Sunday, December 25, 2011

Have a blessed Christmas all :The doctor never reported that the angels sang....!

One of my favourite books in the Bible is Gospel of Luke. Luke, as well as the Acts of the Apostles are supposed to have been written by the Greco-Syrian physician, Luke. Although not an eyewitness to the many of the events he reported on, he drew heavily on eye witness accounts about the life on Jesus as well as the events which took place around the early church. His accounts all carry the trademark attention to personal details and emotions.

His account of the night of Jesus birth has provided many of the inspirations for the celebration of Christmas. Unfortunately they have been pretty much distorted by romantic notions and more recent commercial interests.

"Hark!" The herald angels sang. Or did they? The romanticized accounts all have mass choir of angels celebrating proclaiming "Peace on earth, goodwill to men!". Fireworks in the sky even!

But careful reading of Luke's account actually shows us a very different reality. The angels appeared to shepherds in the darkness of the fields. Their appearance was not at all comforting. In fact they were a terrifying spectacle.The angels had to reassure the shepherds. They had a simple message. Luke documented that the angels spoke the message rather than sang. There was no musical performance in the sky. Yes, the angels were praising God, but praises can be uttered and not sang.

It was a terrifying spectacle. And an earthshaking message. There was to be a major paradigm shift in the affairs of men. Their Messiah had been born.

It is like that for other aspects of life, isn't it? Major paradigm shifts are often terrifying events. The mistake Management often makes is to ignore how unsettling and terrifying paradigm changes are to the workforce. There is often no peace on earth and goodwill to men, other than to those in political alignment. The angels did make it clear, "...and on earth, Peace to those on whom His favour rests."

Nonetheless, Gigamole would like to wish that you all have a very blessed Christmas.

Thursday, December 22, 2011

We need a major rethink of our educational system.... and please do so outside of the box.

One of the areas that Singapore can be very proud of is how we have been able to make education so available to our kids, to the extent that we can say that no child will be denied a chance to go to school. In the previous generation there many capable people who had limited opportunities simply because they did not have access to education. But not anymore. Education has indeed been the great leveler for this generation. Because schooling is now accessible to every child regardless of his/her  socioeconomic background, career opportunities are limited more by abilities and skills rather than the individual's socioeconomic stratum. Likewise for gender and ethnicity.

But sadly this appears true only to a certain degree.

The Ministry of Education (MOE) should be congratulated for making examination data available to the public. One wishes though that they would put up more detailed data, and not only cherry picked information for public consumption.

The recent data is quite instructive. They are really quite similar to previous years' data and therefore really doesn't say anything new. True, there are some wiggly movements in percentages, but they are relatively small changes. Over a long period one can see that the performance data is relatively stable. Boringly stable. This stability is actually both comforting and alarming. Comforting because it means the MOE has done an excellent job in providing education. Not much more to do. Alarming because despite all this effort, fixed disparities in educational performances between ethnic groups are apparent.

If we look at the performance at the Primary School Leaving Examinations,we see more than 90% of students pass the exams. But only the Chinese outperform the national average. The Malay students, as a group, under-perform everyone else.

This ethnic ranking not only persist at the O-levels, but the differences are markedly accentuated. And this is for 5 O-level passes. I am quite sure if we set more stringent criteria, even greater differences can be demonstrated.

This is alarming because the data is not improving despite what the amount of resources the MOE has put into the school system. I am sure the MOE is aware of this problem. But I hope they are not ignoring it. Something drastic needs to be done because the current models are not working.

To an outsider, looking at the data, such 'fixed' differences suggest a number of possibilities:
a] Our delivery of education has ethnic biases;
b] Our way of assessing has ethnic biases;
c] Ethnic biases exist in both instruction and assessment; or
d] There are real ethnic related limitations in abilities.

Since I do not subscribe to there being biologically and ethnically related limitations in ability, it must be that the first three are valid.

The MOE must spare no effort to get to the bottom of this problem. It must not rest on the laurels of its past accomplishments. There are unintended ethnic biases in how education is delivered to the public as well as ethnic biases in how the examinations are set. It is not adequate to congratulate ourselves on the performance at a national level, because this is invariably defined by the performance of the largest and most successful ethnic group. This is unfair to the minority groups who may have unaddressed special needs and considerations.

We need to remodel our educational paradigm to level the playing field for all ethnic groups.

Monday, December 19, 2011

Should the finger be pointing at the CEO? A moleview of the SMRT saga....

image from here
All of sudden there seems to be deluge of bad news for SMRT. The latest involves a woman who fell and and sustained a head injury. Apparently she remains in coma. Gigamole wishes her well.

The public outcry against the SMRT is both understandable and justified. The hounds are now baying for the head of the CEO, Saw Phaik Hwa. The mass media has been particularly unkind, I think, and has dug up as many photos as they have on  file that portray her in the most unflattering light.

However, Gigamole somehow feels this antipathy against the CEO has been somewhat misplaced. Yes, because she heads the SMRT, the responsibility for all the mishaps falls squarely on her lap. Bt we should not forget that as CEO she acts upon the guidance of the SMRT Board. It was also the SMRT Board who examined her credentials and appointed her to the post. It was the SMRT Board who crafted up the directions and strategies for the CEO. By appointing Ms Saw to the post, the Board obviously prioritized the retail agenda above operational and service needs. Whether they did this as a conscious strategic  decision is unclear. It may well have been it seemed like an OK thing to do at that time, and only now shown to be inappropriate.

It seems clear at the moment that the SMRT CEO did all she could within her capabilities. Unfortunately though her experience was principally in retail and marketing. Was she someone who had a good insight into the technical/engineering and operation needs of the SMRT? Should we blame her for  lapses in areas outside her expertise. Yes, as she is CEO; but not entirely, as the Board should account for why they did not think operational/service skills were critically important for a train and transport company. Transport Minister Lui was spot on when he picked up the phone to speak with Chairman SMRT. This is a problem squarely shared by the Board and Management.

So for those who are happily shooting off arrows at Ms Saw, hold your fire a bit, and see if perhaps some of the arrows need to be redirected towards the SMRT Board.

Saturday, December 17, 2011

The Singapore Medical Council Physician's Pledge - What motivates doctors nowadays?

Pointing the finger at the SMRT for their Freudian slip prodded me to think about what motivates our doctors nowadays. Or at least what should motivate our doctors nowadays.

It seems to me that many doctors nowadays are quite happy to regard their practice as a business. Quite understandably so since every other aspect of health care has become such a business. Ever since the mid 1980s in Singapore, when Medicine became defined as one of the pillars of our economic growth, the practice of medicine has become increasingly premised upon a business-like quid pro quo relationship between doctors and patients.

Yet the very ethos of Medicine is not built upon any kind of a business model. In fact the Hippocratic traditions de-emphasized the rights (pecuniary or otherwise) of the physician and instead focused on the duties of the physician. The Hippocratic Oath was really all about the duties of the physician. Likewise, our SMC Physician's Pledge is heavy on duties and does not even mention payments for services rendered.

In fact the very first line of the Pledge reads: "I solemnly pledge to dedicate my life to the service of humanity". Some will of course argue that this is wholly unrealistic, and that doctors do have to make a living, and perhaps even to live in the lap of luxury. But they forget that this was the pledge they took. Theirs was to dedicate their life to the service of humanity. If this was unrealistic, perhaps they should not have taken the pledge.

The great Canadian physician Sir William Osler, made it equally clear - “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.

In today's world, this calling is so easily brushed aside in favour of the allure of "Income Opportunities". I do not mean to belittle the sacrifices of many doctors who do have their hearts in the right place. Indeed there are many of them. Many I have had the privilege of knowing as teachers, friends and colleagues. But I think even they would not disagree that the practice of medicine in Singapore has to a large part, degenerated to a mere trade or business.

What is the purpose of the Physician's Pledge if we are not to take it seriously?

On another note, I wonder why hospital CEOs are not expected to take a similar pledge of service and duty to patients. After all, it is their management performance indicators that compel doctors to behave after a certain fashion. Can we expect a doctor bound in service to a hospital to put the patient's interest first, and disregard the clarion call to seize the hospital's "Income Opportunities"?

Friday, December 16, 2011

Can an organization such as the SMRT commit a Freudian slip? Of course...!

In psychology there is a term, parapraxis, that refers to the situation when you do something that was really not what was intended. In layman terms, this is often referred to as a 'slip of the tongue' when you say something unintended. We excuse ourselves through the maxim, 'a slip of the tongue is no fault of the mind'. This is of course quite untrue. Slips of the tongue often reflect a primary fault with the mind, and often betrays what the the speaker is covertly thinking, albeit subconsciously. At cocktail parties, we laugh at such Freudian slips when people chatter about meaningfully under the influence of alcohol. At other times, such Freudian slips occur when a persons guard is let down, or he/she is operating under duress.

So I was quite amused by the recent gaffe by SMRT when it sent out the message to taxi drivers during the breakdown of train services. "Income Opportunities" headed the message that the SMRT had trumpeted to taxi drivers. Quite insensitive and inappropriate. Of course the SMRT quickly came out and apologized for the message. It was a template message which had been wrongly used. Of course. In normal conversation, this is exactly what happens when someone says something unintended. He/she had used the wrong template message in his mind. It is nothing more than parapraxis. A slip of the tongue. A Freudian slip that revealed what the speaker had been thinking about.

So the SMRT really did have a Freudian slip. One could of course argue that an organization such as the SMRT, not being alive, does not really have a mind, and is incapable of committing a Freudian slip. But in reality it does have a corporate mind and a corporate consciousness. So the Freudian slip gave us a rare glimpse of the SMRT corporate mind. And the image is not at all attractive. "Income opportunities". Is that what it is all about? We know that SMRT has a duty to return shareholder value, but we should seriously question the SMRT about its raison d'etre.

At a broader level, we should be concerned that our society has become so preoccupied by "income opportunities". Sadly it seems like things are only worth doing if it has a clear potential for revenue generation. Tragically the practice of medicine seems to be rushing down that road too.