[updated feb 2006] some weeks ago i got a lift home from alexandra from my cousin-in-law aaron, who has been married to my cousin winnie since we were in j1 and living just next door in number 52. i don't think he's said more than fifty words to me in all this time. when was i ever home, when i was in jc? and then he was finishing up ns, and after that i was in the states for four years and anyway, even nowadays i hardly see him, except at family lunches and that sort of thing. so our conversation on the 40 minute ride home is the most i've heard him speak in so many years, and contained more information that i've found out about him than in the last seven years. such as:

having already got his m.med and completed his 6 years of specialist trainig in geriatric psychiatry, he's now training for a second post-graduate degree in internal medicine. if he passes his specialists' exams this november he'll be the first psychiatrist in singapore with a second speciality. the housemen in our year that i've told this to since have thought he jiapa very eng and is wasting his time, and certainly progression in his career has been stalled during this sabbatical period. he would have been starting on the consultant track that same year had he stayed put, but he believes this is the right course. it means a substantial salary reduction, high expenses for his second degree, going back to school with housemen, serving housemanship all over again - at his age - it has got to be tough-going - and after that, having to start all over again as a registrar. he thinks it is absurd for psychiatrists to treat patients only for their psychological problems, as if they were disembodied brains, and leave the physical disorders to doctors in other fields. internal medicine and psychiatry must go hand in hand - this is especially clearin the case of geriatrics who usually come bundled with many medical problems.

but it isn't only to become a better doctor that he is doing this, but to make a marked point. "in singapore, there are many doctors who regard psychiatry as a woolly discipline, for slackers and dabblers who haven't got it in them to practise "real medicine."....in psychiatry there is no physical cause that can be pinpointed. "the moment you do - say, if you decide a certain part of the brain is damaged, then it immediately comes under the provenance of neurology." such self-superiority and contempt led, during the sars epidemic, to incompetent, irrelevant decrees forced on the whole body of psychiatrists at woodbridge hospital (he declined to elaborate) by other doctors, which made him furious and acutely aware of the perception gap. at the same time, sars it was a severe setback to him to find that many of his fellow psychiatrists have indeed become out of touch with their early basic medical training when sars forced them to take a hand in treating patients for non-psychiatric disorders. he decided there and then that he would train as an internist, not only to become a better doctor, but also to prove that psychiatrists are not inferior doctors, and can pass any exam an internist can.

what if you don't pass this november? wouldn't your critics have a field day? he shrugs. nevermind, i can take it twice, maybe three times. and even if i don't pass, in the process of training i would have learnt more and fulfilled my personal aim of becoming a better doctor. [ed. 2005 - he did pass. ha!]

why psychiatry? "even when i was a medical student i found the field most fascinating, because it is most unique...to a cardiologist or a renal specialist, a heart is a heart, and kidneys are kidneys. uncle a, b, c or d come in, they all have angina or kidney failure, they are indistinguishable to the doctor. two patients may both have hallucinations, but the whats and the whys are distinctly different. a singaporean might come in and say, sun wukong talked to me. and then the american will come in and say he's heard voices from god, but he would never hallucinate about sun wu kong." he also enjoys the research component of his work in the closely-related fields of geriatrics and neurology.

how far has he realised his other aim then? "at that time, i was angry, and i did not think things through entirely. now i realise that even if i get my degree, i am only one doctor. i am nobody." it won't change the general impression, unless more psychiatrists are willing to do what he did. "of course we all start out being garang and wanting to save the world, and then being frustrated by the system and becoming disillusioned and also worn out by the demands of the profession. so we settle for being good doctors." what are good doctors then? "patient before self, individual before system." aren't there people like that? "there are many doctors in politics, many at the administrative level, they're heads of hospitals, departments...they are intelligent, even brilliant doctors, and they are shrewd, able administrators, even very competent politicians, but they are not good doctors"..."in this country, unfortunately, changes happen only at the ministerial level." but who are the people who make it to the high echelons of MOH? "even heads of department, heads of hospitals, well, they can be replaced easily. by the time you become minister, well, a minister is interested in the protection of the system, even if it is at the expense of the patient." so in the end you decide that it is more important to be a good doctor. and that is what he can do.

i suppose what i was most surprised about was that the thrust of most of what he was saying seemed most unexpected for a doctor. because whichever way you look at it in singapore those who have become doctors are often the ones who have taken the right combination of classes in secondary school and again in jc and got straight As and done what was right (and also what was seen as most conventional) at the right times - so that to be a doctor in singapore means to have many times willingly adhered to the prejudices of the system, to have made some of the most conventional choices in deference to the system, and to have benefitted most precisely from abiding by the system. so that i never really thought about doctors resenting the system. i shall investigate directly.

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