Sunday, January 25, 2009

Heart-attack care: Transparency the best policy

Heart-attack care: Transparency the best policy

January 25, 2009

ST letter by Ms Lee Wei Ling

IN MY column, ‘Righting a wrong comes from the heart’, last Sunday, I described the status of treatment of acute myocardial infarction (AMI) in the public health-care sector. I stated the facts which were accurate up to Jan 1 this year. I felt that both the public and general practitioners (GPs) should have the relevant information about the capabilities of all our public-sector hospitals.

I wrote about it because my medical school classmate, a GP, was flabbergasted when I told her that Tan Tock Seng Hospital had no round-the-clock capability to open up obstructed heart arteries by ‘ballooning’ on an emergency basis.

Another medical school classmate, a specialist in the private sector, was forced by the SCDF ambulance to have her mother admitted to Tan Tock Seng last month and there was no doctor capable of doing ballooning on an emergency basis until she found one to do so.

Alexandra Hospital had no such capability and my classmate advised all her patients to go to the nearest hospital if they suspect AMI. She subsequently obtained feedback from other doctors that the ballooning service at Changi General Hospital was not great. I chose not to mention Changi General Hospital in my column, nor did I say that ‘only the National Heart Centre and National University Hospital are able to handle heart-attack patients after office hours’.

But in yesterday’s report, (’Most hospitals offer 24/7 heart-attack care’), Tan Tock Seng Hospital, the Ministry of Health and the Singapore Civil Defence Force seem perturbed by what I wrote.

Instead of looking forward to improving care of AMI patients, all three organisations expressed unhappiness about this public disclosure.

My view is that the public will be understanding and forgiving if they know this is the best service the Government can provide, given the various constraints. Giving the public the knowledge means AMI patients can make an informed and wise choice when deciding where to go for treatment.

Prof Lee Wei Ling

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Tuesday, January 20, 2009

Lee Wei Ling: Righting a wrong comes from the heart

Lee Wei Ling: Righting a wrong comes from the heart

January 20, 2009

Since young, I have always been upset with myself if I knew something was wrong and I could put it right but didn’t.

Hence, I often find myself on ‘quests’ or ‘missions’, ‘jousting with windmills’. Sometimes, I criticise my friends, saying, perhaps impatiently, ‘you have lost the fire in your belly’.

If there is something wrong that we know of, I believe we should try to set it right whether or not it is our business to do so. Not to do so implies we condone the wrong and hence we would be guilty of committing the wrong too.

The concept of ‘guilty by omission’ is not one that is held commonly here. But it is enshrined in the legal systems of the United States and France.

You can be sued in the US if you do not clear the ice on the sidewalks around your home and as a result, someone slips and fractures a bone. You did not cause the fracture but you would be guilty by virtue of having omitted to clear the ice.

Let me give a concrete example closer to home of the consequences of such omission: A few months ago, a colleague’s mother suffered a heart attack and was rushed by ambulance to Tan Tock Seng Hospital at night.

Horror of horrors, there was no cardiologist there. My friend desperately called one of several private cardiologists she knew personally, being a doctor herself. But what could a layman have done in similar circumstances? Nothing.

Neither Alexandra Hospital nor Tan Tock Seng outside of office hours has the resources to handle acute myocardial infarctions (AMI) or heart attacks.

Thus, they are not in a position to give patients the best chance of surviving heart attacks. Of those who survive, the chance of impaired function of the heart would be higher than for patients treated in hospitals where cardiologists and facilities were available as in the National Heart Centre (NHC) or National University Hospital (NUH).

These problems are beyond my areas of responsibility. But I am a doctor; I know what is wrong; and I know what needs to be done. I would have been guilty by omission if I had not tried to solve this problem.

So I engaged the ambulances which come under the Singapore Civil Defence Force, NHC, NUH and got them all to agree that when their ambulances pick up patients with AMI, they would bypass Alexandra and Tan Tock Seng and go only to NUH or NHC.

I do not believe homo sapiens are necessarily at the top of the evolutionary pyramid. But it is indisputable that we are different from other species in several ways.

Scientists once assured us that we were the only species that possessed language. Then research with gorillas and chimpanzees showed that they too could master sign language. Another distinguishing trait of humans was thought to be our capacity to use tools. But then we learnt otters could smash molluscs with rocks and apes could strip the leaves from twigs to use them to fish for termites.

The one feature that definitely does separate us from other animals is our highly developed sense of morality. We seem to have a primal understanding of good and evil, right and wrong, of what it means to suffer not only our own pain but also the pain of others.

Morality may be a hard concept to grasp, but we acquire it fast. A preschooler, for instance, may learn that it is not all right to eat in class because a teacher says so. If the rule is lifted, the child will happily eat in class. But if the same teacher says it is okay to push another student off a chair, the child would hesitate. He will think: ‘No, the teacher should not say that.’

In both cases, somebody would have taught the child the rules, but the rule against pushing has a stickiness about it. It resists coming unstuck even if someone in authority countenances its breach. That is the difference between a moral imperative and mere social convention. Some psychologists like Michael Schulman believe children can innately intuit the difference.

Of course, the child might on occasion hit some other child and won’t feel particularly bad about it - unless, of course, he is caught. The same is true of people who steal or despots who slaughter their people.

Marc Hauser, professor of psychology at Harvard University, has written: ‘Moral judgment is pretty consistent from person to person - that is, we all know what is right and what is wrong. Moral behaviour, however, is scattered all over the chart.’

The rules we know, even the ones we intuit, are by no means the rules we follow. There are people who have no moral instinct - psychopaths and anti-social people who commit crimes and seem incapable of being reformed. They stand out precisely because their behaviour is so bizarre.

Of the rules that we do follow, it is easier for most people to follow rules that require passively not doing anything wrong. Actively doing something right, especially if that something does not fall within our area of responsibility, is uncommon.

It is good for any country to have an active citizenry. And that is precisely why the concept of ‘guilt by omission’ should be a part of our ethos.

As Singapore climbs the economic ladder, its need for people who would feel guilty if they omitted to do something right - not merely passively do no wrong - will increase.

A rich middle-class society encircled by the material pleasures of life, happily oblivious of social inequities and the suffering of the less fortunate among us, will never become a civil or gracious society.

On the other hand, a country with little financial reserves, a middle class that is not wealthy but is socially active, that tries to lift the lowest common denominator in that society, is one that would be heading in the right direction.

Some things cannot be legislated but must come spontaneously from the heart. The desires to right wrongs and help others are examples.

Singapore is a great place for social experiments to improve both the country and the individual.

Lee Wei Ling

# The writer is director of the National Neuroscience Institute.

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Sunday, January 4, 2009

Lee Wei Ling: My house is shabby, but it is comfortable

Lee Wei Ling: My house is shabby, but it is comfortable

Written by Lee Wei Ling, for the Sunday Times, 04 Jan 2009

In 2007, in an end-of-year message to the staff of the National Neuroscience Institute, I wrote: ‘Whilst boom time in the public sector is never as booming as in the private sector, let us not forget that boom time is eventually followed by slump time. Slump time in the public sector is always less painful compared to the private sector.’

Slump time has arrived with a bang.

While I worry about the poorer Singaporeans who will be hit hard, perhaps this recession has come at an opportune time for many of us. It will give us an incentive to reconsider our priorities in life.

Decades of the good life have made us soft. The wealthy especially, but also the middle class in Singapore, have had it so good for so long, what they once considered luxuries, they now think of as necessities.

A mobile phone, for instance, is now a statement about who you are, not just a piece of equipment for communication. Hence many people buy the latest model though their existing mobile phones are still in perfect working order.

A Mercedes-Benz is no longer adequate as a status symbol. For millionaires who wish to show the world they have taste, a Ferrari or a Porsche is deemed more appropriate.

The same attitude influences the choice of attire and accessories. I still find it hard to believe that there are people carrying handbags that cost more than thrice the monthly income of a bus driver, and many more times that of the foreign worker labouring in the hot sun, risking his life to construct luxury condominiums he will never have a chance to live in.

The media encourages and amplifies this ostentatious consumption. Perhaps it is good to encourage people to spend more because this will prevent the recession from getting worse. I am not an economist, but wasn’t that the root cause of the current crisis - Americans spending more than they could afford to?

I am not a particularly spiritual person. I don’t believe in the supernatural and I don’t think I have a soul that will survive my death. But as I view the crass materialism around me, I am reminded of what my mother once told me: ‘Suffering and deprivation is good for the soul.’

My family is not poor, but we have been brought up to be frugal. My parents and I live in the same house that my paternal grandparents and their children moved into after World War II in 1945. It is a big house by today’s standards, but it is simple - in fact, almost to the point of being shabby.

Those who see it for the first time are astonished that Minister Mentor Lee Kuan Yew’s home is so humble. But it is a comfortable house, a home we have got used to. Though it does look shabby compared to the new mansions on our street, we are not bothered by the comparison.

Most of the world and much of Singapore will lament the economic downturn. We have been told to tighten our belts. There will undoubtedly be suffering, which we must try our best to ameliorate.

But I personally think the hard times will hold a timely lesson for many Singaporeans, especially those born after 1970 who have never lived through difficult times.

No matter how poor you are in Singapore, the authorities and social groups do try to ensure you have shelter and food. Nobody starves in Singapore.

Many of those who are currently living in mansions and enjoying a luxurious lifestyle will probably still be able to do so, even if they might have to downgrade from wines costing $20,000 a bottle to $10,000 a bottle. They would hardly notice the difference.

Being wealthy is not a sin. It cannot be in a capitalist market economy. Enjoying the fruits of one’s own labour is one’s prerogative and I have no right to chastise those who choose to live luxuriously.

But if one is blinded by materialism, there would be no end to wanting and hankering. After the Ferrari, what next? An Aston Martin? After the Hermes Birkin handbag, what can one upgrade to?

Neither an Aston Martin nor an Hermes Birkin can make us truly happy or contented. They are like dust, a fog obscuring the true meaning of life, and can be blown away in the twinkling of an eye.

When the end approaches and we look back on our lives, will we regret the latest mobile phone or luxury car that we did not acquire? Or would we prefer to die at peace with ourselves, knowing that we have lived lives filled with love, friendship and goodwill, that we have helped some of our fellow voyagers along the way and that we have tried our best to leave this world a slightly better place than how we found it?

We know which is the correct choice - and it is within our power to make that choice.

In this new year, burdened as it is with the problems of the year that has just ended, let us again try to choose wisely.

To a considerable degree, our happiness is within our own control, and we should not follow the herd blindly.

Lee Wei Ling

The writer is director of the National Neuroscience Institute.

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