walked over to the coffee table and pulled the paper
towards me. Without even looking at what it says, I signed my name on
it and pushed the paper to him. "LD, are you pregnant?" Since mother's
accident, this is the first time he spoke to me. I could not control
my tears any further and they fell like raindrops. I said: "Yes, but
its ok, you can leave now." He did not go, in the dark, we sat, facing
each other.

Hubby slowly moved over me, his tears wet the blanket. In my heart,
everything seems so far away, so far that even if I sprint, I could
never reach them. I cannot remember how many times he repeated "sorry"
to me. I had originally thought that I would forgive him, but now I
can't. In the western restaurant, in front of that girl, that cold
look in his eyes, I will never forget, ever.

We have drawn such deep scars in each other's heart. For me, it's
unintentional; for him, totally intentional. I had been waiting for
this moment of reconciliation, but I realized now, what had gone past
is gone forever and could not repeated.

Other than the thought of the baby inside me that would bring some
warmth to my heart, I am totally cold towards him, I no longer eat
anything he buys for me, I don't take any presents from him and I
stopped talking to him..

From the moment I signed on that piece of paper, marriage and love had
vanished from my heart. Sometimes, hubby will try to come into the
bedroom, but when he walks in, I will walk out to the living room.

He had no choice but to sleep in mother's room. At night, from his
room, I can hear light sounds of groaning, I kept quiet. This used to
be his trick; last time, whenever I ignore him, he would fake illness
and I will surrender and find out what is wrong with him, he would
then grab me and laugh.

He has forgotten that last time I cared for him and am concerned
because there was love, but now, what is there between us? Hubby's
groaning came on and off continuing but I continuously ignored him.

Almost everyday, he would buy something for the baby, infant products,
children products and books that kids like to read. Bags and bags of
it stacked inside his room till it is full. I know he is trying to use
this to reach out to me, but I am no longer moved by his actions. He
has no choice but to lock himself in his room and I can hear his
typing away on his computer keyboard, maybe he is now addicted to web
surfing but none of that matters to me anymore.

It was sometime towards the end of spring in the following year, one
late night, I screamed because of a sudden stomach pain, hubby came
rushing into the room, its like he did not change and sleep, and had
been waiting for this moment. He carried me and ran down the stairs,
stopped a car, holding my hand very tightly and kept wiping the sweat
off my brow, throughout the journey to the hospital.

Once we reached the hospital, he carried me and hurried into the
delivery suite. Lying on the back of his skinny but warmth body, a
thought crossed my mind: In my lifetime, who else would love me as
much as he did?

He held the delivery suite door opened and watch me go in; his warm
eyes caused me to manage a smile at him despite my contraction pain.
Coming out of the delivery room, hubby looked at our son and me, eyes
tear with joy and he kept smiling. I reached out and touched his hand.

Hubby looked at me, smiling and then he slowly collapsed onto the
floor. I cried out for him in pain... He smiled, but without opening
that tired eyes of his... I had thought that I would never shed any
tear for him, but the truth is, I have never felt a deeper pain
cutting through my body at that moment.

Doctor said that by the time hubby discovered he had liver cancer, it
was already in terminal stage and it was a miracle that he managed to
last this long. I asked the doctor when he first discovered he had
cancer. Doctor said about 5 months ago and consoled me saying:
"Prepare for his funeral."

I disregarded the nurse's objection and rushed home, I went into his
room and checked his computer, and a suffocating pain hits me.

Hubby's cancer was discovered 5 months ago, his groaning was real, and
I had thought that... the computer showed over 200 thousand words he
wrote for our son: "Son, just for you, I have persisted, to be able to
take a look at you before I fall, is my biggest wish now... I know
that in your life, you will have many happiness and maybe some
setbacks, if only I can accompany you throughout that journey, how
nice would it be. But daddy now no longer has that chance. Daddy has
written inside here all the possible difficulties and problems you may
encounter during your lifetime, when you meet with these problems, you
can refer to daddy's suggestion....

Son, after writing these 200 thousand words, I feel as if I have
accompanied you through life journey. To be honest, daddy is very
happy. Do love your mother, she has suffered, she is the one who loves
you most and also the one who loves me most..."

From play school to primary school, to secondary, university, to work
and even in dealing with questions of love, everything big and small
was written there..

Hubby has also written a letter for me:

"My dear, to marry you is my biggest happiness, forgive me for the
pain I have caused you, forgive me for not telling you my illness,
because I want to see you be in a joyful mood waiting for the arrival
of our baby...My dear, if you cried, it means that you have forgiven
me and I would smile, thank you for loving me...These presents, I'm
afraid I cannot give them to our son personally, could you help me to
give some of them to him every year, the dates on what to give when
are all written on the packaging... "

Going back to the hospital, hubby is still in coma. I brought our son
over and place him beside him. I said: "Open your eyes and smile, I
want our son to remember being in the warmth of your arms..." He
struggled to open his eyes and managed a weak smile. Our son still in
his arms was happily waving his tiny hands in the air. I press the
button on the camera and the sound of the shutter rang through the air
as tears slowly rolled down my face....

A fatal misunderstanding and the person who loves me the most in this
world is gone forever..."Cruel misunderstandings one after another
disrupted the blissful footsteps to our family. Our originals intend
of having Mother enjoy some quiet and peaceful moments in her
remaining years with us went terribly wrong as destiny's secret is
finally revealed at a price, every thing became too late.".........

This is a true story...
LEARNING POINT - DO NOT EVER HOLD ON TO OFFENCES!!!

I am totally speechless, this story brought tears to my eyes as I read
through each line eager to know what would happen next. It truly
showed the devastating power of grudges and anger!

Simple humility and communication would have resolved most of the
problems in that story, as well as patience....
This story has really touched my heart and life as a whole and it has
stimulated a paradigm shift.. Though it is very sad, it is also very
refreshing to know that from today, I can consciously start to live a
life free of grudge. People please let's live a life devoid of
grudges.

Communication with your loved ones is THE key.

Let's have a generous spirit!

2009-08-05T22:13:00.002+08:00

I was waiting for the lift at SMU and was struck by this message that they plaster on their lifts.

It left a deep impression on me, not so much about knowledge per se, but the fact that acquiring knowledge for the purpose of giving it away requires a generous spirit.

My last encounter will the notion of "generosity in spirit" was when I heard Prof Leonard Berry share about the Mayo Clinic when he visited Singapore recently. He said, one of the key reasons why Mayo Clinic has been so successful with their primary value of putting the needs of the first, is that of the "spirit of the Clinic" which he described as generous. In particular, he said that "generosity" is an input to service organisations success, not just an outcome, but because it wins the hearts of stakeholders - including those who perform the service for customers - and strengthens their commitment.

"Where selfishness saps the human energy from service, generosity has the opposite, positive effect." How true it is!

I am beginning to see that as I now lead a new organisation, generosity too has a significant impact. We want to be a hospital that is not just generous to our patients but in the same breath be generous to our employees as well. In so doing, we can expect our staff to be generous in their service to our patients and go the extra mile if necessary.

We are off to a great start! Let's err on the side of generosity and be gracious.

We go faster when there is no Monkey...

2009-08-01T21:56:00.003+08:00

This is an accidental learning. I was at a corporate sports carnival walking the narrow trail with a big group of people at the Macritchie reservior when suddenly the pace slowed significantly. Looking ahead, I realised that the group was attracted to some monkeys who had appeared. They stopped to take a good look at the monkeys and to snap a picture or two.

After a while the monkeys dispersed into the trees and the pace of the walk picked up again.

I turned to the person whom I was walking with and remarked innocently, "We go faster without the monkeys."

Then I thought to myself, how true also in real life and in corporate life isn't it!!

Quite a lesson...

An Inspiring Story...

2009-07-29T22:21:00.002+08:00

I received this via email this evening.

The story illustrates to me the power of a strong value system and spirit of generosity.

============================
Tan Sri Robert Kuok Hock Nien (born 6 October 1923, in Johor Bahru, Johor), is an influential Malaysian Chinese businessman. According to Forbes his net worth is estimated to be around $10 billion on May 2008, making him the richest person in Southeast Asia.

He is media shy and discreet; most of his businesses are privately held by him or his family. Apart from a multitude of enterprises in Malaysia, his companies have investments in many countries throughout Asia. His business interests range from sugarcane
plantations (Perlis Plantations Bhd), sugar refinery, flour milling, animal feed, palm oil and mining to finance, hotels, properties, trading and freight and publishing.

On the occasion of Kuok Group's 60th Anniversary 10 April 2009, Robert Kuok Hock Nien's notes on those sixty years provide an interesting insight in to how success comes about.

1) My brothers and I owe our upbringing completely to Mother. She
was steeped in Ru-Jiao, the teachings of Confucius, Mencius, Laozi and
other Chinese sages. Ru-Jiao teaches the correct behaviour for a human
being on his life on earth. Mother gently, and sometimes strongly, drummed
into the minds of her three boys the values of honesty, of never cheating,
lying, stealing or envying other people their material wealth or physical
attributes.
2) Father died on 25 December 1948 night without leaving a will.
Following the Japanese surrender, he had re-registered the firm as a sole
proprietorship. We went to court to get an appointment as managers,
permitting us to continue to manage Tong Seng & Co. The judge said that,
as there were two widows, the firm and the estate should be wound up.

(3) We decided to establish Kuok Brothers Limited. In mid-January 1949, five of us met at a small roundtable in our home in Johore Bahru. Present were my MOTHER, cousin number five HOCK CHIN, cousin number twelve HOCK SENG, my brother HOCK KHEE nicknamed Philip (a.k.a. cousin number seventeen), and myself (a.k.a. cousin number twenty). We sat down and Mother said, "Nien, would you like to start?" I said, "Fine, yes I will start." To cut the long story short, we got started, and commenced business from a little shop house in Johore Bharu on 1 April 1949.

(4) As a young man, I thought there was no substitute for hard work
and thinking up good, honest business plans and, without respite, pushing
them along. There will always be business on earth. Be humble; be
straight; don't be crooked; don't take advantage of people. To be a successful
businessman, I think you really need to brush all your senses every
morning, just as you brush your teeth. I coined the phrase "honing your
senses" in business: your vision, hearing, sense of smell, touch and
taste. All these senses come in very useful.

(5) Mother was the captain of our ship. She saw and sensed everything, but being a wise person she didn't interfere. Yet she was the background influence, the glue that bound the Group together. She taught
my cousins and my brothers and me never to be greedy, and that in making money one could practise high morality. She stressed that whenever the firm does well it should make donations to the charities operating in our societies. She always kept us focused on the big picture in business. For example: avoid businesses that bring harm, destruction or grief to people. This includes trades like gambling, drugs, arms sales, loan-sharking and prostitution.

(6) We started as little fish swimming in a bathtub. From there we
went to a lake and now we are in the open seas. Today our businesses cover
many industries and our operations are worldwide but this would not have
been possible without the vision of the founding members, the dedicated
contributions and loyalty of our colleagues and employees, and very
importantly the strong moral principles espoused by my mother.

(7) When I hire staff I look for honest, hardworking, intelligent people. When I look candidates in the eye, they must appear very honest to me. I do not look for MBAs or exceptional students. You may hire a
brilliant man, summa cum laude, first-class honours, but if his mind is not a fair one or if he has a warped attitude in life, does brilliance really matter?

(8) Among the first employees were Lau Teo Chin (Ee Wor), Kwok Chin
Luang (Ee Luang), Othman Samad (Kadir) and an Indian accountant called
Joachim who was a devout Roman Catholic and who travelled in every day
from Singapore where he lived.

(9) I would like on this special occasion to pay tribute to them and in particular to those who were with us in the early days; many of whom are no longer here. I have already mentioned Lau Teo Chin (Ee Wor) and Kwok
Chin Luang (Ee Luang) and Othman Samad (Kadir), there are others like Lean Chye Huat, who is not here today due to failing eyesight, and Yusuf Sharif who passed away in his home country India about one and a half years ago and the late Lee Siew Wah, and others who all gave solid and unstinting support and devotion to the Company. It saddens me that in those early difficult years these pioneers did not enjoy significant and substantial rewards but such is the order of things and a most unfortunate aspect of capitalism. However through our Group and employee Foundations, today we are able to help their descendants whenever there is a need to.

(10) I have learnt that the success of a company must depend on the
unity of all its employees. We are all in the same boat rowing against the
current and tide and every able person must pull the oars to move the boat
forward. Also, we must relentlessly endeavour to maintain and practise the
values of integrity and honesty, and eschew and reject greed and
arrogance.

(11) A few words of caution to all businessmen and women. I recall the Chinese saying: shibai nai chenggong zhi mu (failure is the mother of success). But in the last thirty years of my business life, I have come to
the conclusion that the reverse phrase is even truer of today's world: chenggong nai shibai zhi mu. Success often breeds failure, because it makes you arrogant, complacent and, therefore, lower your guard.

(12) The way forward for this world is through capitalism. Even China
has come to realise it. But it's equally true that capitalism, if allowed
to snowball along unchecked, can in many ways become destructive.
Capitalism needs to be inspected under a magnifying glass once a day, a
super-magnifying glass once a week, and put through the cleaning machine
once a month.

In capitalism, man needs elements of ambition and greed to
drive him. But where does ambition end and greed take over? That's why I
say that capitalism, if left to its own devices, will snowball along, roll
down the hill and cause a lot of damage. So a sound capitalist system
requires very strongly led, enlightened, wise governments. That means
politician-statesmen willing to sacrifice their lives for the sake of
their people. I don't mean politicians who are there for fame, glory and to line
their pockets.

(13) To my mind the two great challenges facing China are the restoration of education in morals and the establishment of a rule of law. You must begin from the root up, imbuing and infusing moral lessons and
morality into youth, both at home and from kindergarten and primary school upward through university. Every Chinese needs to accept the principle of rule of law; then you have to train upright judges and lawyers to uphold the legal system.

(14) Wealth should be used for two main purposes. One: for the
generation of greater wealth; in other words, you continue to invest,
creating prosperity and jobs in the country. Two: part of your wealth
should be applied to the betterment of mankind, either by acts of pure
philanthropy or by investment in research and development along the
frontiers of science, space, health care and so forth.

Is this true?

2009-07-28T20:39:00.002+08:00

What kind of a person are you?

Inspiring Lessons from Mayo Clinic by Prof Leonard Berry

2009-07-27T22:50:00.005+08:00

Since the day that I have been introduced to the Mayo Clinic, I have been a fan of Mayo Clinic.

The Mecca of Healthcare, as the hospital is popularly known, holds a simple value since its founding by Dr Mayo over 140 years ago - that the "Needs of the Patient come first". This simple value of putting the patient first and team-based medicine has put Mayo Clinic at the forefront of Medicine. Many patients come to the Mayo Clinic looking for miracle because they have been to many other healthcare facilities and found no firm diagnosis for their conditions and little hope of recovery. Many at Mayo Clinic did in fact receive their "miracles" and their positive "word of mouth" has helped to build trust at mayo Clinic.

There are many Mayo Clinic lessons for us at JGH. Prof Leonard Berry's book on "Management Lessons at mayo Clinic" is such an inspirational and delightful read. Today, many of us have the pleasure of listening to Prof Berry's lecture at Alexandra Hospital. The pictures below show his summary on the lessons from mayo Clinic.

Thanks Prof Berry for bringing to us the inside story of the Mayo Clinic!

JGH - URA Centre Model Perspectives

2009-07-27T22:29:00.004+08:00

The Transformation at Jurong Lakeside that JGH will be a part of

JGH is one of the key projects at the Lakeside transformation

Located next to IMM and close to the MRT

Another perspective of the exciting lakeside development at Jurong

For staff of JGH who have yet to make a trip to Jurong East to catch a site of where our future hospital will be located, here are some pictures taken of the masterplan model at URA Centre.

As you can see, JGH will be developed amidst very interesting developments at Jurong. One of our challenges will be to figure out how we can create a restful environment within a rather urban setting. Participants at our main consultant design competition have already given various ideas how it may be done. We will incorporate greenery into patient care areas to reduce stress of experiencing healthcare and create a sense of bringing the outside indoors.

Take a trip to the site and see for yourself!!

Click here if you can see the pictures: http://icansmell.blogspot.com/2009/07/jgh-ura-centre-model-perspectives.html

Jurong General Hospital July 09 Issue of Staff Newsletter

2009-07-27T10:15:00.002+08:00

JGH has planned various ways of communicating with our staff who are nested in various hospitals currently. One of which is a newsletter - here is the first issue (July 2009). Staff can also facebook me at www.facebook.com/heejug and here about recent happenings at JGH via my postings and status updates.

In the first tea sessions that I've had with JGH staff nested at TTSH and NUH, I have come to realise that I have such a great group of staff who is excited about the hospital and making a difference to patients.

We have now started on crafting the Mission, Vision and Core Values of Jurong General Hospital. Staff can look forward to being engaged in thsi process as well.

Cheers

Public perception could hinder healthcare reforms?

2009-07-26T23:31:00.005+08:00

The New York Times carried an article "Forget who pays the bill, but who sets the costs".

What's interesting to me is the following excerpt from the article:

"Thus the political challenge facing any effort at an overhaul: Americans say they want change, but they also want to preserve their own status quo.

The disconnect can be explained partly by the peculiar economics of health care. Because third parties — the government or a private insurer — typically pay the bill, many people miss the fact that the money originally comes from them. They see the benefits of medical care without seeing the costs.

But trust in doctors is a factor as well. Even when doctors order costly treatments with serious side effects and little evidence of their being effective, as studies find is common, patients are loath to question the decision. Instead of blaming such treatments for the rising cost of medicine, many people are inclined to blame forces that health economists say are far less important, like greedy insurance companies or onerous malpractice laws."

Obama Health Reforms Pushing the frontier to have doctors salaried instead of fee-for-service...

2009-07-25T23:50:00.002+08:00

Some of the most prestigous names in US Healthcare eg. Mayo Clinic, Cleveland clinic have gone the way of putting their doctors on salary instead of fee-for-service. The objective is to take out any incentive for doctors to order unnecessary tests and services for patients.

In the latest drive under the President Obama Health reform, this issue is again surfaced as an appropriate approach for the rest of US healthcare to follow in their quest to control costs.

What do doctors in Singapore think?

Mission, Vision and Values of JGH

2009-07-24T21:22:00.003+08:00

Tomorrow is yet another milestone for JGH. We will kick-off the series of conversations of what we stand for, where do we want to be, how do we get there, and values each and every staff member at the new Jurong General Hospital need to embrace.

The JGH team is determined not to allow this exercise to become mere words on the walls of hospital but living words that we will all embrace and live out on a daily basis. Our Patients, Our Community and Our Staff must become better because of the work that we do.

When I was interviewed by 938LIVE on 20 May 2009 and asked what is my vision for JGH. I said, "I'm actually looking forward to JGH being an integral part of the community in the western region, where residents can rely on for their health and fitness needs. We will work closely with the new community hospital and also the primary care clinics in our area so that patients can expect holistic care beyond the hospital into the community." I added that "... in designing the hospital's services and processes, patients' needs will be our main focus and we hope to make it hassle free for them."

However, it is not only just the patients and the community that must benefit. We must also be a hospital where staff will flourish. That's why, in the first JGH advertisement in the Straits Times on 4 July 2009, both Chairman Medical Board A/ Prof Cheah Wei Keat and I said that, "we envision an environment that fosters excellent patient care, where staff are Empowered to Excel and Encouraged to learn and grow."

Jurong General Hospital is where the birth of a new era in healthcare will take place. We want to make it a meaningful endeavour for ALL our staff, while at the same time make a difference to our patients and the community.

To ALL the Staff of Jurong General Hospital, thank you for taking part in this journey with me. I look forward to your ongoing commitment, dedication as we plan, design and build not just an excellent hospital but a healthcare institution for generations to come!

I also thank my colleagues in healthcare for backing me up in this journey.

Prof Ng Han Seong wins the National Medical Excellence 2009 Outstanding Clinician Mentor Award! Congratulations!!

2009-07-22T22:49:00.005+08:00

Prof Low Poh Sim, NUH Paediatrics

Prof Mike Chee, Duke-NUS

Prof John Wong, Dean NUS-YLL Medical School

Prof Ng Han Seong

Prof Ng Han Seong, Chairman Medical Board of Singapore General Hospital (SGH) was awarded the National Medical Excellence Outstanding Clinician Mentor Award 2009 this evening at CHIJME's Hall. He is a very well respected doctor who is always keen to impart his knowledge/ wisdom to the younger generation. An excellent storyteller, a fountain of inspiration and an excellent leader! Above all, a great clinician! Congrats Han Seong!!

The occasional great signs...

2009-07-21T22:31:00.002+08:00

Found at the new ION shopping centre...

53% of flu cases in Singapore are H1N1 positive

2009-07-20T22:49:00.002+08:00

Community spread is certainly in full swing in Singapore. The odds of someone with flu symptoms carrying the H1N1 is as likely as a coin toss!

Fortunately, H1N1 is not as dangerous as it was originally feared. But, Singapore has already seen it first death late last week. It is reported that 2 more cases are hospitalised in the intensive care unit because they sought treatment late.

For most of us, life should go on as usual. The high risk groups, namely pregnant ladies, young children and those with multiple chronic co-mobidities should take necessary precautions.

Let's take personal responsibilities in hygiene, stay fit and healthy to ensure that we and our loved ones are safe. When down with symptoms, put on a mask and head to the doctor early.

New Generation Old Generation Grandparents

2009-07-19T22:56:00.004+08:00

This evening, we celebrated my son's 3rd birthday at Jumbo Seafood.

My mom, in particular, has been looking forward to this celebration. Not only is it her grandson's birthday but also my eldest's brother's birthday. Even though my parents try to be fair to both boys and girls in our family (and they are), you can tell the boys still feature strongly in their mind.

We had a fabulous time! For me I am just happy that my parents are happy; and everybody seem to enjoy themselves. My son in particular was very happy with his purple barney cake!

My parents in their late 60s have simple pleasures. Their way of expressing love is for family members to have a good meal and all of us could eat heartily. They are happy when they see their children each having a good family and hold a good job. Till today, my mother still wait for me to come back to have dinner, made sure that the food is hot and sit around looking at me when I eat and smiles when I enjoy the food. That's why I feel guilty sometimes when I need to attend official function and forget to tell her that I won't have dinner at home. Many times, I will not eat my fill and still come home for dinner because I cannot bear to disappoint her.

Tonight, when my father whipped out his mobile to snap a picture of my son during the birthday celebration surprised me. They are trying to keep current with the new generation, and I appreciate their effort.

For me, I am just glad that I can still play a part in my parents' lives. I am most fortunate to have a wife who is so understanding and supportive in this regard. My parents can stay as they are, they don't have to catch up with the new generation, I love them as they are.

Take care of our children...

2009-07-18T20:23:00.004+08:00

I have a clear weakness. I can't stand the sight nor knowledge of any abuse/ hurt to children.

A moment ago, I found out about the new Boston Children Hospital blogsite (THRIVE) and read an article "The Shaken Children Syndrome". It is a real story of a father who was left to look after an infant while the wife was out, shook the kid so hard to stop her from crying that left with the syndrome - throwing up milk, shaking from one side of her body, seizure, etc. I don't think the father intended for the outcome (or at least I hope he didn't) but the impact to the child...sigh...I cringe to even to think about it.

Over the years, I have come across other situations that occasionally still give me the flashback.

I remember once I was at Hougang Mall foodcourt. A man returned with a bowl of noodles with clear soup. As he prepared to land the food on the table, the bowl slipped off the tray and the bowl of noodle with soup was splattered on his 2 year old boy who was seated there. Fortunately, there was a GP clinic nearby on the same floor... the boy was rushed there...I hope he is fine.

Another occasion was at the East Coast. A couple was jogging with a baby in the pram. As they were jogging the baby was sliding out... this time, I was glad they realised it soon enough. The baby only landed up with some abrasion on his knee, but the outcome could have been way way worst!!

You can imagine, I have been extremely careful since when I am at the foodcourt with my kids. And, I will never ever bring my kids in a pram while jogging! You can imagine, I do not enjoy going to hougang mall foodcourt.

Accidents do happen, but when it out of our own negligence, it will be regretable. So, lets take care of our children...

Taking things in stride...

2009-07-17T23:21:00.002+08:00

It is the weekend again. Another week has just concluded. The days flew by... fortunately, this has been a great week. Not everything turned out the way I wanted it to be, but I take it in my stride because i know that there are more things that turned out well.

The first JGH Staff newsletter came out early this week. All JGH staff currently nested in various institutions received a personal copy by post. I proudly presented copies too to several other people who matter.

Our very own email domain jgh.com.sg was rolled out this week and naturally I got my new permanent email hee_jug_foo@jgh.com.sg. With this settled, my namecard went to the printers today and from next week, I will be able to hand out my JGH name cards.

We conducted the JGH consultant tender interviews today. Had a very fruitful session clarifying the proposals and we look set to award to the winning architect soon. The design of the hospital will receive very prominent mention too, so watch out for it.

Completed a ton of reading this week, more than I had expected and feeling great that my desk is clear and my bags are lightened.

Interviewed 3 important hires this week, found out that 1 candidate for a strategic position has accepted my offer. Hiring went well as expected this week!

The study trip overseas to learn about hospital designs and care models is on track and we look set to have a great trip with my management team.

... I see the sun rising about JGH and feeling proud of the founding team that I have assembled for the hospital. What a way to start the weekend!

My next reading...

2009-07-16T22:42:00.001+08:00

"The practice of Slow Medicine has taught me that it is wise to slow down and moderate the urgent pressures of decision-making that are often pushed prematurely on elders by society, the medical profession, worried friends and family. Well-intentioned, we want to make good and humane choices for ourselves and for those we love. We are worried by guilty feelings of neglect if we wait too long to act. We often experience nagging doubts of our adequacy in these new and very changed relationships." My Mother, Your Mother by Dr Dennis Maccullough

Read this book with me...

How much is a life worth?

2009-07-16T22:20:00.002+08:00

People, particularly those of us in healthcare, often talks about the value of a life in so many ways because we come across such situations of dealing with a patient's health (hence their lives) up close and personal daily. Nevermind the fact that not all of us are at the frontline with patients.

We cringe everytime...

The New York Times carry a provocative article "Why we must ration healthcare" today. Central to the article is whether society as a whole can afford to provide unlimited care to save a life that even when sustained is not "worth living"?

At the individual level, this often evoke a strong reaction "who are you to decide what's a life worth? Are you playing god?" ...

At the society level, when paying unlimited amount to sustain a life mean that less will be available for others, in a world of finite resources will present similar dilemma. The question that will likely be evoked is "why is your life more important than mine?"

What then usually happens is that people begin "game" this dilemma by playing a creeping game. "I know I am not god, so I will just do my best for THIS patient. Now if I only do it for this patient, I know it is expensive but society can still afford it and most of all I save a life."...then we hope that we never have to deal with this again. The truth is...someone else would.

The laws of mathematics will then apply. 1+1+1+........+ 1 = a very large number. The next thing we know, healthcare expenditure as a percentage of GDP would have crept up from 3% to 5% to 7% to 10% to 14% to 16% and this expenditure is slowly but surely crowding out money necessary for education, transportation, defence...gee we heard about this before!

Someone from the crowd will shout, "why do we spend so much on healthcare"?

So, how much is a life worth?

Too Aggressive Medicine?

2009-07-15T23:04:00.003+08:00

The diagnosis of cancer is frightening. The most obvious reaction is to opt for the most high-tech, most advanced and more often the most aggressive treatment.

But, is this approach doing more harm than good? I chance upon the table above on 5 treatment options for prostate cancer with significantly different cost implications, side-effects without significant differential outcome.

Most people do not die from prostate cancer. Reports seems to point to the fact that most people can carry prostate cancer for rather long period of time and when they do die, the reason is seldom prostate cancer but other causes. Given such prognosis, evidence seems to suggest that "Watchful Waiting" that cost $2400 produces similar outcome to highly aggressive Proton Beam therapy costing $50,000. Think about it.

I also chance upon a "Status Update" from a fellow Facebooker this week. She updated "could I have brain tumour? How could I have headache for so long?" For most headache, we could sleep it out - cost is $0. Alternatively, we could take 2 paracetamol and the cost is $0.20. For more aggressive diagnosis, we could get a CT scan and pay $700. On average would outcome be significantly better? Guess not.

We need better evidence to support the treatment that modern healthcare prescribes...

In the World of "Fast Medicine", is there room for "Gentle Deaths"?

2009-07-13T23:27:00.003+08:00

This is an informative video from the New York Times.

Is this just a western concept, or is this relevant for the Singapore society as well?

Lowering our "Frenetic Energy"

2009-07-13T21:55:00.002+08:00

This evening, I had an unusual appointment with someone who made time for me.

There were a few firsts throughout the evening...

First, we started with wine - 2 bottles of wine to be precise. As I took each sip, I was delivered practical lessons on wine appreciation and found out what "structure" and "finish" actually feel in my mouth.

As we appreciated the "finish" of fine wine, I was delivered the message of "Lowering our Frenetic Energy" - it takes time to slowly appreciate what a good wine can bring and hurrying through it makes us miss the goodness. How true it is isn't is - especially in the fast pace life of Singapore. We are hurried on many things, our project, assignment, tasks and perhaps even our dreams! When we done with one thing, we do not spend the time to reflect, appreciate and learn, and move on to another thing quickly. We sometimes need to slow down to go faster - remember the last time that happened? I do, and it felt good.

Second (another First), consider what are the things that you really MUST learn and develop a consciousness and habit to concertedly do so. These "must learns" preferably should not be industry specific and portable and they include developing a wide network. When done, we can look forward to achieving independence in the future.

Third (yet another First), if we want (and mean) real breakthroughs, we need to really get out of our comfort zone...Many times we can be carried by the "waves" of life to a point in life where we are satisfice, but never realise our true potential.

Inspite of the influence of alcohol (or because of the influence of alcohol), these messages were delivered with sparkling clarity and the message struck a chord with the inner me.

The challenge is: 10 years from now, look back and see if I have indeed learnt anything or have I allow the waves to carry me through...

The Searchable me on google...

2009-07-11T00:43:00.002+08:00

I googled myself tonight, and found many things about me :-)

I decided to tag myself for posterity...

NUS Outstanding Science Alumni Award 2007

Same Award but another article

CGH Caring Article - Leaving CGH for SGH

CGH Article - Launch of SQ

Response on Cut Waste

Jurong General Hospital to be completed by 2014

A complaint about my reply in the papers

Straits Times - Hiring for Jurong General Hospital

Helming GPO

Medical technology Standards Committee

Quote on Diversity/ SMU

938Live - Leadership at up and coming Jurong general Hospital unveiled

to be con't...

I Got my NEW iPhone 3G S!... But Why?

2009-07-10T23:34:00.002+08:00

Finally, the latest iPhone 3G S is launched tonight at the Comcentre!

I got my Black 32G wonder amidst the queue that snaked in an endless fashion in front of comcentre. I figured that there must be more than a few thousand people in line, all waiting for the coveted new iPhone. The most surprising sight that caught my wife's attention was that of a mother with infant in arm queuing patiently. Singtel organised the event very well. Tired customers were given bottled water with launch event and music entertainment screened at various locations to help manage the psychology of waiting.

It is not hard to see the enthusiasm. Some people were sighted with their laptop and mobile broadband setting up their brand new iPhone by any corner they could fine. The excitement is too hard to contain even during the journey home! It must be set up immediately.

By now, my phone is fully set up! My 2000 songs on iTunes, 700 contacts, calendar are fully sync'ed on my iPhone and set up to be updated via the Apple Mobileme cloud on the fly. I downloaded the Straitstimes and facebook apps and found them to be amazing features. Most of all, the iPhone works so well with my Mac! I am right, getting the latest iPhone 3GS completes my transition from windows to Mac.

As my iPhone (not phone) is being charged, I am thinking about why is the iPhone so popular? To say the least, I have never seen any queue for any other phone before, certainly not the various Nokias that have come online over the years. Why am I personally excited about my latest acquisition?

I propose 3 reasons:

(1) iPhone is a indeed a beautiful phone with an almost perfect form factor

(2) iPhone is riding on the strong network effects from high ownership of iPods. Many people already have their songs ready to take advantage of the phone's feature. Plus, iTunes that is set up for our iPods is immediately ready for the iPhone.

(3) the wide variety of iPhone apps available eg. Straits Times apps, help to make ownership of the iPhone even more useful. One gets breaking news on the fly, update facebook status, view stock prices, etc etc on a very user friendly interface.

PLUS, Apple has made the iPhone 3GS even better! The voice command (it actually works), seamless synchronisation, video, sms forwarding, landscape keyboard, much more sensitive keypad etc makes this iPhone better than the 2 previous incarnations.

I am still not sure why I need the new iPhone 3GS, but owning it certainly feels good and cool!

Transparency promotes quality?

2009-07-09T23:21:00.002+08:00

For a while now, I have been fan of Paul Levy, the President and CEO of Beth Israel Deaconess Medical Center in Boston. I studied his turnaround of BIDMC when I was doing the Advanced Management Programme in Harvard 2007, but it is how he has advocated transparency in management and quality through his blog www.runningahospital.blogspot.com that I am really a fan of.

It is not uncommon that he publishes communication with his staff on various issues. Here is one from his Director Critical Care Quality...

The good thing is, he does not publishes only the good stuff but also when things go wrong. I believe this creates direct pressure on his hospital to make the necessary improvements while they celebrate when they achieve success. It is a double edge sword that Paul Levy has used to good effects.

So far, my sense for BIDMC is that transparency does seems to promote quality... you think?

The Healthcare conundrum to avoid...

2009-07-08T23:06:00.002+08:00

When I was last at Houston Texas, I could not help but be amazed by the medical enterprise at an entire district known as Texas Medical Centre. Brand name hospitals and specialist centres are there and the hotel where I stayed was practically filled with patients. Hotels run shuttle bus services to and from hospitals for patients and their next-of-kin.

It is in this setting that this new BBC article reports the Healthcare conundrum, ie more spending per patient in Texas is not translated into better patient outcome, and that the "business" of healthcare is inducing unnecessary demand for services that patients do not need.

Prof Christensen is right. Doing more of what we currently have in healthcare cannot help. We need to disrupt the way healthcare is being provided through coherent solution shops, value-added Process (VAP) clinics for illnesses that are already well understood and where precision/ empirical medicine may be practiced; and facilitated networks (disease management plans) where providers are rewarded to keep patients well, and patients are incentivised to comply with their therapy.

What do lawyers really do?

2009-07-07T21:00:00.003+08:00

...well at least I call this into question for the lawyer that my wife just met!

Late last week, the lawyer's office called my wife. The assistant conveyed to my wife the lawyer's question, "do you want to settle for a 50-50" in the traffic accident claim. To which my wife replied, "No". "Then you will need to come down to the lawyer's office, because our lawyer needs to speak with you", came the reply.

This call came some 7 months after the traffic accident that my wife had the misfortune to encounter with a huge truck/ lorry while on her way to fetch my daughter along Bukit Timah. Silence for 7 full months, then a call to ask the client to "settle". What a way to earn their fees, probably wrote one letter to the other party, waited for the response, and ask the client to settle? I thought, surely they must have done more, and wife will do well to find out more by meeting the lawyer.

My wife turned up at the lawyer's office today.

The lawyer looked at my wife and the first sentence that he uttered was "I think you better settle for 50-50"!

When asked why, he said that based on the reply from the other driver, he said that because there are no witnesses, it will be very difficult to prove my wife's version of how the accident happened. Then he said, "only God knows whether you are telling the truth!" To which, the only correct reply should have been "only God knows why you are a lawyer!"

He went on to try to "scare" my wife into accepting the 50-50 settlement. He said that if she were to reject the 50-50 settlement, the case will have to go to mitigation/ court and whatever the outcome my wife would have to be responsible for his fees of $2500! The keyword emphasised was "whatever the outcome". Of course, he went on to say that "for heaven sake, this is just a road traffic accident claim, I have 1600 other cases, and you want to pursue this case?!"

I am glad my wife gave the only correct answer, "what's the point you are trying to make?"

All these prompted my question, "what do lawyers really do?"

(1) Nothing that he said or shown my wife at his office has shown that he has gone beyond the information and forms that we have completed as part of insurance claim.

(2) Based on his words and behavior, he has already given up "fighting" for the case - although I am not even convinced that he even attempted to try.

(3) Nothing that he will say during mitigation/ court hearing will be any attempt to argue the case for his client. In fact, he discredited his client by asserting without evidence that my wife had lied about the facts of the accident by his statement "only God will know whether you are telling the truth."

(4) Why should he as the lawyer be paid regardless of his effort and outcome?

My conclusion is that he has done nothing for his client (my wife) and come to think about it, we did not even appoint him as our lawyer, maybe he was signed up by the insurance company.

So, it begs the question: what does he as a lawyer really do (looks like nothing)? With his behavior and performance ANY client with a sound mind and half a kidney could do a better job.

What IS the role of a lawyer in such situations?

The Silver Tsunami - doctors in America need to learn how to treat the elderly

2009-07-06T22:12:00.001+08:00

I was forwarded an email containing the following article that I find so interesting as we prepare for the Silver Tsunami in Singapore...

July 2, 2009
Op-Ed Contributor

The Patients Doctors Don’t Know
By ROSANNE M. LEIPZIG

AS they do every July, hospitals across America are welcoming new interns,
fresh from medical school graduation. Given how much these trainees have
yet to learn, common wisdom holds that it’s not a good time of year to get
sick. This may be particularly true for older patients, because American
medical schools require no training in geriatric medicine.

Often even experienced doctors are unaware that 80-year-olds are not the
same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and
difficulty breathing; an 80-year-old with the same illness may have none of
these symptoms, but just seem “not herself” confused and unsteady, unable
to get out of bed.

She may end up in a hospital, where a doctor prescribes a dose of
antibiotic that would be right for a woman in her 50s, but is twice as much
as an 80-year-old patient should get, and so she develops kidney failure,
and grows weaker and more confused. In her confusion, she pulls the tube
from her arm and the catheter from her bladder.

Instead of re-evaluating whether the tubes are needed, her doctor then asks
the nurses to tie her arms to the bed so she won’t hurt herself. This only
increases her agitation and keeps her bed-bound, causing her to lose muscle
and bone mass. Eventually, she recovers from the pneumonia and her mind is
clearer, so she’s considered ready for discharge but she is no longer the
woman she was before her illness. She’s more frail, and needs help with
walking, bathing and daily chores.

This shouldn’t happen. All medical students are required to have clinical
experiences in pediatrics and obstetrics, even though after they graduate
most will never treat a child or deliver a baby. Yet there is no
requirement for any clinical training in geriatrics, even though patients
65 and older account for 32 percent of the average doctor’s workload in
surgical care and 43 percent in medical specialty care, and they make up 48
percent of all inpatient hospital days. Medicare, the national health
insurance for people 65 and older, contributes more than $8 billion a year
to support residency training, yet it does not require that part of that
training focus on the unique health care needs of older adults.

Medicare beneficiaries receive care from doctors who may not have been
taught that heart attacks in octogenarians usually present without chest
pain, or that confusion can be due to bladder infections, heart attacks or
Benadryl. They do not routinely check for memory problems, or know which
community resources can help these patients manage their conditions.
They’re uncomfortable discussing goals of care, and recommend screening
tests and treatments to patients who are not going to live long enough to
reap the benefits.

I was part of a group of doctors and medical educators who recently
published in the journal Academic Medicine a set of minimum abilities that
every medical student should demonstrate before graduating and caring for
elderly patients. Nicknamed the “don’t kill Granny” list, it includes being
able to prescribe medicines, assess patients’ ability to care for
themselves, recognize atypical presentations of common diseases, prevent
falls, recognize the hazards of hospitalization and decide on treatments
based on elderly patients’ prognosis and their personal preferences.

The 2008 Institute of Medicine report “Retooling for an Aging America”
resolved that all licensed health care professionals should be required to
demonstrate such competence in the care of older adults. But this
resolution lacks teeth. Medical resident training programs that receive
Medicare money should be required to demonstrate that their trainees are
competent in geriatric care. Medicare should finance medical training in
nursing homes. And state licensing and medical specialty boards should
require demonstration of geriatric competence for licensing and
certification.

Basic geriatric knowledge is preventive medicine. Nurses, social workers,
pharmacists and other health care professionals should have it, too, in
order to improve care for older people. But until doctors get this basic
training, we can’t even begin to give 80-year-olds the care they need.

Rosanne M. Leipzig, a physician, is a professor at Mount Sinai School of
Medicine.

Effective CEOs spend more time on less things

2009-07-06T21:19:00.002+08:00

An article in the New York Times caught my eye today. Entitled "How to be an Effective CEO", it is a good reminder of timeless advice that need to be brought from "the back of the mind to the front of the mind."

Basically, a CEO needs to spend more time on less things. The most consistent "thing" among the few things is PEOPLE. Hire the right people to do the things that CEO should not spend his time on, spend time with good people, and counsel people who need improvement.

The article talks about 2 timeless classics, Peter Drucker and Steven Covey's 7 Habits of Highly Effective People.

Peter Drucker's advice to CEO:

(1) Find time for uninterupted work.

(2) Spend time on people

(3) Focus on allocating resources

(4) Focus on strengths rather than managing weaknesses.

Steven Covey's 7 Habits:

(1) Be proactive

(2) Begin with the end in mind

(3) Put First thing first

(4) Think win/ win

(5) Seek first to understand, then be understood

(6) Synergise

(7) Sharpen the saw

These are not new concepts, but important reminders for leaders leading others through change and challenging times.

Another important point that my chairman recently reminded us, "Work in Quadrant 2" - Work that are important but not urgent. He is really talking about spending time "Planning" and not fighting fire all the time. In fact, if we plan well, we will fight less fire! How true. The book "The Living Company" is really a great book about planning for the future...

Let's not get carried away, while we plan for tomorrow...Let's LIVE today!

Preparing for the new iPhone 3G S

2009-07-05T22:27:00.002+08:00

SingTel will have a launch event on 10 July 2009 (Friday) for the new iPhone 3G S in Singapore.

Enthusiasts who signed up with SingTel got an email on Friday - me included!

I am not sure whether I count as an iPhone enthusiast? "Yes"...because I owned the last 2 versions of the iPhone but ... "Maybe" - because I sold them within 2 weeks! Main reasons, smallish screen keypad, inability to forward sms and slow.

My recent ownership of a brand new 24" iMac piqued my interest in many things Apple. The launch of the new iPhone 3G S cannot be more timely. You can say, it sort of "completes" my conversion from Windows to Mac.

The new iPhone 3G S took care of all my pet peeves. It is not only faster, it provides a larger screen keypad in landscape position, sms forwarding function and like all things Apple, other sexy functions and programmes such as video and a better camera.

Since Singtel's announcement of the 10 July launch, I have been making preparations for my impending ownership. I sold my Nokia E71 today and then just an hour ago, I used a programme PocketMac to transfer all my contacts from my Blackberry phone to mac Address Book. I must say that for someone who owns a Mac and Blackberry, the free PocketMac software is very neat and handy. Just remember to run the driver update as well for the new Bold, Storm and Curve handset before launching the programme. The synchronisation was flawless and effortless!

I know, yes, I am aware of the many reports talking about the overheating problem for the new iPhone 3G S. I understand that this only becomes a problem when multiple programmes are run at the same time, and for long conversations. Unless one is trying to stress-test the phone, I do not think that a normal user like me will face such problems. Afterall, my new Nokia E71 also becomes quite hot when I am on the phone for a long time! This morning, I was trading sms with a friend who is also waiting for the new iPhone. I texted him that "not bad, buy one phone and get a toaster for free", and his reply was quite humorous and telling..., he replied "Being toasted is better than getting microwaved on windows based phone."

I wonder how the new iPhone 3G S will work out for my kind of lifestyle. In any case, I am prepared to give iPhone a 3rd chance. Hopefully, this time my ownership will be much more enduring. If not, I will sell it within 2 weeks again.

Developing a conscience of being environmentally friendly...

2009-07-04T22:06:00.002+08:00

The Inconvenient Truth by El Gore about global warming...

A recent video entitled "Home" talks about the damage being inflicted on mother earth and that mankind has 10 years to change the way we live and to avert depletion of natural resources and catastrophic damage to earth's climate. My reservist colleague alerted me to this video. He said that he watched the hour long video with his 11 year old daughter and it changed the way she thought about the importance of being environmentally friendly. Tonight, I watched the video on youtube, as I key in my thoughts on my blog.

Personally, I've observed that the weather has become noticeably hotter, especially in recent times. Has the hole in the ozone layer become bigger? Freak weather has also become sort of the norm as we tune in to the news. I am trying to reason away the changes that I am seeing before my very eyes, but I could not. The damage being inflicted on our environment and consequently the impact on our climate has become quite clear.

The last few days, I turned my attention on the vehicle that I drive. Instinctively, my love for old mercedes benz took over. I chanced upon a rare 1984 Mercedes 380 SEC and it gripped my attention. As I thought about the prospect of buying that car, I reflected on the impact it will have on the environment and evoked a self discussion on whether it is indeed a need or want. Why do I need a 3.8 litre car? The consumption of the car will be almost twice that of my current car. Other than the cost of petrol, what will that mean in terms of my carbon footprint? Obviously there was tug-of-war between my heart, which indicate the MB 380 SEC would be such a lovely purchase and would satisfy my emotional being; and my head, which question the purchase from the angle of excess and impact on the environment. My heart, gave in today (just a little bit) and I swung by to Borneo motors to look at the new 1.8 Litre Toyota Prius. The hybrid car can do 23km on one litre of petrol, a saving of at least 60% of my current car. My head was nodding but my heart hurts as I stared at the Prius - it is so ugly, so plain, so lacking in character...but most of all, so inaccessible because there is a 5 months wait for the car!

I am thinking, the new Toyota Prius will be such a statement that I can carry regarding the message of environmentally friendly to others. Maybe, it may trigger a conversation around why do I still buy a car that I know is so plain? ... not to mention to pay a premium for it!

I am positive that my conscience of being environmentally friendly is currently being shaped in a significant manner. Even as this happens, I am determined that I will be a good advocate for the environment but one who will be practical in the world that we live in. By this I mean, I will continue to ask for a plastic bag when I need one for it is not practical for me to tuck a bag in my pocket wherever I go. But where I can do without one, such as my recent visit to Ikea, I will do without one.

So, should go for the MB 380 SEC or the Toyota Prius 1.8 ?

Are we Ugly Singaporeans?

2009-07-03T22:06:00.003+08:00

This morning, I got up really early. My wife who was up early too to get my daughter ready for school told me that the Ikea sale is on, and for "Friends of Ikea", we get to have free breakfast starting from 7.30am.

Thrilled by the idea of "free" breakfast and the prospect of spending time with my wife, we were soon quickly making our way to the Ikea at Tampines. By the time we arrived, the crowd was thin and people were only beginning to arrive. Without having to wait in line, we got our free coffee, an apple and a cinnamon roll each and made our way to the table and started on our breakfast.

Then, I overheard a conversation. Someone said in a rather cynical and almost mocking manner, "look at all these Singaporeans, got free food only they come and bring the whole family... Singaporeans." It started me thinking...

By now, Singaporeans would have heard about this phrase "Ugly Singaporeans" and perhaps used the phrase on our fellow countrymen a number of times. Unbeknown to many of us, probably the same phrase has been used on us, by others. Usually the circumstances where the phrase is used include: people forming/ joining long queues to get a good deal, free drinks/ food attracting many people to get their hands on them, people on MRT not giving their seats to the elderly/ pregnant ladies, etc; people not giving way to other drivers who wishes to switch lanes...While I personally do not condone such behavior and attitudes, I question whether such stereotypical labeling of the Singapore society and people is justified.

Take this morning experience at Ikea for example. Is it only "ugly Singaporeans" who would turn up when there is free food? I do not think so and I also think there is nothing wrong doing so. At least I think Singaporeans appreciate good value when they see one. In fact, I will feel extremely sorry for Singaporeans when they see a good deal, do not know it is a good deal and hence not avail themselves. Does turning up at Ikea for free breakfast make us "ugly Singaporeans?" I think not.

Even when we see the set of bad behavior by some Singaporeans listed above, is it justified to lavishly use the label "ugly Singaporeans" for the whole society? In my many travel overseas and having lived in the US for 3 years, I have seen similar behavior but I have never heard or heard so consistently people say..."Ugly Americans", "Ugly British", "Ugly Chinese" as we do in Singapore.

Labels when used consistently can conjure a false image of society and people. In psychology, we know that when a person for example is consistently labelled as stupid will after some time believe that his mental capacity is limited and adverse affect his development. I believe the same can be said at the societal level. An eagle will soar like a real eagle when she believes she is one, otherwise she will bump around like a chicken and never realise her full potential.

By now, I believe there are already other labels of Singaporeans that are already deeply ingrained... remember "Kia Su" (afraid to lose) ? Are we "Ugly Singaporeans" and "Kia Su"?

I implore all of us to stop using undesirable labels on ourselves. In every society, there will be black sheep (us included) but we must not brand/ label the whole society because of a few black sheep. Address the behavior, make the improvements and move on. Let us not be too hard on ourselves.

We are not "Ugly Singaporean" but like all human beings, we do fail sometimes.

We are the World

2009-07-01T23:07:00.002+08:00

This is such a powerful song. I remember I waited to watch the live broadcast on TV when I was much younger. I am very glad in the age of youtube, I get to watch it again with such clarity.

There is a cause bigger than ourselves, our own success...

Keep this in mind as we get caught up in this rat race going nowhere. Pause...know how fortunate we are, and help make a difference in the world that we live in.

WE ARE THE WORLD...

There comes a time
When we head a certain call
When the world must come together as one
There are people dying
And it's time to lend a hand to life
The greatest gift of all

We can't go on
Pretending day by day
That someone, somewhere will soon make a change
We are all a part of
God's great big family
And the truth, you know love is all we need

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

Send them your heart
So they'll know that someone cares
And their lives will be stronger and free
As God has shown us by turning stone to bread
So we all must lend a helping hand

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

When you're down and out
There seems no hope at all
But if you just believe
There's no way we can fall
Well, well, well, well, let us realize
That a change will only come
When we stand together as one

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

The beginning of evidence based medicine?

2009-07-01T21:27:00.002+08:00

The New York Times reported that a high powered panel appointed by the Obama administration as part of healthcare reforms has recommended that priorities be given to comparing effectiveness of competing drugs, medical devices, operations and other treatment for various medical conditions.

Prof Christensen in his book said that medicine as it is practiced today is largely in the realm of intuitive medicine where medical therapy is left largely to the judgement and experience of the doctor. Even where there are evidence to suggest rule-based treatment, the current system is not atuned to it.

The NYT article went on to give the example of abnormal heart rhythm known as atrial fibrillation. In such cases, a doctor may recommend drugs or a surgical procedure known as ablation, with little evidence as to which strategy works better or has fewer side effects.

Could this be the beginning of the push for evidence based medicine with new reimbursement incentives tied to it to drive the right "business models" to make healthcare more affordable, better quality and more convenient?

My Last Bowl...

2009-06-29T21:53:00.002+08:00

Yesterday, I brought my family to the coffee shop at serangoon gardens, where I have my regular weekend breakfast, for the last time.

The coffee shop will make way for new development. A Shop-and-Save grocery will take its place. Across the road, what used to be a 3-storey building housing the NTUC Fairprice supermarket, the coffeebean, DBS Bank and the mama-shop has also disappeared. We are told there will be more exciting development in its place, but I am unexcited by all these changes.

Serangoon Garden is one of the last frontier in Singapore where busyness is still confined to small shop houses in a kind of homely environment. My estate at Seletar Hills is yet another.

Every weekend, when I turned up at the coffee shop with my wife and order my usual Mee Kia and Kopi-C, the hectic pace of life seems to slow down, the worries fade and there is a sense of taking in the private moments amidst the other patrons. Most of the other people at the coffee shop are familiar faces - one who always brings his Straits Times and faces the road, an old man who collects old cardboard boxes will rest at his usual corner, the coffee lady will shout out the order often prefaced with a "Lai" (come in chinese)... At the same familiar table where I sat, I remembered sharing with my wife the good news when I was first appointed as CEO of Jurong General Hospital.

There is so much about the silly coffee shop that mean so much to me.

My job now is to find another coffee shop somewhere, where the same feelings will beckon...

Disrupting the business model of the physician's practice - Chapter 4 Clayton's Book

2009-06-28T23:17:00.002+08:00

This chapter carries a simple message.

The physician practice comprise 3 business models in one organisational setup, similar to that of the general hospital. In trying to be all things to all people, physician practices align resources to maximise flexibility rather than cost effectiveness.

The 3 business models are:

1. straightforward diagnosis and treatment of disorders in the realm of "precision medicine", eg. ear ache, flu, red eye, sore throat.

Clayton proposes that the "retail Clinic" such as MinuteClinic staffed only by nurse practitioners will disrupt this business model.

2. Ongoing oversight of patients with chronic diseases eg. diabetes, high cholestrol, lupus.

As in Chapter 6, Clayton proposes that transfer of patients to network facilitated models including disease management networks and network of patients/ families will disrupt this business model.

3. Disorders in the realm of intuitive medicine - primary care physicians, having freed themselves from (1) and (2) above and with the help of disruptive technology enabling diagnosis and testing onsite can disrupt the practice of specialists.

Clayton proposes that there are at least 3 types of technological innovation that will help propel primary care physicians in their move upstream:

(i) technology that brings analytical and imaging capabilities to point of care

(ii) online decision tool that distill massive volumeof published information algorithm that guide diagnosis

(iii) telemedicine.

To "heal" the physician practice, care integration at the system level (not local) will be critical. To do this job well, there is a need for a system level electronic health records. While this need is long recognised but progress has been slow because at the local level physicians do not have the incentive to implement electronic medical records and at the larger healthplan and health system level (eg intermountain, mayo), progress has been made largely in proprietory systems that is difficult to integrate at the systems level.

Healthcare can take a leaf off how standards are developed in other industry in this regard.

Role of Value Network to Disrupt Healthcare - Chapter 6 of Clayton's book

2009-06-27T22:30:00.003+08:00

I have been disciplined indeed. Today, I am on to Chapter 6 "Integrating to make it happen" of the Innovator's Prescription book.

Disrupting hospitals require separating the business models of "Solution Shop" for intuitive medicine, and "Value Added Process" clinics for diseases where precision medicine is available.

Specifically, for chronic diseases, what is needed is the development of coherent solution shops to come out with focused diagnosis of what cause the disease, valued-added process clinics to address diseases where rule-based therapy is available; and the creation of the right incentives for patients and providers to ensure that therapy and behavior changes so necessary for managing chronic illnesses, are complied with.

Disruptive Innovation require 3 enablers:

(1) Techonology

(2) Business Model

(3) Value Network.

Value Network, in clayton's words "is the context within which a firm establishes its business model, and how it works with suppliers and channel partners so that together they can respond profitably to the needs of a class of customers".

The innovative disruptions for hospitals and the management of chronic diseases require the context of a NEW value network to work effectively.

NEW value network because when disruptive innovators attempt to commercialise their innovation within the established value network, that system either rejects it or co-opt the potential disruption, forcing it to conform to the existing value network in order to survive.

Clayton asserts that the mechanism that governs how players act and interact is reimbursement. Current mode creates an interdependent, mutually reinforcing bond between players in the current value network and unfortunately funnels volume to the highest business cost provider because they are the most comprehensive. Money still makes the world go round!

Only a few players can play the role of integrator of various players in healthcare to create a NEW value network. Clayton's book proposes that (a) Fixed Fee Providers and (b) large employers are the best candidates to perform the role of integrator to bring this about.

Why Fixed Fee Providers/ Health Systems?

Examples include Kaiser Permanente in California, Intermountain Healthcare in Utah, Geisinger Health System in Pennsylvania, Via Christi Health System in Kansas, and Veterans Health Administration.

I. They have a long term view and willing to spend money today in order to save money tomorrow

II. Make money by keeping members well, no sick

III. Has electronic medical record of patients to know and care personally

IV. Be in geographic positions where care can be provided conveniently

V. Capable of implementing the needed changes with decisiveness

For the same reasons, large employers are also in the position to be good integrators to create a new value network. Examples in the US are Purdue farms, Toyota, Pitney Bowes, Sprint, general Mills and Qualcomm.

Clayton went on to propose that as large employers begin to do so, it almost appears that the old mantra of "stick to your knitting" and focus on core competencies may be violated. He clarified that vertical integration in a supply chain happens because employers cannot at this time be assured of cost and performance effective services from other health stakeholders. They need to play an orchestrating role to bring about disruptive innovation. When the system settles down and employers can now expect healthcare for their employees to be low cost, high quality and conveniently accessed, the company can then get back to their knitting.

Based on the discussion in this chapter, it is quite obvious to me that Jurong General Hospital can play the role of "integrator" of healthcare players in the population in the west (see point above about "geographic position") to create a new value network and in the process "disrupt" the way healthcare has been provided in Singapore.

Onwards to chapter 4 tomorrow, "Disrupting the business model of the physician practice (Specialist Outpatient clinics in Singapore context)"...

In Memory of Michael Jackson...

2009-06-26T23:19:00.002+08:00

Michael Jackson passed away today at 52.

I received the breaking news via sms at 6.23am that he is dead, but I ignored it because I figured it must be one of those unconfirmed stories and the media trying to generate some interests.

In a sense, I did not want it to be true. Michael Jackson is a fantastic singer and I best remember him through his song "Heal the World". Here it is, in tribute to you Michael Jackson. May you rest in peace...

There's A Place In
Your Heart
And I Know That It Is Love
And This Place Could
Be Much
Brighter Than Tomorrow
And If You Really Try
You'll Find There's No Need
To Cry
In This Place You'll Feel
There's No Hurt Or Sorrow

There Are Ways
To Get There
If You Care Enough
For The Living
Make A Little Space
Make A Better Place...

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

If You Want To Know Why
There's A Love That
Cannot Lie
Love Is Strong
It Only Cares For
Joyful Giving
If We Try
We Shall See
In This Bliss
We Cannot Feel
Fear Or Dread
We Stop Existing And
Start Living

Then It Feels That Always
Love's Enough For
Us Growing
So Make A Better World
Make A Better World...

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

And The Dream We Were
Conceived In
Will Reveal A Joyful Face
And The World We
Once Believed In
Will Shine Again In Grace
Then Why Do We Keep
Strangling Life
Wound This Earth
Crucify Its Soul
Though It's Plain To See
This World Is Heavenly
Be God's Glow

We Could Fly So High
Let Our Spirits Never Die
In My Heart
I Feel You Are All
My Brothers
Create A World With
No Fear
Together We'll Cry
Happy Tears
See The Nations Turn
Their Swords
Into Plowshares

We Could Really Get There
If You Cared Enough
For The Living
Make A Little Space
To Make A Better Place...

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

Heal The World
Make It A Better Place
For You And For Me
And The Entire Human Race
There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

There Are People Dying
If You Care Enough
For The Living
Make A Better Place
For You And For Me

You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me
You And For Me

Disruptive solution for the care of chronic illnesses - Chapter 5 Clayton's book

2009-06-26T22:19:00.002+08:00

Having the right incentive structure is very important.

Over the last 2 days, I have been diligently reading Clayton's book Innovator's Prescription. The keyword here is "diligent", ie read relatively intensely and with a highlighter in hand to highlight key points and a pen nearby, to scribble notes along the margin of the book. It does help too that my copy of the book was personally autographed by Prof Christensen himself when he was recently in Singapore.

Buy why? One major reason, although I personally love reading, is that my Chairman has started a series called "Talk the Walk, Walk the Talk". This is a regular session where we will discuss possible disruptions to public healthcare using ideas from the Innovator's Prescription book. The first session has been scheduled on 1 July! Hence, got to push on the reading...

Tonight, I finished Chapter 5 - the chapter on "Disruptive solution for the care of chronic illnesses". Here, Singapore has started some work to push the boundaries by incentivising people to start treatment early by allowing the use of medisave in the outpatient setting and tracking the improvement of health outcomes over time. But more remains.

Why a special chapter on disrupting care for chronic illnesses? It is widely known for example that 5 chronic illnesses - diabetes, congestive heart failure, coronary artery disease, asthma abd depression account for majority of the healthcare cost. In fact, the large share of expenditure by patients in the last 18 months of their life is largely due to the impact of treating the manifestation of symptoms from chronic illnesses.

What have I learnt from the discussions in this chapter?

1. The current business models used to care for patients with chronic illnesses are primarily set up to deal with acute diseases, ie they make money when people are sick and not when they are well.

2. There are 2 types of chronic illnesses, (a) intuitive chronic illnesses, ie those where diagnosis and treatment lacks clarity eg. lupus, chronic fatique, etc and (b) rule-based chronic illnesses, ie those where precision medicine is/ almost available and treatment are rule based eg. diabetes, chronic hepatitis, blood cancers.

3. Intuitive chronic illness require coherent solution shop approach, ie organised teams of specialists coming together to arrive at a correctly defined diagnosis and treatment protocol. Mayo clinic is well known in this regard and practices what is popularly known as Team Medicine.

4. Rule-based chronic illnesses is easy to manage but require long term compliance by patients to therapy and behavior modifications. The keywords here are "compliance" and "behavior changes"

5. Clayton invests a significant proportion of the chapter to identify categorization of types of chronic illnesses, the likelihood for compliance by patients and the various business models that may incentivise both the provider and the patient's behavior. There are essentially 4 types of chronic illnesses:

i. High immediate consequences + low behavior dependent eg. Epilepsy

ii. High immediate consequences + High behavior dependent eg. Chronic back pain

iii. Low immediate consequences + low behavior dependent eg. hyperlipidemia

iv. Low immediate consequences + high behavior dependent eg. Type II diabetes

6. Group (i) is already quite effectively managed by current business model. As consequences are immediate and low behavior change is required, patient will comply to treatment and doctors simply must schedule follow-up and they get paid.

Group (ii) and (iv) where it is high behavior dependent, the ideal approach is through facilitated networks eg. alcoholic anonymous where patients share information and teach each other how to overcome alcoholism.

Group (iii) and (iv) needs to be overseen by providers that profit from keeping their patients well rather than from their sickness. The entities that can profit are those who are integrated providers who are also insurers, or those who provide health care to a group of patients at a fixed fee. Employers like GE, HP have started have been using "disease management networks" to contract care for employees with certain costly chronic illnesses, and have proven to be successful in containing cost while improving outcome.

7. Patients are generally more interested in their financial health than their physical health. One approach to incentivise patients' compliance to therapy is to tie compliance to financial wellbeing.

Some ideas are already in action in Singapore. The national "Delivering on Target (DOT)" programme first started by SingHealth has proven early success but more needs to be done from the reimbursement angle.

It is also interesting to note what Cleveland clinic has reportedly started to do. They have moved away from the traditional departmental approach of medicine, surgery, paediatrics etc into "institutes" which comprise an integration of various specialists working together in "coherent solution shops".

I started this blog talking about incentives. It is therefore fitting to end to note that even in healthcare, the correct incentives built into business models can drive both provider and patients' behavior in a manner that will provide better outcomes and make healthcare more affordable!

Disrupting the hospital business model - Clayton's prescription

2009-06-25T22:51:00.004+08:00

It is so nice to be able to make a new entry into my blog after a long period of hiatus.

The truth is, my new responsibilities at the new Jurong General Hospital has been keeping me extremely engaged. All exciting stuff and a marvelous learning experience, but more about it next time.

I am now catching up on my readings. A key read is the Innovator's prescription by Professor Clayton Christensen from HBS. Chapter 3 of his book focus on the theme of disrupting the general hospital that we have come to be familiar with.

Professor Clayton asserts that there are fundamentally 3 business models:

(a) the Solution shop - this is the sphere of intuitive medicine where "hypothesis testing" usually within the domain of diagnosis is carried out. To facilitate discovery, highly skilled professionals are required and equipped with the most sophisticated technology. It is little wonder here that the "value" of medicine is less clearly classified and the costs are much higher.

(b) The Value-adding Process (VAP) - once a definitive diagnosis is made, and it is clear what the patient needs then the next steps would be "how to fix the problem" effectively, affordably and conveniently. Here trained healthcare professionals can follow a series of "proven value adding" steps to get the job done.

(c) Facilitated network - where multiple parties in the health eco-system are sufficiently capable to do their jobs, then what is needed to deliver value is to facilitate their effective interaction to deliver value.

Prof Christensen says in his book that because general hospitals tries to co-mingle the business models of solution shop and VAP services, there is substantial internal incoherence, escalation of costs and impossible to measure "value". The current model of reimbursement in healthcare system whose payout is undifferentiated for services delivered through solution shops and VAP clinics serve to perpetuate this co-mingling.

The proposed solution is to establish "Hospitals within Hospital" where integrated/ coherent solution shops eg. for treatment of Asthma like National Jewish Medical and Research Centre in Denver; and VAP specialised hospitals eg. The Aravind Hospitals in India for Eye surgery and Coxa Hospital in Finland for hip and knee replacement may be established.

General hospitals who try to be all-things-to-all people incur high cost of complexity. General hospitals will always be needed, it is just that over time we will need lesser of them as the machineries of disruption begin to work. As technology improves, more sophisticated care for more patients can be carried out in VAP hospitals with equal or better quality than general hospitals.

It will be interesting to see how this disruption to general hospitals will pan out in Singapore. It will be useful lessons for me as my team plans for JGH.

The "Economics" and "Repugnance" of Organ Donation

2009-05-31T19:52:00.002+08:00

Here is an interesting article from the New York Times that is a useful read...

July 9, 2006
FREAKONOMICS
Flesh Trade By STEPHEN J. DUBNER and STEVEN D. LEVITT

Weighing the Repugnance Factor

How's this for a repugnant situation? Take someone you love, perhaps your spouse or your sibling, and find a stranger who will accept a really big bet that your loved one will die prematurely — and if indeed that happens, you pocket a few million dollars.
This, of course, is how life insurance works. And most Americans don't find this idea repugnant at all. They used to, however. Until the mid-19th century, life insurance was considered "a profanation," as the sociologist Viviana Zelizer has written, "which transformed the sacred event of death into a vulgar commodity."

Alvin Roth, a Harvard economist who studies the design of markets, has done a lot of thinking about repugnance. On some issues, he notes, repugnance will recede, as with life insurance — or, even more momentously, the practice of charging interest on loans. In other cases, the reverse happens: a once-accepted behavior like slaveholding comes to be seen as repugnant.
One case of repugnance is far from settled: the dispute over how human organs for transplantation should be allocated — and, perhaps, even sold. If you happen to have a failing heart or liver or kidneys, you will almost certainly die without a transplant, but if you aren't lucky enough to get an organ through an official registry, you can't legally purchase one at any price. So instead of a free market in organs, we have a volunteer market. Some people agree to give up their usable organs once they die. In the case of a living donor, someone sacrifices a kidney or a portion of a liver to a recipient, most likely a family member.

In the space of just a few decades, transplant surgery has become safe and reliable (to say nothing of miraculous). But success breeds demand: as more patients get new organs, more patients want them. In 2005, more than 16,000 kidney transplants were performed in the U.S., an increase of 45 percent over 10 years. But during that time, the number of people on a kidney waiting list rose by 119 percent. More than 3,500 people now die each year waiting for a kidney transplant.

To an economist, this is a basic supply-and-demand gap with tragic consequences. So what can be done to increase the supply of organs?
A big problem is that would-be suppliers are not given very strong incentives to step forward. In much of Europe, the choice is made for them: instead of "opting in" to donate, the default assumption is that your usable organs will be harvested upon your death unless your family "opts out." But Europe, too, still has a sizable organ shortage, in part because traffic fatalities — which tend to produce desirable organs for harvest — are on a downward trend in Western countries.

If it's hard to get people to give up their organs upon death, consider how much harder it is to persuade a living person to donate a kidney. (From a medical perspective, a kidney from a living donor is far more valuable than a cadaver kidney.) Even though most people can live safely on one kidney, there is still a price to be paid in discomfort, risk, fear and lost wages. But the United States, like pretty much every other country in the world, forbids a donor to collect on that price, or any other.

It is hard to find an economist who agrees with this policy. Gary Becker and Julio Jorge Elias argued in a recent paper that "monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than 12 percent."

Some noneconomists may well find this reasoning repugnant. There are many reasons, after all, for banning the sale of organs. Some people consider it immoral to commodify body parts (although it is now commonplace to not only sell sperm and eggs but also to rent a womb). Others fear that most organ sellers would be poor while most buyers would be rich; or that someone might be pressured into selling a kidney without fully understanding the risks.
But why, Becker and Elias ask, should poor people "be deprived of revenue that could be highly useful to them"? Even more compelling is the fact that a poor person is just as likely as a wealthy person (if not more so) to need a new kidney — and, with no legal market for organs, is just as likely to die while waiting on a list.

Alvin Roth, even though he is an economist, is smart enough to realize that repugnance will keep Americans from embracing a true market for organs anytime soon. So, along with several other scholars and medical personnel, he has helped design a clever alternative, the New England Program for Kidney Exchange. Imagine that you have a wife who is dying of renal failure, and that you would give her one of your kidneys, but you are not a biological match. Now imagine that another couple is in the same bind. The kidney exchange locates and matches the couples: you donate your kidney to the stranger's wife, while the stranger gives his kidney to your wife; the operations are performed simultaneously to make sure no one backs out. Although this system has yielded only a couple dozen transplants so far, it illustrates an economist's understanding of incentives: if you can't get someone to give an organ out of altruism, and you can't pay him either, what do you do? Find two parties who are desperate to align their incentives.

Otherwise, who in his right mind would step forward to donate a kidney to a stranger? In fact, we recently spoke to one such potential donor who asked to remain anonymous. Donor is married, with four children and a precarious financial situation. Because Donor had a sibling who nearly needed an organ transplant, the idea got into Donor's head to perhaps sell a kidney to a stranger. Through a donor Web site, Donor met a potential recipient, whom we'll call Recipient. It wasn't until the process was well under way that Donor learned it was illegal to be paid. In the end, however, Donor's moral mission overrode the financial need, and Donor decided to go ahead with the transplant.

Donor has undergone extensive testing at the hospital where Recipient will have the transplant. Both Donor and Recipient have had to lie repeatedly to the doctors, pretending they are old friends. "If they find out you met on the Internet," Donor explains, "they assume it's for money, and they'll call off the operation."

If all goes well, the transplant may happen soon. Consider the parties who stand to profit from this transaction: Recipient, certainly, as well as the transplant surgeons, the nurses, the hospital, the drug companies. Everyone will be paid in some form — except for Donor, who not only isn't being paid but, in return for carrying out a deeply altruistic act, also has to pay the additional price of lying about it.

Surely there are some people, and not just economists, who would find this situation — well, repugnant.

Stephen J. Dubner and Steven D. Levitt are the authors of "Freakonomics: A Rogue Economist Explores the Hidden Side of Everything."

More information on the research behind this column is at www.freakonomics.com.

Farewell SGH and SingHealth...See You again!

2009-05-28T12:11:00.000+08:00

"Some" is NOT a number, "Soon" is NOT a time

2009-04-30T22:29:00.004+08:00

This is quite a well known quote from Don Berwick.

Indeed, when people are indecisive or are afraid to make decisions, they resort to vague answers like these.

Other famous variants include, "use your best judgement", "do your best".

No wonder, we are paralysed by inaction when directions are vague.

Come on people, make a stand, and take a stand!

How Singaporeans can help with Swine Flu preparedness

2009-04-29T20:54:00.002+08:00

The media is filled with news about the swine flu outbreak with Mexico as the epicentre.

By now, more than 16 countries have reported cases - some confirmed, some still suspects and today we received news about the first death of a 23-month old toddler in the US.

Singapore, to-date is still clear, but as a nation we are gearing up and are now at DORSCON level YELLOW of preparedness.

10 ways fellow Singaporeans can help?

1. Maintain high level of personal hygiene.

2. Be considerate - if you are not feeling well, cover your mouth with a mask, and see a doctor. Cover your mouth when you cough.

3. Protect yourself - if you can help it, why put yourself at risk by visiting the affected countries?

4. Try NOT to visit hospitals, unless absolutely necessary

5. If you need to visit a hospital, do NOT bring a crowd - limit to ONLY 2 visitors per patient. Do not be angry with hospital staff when they are just doing their job controlling visitors

6. Love your loved ones - don't bring your kids to hospitals

7. Mask up when requested at Hospitals - please PUT ON your surgical mask when asked to do so in a hospital. It is to protect you. And because you are protected, your family is also protected

8. Dispose of your mask properly in bins - otherwise somebody else will have to pick up your used masks and may be infected

9. If you are a patient, the hospital may call you to ask for postponement of non-emergency surgery as part of outbreak preparedness. We understand you are anxious about your medical condition and your surgery but know too that such measures are taken in the interest of patients and the public. Speak to your doctor if you have concerns

10. If you know of others who bears the symptoms of swine flu and have travel history to affected countries, gently nudge them to see a doctor as soon as possible. Over them a mask if you have one.

If we all play our part, Singapore will be better prepared to weather this storm. Thank you.

A Tribute to my mentor in healthcare...

2009-04-28T23:34:00.002+08:00

My wife was doing some springcleaning this week, and she found a montage and tribute that I wrote for Song Khim (my mentor in healthcare) in 2000 when he left Changi General Hospital for NUH.

Looking back, the quote that I wrote for him is almost like a prophesy when I read it today - some 9 years later:

"The seed that you have sown in each one of us will bear much fruits all through the years! Thanks for developing, nurturing, and leading me, Ops and CGH."

The pictures tell the many faces possible from a simple me... enjoy

Be on Stage...

2009-04-16T22:54:00.003+08:00

When I got up this morning, I flipped to my facebook and saw an interesting video post by a friend with a comment that said "touching...". As it was still early, I decided to click on the video to see what could get a grown man to say "touching".

The video was about a lady Susan Boyle taking the stage on the Britain Got Talent show. She was fat, had unflattered features and did not look the look of a winner. One could tell that the judges were cynical about her and as the camera panned the audience, it is easy to tell too that they too were against her. How could a star emerge from someone as ordinary as her was the unspoken language. When asked what was her dream, she said she wanted to be a professional singer. Answering the question, "Why has it not worked out so far", she said "because she has not been given a chance before, and tonight it is going to change..."

When the music started and when Susan Boyle started to Sing the song "I Dreamed the Dream" from Le Miserable, the crowd and the judges were immediately awed by her voice. Before long, she had a standing ovation and the rest is history....

There is a Susan Boyle in all of us. We all have talents, but like Susan Boyle, our talents need to be "on stage" before they may be recognised and enjoyed.

Have we taken the courage to allow our talents to be on stage? If not, watch this video on youtube and be encouraged.

Lyrics:(...quite a sad song though)

There was a time when men were kind

When their voices were soft

And their words inviting

There was a time when love was blind

And the world was a song

And the song was exciting

There was a time

Then it all went wrong

I dreamed a dream in time gone by

When hope was high

And life worth living

I dreamed that love would never die

I dreamed that God would be forgiving

Then I was young and unafraid

And dreams were made and used and wasted

There was no ransom to be paid

No song unsung, no wine untasted

But the tigers come at night

With their voices soft as thunder

As they tear your hope apart

And they turn your dream to shame

He slept a summer by my side

He filled my days with endless wonder

He took my childhood in his stride

But he was gone when autumn came

And still I dream he'll come to me

That we will live the years together

But there are dreams that cannot be

And there are storms we cannot weather

I had a dream my life would be

So different from this hell I'm living

So different now from what it seemed

Now life has killed the dream I dreamed.

Bitter and Sweet

2009-04-09T23:14:00.002+08:00

Life's perfection sometimes lie in its imperfection.

I just watch a video on facebook called "Beautifully Imperfect". The setting is one at the funeral where the wife steps up to say her eulogy for her deceased husband. She described noises that would ordinarily disgust most people - her husband's snore which she described it as a car engine that refused to start in the morning, and his "rear wind" that would be so loud in bed that it would sometimes jolt himself awake. However, these are noises that remind her of his presence and she has come to miss with his passing. These imperfections are perfect for her and she would give anything to hear these sounds again when she goes to bed.

The bitter and sweatness of life needs to be treasured. In a different kind of way, I am beginning to experience these same types of feelings over the last few days - not in my personal relationships - but with the people around me in a special place. A place where I have easily grown to love and in my imperfect ways helped made it more beautiful. The sound and scent I have grown familiar and the people super special. But I know that I know that know, I will treasure the time I've had.

Why Vision is important...From Alice in the Wonderland

2009-04-04T06:08:00.003+08:00

Organisations as much as individuals need vision. Vision offer dreams and hope and make existence more meaningful. This is a quote from Alice in the Wonderland story that will serve to remind us of this...

"Would you tell me, please, which way I ought to go from here?"

"That depends a good deal on where you want to get to," said the Cat.

"I don’t much care where--" said Alice.

"Then it doesn’t matter which way you go," said the Cat."

--so long as I get SOMEWHERE," Alice added as an explanation.

"Oh, you’re sure to do that," said the Cat, "if you only walk long enough."

Grace in Medicine

2009-04-01T22:23:00.003+08:00

No one in healthcare wants mistakes to occur, especially when they harm patients.

However, when mistakes do occur, as humans do - honesty, transparency and the willingness to learn from mistakes have proven to be key successful ingredients when communicating with patients.

This Grand Rounds blog entry "Getting a finger from the patient" is an interesting read about grace from patients when healthcare providers do the right thing when things go wrong.

Will the finger save mankind?

2009-03-29T20:26:00.003+08:00

I was driving back home after breakfast this morning, when I turned in to the sleepy quiet road leading to my house. "Sleepy and quiet" because there usually isn't alot of fast traffic, until...

As I made that turn, I had to straddle between 2 lanes because there were cars parked along the left hand side as this was a residential estate. Little did I realised that there was an on coming taxi. I quickly pulled my car left and stepped on the brakes to avoid a collision. Before I could wave that I was sorry, I noticed that the taxi driver did not even try to slow down (even though I was at fault) and instead directed all his energy and attention to show me the "perfect finger". I am convinced that he was not interested in avoiding an accident, showing his middle finger to me was more important. It is as if the finger was a magic wand, "waving it" will magically prevent any collision.

If this were true, I wonder it will heal the world and save mankind? Maybe, just maybe, it may even help the world turn the corner during this global financial crisis!

The longing to be home...

2009-03-27T09:20:00.002+08:00

It has been 2 weeks since I left home for a series of learning visits to US hospitals, attended a summit and a congress. At the end of the first week in the US, I learnt that my wife had been admitted to the hospital for dengue fever.

Even though I had an eventful time in the US, this time the longing to be home has never been stronger. The thought that I am really needed at home but am miles apart from my family was a difficult feeling to describe. My heart was really hurt when I called back one day, only to realised that my wife's platelet count had continued on the decline to 23k, my daughter Mel missed her mother so much that she cried for 3 hours and my eldest daughter told my wife that she felt like an orphan. That was when an early flight back to Singapore was confirmed and now I am on my way home.

While catching an internal flight earlier, I was really worried when my flight which was scheduled at 2.40pm was delayed to 5.30pm, then changed to 4.00pm due to changing weather conditions. The thought that I will arrive home later than scheduled on Saturday was not an outcome that I desire. Thank God, I made it through that flight and am now awaiting SQ flight to Singapore.

Yes, it will be Saturday morning when I arrived in Singapore. Perfect time for me to catch my usual breakfast with wife at the mee kiah stall at Serangoon. At the same time, I can almost imagine my 3 kids swooning over me at the door.

Glad to be home soon...what a wonderful life!!

That's why people don't stay healthy...

2009-03-24T06:53:00.002+08:00

I received this random email and found it very funny. Funny because people do engage in such kinds of reasoning (hopefully rarely) and irrational exuberance...enjoy!

Q: Doctor, I've heard that cardiovascular exercise can prolong life; isthis true? !

A: Your heart is only good for so many beats, and that's it... don't wastethem on exercise. Everything wears out eventually. Speeding up your heartwill not make you live longer; that's like saying you can extend the lifeof your car by driving it faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?

A: You must grasp logistical efficiencies. What does a cow eat? Hay andcorn. And what are these? Vegetables. So a steak is nothing more than anefficientmechanism of delivering vegetables to your system. Need grain? Eatchicken.. Beef is also a good source of field grass (green leafyvegetable). And a pork chop can give you 100% of your recommended dailyallowance of vegetable products.

Q: Should I reduce my alcohol intake?

A: No, not at all. Wine is made from fruit. Brandy is distilled wine, thatmeans they take the water out of the fruity bit so you get even more of thegoodness that way. Beer is also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?

A: Well, if you have a body and you have fat, your ratio is one to one. Ifyou have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?

A: Can't think of a single one, sorry. My philosophy is: No Pain...Good!

Q: Aren't fried foods bad for you?

A: YOU'RE NOT LISTENING!!! .... Foods are fried these days in vegetableoil. In fact, they're permeated in it. How could getting more vegetables bebadfor you? !

Q: Will sit-ups help prevent me from getting a little soft around themiddle?

A: Definitely not! When you exercise a muscle, it gets bigger. You shouldonly be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?

A: Are you crazy? HELLO Cocoa beans! Another vegetable!!! It's the best!feel-good food around!

Q: Is swimming good for your figure?

A: If swimming is good for your figure, explain whales to me.

Q: Is getting in-shape important for my lifestyle?

A: Hey! ! 'Round' is a shape!Well, I hope this has cleared up any misconceptions you may have had aboutfood and diets. And remember: 'Life should NOT be a journey to the gravewith the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - bodythoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride'AND..... For those of you who watch what you eat, here's the final word on nutrition and health.It's a relief to know the truth after all those conflicting nutritionalstudies.

1. The Japanese eat very little fat and suffer fewer heart attacks thanAmericans.

2. The Mexicans eat a lot of fat and suffer fewer heart attacks thanAmericans.

3. The Chinese drink very little red wine and suffer fewer heart attacksthan Americans.

4. The Italians drink a lot of red wine and suffer fewer heart attacks thanAmericans.

5. The Germans drink a lot of beers and eat lots of sausages and fats andsuffer fewer heart attacks than Americans.

CONCLUSION

Eat and drink what you like. Speaking English Being American is apparently what kills you.

Craving for Chinese Food...

2009-03-22T06:30:00.003+08:00

I have been in the US for the last week, without a tinge of chinese food in my belly. My only comfort came from the Myojo Maggie chicken curry noodles that my wife lovingly prepared for me before my trip. In fact, this "scarce" commodity became a source of envy amongst my colleagues, especially when prepared piping hot with my portable cooker!

The steak, salmon, ribs, chicken, fish cooked in the loviest western, italian style topped with generous portions of salad and other toppings just don't cut it. I figured with the salad that I have consumed, I must have eaten a whole year worth of vegetables in my diet. Fortunately, the company of colleagues and conversations were fantastic and made the time "bearable."

Today is the end of our learning trip, and the beginning of my attendance at the American Colleage of Healthcare Executive Congress at Chicago. At $88/ per night stay at the Central Loop hotel in downtown Chicago, my room is basic and the airconditioning produces a humming noise. I certainly hope that the sound will go away but what I desire even more is what I will be having for dinner - hot chinese food - I hope :-)

I look forward to coming home. I miss my family and the familiar creature comfort that I am beginning to look forward to. Wish me luck in my search for chinese food...

Blessings and curses - what we need to know

2009-03-08T21:16:00.002+08:00

When we read Deuteronomy 28, we can develop mixed feelings when we are not careful.

The chapter starts with God's blessings and used 14 verses to describe the different blessings when we follow his word. However, the rest of the 54 verses in the chapter describe the curses for disobedience. Have you ever asked yourself why the "imbalance"? Shouldn't more "airtime" be used for Blessings and lesser for "Curses"?

The answer lies with the fact that as believers, we are no longer living in the old covenant (time of Deuteronomy) but under the new covenant. The new has come and the old has passed away. Living under the new covenant means that the blessings of the old covenant we will continue to enjoy, and at the same time we are redeemed from the curses under the old covenant!

So, when we read Deuteronomy chapter 28 again under this new understanding, the "curses" as they are written are curses that we are already redeemed from, i.e. now inverted as blessings. For example, verse 43 says "The alien who lives among you will rise above you higher and higher, but you will sink lower and lower. 44 He will lend to you, but you will not lend to him. He will be the head, but you will be the tail." For the new covenant believer, we can be assured that we will NOT sink lower and lower, that we will NOT be the tail, and that we will be in a position to lend..." In fact, when we apply God's blessings from verses 1 to 14 to this situation, we will even flourish because God will bless everything that we put our hands to.

Taken in context, Deuteronomy 28 is in fact a very encouraging chapter to believers - actually what the people need especially during this time of unprecedented global financial crisis.

I hope this revelation will be a timely blessing for others as well. The chapter is quoted below for easy reference.

Deuteronomy 28
Blessings for Obedience
1 If you fully obey the LORD your God and carefully follow all his commands I give you today, the LORD your God will set you high above all the nations on earth. 2 All these blessings will come upon you and accompany you if you obey the LORD your God:
3 You will be blessed in the city and blessed in the country.
4 The fruit of your womb will be blessed, and the crops of your land and the young of your livestock—the calves of your herds and the lambs of your flocks.
5 Your basket and your kneading trough will be blessed.
6 You will be blessed when you come in and blessed when you go out.
7 The LORD will grant that the enemies who rise up against you will be defeated before you. They will come at you from one direction but flee from you in seven.
8 The LORD will send a blessing on your barns and on everything you put your hand to. The LORD your God will bless you in the land he is giving you.
9 The LORD will establish you as his holy people, as he promised you on oath, if you keep the commands of the LORD your God and walk in his ways. 10 Then all the peoples on earth will see that you are called by the name of the LORD, and they will fear you. 11 The LORD will grant you abundant prosperity—in the fruit of your womb, the young of your livestock and the crops of your ground—in the land he swore to your forefathers to give you.
12 The LORD will open the heavens, the storehouse of his bounty, to send rain on your land in season and to bless all the work of your hands. You will lend to many nations but will borrow from none. 13 The LORD will make you the head, not the tail. If you pay attention to the commands of the LORD your God that I give you this day and carefully follow them, you will always be at the top, never at the bottom. 14 Do not turn aside from any of the commands I give you today, to the right or to the left, following other gods and serving them.

Curses for Disobedience
15 However, if you do not obey the LORD your God and do not carefully follow all his commands and decrees I am giving you today, all these curses will come upon you and overtake you:
16 You will be cursed in the city and cursed in the country.
17 Your basket and your kneading trough will be cursed.
18 The fruit of your womb will be cursed, and the crops of your land, and the calves of your herds and the lambs of your flocks.
19 You will be cursed when you come in and cursed when you go out.
20 The LORD will send on you curses, confusion and rebuke in everything you put your hand to, until you are destroyed and come to sudden ruin because of the evil you have done in forsaking him. 21 The LORD will plague you with diseases until he has destroyed you from the land you are entering to possess. 22 The LORD will strike you with wasting disease, with fever and inflammation, with scorching heat and drought, with blight and mildew, which will plague you until you perish. 23 The sky over your head will be bronze, the ground beneath you iron. 24 The LORD will turn the rain of your country into dust and powder; it will come down from the skies until you are destroyed.
25 The LORD will cause you to be defeated before your enemies. You will come at them from one direction but flee from them in seven, and you will become a thing of horror to all the kingdoms on earth. 26 Your carcasses will be food for all the birds of the air and the beasts of the earth, and there will be no one to frighten them away. 27 The LORD will afflict you with the boils of Egypt and with tumors, festering sores and the itch, from which you cannot be cured. 28 The LORD will afflict you with madness, blindness and confusion of mind. 29 At midday you will grope about like a blind man in the dark. You will be unsuccessful in everything you do; day after day you will be oppressed and robbed, with no one to rescue you.
30 You will be pledged to be married to a woman, but another will take her and ravish her. You will build a house, but you will not live in it. You will plant a vineyard, but you will not even begin to enjoy its fruit. 31 Your ox will be slaughtered before your eyes, but you will eat none of it. Your donkey will be forcibly taken from you and will not be returned. Your sheep will be given to your enemies, and no one will rescue them. 32 Your sons and daughters will be given to another nation, and you will wear out your eyes watching for them day after day, powerless to lift a hand. 33 A people that you do not know will eat what your land and labor produce, and you will have nothing but cruel oppression all your days. 34 The sights you see will drive you mad. 35 The LORD will afflict your knees and legs with painful boils that cannot be cured, spreading from the soles of your feet to the top of your head.
36 The LORD will drive you and the king you set over you to a nation unknown to you or your fathers. There you will worship other gods, gods of wood and stone. 37 You will become a thing of horror and an object of scorn and ridicule to all the nations where the LORD will drive you.
38 You will sow much seed in the field but you will harvest little, because locusts will devour it. 39 You will plant vineyards and cultivate them but you will not drink the wine or gather the grapes, because worms will eat them. 40 You will have olive trees throughout your country but you will not use the oil, because the olives will drop off. 41 You will have sons and daughters but you will not keep them, because they will go into captivity. 42 Swarms of locusts will take over all your trees and the crops of your land.
43 The alien who lives among you will rise above you higher and higher, but you will sink lower and lower. 44 He will lend to you, but you will not lend to him. He will be the head, but you will be the tail.
45 All these curses will come upon you. They will pursue you and overtake you until you are destroyed, because you did not obey the LORD your God and observe the commands and decrees he gave you. 46 They will be a sign and a wonder to you and your descendants forever. 47 Because you did not serve the LORD your God joyfully and gladly in the time of prosperity, 48 therefore in hunger and thirst, in nakedness and dire poverty, you will serve the enemies the LORD sends against you. He will put an iron yoke on your neck until he has destroyed you.
49 The LORD will bring a nation against you from far away, from the ends of the earth, like an eagle swooping down, a nation whose language you will not understand, 50 a fierce-looking nation without respect for the old or pity for the young. 51 They will devour the young of your livestock and the crops of your land until you are destroyed. They will leave you no grain, new wine or oil, nor any calves of your herds or lambs of your flocks until you are ruined. 52 They will lay siege to all the cities throughout your land until the high fortified walls in which you trust fall down. They will besiege all the cities throughout the land the LORD your God is giving you.
53 Because of the suffering that your enemy will inflict on you during the siege, you will eat the fruit of the womb, the flesh of the sons and daughters the LORD your God has given you. 54 Even the most gentle and sensitive man among you will have no compassion on his own brother or the wife he loves or his surviving children, 55 and he will not give to one of them any of the flesh of his children that he is eating. It will be all he has left because of the suffering your enemy will inflict on you during the siege of all your cities. 56 The most gentle and sensitive woman among you—so sensitive and gentle that she would not venture to touch the ground with the sole of her foot—will begrudge the husband she loves and her own son or daughter 57 the afterbirth from her womb and the children she bears. For she intends to eat them secretly during the siege and in the distress that your enemy will inflict on you in your cities.
58 If you do not carefully follow all the words of this law, which are written in this book, and do not revere this glorious and awesome name—the LORD your God- 59 the LORD will send fearful plagues on you and your descendants, harsh and prolonged disasters, and severe and lingering illnesses. 60 He will bring upon you all the diseases of Egypt that you dreaded, and they will cling to you. 61 The LORD will also bring on you every kind of sickness and disaster not recorded in this Book of the Law, until you are destroyed. 62 You who were as numerous as the stars in the sky will be left but few in number, because you did not obey the LORD your God. 63 Just as it pleased the LORD to make you prosper and increase in number, so it will please him to ruin and destroy you. You will be uprooted from the land you are entering to possess.
64 Then the LORD will scatter you among all nations, from one end of the earth to the other. There you will worship other gods—gods of wood and stone, which neither you nor your fathers have known. 65 Among those nations you will find no repose, no resting place for the sole of your foot. There the LORD will give you an anxious mind, eyes weary with longing, and a despairing heart. 66 You will live in constant suspense, filled with dread both night and day, never sure of your life. 67 In the morning you will say, "If only it were evening!" and in the evening, "If only it were morning!"-because of the terror that will fill your hearts and the sights that your eyes will see. 68 The LORD will send you back in ships to Egypt on a journey I said you should never make again. There you will offer yourselves for sale to your enemies as male and female slaves, but no one will buy you.

Creatures of Habit

2009-03-08T10:08:00.002+08:00

Every weekend, I look forward to having breakfast with my wife. Not just any breakfast, but breakfast at a noodle stall at a corner coffee shop at Serangoon garden. And, every week, I will have the same, "Mee Kiah Tah" (small noodles, dry with chilli) and my regular "kopi-C" (coffee with evaporated milk).

There is nothing special about the taste of the food and drink but the routineness of the taste, experience, familiarity with the people allow me to feel comfortable as if I am at home, and yet have a sense of being away. Here is where I have some of the best conversations with my wife and time of reflection.

My children too have become familiar with the routine. I try not to bring them on a Saturday because that's my time with my wife. But on Sunday, they join us and they enjoy it too.

We are all creatures of habit, and an occasion sense of routine is good for the soul.

What we should know about stress...

2009-03-04T23:19:00.002+08:00

Got this article from in my Facebook inbox

"What do hopelessness, helplessness and stress have to do with rats, astronauts and you? Did you know that right after splashdown, one of the most difficult phases of space flight, NASA doctors found significant changes in the Apollo astronauts' immune systems?

Researchers have also found that rats, given electric shocks from which they cannot escape, give up and become helpless. When placed in a box where they can escape the shocks just by moving to the other side, these rats don't even try. They also develop stomach ulcers and abnormal brain chemistry. And, it's not because of the shocks. Another group of rats received the same amount of electricity, but they could turn the current off by pressing a bar. They remained healthy.

There is no longer any question about it. Many, many studies have verified that the health of our immune systems is linked to our stress levels and our attitudes about life in general.

Now a certain amount of stress is good for us and can give us more energy and greater concentration. But too much stress causes it to break down. When my wife, Diane, was battling cancer 20+ years ago, she put a lot of energy into building up her immune system. She monitored her thoughts as carefully as she controlled her diet. If you're concerned about living a long and healthy life, or if you're fighting a serious illness, developing a sense of control about your life can be as important as anything else you do. Some say you are what you eat. But it looks more and more like you are also what you think and feel."

Lou Tice The Pacific Institute www.thepacificinstitute.com

The Market - Is there one?

2009-03-04T22:38:00.002+08:00

This is a chart that came in one of the random emails that I received.

Over the last few days, the dow plunged and the ST went into the 1500 range. Will Dow breach the 5000 level? If the GE (one of the most revered company in the world) is showing this kind of chart, the bottom of the market I guess is anybody's guess (no pun intended).

Professor in the making...

2009-03-03T21:29:00.000+08:00

Isn't he cute? That's my son, my bundle of joy!

Daniel Craig, poor guy...

2009-03-02T22:44:00.002+08:00

I recently updated my profile picture on facebook using a photo that my wife took of me when I changed into my tuxedo for the HRM Award.

Then came a comment, "wow.. look a bit like daniel craig...... the bow tie..."

Totally oblivious about who is Daniel Craig and how he might be so unfortunate to look like me, I googled him and found this photo of him holding a toy gun. Given that I held a real gun before in my last life as a police officer, I think the remark could have been more accurate "Wow... daniel craig look a bit like you...... the bow tie..." :-))))))))

Somehow, this still does not sound right? What do you think?

Another Rainbow Sighting...

2009-03-02T22:14:00.003+08:00

On my way home today, I had another rainbow sighting! God is reminding Singaporeans that things are going to be all right... perhaps after lightning struck the Merlion (our national symbol)yesterday.

Patient communication, how much is too much, how little is too little?

2009-03-01T21:51:00.002+08:00

As I was driving home this saturday, I received an sms from a good friend. I resisted reading the sms till I reached home but my heart sank when his message read "who is the best doctor for pancreatic cancer?"

After trading a few sms's, I found out that it is his mom who had just been diagnosed with pancreatic cancer at a private hospital. I volunteered to hook him up with a colleague on Monday for a second opinion and map the course for treatment.

Personally, I could identify with his situation because some 15 years or so back, my father too was diagnosed with cancer. I remembered at that time I was getting ready to come home when I received the call from my mom. She told me that father had just seen the doctor and after the CT scan, the doctor said it was cancer and he needed surgery. My world fell apart before my eyes - I was devastated. At that time, I did not know much about cancer except that most people die from it. To know that one of the most precious person in my life was diagnosed with cancer was not something I was emotionally prepared to accept.

As I was approaching home, I remembered that I should take a hold of myself and be stable so that I do not worry my father. When I saw my father, I told him that there is nothing medical science cannot handle these days, and for all you know, it may not be cancer afterall. I could see a sense of relief when he heard that maybe, just maybe it was not cancer. It was clear to me and the rest of my family that my father could not take the news that he had cancer well. His emotional tailspin would affect his will to fight and affect his chances for recovery.

Rightly, or wrongly (turns out to be right) we decided to hide his cancer diagnosis from him.

I made an appointment to speak with his attending doctor at a private hospital and explained to him to keep the diagnosis from my dad. He agreed after my appeal. We explained to my dad that his condition (we no longer used any association to cancer eg. oncology, carcinoma, etc) will still require surgery and he agreed to go to it. Fortunately for him, a clean line could be achieved with the cancerous part of his body and it was assessed that he did not need either chemo or radiation theraphy after surgery. With this, our storyline could continue.

Looking back, limiting communication with my father about the cancer diagnosis is the right thing, and we feel gave him the spirit to take the treatment well and to recover. Today, he is in remission and I thank God that he has remained strong and healthy.

Depending on the situation/ condition, perhaps it would have made better sense to communicate with my father about his cancer diagnosis so that the appropriate interventions be carried out. In life we will never know, but my experience taught me the importance of involving the whole family in a united effort to fight a hideous disease that is still plaguing the world.

Now I wonder for my friend who is in the thick of this... I pray that his mom will pull through this journey.

Having lunch with patients...

2009-02-28T21:57:00.002+08:00

Today, I hosted a regular Patient Feedback Lunch. Some 10 patients and their family turned up and we had a very good conversation about what we can do to improve hospital processes and patient experience.

I first know about this idea to invite patient back for lunch when I was working at Toa payoh Hospital in 1993. The then CEO had the idea that it would be great if our staff could hear patients' feedback in person, while at the same time engage patients in our journey of quality improvement. To qualify to be invited, there was only one criteria - patients must have complained about their care and service in the hospital before. I remembered when he first mooted this idea, the leadership was quite concerned - to say the least. Many could not imagine how such a setup could produce any meaningful conversation as patients, we thought, would be too emotional about their experiences that led to their complaints. I was one of those.

When it was time for me to attend the first patient feedback lunch, I prepared mentally for a "show down". What became obvious to me very quickly was that patients appreciated the opportunity to be invited back to share their feedback for improvement, and the lunch with patients generated significant goodwill. Of course, there were the infrequent emotional "outburst" from patients. But, I have found that when patients know that we are sincere about making the improvements and gave them a listen ear, they quickly settle down and turn their comments into constructive feedback. Other patients in the midst also often provided alternative views on various care and service process issues and that helped balance the discussions. Having seen how powerful such a lunch session with patients could be, I have been a convert ever since.

So, when I moved to SGH some 5 years ago, I brought along this practice; and with the help of a very supportive and inspired SQ and Comms team we started it and have never looked back.

Personally, I am inspired after every patient feedback lunch that I host. Listening to patients, I know that the work that we do make a real difference to real people and that helped fan the flame that kept me going for 16 years in Singapore healthcare. What makes it even sweeter is to be able to make a difference along side a bunch of great people equally dedicated and committed to the cause!

SGH - Employer of Choice @ HRM 2009!

2009-02-26T23:22:00.002+08:00

SGH HR Director Ms Anna Fok Receiving the HRM 2009

Employer of Choice Award on Behalf of

Singapore General Hospital on 26 Feb 2009

It has been quite a night at the HRM Award event for SGH! Nominated for 5 categories of award, Singapore General Hospital won in 3 categories, namely:

Employer of Choice Award

Best Work-Life Harmony Award

Best Performance Management Award

SGH Director HR Ms Anna Fok, who was herself nominated for the Best HR Leader Award, represented SGH to receive the night's TOP trophy - The Employer of Choice Award! Even though Anna was not given the Best HR Leader Award tonight, she is definitely MY WINNER!

Congratulations Anna and the SGH HR Team for doing us proud. There is always something special about being part of the SGH team and these awards are recognition for the good work and dedication of our staff.

Well done, folks!

Rainbow - A Reminder of God's Promises

2009-02-25T19:21:00.006+08:00

Rainbow peeking from the side of my house

A beautiful Arc...

Directly above my house

Wow!

My side of the Rainbow!

It rained cats and dogs this afternoon. The combination of lightning and thunder was so potent that it woke my kids from their deep afternoon slumberland.

But by 7:15pm, a beautiful rainbow appeared above my house. I have never seen such a perfect full arc of colours before in person! My wife, kids and I spent time outside just marveling at God's creation until the rainbow finally faded. At the same time, our hearts warmed because it is a reminder of all of God's promises to us. We can always expect good things to happen to us, but there are times that we needed that reminder - this is reason enough for God to create the rainbow.

Enjoy the sight... and claim God's promises for yourself as well!

Touching a piece of old Singapore

2009-02-22T21:31:00.002+08:00

Sometimes I think Singaporeans like me take being in Singapore for granted.

As usual, by late afternoon on a Sunday today, my family began the round of questions on where should we have our family dinner. Having just completed my run around my estate, my brain was cleared of the week-long gunk and a brainwave hit me. I said, why don't we try Lau Pa Sat?

There was a period of silence and I could tell everyone's brain was processing what I had just said. I broke the silence by telling everyone that I am told there are lots of food there. I named Prawn Noodles, and my mom's face brightened up and she said she has been craving it. I continued that there is a street full of satay stalls (like the old satay club) and Brittney's face lighted up. By the time, I finished by bath, i realised that my entire family was tucked in my MPV, engine fired up and ready to go.

The experience was pleasant right from the beginning. As my car inch towards Lau Pa Sat, a car parked just outside the food centre signaled to leave. So, I got the best parking spot!

The number of stalls in Lau Pa Sat amazed me. The food centre is lined up in "Streets" with many stalls along the streets. We were spoilt for choice. The only dark spot then was that there were many touts following us egging us on to their stall. We ignored them and soon they left us alone - good grief! I went for chah Kuay Teow - apparently a famous one from Lakeview. My mom went instead for fish soup, Brittney for porridge, melody noodles, Zachary noodles and fried chicken wings and we topped it off with 10 chicken satay, 10 mutton satay and 4 glasses of sugarcane drink. It was quite a meal but I feel a sense of relief that I had put in the run earlier.

After a happy meal, I brought my children around the Lau Pa Sat. Showed them the satay street, told them about the famous satay club in Singapore. I told them about the history of Lau Pa Sat, took some pictures and felt a sense of satisfaction that I had taken the time to experience a piece of old Singapore. Apparently, Lau Pa Sat was part of the Telok Ayer Market ordered to be set up by Sir Stamford Raffles at the port where the chinese immigrants arrived in Singapore. It was restored in its present day glory in the 1980s and gazetted for preservation in 1973.

The Lau Pa Sat stood in stark contrast to the skyscrapers along Robinson Road, the heart of Singapore business and financial district - a reflection of the past as we experience the present and future.

Looks like my family will be back to Lau Pa Sat for many more meals - good food, wide selection and minus the crowd. I wish the touting will stop though.

Wave to me when you see me at Lau Pa Sat!