Monday, February 9, 2009

Freedomto think - Ngiam Tong Dow's views

Today's Straits Times carried an opinion piece from Ngiam Tong Dow entitled "Fostering the freedom to think". Not altogether new with respect to ideas, but provided much food for thought. I mean, we all know we ought to foster a culture where people are free to think...and innovate. The question is how ...and when?

It made me think about how we train doctors, and what it means for doctors to be 'free' in their thinking...Quite frankly, I am not sure I feel very comfortable with doctors who think too much ... It seems to me like most of the practice of medicine is really based on dependability and quality of diagnosis and care. This comes only with experience, and drill. The more a surgeon does, the better he gets. The more cases a dermatologist sees, the better he is in making a diagnosis. Likewise, the more trauma cases a physician gets to manage, the faster and safer he is when confronted with a crisis situation. I mean, do I really want a physician who is thinking about creative ways of sticking an endotracheal tube down my lungs if I am suffocating?

Having said that, it is true that the medical profession will benefit from a group of smart people thinking of ways to innovate therapy. These are the so called clinician researchers. But these represent a minority of doctors in the profession. The people who go on and win awards. The vast majority of doctors really need to go out there and try and do a decent job of looking after their patients. I think that's what a patient really expects. After all medical malpractice is really based on peer acceptability of what you do. Woe betide the practitioner who innovates too much in managing his patients. That's why I shudder when I read about our Medical School experimenting with all kinds of newfangled ways to teach our medical students. Problem based learning...vertical integration...horizontal integration...and what not.......What on earth are they thinking? We don't really need to make all our doctors become experimental physicians and surgeons! What we need are safe, caring and consistent practitioners of their craft.

To some extent it does mirror Mr Ngiam's have a bunch of safe (perhaps restricted, oversafe) architects in HDB who do a fairly good job in delivering cost effective (albeit unimaginative) solutions. If and when they go to Surbana, they can let fly and win innovation awards.

Let it be that way with our training of doctors. Put the bulk of them through a stiff rigorous training so that they become competent, safe and caring practitioners. Restricted and unimaginative, perhaps. But find some way to identify and allow the really good ones to break free from the constraints of their mundane practice, and innovate for the benefits of patients at large.

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