Wednesday, March 23, 2011

Is there such a thing as a Noble Profession?

Thanks to Dr Susan Lim, everyone is once again obsessed with our favourite past-time - money and talking about it. If you talk to enough people, you'll find that everybody is exceedingly upset with Susan Lim for having the audacity to make money. It has even reached the stage where Susan Lim has become a verb for "overcharging."

The fact that Dr Lim never made money off the general public is irrelevant. The fact that she's in private practice and very successful because she's very good at what she does is also irrelevant. As far as a most people in the streets of Singapore and in cyberspace are concerned, Dr Susan Lim is a symbol of a greedy healthcare system that's milking the poor.

As far as most of the chat rooms are concerned, Dr Lim is wrong because she wants to make money. Talk to enough people about the case and they'll tell you that -"If you want to make money you should be a banker not a doctor," or "Doctors are supposed to save lives not make money." One journalist even went as far as to remind me,"She has a Hippocratic Oath to save lives."

It seems that the thing that's making people very upset with Dr Lim is the fact that she runs a very successful business? Yes, like it or not, a private medical practice is a business with rents and staff who need to be paid. Yet, because private medical practices are ..."Medical" they're supposed to be about something more than just paying the bills and turning a profit.

There are, as they say, professions and professions. Some professions are about making money. Nobody seems to mind when stock brokers make money - they wouldn't be stock brokers otherwise, would they? Then there are professions that notorious for keeping people broke - writing is one of them. Then there are what you call the "Nobel" professions, which are supposed to be about the greater good of mankind rather than making money. However much these professions don't make - they carry an aura of respectability about them.

I take teaching as an example. Teaching is known for being badly paid. Yet, it is a "noble" profession and being a teacher or a school master carries a certain aura to it, which money apparently cannot buy. I remember my late step-grandma who said that she was always relieved when step-grandpa went back to school, it was time when she could hold her head up high and tell the world that she was "Mrs Hart Smith." Step-grandpa Hart worked in the days when teachers did not get paid during holidays. So, he became a salesman for World Book. He made A LOT more money a salesman than he did as a teacher. Yet, as far as the community was concerned, his respectability came from being a teacher.

In a way, doctoring is supposed to be like teaching. Like the teacher and the lawyer, the doctor is a learned man. In addition to being learned, the doctor also saves lives. I think of Dr Christopher Khng, one of my ophthalmologist who teaches and operates on eyes. He says,"When you do good operation you help one person - but when you teach ten people how to do a good operation you help ten times the people." Doctors wear white coats, the colour of purity.

I enjoyed working in the healthcare space. It helped me to understand certain medical conditions and it helped me do some good by getting people I knew to look after their eye-sight.

However, as much as doing good is exceedingly satisfying, I am left wondering if there's such a thing known as a noble profession any more?

It started out with Singapore's politicians. It's a well known fact that Singapore has the world's HIGHEST PAID POLITICIANS. American politicians make their fortune after politics. Here, the politicians have a fortune thrust upon them. Our President, who is primarily a ceremonial figure who's main function seems to be shaking hands once a year on National Day only make some S$4 million a year.

When a few of us grumbled, the politicians made the point that high salaries for PUBLIC SERVANTS was necessary because the nation needed to get bright young things in PUBLIC SERVICE and to stay there. The politicians also made the point that highly paid PUBLIC SERVANTS did not shake down the poor for bribes. Much better to keep a PUBLIC SERVANT content with his lot so that he focuses on the job on hand.

If you think about it, this is a sound argument. Yes, we expect our PUBLIC SERVANTS to be noble people who want to serve society rather than engage in the grubby world of commerce. However, we understand that they need to live and if they see the possibility of living comfortably they're less likely to steal from us. Singapore is close enough to places where being an honest person is akin to being supernatural - able to function without life's basic necessities.

So, we've already bought the idea of the necessity of PUBLIC SERVANTS in NOBLE Professions being handsomely paid.

The next step is to look at the obvious - if we can accept the argument that PUBLIC SERVANTS must be well paid - surely the same argument applies to other so called NOBEL PROFESSIONS.

Then, let's look at the facts - the "Nobel professions" have already been industrialised. Let's go back to the example of teaching. Teachers may be a "noble" lot dealing with something other than money, but education is most certainly an industry and the teachers are slowly but surely realising that what they do for a living is a skill that can be packaged and sold just like any other.

Let's look at America as an example. America has the world's BEST universities. Places like Harvard, Princeton and Yale consistently rank amongst the world's top ten. How do these universities do it? Well, it's simple - they produce the guys who will get hired and promoted to top levels of the corporate sector. This in turn makes them more attractive as places to study and people are willing to pay vast sums of money to get in. If you are brainy but broke, the university has scholarships, bursaries and other schemes to help you out - but the bottom line is - the university still gets paid for providing you with a service.

The universities with the most successful business continue to climb world rankings. Those that fail - die. Nobody denies that Harvard is expensive - nobody denies that Harvard is a WORLD CLASS institution. The rules are simple - if you don't like Harvard's fees - you don't go there.

This is as business like and mercenary as it gets. While the American University system is acknowledged as the world's best despite it's mercenary nature, the same is not true lower down the education ladder. American High Schools are funded by the tax payer and any kid can goto high school. When you think of American High Schools, you usually think of a war zone in the same way that you think of an American University as a centre of excellence.

The Europeans who once stood out as the bastion of mass education have learnt the lesson. Business methods work in the supposedly noble business of education. European universities are now charging students for the service of teaching. In the UK, the universal truth remains - the schools that are run like businesses (misleadingly known as public schools) still produce the bulk of graduates at elite levels.

Teaching may be a noble profession but education is big business whatever anyone tells you. I live in Singapore where teaching is an industry. Local publishers survive on text book publishing. Parents spend good money on old exam papers so that they're kids can pass. Not all teachers are civil servants working in schools. If you're unemployed, become a tutor - you'll always have work. If you're entrepreneurial, you should also be a tutor. Retired school teachers with a name, make a very good living either by teaching only children of the well to do or setting a mass market tuition centre.

What is true of education has been more true of health care. Health care is, like it or not an industry in its own right. The doctor may be "noble" and willing to work for free but he or she would not be able to afford to provide you with basic health care without the people who make the equipment and the medicines. Nobody is suggesting that it's wrong for GlaxoSmith Kline or Norvartis not to charge money for their research, development and production.

Say what you like about big pharmaceutical companies but they've produced life saving stuff. Think of Asprin, which seems to cure just about anything. Think of HIV medications - which remain prohibitively expensive for many but have also given many others the chance to live healthy normal lives. More will be done in the field of pharmaceutical healthcare - however, someone has to pay for this and ultimately it's the consumer.

Doctors are part of this industry whether we like it or not. The industry that produces many of the miracle drugs we now take for granted, relies on the feedback of doctors.

Much as we hark back to the ideal of a doctor being all about saving lives no matter the financial status of the life to be saved, it is just that - an ideal. Doctors need to live too and the more well looked after they are, the more they are able to focus on the business of saving lives.

This is especially true of private practice. Doctors in private practice may not like to admit it but they are running a business and you cannot expect them to work on nothing but the love of it. The doctor may want to save your life for free - but the industry that supplies him will want him to pay for the medication and the landlord of his practice will expect to be paid. The staff of the practice will also expect their salaries.

Let's face it, the doctors who make it big in private practice are good at what they do or at least they're good enough for people to open their wallets. The Susan Lim's, Julian Theng's and Ron Yeoh's of this world are darn good at what they do - hence they get people who are willing to pay them top dollar.

I've always believed that life has to be about something more than just money. However, to expect people to provide you with something for nothing is unrealistic. Money is necessary in order to get progress. You need that to fund things like research and development. The money has to come from somewhere and more often than not, it is from the consumer and tax payer.

It's also proven that systems that have an element of business to them tend to be better at providing the basic service. If I had ten high paying clients, I could focus on just ten. My concentration for every client would be better than if I had to service a hundred poor paying ones. You like at the difference between the American University System and High School system as the best comparison.

Noble professions are not immune from the basic rules of business. Education, healthcare and dare I say legal systems are becoming more industrialised and not all of this is bad.

While noble professions may be less so, that does not exclude people from being noble. My favourite litigator devotes an incredible amount of time to "bro-bono" work and he's not the only lawyer doing it. His argument is that he believes in a system and the work he devotes to cases like Zen and Eric is a way of paying providence for giving him clients like Zim.

The same is true for doctors. Susan Lim may have charged Pangiran Damit millions, but she has given free surgery before. Dr Ron Yeoh has a lucrative eye care practice in Camden Medical centre serving an elite client el, but he and his team continue to do work at the National Eye Centre (SNEC).

Doctors and lawyers do give away pro-bono work. However, they have to get the money from somewhere to keep their practices flowing.

You cannot expect people to be noble without any consideration to their ability to take care of themselves. As one taxi driver says - "You cannot expect me to treat you like you are in a restaurant but pay me a Kopi Diam rate."


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bluexpresso said...

Nobody's saying Susan Lim shouldn't make good money. The question is how much. Jacking up the bill for last 6 months compared to previous years makes her look like she's exploiting the last days of the patient.

Trebuchet said...

I'm quite happy with market rates and such. But I do have issues with misusing the concept of a free market when discussing monopoly and oligopoly situations.

I also believe that 'noble' professionals have a duty to be a little altruistic in some ways. A doctor occasionally does waive charges or charge a bit below market rate; a lawyer does pro bono work; a teacher works for $1 per student per hour.

It's OK to be a non-altruistic professional as well, if your professionalism goes that way. Nobody blinks (as you said) at engineers or bankers making big bucks. Or architects even.

But with ministers... heh, I'd love a job where I could set my own pay and give myself a pension too. And even have 'secret bonuses'. This is different from CEOs, who can be replaced by a board.

jonathan said...
This comment has been removed by the author.
sammy said...

the pass 6month is the treatment with intensive care. The doctor have to forgo all her patient if the brunei patient called her. unless pass few year the patient was able to walk and accompany by her family to the clinic, but still the clinic has to close. in a year she can come 4 to 10 time. but during the 6 month it's continuos. So how can you compare bluexpresso?
you can eat a $ 3 chicken rice for 10 time a year
the next year you eat $3 chicken rice for full 6 month.
how can you compare both year on what you spent on chicken rice.

emily said...

Hello, may i join in this conversation ? I have been following the susan lim saga because i am her patient and travel to see her every year. I know of the Royal patient because i have had the bad luck to have been referred to her male assistant in 2007 when she was "called away overseas to attend to an emergency" in JUne, which is when i usually have the time to make the trip.Despite being in Singapore for the whole week, i could not get an appointment and when i turned up unannounced, i was shocked to find her usually bustling clinic empty with her many staff sitting idle. There must have been many other patients like me that the practice had to turn away. This must have been a huge opportunity cost which the doctor must have factored in, to attend to a dying patient, while turning away us "living" patients. This week, i was in Singapore, and decided to attend the Hearing, since it was so highly publicised in Indonesia. I was quite shocked to find out that in fact, the doctor had sent her bills periodically throughout the treatment, so the patient would have known the fees, but still used Dr Lim's services. What was even more of a revelation was the fact that the doctor had sent the patient away three times, once to NUH to be under Professor John Wong, and twice back to Brunei. But the patient kept returning to her care despite the fact that the doctor had sent her bills regularly to the Brunei Commission. I liken this to a client who has been a regular at a famous hair dressing salon over many years. In the last year, she frequents him daily for hair wash, shampoo and treatments, manicures and pedicures,but at the end of 6 months, she refuses to pay though she has received the same good service at the same rates. Worse still, she complains to the consumer organisation !
Face it, this is a commercial world; if you insist and consume services, you must be expected to pay, at least at the rates you have been paying in the previous years. I fail to understand what is the case, and why so much time and money is wasted on this quite ridiculous persecution. But reading your blogs, I have come to a view that at the end, it IS money that drives the economy and its people, and it must be that the Senior Counsel for SMC sees in Dr Lim's case, a cash machine, which must be earning him, after all this time, surely a few million. Are Singaporeans happy to line his pockets with their hard earned money when they can do so much more to help the underpriveleged, and where there is so much disaster, poverty and suffering in this world today ?

Tang Li said...

Hi Emily - you can always feel free to contact me via email at In the mean time, why don't you comment on the following blog -

Betty said...

i can't see what the fuss is about, especially coming from Singapore - a capitalist economy. If i am not mistaken, in 2007, MM Lee, in justifying a hike in Ministers salaries, quoted Minister Ng Eng Hen as having earned $4.5 million when he was a surgeon at the same hospital as dr Lim way back in 2001 !!! Surely there must have been some lements of overcharging there, especially since there were guidelines on fees. But instead, MM Lee was proud of this and stated that the best in the profesions should be rightly rewarded which i agree is a fact of life. Why then, is Dr Lim being crucified when she delivered exceptional services to Royals who knew what her charges were yet kept insisting for more of her and only her ? It was after all, not the man on the street being overcharged ! I feel that it is an absolute waste of public funds being used to line the pockets of SC and MP Alvin Yeo. It is he, who in continuing this persecution of Dr Lim, as if she was a murderer, who is greedy - Alvin Yeo the MP. Just look at his assets. He should be the last to criticise her

Jumari said...

Indeed, a noble profession - Here is an excerpt of Minister of Health Khaw Boon Wan's speech at the launch of Singapore Medicine(MOH website):
"To be sure, Singapore does attract large numbers of foreign patients....But our dream was much more ambitious. With 500 million people in ASEAN, just 10% alone would be a sizeable ... for our healthcare sector..... ....of course there are patients who demand frills, branded implants just as there will be buyers of lexus who can afford and want more than corollas. Our response should be to offer them Lexus, with the wood panelling, full leather upholstery, and custom-made Levinson sound system."