The Singapore Medical Council Physician's Pledge Affirmation Ceremony

06 May 2006

By Prof K Satku, Director of Medical Services

Venue: College of Medicine Building

Professor Nambiar,

President of the Singapore Medical Council;

Members of the Singapore Medical Council;

Distinguished guests, colleagues;

Ladies and gentlemen;

INTRODUCTION

Today is Election Day. Singaporeans are voting for their choice of leaders to carry on building the Singapore Dream.

Today also marks the commencement of a different dream - your own dream of being a medical doctor. All the hard work, the support and encouragement of your parents and family, friends and loved ones will culminate today, marking the end of 6 years of medical school and housemanship. I congratulate each of you on your achievement, and welcome you as a member of the revered medical profession.

BUILD PATIENT TRUST

The medical profession is old as age itself. Medicine, with its noble legacy of healing, is rich and momentous beyond comparison. Unknowingly perhaps, you have come to inherit this rich tradition.

But in time to come, each of you will be called upon to uphold this legacy. Patients will seek your advice and guidance for their health matters. The sick will look to you for care and compassion, for relief of their pain and suffering. With this, people will accord you the respect that doctors have enjoyed since time immemorial. It is a heavy responsibility.

In this duty, you must always place your patient's interest first. Whether you practice surgery, family medicine or paediatrics, whatever you do must be for the good of the patient. This does not mean that you should always recommend or insist on the latest and most expensive treatment. It also does not mean that you should unilaterally decide what is best for the patient.

In your interactions with patients, you should provide holistic medical advice based on the best available evidence, taking into account all other patient concerns, be they social, financial, religious or ethical considerations.

You must be an uncompromising patient advocate. Use your expertise responsibly to influence and advance the health of your patient. When you see that your patient is being shortchanged or harmed by either the system or individuals in the course of seeking treatment, do not be afraid to speak up.

But speaking up for changes to the system may fall on deaf ears. I have been a junior doctor once and I know the difficulties inherent in our system. You may not always succeed but you must always try and after sometime you will surely be heard.

You must build on the sanctity of the patient-doctor relationship. Some patients are not easy to deal with, or may be slow to understand your advice, or may have other difficulties.

Never chastise or lose your patience with them.

I have been practicing as a doctor for more than 30 years. I have seen all kinds of patients, and all kinds of doctors. From my personal observations, some of the most vulnerable patients may be the NS men and the lonely poor elderly.

Never lose the fundamentals of good doctoring; sustain their self-esteem and autonomy. Learn to respect patients as individuals in their own right even when you act in their interest.

Master communication skills that will allow you to disengage from the occasional difficult patient. This should be done in a professional way without damaging the patient-doctor relationship.

Above all else, remember that we would be nothing if not for our patients.

The legacy of the medical profession is a glorious one. Do not squander the trust that patients will place in you. Build on the legacy of those good doctors that came before us.

BUILD A CAREER

Many of you are bonded to the public health care sector for the next few years. There is much that you can learn on the job. Adopt a positive attitude and make the best use of this opportunity.

Plan for your career. Be ambitious and aim high. But be careful never to lose sight of the reasons why you became a doctor in the first place. Let me elaborate.

First, don't look at each posting as just a job that has to be done. Think of it as a component of an overall career plan. For those of you who will become specialists, the path is relatively well marked out once you have been accepted into a training programme.

For those who choose to become GPs, you will play an increasingly crucial role in our healthcare system. Primary care has taken front stage as the prevalence of chronic diseases like diabetes mellitus and hypertension continue to surge.

I urge you to enroll in either the Graduate Diploma in Family Medicine or the Master of Medicine programmes. These programmes will equip you with the skills to be a better Family Physician and function as the coordinator of care for your patients.

Second, make learning, teaching and research a part of your career. I am sure you know that to renew your practicing certificate, you will need to fulfill the requisite amount of Continuing Medical Education.

But surely, this cannot be the impetus for you to continue learning? Medical knowledge is advancing rapidly and if you do not keep up, not only will your patients suffer; you, as a doctor, would have let them down.

Learning need not be a painful chore. One way to make it easier is to engage in teaching. Teaching allows you to constantly refresh what you already know, helps you see things from a different perspective, and sharpens your understanding of medicine.

Likewise, you must take part in research. It will develop your analytical skills that will serve you well as a clinician.

All of you should integrate teaching and research into your practice.

Third, stay the path, be resolute and never waver or lose sight of the reasons why you became a doctor. During your practice, you will encounter distractions of all sorts.

If you are not careful, you will adopt values and do things that you would not have considered appropriate for a medical professional. For example, you must not take the lure of money lightly. You must never prey on the insecurities and haplessness of your patients and induce unnecessary demand for your services.

Some of you might have heard of colleagues who have been disciplined by the Medical Council, for professional misconduct like selling sedatives to addicts. While you might get away with it once or twice, it will ultimately lead you down a slippery slope.

As a regulator, MOH can build safeguards, incentives and disincentives into our health care system, but the good and honest professional never needs to fear the regulator. He never sees or feels the weight of the law.

Even when he commits a genuine mistake, it is likely that the profession would forgive him. Indeed, MOH is committed to regulate the health care industry with a light touch, as we believe that health care professionals are good people committed to doing a good job.

Nonetheless, for those few who insist on making a mockery of the dignity of medicine, or who repeatedly let your patients down through negligent practice; be cautioned - for the full weight of the law would be on you.

As a doctor, you will earn a living that is commensurate with your expertise. You will have plenty of opportunity to build a rewarding career out of good medicine. But if you are thinking first how you can make money in Medicine, I'm afraid you are in the wrong profession. Remember always, you are here because you want to be a doctor. So never lose your way. It is not worth it.

BUILD PROFESSION VALUES

Last but not least, you must remember that as a doctor, you will be constantly judged by the way you carry yourself in public, and in front of your colleagues.

I am not referring to appropriate attire or dressing - as that goes without saying; I am referring to the professional bearing and conduct that is expected of you.

As guardians of confidentiality, patients trust that you would respect their need for privacy. Always be circumspect about what you communicate to your colleagues in public places or elsewhere. Gossip mongering has no place in doctoring, so do not mar the reputation of the medical profession. Always take your patient's confidence in you seriously.

Doctors are also leaders of a team of health professionals. You can and must demand high standards always. Junior team members, be they medical students, housemen or nurses who fall short of expectations should be corrected, and you must do so firmly. However, there is no need to ridicule or to humiliate them in front of the patient or ortherwise.

It is a shame that such behavior seems to have taken on a life of its own - inherited like a bad gene from one generation to the next. Unspoken, untaught, and unknown to us, doctors copy and buy into this "hidden culture". It doesn't reflect well on the profession. It will not reflect well on you.

Be a leader, build collegiality, and set good examples for others. You will in turn gain the respect of those you work with.

CONCLUSION

The pledge which you will recite and sign later is an adaptation of the Hippocratic Oath and the Declaration of Geneva. These are documents that have guided the practice of medicine for many years. Stay the course and I am sure all of you will become good doctors and fine professionals.

I note that some of you have joined us from overseas. I am glad that you have chosen Singapore as a suitable place to build your career. I am sure you will not be disappointed. I welcome you whole heartedly into our family of health care professionals.

In closing, I wish you all every success in your future endeavors.

Thank you.