25/5/97 World has turned, but have we?
|Sunday, May 25,1997
The Sunday Times, Page 4
World has turned, but have we?
The impact of this fact will take a long while to sink in, although many people who already have difficulty working their video recorders and washing machines must feel even more diminished.
If chess is the ultimate expression of rational thought, and to be human is to be a thinking animal- this has been the foundation of Western thought since Descartes- then what does humanity mean after this event? How are we going to redefine ourselves?
In Chinese chess or xiangchi, one player has two elephants, among other pieces, and his opponent, two ministers, because the two words sound alike (xiang). They are roughly the equivalent of the bishops in chess, except that the elephants and ministers cannot cross the half- line of the xiangshi board, which is marked by a river.
An age-old proverb has come out of this rule: fei xiang bu guo he, or "flying elephants do not cross the river". There are just some things that one cannot do.
But in 1990, two elephants swam across the strait from Johor to Pulau Tekong, and in the following year, another one swam across to Pulau Ubin. I remember a former colleague laughing about it thenñ another truism turned on its head.
Looking back on those two episodes, which were reported by a largely bemused press, and now Deep Blue's win over Garry Kasparov, I guess I can use the elephants' swim across the water as a kind of sign of a major turning point.
I do not need to tell you that the world has, and is changing in a speed that has left many of us bewildered, or worse, totally displaced. What I want to say though, is that in this new world, many assumptions like fei xiang bu guo he can no longer apply.
People certainly realise this. But old assumptions die hard, especially if they are the ones that have seen us succeed in one generation what it took other developed economies several generations. I worry if we are not grappling with challenges and change with the old mindset when they demand a radically different one, even if we use the buzzwords of the new age, such as "creativity" and "information superhighway".
Which is why I was excited last Saturday by a speech given by Ms Ho Ching, the head of Singapore Technologies, the excerpt of which we have reproduced in this week's Sunday Review.
In that speech, she overturned several assumptions that had driven Singapore in the last 30 years, specifically in infrastructure, services and education.
Her most radical suggestion was the lifting of the cap on the quotas on doctors and lawyers. The assumption has always been that these two special professional services are not subject to market forces, she said. We believe that the more lawyers we have, the more lawsuits will be generated; and the more doctors we have, the more the patients are likely to be over-treated unnecessarily with ever increasing costs.
That has been a fei xiang bu guo he assumption held firmly by at least the authorities, if not the general population. But the world has turned. Asia is projected to grow at a compounded rate of nearly 8 per cent for the next 10 years. Think of the growing middle and upper middle classes of perhaps several hundred millions in Asia, said Ms Ho.
Singapore could serve them in the medical services among others, and become a medical hub on this side of the globe. Some of the best brains both here and from around the world should be attracted to practise medicine, or do medical research, here.
There will be no lack of cynics who will see the suggestion as Ms Ho pushing her own agenda, since Singapore Technologies has entered the health-care business in China recently in partnership with a Canadian company. But it's not my place to defend her here.
WHEN the Raffes Medical Group was preparing to list itself on Sesdaq, I discussed doing a Life! cover profile of its chairman, Dr Loo Choon Yong, with some of my colleagues.
There was a certain uneasiness among them. Here was a doctor going "commercial"- wasn't there some ethical line crossed? It did not help that Dr Loo is a friend and old classmate, a fact which I declared to my colleagues, if they did not already know.
We did the story nevertheless, after much heated discussion, although I doubted if my colleagues were as excited about the event as I was- not because the chairman is a friend, but because it represented a breakaway from the traditional mindset of doctors and their halo-ed place outside the marketplace.
By sheer coincidence (or was it?), barely a week after our story, The Straits Times carried a Sydney Morning Herald report on the Australian Medical Association persuading its doctors to buy hospitals - "for the patients' sake".
"The AMA's long-held opposition to medical ownership for private hospitals- because of its potential conflict of interest and exploitation of patients- has been dropped dramatically in a bid to stave off United States-style managed care and ownership by foreign multinationals," the report said.
The president of the AMA, Dr Keith Wollard, although conceding that the move did have potential for conflict of interest, maintained nevertheless that patients would be better served by doctors than by insurance companies and huge companies.
The story vindicated my decision to profile Dr Loo, I told myself, and I made sure my colleagues get to read that pick-up from the Sydney Morning Herald.
A fortnight ago, in an Insight feature written by my colleague Ravi Veloo, several top doctors were quoted as agreeing that "the main challenge facing the medical profession today is how not to become money-minded in an increasingly money-conscious society".
Associate Professor Goh Lee Gan of the Department of Community, Occupational and Family Medicine at the National University Hospital, whom several sources commended to Ravi as a respected and conscientious doctor, teacher and commentator on the profession, said the doctor has three struggles. To be a saint, a scientist or a shopkeeper.
"I think we are increasingly being seen as shopkeepers," he said, when he referred to the listing of Raffles.
Dr Leslie Lam, a leading cardiologist in private practice here, also criticised the move.
But Dr Lam could become a saint- he did charity work in Myanmar and the Seychelles, and plans to spend one or two afternoons at the Singapore Heart Centre as a form of "national service"- only because he had been a good scientist and an efficient shopkeeper.
His patients are some of the wealthiest people in the region, including the members of the Bruneian royal family, so he must be a good doctor and a good scientist who keeps up with the latest medical technology and research findings.
He has to be an efficient shopkeeper, to run his clinic smoothly and provide a level of service that attracts and equally important, retains, his wealthy patients.
If Dr Lam had started out doing charity work in Myanmar after he left the public sector, he would be a saint in the most literal sense of the word, but Singapore would be the poorer for it. We should be grateful that he has made a success of himself first, before he gives off of himself.
We can boast many top medical specialists like Dr Lam, who have drawn the wealthy from around the region, and created a kind of spillover traffic that cannot but be good for the country's economy. Some have also volunteered to do charity work or "national service" after they have become successful materially.
The difference between Dr Lam and Dr Loo is that the latter has chosen to go beyond a one-man outfit, and build up the country's biggest chain of clinics as well as a day surgery centre, built on land which he had bought when property prices were low.
When Dr Loo was building up his business, he was seen by some of his peers as an "opportunist". Yes, he seized opportunities, and he maximised their potential. He is a successful entrepreneur.
He is providing jobs for a number of doctors who may not have entrepreneurial flair, and who do not wish to slog long hours as GPs in the highly competitive Housing Board estates.
Let me not mince words: Every successful GP in the HDB heartland has to be a good shopkeeper, besides being a good doctor, or he will be driven out by the competition. A GP friend of mine makes sure he patronises, in turns, all the stalls in the food centre next to his clinic. Every stallowner is a potential patient, if he isn't already.
Dr Loo can stop all the carping by his critics if he ceases practising medicine altogether, and just concentrates on his job as chairman of Raffles. But he has chosen to continue to see patients at least part of the day.
While a Dr Loo of the next generation will stay on in Singapore and attract good doctors to work for a company that is accountable to both shareholders and the public, a Dr Lam of the next generation may just not be around.
Because, he is a one-man operation, and hence highly mobile. As the region prospers, it will not be longñ10 years perhapsñ when there will be intense bidding for top professionals in the medical as well as other critical fields from the different countries.
And given the high-entry barrier into the Good Life in Singapore, the top doctors of the new generation may choose to go to where the bid is not only the highest, but where they can also avail themselves of the whole works- a seaside bungalow, a city penthouse apartment, country clubs, servants, chauffeurs, gardeners, fancy cars.
Further down the road when cyber-medicine comes about, it will not only be the region, but the whole world, which will compete for the best medical specialists.
As corporate financial consultants William Rees Mogg and James Dale Davidson suggest in their new book, The Sovereign Individual:
"A patient facing the need for an operation in 24 hours or perhaps even 45 minutes could deputise digital assistants to locate the top 10 surgeons worldwide available to perform such a task remotely, review their success rates in similar cases and solicits offers for their particular case from corresponding digital servants.
"All of this can be canvassed in a matter of moments."
In this kind of future, a good doctor can choose to live anywhere in the world outside the jurisdiction of any sovereignty that wants to tax him more than what he wishes to pay.
So I say, better that we have our own doctor-entrepreneurs set up successful hospitals here, and remain here, to provide jobs for other doctors and medical workers from both here and the rest of the world. Because ultimately, the larger community will benefit.
Brigadier-General George Yeo, Minister for Information and the Arts, has spoken more than once about the potential intellectual and moral confusion that could come with the exponential growth of new knowledge.
In the post-ideological world where even the leaders of the developed countries have shifted their roles from statesmen to global salesmen, and where commerce and pragmatism rule (see Review Cover Story), the new morality will be that of the market.
It will emphasise the importance of productivity and efficiency. As with the merchants in the Renaissance city-states, trust will be paramount. Be greedy, and you lose the trust of your customers, who will ostracise you and boycott your business.
Because it is the first doctor-run listed company, Raffles Medical Group has to set an example in trust, productivity and efficiency. Everyone is watching, and not just the audit unit in the Ministry of Health. Aspiring young doctor-entrepreneurs will think twice about following in its footsteps, if it does not succeed as both a medical practice as well as a business.
Which will be sad day for Singapore, because we need more of our own doctor-run hospitals and medical institutions, to succeed as a medical hub. If we fail, the biggest losers will not be the highly mobile doctors, but the masses out there, who are just good or average workers, for whose services other countries are unlikely to bid for.
They will be left praying for saints to come to bail them out.